Factors Associated With SNAP Online Fruit and Vegetable Purchasing Among Produce Incentive Program Participants.

The Supplemental Nutrition Assistance Program (SNAP) is a federally funded and state adminis­tered program to combat food insecurity. Analyz­ing factors in SNAP participation is important to understanding consumption in food systems and supporting community development. As of 2019, 565,900 Oklahomans participate in the SNAP pro­gram, approximately 84% of those eligible for the program. This leads to two questions: why do those who are eligible participate, and how can we better reach those who do not? We analyzed county-level SNAP participation among the income-eligible to identify explanatory characteris­tics of SNAP usage. Data from sources such as the U.S. Department of Agriculture Economic Research Service (USDA ERS) and the U.S. Census Bureau were used to perform a regression analysis on 12 variables, such as store access and number of dependents. The percentage of house­holds with children under 18 and the unemploy­ment rate are associated with increases in SNAP participation among those eligible. Store access and rurality are associated with a decline in SNAP usage. These findings will aid policymakers, SNAP administrators, and outreach education groups in improving program participation by targeting groups susceptible to food insecurity and with low SNAP usage who could benefit from participation.

Healthy food incentive program implementation targeting people receiving Supplemental Nutrition Assistance Program (SNAP) benefits is supported by the federal Food Insecurity Nutrition Incentive (FINI) grant program. This study examined factors contributing to increased SNAP use at farmers' markets with an FINI-funded incentive program. Implementation evaluation. Sixteen states and District of Columbia. Two hundred eighty-two FINI-funded farmers' markets open in 2016. Weekly SNAP sales and transactions per 1000 SNAP households in the Zip Code Tabulation Areas around markets. Two-level hierarchical regression modeling. Most farmers' markets (53%) had less than 100 SNAP transactions in 2016. Weekly SNAP sales and transactions per 1000 SNAP households were 69.9% and 47.7% higher, respectively, if more than 1 incentive was available versus 1. Not having paid market staff resulted in declines in these sales (-34.3%) and transactions (-38.1%) compared to markets with paid staff. There was a 6.2% and 5.1% increase in SNAP sales and transactions for each additional produce vendor. Weekly SNAP sales and transactions were about 2 to 3 times higher in rural areas compared to metropolitan. Clustering of markets within states explained 10% of the variation in weekly SNAP sales and transactions. Four implementation factors were identified that may facilitate the reach of SNAP-based monetary incentive programs at farmers' markets to maximize reach and impact among SNAP shoppers.

BackgroundThe Supplemental Nutrition Assistance Program (SNAP) has financial incentive programs where recipients can purchase fruits and vegetables (F&V) at select sites for half price or less, leading to increased F&V consumption and projected savings in healthcare costs. Yet, limited awareness and uptake of these programs present barriers to widespread utilization, thus limiting potential impact.ObjectiveThe Veggie Vouchers intervention was designed to increase awareness and uptake of a SNAP F&V incentive program in South Carolina among families with children 2–17 years of age. The primary aim of this study was to determine intervention feasibility and acceptability among caregivers and pediatricians. Patterns of preliminary efficacy were secondarily examined for changes in diet-related outcomes.MethodsThis single-arm feasibility study leveraged social determinants of health screenings in a pediatric clinic to identify families who were eligible for a SNAP F&V incentive program. Eligible caregivers received brief education about this program from their pediatrician and an initial free trial to incentivize uptake. Free trial redemption rates were tracked, along with subsequent SNAP F&V incentive program use after the free trial ended. Surveys assessed intervention acceptability and changes in household food security, nutrition security, and children’s dietary intake.ResultsCaregivers (n = 91; 100% female; 77% Black) and pediatricians (n = 37) were enrolled within 10 months. Most caregivers (70.3%) used their free trial (redeemers), with 58% of “non-redeemers” reporting transportation challenges as reasons for non-redemption. Over 91% of “redeemers” were satisfied with the amount, variety, and quality of F&V; 90.5% reported the free trial made it easier for them and their child to eat more F&V; and 18.8% utilized the SNAP F&V incentive program after the free trial ended. Most assessment time points achieved ≥ 70% survey completion rates. Pediatricians (88.9%) felt the intervention was easy to implement, and 100% reported minimal-to-no disruptions in clinic flow. Initial patterns indicated potential improvements in household food security and nutrition security throughout the intervention for “redeemers,” compared to “non-redeemers”.ConclusionsFindings support the feasibility and acceptability of the Veggie Vouchers intervention, yet additional strategies should be explored in a larger randomized controlled trial to enhance sustained SNAP F&V program use.Trial registrationClinicalTrials.gov, NCT06593028. Retrospectively registered on September 11, 2024, https://clinicaltrials.gov/study/NCT06593028.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40814-025-01732-3.

