William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts.
Boston University School of Public Health, Boston, Massachusetts.
JAMA Netw Open. 2023 Aug 1;6(8):e2326332. doi: 10.1001/jamanetworkopen.2023.26332.
Understanding how social policies shape health is a national priority, especially in the context of the COVID-19 pandemic.
To understand the association between politically motivated changes to Nebraska's Supplemental Nutrition Assistance Program (SNAP) policy and public health measures during the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used synthetic control methods to estimate the association of Nebraska's decision to reject emergency allotments for the SNAP with food security and hospital capacity indicators. A counterfactual for Nebraska was created by weighting data from the rest of the US. State-level changes in Nebraska between March 2020 and March 2021 were included. Data were acquired from the Census Bureau's Household Pulse Survey on individual food security and mental health indicators and from the US Centers for Disease Control and Prevention on hospital-level capacity indicators. Data analysis occurred between October 2022 and June 2023.
The rejection of additional SNAP funds for low-income households in Nebraska from August to November 2020.
Food insecurity and inpatient bed use indicators (ie, inpatient beds filled, inpatient beds filled by patients with COVID-19, and inpatients with COVID-19).
The survey data of 1 591 006 respondents from May 2020 to November 2020 was analyzed, and 24 869 (1.56%) lived in Nebraska. Nebraska's population was composed of proportionally more White individuals (mean [SD], 88.70% [0.29%] vs 78.28% [0.26%]; P < .001), fewer individuals who made more than $200 000 in 2019 (4.20% [0.45%] vs 5.22% [0.12%]; P < .001), and more households sized 1 to 3 (63.41% [2.29%] vs 61.13% [1.10%); P = .03) compared with other states. Nebraska's rejection of additional funding for SNAP recipients was associated with increases in food insecurity (raw mean [SD] difference 1.61% [1.30%]; relative difference, 19.63%; P = .02), percentage of inpatient beds filled by patients with COVID-19 (raw mean [SD] difference, 0.19% [1.55%]; relative difference, 3.90%; P = .02), and percentage of inpatient beds filled (raw mean [SD] difference, 2.35% [1.82%]; relative difference, 4.10%; P = .02).
In this cross-sectional study, the association between social policy, food security, health, and public health resources was examined, and the rejection of emergency allotments in Nebraska was associated with increased food insecurity. Additionally, this intervention was associated with an increased rate of hospitalizations for COVID-19 and non-COVID-19 causes.
了解社会政策如何影响健康是国家的优先事项，尤其是在 COVID-19 大流行的背景下。
了解内布拉斯加州补充营养援助计划 (SNAP) 政策的政治动机变化与 COVID-19 大流行期间公共卫生措施之间的关联。
设计、设置和参与者：本横断面研究使用合成控制方法来估计内布拉斯加州拒绝 SNAP 紧急拨款的决定与食品安全和医院容量指标之间的关联。通过加权来自美国其他地区的数据，为内布拉斯加州创建了一个反事实。纳入了 2020 年 3 月至 2021 年 3 月期间内布拉斯加州的州级变化。数据来自人口普查局的家庭脉搏调查，涉及个人食品安全和心理健康指标，以及美国疾病控制与预防中心的医院容量指标。数据分析于 2022 年 10 月至 2023 年 6 月进行。
2020 年 8 月至 11 月，拒绝为内布拉斯加州的低收入家庭提供额外的 SNAP 资金。
食品安全和住院床位使用指标（即住院床位占用、COVID-19 患者占用的住院床位和 COVID-19 住院患者）。
分析了 2020 年 5 月至 2020 年 11 月期间来自 1591006 名受访者的调查数据，其中 24869 人（1.56%）居住在内布拉斯加州。内布拉斯加州的人口中，白人的比例更高（平均[标准差]，88.70%[0.29%]比 78.28%[0.26%]；P<0.001），2019 年收入超过 20 万美元的人比例更低（4.20%[0.45%]比 5.22%[0.12%]；P<0.001），1 至 3 人家庭规模的比例更高（63.41%[2.29%]比 61.13%[1.10%]；P=0.03），与其他州相比。内布拉斯加州拒绝为 SNAP 接受者提供额外资金，这与食品安全状况恶化有关（原始平均[标准差]差异 1.61%[1.30%]；相对差异，19.63%；P=0.02），COVID-19 患者占用的住院床位比例增加（原始平均[标准差]差异，0.19%[1.55%]；相对差异，3.90%；P=0.02），以及住院床位占用率增加（原始平均[标准差]差异，2.35%[1.82%]；相对差异，4.10%；P=0.02）。
在这项横断面研究中，研究了社会政策、食品安全、健康和公共卫生资源之间的关联，内布拉斯加州拒绝紧急拨款与食品安全状况恶化有关。此外，这一干预措施与 COVID-19 和非 COVID-19 原因导致的住院率增加有关。
