self-reported hyperlipidemia and hypertension. Further, adults living with the most severe levels of food insecurity had a twofold increased risk of diabetes compared with adults with immediate access to healthful foods. Additional work by Seligman and colleagues (2010a,b, 2011) showed that food insecure individuals with diabetes were twice as likely as food secure individuals with diabetes to experience severe hypoglycemic episodes and poor diabetes self-management.

Self-Reported Health or Health Status

Various studies examining food insecurity have found that individuals who are food insecure often report poorer health. To illustrate, self-reported health status in food secure and food insecure women was reported in a study using data from the 1999 Panel Study of Income Dynamics (Jones and Frongillo, 2006). Although only 8 percent of all women surveyed were food insecure, younger food insecure women reported fewer sick days but were far more likely to report their health as fair or poor compared with older food secure women. Another study of food insecurity and self-reported health of adults in the lower Mississippi Delta found that about 20 percent of this population-based sample was food insecure and that the food insecure were more than twice as likely as food secure participants to report their health as fair/poor (Stuff et al., 2004). In a multisite study of young children that was part of the Children’s Sentinel Nutrition Assessment Project, parents in food insecure households were nearly twice as likely as parents in food secure households to report their child’s health as fair or poor (Cook et al., 2004).

Collectively, the strongest evidence for an association between food insecurity and adverse health outcomes is in adults. Evidence for an association between food insecurity and increased risk for obesity is also stronger for adults than for children, and the association with increased risk for type 2 diabetes or adverse diabetes outcomes is stronger than that for other chronic diseases. The evidence is unclear, however, on whether poor health status and risk for chronic disease are due to food insecurity or whether they lead to greater risk for food insecurity.

Impact of SNAP Participation on Food Insecurity

Evidence reviewed by the committee suggests that SNAP participation can reduce the prevalence of food insecurity (Borjas, 2004; Mykerezi and Mills, 2010; Nord and Prell, 2011; Van Hook and Balistreri, 2006; Yen et al., 2008). In interpreting this evidence, the committee considered that self-selection of SNAP participants into the program could create a bias. For example, Nord and Golla (2009) examined monthly data on both house-



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