Suffering, the Safety Net, and Disparities During COVID-19

The economic and public health crisis caused by COVID-19 was devastating and disproportionately hurt Blacks and Hispanics and some other groups. Unemployment rates and other measures of material hardship were higher and increased more during the crisis among Blacks and Hispanics than among non-Hispanic Whites. Congress authorized a historic policy response, incorporating both targeted and universal supports, and expanding both the level and duration of benefits. This response yielded the remarkable result of an estimated decline in the Supplemental Poverty Measure between 2019 and 2020. We study administrative data to investigate the impact of the Supplemental Nutrition Assistance Program (SNAP) during the crisis. We find that participation in SNAP increased more in counties that experienced a larger employment shock. By contrast, the increase in total SNAP benefits was inversely related to the employment shock. The SNAP benefit increases were less generous to Black and Hispanic SNAP participants than to White.

Examining SNAP and TANF caseload trends, responsiveness, and policies during the COVID‐19 pandemic

Temporary Assistance for Needy Families (TANF) and Supplemental Nutrition Assistance Program (SNAP) cases increased by 3.3 million between March and June 2020, their largest quarterly increase ever. During the pandemic, many states adopted a wide set of policies and procedures to facilitate program enrollment, retention, and eligibility. I track these policies and create a pandemic policy index measuring state generosity. States that adopted more generous policies experienced larger TANF and SNAP caseload growth, especially eligibility policies such as exempting TANF work requirements or SNAP P‐EBT availability. Analyzing the caseload relationship to labor markets, caseloads were less responsive to unemployment rate changes during the pandemic relative to the pre‐pandemic period.

Policy learning from crises: lessons learned from the Italian food stamp programme

Advancing learning is a central tenet for improving public action. Recent calls for agility, robustness, prototyping and other strategies for coping with crises imply continual learning and improvement. This article contributes to challenging this ideal interpretation of the learning process. It provides conceptual and methodological tools to investigate the relationship between policy learning and policy change and sheds light on the diverse dynamics and types of learning that can emerge from crises. At the conceptual level, the article presents a learning matrix that classifies the possible outcomes in the relationship between learning and change. On methods, our research design includes process tracing, binary comparisons, and an innovative real-time approach to the study of learning. The article investigates three municipal case studies from the Italian food stamp programme implemented during the COVID-19 lockdowns. The repetition of the programme over a short period of time offers the opportunity to investigate inter-crisis learning, the process by which lessons from the first wave of implementation contributed to reforms in the second delivery. The coronavirus crisis magnified the acquisition of knowledge and provided radical inter-programme lessons – long-term, non-incremental learning beyond the management of the emergency. Yet, the findings also highlight how this window of opportunity for learning quickly closed and how certain lessons learned may be lost in the process of reform, hard to implement or are unlikely to be extrapolated across contexts.

IMPACTS OF IN-KIND TRANSFERS SIZE BOOSTS ON ELIGIBLE FOOD EXPENDITURES IN THE UNITED STATES

This article examines the causal effects from Supplemental Nutrition Assistance Program (SNAP) benefit enhancements on eligible food expenditures, the fiscal years 2020 and 2021 considered. Through a quasi-experimental research design embedded in a difference-indifference estimation method, the paper uses Consumer Expenditure Diary Survey data to yield interesting results. I find that enrolled households adjust their spending behavior in response to boosts in in-kind transfer. However, on eligible foods, increases in the program allocation levels disproportionately impacted participants spending. Estimates undergone several sensitivity checks which successfully validate their robustness. As policy implication, achieving a more meaningful impact requires food assistance experts to design some threshold of expenses for eligible expenditures.

