{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T15:31:56Z","timestamp":1786375916198,"version":"build-2736575974"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Government shutdowns expose safety-net programs to unplanned disruptions, but little is known about how unexpected benefit interruptions affect chronic disease management. In November 2025, a shutdown-related delay in Supplemental Nutrition Assistance Program (SNAP) benefit issuance disrupted food access for millions of Americans.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted semi-structured interviews with 20 SNAP recipients living with HIV, nested within a 54-person cohort with daily antiretroviral therapy adherence monitoring. Interviews explored monthly SNAP cycle experiences, food-HIV management connections, and the November 2025 benefit delay. Pre-shutdown adherence is reported across the parent cohort; during-shutdown adherence is reported across 9 participants whose monitoring extended into the disruption.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four themes emerged: Routine food access required planning; the monthly SNAP cycle imposed cognitive and material burden affecting chronic disease self-management; the November 2025 disruption was qualitatively distinct because added uncertainty compounded burden and destabilized self-management; and community supports partially buffered consequences. Across the 54-person parent cohort, median pre-shutdown adherence was 72%; among 9 participants monitored during the disruption, median during-shutdown adherence was 40%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Unexpected benefit disruptions impose uncertainty that adds cognitive burden and upsets the routines essential for chronic disease management. Safety-net programs should prioritize benefit reliability alongside adequacy, with implications extending across chronic conditions that depend on daily self-management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/haschl\/qxag194","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T11:58:37Z","timestamp":1784721517000},"source":"Crossref","is-referenced-by-count":0,"title":["SNAP disruption during a government shutdown and implications for chronic disease self-management: a qualitative study"],"prefix":"10.1093","volume":"4","author":[{"given":"Elizabeth","family":"Whidden","sequence":"first","affiliation":[{"name":"Department of Medicine (Infectious Diseases), University of Pennsylvania School of Medicine , Philadelphia, PA 19104 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Ellingson","sequence":"additional","affiliation":[{"name":"Department of Medicine (Infectious Diseases), University of Pennsylvania School of Medicine , Philadelphia, PA 19104 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8705-0235","authenticated-orcid":false,"given":"Charlotte","family":"Babbin","sequence":"additional","affiliation":[{"name":"Department of Medicine (Infectious Diseases), University of Pennsylvania School of Medicine , Philadelphia, PA 19104 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliza W","family":"Kinsey","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine , Philadelphia, PA 19104 ,","place":["USA"]},{"name":"Department of Medical Ethics and Health Policy, University of Pennsylvania School of Medicine , Philadelphia, PA 19104 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7920-7191","authenticated-orcid":false,"given":"Aaron","family":"Richterman","sequence":"additional","affiliation":[{"name":"Department of Medicine (Infectious Diseases), University of Pennsylvania School of Medicine , Philadelphia, PA 19104 ,","place":["USA"]},{"name":"Department of Medical Ethics and Health Policy, University of Pennsylvania School of Medicine , Philadelphia, PA 19104 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"2026081011240325300_qxag194-B1","volume-title":"Supplemental Nutrition Assistance Program (SNAP)\u2014Key Statistics and Research","author":"US Department of Agriculture","year":"2025"},{"key":"2026081011240325300_qxag194-B2","volume-title":"SNAP Is Linked With Improved Health Outcomes and Lower Health Care Costs","author":"Carlson","year":"2022"},{"issue":"12","key":"2026081011240325300_qxag194-B3","doi-asserted-by":"publisher","first-page":"1636","DOI":"10.2105\/AJPH.2019.305325","article-title":"Links of the supplemental nutrition assistance program with food insecurity, poverty, and health: evidence and potential","volume":"109","author":"Keith-Jennings","year":"2019","journal-title":"Am J Public Health"},{"key":"2026081011240325300_qxag194-B4","author":"R M"},{"key":"2026081011240325300_qxag194-B5","author":"Gearing"},{"issue":"15","key":"2026081011240325300_qxag194-B6","doi-asserted-by":"publisher","first-page":"1389","DOI":"10.1056\/NEJMp2200306","article-title":"How can we fully realize SNAP's health benefits?","volume":"386","author":"Gundersen","year":"2022","journal-title":"N Engl J Med."},{"issue":"1","key":"2026081011240325300_qxag194-B7","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1002\/pam.22093","article-title":"Salience, food security, and SNAP receipt","volume":"38","author":"Gregory","year":"2019","journal-title":"Journal of Policy Analysis and Management"},{"issue":"2","key":"2026081011240325300_qxag194-B8","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0246946","article-title":"SNAP timing and food insecurity","volume":"16","author":"Gregory","year":"2021","journal-title":"PLoS One"},{"issue":"2","key":"2026081011240325300_qxag194-B9","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1257\/pol.2.2.142","article-title":"The first of the month effect: consumer behavior and store responses","volume":"2","author":"Hastings","year":"2010","journal-title":"Am Econ J Econ Policy."},{"issue":"11","key":"2026081011240325300_qxag194-B10","doi-asserted-by":"publisher","first-page":"1380","DOI":"10.1002\/hec.3428","article-title":"Does the timing of food stamp distribution matter? 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