SNAP Participation and Cancer Screening for Adults With Food Insecurity.

Abstract

Food insecurity affects nearly 1 in 5 US adults and is associated with barriers to preventive health care. Whether food insecurity is associated with lower national cancer screening adherence and whether Supplemental Nutrition Assistance Program (SNAP) participation is associated with attenuation of these disparities remain unclear. To evaluate the association between food insecurity and guideline-concordant colorectal, breast, and cervical cancer screening and to assess whether SNAP participation was associated with attenuation of screening disparities among food-insecure adults. This cross-sectional study used 2022 Behavioral Risk Factor Surveillance System data, a nationally representative survey of noninstitutionalized US adults. The study took place from May 22 to July 21, 2025. Data analyses were conducted from June 3 to July 7, 2025, and included respondents with complete food insecurity, SNAP participation, covariate, and age- and sex-eligible cancer screening data. Self-reported food insecurity during the past 12 months; SNAP participation served as the primary effect modifier. Guideline-concordant colorectal, breast, and cervical cancer screening based on US Preventive Services Task Force recommendations. Of 251 107 adults included in the analytic cohort, 47 453 (18.9%) reported food insecurity; food-insecure respondents were more often younger than 65 years (35 031 [73.8%] vs 118 063 [58.0%]) and female (27 690 [58.4%] vs 106 203 [52.2%]) compared with food-secure respondents. Screening adherence was lower among food-insecure than food-secure adults for colorectal (10 115 [51.6%] vs 59 825 [63.8%]), breast (1459 [61.2%] vs 7457 [72.5%]), and cervical cancer screening (1124 [39.8%] vs 4682 [50.3%]). In adjusted analyses stratified by SNAP participation, food insecurity was associated with lower odds of colorectal (adjusted odds ratio [aOR], 0.78; 95% CI, 0.74-0.83), breast (aOR, 0.69; 95% CI, 0.60-0.79), and cervical cancer screening (aOR, 0.63; 95% CI, 0.49-0.81) among respondents not enrolled in SNAP. Among food-insecure respondents, adjusted probabilities of being up to date with screening were higher among SNAP participants than nonparticipants for colorectal (48.2% [95% CI, 46.1%-50.2%] vs 46.3% [95% CI, 44.1%-48.4%]; difference, 1.9 [95% CI, 0.5-3.6] percentage points), breast (56.1% [95% CI, 54.0%-58.3%] vs 52.7% [95% CI, 49.7%-55.8%]; difference, 3.4 [95% CI, 1.3-5.6] percentage points), and cervical (51.3% [95% CI, 48.9%-53.8%] vs 45.2% [95% CI, 42.5%-47.4%]; difference, 6.1 [95% CI, 3.8-8.4] percentage points) cancer screening. In this cross-sectional study of 251 107 US adults, food insecurity was associated with lower likelihood of guideline-concordant colorectal, breast, and cervical cancer screening. Among food-insecure adults, SNAP participation was associated with higher adjusted screening probabilities than nonparticipation.