Does Participation in SNAP During Early Childhood Protect Against the Long-Term Cardiovascular Risks of Food Insecurity?

This study asked whether participation in the Supplemental Nutrition Assistance Program (SNAP) during early childhood can protect against the long-term cardiovascular effects of food insecurity. Researchers followed 1,071 children from birth to age 22 using data from the Future of Families–Cardiovascular Health Among Young Adults study. They found that early food insecurity was linked to worse cardiovascular health, with a 2.2-point lower Life’s Essential 8 score and 1.4 times higher odds of obesity. However, this association disappeared among children whose families received SNAP benefits, suggesting that early participation in the program may lessen later cardiovascular risks.

The Policy Scientist’s Perspective

This article addresses one of the most consequential questions in public policy: whether early-life food assistance can alter long-term health trajectories. The broader importance lies in its connection to intergenerational inequality—how economic disadvantage in childhood manifests decades later in measurable health outcomes. Few policy interventions reach as deeply across the life course as food security programs, and the potential of SNAP to mitigate later cardiovascular risk makes this study particularly timely amid current debates over social safety net reform. The data, drawn from the longitudinal Future of Families–Cardiovascular Health Among Young Adults study, provide unusually rich life-course measures, though the design remains observational. The regression-based analysis is not causal in the strict sense, but its longitudinal scope and robustness checks lend it substantial credibility. The findings make an important empirical contribution to understanding how early material deprivation shapes adult health, offering rare quasi-longitudinal evidence of policy relevance.

Full Citation and Link to Article

Lam, E. L., Gauen, A. M., Kandula, N. R., Notterman, D. A., Goldman, N., Lloyd-Jones, D. M., Allen, N. B., & Shah, N. S. (2025). Early childhood food insecurity and cardiovascular health in young adulthood. JAMA Cardiology, 10(8), 762–769. https://doi.org/10.1001/jamacardio.2025.1062

Extended Summary

Central Research Question

This study investigates whether early childhood food insecurity is associated with worse cardiovascular health in young adulthood, and whether participation in the Supplemental Nutrition Assistance Program (SNAP) mitigates that relationship. The research examines the long-term health implications of food insecurity experienced during ages three to five, focusing on the potential protective role of a major U.S. anti-poverty intervention. The central question links early-life socioeconomic disadvantage to later-life biological outcomes, situating the analysis within the broader framework of the social determinants of health. Specifically, the authors ask whether participation in SNAP during early childhood can buffer the negative cardiovascular consequences typically associated with food insecurity.

Previous Literature

Prior studies have consistently found that food insecurity—a chronic lack of access to sufficient, nutritious food—is associated with poorer physical and mental health across the life span. Adult studies show that food-insecure individuals have higher odds of obesity, diabetes, and cardiovascular mortality. For example, national data have demonstrated 1.3 times higher odds of obesity and 1.4 times higher odds of prediabetes or diabetes among food-insecure adults, as well as increased cardiovascular mortality. These studies underscore the cumulative health burden of material deprivation but rarely capture the timing of exposure or its life-course consequences.

Research on childhood food insecurity, by contrast, has focused mainly on short-term outcomes such as weight gain, academic performance, and social-emotional development. Less is known about whether these early-life experiences translate into measurable differences in adult health indicators. The literature suggests that early childhood represents a critical developmental window for obesity prevention and cardiovascular risk formation, making this period especially relevant for interventions.

Evidence on SNAP’s role in shaping health trajectories is mixed. Some studies find that SNAP participation reduces food insecurity and improves children’s health, while others indicate that diet quality among SNAP recipients remains low. Research by Hoynes, Schanzenbach, and Almond (2016) and later by Bailey et al. (2024) showed that childhood access to food assistance predicts longer-term gains in health and life expectancy, suggesting intergenerational benefits. However, these findings rely largely on historical or quasi-experimental data that predate the Life’s Essential 8 (LE8) cardiovascular health framework introduced by the American Heart Association in 2022. This study thus fills an important gap by integrating contemporary health metrics into a longitudinal, life-course analysis of food insecurity and SNAP participation.

Data

The study uses data from the Future of Families–Cardiovascular Health Among Young Adults (FF-CHAYA) study, an ancillary project to the Future of Families and Child Well-Being Study (FFCWS). The FFCWS is a large, longitudinal cohort originally designed to follow children born between February 1998 and September 2000 in 20 U.S. cities, oversampling births to unmarried mothers and low-income households. The FF-CHAYA project extends this cohort into young adulthood (mean age 22.3 years as of 2021–2023) and collects comprehensive cardiovascular health data.

The analytic sample includes 1,071 participants with complete data on childhood food insecurity and adult cardiovascular health. Food insecurity was assessed using the U.S. Department of Agriculture’s 18-item Food Security Survey administered to the primary caregiver at child ages three and five. Responses categorized households as having high, marginal, low, or very low food security. Consistent with prior research, the authors treated any experience of marginal, low, or very low security at either time point as “food insecurity.” Approximately 39% of participants were food insecure during early childhood, and 44% participated in SNAP.

Cardiovascular health in young adulthood was measured using the American Heart Association’s Life’s Essential 8 (LE8) score, a composite index of eight behaviors and factors: diet, physical activity, nicotine exposure, body mass index (BMI), blood lipids, blood glucose, blood pressure, and sleep health. Because sleep data were unavailable, the authors computed a seven-component unweighted average score, consistent with prior methodological guidance. Clinical risk factors were also included, such as BMI ≥30, elevated cholesterol, high blood pressure, and HbA1c ≥5.7%.

