Abstract：
OBJECTIVE: The Supplemental Nutrition Assistance Program (SNAP) addresses food insecurity for low-income households, which is associated with access to care. Many US states expanded SNAP access through policies eliminating the asset test (ie, restrictions based on SNAP applicant assets) and/or broadening income eligibility. The objective of this study was to determine whether state SNAP policies were associated with the use of mammography among women eligible for breast cancer screening.
METHODS: Data for income-eligible women 40 to 79 years of age were obtained from the 2006 to 2019 Behavioral Risk Factor Surveillance System. Difference-in-differences analyses were conducted to compare changes in the percentage of mammography in the past year from pre- to post-SNAP policy adoption (asset test elimination or income eligibility increase) between states that and did not adopt policies expanding SNAP eligibility.
RESULTS: In total, 171,684 and 294,647 income-eligible female respondents were included for the asset test elimination policy and income eligibility increase policy analyses, respectively. Mammography within 1 year was reported by 58.4%. Twenty-eight and 22 states adopted SNAP asset test elimination and income increase policies, respectively. Adoption of asset test elimination policies was associated with a 2.11 (95% confidence interval [CI], 0.07-4.15; P = .043) percentage point increase in mammography received within 1 year, particularly for nonmetropolitan residents (4.14 percentage points; 95% CI, 1.07-7.21 percentage points; P = .008), those with household incomes <$25,000 (2.82 percentage points; 95% CI, 0.68-4.97 percentage points; P = .01), and those residing in states in the South (3.08 percentage points; 95% CI, 0.17-5.99 percentage points; P = .038) or that did not expand Medicaid under the Patient Protection and Affordable Care Act (3.35 percentage points; 95% CI, 0.36-6.34; P = .028). There was no significant association between mammography and state-level policies broadening of SNAP income eligibility.
CONCLUSIONS: State policies eliminating asset test requirements for SNAP eligibility were associated with increased mammography among low-income women eligible for breast cancer screening, particularly for those in the lowest income bracket or residing in nonmetropolitan areas or Medicaid nonexpansion states.
METHODS: Data for income-eligible women 40 to 79 years of age were obtained from the 2006 to 2019 Behavioral Risk Factor Surveillance System. Difference-in-differences analyses were conducted to compare changes in the percentage of mammography in the past year from pre- to post-SNAP policy adoption (asset test elimination or income eligibility increase) between states that and did not adopt policies expanding SNAP eligibility.
RESULTS: In total, 171,684 and 294,647 income-eligible female respondents were included for the asset test elimination policy and income eligibility increase policy analyses, respectively. Mammography within 1 year was reported by 58.4%. Twenty-eight and 22 states adopted SNAP asset test elimination and income increase policies, respectively. Adoption of asset test elimination policies was associated with a 2.11 (95% confidence interval [CI], 0.07-4.15; P = .043) percentage point increase in mammography received within 1 year, particularly for nonmetropolitan residents (4.14 percentage points; 95% CI, 1.07-7.21 percentage points; P = .008), those with household incomes <$25,000 (2.82 percentage points; 95% CI, 0.68-4.97 percentage points; P = .01), and those residing in states in the South (3.08 percentage points; 95% CI, 0.17-5.99 percentage points; P = .038) or that did not expand Medicaid under the Patient Protection and Affordable Care Act (3.35 percentage points; 95% CI, 0.36-6.34; P = .028). There was no significant association between mammography and state-level policies broadening of SNAP income eligibility.
CONCLUSIONS: State policies eliminating asset test requirements for SNAP eligibility were associated with increased mammography among low-income women eligible for breast cancer screening, particularly for those in the lowest income bracket or residing in nonmetropolitan areas or Medicaid nonexpansion states.
摘要：
目标：补充营养援助计划（SNAP）解决了低收入家庭的粮食不安全问题，这与获得护理有关。美国许多州通过消除资产测试的政策扩大了SNAP访问范围(即，基于SNAP申请人资产的限制)和/或扩大收入资格。这项研究的目的是确定国家SNAP政策是否与符合乳腺癌筛查条件的女性使用乳房X线照相术有关。
方法：从2006年至2019年行为危险因素监测系统获得了符合收入的40至79岁女性的数据。进行了差异分析，以比较过去一年中从SNAP政策采用前后（资产测试取消或收入资格增加）的乳房X光检查百分比的变化，这些州和未采用扩大SNAP资格的政策的州之间。
结果：总计，171684和294647名符合收入资格的女性受访者被纳入资产测试淘汰政策和收入资格增加政策分析，分别。1年内乳房X线照相术报告58.4%。28个州和22个州采取了SNAP资产测试取消和增收政策，分别。采用资产测试淘汰政策与2.11相关(95%置信区间[CI]，0.07-4.15；P=.043）在1年内接受的乳房X光检查增加了百分点，特别是对于非大都市居民(4.14个百分点；95%CI，1.07-7.21个百分点；P=.008)，家庭收入<25,000美元（2.82个百分点；95%CI，0.68-4.97个百分点；P=0.01），和居住在南方各州的人（3.08个百分点；95%CI，0.17-5.99个百分点；P=.038）或根据《患者保护和平价医疗法案》未扩大医疗补助的人（3.35个百分点；95%CI，0.36-6.34；P=.028）。乳房X线照相术与扩大SNAP收入资格的州一级政策之间没有显着关联。
结论：国家政策取消了SNAP资格的资产测试要求，与符合乳腺癌筛查资格的低收入女性的乳房X线检查增加有关，特别是对于那些处于最低收入阶层或居住在非大都市地区或医疗补助非扩张州的人。
方法：从2006年至2019年行为危险因素监测系统获得了符合收入的40至79岁女性的数据。进行了差异分析，以比较过去一年中从SNAP政策采用前后（资产测试取消或收入资格增加）的乳房X光检查百分比的变化，这些州和未采用扩大SNAP资格的政策的州之间。
结果：总计，171684和294647名符合收入资格的女性受访者被纳入资产测试淘汰政策和收入资格增加政策分析，分别。1年内乳房X线照相术报告58.4%。28个州和22个州采取了SNAP资产测试取消和增收政策，分别。采用资产测试淘汰政策与2.11相关(95%置信区间[CI]，0.07-4.15；P=.043）在1年内接受的乳房X光检查增加了百分点，特别是对于非大都市居民(4.14个百分点；95%CI，1.07-7.21个百分点；P=.008)，家庭收入<25,000美元（2.82个百分点；95%CI，0.68-4.97个百分点；P=0.01），和居住在南方各州的人（3.08个百分点；95%CI，0.17-5.99个百分点；P=.038）或根据《患者保护和平价医疗法案》未扩大医疗补助的人（3.35个百分点；95%CI，0.36-6.34；P=.028）。乳房X线照相术与扩大SNAP收入资格的州一级政策之间没有显着关联。
结论：国家政策取消了SNAP资格的资产测试要求，与符合乳腺癌筛查资格的低收入女性的乳房X线检查增加有关，特别是对于那些处于最低收入阶层或居住在非大都市地区或医疗补助非扩张州的人。
