Few Changes in Food Security and Dietary Intake From Short-term Participation in the Supplemental Nutrition Assistance Program Among Low-income Massachusetts Adults

ObjectiveTo examine whether short-term participation in the Supplemental Nutrition Assistance Program (SNAP) affects food security and dietary quality among low-income adults recruited from a Massachusetts-wide emergency food hotline.MethodsA 3-month, longitudinal study was conducted among 107 adults recruited at the time of SNAP application assistance. Outcomes included household food security (10-item US Department of Agriculture Food Security Survey Module), dietary intake (eg, grains, fruit) and diet quality (modified Alternate Healthy Eating Index). Data were analyzed using paired t tests and multivariable linear regression.ResultsSupplemental Nutrition Assistance Program participation was not associated with improved household food security over 3 months (P = .25). Compared with non-participants, SNAP participants increased refined grain intake by 1.1 serving/d (P = .02), from baseline to follow-up. No associations were observed with other foods, nutrients, or dietary quality.Conclusion and ImplicationsPolicies that simultaneously improve household food security and dietary quality should be implemented to support the health of low-income Americans participating in this crucial program.     

State Implementation of SNAP Waivers and Flexibilities During the COVID-19 Pandemic: Perspectives From State Agency Leaders

ObjectiveTo describe state agencies’ implementation of the Supplemental Nutrition Assistance Program (SNAP) during the first year of the coronavirus disease of 2019 (COVID-19) pandemic, barriers and facilitators to SNAP implementation, and recommendations to improve SNAP implementation.DesignQualitative methodology guided by Bullock's determinants of policy implementation framework using 7 semistructured, virtual focus groups in April 2021.SettingTwenty-six states representing all 7 US Department of Agriculture Food and Nutrition Service regions.ParticipantsFour focus groups with state-level SNAP administrators and 3 focus groups with state-level SNAP supportive services (Supplemental Nutrition Assistance Program-Education, Employment & Training, and Outreach) supervisors (n = 62).Phenomenon of InterestSupplemental Nutrition Assistance Program implementation during the COVID-19 pandemic.AnalysisThematic analysis using a phronetic iterative approach.ResultsSix primary themes emerged: the policy response, technology needs, collaboration, participant communication, funding realities, and equity. Implementation challenges included the design of waivers in the early pandemic response, inadequate federal guidance and funding, outdated technology, and prepandemic regulations limiting state authority. Modernized technology systems, availability of virtual programming, partnerships, and enhanced benefits facilitated SNAP implementation.Conclusions and ImplicationsSupplemental Nutrition Assistance Program administrators adapted their programs to deliver services virtually during the COVID-19 pandemic. These experiences highlighted the importance of certain policy determinants, such as modernized technology and streamlined application processes, to improve outcomes for SNAP participants and staff.     

The Impact of ABAWD Time Limit Reinstatement on SNAP Participation and Employment

ObjectiveEstimate the impact of the Supplemental Nutrition Assistance Program (SNAP) time limit for able-bodied adults without dependents (ABAWD) on SNAP participation, employment, and earnings.DesignA quasi-experimental study using state administrative SNAP and earnings data to compare outcomes for SNAP participants before and after the time limit went into effect.ParticipantsSupplemental Nutrition Assistance Program participants in the study cohorts in Colorado, Missouri, and Pennsylvania (N = 153,599).Main Outcome MeasuresMonthly SNAP participation, quarterly employment, annual earnings.AnalysisLogistic and ordinary least squares multivariate regression models.ResultsTime limit reinstatement reduced SNAP participation by 7 to 32 percentage points in the 12th month of time limit reinstatement but did not generate evidence of improved employment or annual earnings (1 year after time limit reinstatement, employment decreased by 2 to 7 percentage points and annual earnings decreased by $247 to $1,230).Conclusions and ImplicationsThe ABAWD time limit reduced SNAP participation but did not improve employment and earnings. SNAP may provide helpful support to participants as they seek to enter or re-enter employment, and removing this support may be detrimental to their employment prospects. These findings can inform decisions about requesting waivers or pursuing changes to ABAWD legislation or regulations.     

Dietary Intake Changes in Response to a Sugar-Sweetened Beverage Reduction Trial for Various Supplemental Nutrition Assistance Program (SNAP) Eligibility Groups

Objective

To examine dietary intake differences resulting from a sugar-sweetened beverage reduction intervention by 3 Supplemental Nutrition Assistance Program (SNAP) participation groups: SNAP participants (n?=?56), income-eligible nonparticipants (n?=?30), and income-ineligible nonparticipants (n?=?60).

