Buffering the Hardship: The Impact of SNAP and Parental Mental Health on Child Medical Neglect

• In Event: Poverty, Policies, and Program Participation's Relationship to Child and Adolescent Well-being

Abstract

Child medical neglect is an under-recognized form of maltreatment associated with adverse physical and mental health outcomes. While prior studies suggest that state-level expansions of the Supplemental Nutrition Assistance Program (SNAP) may reduce child maltreatment, less is known about whether SNAP participation itself is associated with child maltreatment, particularly medical neglect. This study examined the association between SNAP participation and child medical neglect among households with incomes below 200% of the federal poverty level (FPL), as many states have expanded SNAP eligibility to this level through Broad-Based Categorical Eligibility. This cutoff captures the realistically eligible population to test whether poverty and parental mental health moderate the association between SNAP and child medical neglect. 

We analyzed data on N=103,005 children aged 0–17 years (representing approximately 69 million children) from the 2023–2024 National Survey of Children's Health. We estimated survey-weighted logistic regression models to examine the association between child medical neglect (unmet healthcare needs in the past 12 months) and household SNAP participation in the past 12 months among children in households with incomes at or below 200% of the federal poverty level (FPL), controlling for continuous FPL and parental mental health, child age, sex, race/ethnicity, insurance status, family structure, caregiver education, and survey year. We subsequently tested two interactions: SNAP × FPL and SNAP × parental mental health. 

Among children in households at or below 200% of the FPL, 17.0% lived in SNAP-participating households and 3.5% experienced medical neglect. In survey-weighted models, we found no overall association between SNAP participation and child medical neglect. SNAP participation did not reduce the odds of medical neglect (OR = 1.05, p = 0.665), and household FPL was not associated with medical neglect (OR = 0.99, p = 0.379). In contrast, having no health insurance was significantly associated with higher odds of medical neglect (OR = 3.03, p < 0.001), and poor self-reported parental mental health was the strongest predictor: children whose parents reported poor mental health had 6.5 times the odds of medical neglect compared to those whose parents reported excellent mental health (p < 0.001). In models including interaction terms, the SNAP × FPL interaction was not significant (p = 0.209), and the SNAP × parental mental health interaction was also not significant (F = 0.64, p = 0.669). 

While SNAP is a critical tool for promoting food security, our findings suggest that it does not produce a meaningful “spillover effect” in reducing child medical neglect, indicating that providing resources earmarked for food may not alleviate barriers to children’s access to healthcare. Instead, structural and individual factors—specifically lack of health insurance and poor parental mental health—appear to be more potent predictors of child medical neglect than household income or food assistance. Policymakers should recognize that food assistance alone may be insufficient to reduce child medical neglect and prioritize reducing barriers to healthcare access—particularly through improved insurance coverage—and addressing parental mental health, which emerged as key predictors in our study.

Author

• Xi Wang, Boston College
  Presenting Author