INTRODUCTION:Access to medications for opioid use disorder (MOUD) varies across racial and ethnic groups. As the largest payer for MOUD, Medicaid has potential to ensure access for all enrollees. We aimed to quantify recent trends and state variation in MOUD use by race and ethnicity in Medicaid. METHODS:Using a distributed research network, we conducted a cross-sectional study of 11 states' Medicaid data from 2016 to 2020. Among enrollees diagnosed with opioid use disorder (OUD), we measured the percent receiving MOUD (overall; and methadone, buprenorphine, naltrexone, separately), continuity of MOUD for ≥180 days, and claims-based overdose event rates. We estimated logistic regression models in each state with fixed effects for year, race/ethnicity, and year and race/ethnicity interaction terms to examine changes in demographic differences in outcomes over time, adjusting for patient characteristics. We pooled estimates using random effects meta-analyses. RESULTS:Of the 542,414 enrollees with OUD in 2020, 430,891 (79.4%) were non-Hispanic white, 77,952 (14.4%) were non-Hispanic Black, 17,094 (3.2%) were Hispanic, and 16,477 (3.0%) had other race or ethnicity. MOUD use increased among enrollees in all racial and ethnic groups over time. The share of non-Hispanic white enrollees diagnosed with OUD receiving MOUD increased from 52.3% to 68.8% from 2016 to 2020 while the percent of non-Hispanic Black enrollees receiving MOUD from 37.2% to 49.7% during that period. Differences were widest for buprenorphine versus methadone or naltrexone. In adjusted analyses, Hispanic and Non-Hispanic Black enrollees were less likely to receive MOUD (adjusted odds ratios (AOR) = 0.67 [95 CI 0.49-0.91] and AOR = 0.41 [95 CI 0.33-0.52], respectively) compared to non-Hispanic white enrollees in 2016. Differences in receipt of MOUD did not change from 2016 to 2020. Non-Hispanic Black enrollees were less likely to have continuous MOUD relative to non-Hispanic white enrollees (AOR = 0.68 [95 CI 0.61-0.77)]. Overdose events peaked in 2017 for all racial and ethnic groups and were highest for Hispanic enrollees in 2020. CONCLUSION:MOUD increased among all racial and ethnic groups in 11 state Medicaid programs from 2016 to 2020. Yet, racial and ethnic differences in MOUD persisted, especially for buprenorphine. Our findings can inform Medicaid efforts to improve access to MOUD for all enrollees affected by OUD.

Adolescent dating violence (ADV) is highly prevalent among girls in the United States (US) and increases risk for depression, suicide ideation, and suicide attempts. Restorative justice (RJ), a policy-based, survivor-centered approach to harm repair and accountability, may be a structural intervention to promote mental health among ADV girl survivors. However, little is known about whether and how state-level RJ policies are associated with mental health or whether these associations differ by ethnoracial identity. Therefore, this study examined (1) associations between adolescent-focused, state-level RJ policies and depressive symptoms, suicide ideation, and suicide attempts among ADV girl survivors and (2) differences across ethnoracial identities. Individual-level data were from the 2013–2019 waves of the Youth Risk Behavior Survey, a state-representative, cross-sectional survey conducted biennially among public and private schools with adolescents who are in 9th to 12th grade in the US (N = 30,330). State-level policy data were from a US RJ legislative database. Generalized estimating equations using log binomial regression were used to examine lagged associations between state RJ policy adoption and mental health outcomes among ADV girl survivors and test for effect measure modification by ethnoracial identity. There were no associations between residing in a state with an RJ policy (vs. without) and depressive symptoms, suicide ideation, or suicide attempts among ADV girl survivors. The associations for depressive symptoms and suicide ideation did not vary by ethnoracial identity. However, the association between residing in a state with an RJ policy (vs. without) and attempting suicide varied by ethnoracial identity (b [95

