Examining state SNAP policies as a primary prevention strategy for early life exposure to violence and other adverse childhood experiences

项目总结/摘要 儿童和青少年遭受暴力是美国一个普遍而紧迫的公共卫生问题。 新的研究表明，一种独特的经济压力，粮食不安全（即，有限或不确定 获得适足食物）是多种形式暴力和其他不良童年的风险因素 美国儿童和青少年的经验（ACE）。补充营养援助计划（SNAP） SNAP是美国解决粮食不安全问题的最大计划，而SNAP的规则和法规基本上是确定的。 在联邦一级，各州可以选择采用几项SNAP政策，以扩大资格并简化 招生先前的研究表明，国家采用这些政策与SNAP的增加有关 参与和减少粮食不安全。因此，鉴于粮食不安全是暴力的一个风险因素， 对于其他ACE，州采用SNAP政策，扩大资格并简化注册也可能有助于 儿童和青少年遭受暴力和其他ACE的比例下降。家庭压力的引导 模型，我们将利用各州采用特定SNAP资格和注册政策的可变性 审查其与多种形式的暴力行为的联系，包括虐待和忽视儿童、青年约会 暴力，青少年和父母自杀行为，亲密伴侣暴力，以及其他ACE，包括 父母心理健康和物质使用障碍。我们将使用多种调查和管理数据 来源和纵向，准实验性研究设计，以解决三个具体目标，在此期间 2005-2019年：（目标1）审查国家采用SNAP政策的关联，这些政策扩大了资格， 简化早期生活中暴露于暴力和其他ACE的登记;（目标2）评估 国家采用SNAP资格和入学政策与早期生活暴露于暴力的关系， 其他ACE在州医疗补助扩张和更高的州最低工资背景下有所不同;以及（目标3） 评估州采用SNAP资格和入学政策与早期生活的关系是否 暴露于暴力和其他ACE的情况因种族/民族而异。这项研究将是第一个 研究SNAP资格和入学政策与暴力和其他ACE的关联。这 研究具有潜在的转化影响，直接告知我们的理解是否（目标1）， 在什么情况下（目标2），以及针对哪些人群（目标3），具体的SNAP资格和入学政策是 有效防止生命早期暴露于暴力和其他ACE。该提案是对CDC的 目标一，因为它将审查一项改善社会状况、粮食不安全的计划的影响， 暴力和其他ACE的初级预防战略。

PROJECT SUMMARY/ABSTRACT Child and youth exposure to violence is a prevalent and pressing public health issue in the United States. Emerging research indicates that a distinct form of economic pressure, food insecurity (i.e., limited or uncertain access to adequate food), is a risk factor for multiple forms of violence, and other adverse childhood experiences (ACEs), among U.S. children and youth. The Supplemental Nutrition Assistance Program (SNAP) is the largest program addressing food insecurity in the U.S. While SNAP rules and regulations are largely set at the federal level, states have the option to adopt several SNAP policies that expand eligibility and simplify enrollment. Prior research indicates that state adoption of these policies is associated with increases in SNAP participation and decreases in food insecurity. Thus, given that food insecurity is a risk factor for violence and other ACEs, state adoption of SNAP policies that expand eligibility and simplify enrollment may also contribute to decreases in rates of child and youth exposure to violence and other ACEs. Guided by the Family Stress Model, we will leverage variability in state adoption of specific SNAP eligibility and enrollment policies over time to examine their association with multiple forms of violence, including child abuse and neglect, youth dating violence, youth and parental suicidal behavior, and intimate partner violence, and other ACEs, including parental mental health and substance use disorders. We will use multiple survey and administrative data sources and a longitudinal, quasi-experimental study design to address three specific aims over the period 2005-2019: (Aim 1) Examine the association of state adoption of SNAP policies that expand eligibility and simplify enrollment with early life exposure to violence and other ACEs; (Aim 2) Assess whether the association of state adoption of SNAP eligibility and enrollment policies with early life exposure to violence and other ACEs differs in the context of state Medicaid expansion and higher state minimum wage; and (Aim 3) Assess whether the association of state adoption of SNAP eligibility and enrollment policies with early life exposure to violence and other ACEs differs by race/ethnicity. The proposed research will be the first to examine the association of SNAP eligibility and enrollment policies with violence and other ACEs. This research has the potential for translational impact by directly informing our understanding of whether (Aim 1), in what contexts (Aim 2), and for which populations (Aim 3) specific SNAP eligibility and enrollment policies are effective in preventing early life exposure to violence and other ACEs. This proposal is responsive to CDC’s Objective One as it will examine the impact of a program that improves a social condition, food insecurity, as a primary prevention strategy for violence and other ACEs.