OPINIONS, IDEAS, & PRACTICE
studies were primarily conducted among
Supplement 3, 2023, Vol. 113, No. S3
AJPH
S206
Federal Nutrition
Assistance Programs
and Adolescent
Food Insecurity: A
Complicated Picture
Kristin Mmari, DrPH, MA
ABOUT THE AUTHOR
Kristin Mmari is with the Department of Population, Family, and Reproductive Health,
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
A
dolescent food insecurity is a
growing public health concern
and is closely tied to a number of nega-
tive health behaviors and outcomes, in-
cluding substance use, transactional
sex, and poorer diet behaviors, which
can have long-term health conse-
quences well into adulthood.1,2 Food
insecurity affects adolescents different-
ly than adults or younger children
because of the rapid rate of physical,
emotional, and social development
that adolescents experience and
higher levels of nutrient energy need-
ed to support these changes. In fact,
the adolescent developmental period
is second only to early childhood in
terms of the sheer number of physical
and psychological transformations an
individual experiences.
Yet, in the United States, despite the
critical importance of obtaining healthy
nutrition during this phase of develop-
ment, there is evidence that food insecu-
rity is more prevalent during adolescence
1
than in any other stage of childhood.
Data from the Current Population Survey
(CPS), for example, indicate that among
all food-insecure households with
Editorial Mmari
children, 26% contained an adolescent
aged 13 to 15 years, while 17% con-
tained a child aged 5 to 8 years, and
only 12% had a child aged 4 years or
younger.3 Furthermore, there is evi-
dence that when food insecurity occurs
in households with multiple children of
different ages, the experience of food
insecurity is most acute for older chil-
dren and adolescents, as caretakers
have reported allocating food to youn-
ger children at the disadvantage of ado-
lescent children.4,5
FEDERAL RESPONSES TO
FOOD INSECURITY
Currently, the Supplemental Nutrition
Assistance Program (SNAP) is the larg-
est nutrition assistance program in the
United States that aims to “alleviate
hunger and nutrition” and enable low-
income households to obtain a “more
nutritious diet.” Before the COVID-19
pandemic, multiple studies found that
participants receiving SNAP were 5 to
20% less likely to be food insecure than
those who were eligible but not enrolled
in the program.6,7 However, these
adults, with limited research focused ex-
clusively on adolescents. One of the few
studies that examined the impact of
SNAP on adolescent food insecurity
used the National Health and Nutrition
Examination Survey to examine wheth-
er increased SNAP benefits during the
Great Recession of 2008 improved food
insecurity and diet quality in low-income
youth (aged 2–18 years).8 Findings
showed that the additional benefits
that SNAP households received were
not enough to reduce food insecurity
among young people.
Before the COVID-19 pandemic, food
insecurity increased from 11% in 2018
to 38% in March 2020. In April 2020,
35% of households with children aged
18 years and younger were food inse-
cure.9 To combat the growing food
insecurity crisis, the Families First
Coronavirus Act increased SNAP bene-
fit allotments up to the maximum
allowable amount and also enacted the
Pandemic Electronic Benefits Transfer,
or P-EBT, for households with children
eligible to receive free or reduced-price
school meals, equivalent to approxi-
mately $114 per child per month
(http://bit.ly/3GKss3M).
While studies on the impact of these
programs are still emerging, findings
suggest that P-EBT may have been
more effective in reducing food insecu-
rity among households with children,
while expansions in SNAP benefits had
less of an impact, particularly among
those at greatest disadvantage. One
study, for example, found that those
who lost jobs because of the pandemic
had the highest level of food insecurity
but the weakest association with food
assistance programs.10 However, an-
other study on the impact of P-EBT
showed that in the 2020–2021 school
year, the program reduced food