COVID-19 Benefits and Dietary Behaviors Among Mothers From Low-Income,Food-Insecure Households

ObjectiveTo examine the dietary behaviors of mothers from very low food security (VLFS) households following the availability of coronavirus disease 2019 (COVID-19) unemployment and Supplemental Nutrition Assistance Program benefits.MethodsDiet and food security status were obtained from 2,584 California mothers during Federal Fiscal Year 2020. Fruits, vegetables, and 100% fruit juice (FV100%FJ), sugar-sweetened beverages, and water intake, and Healthy Eating Index-2015 scores, were compared across 4 groups (before vs after COVID-19 benefits by VLFS vs non-VLFS households) with race/ethnicity and age as covariates.ResultsBefore COVID-19 benefits, VLFS was associated with fewer cups of FV100%FJ (P = 0.010), more fluid ounces of sugar-sweetened beverages (P = 0.004), and poorer diet quality (P = 0.003). After COVID-19 benefits, mothers from VLFS vs non-VLFS households reported similar dietary outcomes. VLFS mothers reported 0.96 (95% confidence interval, 0.53–1.38) more cups of FV100%FJ after COVID-19 benefits.Conclusions and ImplicationsCoronavirus disease 2019 benefits may have reduced dietary inequities among low-income families. Associations between increased Supplemental Nutrition Assistance Program and unemployment benefits and decreased costs associated with the negative health outcomes linked to food insecurity and poor diets would be of value.     

Supplemental nutrition assistance program participation and sugar-sweetened beverage consumption,overall and by source

IntroductionThis paper examined patterns in adults' sugar-sweetened beverage (SSB) consumption and caloric intake by Supplemental Nutrition Assistance Program (SNAP) participation status and by source of purchases in the United States (US).MethodCross-sectional analysis of consumption of SSBs by source of purchases using 24-hour dietary recall data obtained from the US National Health and Nutrition Examination Survey 2003–2010 (N = 17,891). Bivariate analysis and multivariable regressions were used to examine the association between SNAP participation and SSB calories consumed overall and by source.ResultsSSBs account for approximately 12% of total daily caloric intake (258 kcal) among SNAP participants, higher than that of SNAP-eligible nonparticipants (9% total daily intake, 205 kcal) and SNAP-ineligible nonparticipants (6% total daily intake, 153 kcal). Among income-eligible adults, participating in SNAP is associated with 28.9 additional SSB calories, of which most were obtained from a store. From 2003–04 to 2009–10, SSB prevalence and caloric intake were flat among SNAP participants while it declined among both SNAP-eligible and SNAP-ineligible nonparticipants; this pattern held for all sources of SSBs except for those purchased from fast-food restaurants, which were not statistically reduced among nonparticipants.ConclusionSNAP participants consumed more SSB calories compared to SNAP-eligible nonparticipants; and their SSB prevalence and caloric intake trend was flat over the 2003–04 to 2009–10 period. SNAP-Education interventions that focus on improving access to healthy food in poor neighborhoods may benefit SNAP participants.     

Fruit and Vegetable Purchasing Patterns and Supplemental Nutrition Assistance Program Participation: Findings From a Nationally Representative Survey

BackgroundPrevious studies suggest that Supplemental Nutrition Assistance Program (SNAP) participants purchase less produce than nonparticipants. Whether this is due to buying smaller amounts or to being less likely to buy any produce is unclear. Purchase patterns may also differ over the monthly distribution cycle.ObjectiveTo examine differences in the likelihood and amounts of fruits and vegetables purchased between SNAP household compared with nonparticipant households and to determine differences in produce purchases among SNAP households at different time points in the monthly distribution cycle.DesignCross-sectional.Participants/settingData from 4708 households in the National Household Food Acquisition and Purchase Survey (April 2012 to January 2013). Participants recorded all foods acquired over 7 days.Main outcome measuresFruits and vegetables acquired over a 7-day period.Statistical analyses performedWeighted logistic and linear regression models adjusting for household and primary respondent characteristics were used to compare odds of purchasing fruits and vegetables and amounts purchased across 3 categories: SNAP participants, SNAP-eligible nonparticipants, and ineligible nonparticipants. SNAP participants were further subdivided according to weeks since last receiving benefits.ResultsIn adjusted analyses, SNAP participants and nonparticipants were similarly likely to purchase fruits and vegetables. However, SNAP households within a week of receiving benefits were more likely than SNAP households later in the benefit cycle to buy fruit overall, especially frozen or canned fruit, and vegetables overall, including fresh, frozen or canned, starchy, and nonstarchy vegetables (fruit odds ratio [OR] 1.68, 95% confidence interval [CI] 1.12, 2.53; vegetable OR 1.63, 95% CI 1.04, 2.55 vs households in middle of cycle). In contrast, those in the last week of the benefit cycle were less likely to purchase fruit, especially fresh fruit, and vegetables, especially fresh and nonstarchy vegetables (fruit OR 0.58, 95% CI 0.35, 0.94; vegetable OR 0.58, 95% CI 0.42, 0.79 vs. households in middle of cycle), and when they bought vegetables, they bought significantly less.ConclusionConsidering all SNAP households together at different points in their distribution cycle masks substantial declines in purchasing fruits and vegetables over the monthly cycle.     