Digital Promotions Campaign Increases SNAP Participation at New England Farmers’ Markets: A Randomized Controlled Trial

Introduction: The Supplemental Nutrition Assistance Program (SNAP) is the largest food assistance program for low-income Americans. Investigating mortality in this population is crucial to determining what further efforts are needed to reduce health disparities. The National Center for Health Statistics (NCHS) does not provide mortality data by SNAP participation status, so diet-related mortality according to SNAP eligibility and participation is not well established. Objective: To examine cardiometabolic mortality among SNAP participants, SNAP eligible non-participants, and the SNAP ineligible population. Methods: We used data from the National Health Interview Survey for 499,741 US adults age≥25y from 2000-2009 to assess SNAP eligibility and participation. These data were merged with the NCHS Linked Mortality file (2000-2009) to create a nationally representative cohort. Participants were followed until death or through Dec 31, 2011. Survey-weighted Cox-proportional hazards models were used to estimate hazard ratios of cause-specific mortality by SNAP eligibility and participation. Results: Over a mean of 6.8 y of follow-up (maximum 11.9 y), we observed 7408 CHD deaths, 2185 stroke deaths and 1376 diabetes deaths. For all outcomes, in particular diabetes, SNAP participants had highest risk, followed by SNAP eligible non-participants, and then SNAP-ineligible individuals (Figure, panel A). Considerable differences in cause-specific risk of mortality were observed between race/ethnicities among SNAP participants, SNAP eligible non-participants, and the SNAP ineligible population (Figure, panel B). Conclusion: Major health disparities exist between SNAP participants, SNAP eligible non-participants, and SNAP ineligible Americans, as well as by race/ethnicity. Ways to improve health outcomes of SNAP participants, including potential revisions to SNAP programming, are urgently needed to reduce these inequities.

The Need to Incorporate Diversity, Equity, and Inclusion: Reflections from a National Initiative Measuring Fruit and Vegetable Intake

A Consideration of the Evaluation of Demonstration Projects to End Childhood Hunger (EDECH)

Mobile produce markets (MPM) offering Supplemental Nutrition Assistance Program (SNAP) incentive programmes have the potential to provide accessible and affordable fruits and vegetables (FV) to populations at risk of food insecurity. The objective of this study is to characterise the customer base of an MPM and describe their participation at twelve market sites serving low-income seniors. In 2018, customers from an MPM in Rhode Island (RI) participated in a cross-sectional survey (n 330; 68 % response rate), which measured dietary patterns, food security and food shopping behaviours. We compared the shopping habits and market experiences of customers who currently received SNAP benefits with those who did not currently receive SNAP benefits. An MPM in RI which offers a 50 % discount for FV purchased with SNAP benefits. This study describes current market customers at twelve market sites serving low-income seniors. Market customers were mostly low-income, female, over the age of 50 years and Hispanic/Latino. Most customers received SNAP benefits, and almost half were food insecure. In addition, three quarters of SNAP customers reported their SNAP benefits last longer since shopping at the markets. Mixed logistic regression models indicated that SNAP customers were more likely to report buying and eating more FV than non-SNAP customers. MPM are critical resources of affordable produce and have been successful in improving access to FV among individuals of low socio-economic status in RI. This case study can inform policy and programme recommendations for MPM and SNAP incentive programmes.

Recent research has shown that the Supplemental Nutrition Assistance Program (SNAP) effectively reduces food insecurity. Questions remain, however, about the extent to which SNAP affects the quality of adult participants’ diets. These questions have surfaced in the context of the increasing public costs of diet-related illnesses, such as diabetes, high blood cholesterol, and heart disease, and have led to discussions about restricting the use of SNAP benefits to purchase some food items. This report examines Healthy Eating Index (HEI) scores for adults in low-income households that do and do not participate in SNAP. To disentangle the choice of whether to participate in SNAP from diet choices, this model uses a unique data set that matches State-level SNAP policy variables to individual-level data from four waves of the National Health and Nutrition Examination Survey (NHANES). Two important kinds of results emerge: the effect of SNAP on the diet quality of those who choose to enroll, and a total comparison of SNAP participants and nonparticipants after SNAP’s effects are taken into account. On the first, this report shows that SNAP participation results in a large increase in the likelihood of consuming whole fruit and a slightly lower consumption of dark green/orange vegetables. On the second, the report finds that SNAP participants have slightly lower HEI scores (both total and components) than nonparticipants, meaning that they have slightly lower diet quality. They do, however, consume less saturated fat and sodium than nonparticipants.