insecurity among SNAP households by
28% and had the largest effects in alle-
viating food hardship in states with
relatively high rates of school closures
because of the COVID-19 pandemic.11
Yet, few studies have assessed the
impact of these federal nutrition as-
sistance programs exclusively on ado-
lescent food insecurity during the
pandemic.
BALTIMORE STUDY
To specifically address the gap in re-
search on the associations between fe-
deral nutrition assistance programs and
adolescent food insecurity during the
pandemic, we conducted a study among
adolescents aged 14 to 19 years in Balti-
more City, Maryland. Our sample was
drawn from a database of 1100 adoles-
cents who completed an application to
a Baltimore City youth employment pro-
gram and who lived in households eligi-
ble to receive SNAP.
Adolescent participants completed
two online surveys: one during the
COVID-19 school lockdown period, from
October 2020 to January 2021, and an-
other a year later, from November 2021
to January 2022, after schools had
reopened. For each adolescent who
participated in the surveys (n 5 284), we
matched their household with data
from the Maryland Department of Hu-
man Services that allowed us to observe
each adolescent’s household participa-
tion in three federal nutrition assistance
programs—SNAP, Summer SNAP, and
P-EBT—as well as the amounts that
were received from each program. The
Summer SNAP program was originally
designed as a pilot program to deter-
mine whether providing an additional
$30 per adolescent child (aged 14–17
years) per summer month could alleviate
food insecurity among adolescents.
However, because of the expansions of
SNAP and the initiation of the P-EBT
program during the pandemic, which
targeted the same households, we
assessed all three programs, sepa-
rately and aggregately, with adoles-
cent food insecurity.
Our results showed that there was
no association between any of these fe-
deral nutrition assistance programs
and adolescent food insecurity. While
food insecurity among our adolescent
sample went from 48% during the first
survey to 38% in the second survey,
this decrease was not related to their
household participation in federal nu-
trition assistance programs. Instead,
other factors that were not measured
might have been related to the decrease
in food insecurity, such as schools being
reopened or community food pantries
being more available, which could have
provided greater access to meals and
food distribution. More research is
needed to further explore the factors
that influence adolescent food insecurity
in Baltimore.
RECOMMENDATIONS FOR
ADDRESSING ADOLESCENT
FOOD INSECURITY
Our study in Baltimore suggests that
current federal efforts to reduce food
insecurity among children in the United
States have largely ignored the needs
of adolescents. While programs such as
SNAP have the potential to be success-
ful, as studies have shown among
adults, they have failed to acknowledge
adolescence as a distinct and impor-
tant developmental stage. This may be
because SNAP benefits are tied to the
US Department of Agriculture’s Thrifty
Food Plan, which is the estimated cost
to provide a nutritionally adequate
meal at a minimal price. It is based on a
OPINIONS, IDEAS, & PRACTICE
family of four, consisting of a man and
a woman aged 20 to 50 years, one child
aged 6 to 8 years, and another child
aged 9 to 11 years.12 The maximum
SNAP benefit is then adjusted for differ-
ences in family size. The benefits do
not, however, adjust for differences in
the ages of children in the household,
leaving the additional nutritional needs
of adolescents out of the formulation.
When households participate in
SNAP, the benefits are provided to the
head of household, who is assumed to
be the person actively obtaining and
preparing food for all household mem-
bers. However, research has shown
that adolescent children in low-income
households are active participants in
family food acquisition and prepara-
AJPH
tion.4 In households with younger chil-
dren, research has also shown that
Supplement 3, 2023, Vol. 113, No. S3
adolescent children have skipped
meals to protect their younger siblings
from experiencing hunger.5,13 In a lon-
gitudinal study of Baltimore’s families in
public housing, researchers also found
that it was common for adolescents to
start taking on economic responsibili-
ties in the household, calling it “ex-
pedited adulthood,” and providing an
average of 22% of their families’
income.14(p132) Yet, for an adolescent to
receive any SNAP benefits directly, they
either need to be working and living in-
dependently outside of their parent’s
home or be homeless.15
As part of our study in Baltimore de-
scribed previously, a separate qualita-
tive study was conducted to explore
how adolescent food insecurity can be
best addressed. We interviewed ado-
lescents, parents, and policy advocates.
Interestingly, the only strategy all three
groups agreed on was to increase
SNAP benefits and expand eligibility to
ensure that all children in the house-
hold had a nutritious diet. Other
Editorial Mmari S207
 OPINIONS, IDEAS, & PRACTICE
strategies, such as having SNAP bene-
fits sent directly to adolescents or hav-
ing better access to free meals at
schools, were less supported by all
three groups.16
To understand more about how ado-
lescents think about reducing food in-
security among their peers, we asked
adolescents in Baltimore this question
in 2017. They overwhelmingly reported
the importance of combining food with
other services and programs to de-
crease the level of stigma that would be