Unemployment,SNAP Enrollment,and Food Insecurity Before and After California's COVID-19 Shutdown

ObjectivesTo examine whether the decrease in very low food security (VLFS) observed in California shortly after California's coronavirus disease (COVID-19) shutdown remained throughout Federal Fiscal Year (FFY) 2020. To investigate associations among unemployment, Supplemental Nutrition Assistance Program (SNAP) enrollment, and VLFS across FFY 2020.MethodsTelephone interview responses from mothers from randomly sampled households from low-income areas throughout California to the 6-item US Department of Agriculture Food Security Survey Module identified VLFS families. Logistic regression examined VLFS rates before vs after California's COVID-19 shutdown, with race/ethnicity, age, and education as covariates. Pearson correlations were calculated for unemployment, SNAP enrollment, and VLFS.ResultsMost (66.4%) of the 2,682 mothers were Latina. VLFS declined from 19.3% before to 14.5% after California's COVID-19 shutdown (adjusted odds ratio, 0.705; P = 0.002). The correlation for unemployment and SNAP household participation was 0.854 (P = 0.007), and for SNAP participation and VLFS was −0.869 (P = 0.005).Conclusions and ImplicationsPublicly-funded assistance programs may lower food insecurity, even during a time of increased economic hardship. Examining the specific factors responsible for the observed decline in VLFS has merit. Whether VLFS remains below the rate observed before California's COVID-19 shutdown is worthy of ongoing study.     

The Supplemental Nutrition Assistance Program,Food Insecurity,Dietary Quality,and Obesity Among US Adults

Objectives. We examined whether Supplemental Nutrition Assistance Program (SNAP) participation changes associations between food insecurity, dietary quality, and weight among US adults.Methods. We analyzed adult dietary intake data (n = 8333) from the 2003 to 2010 National Health and Nutrition Examination Survey. Bivariate and multivariable methods assessed associations of SNAP participation and 4 levels of food security with diet and weight. Measures of dietary quality were the Healthy Eating Index 2010, total caloric intake, empty calories, and solid fat; weight measures were body mass index (BMI), overweight, and obesity.Results. SNAP participants with marginal food security had lower BMI (1.83 kg/m²; P < .01) and lower probability of obesity (9 percentage points; P < .05). SNAP participants with marginal (3.46 points; P < .01), low (1.98 points; P < .05), and very low (3.84 points; P < .01) food security had better diets, as illustrated by the Healthy Eating Index. Associations between SNAP participation and improved diet and weight were stronger among Whites than Blacks and Hispanics.Conclusions. Our research highlights the role of SNAP in helping individuals who are at risk for food insecurity to obtain a healthier diet and better weight status.Food insecurity, broadly defined as having limited access to adequate food,1 is associated with increased stress levels and reduced overall well-being.2 In addition, food insecurity has been shown to diminish dietary quality and affect nutritional intake and has been associated with chronic morbidity (e.g., type 2 diabetes, hypertension) and weight gain.1,3–5 In 2012, approximately 14.5% of US households (17.6 million households) experienced food insecurity, of whom 5.7% (7.0 million households) experienced very low food security (i.e., reduction in food intake).6 The Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps, is the largest government assistance program in the United States and seeks to alleviate food insecurity in US households.7 SNAP has the potential to mitigate the adverse effects of food insecurity on health outcomes not only through attenuating food insecurity but also by enhancing the dietary quality of its participants.8,9Although cross-sectional studies have found no significant differences in food insecurity levels between SNAP participants and nonparticipants,10,11 in a longitudinal study, Nord observed a 28% reduction in the odds for very low food security among households that remained on SNAP throughout the year relative to those who left before the last 30 days of the year.12 In addition, studies by Leung and Villamor13 and Webb et al.14 found that independent of food insecurity, SNAP participation is associated with the increased likelihood of obesity, and other studies have observed lower dietary quality specifically among SNAP participants.15,16 Kreider et al. used partial identification bounding methods to take into account the endogenous selection and misreporting of SNAP enrollment and found that SNAP reduced the prevalence of food insecurity, poor general health, and obesity among children.17Thus, the interrelationships among SNAP participation, food insecurity, dietary quality, and weight status warrant further investigation to inform SNAP programming, policy, and outreach to ultimately improve the health and well-being of SNAP participants. We explored these relationships in data from the National Health and Nutrition Examination Survey (NHANES) over multiple years. We aimed to determine mitigating effects SNAP participation might have on the association of food insecurity with dietary quality and obesity among a nationally representative sample of US adults.     