OBJECTIVE:The aims of this nationally representative cross-sectional study were to examine 1) the association of food hardship with family resilience and connection among families with children ages 6 to 17 years and 2) whether participation in Supplemental Nutrition Assistance Program (SNAP) benefits modified this association. METHODS:We used 2019-21 data from the National Survey of Children's Health. We conducted multivariable generalized linear regression to calculate risk ratios (RRs) and 95% confidence intervals (CIs) examining the association of food hardship with an established measure of family resilience and connection. Then, among households with incomes <200% of the federal poverty level (FPL), we examined whether the association of food hardship with family resilience and connection differed among households participating and not participating in SNAP. We adjusted analyses for household characteristics and participation in other social safety net programs. RESULTS:Families who experienced food hardship were less likely (RR = 0.73, 95% CI 0.69, 0.76) to have high family resilience and connection compared to families who did not experience food hardship. SNAP participation did not modify this association among households with incomes <200% FPL (RR = 0.71, 95% CI 0.65, 0.78 for SNAP-participating households; RR = 0.71, 95% CI 0.65, 0.77 for nonparticipating households). CONCLUSIONS:Results add to evidence demonstrating that food hardship is a risk factor for lower family resilience and connection. Results highlight the need for further programs and policies, in addition to SNAP, to support families experiencing food hardship and promote family resilience and connection.

INTRODUCTION:The aim of this study was to examine the associations between state-level expansion of Supplemental Nutrition Assistance Program eligibility and adolescent bullying. METHODS:This cross-sectional ecologic study used data from the Supplemental Nutrition Assistance Program Policy Database and the Youth Risk Behavior Survey (2013-2021) in 41 states. Log-binomial regression compared the risk of any bullying, school bullying, and electronic bullying among adolescents (Grades 9-12) in states that had both broad-based categorical eligibility policies to expand Supplemental Nutrition Assistance Program eligibility (i.e., asset test eliminated and income limit increased) and the asset test eliminated only with the risk among adolescents in states with neither policy. RESULTS:In primary analyses (2013-2019), including 645,244 adolescents, those in states with both broad-based categorical eligibility policies had lower risk of experiencing any bullying (RR=0.87, 95% CI=0.84, 0.89), school bullying (RR=0.86, 95% CI=0.83, 0.89), and electronic bullying (RR=0.85, 95% CI=0.82, 0.88) than adolescents in states with neither policy. Similarly, adolescents in states with the asset test eliminated only had lower risk of experiencing any bullying, school bullying, and electronic bullying than adolescents in states with neither policy. Secondary analyses that included 2021, a COVID-19 pandemic year, showed that adolescents in states with both policies had lower risk of experiencing each type of bullying, whereas adolescents in states with the asset test eliminated only had lower risk of experiencing electronic bullying, than adolescents in states with neither policy. CONCLUSIONS:State broad-based categorical eligibility policies were associated with a lower risk of adolescent bullying. Results suggest that expanding Supplemental Nutrition Assistance Program eligibility, including through state broad-based categorical eligibility policies, may contribute to reductions in bullying.

Starting in March 2020, the COVID-19 pandemic strained the healthcare system in the United States, directly and indirectly changing the provision of many types of care, including maternity care. This paper describes longer-term changes in maternal health services utilization in the U.S. during the COVID-19 pandemic. Using United States monthly aggregated birth record data from 2016 to 2023, we examined changes in the average number of prenatal visits (overall and by delivery pay type) and total births (overall, by pay type, and by birthplace) before, during, and after the pandemic. We estimated monthly time series models replicating pre-pandemic patterns from January 2016 to February 2020. We then extended those models to predict monthly levels of each outcome had COVID-19 not occurred from March 2020 through December 2023. We compared observed and predicted levels from March 2020 onward, assessing differences associated with COVID-19. There were persistent and significantly lower-than-expected levels of average number of prenatal care visit across all COVID-19 months. There was also a temporary significant drop in total births during 2020 that recovered to expected levels in 2021, except for an increase in the total self-pay births in 2023. Patterns by pay type were similar to the overall patterns observed. Total non-hospital births were significantly higher than expected for the entirety of the pandemic, with large increases in intentional home births. Most initial changes to maternity care persisted throughout and continued after the pandemic, resulting in lower levels of prenatal care visits and higher numbers of home births. These findings show sustained changes to maternity care provision and access prompted by COVID-19, which highlight how vulnerable maternity services are to healthcare disruptions and suggest prolonged effects on equitable access to safe care.