associated with food assistance pro-
grams.2 Another study conducted
among adolescents in 2016 supported
this finding and also confirmed that the
preferred way to obtain food among
adolescents would be through a formal
Supplement 3, 2023, Vol. 113, No. S3
13
employment program. Indeed, re-
searchers who utilized data from the
Current Population Survey with a food
security module found that adolescent
employment was associated with an
11% to 22% reduction in household
food insecurity.17
Taking these considerations in mind,
AJPH
one federal program that might be able
to combine food services with employ-
ment for adolescents is the Public Law
113-128 Workforce Innovation and
Opportunity Act, which was designed
to help get low-income job seekers into
high-quality jobs and careers and help
employers hire and retain skilled work-
ers (https://bit.ly/3QJbpVm). Within this
act, there is a comprehensive program
specifically for youths aged 14 to 24
years who face barriers to education,
training, and employment. Since provid-
ing food provisions for adolescent
participants is not part of the program,
emphasizing how adolescent food inse-
curity might be addressed through this
program is clearly still warranted. In
June of 2023, the US Department of
Agriculture’s Food and Nutrition Service
S208 Editorial Mmari
and the US Department of Labor’s
Employment and Training Administration
partnered to develop strategies to better
connect SNAP participants with employ-
ment and career training programs.
Although adolescents were not the focus
of the meeting, the partnership between
these two institutes suggests that a
federal response for combining nutrition
assistance with employment for young
people may be possible.
CONCLUSION
Addressing adolescent food insecurity
is a critical, but complicated issue. The
stakes, however, are too high to ignore.
Federal nutrition assistance programs,
such as SNAP, need to acknowledge
the different developmental needs of
adolescents and better reflect what
households with children need to en-
sure all members maintain an ade-
quate diet. In addition, given the stigma
that so many adolescents have re-
ported with food assistance programs,
combining nutrition assistance with
employment development should be
considered as another potential strategy
for alleviating food insecurity among
adolescents. The COVID-19 pandemic
brought attention to the widespread
problem of food insecurity in the United
States, which consequently enabled
Congress to act quickly to develop
responses that helped alleviate food
insecurity for many households; howev-
er, the picture is still not clear for ado-
lescents. More research and attention
on this unique life stage is needed, with
real solutions developed for both ado-
lescents and their families.
CORRESPONDENCE
Correspondence should be sent to Kristin Mmari,
Department of Population, Family, and Reproduc-
tive Health, Johns Hopkins Bloomberg School of
Public Health, 615 N Wolfe St, Baltimore, MD
21205 (e-mail: kmmari1@jhu.edu). Reprints can
be ordered at https://ajph.org by clicking the
“Reprints” link.
PUBLICATION INFORMATION
Full Citation: Mmari K. Federal nutrition assistance
programs and adolescent food insecurity: a com-
plicated picture. Am J Public Health. 2023;113(S3):
S206–S209.
Acceptance Date: October 3, 2023.
DOI: https://doi.org/10.2105/AJPH.2023.307489
ACKNOWLEDGMENTS
This work was supported, in whole or in part, by
the Bloomberg American Health Initiative Van-
guard Award.
I would also like to thank Susan Gross, PhD, for
her review of the draft of this editorial.
CONFLICTS OF INTEREST
There are no conflicts of interest from financial or
affiliation-related activities.
REFERENCES
1. Heflin C, Kukla-Acevedo S, Darolia R. Adolescent
food insecurity and risky behaviors and mental
health during the transition to adulthood. Child
Youth Serv Rev. 2019;105:104416. https://doi.org/
10.1016/j.childyouth.2019.104416
2. Mmari K, Offiong A, Gross S, Mendelson T. How
adolescents cope with food insecurity in Balti-
more City: an exploratory study. Public Health
Nutr. 2019;22(12):2260–2267. https://doi.org/10.
1017/S1368980019001216
3. Nord M, Golla M. Does SNAP decrease food
insecurity? Untangling the self-selection effect.
Economic Research Report No. 85. Washington,
DC: US Department of Agriculture, Economic
Research Service; 2009.
4. Fram MS, Frongillo EA, Jones SJ, et al. Children
are aware of food insecurity and take responsi-
bility for managing food resources. J Nutr. 2011;
141(6):1114–1119. https://doi.org/10.3945/jn.
110.135988
5. Moffitt RA, Ribar DC. Child age and gender differ-
ences in food security in a low-income US inner-
city population. Eur Econ Rev. 2018;109:23–41.
https://doi.org/10.1016/j.euroecorev.2018.04.005
6. Mabli J, Ohls J. Supplemental Nutrition Assistance
Program participation is associated with an in-
crease in household food security in a national
evaluation. J Nutr. 2015;145(2):344–351. https://
doi.org/10.3945/jn.114.198697
7. Nord M, Prell M. Food security improved follow-
ing the 2009 ARRA increase in SNAP benefits.
Economic Research Report No. 116. Washington,
DC: US Department of Agriculture, Economic
Research Service; 2011.
8. Hudak KM, Racine EF, Schulkind L. An increase in
SNAP benefits did not impact food security or
diet quality in youth. J Acad Nutr Diet. 2021;
121(3):507–519.e12. https://doi.org/10.1016/j.
jand.2020.09.030
9. Kakaei H, Nourmoradi H, Bakhtiyari S, Jalilian M,
Mirzaei A. Effect of COVID-19 on food security,
hunger, and food crisis. In: Dehghani MH, Karri RR,
 OPINIONS, IDEAS, & PRACTICE

