Carrying Firearms and Suicide Risk Among Adolescents.

Medication adherence is a primary determinant of chronic disease outcomes, yet remains suboptimal, particularly among low-income populations. Scarcity theory posits that economic hardship imposes cognitive burdens that affect decision-making, potentially undermining health behaviors like adherence. However, much of the existing research on scarcity relies on artificial exposures (eg, priming) and intermediate outcomes (eg, cognitive tasks), with limited replicability. Additionally, few studies have rigorously evaluated whether scarcity relief translates into changes in objectively measured health behaviors like daily medication adherence. To address this gap, we evaluated whether short-term scarcity relief is associated with improved medication adherence. We leveraged 2 features that create a natural experiment within the Supplemental Nutrition Assistance Program (SNAP), which provides low-income households in the US with monthly cash-like benefits to buy food. First, in many localities the timing of SNAP benefit disbursement within the month is randomly assigned at enrollment. Second, there is a predictable cycle of decreased scarcity after each payment followed by recurrence at the end of the benefit cycle (hereafter ). Together, these features create a schedule analogous to randomizing beneficiaries to higher or lower scarcity on a given day. We enrolled Philadelphia-area SNAP recipients with HIV between June 2024 and August 2025 who reported missing 2 or more oral antiretroviral therapy (ART) doses in the prior 30 days. Participants were recruited from counties where SNAP disbursement dates are randomly assigned based on case number to 1 of the first 10 business days of the month. We focused on HIV because ART requires high adherence and lacks cost-sharing, minimizing confounding by income-related medication access barriers. We followed participants for 4 months and measured daily ART adherence objectively using electronic pill caps (CleverCaps).