A Randomized Controlled Trial Measuring Effects of Extra Supplemental Nutrition Assistance Program (SNAP) Benefits on Child Food Security in Low-Income Families in Rural Kentucky

Abstract Background To reduce childhood hunger, the US Department of Agriculture funded several innovative demonstration projects, including the Kentucky Ticket to Healthy Food project. Objective The study tested the hypothesis that Ticket to Healthy Food would reduce child food insecurity (FI-C) among rural, low-income households. Design The study used a randomized controlled trial in which households were randomly assigned to treatment and control groups. Outcomes were measured using household surveys and administrative data. Survey data were collected at baseline (n=2,202) and follow-up (n=1,639) 8 to 11 months into the project. Participants/setting Households in 17 counties in southeastern Kentucky that had at least 1 child younger than 18 years and received a Supplemental Nutrition Assistance Program (SNAP) benefit amount less than the maximum at baseline. Intervention Between January 2017 and March 2018, treatment households on SNAP received additional monthly benefits ranging from $1 to $122 based on distance to grocery store and earned income. Main outcome measures Key outcomes included FI-C (primary), food insecurity among adults and households, and food expenditures (secondary). Statistical analyses performed Logistic and linear regression models were used to estimate differences between the treatment and control groups, controlling for baseline characteristics. Socioeconomic subgroups were also analyzed. Results The Kentucky Ticket to Healthy Food project did not reduce the primary outcome, FI-C (treatment=37.1%, control=35.2%; P=0.812), or secondary outcomes of very low food security among children (treatment=3.7%, control=4.4%; P=0.204) or food insecurity among adults (treatment=53.9%, control=53.0%; P=0.654). The project increased households’ monthly food spending by $20 (P=0.030) and led more households to report that monthly benefits lasted at least 3 weeks (treatment=65%, control=56%; P=0.009). Conclusion A demonstration project to reduce FI-C by raising SNAP benefits for Kentucky households with children did not reduce FI-C or other food insecurity measures. Future research should explore the effect of different increases in SNAP benefits and collect repeated measures of FI-C to assess whether intervention effects change over time. Funding/Support This article is published as part of a supplement supported by the US Department of Agriculture, Food and Nutrition Service.