Covariates included the child’s sex, mother’s education, age at birth, and household income at age five. These variables were selected to adjust for socioeconomic confounders correlated with both SNAP participation and cardiovascular outcomes. The dataset’s longitudinal design and detailed health measures make it one of the most robust U.S. sources for examining the developmental origins of adult cardiovascular health.

Methods

The analysis relied primarily on multivariable regression to estimate associations between early childhood food insecurity and young adult cardiovascular health. Linear regression models predicted continuous LE8 scores, while logistic and multinomial logistic regressions were used to model categorical outcomes and specific clinical thresholds.

The first model included only the primary exposure (food insecurity) and adjusted for child sex. The second model added maternal and household covariates—income, education, and maternal age—to account for baseline socioeconomic status. To test whether SNAP participation moderated the effects of food insecurity, the authors introduced an interaction term between food insecurity and SNAP participation. When the interaction was significant, analyses were stratified by SNAP participation status.

For secondary analyses, the authors examined categorical LE8 classifications (high, moderate, or low cardiovascular health) and cardiovascular-kidney-metabolic (CKM) syndrome staging, a measure of cumulative cardiometabolic burden. They also tested for interaction effects by sex. Statistical significance was defined as p < 0.05 (two-sided). All analyses were performed in R (version 4.3).

While the observational design precludes causal inference, the study’s strengths include longitudinal measurement, careful covariate adjustment, and the use of validated health metrics. The modeling approach focuses on associations rather than causal mechanisms, and no instrumental variable or quasi-experimental design was employed. Nonetheless, the authors’ treatment of confounders and robustness checks enhances internal validity.

Findings/Size Effects

Food insecurity during early childhood was significantly associated with lower cardiovascular health in young adulthood. Specifically, young adults who experienced food insecurity had a 2.2-point lower overall LE8 score (β = −2.2; 95% CI, −4.0 to −0.4) compared with those from food-secure households. Among the LE8 components, the largest effect was observed for BMI, with a 4.9-point lower BMI subscore (β = −4.9; 95% CI, −9.6 to −0.3).

The odds of being obese (BMI ≥30) were 1.40 times higher (95% CI, 1.07–1.84) for those who had experienced food insecurity as children. No significant associations were found for blood pressure, cholesterol, or blood glucose, suggesting that early food insecurity primarily affects body composition rather than metabolic or vascular function by early adulthood.

The SNAP interaction produced one of the study’s most important findings. The negative association between childhood food insecurity and cardiovascular health was pronounced among individuals whose families did not participate in SNAP (β = −4.9; 95% CI, −7.6 to −2.3), but absent among those whose families did (β = 1.0; 95% CI, −1.6 to 3.7). In other words, SNAP participation appeared to eliminate the disadvantage associated with early food insecurity.

Component-level analysis showed that, among nonparticipants, food insecurity was linked to worse physical activity (β = −11.5; 95% CI, −20.9 to −2.1) and BMI (β = −7.7; 95% CI, −14.4 to −1.1) scores. Among SNAP participants, food insecurity was paradoxically associated with a slightly higher diet score (β = 5.9; 95% CI, 0.0004 to 11.9), suggesting possible long-term dietary benefits from program participation.

Sex-specific analyses indicated that food insecurity was significantly associated with lower LE8 scores among female participants (β = −2.4; 95% CI, −4.8 to −0.3) but not males, implying gendered differences in vulnerability or behavioral pathways. Additional analyses found higher odds of moderate (vs. high) cardiovascular health among food-insecure participants (adjusted odds ratio, 1.46; 95% CI, 1.04–2.06). The relationship held for certain CKM syndrome stages—particularly stages 1 and 3–4—indicating that food-insecure children were more likely to show early signs of adiposity and subclinical cardiovascular dysfunction by their early twenties.

Effect sizes were moderate but meaningful, especially given the young age of the cohort. A 2.2-point decrease in LE8 score has previously been associated with increased lifetime cardiovascular disease risk. The protective role of SNAP, eliminating roughly five points of LE8 difference between groups, represents a sizable mitigation effect in population-health terms.

Conclusion

This study provides robust longitudinal evidence linking early childhood food insecurity to poorer cardiovascular health in young adulthood, particularly through higher BMI and lower physical activity. Importantly, SNAP participation during early childhood appears to mitigate these adverse effects, suggesting that early access to food assistance may produce lasting benefits for health trajectories.

The research contributes meaningfully to the literature on social determinants of health by documenting a plausible life-course pathway between material deprivation and cardiovascular outcomes. Its primary limitation is the inability to infer causality, as the design is observational and potentially subject to unmeasured confounding. Nonetheless, the longitudinal data, consistency across models, and magnitude of effects strengthen confidence in the findings.

Generalizability is strongest for urban, low-income populations, as the cohort was deliberately oversampled from those groups. However, the mechanisms identified—nutritional adequacy, stress buffering, and resource substitution—likely operate across contexts, suggesting broader relevance to other high-income nations with comparable food-assistance programs.

In methodological terms, the use of regression analysis rather than quasi-experimental or randomized designs limits causal interpretation. Yet, the precision of the estimates, the long temporal span of observation, and the use of validated health indices elevate its empirical rigor. As one of the first studies to apply the Life’s Essential 8 framework to longitudinal data linking childhood socioeconomic conditions to adult cardiovascular health, it stands out as a significant addition to the field.

Overall, the study underscores the enduring impact of early socioeconomic environments on adult health and highlights SNAP as a potentially powerful tool for long-term cardiovascular prevention. It exemplifies how public policy interventions in early childhood can produce measurable health dividends decades later, providing a compelling case for continued investment in evidence-based nutrition assistance programs.