Participation in the Supplemental Nutrition Assistance Program and Dietary Behaviors: Role of Community Food Environment

BackgroundThe United States Department of Agriculture’s Supplemental Nutrition Assistance Program (SNAP) is the country’s largest nutrition assistance program for low-income populations. Although SNAP has been shown to reduce food insecurity, research findings on the diet quality of program participants are inconsistent.ObjectiveThis study evaluated whether the community food environment is a potential moderator of the association between SNAP participation and eating behaviors.DesignThis cross-sectional study used participant data from a telephone survey of 2,211 households in four cities in New Jersey. Data were collected from two cross-sectional panels from 2009 to 2010 and 2014. Food outlet data were purchased from commercial sources and classified as supermarkets, small grocery stores, convenience stores, or limited service restaurants.Participants/settingAnalysis is limited to 983 respondents (588 SNAP participants) with household incomes below 130% of the federal poverty level.Main outcome measuresEating behaviors were assessed as frequency of consumption of fruit, vegetables, salad, and sugar-sweetened beverages.Statistical analyses performedInteraction and stratified analyses using gamma regression determined the differences in the association between SNAP participation and eating behaviors by the presence or absence of food outlets adjusted for covariates.ResultsSNAP participation was associated with a higher frequency of consuming sugar-sweetened beverages (P<0.05) when respondents lived within ¼ to ½ mile of a small grocery store, supermarket, and limited service restaurant. SNAP participants who did not live close to a convenience store reported a lower frequency of sugar-sweetened beverage consumption (P=0.01), and those living more than ½ mile away from a supermarket reported a lower frequency of fruit consumption (P=0.03).ConclusionsThe findings from this study suggest that the community food environment may play a role in moderating the association between SNAP participation and eating behaviors. Although SNAP participation is associated with some unhealthy behaviors, this association may only hold true when respondents live in certain food environments.     

Use of Survival Analysis to Predict Attrition Among Women Participating in Longitudinal Community-Based Nutrition Research

ObjectiveTo identify participant characteristics and study methodology that influenced the completion of a 15-month community-based longitudinal study evaluating the impact of the Supplemental Nutrition Assistance Program Education and Expanded Food and Nutrition Education Program.DesignObservational longitudinal 15-month study across 12 data collection timepoints. Sociodemographic characteristics were collected with a paper-based survey at baseline.SettingFive counties across central and southern Illinois.ParticipantsWomen, aged 18 to 65 years (n = 297), recruited at sites likely to serve families eligible for the Supplemental Nutrition Assistance Program Education and Expanded Food and Nutrition Education Program (housing departments, child care centers, etc).Main Outcome MeasuresPredictors of participant attrition during the study duration.AnalysisCox proportional hazard models.ResultsNinety-seven participants were retained across the full study. In unadjusted models, greater income and education levels were significantly related to lower attrition; however, this relationship did not persist in a multivariate model. When adjusted for other characteristics, larger household size was the only measured variable significantly related to greater odds of attrition (odds ratio = 1.09; 95% confidence interval = 1.02, 1.17).Conclusions and ImplicationsSeveral characteristics predicting attrition in other settings were not significant in this study. Future attrition analyses that evaluate social support, transportation capacity, and type of phone in longitudinal nutrition education studies are warranted.     

