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

项目摘要 社会决定因素，包括与粮食和住房有关的社会决定因素，对健康有着强大的影响， 是如何最好地利用政策来改善个人的社会环境和相关健康的不确定性 结果。目前，11%的美国人面临粮食不安全，其中包括35%收入低于法定标准的家庭 在COVID-19大流行期间，联邦贫困线和粮食不安全率急剧上升。 越来越多的文献发现粮食安全和心理健康之间的联系，提出了一个双向的 关系，其中粮食不安全增加了压力和焦虑，导致心理健康状况较差， 精神疾病损害了持续获得食物的机会。改善粮食安全可能对改善心理健康至关重要 低收入人群的健康，特别是COVID-19，但有机会检查因果影响 这种干预是罕见的。补充营养援助计划（SNAP）已被证明， 有效减少而不是消除低收入家庭的粮食不安全。许多家庭在 由于SNAP的好处过早耗尽，SNAP仍然存在粮食不安全问题。不少政策专家认为， 增加对SNAP的投资将提高受援者购买健康食品的能力， 平稳地消费其利益，可能改善健康结果。但这一假设并没有 到目前为止都经过严格的测试。在大流行期间，联邦政府采取了前所未有的措施， 增加SNAP对低收入家庭的福利。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。我们利用这个 一个自然的实验，以检查是否增加粮食安全的SNAP变化减少精神疾病 在大流行期间。因此，我们将阐明粮食安全与心理健康之间的因果关系。 健康，以及它们与医疗保健利用的联系。最后，我们将评估福利支出率的变化， 为SNAP政策的更广泛设计提供信息，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， COVID-19大流行，B）检查SNAP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- 收入个人与以前诊断的条件，和c）估计是否增加SNAP预算， 分配影响SNAP每月福利使用模式。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，该数据集涵盖COVID-19大流行，包括行政 医疗补助索赔，来自SNAP计划的行政索赔，以及每周使用SNAP福利的数据 为受益人。我们的团队处于有利地位，可以研究粮食不安全与粮食安全之间的联系， 精神健康，并评估相关的公共卫生，临床和政策影响。

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.