Originally published on Boston University School of Public Health

The Supplemental Nutrition Assistance Program (SNAP) serves as a buffer against food insecurity for millions of low-income Americans. Food insecurity and other economic hardships are associated with health, developmental, behavioral, and educational issues for children and their caregivers. The majority of SNAP participants with children have earned income, but low-wage workers often have unstable working hours, work seasonal jobs, or have sporadic overtime hours that can result in unpredictable income fluctuations—and when family income increases, it can trigger rapid reductions or termination of SNAP benefits.

Families with young children who experience a reduction or cutoff in SNAP benefits because of increased income are more likely to experience food insecurity and report poor health, according to a new study from Children’s HealthWatch, based at Boston Medical Center (BMC) and led by a School of Public Health doctoral student.

The study, published in the May issue of Health Affairs, found that families whose SNAP benefits were reduced or cut off were more likely to experience food insecurity, energy insecurity, and to forgo health care than those with consistent benefits.

“These findings raise serious concerns about abrupt SNAP reductions and cutoffs for families whose income fluctuates,” says doctoral student Stephanie Ettinger de Cuba, executive director of Children’s HealthWatch at BMC and a researcher at the School of Medicine. “The economic hardships these families face can take a serious toll on child and caregiver health, including through high levels of stress, inadequate nutrition, and compromised immune systems, leading to increased strain on the healthcare system.”

Children’s HealthWatch surveyed over 8,500 families in five US cities from 2007-2015 who participated in SNAP in the previous year. Twenty percent reported a reduction in SNAP benefits because of income increase, while 16 percent reported benefits being cut off because of income increase.

Families whose benefits were reduced experienced more negative outcomes than those who were cut off, including greater odds of housing instability, children and caregivers being in fair or poor health, and maternal depressive symptoms. The researchers say this seemingly counterintuitive finding could be explained by the possibility that income increases large enough to result in a cutoff may help buffer families from some hardships.

The researchers say policymakers should consider ways to make SNAP reductions less abrupt for working families, and smooth the transition out of receiving benefits so that families have a chance to stabilize financially.

“Policymakers could take into account the timing and amount of income increases over a longer period to provide a more realistic picture of family employment and income stability,” says Deborah A. Frank, founder of Children’s HealthWatch and professor of child health and well-being at the School of Medicine. “The unintended impacts on child health of benefit loss immediately following potentially short-lived income increases are too great for us to continue with the status quo.”

The study was co-authored by Timothy Heeren, professor of biostatistics. The other co-authors were: were Allison Bovell-Ammon of Children’s HealthWatch and BMC; Sharon Coleman of BU’s Biostatistics and Epidemiology Data Analytics Center; John T. Cook of the School of Medicine; Mariana Chilton of Drexel University; Molly Knowles of the University of Pennsylvania; Maureen M. Black of the University of Maryland; Diana Becker Cutts of the Hennepin County Medical Center in Minneapolis, Minnesota; and Patrick H. Casey of the University of Arkansas.