Safety net program participation and churning during the Covid-19 pandemic

A longitudinal analysis of low-income California families

Datos Bibliográficos

ID19488695
AutoresSydney Dougan (Berkeley Public Health Division), Kaitlyn E Jackson (0000-0002-5154-1494, Harvard University), R Hamad (0000-0003-0730-4077, Harvard University), Wendi Gosliner (0000-0001-5092-9289, University of California Division of Agriculture and Natural Resources), Kristina Dang (University of Southern California), Elise Sheinberg (0000-0002-5744-6324, Harvard University), Lia C H Fernald (0000-0003-1555-4607, Berkeley Public Health Division, autor de correspondencia)
Año2026
Volumen35
Páginas101932
Fecha de publicación2026-05-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaSSM - Population Health (JOURNAL)
Identificadores de la revistaISSN: 2352-8273 • E-ISSN: 2352-8273
EditorialElsevier BV (PUBLISHER)
DOI10.1016/j.ssmph.2026.101932
PMID42405322
OpenAlexW7160598334
IdiomaEN
Referencias citadas31

Objective: Studies of participation in US safety net programs consistently find improvements in health equity, yet few have measured multi-program participation over time, or linked these trajectories to health during the COVID-19 pandemic. This study characterizes longitudinal participation phenotypes in SNAP, WIC, and Medicaid and examines their associations with mental and physical health. Methods: We used longitudinal data from a cohort of low-income families (n = 361, 2019-2023) and applied sequence analysis (Hamming distance) and cluster analysis to identify distinct trajectories of program use. We then characterized sociodemographic profiles across clusters and applied regression analyses to estimate associations between the safety net use phenotypes and self-reported health. Results: We identified six unique trajectories of participation. While program use increased initially (2019-2021), it was followed by declines and "churning" (cyclical loss/gain) in 2022-2023. The most prevalent clusters were "all programs" (25%) and "rapid churning" (22%). Consistent with the hypothesis that administrative burdens harm health, participants with stable, full participation ("all programs") had consistently lower prevalence of adverse health outcomes compared to other clusters. Vulnerable groups (lower-income, racial/ethnic minorities) were disproportionately represented in high-churn clusters. Conclusion: Administrative volatility and "churning" were common, and results suggest that stability in coverage is a key driver of health equity. Policymakers should prioritize specific administrative safeguards, such as cross-program coordination, data sharing, and recruitment strategies to support vulnerable groups

Churning · Data collection · Safety net · Work (physics) · Advanced Causal Inference Techniques · Food Security and Health in Diverse Populations · Poverty, Education, and Child Welfare