Evaluating the Implementation and De-Implementation of Pandemic Era SNAP Expansion Policies on Diet and Health: A Mixed Methods Project

评估大流行时代 SNAP 饮食和健康扩展政策的实施和取消实施：混合方法项目

• 批准号: 10832272
• 负责人: Cindy Leung
• 金额: $ 229.92万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-22 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10832272
• 关键词: Administrator; Adopted; Adult; Advisory Committees; Affect; American; COVID-19 impact; COVID-19 pandemic; Client; Coping Skills; Cross-Sectional Studies; Data; Data Set; Data Sources; Databases; Deimplementation; Diet; Economics; Eligibility Determination; Ethnic Origin; Evaluation; Expenditure; Focus Groups; Food; Food Policy; Future; Goals; Health; Household; Hunger; Individual; Information Dissemination; Interview; Knowledge; Learning; Life Cycle Stages; Low income; Measures; Mediating; Mental Health; Methods; National Health and Nutrition Examination Survey; Outcome; Participant; Pathway interactions; Persons; Physiologic pulse; Play; Policies; Policy Maker; Poverty; Race; Recording of previous events; Research; Research Design; Research Methodology; Role; Running; Security; Surveys; United States; United States Department of Agriculture; Work; cost; data integration; design; diverse data; experience; expiration; flexibility; food insecurity; food security; health equity; health equity promotion; implementation evaluation; improved; innovation; insight; lens; marginalized population; novel; nutrition; pandemic disease; panel study of income dynamics; physical conditioning; population health; post-pandemic; poverty alleviation; pre-pandemic; programs; public database; public health emergency; response; waiver

PROJECT SUMMARY The USDA Supplemental Nutrition Assistance Program (SNAP) has played a critical role in mitigating national food insecurity during the pandemic. Since March 2020, many federal and state-level policies have been enacted to expand SNAP eligibility, enhance SNAP benefits, and reduce the administrative burden of applying for and maintaining SNAP benefits. By March 2023, most flexibilities and pandemic-era SNAP benefit boosts were discontinued, resulting in a “hunger cliff” with considerable implications for poverty, food insecurity, and health equity. There are significant knowledge gaps about the implementation and subsequent de- implementation of pandemic-era SNAP policy changes and their effects on the health of low-income Americans. The overall objective of this application is to evaluate the effects of implementation and de- implementation of pandemic-era SNAP expansion policies on adult health outcomes using a mixed methods approach that builds on the project team’s robust existing work. The central hypothesis is that the onset of SNAP expansion policies led to better physical and mental health outcomes, mediated by higher food expenditures, lower food insecurity, and higher diet quality; the sunset of these policies adversely affected health through these same pathways. In Aim 1, the project team will create a novel comprehensive database to document states’ implementation and de-implementation of SNAP expansion policies from 2020 to 2023 through surveys and focus groups with state SNAP administrators. In Aim 2, the project team will conduct a national survey and in-depth interviews with SNAP participants to understand how the expiration of SNAP expansion policies impacted program utilization, food insecurity, and health. Finally, in Aim 3, robust methods for causal inference will be applied to three nationally representative datasets to examine national and state- level SNAP expansion policies on adult health and intermediate outcomes. This project will employ a sequential mixed methods study design to integrate data across all aims and add context and richness to the interpretation of the results. To promote inclusivity and support the dissemination of results to key audiences, the project team will regularly engage with a Policy Advisory Committee, including experts in federal and state/local SNAP policy, poverty alleviation, and nutrition security, and a Client Advisory Committee, comprised of individuals with lived experience using SNAP benefits. This comprehensive and rigorous evaluation will provide important evidence about the effects of the onset and sunset of SNAP expansion policies on the health of low-income Americans. Results from this project will be of direct relevance to policymakers and other stakeholders to inform planning for future public health emergencies and long-term food policy.

项目概要 美国农业部补充营养援助计划 (SNAP) 在缓解国家营养不良方面发挥了关键作用 疫情期间粮食不安全。自 2020 年 3 月以来，许多联邦和州级政策已 颁布旨在扩大 SNAP 资格、增强 SNAP 福利并减轻申请的行政负担 获取并维持 SNAP 福利。到 2023 年 3 月，大多数灵活性和大流行时期的 SNAP 福利都会增加 中止，导致“饥饿悬崖”，对贫困、粮食不安全和 健康公平。关于实施和后续设计存在重大知识差距 大流行时期 SNAP 政策变化的实施及其对低收入人群健康的影响 美国人。该应用程序的总体目标是评估实施和取消的效果 使用混合方法实施大流行时期针对成人健康结果的 SNAP 扩展政策 建立在项目团队稳健的现有工作基础上的方法。中心假设是， SNAP 扩张政策通过更高的食物水平带来了更好的身心健康结果 支出、减少粮食不安全和提高饮食质量；这些政策的取消产生了不利影响 通过这些相同的途径获得健康。在目标 1 中，项目团队将创建一个新颖的综合数据库 记录各州 2020 年至 2023 年 SNAP 扩张政策的实施和取消实施情况 通过调查和与州 SNAP 管理员进行焦点小组讨论。在目标 2 中，项目团队将进行 全国调查和对 SNAP 参与者的深入访谈，了解 SNAP 的到期情况 扩张政策影响计划利用、粮食不安全和健康。最后，在目标 3 中，稳健的方法 因果推断将应用于三个具有全国代表性的数据集，以检查国家和州的情况 关于成人健康和中期成果的 SNAP 扩展政策。该项目将聘用一名 顺序混合方法研究设计整合所有目标的数据，并为研究增添背景和丰富性 结果的解释。为了促进包容性并支持向关键受众传播成果， 项目团队将定期与政策咨询委员会合作，其中包括联邦和 州/地方 SNAP 政策、扶贫和营养安全以及客户咨询委员会，包括 具有使用 SNAP 福利生活经验的个人。此次全面、严格的评估将 提供关于 SNAP 扩张政策的开始和结束对健康影响的重要证据 的低收入美国人。该项目的结果将与政策制定者和其他方面直接相关 利益相关者为未来突发公共卫生事件和长期粮食政策的规划提供信息。