SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM PARTICIPATION AND HEALTH: EVIDENCE FROM LOW-INCOME INDIVIDUALS IN TENNESSEE

1. INTRODUCTION The Supplemental Nutrition Assistance Program (SNAP), formerly the Food Stamp Program, is designed to provide food assistance via benefit payments to households meeting the eligibility criteria. Among the largest and most widely available Federal food assistance programs in the United States, and second only to the National School Lunch Program (NSLP), SNAP is the nation's key nutrition safety net which provides an in-kind benefit for low-income households to buy food. Program cost for SNAP was $53.63 billion for fiscal year (FY) 2009, putting food on the table for 15.2 million households and 33.7 million individuals each month (USDA-FNS 2010). The major purpose of SNAP is to help low-income households obtain adequate and nutritious diets by providing electronic debit cards that can be redeemed for food with few restrictions. Unlike other food assistance and nutrition programs such as the NSLP and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), both of which are targeted at specific populations, anyone who meets eligibility guidelines based entirely on financial need can receive SNAP benefits. With much of the nation's food assistance resources distributed by SNAP, it is important that policy makers have improved analytical tools for evaluating program participation and for estimating the impacts of SNAP participation on the nutrition and health status of program participants. Fox, Hamilton, and Lin (2004) review the literature on the effects of USDA's food and nutrition assistance programs, including SNAP, on a variety of outcome variables ranging from household food expenditures, nutrient availability, food insecurity, and individual dietary intake to health outcomes such as overall health, birth outcomes, and obesity.1 SNAP participation can impact health outcomes in several ways. First, to the extent that SNAP benefits represent effective income increases, and given the predominantly positive effect of income on health (Deaton and Paxson 1998, 2001; Ettner 1996; Lindeboom, Portrait, and van den Berg 2002; Lundberg 1991; Smith 1999), it is posited that the additional purchasing power can allow individuals to consume more or better health care. SNAP participation can improve health outcomes in other ways. For example, Yen et al. (2008) find that SNAP participation reduces the severity of food insecurity. It is possible that food security could then lead to better health outcomes. SNAP can have an adverse effect on health outcomes, too. For instance, Meyerhoefer and Pylypchuk (2008) and Chen, Yen, and Eastwood (2005) find that SNAP participation contributes to overweight and obesity among women. This study contributes to this body of empirical literature by investigating the effect of participation in SNAP on an important and direct health outcome variable: self-assessed health (SAH) status, a widely used indicator of health-related quality of life (Idler and Benyamini 1997). Two studies have investigated the effects of SNAP on SAH. Using data from the 1997 National Longitudinal Survey of Youth (NLSY), Gibson (2001) examines SAH and the prevalence of chronic disease among youth. SNAP participation is not found to be significantly related to either outcome. Fey-Yensan et al. (2003) examine self-reported general-health status and functional status, along with other outcomes, in a small group of low-income elderly individuals in Connecticut. Results of Chi-square analysis suggested no difference between SNAP participant and nonparticipant groups in general-health status or functional status. Another study by Miller and Korenman (1992) examines direct measures of child health. Food stamp receipt is found to be positively associated with the prevalence of "stunting" (being below the 10th percentile in height for children of the same age and sex) for chronically poor children but the effect was small in magnitude. Poor children who received food stamps for half but not all of their years in poverty are significantly less likely to be "wasted" (being below the 10th percentile in weight for children of the same height and sex) than children with a comparable poverty history who never received food stamps. …