Connecting Families at Risk for Food Insecurity With Nutrition Assistance Through a Clinical-Community Direct Referral Model

ObjectiveTo assess the feasibility of a clinical-community direct referral model to enroll eligible households in the Supplemental Nutrition Assistance Program (SNAP).MethodsPediatric clinics screening for food insecurity (n = 27) invited families experiencing food insecurity to participate in a direct referral to a local organization that assists with SNAP applications. A food stamp specialist telephoned participants to determine SNAP eligibility, assist with the application, and/or provide other supports. Referrals, eligibility determination, enrollment, and estimated benefits were tracked.ResultsA total of 486 families were referred to the community partner; 72% (n = 351) were successfully contacted by a food stamp specialist, with 17% (n = 83) applying for SNAP benefits. Another 16% (n = 79) were already enrolled in SNAP but received an additional service.Conclusions and ImplicationsThis referral model was feasible and increased the number of families who received nutrition assistance. This approach could be adapted for other health-related social needs.     

Evaluation of supplemental nutrition assistance program education: application of behavioral theory and survey validation

ObjectiveApplication of the Transtheoretical Model (TTM) to Supplemental Nutrition Assistance Program Education (SNAP-Ed) evaluation and development and validation of an evaluation tool used to measure TTM constructs is described.MethodsSurveys were collected from parents of children receiving food at Summer Food Service Program sites prior to SNAP-Ed participation.ResultsItem analysis of survey data (n = 149) suggests the survey is valid and reliable. Structural Equation Modeling confirmed the use of the TTM constructs in predicting SNAP-Ed participants' fruit and vegetable consumption. Perceived barriers (P = .04) and self-efficacy (P = .006) were associated with fruit and vegetable consumption, whereas perceived benefits were not.Conclusions and ImplicationsApplication of theory and survey validation can enhance SNAP-Ed evaluation.     

An Increase in SNAP Benefits Did Not Impact Food Security or Diet Quality in Youth

BackgroundLow diet quality during childhood and adolescence is associated with adverse health outcomes later in life. Diet quality is generally poor in American youth, particularly in youth of low socioeconomic status. The Supplemental Nutrition Assistance Program (SNAP) is the primary safety net to help low-income households afford a healthy diet. Yet self-selection into the program creates challenges in estimating the relationship between SNAP and diet outcomes.ObjectiveThis study examined how the increase in SNAP benefits during the American Recovery and Reinvestment Act (ARRA) affected food security and diet quality in low-income youth.DesignThis analysis used a difference-in-differences design and data from the National Health and Nutrition Examination Survey 2007-2008 to 2011-2012 waves.Participants/settingThe sample included children and adolescents aged 2 to 18 years with household income ≤250% of the Federal Poverty Line. Food security and diet outcomes in SNAP-eligible youth (n = 2,797) were examined, with children in nearly SNAP-eligible households serving as a comparison group (n = 1,169). The diet quality analysis stratified the sample by age range.Main outcome measuresThe study assessed food security and 6 dietary outcomes: 2 nutrients (sodium and fiber), 3 food categories (fruit, vegetables, and sugar-sweetened beverages), and 1 measure of overall diet quality (Healthy Eating Index 2010).Statistical analysis performedLogistic regression and linear regression were used to estimate the relationship between SNAP eligibility and child food security and diet.ResultsIn unadjusted analysis, approximately 64% of SNAP-eligible children were food secure before ARRA and 73% were food secure while ARRA was in effect. Using logistic regression in a difference-in-differences framework, the ARRA SNAP benefit increase was not significantly associated with food security (odds ratio 1.37, P = 0.43). Diet quality of SNAP-eligible children was low, scoring a 46 out of 100 on the Healthy Eating Index 2010. Measures of diet quality did not significantly change from the pre-ARRA period to the ARRA period; this did not differ by age range.ConclusionsThe increase in SNAP benefits during ARRA did not significantly impact food security or diet quality in low-income children and adolescents. Additional research to better understand how SNAP benefits impact dietary choice is warranted.     

