SNAP Participation Linked to Smaller Colorectal Screening Gap

Food-insecure adults were approximately 14% less likely to be up-to-date with colorectal cancer (CRC) screening than their food-secure peers, but only if they were not enrolled in the Supplemental Nutrition Assistance Program (SNAP). Among SNAP participants, the screening penalty tied to food insecurity essentially disappeared, according to a cross-sectional analysis of more than 251,000 US adults published in JAMA Network Open.¹

The finding positions nutrition assistance as a potential lever on preventive care utilization at a moment when SNAP eligibility and benefit levels are under active political pressure² and gives payers and health systems a concrete reason to prioritize food insecurity screening.

What the Analysis Found on Colorectal Screening

Researchers analyzed 2022 Behavioral Risk Factor Surveillance System (BRFSS) data, applying US Preventive Services Task Force criteria for guideline-concordant screening. For CRC, adherence meant stool testing within 1 year, sigmoidoscopy within 5 years, or colonoscopy within 10 years among adults aged 45 to 75 years. Food insecurity was evaluated using a single item (SDHFOOD1) asking how often bought food did not last and money was lacking to get more over the past 12 months, with "often" or "sometimes" responses classified as food insecure.

Of the 251,107 adults in the analytic cohort, 47,453 (18.9%) reported food insecurity. In the unadjusted data, 51.6% of food-insecure adults were up to date with CRC screening compared with 63.8% of food-secure adults. This marks a 12.2–percentage-point gap, the largest raw disparity of the 3 screening modalities examined.

The adjusted models are where SNAP enters. Among adults not enrolled in SNAP, food insecurity was associated with lower odds of CRC screening (adjusted odds ratio [aOR], 0.78; 95% CI, 0.74 to 0.83). Among SNAP participants, the association was attenuated and no longer statistically significant (aOR, 0.94; 95% CI, 0.86 to 1.03), with a significant test for interaction (P = .008). Modified Poisson models produced a materially similar picture (adjusted risk ratio, 0.86; 95% CI, 0.82 to 0.90 among nonparticipants).

How Large the SNAP-Associated Difference Actually Is

However, the absolute numbers are more modest than the odds ratios suggest. Among food-insecure adults, the marginal adjusted probability of being up to date with CRC screening was 48.2% (95% CI, 46.1% to 50.2%) for SNAP participants versus 46.3% (95% CI, 44.1% to 48.4%) for nonparticipants. This translates to an absolute difference of 1.9 percentage points (95% CI, 0.5 to 3.6; P = .009).

That is the smallest of the 3 modality-specific differences the authors reported, as the corresponding gaps were 3.4 points for breast cancer screening and 6.1 points for cervical cancer screening. In other words, CRC screening showed the widest food-insecurity disparity but the narrowest SNAP-associated offset. While the study does not explain the cross-modality variation, colonoscopy's known logistical demands, including bowel prep, time off work, transportation, and often an escort home, are a plausible factor.

Sensitivity analyses restricted to households earning less than $25,000 annually—a population closer to SNAP eligibility—sharpened the pattern. Among nonparticipants in that income band, food insecurity was associated with an aOR of 0.72 (95% CI, 0.67 to 0.79) for CRC screening, versus 0.89 (95% CI, 0.79 to 0.99) among SNAP enrollees.

How the Data Fit Known Screening Barriers

The individual-level signal is not new. A multilevel analysis of California Health Interview Survey data previously reported on in The American Journal of Managed Care^® (AJMC^®) identified food insecurity as a predictor of CRC screening nonadherence, alongside area-level health care resources and health maintenance organization penetration.³ The BRFSS study extends that observation nationally and adds the effect-modification question that the earlier work did not address.

The results also sit alongside AJMC reporting on the structural drivers of CRC screening gaps. An analysis of more than 535,000 adults found that rural residents were less likely to be screened, with more than 70% of the rural-urban gap unexplained by education, income, insurance, or provider access, pointing to unmeasured barriers of exactly the kind food insecurity may partly represent.⁴ Separately, a retrospective review found that specific social determinants were associated with colonoscopy noncompletion in a Medicaid population and that fecal immunochemical tests carried higher completion rates.⁵

What This Means for Managed Care Stakeholders

The authors were explicit that the cross-sectional design precludes causal inference, and they acknowledged that SNAP participants may differ from eligible nonparticipants in unmeasured ways, including baseline engagement with social services and the health system, which could independently drive screening uptake.¹ Food insecurity was also captured with a single dichotomized BRFSS item, and screening status was self-reported.

Still, the operational implication is fairly narrow and testable, as health plans and systems already collecting food insecurity data during preventive visits have a defensible basis for pairing that screening with active SNAP referrals, rather than passive resource lists.

For CRC specifically, the small absolute SNAP-associated difference argues that benefits assistance alone will not close the gap and that it likely needs to be bundled with lower-burden screening modalities and navigation support. Broader social-needs interventions have raised cancer screening rates by a median of 8.4 percentage points, a benchmark against which a 1.9-point SNAP-associated difference looks like one input among several rather than a standalone solution.

References

1. Mevawalla A, Chatzipanagiotou OP, Sarfraz A, et al. SNAP participation and cancer screening for adults with food insecurity. JAMA Netw Open. 2026;9(7):e2621403. doi:10.1001/jamanetworkopen.2026.21403
2. Hardy K. Food stamp changes will cost states billions, raising fears about SNAP’s future. States Newsroom. July 9, 2026. Accessed July 15, 2026. https://www.newsfromthestates.com/article/food-stamp-changes-will-cost-states-billions-raising-fears-about-snaps-future
3. Shariff-Marco S, Breen N, et al. Multilevel predictors of colorectal cancer screening use in California. Am J Manag Care. 2013;19(3):205-216.
4. Steinzor P. Rural-urban disparities in colorectal cancer screening persist. AJMC^®. Published online September 18, 2025. Accessed July 14, 2026. https://www.ajmc.com/view/rural-urban-disparities-in-colorectal-cancer-screening-persist
5. Stone BK, Gates JI, Monteiro KA. Social determinants of health: are colonoscopies always fit for duty? Am J Manag Care. 2023;29(8):395-401. doi:10.37765/ajmc.2023.89405