Beyond Food Assistance: A Scoping Review Examining Associations of Nonfood Social Safety Net Programs in the United States With Food Insecurity and Nutrition Outcomes

Abstract

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.

Keywords: Medicaid; TANF; food access; public assistance; social determinants of health.