OBJECTIVE:To conduct a scoping review to summarize the state of the evidence on associations between participation in nonfood social safety net programs (eg, income assistance, housing assistance) in the United States and food- and nutrition insecurity-related outcomes. BACKGROUND:Food and nutrition insecurity are persistent public health challenges in the United States that increase chronic disease risk and exacerbate health disparities. Several food assistance programs enhance food and nutrition security. Nonfood social safety net programs, however, may also improve these outcomes by relieving households' financial strain. Understanding the scope of research on nonfood social safety net programs' associations with not only food insecurity but also nutrition insecurity is needed to understand their potential to reduce the burden of diet-related chronic disease. METHODS:Six databases were systematically searched for peer-reviewed articles. Articles were included if they were published between 1995 and 2023; conducted in the United States; available in English; included a dependent variable of food- and/or nutrition insecurity-related measures; and included an independent variable of participation in a federally funded, nonfood social safety net program. RESULTS:Included articles (n = 65) reported on studies that examined 10 unique social safety net programs; 8 studies examined program interactions. Twenty studies focused on COVID-19 pandemic-era programs. Fifty-eight studies used food insecurity, food insufficiency, or food hardship as outcomes, and 11 studies used nutrition insecurity-related outcomes. Overall, results suggest that participation in nonfood social safety net programs is associated with reductions in food insecurity. Current evidence for an association between program participation and nutrition insecurity-related outcomes is limited. CONCLUSION:Further research is warranted on the association between nonfood social safety net programs and nutrition insecurity; potential interactions between social safety net programs; associations between the expiration of pandemic-era programs and food and nutrition insecurity; and how program impacts might differ among populations with persistent disparities in food and nutrition insecurity.

BACKGROUND Individuals with chronic pain often turn to the health care system for treatment and pain management strategies, but barriers to health care access can make this difficult. METHODS We analyzed data from the 2018 and 2019 North Carolina Behavioral Risk Factor Surveillance System (NC BRFSS) surveys to understand whether coping mechanisms for chronic pain differed by specific health care barriers, sex, and race/ethnicity. We assessed 4 health care barriers: coverage barrier (no health insurance), provider barrier (no personal doctor/provider), cost barrier (not seeing a doctor in the past year due to cost), and checkup barrier (no checkup in the past 2 years). RESULTS Compared to individuals with no health care barriers, individuals with any health care barrier used coping mechanisms tied to the health care system (e.g., prescription drugs and non-medication pain therapies) less frequently. Differences were also observed by sex and race/ethnicity. Among individuals with or without barriers, men reported using alcohol and marijuana or other street drugs to cope more frequently than women, while women used prescription medications more frequently than men. Among individuals with at least one barrier, Black, non-Hispanic individuals reported using prescription drugs and non-medication pain therapies less frequently than White, non-Hispanic individuals. LIMITATIONS The response rate for the NC BRFSS surveys was low, though adjusted for by weighting. We were limited by the available categories for coping mechanisms, and we restricted race/ethnicity analyses to White, non-Hispanic and Black, non-Hispanic individuals. CONCLUSIONS Our findings indicate that differences in the use of prescription and non-prescription pain therapies by race/ethnicity for individuals with chronic pain may also be interconnected with health care access barriers.

