Research Article| Volume 57, ISSUE 4, P525-532, October 2019

SNAP, Young Children's Health, and Family Food Security and Healthcare Access


      The Supplemental Nutrition Assistance Program (SNAP) is the largest nutrition assistance program in the U.S. This study's objective was to examine the associations between SNAP participation and young children's health and development, caregiver health, and family economic hardships.


      Cross-sectional data from 2006 to 2016 were analyzed in 2017 for families with children aged <3 years in 5 cities. Generalized estimating equations and logistic regression were used to evaluate the associations of SNAP participation with child and caregiver health outcomes and food insecurity, forgone health care, and health cost sacrifices. Nonparticipants that were likely to be eligible for SNAP were compared with SNAP participants and analyses adjusted for covariates including Consumer Price Index for food to control for site-specific food prices.


      The adjusted odds of fair or poor child health status (AOR=0.92, 95% CI=0.86, 0.98), developmental risk (AOR=0.82, 95% CI=0.69, 0.96), underweight, and obesity in children were lower among SNAP participants than among nonparticipants. In addition, food insecurity in households and among children, and health cost sacrifices were lower among SNAP participants than among nonparticipants.


      Participation in SNAP is associated with reduced household and child food insecurity, lower odds of poor health and growth and developmental risk among infants and toddlers, and reduced hardships because of healthcare costs for their families. Improved SNAP participation and increased SNAP benefits that match the regional cost of food may be effective preventive health strategies for promoting the well-being of families with young children.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Coleman-Jensen A, Rabbitt M, Gregory C, et al. Household food security in the United States in 2016. Published 2017. Accessed August 1, 2018.

        • Shankar P
        • Chung R
        • Frank DA
        Association of food insecurity with children's behavioral, emotional, and academic outcomes: a systematic review.
        J Dev Behav Pediatr. 2017; 38: 135‒150
        • Cook JT
        • Black M
        • Chilton M
        • et al.
        Are food insecurity's health impacts underestimated in the U.S. population? Marginal food security also predicts adverse health outcomes in young U.S. children and mothers.
        Adv Nutr. 2013; 4: 51‒61
        • Gundersen C
        • Ziliak JP
        Food insecurity and health outcomes.
        Health Aff (Millwood). 2015; 34: 1830‒1839
      2. USDA Food and Nutrition Service. Supplemental Nutrition Assistance Program participation and costs. Accessed August 1, 2018.

        • Leftin J
        • Eslami E
        • Strayer M
        Trends in Supplemental Nutrition Assistance Program participation rates: fiscal year 2002 to fiscal year 2009.
        2011 (Published)
        • Miller DP
        • Morrissey T.
        Using natural experiments to identify the effects of SNAP on child and adult health.
        2017 (Published)
        • Mabli J
        • Worthington J.
        Supplemental Nutrition Assistance Program participation and child food security.
        Pediatrics. 2014; 133: 610‒619
        • Ratcliffe C
        • McKernan SC
        • Zhang S
        How much does the Supplemental Nutrition Assistance Program reduce food insecurity?.
        Am J Agric Econ. 2011; 93: 1082‒1098
        • Schmidt L
        • Shore-Sheppard L
        • Watson T
        The effect of safety net programs on food insecurity.
        NBER Work Pap Ser. 2013; : 19558
        • Shaefer L
        • Gutierrez I.
        The Supplemental Nutrition Assistance Program and material hardships among low-income households with children.
        Soc Serv Rev. 2013; 87: 753‒779
        • Almond DH
        • Schanzenbach HW
        • Whitmore D
        Inside the war on poverty: review of economics and statistics.
        Rev Econ Stat. 2011; 93: 387‒403
        • Lee BJ
        • Mackey-Bilaver L.
        Effects of WIC and Food Stamp Program participation on child outcomes.
        Child Youth Serv Rev. 2007; 29: 501-517
        • Gregory CA
        • Ver Ploeg M
        • Andrews M
        • et al.
        Supplemental Nutrition Assistance Program (SNAP) participation leads to modest changes in diet quality.
        2013 (Published)
        • Andreyeva T
        • Tripp AS
        • Schwartz MB
        Dietary quality of Americans by Supplemental Nutrition Assistance Program participation status: a systematic review.
        Am J Prev Med. 2015; 49: 594‒604
        • Frongillo EA
        • Jyoti DF
        • Jones SJ
        Food stamp program participation is associated with better academic learning among school children.
        J Nutr. 2006; 136: 1077‒1080
        • Bronchetti ET
        • Christensen G
        • Hoynes HW
        Local Food Prices, SNAP Purchasing Power, and Child Health.
        NBER Work Pap Ser. 2018; : 24762
        • Hoynes H
        • Whitmore Schanzenbach D
        • Almond D
        Long-run impacts of childhood access to the safety net.
        Am Econ Rev. 2016; 106: 903‒934
        • Caswell J
        • Yaktine A.
        Supplemental Nutrition Assistance Program: Examining the Evidence to Define Adequacy.
        Institute of Medicine and National Research Council, Washington, DC2013
        • Edin K
        • Boyd M
        • Mabli J
        • et al.
        SNAP food security in-depth interview study.
        U.S. Department of Agriculture, Food and Nutrition Service, Office of Research and Analysis, Alexandria, VA2013
        • Larson NI
        • Story MT.
        Food insecurity and weight status among U.S. children and families: a review of the literature.
        Am J Prev Med. 2011; 40: 166‒173
        • Crawford PB
        • Webb KL.
        Unraveling the paradox of concurrent food insecurity and obesity.
        Am J Prev Med. 2011; 40: 274‒275
        • Kreider B
        • Pepper JV
        • Gundersen C
        • Jolliffe D
        Identifying the effects of SNAP (food stamps) on child health outcomes: when participation is endogenous and misreported.
        J Am Stat Assoc. 2012; 107: 958‒975
        • Black MM
        • Quigg AM
        • Cook J
        • et al.
        WIC participation and attenuation of stress-related child health risks of household food insecurity and caregiver depressive symptoms.
        Arch Pediatr Adolesc Med. 2012; 166: 444‒451
      3. Bureau of Labor Statistics. Consumer Price Index. Accessed August 1, 2018.

