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.

项目摘要 美国农业部补充营养援助计划（SNAP）在减轻国家营养不良方面发挥了关键作用。 大流行期间的粮食不安全。自2020年3月以来，许多联邦和州一级的政策已经被 颁布，以扩大SNAP资格，提高SNAP福利，并减少申请的行政负担 并维护SNAP的利益。到2023年3月，大多数灵活性和流行病时代的SNAP收益增加 中断，造成“饥饿悬崖”，对贫困、粮食不安全和 健康公平。在执行和随后的取消方面存在重大的知识差距， 实施流行时代的SNAP政策变化及其对低收入人群健康的影响 美国人本申请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SNAP扩展政策对成人健康结果 这种方法建立在项目团队强大的现有工作基础上。核心假设是， SNAP扩张政策导致更好的身心健康结果，由更高的食物介导 支出，降低粮食不安全，提高饮食质量;这些政策的日落对 通过同样的途径健康。在目标1中，项目团队将创建一个新颖的综合数据库， 文件指出，从2020年到2023年，SNAP扩张政策的实施和取消 通过与州SNAP管理员的调查和焦点小组。在目标2中，项目小组将开展一项 对SNAP参与者进行全国调查和深入访谈，以了解SNAP的到期 扩大政策影响到方案利用、粮食不安全和健康。最后，在目标3中，鲁棒方法 因果推理将应用于三个国家代表性的数据集，以检查国家和国家- 在国家一级，SNAP扩大政策涉及成人健康和中间成果。本项目将采用 序贯混合方法研究设计，以整合所有目标的数据，并为 结果的解释。为促进包容性并支持向主要受众传播成果， 项目小组将定期与政策咨询委员会接触，其中包括联邦和 州/地方SNAP政策、减贫和营养安全，以及客户咨询委员会， 使用SNAP福利的个人的生活经验。这一全面而严格的评估将 提供关于SNAP扩张政策的开始和结束对健康的影响的重要证据。 低收入的美国人。该项目的成果将直接关系到决策者和其他 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。