CE21-004 Examining state SNAP policies as a primary prevention strategy for early life exposure to violence and other adverse childhood experiences

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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.