OBJECTIVE:Emergency allotments were issued in the Supplemental Nutrition Assistance Program (SNAP), the largest program addressing food insecurity in the United States, during the COVID-19 pandemic. These emergency allotments temporarily increased the amount of monthly food purchasing assistance received by SNAP-participating households. Our aim was to examine the association of the end of SNAP emergency allotments with food insufficiency and difficulty affording expenses, overall and among households with and without children. METHODS:We used March 2021-April 2022 Household Pulse Survey data from respondents in four states that ended emergency allotments in August 2021 ("earlier ender" states) and eight states that ended emergency allotments after the end of the study period (comparison states). We conducted difference-in-differences analyses to compare changes in the risk of food insufficiency and difficulty affording expenses from before to after the end of emergency allotments in August 2021 between SNAP-participating households in "earlier ender" states and comparison states. RESULTS:Earlier ending of SNAP emergency allotments was associated with a 5.0 percentage point increase in the risk of food insufficiency (risk difference (RD) = 0.05, 95 % confidence interval (CI) 0.03, 0.07) and an 8.0 percentage point increase in the risk of difficulty affording expenses (RD = 0.08, 95 % CI 0.06, 0.09). The increase in the risk of food insufficiency was slightly larger for households with children (RD = 0.06, 95 % CI 0.03, 0.09) than households without children (RD = 0.04, 95 % CI 0.00, 0.08). CONCLUSIONS:SNAP benefit reductions after the end of emergency allotments were associated with difficulty affording food and household expenses among households with and without children.

Objective To describe child protection system (CPS) reports after delivery and examine associations between individual- and hospital-level predictors and CPS reporting in a cohort of infants with prenatal substance exposure. Study design This state-level, retrospective cohort study used administrative data to analyze births to Black, White, and US-born Hispanic mothers with documented prenatal substance exposure. We used a random intercept mixed-model with individual- and hospital-level predictors to capture any association between birth hospital and CPS reporting. Interaction terms allowed for different effects dependent on characteristics of the delivering parent and the dominant demographics of the hospital setting. Results Among 260 525 births during 2018 in California, 2.6% had documented substance exposure, with observed racial differences in substance use and type. Nearly 4% of births to Black mothers had documented cannabis exposure compared with roughly 1% among White and Hispanic mothers. The delivery hospital explained 24% of variance in CPS reporting. Hierarchical models revealed race and insurance-type differences in the likelihood a CPS report followed a substance exposed birth. Namely, publicly-insured births in hospitals where majority births were covered by private insurance had nearly twice the probability of being reported compared with those with private insurance. Conclusions We found variation in CPS reporting of births with diagnosed substance exposure at the hospital level, and interactions between hospital- and individual-level characteristics in their association with the likelihood of CPS reporting. Associations offer insight into potential areas of bias and inconsistency in policy implementation that might be diminished through improved decision-making tools and provider training.

INTRODUCTION:Research suggests that Medicaid expansion may lead to population-level reductions in suicide. However, the time-varying impact on suicide rates has not been well characterized, and it is unknown whether potential suicide reductions are limited to specific injury mechanisms. This study examined the evolving effects of Medicaid expansion on state-level suicide rates disaggregated by injury mechanism and across demographic groups. METHODS:Restricted mortality data for 2005-2021 were obtained from the National Center for Health Statistics. Difference-in-differences approaches with event-study specifications were used to estimate the effects of Medicaid expansion on firearm, nonfirearm, and overall suicide rates among nonelderly adults and demographic subgroups. Analyses were conducted in 2024. RESULTS:Medicaid expansion was associated with 1.01 fewer suicides (95% CI= -1.93, -0.10) and 0.47 fewer firearm suicides (95% CI= -1.05, 0.11) per 100,000 nonelderly adults. The protective effects of expanding Medicaid eligibility grew over time. Among demographic subgroups, reductions were largest for the population aged 18-29 years, including 2.70 fewer suicides (95% CI= -4.55, -0.86) and 1.47 fewer firearm suicides per 100,000 (95% CI= -2.67, -0.27). Expansion was also associated with fewer firearm suicides among adolescents aged 10-17 years (-0.47; 95% CI= -1.05, 0.12). There were no significant reductions in overall suicide among Black individuals (-2.05; 95% CI= -8.22, 4.11), whereas expansion was associated with 0.79 fewer suicides per 100,000 White individuals (95% CI= -1.74, 0.16). CONCLUSIONS:Medicaid expansion resulted in fewer suicide deaths, including those involving firearms. These findings suggest that Medicaid expansion was particularly impactful in preventing suicide among young adults.

