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Original research
State expansion of Supplemental Nutrition Assistance Program eligibility and rates of firearm-involved deaths in the United States
  1. Rebeccah Lyn Sokol1,2,
  2. Anna E Austin3,4
  1. 1School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
  2. 2Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA
  3. 3Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  4. 4Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Rebeccah Lyn Sokol, University of Michigan, Ann Arbor, MI 48109, USA; rlsokol{at}umich.edu

Abstract

Introduction Poverty is a consistent correlate of firearm-involved mortality, yet little work has considered the effects of social and economic policies on these deaths. This study examined associations of state elimination of the asset test and increases in the income limit for Supplemental Nutrition Assistance Program (SNAP) eligibility with rates of firearm-involved suicide and homicide deaths in the United States.

Methods This ecological repeated cross-sectional study used 2015–2019 data from the SNAP Policy Database and death certificate data from the National Vital Statistics System. The exposures were (1) state elimination of the asset test for SNAP eligibility and (2) state elimination of the asset test and increases in the income limit for SNAP eligibility, compared with (3) state adoption of neither policy. The outcomes were firearm-involved suicide deaths and firearm-involved homicide deaths. The research team conducted mixed-effects regressions to estimate associations.

Results State elimination of the asset test for SNAP eligibility (incidence rate ratio (IRR), 0.67; 95% CI, 0.48 to 0.91) and state adoption of both eliminating the asset test and increasing the income limit for SNAP eligibility (IRR, 0.68; 95% CI, 0.49 to 0.92) were associated with decreased rates of firearm-involved suicide deaths compared with state adoption of neither policy. There were no associations with state firearm-involved homicide rates.

Conclusions SNAP is an important social safety net programme that addresses food insecurity, and the present results suggest it may also contribute to reducing firearm-involved suicide.

  • Violence
  • Firearm
  • Ecological Study
  • Public Health
  • Policy

Data availability statement

Data may be obtained from a third party and are not publicly available. Data obtained from the SNAP Policy Database and death certificate data from the National Vital Statistics System.

https://doi.org/10.1136/ip-2023-045035

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Data obtained from the SNAP Policy Database and death certificate data from the National Vital Statistics System.

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    Footnotes

    • Contributors RLS: research guarantor, conceptualisation, methodology, formal analysis, visualisation, writing of original draft, and writing review and editing. AEA: conceptualisation, methodology, data curation, writing of original draft, writing review and editing, and funding acquisition.

    • Funding This study was funded by an award from the US Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (No. R01CE003334).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.