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Although studies have investigated and found an association between childhood trauma, chronic stress, adverse childhood experiences (ACEs) and poor health outcomes, less research emphasizes the interconnectedness between ACEs and subsequent utilization of Supplemental Nutritional Assistance Program (SNAP). A nationally representative data sample was used to explore the relationship between cumulative ACEs and SNAP benefit use after controlling for sociodemographic factors nested within individual, family, and community levels.
Methodology
The data used in this study came from the 2022 National Survey of Children's Health (NSCH). An analytic sample of 4677 children aged 0-17 was obtained. The dependent variable was food insecurity, measured dichotomously as yes or no. The primary independent included cumulative ACEs, which were categorized as 0 ACEs, 1 ACE, 2 ACEs, 3 ACEs, and 4 or more ACEs. The outcome variable was the utilization of SNAP benefits dichotomously coded as "no" or "yes." Chi-square tests were used to obtain the weighted prevalence estimates across cumulative ACEs and utilization of SNAP benefits. Data were analyzed using chi-square and multivariate logistic regression models. Chi-square tests were used to obtain the weighted prevalence estimates, and four nested multivariate logistic regression models were conducted to examine the association between cumulative ACEs and utilization of SNAP benefits while controlling for sociodemographic characteristics.
Results
Based on the parent's reports, out of 6604 children who utilized SNAP benefits, 25% had one ACE, 12% two ACEs, 8.6% 3 ACEs, and 11.4% had four or more ACEs. We found a dose-response between ACEs and utilization of SNAP benefits for children. In model 1, compared to children with no ACEs, children with 1 ACE (AOR=2.53; 95% CI= 2.37– 2.71, p<.001), 2 ACEs (AOR=3.74; 95% CI= 3.43– 4.09, p<.001), 3 ACEs (AOR=5.33; 95% CI= 5.81– 7.06, p<.001), and four or more ACEs had higher odds of utilizing SNAP benefits (AOR=6.41; 95% CI= 5.81– 7.06, p<.001). These significant effects were partially attenuated with the addition of individual, family, and community-level factors in models two, three, and four. In the fully adjusted model (model 4), children with 1 ACE (AOR=1.60, 95% CI = 1.43 - 1.79 p < .001), 2 ACEs (AOR=2.27; 95% CI = 1.95 -2.65, p < .001), 3 ACEs (AOR=2.88, 95% CI = 2.36 - 3.51, p < .001), and 4 or more ACEs (AOR=2.80, 95% CI = 2.32 - 3.38, p < .001) were associated higher odds of utilizing SNAP benefits compared to those with no ACEs, as reported by parents.
Conclusions and Implications
Findings from this study support previous results, concluding the accumulation of ACEs is associated with higher levels of food insecurity. The present study found strong associations between greater food insecurity and ACEs, especially with the accumulation of ACEs. Linkages between ACEs and food insecurity are well supported by research demonstrating strong correlations between economic hardship and poor health. In an effort to build on these findings, scholars should consider focusing future interventions that address food insecurity and ACEs in a trauma informed manner simultaneously.