The Cruel Public Health Consequences of Anti-Immigrant Rhetoric

Changes in immigration policy reflect shifts in the relative emphasis placed on each of these priorities. Since the 1980s, Americans' increasingly polarized views on immigration have contributed to Congress's failure to pass comprehensive immigration reform, frequent changes in aspects of immigration policy that can be regulated without Congress, and a system that is increasingly difficult for immigrants to navigate.1 Two articles in this issue of AJPH address one federal immigration policy: the public charge rule. The public charge rule is designed to ensure that immigrants who enter the United States will be able to sustain themselves without relying on the government for financial support.2 In 1999, the public charge rule stated that noncitizens may be denied a green card if they have received general cash assistance or long-term institutionalization funded by the US government or a state, regional, local, or tribal government.2 Immigrants' use of noncash benefits such as Medicaid and certain cash benefits such as childcare subsidies did not impact their green card eligibility.2 In 2017, the Trump administration leaked a draft of a new rule, stating that Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and housing, energy, and childcare assistance would now factor into public charge determinations. IMPLICATIONS FOR PUBLIC HEALTH PRACTICE By deterring immigrants from seeking public benefits and health care, the 2019 public charge rule may have exacerbated the COVID-19 crisis.2 The 2022 final rule is an important step toward addressing the public health consequences of the 2019 rule, but it must be accompanied by outreach so that immigrants feel safer accessing public benefits.3 DHS should disseminate information through communitybased organizations that have already established trust in immigrant communities,8 and medical-legal partnerships could incorporate immigration lawyers who can provide up-to-date guidance on changing policies.3 However, until Congress passes comprehensive immigration reform, public health professionals will face an uphill battle against the misinformation, confusion, mistrust, and fear that currently constrain immigrants' access to health care and public benefits.3 /4JPH CORRESPONDENCE Correspondence should be sent to Chenoa D. Allen, 328 Clark Hall, 701 South Providence Road, Columbia, MO 65211 (e-mail: chenoa.allen@ gmail.com).

The Role of Community Food Services in Reducing US Food Insufficiency in the COVID-19 Pandemic

(p. 2 2016) suggest that "both public and private food assistance programs serve as important mechanisms to tackle the problem of hunger and food insecurity in the United States." Using the HPS data, Bauer (2020) shows that low-income households with children are more likely to suffer food insufficiency and enroll in food assistance programs (e.g., SNAP, WIC, and Pandemic Electronic Benefit Transfer) during the pandemic. Instead of using the free food access variables from the HPS, we therefore draw on the 2019 County Business Patterns data (US Census Bureau, 2019) to shed light on the role of preexisting Community Food Services (CFS) in mitigating food vulnerability in the states during the current pandemic. [...]while the number of such establishments per 10,000 persons may have changed between 2019 (the most recent year for which data are available at the time of this writing) and March 2020, we suggest that once we control for the main driving forces, such as the spread of the disease and unemployment, which can affect both food insufficiency and CFS capacity, the 2019 CFS establishments per 10,000 persons variable is a reasonable proxy for the amount of experience a given state has with CFS and related establishments and its capacity to deliver free food through such a venue.

Binge Eating Disorder Is a Social Justice Issue: A Cross-Sectional Mixed-Methods Study of Binge Eating Disorder Experts’ Opinions

Background: Binge eating disorder is an autonomous DSM-V diagnosis characterized by discrete rapid consumption of objectively large amounts of food without compensation, associated with loss of control and distress. Environmental factors that contribute to binge eating disorder continue to evolve. This mixed-methods cross-sectional study assessed whether there is consensus among experts in the field about environmental factors that influence adult binge eating disorder pathology. Methods: Fourteen expert binge eating disorder researchers, clinicians, and healthcare administrators were identified internationally based on federal funding, PubMed-indexed publications, active practice in the field, leadership in relevant societies, and/or clinical and popular press distinction. Semi-structured interviews were recorded anonymously and analyzed by ≥2 investigators using reflexive thematic analysis and quantification. Results: Identified themes included: (1) systemic issues and systems of oppression (100%);(2) marginalized and under-represented populations (100%);(3) economic precarity and food/nutrition insecurity/scarcity (93%);(4) stigmatization and its psychological impacts (93%);(5) trauma and adversity (79%);(6) interpersonal factors (64%);(7) social messaging and social media (50%);(8) predatory food industry practices (29%);and (9) research/clinical gaps and directives (100%). Conclusions: Overall, experts call for policy changes around systemic factors that abet binge eating and for greater public education about who can have binge eating disorder. There is also a call to take and account for the narratives and life experiences of individuals with binge eating disorder to better inform our current understanding of the diagnosis and the environmental factors that impact it.