Effectiveness of Expanded Food and Nutrition Education Program in Changing Nutrition-Related Outcomes Among Adults With Low Income: A Systematic Review

ObjectiveTo review the effect of the Expanded Food and Nutrition Education Program (EFNEP) in changing nutrition-related outcomes.MethodsRelevant research conducted before December 2020 was identified using PubMed, Web of Science, Google Scholar, and the EFNEP Research Database. The methodological quality of each eligible study was assessed.ResultsOf the 406 studies found, 30 were eligible; 26 studies were on EFNEP, and 4 included both EFNEP and Supplemental Nutrition Assistance Program Nutrition Education (SNAP-Ed). The sample sizes ranged from 35 to 122,961. Outcome measures included consumption of food groups, nutrients, other nutrition-related behaviors, and food security. At least 1 immediate behavior change (P < 0.05) was reported in each study, but long-term maintenance of behavior change was not evident.DiscussionThis review found a consistent, immediate improvement in nutrition behaviors after program participation but poor retention over time. Overall, variation in programming and outcome measures, incomplete reporting, and generally low study quality by modern standards precluded strong conclusions.Implications for Research and PracticeThis review identified the need for control groups, improved reporting of program protocols, theory-based curriculum, and measurement of long-term outcomes.     

Food Resource Management Mediates the Relationship Between Participation in a SNAP-Ed Nutrition Education Program and Diet Quality

ObjectiveTo examine the mediating effects of food resource management skills (FRM) on the relationship between participation in a Supplemental Nutrition Assistance Program Education (SNAP-Ed) nutrition education program and diet quality.DesignSecondary analysis of data from a propensity score-matched sample of participants (n = 396) and nonparticipants (n = 111) in a SNAP-Ed nutrition education program.AnalysisIndependent-samples t tests were used to compare entry, exit, and gain scores in FRM and diet quality between participants and nonparticipants. Structural equation modeling was used to examine direct and mediated relationships among participation, FRM, and diet quality.Main Outcome MeasuresFood resource management was measured as a summated rating scale, and diet quality measured as Healthy Eating Index and program participation.ResultsMediated effect of FRM on the relationship between participation in a SNAP-Ed program and diet quality was statistically significant (P < 0.01). The effect size for the mediation effect indicated that about 70% of program participation on diet quality was transferred by FRM skills. The hypothesized model had acceptable fit indices as model χ² was nonsignificant (P = 0.31), all fit indices were above 0.9, and the root mean square of error approximation was low at 0.02.Conclusions and ImplicationsParticipation in a SNAP-Ed program enhanced participants’ FRM, which in turn enhanced their diet quality.     

Differences in Food-at-Home Spending for SNAP and Non-SNAP Households Given Geographic Price Variation

BackgroundAs the largest nutrition safety net program in the United States, the Supplemental Nutrition Assistance Program (SNAP) enhances food security by providing low-income households with benefits for food-at-home (FAH) spending. A large literature finds a positive effect of SNAP on FAH spending, but it is unclear whether this relationship varies with area-level prices. SNAP benefits do not explicitly account for price variation across the contiguous United States.ObjectiveOur objectives were to examine the SNAP/non-SNAP difference in FAH spending for households with varying levels of cash income and propensity for SNAP participation and to determine whether this difference varied with area-level prices.Design/participantsCross-sectional data on 2,524 SNAP and non-SNAP households with cash income at or below 185% of the Federal Poverty Level were obtained from the National Household Food Acquisition and Purchase Survey.Main outcome measuresThe outcome was FAH spending relative to the maximum SNAP benefit corresponding to household size.Statistical analyses performedHouseholds were grouped into quintiles based on estimated propensity of SNAP participation. Regression models included interactions between a SNAP participation indicator, a continuous price index for all goods and services, and propensity score quintile indicators.ResultsAccording to some models, the SNAP/non-SNAP spending difference was positive, on average. Among households that tended to have lower cash income and higher propensity of SNAP participation, FAH spending relative to the maximum benefit was 29 to 30 percentage points higher for SNAP households compared to low-income non-SNAP households (P≤0.05). The spending difference was similar across areas with different price levels.ConclusionsSNAP households spent more on FAH compared to low-income non-SNAP households. This association did not vary with area-level prices. Beyond food spending outcomes, future research could extend this work to understand SNAP’s role in promoting food security and other outcomes, given geographic price variation.     

