The association of increased SNAP benefits during COVID-19 with food insufficiency and anxiety among US adults: a quasi-experimental study.

OBJECTIVES: The COVID-19 pandemic and subsequent policy response to mitigate disease spread had far-reaching impacts on health and social well-being. In response, the Supplemental Nutrition Assistance Program (SNAP) underwent several pandemic-era modifications, including a 15 % monthly benefit increase on January 1, 2021. Research documenting the health effects of these SNAP modifications among low-income households and minoritized groups who were most impacted by the economic fallout during the first years of the pandemic is lacking. We aimed to estimate the health effects of the 15 % SNAP benefit increase in January 2021, among SNAP-eligible US households. DESIGN: We estimated the effects of the SNAP increase on food insufficiency, mental health, and financial well-being using a rigorous quasi-experimental difference-in-differences (DID) analysis. SETTING: August 19, 2020, to March 29, 2021. PARTICIPANTS: Participants were drawn from the national US Census Bureau Household Pulse Survey waves 13-27 (n 44 477). RESULTS: Compared with SNAP-eligible non-recipients, SNAP-eligible recipients experienced decreased food insufficiency (-1·9 percentage points (pp); 95 % CI -3·7, -0·1) and anxiety symptoms (-0·09; 95 % CI -0·17, -0·01), and less difficulty paying for other household expenses (-3·2 pp; 95 % CI -4·9, -1·5) after the SNAP benefit increase. Results were robust to alternative specifications. CONCLUSIONS: Expansions of federal nutrition programmes have the potential to improve health and financial well-being. This study provides timely evidence to inform comprehensive safety net nutrition policies during future economic crises and public health preparedness response plans.

Promoting health equity through poverty alleviation policy: Factors associated with receipt of the 2021 U.S. Child Tax Credit in a nationwide sample.

INTRODUCTION: The 2021 temporary expansion of the U.S. Child Tax Credit (CTC) was a potent policy that addressed poverty as a critical social determinant of health. Yet policies can only have their intended effects if they are implemented appropriately, and it is well known that not all who were eligible for the CTC received it. In this study, we investigated which individual- and state-level factors were correlated with receipt of the 2021 expanded CTC among eligible families. METHODS: We used data from the U.S. Census Bureau Household Pulse Survey and included 76,994 CTC-eligible individuals. We used multivariable logistic regressions to evaluate individual- and state-level factors associated with self-reported CTC receipt during July-December 2021. RESULTS: Roughly two-thirds of the CTC-eligible sample reported CTC receipt. CTC receipt was higher among eligible individuals who were female, aged 35-44 years (relative to younger individuals), Black, and married. Receipt was also higher among those with at least some college education, two or more children, and family income above $25,000, and among recipients of the Supplemental Nutrition Assistance Program (SNAP) and Medicaid. For state-level factors, SNAP and Medicaid caseloads and the state earned income tax credit rate were associated with decreased receipt. CONCLUSION: As Congress debates whether to make the CTC expansion permanent, this study provides timely evidence to inform poverty alleviation programs to increase participation among eligible and marginalized groups and achieve health equity.

School Segregation and Health Across Racial Groups: A Life Course Study.

PURPOSE: Contemporary school racial segregation is a manifestation of structural racism shown to harm Black children's health. Yet, evidence on its long-term impacts throughout life, as well as effects among children of other racial backgrounds, is sparse. METHODS: Data on Black and White children were drawn from the National Longitudinal Study of Adolescent to Adult Health. Using multilevel models, we estimated associations between district-level school segregation and measures of short-term and long-term health, including self-reported outcomes and biomarkers. Models were run separately for Black and White children, adjusting for individual- and district-level covariates. We further carried out subgroup analyses by school racial composition (i.e., majority White vs. majority non-White schools). RESULTS: School segregation was associated with worsened short- and long-term risk factors of chronic disease among both Black and White students in terms of exercise and body mass index, but only in majority non-White schools. Moreover, Black students in these schools demonstrated less adolescent drinking and smoking with increased racial segregation and better self-reported health in young adulthood. DISCUSSION: Our findings suggest that segregated majority non-White schools may be targets of systemic disinvestment and may therefore lack sufficient resources for physical education or nutrition. Improvements in some outcomes among Black children may reflect peer influence (i.e., Black adolescents generally drink less than White adolescents), reduced exposure to interpersonal racism from White peers, or positive health fostered by feelings of belonging in Black community. Ensuring all students go to schools with the resources they need to thrive may have positive spillovers for population health.

Pregnancy after Tubal Sterilization in the United States, 2002 to 2015.

BACKGROUND: Tubal sterilization is the most commonly used method of contraception in the United States. Because contraceptive effectiveness influences contraceptive selection, we examined typical use failure rates after tubal sterilization in the United States. METHODS: We estimated rates of pregnancy after tubal sterilization using data from four waves of the National Survey of Family Growth (NSFG), representative samples of U.S. women aged 15 to 44 years, collected in 2002, 2006 to 2010, 2011 to 2013, and 2013 to 2015. Survey weighting was used in survival analysis to examine time to first pregnancy after tubal sterilization. Data from these participants were censored after a tubal reversal procedure, infertility treatment, hysterectomy, or bilateral oophorectomy. Reported pregnancy rates after tubal sterilization procedures were examined by using Kaplan-Meier curves and then multivariable Cox proportional-hazards models to examine the effects of age at tubal sterilization, race/ethnicity, education, Medicaid funding, and postpartum versus interval procedures. RESULTS: Pregnancy after tubal sterilization was reported by 2.9 to 5.2% of participants across NSFG waves. In the most recent survey wave (2013 to 2015), the estimated percentage of participants with pregnancies within the first 12 months after a tubal sterilization procedure was 2.9%; at 120 months after tubal sterilization, the estimated percentage with a pregnancy was 8.4%. At all the time points examined, pregnancy after tubal sterilization was less common after postpartum procedures than after interval procedures; however, this difference was not evident in multivariable models. In multivariable models, chance of pregnancy decreased with age at time of tubal sterilization. Race/ethnicity, education, and Medicaid funding were not consistently associated with pregnancy after tubal sterilization. CONCLUSIONS: These data suggest that there may be nontrivial rates of pregnancy after tubal sterilization.