Changes in Supplemental Nutrition Assistance Program Policies and Diabetes Prevalence: Analysis of Behavioral Risk Factor Surveillance System Data From 2004 to 2014

<b>Objective: </b> <p>Food insecurity is associated with diabetes. The Supplemental Nutrition Assistance Program (SNAP) is the largest US government food assistance program. Whether such programs impact diabetes trends is unclear. The objective of this study is to evaluate the association between changes in state-level policies affecting SNAP participation and county-level diabetes prevalence.</p> <p><b>Research Design and Methods:</b></p> <p>We evaluated the association between change in county-level diabetes prevalence and changes in the US Department of Agriculture SNAP policy index – a measure of adoption of state-level policies associated with increased SNAP participation (higher value indicating adoption of more policies associated with increased SNAP participation; range: 1 to 10) – from 2004 to 2014 using g-computation – a robust causal inference methodology. The study includes all US counties with diabetes prevalence data available from the Center for Disease Control’s US Diabetes Surveillance System.</p> <p><b>Results:</b></p> <p>A total of 3,135 (out of 3,143) US counties were included. Mean diabetes prevalence increased from 7.3% (SD=1.3) in 2004 to 9.1% (SD=1.8) in 2014. The mean SNAP policy index increased from 6.4 (SD=0.9) to 8.2 (SD=0.6) in 2014. After accounting for changes in demographic, economic and healthcare related variables and baseline SNAP policy index, a 1-point absolute increase in the SNAP policy index between 2004 to 2014 was associated with 0.050 (95% CI 0.042 to 0.057) percentage point lower diabetes prevalence per year. </p> <p><b>Conclusion:</b></p> State policies aimed at increasing SNAP participation were independently associated with a lower rise in diabetes prevalence between 2004 and 2014.