Does state-level supplemental nutrition assistance program access reduce firearm mortality among black youth? A two-way fixed effects analysis of age-stratified and cause-specific outcomes across 22 states, 2000-2020

BMC Pediatr. 2025 May 22;25(1):410. doi: 10.1186/s12887-025-05677-7.

ABSTRACT

BACKGROUND: Firearm-related injuries represent a growing public health crisis disproportionately affecting Black youth in the United States. While research has established strong associations between poverty and community violence, the potential for poverty-alleviation policies to reduce firearm mortality remains understudied. This study examines the relationship between state-level Supplemental Nutrition Assistance Program (SNAP) access for Black individuals and firearm mortality rates among Black youth aged 10-34, analyzing variations by cause of death and age group.

METHODS: Using a two-way fixed effects design, we analyzed state-level data from 2000 to 2022, examining how SNAP access affected firearm mortality rates. SNAP access was calculated as the ratio of Black SNAP households to eligible Black households below 125% of the federal poverty line. Outcomes included firearm-related deaths (homicide, suicide, accidental, undetermined) among Black youth aged 10-34, identified through National Vital Statistics System data. We used generalized linear models with Poisson distribution, adjusting for state and year-fixed effects, demographic characteristics, and policy covariates.

RESULTS: SNAP access for Black individuals showed the strongest protective association with firearm homicides among youth aged 10-18 (adjusted RR = 0.93; 95% CI: 0.89-0.97). Increased SNAP access among this age group was also associated with significant reductions in total firearm mortality adjusted for state and year fixed effects (RR = 0.93; 95% CI: 0.88-0.98), and further adjustment resulted in similar estimates. Firearm suicide estimates suggest a potential protective association, particularly for youth aged 19-25 (adjusted RR = 0.90; 95% CI: 0.85-0.96). No associations were found with accidental firearm deaths across age groups.

CONCLUSION: State-level SNAP access for Black individuals demonstrates protective associations with firearm mortality among Black youth, particularly for homicides affecting adolescents aged 10-18 years and suicides for young adults aged 19-25. These findings suggest that expanding receipt of SNAP benefits among families living near or below the federal poverty line could serve as an upstream intervention for reducing firearm violence, especially during critical developmental periods. Future research examining mechanisms linking economic support to violence prevention is warranted to explore integration with other protective interventions.

PMID:40405125 | DOI:10.1186/s12887-025-05677-7