Roy S, eds. COVID-19 and the Sustainable

Development Goals. Amsterdam, Netherlands:
Elsevier; 2022:3–29. https://doi.org/10.1016/
B978-0-323-91307-2.00005-5
10. Bauer L, Ruffini K, Whitmore Schanzenbach D. An
Update on the Effect of Pandemic EBT on Measures
of Food Hardship. The Hamilton Project, Brook-
ings Institution; 2021. Available at: https://www.
brookings.edu/research/an-update-on-the-effect-
of-pandemic-ebt-on-measures-of-food-hardship.
Accessed August 26, 2023.
11. Fang D, Thomsen MR, Nayga RM Jr, Yang W.
Food insecurity during the COVID-19 pandemic:
evidence from a survey of low-income Ameri-
cans. Food Secur. 2022;14(1):165–183. https://
doi.org/10.1007/s12571-021-01189-1
12. US Department of Agriculture Food and Nutrition
Service. SNAP and Thrifty Food Plan. November
21, 2022. Available at: https://www.fns.usda.gov/
snap/thriftyfoodplan. Accessed August 20, 2023.
13. Urban Institute Bringing Teens to the Table: A Focus
on Food Insecurity in America. Washington, DC:
Feeding America; 2016.
14. DeLuca S, Clampet-Lundquist S, Edin K. Coming
of Age in the Other America. New York, NY: Russell
Sage Foundation; 2016.
15. US Department of Agriculture, Food and Nutri-
tion Service. SNAP Eligibility. December 31, 2020.
Available at: https://www.fns.usda.gov/snap/

AJPH
recipient/eligibility. Accessed August 26, 2023.
16. Harper K, Skinner R, Martinez-Baack M, Caulfield
LE, Gross SM, Mmari K. Strategies to improve ad-

Supplement 3, 2023, Vol. 113, No. S3

olescent food security from the perspectives of
policy advocates, parents, and adolescents. Nutri-
ents. 2022;14(22):4707. https://doi.org/10.3390/
nu14224707
17. Hamersma S, Kim M. Food security and teenage
labor supply. Appl Econ Perspect Policy. 2015;
38(1):73–92. https://doi.org/10.1093/aepp/
ppv007

Editorial Mmari S209

Copyright of American Journal of Public Health is the property of American Public Health
Association and its content may not be copied or emailed to multiple sites or posted to a
listserv without the copyright holder's express written permission. However, users may print,
download, or email articles for individual use.