Association of Work Requirements With Supplemental Nutrition Assistance Program Participation by Race/Ethnicity and Disability Status, 2013-2017.


Journal

JAMA network open
ISSN: 2574-3805
Titre abrégé: JAMA Netw Open
Pays: United States
ID NLM: 101729235

Informations de publication

Date de publication:
01 06 2020
Historique:
entrez: 27 6 2020
pubmed: 27 6 2020
medline: 24 11 2020
Statut: epublish

Résumé

Increased work requirements have been proposed throughout federal safety net programs, including the Supplemental Nutrition Assistance Program (SNAP). Participation in SNAP is associated with reduced food insecurity and improved health. To determine whether SNAP work requirements are associated with lower rates of program participation and to examine whether there are racial/ethnic disparities or spillover effects for people with disabilities, who are not intended to be affected by work requirements. This nationally representative, pooled cross-sectional study examined how changes in SNAP work requirements at state and local levels in the US are associated with changes in food voucher program participation. The study combined information on state and local SNAP work requirements with repeated cross-sections from the 2012 through 2017 American Community Survey (with outcomes covering 2013 to 2017). The analytical approaches were based on difference-in-difference and triple-difference methods, after controlling for other economic and social factors. The sample included low-income adults without dependents, stratified by racial/ethnic group and disability status. The study also included parents who would otherwise meet work requirement criteria as a comparison group to estimate triple-difference models. This accounted for otherwise unobserved factors affecting trends in SNAP participation within local areas. Data were analyzed from January 2019 through March 2020. Residence in areas where SNAP work requirements apply. The primary outcome is SNAP participation measured by whether anyone in the household received food vouchers at any point over the prior 12 months. The final analytical sample included 866 000 low-income adults (weighted mean [SE] age, 33.6 [0.01] years; 42.5% [SE, 0.07%] men). The racial/ethnic breakdown was 56.5% (SE, 0.07%) non-Hispanic white respondents, 19.4% (SE, 0.06%) non-Hispanic black respondents, 17.7% (SE, 0.06%) Hispanic respondents, 2.5% (SE, 0.02%) Asian respondents, and 3.9% (SE, 0.03%) respondents of other or multiple races. In final triple-difference models, work requirements were associated with a 4.0 percentage point decrease in participation (95% CI, -0.048 to -0.032; P < .001) for childless adults without disability, equivalent to a 21.2% reduction in SNAP participation (95% CI, -25.5% to -17.0%). For childless adults with disability, work requirements were associated with a 4.0 percentage point reduction (95% CI, -0.058 to -0.023; P < .001), equivalent to 7.8% fewer SNAP participants with disability (95% CI, -11.2% to -4.4%). When the final models were stratified by race/ethnicity, benefit reductions were larger for non-Hispanic black adults (7.2 percentage points; 95% CI, -0.092 to -0.051; P < .001) and Hispanic adults (5.5 percentage points; 95% CI, -0.072 to -0.038; P < .001) than for non-Hispanic white adults (2.6 percentage points; 95% CI, -0.035 to -0.016; P < .001). Because of the association of SNAP with food security and health, work requirements that lead to benefit loss may create nutritional and health harm for low-income Americans. These findings suggest that there may be racially disparate consequences and unintended harm for those with disability.

Identifiants

pubmed: 32589228
pii: 2767673
doi: 10.1001/jamanetworkopen.2020.5824
pmc: PMC7320297
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

e205824

Références

Proc Natl Acad Sci U S A. 2017 Oct 10;114(41):10870-10875
pubmed: 28900012
JAMA Intern Med. 2017 Nov 1;177(11):1642-1649
pubmed: 28973507
Sociol Q. 2010;51(4):678-707
pubmed: 20939129
Am Econ Rev. 2014 May;104(5):322-328
pubmed: 25177042
Am J Public Health. 2019 Oct;109(10):1446-1451
pubmed: 31415201
Disabil Health J. 2019 Apr;12(2):220-226
pubmed: 30322776
Am J Public Health. 2018 Oct;108(10):1349-1351
pubmed: 30138060
N Engl J Med. 2019 Sep 12;381(11):1073-1082
pubmed: 31216419
Cochrane Database Syst Rev. 2018 Feb 26;2:CD009820
pubmed: 29480555
J Nutr. 2015 Feb;145(2):344-51
pubmed: 25644357
J Am Soc Hypertens. 2018 Nov;12(11):e27-e34
pubmed: 30425017
Health Aff (Millwood). 2012 May;31(5):909-19
pubmed: 22566429

Auteurs

Erin Brantley (E)

Milken Institute School of Public Health at the George Washington University, Washington, District of Columbia.

Drishti Pillai (D)

Milken Institute School of Public Health at the George Washington University, Washington, District of Columbia.

Leighton Ku (L)

Milken Institute School of Public Health at the George Washington University, Washington, District of Columbia.

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