Caloric Beverage Intake Among Adult Supplemental Nutrition Assistance Program Participants

Objectives. We compared sugar-sweetened beverage (SSB), alcohol, and other caloric beverage (juice and milk) consumption of Supplemental Nutrition Assistance Program (SNAP) participants with that of low-income nonparticipants.Methods. We used 1 day of dietary intake data from the 2005–2008 National Health and Nutrition Examination Survey for 4594 adults aged 20 years and older with household income at or below 250% of the federal poverty line. We used bivariate and multivariate methods to compare the probability of consuming and the amount of calories consumed for each beverage type across 3 groups: current SNAP participants, former participants, and nonparticipants. We used instrumental variable methods to control for unobservable differences in participant groups.Results. After controlling for observable characteristics, SNAP participants were no more likely to consume SSBs than were nonparticipants. Instrumental variable estimates showed that current participants consumed fewer calories from SSBs than did similar nonparticipants. We found no differences in alcoholic beverage consumption, which cannot be purchased with SNAP benefits.Conclusions. SNAP participants are not unique in their consumption of SSBs or alcoholic beverages. Purchase restrictions may have little effect on SSB consumption.People in the Unites States consume about 20% of their calories from beverages, a share that has increased greatly over recent decades.1 Calories from beverages may be less satiating than calories from food and may therefore contribute to weight gain.2–5 Calories from sugar-sweetened beverages (SSBs) may be particularly problematic because they provide little if any essential nutrients. Policies suggested or enacted to reduce SSB consumption include taxing SSB purchases6–9 and restricting the size of SSBs sold by food service establishments. Most recently, the discussion has moved to whether participants in the Supplemental Nutrition Assistance Program (SNAP) should be prohibited from using benefits to purchase SSBs. SNAP provides nutrition assistance to low-income individuals and families through electronic benefit transfer cards that can be used to purchase food at authorized food retailers. SNAP benefits can be used to purchase almost all foods, with the exceptions of hot foods or food that will be eaten in the stores, alcoholic beverages and tobacco products.New York City requested a waiver from the Food and Nutrition Service of the US Department of Agriculture to restrict the use of SNAP benefits for purchases of some SSBs10 but was denied. Several high-profile commentators argued that the SNAP program may be subsidizing obesity and should be modified to encourage greater consumption of healthy foods and reduced consumption of empty calories such as SSBs.11,12 Others have argued that such restrictions could increase administrative costs but would have little impact on consumption patterns because most participants’ SNAP benefit only covers a portion of the household’s total food spending, and they could just use their cash food budgets to purchase SSBs.13 It has also been argued14 that imposing restrictions on only 1 part of the population is unfair when consumption of SSBs and obesity are fairly widespread among all Americans. Restrictions on SNAP purchases could have unintended consequences, such as reducing participation or substitution with other energy-dense foods.Despite the prominent appeals to restrict SNAP participants’ purchases, little evidence has shown that SNAP participants’ SSB consumption is different from that of the average consumer or other low-income consumers. Using longitudinal data for a cohort of US youths, no differences were found between SNAP participants and otherwise similar nonparticipants in the frequency of consumption (not total calories) of soft drinks, 100% fruit juice, and milk.15 Purchases of different beverages at 1 chain grocery store in New England for a sample of families that participated in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program over a 2-year period showed that among the participants, those who also received SNAP benefits purchased a higher percentage of SSBs than did non-SNAP participants.16 This study did not consider all SNAP households (or any other low-income households that did not participate in either SNAP or the Special Supplemental Nutrition Program for Women, Infants, and Children); examined beverage purchases at only 1 grocery store chain in New England; did not consider beverage purchases at bars, restaurants, or other food retailers; and did not consider beverage intake among household members. Both of these studies examined only a segment of all SNAP participants.Alcoholic beverages contribute a sizable share of total beverage calories for those who consume them. Alcoholic beverages cannot be purchased with SNAP benefits. If SSB purchases are restricted in SNAP, participants could use other resources to purchase SSBs, just as they may to purchase alcoholic beverages. Although there are important distinctions between SSBs and alcohol (e.g., tax rates, controlled points of purchase, limits on who can purchase, and some health benefits of moderate consumption), examining how alcohol consumption differs between participants and nonparticipants may provide insight into how a restriction on SSBs could affect purchases among SNAP participants.We used national-level data on individual beverage intake to investigate intake of SSBs, alcohol, and other caloric beverages (milk and juice) for SNAP participants and otherwise similar nonparticipants. After comparing average intake of these beverage types, we used regression to explore whether differences across participant groups are explained by differences in observable characteristics. We separately estimated the probability of consuming each beverage type and the total number of calories consumed among consumers of each beverage. We augmented our main estimates with instrumental variable estimates that account for self-selection of SNAP participants.