Mental Health Care Utilization, Unmet Care Needs, and Barriers to Receiving Care in Adolescence Among Transgender and Nonbinary Young Adults.

Food insecurity, or lack of access to enough food for an active, healthy lifestyle (), is a pressing public health issue in the United States. Food insecurity is associated with an increased risk of multiple adverse health-related outcomes for adults and children, including chronic conditions such as diabetes (), mental health conditions such as depression and anxiety (), experiences of violence (), and suicidal behaviors (). Households with children consistently have a higher prevalence of food insecurity than households without children (17.9 % vs. 11.9 % in 2023) (). Among children, lack of access to enough food can be conceptualized as an adverse childhood experience (ACE) given its potential to contribute to toxic stress (; ), disrupt healthy development (), and increase the risk of poor physical and mental health into adulthood (). The Supplemental Nutrition Assistance Program (SNAP) is the largest food and nutrition assistance program in the United States, providing a monthly benefit to eligible low-income households to assist with the cost of food (). For SNAP-participating households, the monthly benefit amount is calculated based on household income, expenses, and size, with maximum benefit amounts set according to household size. Existing research shows that SNAP participation is associated with reductions in food insecurity () and difficulties affording other expenses, such as housing, utilities, and healthcare (). At the onset of the COVID-19 pandemic in March 2020, the federal government expanded SNAP in response to rising unemployment and economic insecurity (). Specifically, the Families First Coronavirus Response Act allowed states to to issue emergency allotments in SNAP () Under emergency allotments, all SNAP-participating households received the maximum monthly benefit possible for their household size (). While this increased benefits for many households, households that were already receiving the maximum benefit possible did not initially experience an increase (). In April 2021, emergency allotments were further expanded to ensure that all SNAP-participating households received a minimum benefit increase of $95 per month (). At the federal level, SNAP emergency allotments expired in March 2023 with the end of the COVID-19 public health emergency. Although most states continued emergency allotments up to their expiration, 18 states ended emergency allotments earlier, between April 2021 and February 2023 (). Existing studies (; ; ; ; ) have examined the implications of emergency allotments for household food insecurity and food insufficiency, a closely related but narrower construct focused solely on whether a household has enough food to eat (). Results from these studies indicate that SNAP emergency allotments were associated with a decreased risk of difficulty affording enough food among SNAP-participating adults early in the pandemic () and among households with children (). Results also show that the percent of adults reporting that their household did not have enough food to eat increased after states ended emergency allotments early (; ) and after emergency allotments expired at the federal level (). Results from one study indicate that difficulty affording household expenses also increased after emergency allotments expired at the federal level (). The potential implications of states ending emergency allotments early for food insufficiency and difficulty affording household expenses among households with and without children have not been examined.