Leveraging SNAP to Improve Mental Health Outcomes: Evidence from the COVID-19 Emergency Response

利用 SNAP 改善心理健康结果：来自 COVID-19 应急响应的证据

• 批准号: 10605763
• 负责人: Chima Ndumele
• 金额: $ 60.27万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-21 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10605763
• 关键词: Adherence; American; Anxiety; Area; Budgets; COVID-19; COVID-19 pandemic; Clinical; Connecticut; Consumption; Data; Data Set; Diagnosis; Emergency response; Family; Family Leave; Federal Government; Food; Food Access; Food Policy; Frequencies; Health; Health Care Costs; Health Food; Health Policy; Health Services; Heart Diseases; Hospitalization; Household; Housing; Impairment; Income; Individual; Interdisciplinary Health Team; Intervention; Investments; Link; Literature; Low Income Population; Low income; Malnutrition; Mediating; Medicaid; Mental Health; Mental disorders; Natural experiment; Outcome; Pathway interactions; Pattern; Persons; Physicians; Physiologic pulse; Policies; Population; Positioning Attribute; Poverty; Public Health; Reporting; Research Personnel; Residual state; Resources; Stress; Surveys; Testing; Time; Treatment outcome; Uncertainty; adverse outcome; behavioral health; beneficiary; care systems; comorbidity; cost; design; diabetes risk; exhaust; exhaustion; food insecurity; food security; health care service utilization; improved; lower income families; novel; nutrition; pandemic disease; policy implication; programs; response; severe mental illness; social; social determinants; symptom treatment

Project Summary Social determinants, including those related to food and housing, have a powerful impact on health, but there is uncertainty on how to best leverage policy to improve individuals’ social circumstances and related health outcomes. Presently, 11% of Americans have food insecurity, including 35% of families with incomes below the federal poverty line, and rates of food insecurity have increased dramatically during the COVID-19 pandemic. A growing literature finds associations between food security and mental health, positing a bi-directional relationship, wherein food insecurity increases stress and anxiety leading to poorer mental health, and serious mental illness impairs consistent access to food. Improving food security may be critical to improving mental health in low-income populations, particularly with COVID-19, but opportunities to examine the causal impact of such an intervention are rare. The Supplemental Nutrition Assistance Program (SNAP) has been shown to be effective in reducing, but not eliminating, food insecurity for low-income households. Many families on SNAP have residual food insecurity due to early exhaustion of SNAP benefits. Many policy experts believe that an increased investment in SNAP would both enhance the capacity of recipients to purchase healthy food and smooth the consumption of their benefits, potentially improving health outcomes. But this hypothesis has not been rigorously tested to date. During the pandemic, the federal government took unprecedented steps to increase SNAP benefits to low-income families. In January 2021, SNAP household budgets were increased by 15%, leading to an increase in federal SNAP benefits of about $40 per month on average. We leverage this natural experiment to examine whether increased food security from the SNAP changes reduced mental illness during the pandemic. We will thereby elucidate the causal relationship between food security and mental health, and their links to healthcare utilization. Finally, we will assess changes in the rate of benefit spending to inform the broader design of SNAP policy to optimize health outcomes. Our specific Aims are to a) assess whether increased SNAP budget allotments was associated with changes in indicators of mental health during the COVID-19 pandemic, b) examine the effect of an increase in SNAP budget allotment on the use of, and adherence to, recommended care services, and rates of adverse outcomes and health care costs among low- income individuals with previously diagnosed conditions, and c) estimate whether an increase in SNAP budget allotments impacted patterns of SNAP monthly benefit use. To answer these first-order policy questions, we use a data from a novel, linked panel dataset that spans the COVID-19 pandemic and includes administrative Medicaid claims, administrative claims from the SNAP program, and data on the weekly use of SNAP benefits for beneficiaries. Our team is well-positioned to examine the understudied link between food insecurity and mental health and to assess the related public health, clinical, and policy implications.

项目摘要 社会决定因素，包括与食物和住房有关的决定因素，对健康有强大的影响，但 在如何最好地利用政策来改善个人的社会环境和相关健康方面存在不确定性 结果。目前，11%的美国人存在粮食不安全问题，其中35%的家庭收入低于 在新冠肺炎大流行期间，联邦贫困线和粮食不安全率大幅上升。 越来越多的文献发现，食品安全和心理健康之间存在双向联系。 关系，其中粮食不安全增加了压力和焦虑，导致心理健康较差，并严重 精神疾病损害了人们对食物的持续获取。改善食品安全可能是改善精神状态的关键 低收入人群的健康，特别是与新冠肺炎有关的问题，但有机会检查其因果影响 这样的干预是罕见的。补充营养援助计划(SNAP)已被证明 有效地减少但不是消除低收入家庭的粮食不安全。许多家庭都在 由于SNAP福利过早耗尽，Snap存在剩余的粮食不安全问题。许多政策专家认为， 增加对SNAP的投资将既增强接受者购买健康食品的能力，又将 让他们的福利畅通无阻，潜在地改善健康结果。但这一假设并没有 到目前为止经过了严格的测试。在大流行期间，联邦政府采取了前所未有的措施 增加对低收入家庭的SNAP福利。2021年1月，SNAP家庭预算增加了 15%，导致联邦SNAP福利平均每月增加约40美元。我们利用这一点 检验SNAP变化带来的食品安全增加是否会减少精神疾病的自然实验 在大流行期间。因此，我们将阐明食品安全和心理之间的因果关系。 健康，以及它们与医疗保健利用的链接。最后，我们将评估福利支出比率的变化，以 向更广泛的SNAP政策设计提供信息，以优化健康结果。我们的具体目标是：a)评估 SNAP预算拨款的增加是否与心理健康指标的变化有关 新冠肺炎大流行，b)审查国家行动方案预算拨款增加对使用的影响，以及 坚持、推荐的护理服务，以及低成本人群的不良后果和医疗费用比率 有先前诊断疾病的收入个人，以及c)估计SNAP预算是否增加 拨款影响了SNAP每月福利的使用模式。为了回答这些首要的政策问题，我们 使用来自一个新的、链接的面板数据集的数据，该数据跨越新冠肺炎大流行，包括行政管理 医疗补助申请、SNAP计划的管理索赔以及SNAP福利每周使用的数据 对受益人而言。我们的团队很好地研究了粮食不安全和粮食短缺之间的联系 并评估相关的公共卫生、临床和政策影响。