        • Dowd JB
        • Zajacova A.
        Reliability of self-rated health in U.S. adults.
        Am J Epidemiol. 2011; 174: 977‒983
        • Kemper KJ
        • Babonis TR.
        Screening for maternal depression in pediatric clinics.
        Am J Dis Child. 1992; 146: 876‒878
        • Gamliel A
        • Ziv-Baran T
        • Siegel RM
        • Fogelman Y
        • Dubnov-Raz G
        Using weight-for-age percentiles to screen for overweight and obese children and adolescents.
        Prev Med. 2015; 81: 174‒179
        • Glascoe F
        Evidence-based approach to developmental and behavioural surveillance using parents’ concerns.
        Child Care Health Dev. 2000; 26: 137‒149
        • Kimbro RT
        • Rigby E.
        Federal food policy and childhood obesity: a solution or part of the problem.
        Health Aff (Millwood). 2010; 29: 411‒418
        • Basu S
        • Berkowitz SA
        • Seligman H
        The monthly cycle of hypoglycemia: an observational claims-based study of emergency room visits, hospital admissions, and costs in a commercially insured population.
        Med Care. 2017; 55: 639‒645
        • Mulik K
        • Haynes-Maslow L.
        The affordability of MyPlate: an analysis of SNAP benefits and the actual cost of eating according to the dietary guidelines.
        J Nutr Educ Behav. 2017; 49: 623‒631
        • Anderson PM
        • Butcher KF.
        The Relationships Among SNAP Benefits, Grocery Spending, Diet Quality, and the Adequacy of Low-Income Families’ Resources.
        Center on Budget and Policy Priorities, Washington, DC2016
        • A quick guide to SNAP eligibility and benefits
        Center on Budget and Policy Priorities.
        2018 (Published)
        • Meyers A
        • Joyce K
        • Coleman SM
        • et al.
        Health of children classified as underweight by CDC reference but normal by WHO standard.
        Pediatrics. 2013; 131: e1780‒1787
        • Tarasuk V
        • Cheng J
        • de Oliveira C
        • et al.
        Association between household food insecurity and annual health care costs.
        CMAJ. 2015; 187: E429‒E436
        • Cook JT
        • Poblacion AP.
        Estimating the health-related costs of food insecurity and hunger.
        Bread for the World Institute, 2016
        • Frank DA
        • Ettinger de Cuba S
        • Sandel M
        • et al.
        SNAP cuts will harm children in the USA.
        Lancet. 2013; 382: 1155‒1156
        • Sonik RA
        Massachusetts inpatient Medicaid cost response to increased Supplemental Nutrition Assistance Program benefits.
        Am J Public Health. 2016; 106: 443‒448
        • Samuel LJ
        • Szanton SL
        • Cahill R
        • et al.
        Does the Supplemental Nutrition Assistance Program affect hospital utilization among older adults? The case of Maryland.
        Popul Health Manag. 2018; 21: 88‒95

      Linked Article