Abstract
Pregnant women are likely to be sensitive to daily fluctuations in nutritional intake. To see if income constraints at the end of the month limit food consumption and trigger health problems, we examine how the date that benefits are issued for the Supplemental Nutrition Assistance Program (SNAP) changes the probability that a woman will go to the Emergency Room (ER) for pregnancy-related conditions using administrative data from SNAP and Medicaid from Missouri for 2010–2013. SNAP benefits in Missouri are distributed from the 1st through the 22nd day of the month based on the birth month and the first letter of the last name of the head of the household, making timing of SNAP issuance exogenous. We estimate probit models of the calendar month and SNAP benefit month on the probability of a pregnancy-related ER visit for women age 17–45, or the sample at risk of being pregnant. We also examine the relationship between SNAP benefit levels and ER visits. We found that women who received SNAP benefits in the second or third week of the calendar month were less likely to receive pregnancy-related care through the ER in the week following benefit receipt. Results suggest that SNAP benefits might be related to patterns of pregnancy-related medical care accessed through the ER. Since SNAP issuance date is within state control in the United States, states may want to consider the health effects of their choice.
Similar content being viewed by others
Notes
At the clinical level, deficit of calcium affects gestational hypertension, pre-eclampsia, and pre-term delivery through its effects on endothelial cells, allowing the bioavailability of this vasodilator in the vasculature (López-Jaramillo 1996).
References
Almond, D., Hoynes, H. W., & Schanzenbach, D. W. (2011). Inside the war on poverty: The impact of food stamps on birth outcomes. The Review of Economics and Statistics, 93(2), 387–403.
Basu, S., Berkowitz, S. A., & Seligman, H. (2017). The monthly cycle of hypoglycemia: An observational claims-based study of emergency room visits, hospital admissions, and costs in a commercially insured population. Medical Care, 55(7), 639–645.
Borjas, G. J. (2004). Food insecurity and public assistance. Journal of Public Economics, 88(7), 1421–1443. https://doi.org/10.1016/s0047-2727(02)00188-3.
Carr, J. B., & Packham, A. (2017). SNAP benefits and crime: Evidence from changing disbursement schedules. Department of Economics Working Paper # - 2017-01. Oxford, OH: Miami University Farmer School of Business. Retrieved from http://www.fsb.muohio.edu/fsb/ecopapers/docs/packhaam-2017-01-paper.pdf.
Castellari, E., Cotti, C., Gordanier, J., & Ozturk, O. (2016). Does the timing of food stamp distribution matter? A Panel-Data Analysis of Monthly Purchasing Patterns of US Households Health Economics. https://doi.org/10.1002/hec.3428.
Castner, L., & Henke, J. (2011). Benefit redemption patterns in the Supplemental Nutrition Assistance Program (GS-10F-0050L) Washington, DC. Retrieved from http://www.fns.usda.gov/benefit-redemption-patterns-supplemental-nutrition-assistance-program
CDC (Producer). (2018). Natality public-use data 2007-2016. WONDER Online Database. Retrieved from http://wonder.cdc.gov/natality-current.html
Cotti, C., Gordanier, J., & Ozturk, O. (2015). Eat (and drink) better tonight: Food stamp benefit timing and drunk driving fatalities SSRN. Retrieved from https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2589553
Cox, J. T., & Phelan, S. T. (2008). Nutrition during pregnancy. Obstetrics and Gynecology Clinics of North America, 35(3), 369–383. https://doi.org/10.1016/j.ogc.2008.04.001.
Culhane, J. F., Rauh, V., McCollum, K. F., Hogan, V. K., Agnew, K., & Wadhwa, P. D. (2001). Maternal stress is associated with bacterial vaginosis in human pregnancy. Maternal and Child Health Journal, 5(2), 127–134.
Currie, J., & Cole, N. (1991). Does participation in transfer programs during pregnancy improve birth weight? NBER Working Paper #w3832. Cambridge, MA: National Bureau of Economic Research. https://doi.org/10.3386/w3832. Retrieved from http://www.nber.org/papers/w3832.
Currie, J., & Moretti, E. (2008). Did the introduction of food stamps affect birth outcomes in california? In R. Schoeni, J. House, G. Kaplan, & H. Pollack (Eds.), Making Americans healthier: Social and economic policy as health policy. New York, NY: Russell Sage Press.
DePolt, R. A., Moffitt, R. A., & Ribar, D. C. (2009). Food stamps, temporary assistance for needy families and food hardships in three American cities. Pacific Economic Review, 14(4), 445–473.
Fowles, E. R., & Gabrielson, M. (2005). First trimester predictors of diet and birth outcomes in low-income pregnant women. Journal of Community Health Nursing, 22(2), 117–130. https://doi.org/10.1207/s15327655jchn2202_5.
Gassman-Pines, A., & Bellows, L. (2015). SNAP Recency and Educational Outcomes. SSRN Working Paper #2701380. Rochester, NY: SSRN. https://doi.org/10.2139/ssrn.2701380. Retrieved from https://ssrn.com/abstract=2701380.
