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Principal Investigator: Chima Ndumele
Organization: YALE UNIVERSITY
Fiscal Year: 2024
Award: $557,800
Funding agency: National Institute of Nursing Research
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.
Terms: <Adherence><American><Anxiety><Area><Budgets><COVID crisis><COVID epidemic><COVID pandemic><COVID-19><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><CV-19><Cardiac Diseases><Cardiac Disorders><Clinical><Connecticut><Consumption><Coronavirus Infectious Disease 2019><Data><Data Set><Diagnosis><Economic Income><Economical Income><Eligibility><Eligibility Determination><Emergency response><Family><Family Leave><Federal Government><Food><Food Access><Food Policy><Frequencies><Health><Health Care Costs><Health Care Utilization><Health Costs><Health Food><Health Policy><Health Services><Healthcare Costs><Heart Diseases><Hospital Admission><Hospitalization><Household><Housing><Impairment><Impoverished><Income><Individual><Interdisciplinary Health Team><Intervention><Intervention Strategies><Investigators><Investments><Link><Literature><Low Income Population><Low income><Low income group><Malnutrition><Mediating><Medicaid><Mental Health><Mental Hygiene><Mental disorders><Mental health disorders><National Government><Natural experiment><Nutritional Deficiency><Outcome><Pathway interactions><Pattern><Persons><Physicians><Physiologic pulse><Policies><Population><Position><Positioning Attribute><Poverty><Protocol Screening><Psychiatric Disease><Psychiatric Disorder><Psychological Health><Public Health><Pulse><Recommendation><Reporting><Research Personnel><Research Resources><Researchers><Residual><Residual state><Resources><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Stress><Survey Instrument><Surveys><Symptoms><Testing><Uncertainty><Undernutrition><adverse consequence><adverse outcome><behavioral health><beneficiary><care services><care systems><chronic mental illness><co-morbid><co-morbidity><comorbidity><coronavirus disease 2019><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><coronavirus infectious disease-19><cost><design><designing><diabetes risk><dietary deficiency><doubt><exhaust><exhaustion><food insecurity><food security><health care policy><health care service use><health care service utilization><healthcare policy><healthcare service use><healthcare service utilization><healthcare utilization><healthy food><heart disorder><improved><incomes><interventional strategy><low income individual><low income people><lower income families><malnourished><mental illness><novel><nutrition><nutrition deficiency><nutrition deficiency disorder><nutritional deficiency disorder><pandemic><pandemic disease><pathway><persistent mental illness><policy implication><pre-pandemic><programs><psychiatric illness><psychological disorder><response><serious mental disorder><serious mental illness><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><severe mental disorder><severe mental illness><social><social determinants><sociodeterminant>