diff --git a/domains/health/snap-reduces-antihypertensive-nonadherence-through-food-medication-trade-off-relief.md b/domains/health/snap-reduces-antihypertensive-nonadherence-through-food-medication-trade-off-relief.md
new file mode 100644
index 00000000..4aaddefb
--- /dev/null
+++ b/domains/health/snap-reduces-antihypertensive-nonadherence-through-food-medication-trade-off-relief.md
@@ -0,0 +1,17 @@
+---
+type: claim
+domain: health
+description: The effect specificity to food-insecure populations validates that SNAP operates through relieving competing expenditure pressure rather than general health improvement
+confidence: likely
+source: JAMA Network Open, February 2024, retrospective cohort study of 6,692 hypertensive patients using linked MEPS-NHIS data 2016-2017
+created: 2026-04-01
+title: SNAP receipt reduces antihypertensive medication nonadherence by 13.6 percentage points in food-insecure hypertensive patients but has no effect in food-secure patients, establishing the food-medication trade-off as a specific SDOH mechanism
+agent: vida
+scope: causal
+sourcer: JAMA Network Open
+related_claims: ["[[SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent and no operational infrastructure connects screening to action]]", "[[value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk]]", "[[medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate as four independent methodologies confirm]]"]
+---
+
+# SNAP receipt reduces antihypertensive medication nonadherence by 13.6 percentage points in food-insecure hypertensive patients but has no effect in food-secure patients, establishing the food-medication trade-off as a specific SDOH mechanism
+
+Among food-insecure patients with hypertension, SNAP receipt was associated with a 13.6 percentage point reduction in nonadherence to antihypertensive medications (8.17 pp difference between SNAP recipients vs. non-recipients in the food-insecure group). Critically, SNAP showed NO association with improved adherence in the food-secure population. This dose-response specificity validates the mechanism: SNAP relieves the competing expenditure pressure between purchasing food and purchasing medications. In food-insecure households, medication adherence is reduced when food costs create budget pressure. SNAP provides food purchasing power, freeing income for medications. This is a distinct pathway from dietary improvement mechanisms studied in Food is Medicine programs—SNAP here operates through financial trade-off relief, not nutritional change. The mechanism only operates when food insecurity is present, explaining why the effect disappears in food-secure populations. While this study measures adherence rather than blood pressure directly, medication nonadherence is the primary determinant of treatment-resistant hypertension, suggesting this 13.6 pp improvement would translate to significant BP control improvements.