ObjectiveCommunity context influences children’s risk for injury. We aimed to measure the explanatory capacity of two ZIP code-level measures—the Child Opportunity Index V.3.0 (COI) and median household income (MHHI)—for rates of paediatric injury hospitalisations.MethodsThis was a retrospective cross-sectional population-based study of children living in 19 US states in 2017. We examined injury hospitalisation rates for three categories: physical abuse among children <5 years, injuries suspicious for abuse among infants <12 months and unintentional injuries among children <18 years. Hospitalisation counts were obtained from the Healthcare Cost and Utilization Project and population data from the US Census. The COI is a multidimensional measure of communities’ education, health and environment and social and economic characteristics. We used pseudo R2values from Poisson regression models to describe the per cent of variance in rates of each injury category explained by the COI and MHHI.ResultsThe COI explained 75.4% of the variability in rates of physical abuse, representing a 13.5% improvement over MHHI. The COI explained 58.5% of the variability in injuries suspicious for abuse, a 20.7% improvement over MHHI. The COI and MHHI explained 85.7% and 85.8% of the variability in unintentional injuries, respectively; results differed when unintentional injuries were stratified by mechanism and age.ImplicationsThe COI had superior explanatory capacity for physical abuse and injuries suspicious for abuse compared with MHHI and was similar for unintentional injury hospitalisations. COI represents a means of accounting for community advantage in paediatric injury data, research and prevention.

Objectives. To estimate the association of state policies that define prenatal substance use as child abuse and mandate that health care professionals report prenatal substance use to child protective services with congenital syphilis case rates. Methods. We used 2018 to 2022 US data on congenital syphilis case notifications to the National Notifiable Diseases Surveillance System. We conducted linear regression with a generalized estimating equation approach to compare congenital syphilis case rates in states with a child abuse policy only, a mandated reporting policy only, and both polices to rates in states with neither policy. Results. After adjustment for confounders, the rate of congenital syphilis cases was, on average, 23.5 (95% confidence interval = 2.2, 44.8) cases per 100 000 live births higher in states with both a child abuse policy and a mandated reporting policy for prenatal substance use than in states with neither policy. Rates were similar in states with a child abuse policy only and a mandated reporting policy only compared to states with neither policy. Conclusions. The combination of state child abuse policies and mandated reporting policies for prenatal substance use potentially contributes to higher congenital syphilis case rates. ( Am J Public Health. Published online ahead of print February 13, 2025:e1–e9. https://doi.org/10.2105/AJPH.2024.307951 )

INTRODUCTION:An increasing number of states have implemented punitive prenatal substance use policies. These include policies that consider prenatal substance use as grounds for substantiating abuse and neglect or for terminating parental rights (i.e., child abuse policies) and policies that require healthcare professionals to report prenatal substance use to child protective services (i.e., mandated reporting policies). Little research has examined whether these policies reduce substance use during pregnancy. The aim of this study was to examine the association of punitive state prenatal substance use policies with illicit drug use during pregnancy. METHODS:Data from 19 states' 2016-2019 Pregnancy Risk Assessment Monitoring System survey (N= 20,356) were used. Log-binomial regression with a generalized estimating equation approach was conducted to calculate risk ratios and 95% CIs comparing the likelihood of self-reported illicit drug use during pregnancy (i.e., marijuana, synthetic marijuana, heroin, amphetamines, cocaine or crack, tranquilizers, or hallucinogens) among pregnant women in states with and without a punitive prenatal substance use policy. Analyses were conducted in spring 2025. RESULTS:In multivariable analyses adjusted for potential confounders, the likelihood of illicit drug use during pregnancy did not differ between women in states with a punitive prenatal substance use policy and women in states without a punitive prenatal substance use policy (risk ratio RR=1.02; 95% CI=0.93, 1.11). CONCLUSIONS:Results indicate illicit drug use during pregnancy does not differ between states with and without punitive state prenatal substance use policies, suggesting that these policies do not reduce substance use during pregnancy.

