Risk Factors for Unresolved Food Insecurity Among Households Receiving SNAP or WIC

Food insecurity (FI) affects approximately 13.5% of US households and nearly 18% of children.1 FI, persistent or transient, reflects limited or uncertain access to adequate and nutritious food resulting from economic or social conditions.1 Persistent FI denotes long-term household inability to access sufficient food, whereas transient FI is a brief episode, often following sudden unemployment.2Despite federal nutrition programs such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP), studies indicate that households enrolled in food assistance may still experience FI because of structural and socioeconomic barriers.3,4 These findings raise concerns that enrollment alone may be insufficient to meet household food needs. This study aimed to identify child- and household-level risk factors associated with unresolved FI among families receiving WIC or SNAP to inform strategies for addressing unmet needs in vulnerable populations.We conducted a cross-sectional analysis using the 2022 to 2023 National Survey of Children’s Health.5 Our sample consisted of households reporting receipt of WIC or SNAP benefits (unweighted n = 16 482). Our outcome was a caregiver report of FI in the past 12 months. We performed descriptive statistics and fit a multivariate survey-weighted logistic regression model to estimate the association between child/household measures and unresolved FI. Detailed methods are provided in the Supplemental Methods. This analysis of deidentified public data did not constitute human subject research. We used R statistical software for analyses (R Core Team, 2024).Across the National Survey of Children’s Health (70 312 432 children; standard error [SE], 304 917), 3 768 184 (SE, 121 618; 5.4%) children lived in households with FI. Of these, 1 543 187 (SE, 76 978; 41.0%) did not receive WIC or SNAP. Our cohort consisted of 16 375 272 (SE, 238 639) children living in households that received WIC or SNAP, of which 2 207 545 (SE, 94 896; 13.5%) reported FI. Child/household measures are summarized in Table 1.Survey-weighted regression models are shown in Table 2. In adjusted models, older children (aged 6–11 years: adjusted odds ratio [aOR], 1.35 [1.07–1.69]; aged 12–17 years: aOR, 1.46 [1.19–1.80]), children with special health care needs (CSHCN; aOR, 1.40 [1.14–1.72]), and households with lower federal poverty ratio levels (0%–99%: 4.25 [1.93–9.38]; 100%–199%: 4.01 [1.82–8.84]; 200%–399%: 2.27 [1.01–5.10]) had higher odds of FI. Compared to non-Hispanic white children, Asian children had lower odds of FI (aOR, 0.35 [0.21–0.59]). Publicly insured and uninsured children had significantly higher odds of FI compared to those with private insurance alone (public: aOR, 1.58 [1.08–2.32]; uninsured: aOR, 2.34 [1.44–3.81]). Children in households in which the caregiver had only some college or technical school education had increased odds of FI compared to those with a college degree or higher (aOR, 1.41 [1.08–1.85]). Household language, structure, and child’s sex were not significantly associated with FI.In this study of US children, FI affected approximately 1 in 7 children in households receiving WIC or SNAP. To our knowledge, this is the first nationally representative study to evaluate risk factors for FI among benefit-receiving households. Children who were older, with public or no insurance, from lower-income households, and CSHCN had higher odds of experiencing unresolved FI, whereas Asian children had lower odds than non-Hispanic white children.Our findings expand upon prior literature suggesting that older children, those without private insurance, CSHCN, and those in lower-income households experience higher odds of unresolved FI, likely reflecting increased nutritional needs and compounding financial stressors.6 Age-based differences may reflect younger children’s access to both WIC and SNAP, although future subgroup analyses should examine differential benefit receipt. The increased vulnerability among CSHCN highlights the intersection of medical complexity and nutritional access, emphasizing challenges faced by families with children predisposed to high health care utilization.7We did not find significant differences in unresolved FI by household language, counter to a single-center study.8 Because our cohort included only families already enrolled in WIC or SNAP, language barriers to accessing benefits were possibly reduced. Asian children also had lower odds of unresolved FI than non-Hispanic white children. Such differences require further investigation but may be influenced by subgroup aggregation in reporting and factors such as generational support or number of children. As SNAP participation has been shown to reduce FI among Black and multiracial households, our findings may reflect either underreporting or state-level policy differences and outreach strategies, especially as the timeframe spanned expansion of services and subsequent cutbacks during and after the COVID-19 pandemic.1,9 A better understanding of how state-level program delivery and eligibility thresholds influence unresolved FI could inform future policy. Finally, households in which the caregiver had some college/technical education showed higher odds of FI, which may be consistent with the “benefits cliff” phenomenon, in which modest income increases reduce program eligibility without fully compensating for lost benefits.10Although limited because of the cross-sectional nature, including the inability to determine timing/duration of benefit receipt in relation to FI, our findings highlight risk factors associated with unresolved FI among benefit-receiving households. These results raise concerns about whether current nutritional benefits adequately meet families’ needs and underscore the importance of tailoring food assistance and related supports.