Gassman-Pines, A., & Bellows, L. E. (2016). SNAP recency and educational outcomes. Retrieved from https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2701380
Gibson-Davis, C. M., & Foster, E. M. (2006). A cautionary tale: using propensity scores to estimate the effect of food stamps on food insecurity. Social Service Review, 80(1), 93–126.
Goldin, J., Homonoff, T., & Meckel, K. (2016). Is there an Nth of the month effect? The timing of SNAP issuance, food expenditures, and grocery prices. Duke Public and IO Seminar Series, March 29, Durham, NC. Retrieved from https://ipl.econ.duke.edu/seminars/system/files/seminars/1074.pdf.
Gundersen, C., & Oliveira, V. (2001). The food stamp program and food insufficiency. American Journal of Agricultural Economics, 83(4), 875–887.
Gundersen, C., & Ziliak, J. P. (2015). Food insecurity and health outcomes. Health Affairs, 34(11), 1830–1839.
Haider, B. A., Yakoob, M. Y., & Bhutta, Z. A. (2011). Effect of multiple micronutrient supplementation during pregnancy on maternal and birth outcomes. BMC Public Health, 11(3), S19.
Harvey, L. B., & Ricciotti, H. A. (2014). Nutrition for a healthy pregnancy. American Journal of Lifestyle Medicine, 8(2), 80–87. https://doi.org/10.1177/1559827613498695.
Hastings, J., & Shapiro, J. M. (2017). How are SNAP benefits spent? Evidence from a retail panel. NBER Working Paper Series.
Hastings, J., & Washington, E. (2010). The first of the month effect: Consumer behavior and store responses. American Economic Journal: Economic Policy, 2(2), 142–162.
Heflin, C. M., Hodges, L., & Mueser, P. R. (2016). Supplemental Nutrition Assistance Program Benefits and emergency room visits for hypoglycemia. Public Health Nutrition. https://doi.org/10.1017/S1368980016003153.
Heflin, C. M., & Ziliak, J. P. (2008). Food insufficiency, food stamp participation, and mental health. Social Science Quarterly, 89(3), 706–727.
Howard, A. (2009). Review of pregnancy coding guidelines. For the Record, 21(8), 31.
Hoynes, H. W., & Whitmore Schanzenbach, D. (2009). Consumption responses to in-kind transfers: Evidence from the introduction of the food stamp program. American Economic Journal: Applied economics, 1(4), 109–139.
Huffman, S. K., & Jensen, H. H. (2008). Food assistance programs and outcomes in the context of welfare reform. Social Science Quarterly, 89(1), 95–115.
Kavle, J. A., Stoltzfus, R. J., Witter, F., Tielsch, J. M., Khalfan, S. S., & Caulfield, L. E. (2008). Association between anaemia during pregnancy and blood loss at and after delivery among women with vaginal births in Pemba Island, Zanzibar, Tanzania. Journal of Health, Population, and Nutrition, 26(2), 232.
King, J. C. (2003). The risk of maternal nutritional depletion and poor outcomes increases in early or closely spaced pregnancies. Journal of Nutrition, 133(5 Suppl 2), 1732S–1736S.
Kreider, B., Pepper, J. V., Gundersen, C., & Jolliffe, D. (2012). Identifying the effects of SNAP (food stamps) on child health outcomes when participation is endogenous and misreported. Journal of the American Statistical Association, 107(499), 958–975.
Laraia, B. A., Siega-Riz, A. M., & Gundersen, C. (2010). Household food insecurity is associated with self-reported pregravid weight status, gestational weight gain, and pregnancy complications. Journal of the American Dietetic Association, 110(5), 692–701. https://doi.org/10.1016/j.jada.2010.02.014.
López-Jaramillo, P. (1996). Prevention of preeclampsia with calcium supplementation and its relation with the l-arginine: nitric oxide pathway. Brazilian Journal of Medical and Biological Research = Revista Brasileira de Pesquisas Medicas e Biologicas, 29(6), 731–741.
Magriples, U., Kershaw, T. S., Rising, S. S., Massey, Z., & Ickovics, J. R. (2008). Prenatal health care beyond the obstetrics service: utilization and predictors of unscheduled care. American Journal of Obstetrics and Gynecology, 198(1), e71–77. https://doi.org/10.1016/j.ajog.2007.05.040.
McNulty, H., & Scott, J. M. (2008). Intake and status of folate and related B-vitamins: Considerations and challenges in achieving optimal status. British Journal of Nutrition, 99(S3), S48–S54.
Moran, L. J., Sui, Z., Cramp, C. S., & Dodd, J. M. (2013). A decrease in diet quality occurs during pregnancy in overweight and obese women which is maintained post-partum. International Journal of Obesity (London), 37(5), 704–711. https://doi.org/10.1038/ijo.2012.129.