The Crucial Role of Federal Nutrition Programs in Promoting Health Among Low-Income Older Adults

Food insecurity is an enormous problem in the United States, including in the older adult population, with notable negative health impacts such as malnutrition. Food insecurity has increased with the COVID-19 pandemic. Federal nutrition programs such as the Supplemental Nutrition Assistance Program and the Older Americans Act Nutrition Services Program can help alleviate food insecurity. These programs have had some issues, both pre- and post-pandemic, but have been able to adapt to meet the challenges they faced. Food insecurity must be tackled head-on to invest in better health for all older Americans.

Rural Food Insecurity: A Longitudinal Analysis of Low-Income Rural Households with Children in the South

Researchers have noted large spatial variations in rates of food insecurity. But little research exists on why this is so and the impacts it has on rural families. Drawing on a mixed-methods longitudinal study with 124 poor and working-class households in North Carolina, we analyze the processes that shape lower-income rural families’ access to food. We trace the narratives of three families whose stories are emblematic of themes from the larger data set to illumine how space and context influence families’ experiences across the life course. As the caregivers in our study navigated how to feed their families, living in a rural area shaped the resources and often precarious forms of support that they drew on from their social networks, local communities, and the state.

Understanding SNAP Recipient Characteristics to Guide Equitable Expansion of Nutrition Incentive Programs in Diverse Food Retail Settings

Structural barriers, such as food costs, reduce access to healthy foods for populations with limited income, including those benefitting from the Supplemental Nutrition Assistance Program (SNAP). Nutrition incentive programs seek to address this barrier. Evaluations of SNAP-based incentive programming often focus on one setting (i.e., either farmers’ markets or grocery stores). We examined use patterns, characteristics, and preferences among 253 SNAP consumers with access to incentive programming at both a farmers’ market and a grocery store located within five miles of their home. Cross-sectional survey data were collected in 2019 in two Ohio cities. Despite geographic access, 45% of those surveyed were not using the incentive program;most non-users (80.5%) were unaware of the program. Program users compared to non-users had higher household incomes (p < 0.001) and knew more people using the program (p < 0.001). Grocery stores were the most common setting of use (59%);29% used at farmers’ markets;11% used in both settings. User characteristics varied by store setting based on demographics, program experience, fruit and vegetable purchasing and consumption patterns, and social dynamics related to use. Our findings support comprehensive awareness-raising efforts and tailored implementation of incentive programming that attends to diverse segments of SNAP consumers to promote equity in program reach.

SNAP participation and the health and health care utilisation of low-income adults and children.

OBJECTIVE: This article examined whether participation in the Supplemental Nutrition Assistance Program (SNAP) produced changes to adult and child health and health care utilisation during a period of economic recession. DESIGN: Instrumental variables analysis relying on variation in state SNAP policies to isolate exogenous variation in household SNAP participation. SETTING: Nationally representative data on child and adult health from the 2008 to 2013 National Health Interview Survey. PARTICIPANTS: Participants were 92 237 adults and 45 469 children who were either eligible for SNAP based on household income and state eligibility rules or were low income but not eligible for SNAP benefits. RESULTS: For adults, SNAP participation increased the probability of reporting very good or excellent health, and for both adults and children, reduced needing but having to go without dental care or eyeglasses. The size of these benefits was especially pronounced for children. However, SNAP participation increased the probability of needing but not being able to afford prescription medicine, and increased psychological distress for adults and behavioural problems for children under age 10. CONCLUSIONS: SNAP's benefits for adult health and improved access to dental and vision care for adults and children suggest benefits from the program's expansions during the current COVID-induced crisis. Predicted negative effects of SNAP participation suggest the need for attention to program and benefit structure to avoid harm and the need for continued research to explore the causal effects of program participation.