Background Compared to undergoing prenatal care with a physician, care with a midwife reduces the risk of medical interventions and complications during labor and delivery among low-risk pregnant individuals. However, many analyses that assess the relationship between midwifery-led care and birth outcomes condition on live births, potentially inducing a type of collider bias.Objective The objective was to analyse the change in prevalence of caesarean deliveries, primary and secondary postpartum haemorrhage, obstetric trauma, and maternal infection under hypothetical scenarios where midwifery-led prenatal care was increased.Methods Our sample included commercially insured, midwifery-eligible pregnant people in an insurance claims data source. We used g-computation to assess the change in prevalence of caesarean deliveries, primary and secondary postpartum haemorrhage, obstetric trauma, and maternal infection if 10%, 20%, and 50% more pregnant people enrolled in prenatal care with a midwife rather than a physician, among a cohort of low-risk pregnant people with commercial insurance in the U.S. between 2004 and 2015.Results With a 50% increase in midwifery-led care compared with no increase, we found the prevalence of caesarean deliveries was reduced by 5.4 percentage points (95% confidence interval [CI] -5.7, -5.1) and of maternal infection decreased by 1.3 percentage points (95% CI -1.6, -1.0), while the prevalence of primary postpartum haemorrhage increased by 0.5 percentage points (95% CI 0.4, 0.6) and of secondary postpartum haemorrhage increased by 0.6 percentage points (95% CI 0.4, 0.7).Conclusions Increasing midwifery-led prenatal care reduced the prevalence of caesarean deliveries and maternal infections and slightly increased the prevalence of primary and secondary postpartum haemorrhage. Our results were similar to those of studies among live birth cohorts.

Objective Drug-related arrests persist at high levels despite the negative health consequences of incarceration, particularly for those with a substance use disorder. To understand community-level factors potentially contributing to high rates of drug-related arrests, we conducted an ecological study estimating associations between county-level social determinants of health and rates of drug-related charges in North Carolina from 2016 to 2019. Method Allowing a one-year lag between variables, we regressed the county-level rates of drug-related charges on each county-level social determinant of health variable. County-level rates of drug-related charges were the number of drug-related charges per 1000 residents. The county-level social determinant of health variables describe the percent of the population experiencing poverty, unemployment, evictions, food insecurity, or uninsured status. We accounted for spatial dependence of the social determinants of health variables and spatial correlation of the errors. We report direct effects, which measure the effect of a given social determinant of health in a given county on rates of drug-related charges in that same county. Results Poverty, evictions, and food insecurity were not associated with county-level rates of drug-related charges. There was a positive association between both unemployment and drug-related charges and between lack of health insurance and drug-related charges. A one percentage point increase in county-level unemployment was associated with a 3.27 (95 % CI: 1.28, 5.26) percent increase in the rate of next year drug-related charges per 1000 adults. A one percentage point increase in county-level lack of health insurance was associated with a 110.50 (95 % CI: 52.81, 168.18) percent increase in drug-related charges per 1000 adults the following year. Conclusion In this descriptive analysis, we found that a higher percentage of the population unemployed and uninsured were associated with higher rates of drug-related charges in the subsequent year. Areas with high unemployment and a high percentage of the population uninsured may benefit from diversion programs for individuals with substance use disorders.