Nord, M. (2013). Effects of the Decline in the Real Value of SNAP Benefits from 2009 to 2011. Economic Research Report #151. Washington, DC: United States Department of Agriculture, Economic Research Service. Retrieved from https://www.ers.usda.gov/webdocs/publications/45101/39326_err151.pdf?v=41488.
Nord, M., & Prell, M. A. (2011). Food security improved following the 2009 ARRA increase in SNAP benefits. Retrieved from http://www.ers.usda.gov/publications/err-economic-research-report/err116.aspx
Park, C. Y., & Eicher-Miller, H. A. (2014). Iron deficiency is associated with food insecurity in pregnant females in the United States: National Health and Nutrition Examination Survey 1999-2010. Journal of the Academy of Nutrition and Dietetics, 114(12), 1967–1973. https://doi.org/10.1016/j.jand.2014.04.025.
Pick, M. E., Edwards, M., Moreau, D., & Ryan, E. A. (2005). Assessment of diet quality in pregnant women using the Healthy Eating Index. Journal of the American Dietetic Association, 105(2), 240–246. https://doi.org/10.1016/j.jada.2004.11.028.
Ratcliffe, C., McKernan, S.-M., & Zhang, S. (2011). How much does the Supplemental Nutrition Assistance Program reduce food insecurity? American Journal of Agricultural Economics, 93(4), 1082–1098.
Reifsnider, E. (2006). Effective nutritional practices and policies for childbearing and childrearing women. In R. E. Tremblay, R. G. Barr, R. DeV. Peters (Eds.), Encyclopedia on Early Childhood Development. Retrieved from http://www.child-encyclopedia.com/sites/default/files/textes-experts/en/540/effective-nutritional-practices-and-policies-for-childbearing-and-childrearing-women.pdf.
Rifas-Shiman, S. L., Rich-Edwards, J. W., Kleinman, K. P., Oken, E., & Gillman, M. W. (2009). Dietary quality during pregnancy varies by maternal characteristics in Project Viva: A US cohort. Journal of the American Dietetic Association, 109(6), 1004–1011. https://doi.org/10.1016/j.jada.2009.03.001.
Seligman, H. K., Bolger, A. F., Guzman, D., López, A., & Bibbins-Domingo, K. (2014). Exhaustion of food budgets at month’s end and hospital admissions for hypoglycemia. Health Affairs, 33(1), 116–123.
Shapiro, J. M. (2005). Is there a daily discount rate? Evidence from the food stamp nutrition cycle. Journal of public Economics, 89(2), 303–325.
Todd, J. E. (2015). Revisiting the Supplemental Nutrition Assistance Program cycle of food intake: Investigating heterogeneity, diet quality, and a large boost in benefit amounts. Applied Economic Perspectives and Policy, 37(3), 437–458.
Trumbo, P. R., & Ellwood, K. C. (2007). Supplemental calcium and risk reduction of hypertension, pregnancy-induced hypertension, and preeclampsia: An evidence-based review by the US Food and Drug Administration. Nutrition Reviews, 65(2), 78–87.
USDA. (2015). Characteristics of Supplemental Nutrition Assistance Program Households: Fiscal Year 2014. Alexandria, VA: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support Retrieved from http://www.fns.usda.gov/sites/default/files/ops/Characteristics2014.pdf.
USDA. (2016, 06/10/2016). Supplemental Nutrition Assistance Program (SNAP) FY13 through FY16 national view summary. Retrieved from http://www.fns.usda.gov/sites/default/files/pd/34SNAPmonthly.pdf
Wilde, P. E., & Ranney, C. K. (2000). The monthly food stamp cycle: Shopping frequency and food intake decisions in an endogenous switching regression framework. American Journal of Agricultural Economics, 82(1), 200–213.
Williamson, C. S. (2006). Nutrition in pregnancy. Nutrition Bulletin, 31(1), 28–59. https://doi.org/10.1111/j.1467-3010.2006.00541.x.
Wittels, K. A., Pelletier, A. J., Brown, D. F., & Camargo, C. A., Jr. (2008). United States emergency department visits for vaginal bleeding during early pregnancy, 1993–2003. American Journal of Obstetrics and Gynecology, 198(5), e521–526. https://doi.org/10.1016/j.ajog.2007.11.011.
Wu, G., Imhoff-Kunsch, B., & Girard, A. W. (2012). Biological mechanisms for nutritional regulation of maternal health and fetal development. Paediatric and Perinatal Epidemiology, 26(s1), 4–26.
Yen, S. T., Andrews, M., Chen, Z., & Eastwood, D. B. (2008). Food Stamp Program participation and food insecurity: An instrumental variables approach. American Journal of Agricultural Economics, 90(1), 117–132.
Acknowledgements
Financial support for this study was received by the US Department of Agriculture through Cooperative Agreement 58-4000-6-0055-R.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Arteaga, I., Heflin, C. & Hodges, L. SNAP Benefits and Pregnancy-Related Emergency Room Visits. Popul Res Policy Rev 37, 1031–1052 (2018). https://doi.org/10.1007/s11113-018-9481-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11113-018-9481-5