IntroductionBirthing people in the United States suffer from poor pregnancy outcomes and a lack of perinatal care providers, especially nurse-midwives. Prenatal and intrapartum care by a certified nurse-midwife (CNM) is associated with improved perinatal health and lower costs among low-risk pregnant people. Medicaid programs in 20 states reimburse CNMs 10% to 25% less than physicians. On January 1, 2006, an Illinois policy went into effect requiring Medicaid to reimburse CNMs at the same rate as physicians. The objective of this study was to evaluate the association between equal Medicaid reimbursement of CNMs and physicians and CNM-led births in Illinois.MethodsWe included all live births to people aged 18 years or older in Illinois between June 1, 2003, and November 30, 2009. We used an interrupted time series analysis, with and without a synthetic control group, to assess the change in the level and trend of the proportion of CNM-attended births after the implementation of the Illinois policy.ResultsThe study period included 1,103,238 eligible live births in Illinois. Illinois and the synthetic control group were similar overall. Compared with a synthetic control group, we found an increase of 48.1 per 10,000 live births in the level of the number of births attended by a CNM (95% CI, -175.7 to 272.0) and an increasing trend of births attended by a CNM (2.8 per 10,000 live births; 95% CI, -7.4 to 13.1).DiscussionThese findings support evidence that equitable reimbursement will help increase access to CNMs among the Medicaid population.

Economic stress, broadly defined, is associated with an increased likelihood of multiple forms of violence. Food insecurity is a distinct economic stressor and material hardship that is amenable to programmatic and policy intervention. To inform intervention and identify gaps in the current evidence base, we conducted a systematic review to synthesize and critically evaluate the existing literature regarding the association between food insecurity and five forms of interpersonal and self-directed violence: intimate partner violence (IPV), suicidality, peer violence and bullying, youth dating violence, and child maltreatment, in high-income countries. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and searched six electronic databases from their start date through February of 2022. We included studies that examined food insecurity as the exposure and an outcome measure of IPV, suicide, suicidality, peer violence, bullying, youth dating violence, or child maltreatment; were peer-reviewed and published in English; reported quantitative data; and took place in a high-income country. We identified 20 relevant studies. Nineteen studies found that food insecurity was associated with an increased likelihood of these forms of violence. Results highlight the potential for programs and policies that address food insecurity to function as primary prevention strategies for multiple forms of violence and underscore the importance of trauma-informed approaches in organizations providing food assistance. Additional theory-driven research with validated measures of food insecurity and clearly established temporality between measures of food insecurity and violence is needed to strengthen the existing evidence base.

Background Households with low incomes are more likely to experience food and nutrition insecurity due to limited financial resources for necessities. Social safety net programs may improve food and nutrition security by relieving households’ financial strain. Although the relationship between federal nutrition assistance programs and food security is well understood, to date, no reviews have been conducted on the relationship between non-food social safety net programs and food and nutrition security. This evidence is needed to inform evidence-driven policymaking, particularly in the context of increasing food insecurity in recent years. Objective Conduct a scoping review to summarize the state of the evidence on the relationship between participation in non-food social safety net programs in the US and food and nutrition security. Study Design, Settings, Participants We systematically searched 6 databases for peer-reviewed studies examining the relationship between non-food social safety net programs and food security, nutrition security, or related constructs. Measurable Outcome/Analysis Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-Sr) Results Sixty-five articles have been identified that examine a wide range of social safety net programs including tax credits (n=14), Temporary Assistance for Needy Families (n=11), Medicaid (n=9), housing assistance (n=5), unemployment insurance (n=9), stimulus payments (n=4), and others (n=13). Twenty-one studies focus on COVID-19 pandemic-era social safety net programs. We will synthesize across studies to describe differences in the relationship between social safety net program participation and food or nutrition security by: program type, multiple vs. single program participation, food vs. nutrition insecurity, participant demographics, and elements of program administration such as disbursement method. We will identify gaps in the existing evidence base and directions for future research. Full results are forthcoming. Conclusions A review on the relationship between non-food social safety net program participation and food and nutrition security can inform policymaking, resource allocation, and efforts to ensure the potential nutrition benefits of such programs are realized equally among participants. Funding Robert Wood Johnson Foundation