This study investigates whether the Supplemental Nutrition Assistance Program (SNAP) work requirement affects SNAP participation of able-bodied adults without dependents (ABAWDs). Since 1996, ABAWDs have been required to work or participate in work programs at least 20 h per week for SNAP eligibility. Using the sample of SNAP household heads and their youngest child from administrative data for Missouri from 2004 to 2010, we compare the hazard of SNAP exit, exploiting the fact that the work requirement exemption depends on the age of the youngest child and the county of residence. Results indicate a modest reduction in SNAP participation due to the SNAP work requirement. The cumulative survival estimation indicates that the youngest child and household heads are less likely to continue to participate in SNAP for the next 24 months by 4.6 and 7.4 % points when they are expected to be subject to the work requirement.

The Food Stamp Cycle Negatively Impacts Supplemental Nutrition Assistance Program (SNAP) Participants’ Ability to Make Use of Fruit and Vegetable Incentives

SNAP office accessibility and its association with rurality

Background Food insecurity (FI) is an adverse social determinant of health (SDoH) prevalent among pediatric cancer patients and associated with poorer health outcomes in general pediatrics. Receipt of federal SNAP benefits reduces FI in general pediatrics, and is thus a marker of appropriate resource support to mitigate adverse SDoH. Dana-Farber Cancer Institute (DFCI) Acute Lymphoblastic Leukemia (ALL) Consortium Trial 16-001 is the first pediatric oncology clinical trial to prospectively collect parent-reported SDoH, including income, SNAP receipt, and FI. We investigated whether income-eligible pediatric ALL families were successfully receiving SNAP benefits, and whether SNAP receipt was associated with FI. Methods Secondary analysis of children aged 1-17 years with de novo ALL enrolled on the DFCI 16-001-embedded SDoH cohort study at 6 US centers from 2017-2022. We utilized parent-reported SDoH data at diagnosis (T0) and 6-mos (T1) into therapy to identify families as (1) SNAP-eligible, proxied as household income <130% Federal Poverty Level based on federal guidelines; and (2) food insecure, based on validated 2-item screen. McNemar’s test compared SNAP receipt at T0 vs T1 among those eligible at both timepoints. Associations between SNAP eligibility, SNAP receipt, and FI were evaluated with chi-square tests. Results At T0, among 262 evaluable families, 21% reported FI. A total of 20% (n=53) were SNAP-eligible, of whom 60% (n=32) reported FI and 53% (n=28) were receiving SNAP. Among 28 SNAP-recipient families, 61% reported FI. Similarly, at T1, among 223 evaluable families, 25% reported FI. A total of 28% (n=62) were SNAP-eligible, of whom 58% (n=36) reported FI and 58% (n=36) were receiving SNAP. Among 36 SNAP-recipient families, 56% reported FI. A significantly higher proportion of the 33 families SNAP-eligible at both T0 and T1 were receiving SNAP at T1 (70%) compared to T0 (52%) (p=0.034). Among eligible families, SNAP receipt was not associated with lower odds of FI at T0 (OR 1.03, p=0.96) or T1 (OR 0.83, p=0.73). Discussion FI, a well-defined adverse SDoH associated with inferior health outcomes, is highly prevalent among a trial-enrolled pediatric ALL population. Despite care delivery at highly resourced centers with dedicated staff to address social needs, a substantial proportion of likely eligible families (as proxied by income) were not receiving SNAP benefits 6-mos into therapy. Further, receipt of SNAP was inadequate to ameliorate FI in this cohort, with ~60% of SNAP recipients reporting concurrent FI both at T0 and T1. Ensuring successful connection of eligible families to existing benefits is an essential first step. However, high rates of FI among SNAP recipients indicate that resource navigation, though necessary, is not sufficient to address FI for this population. These data provide immediate targets for health equity interventions—including systematic benefits navigation, direct resource provision, and policy-based approaches for benefits augmentation—to address adverse SDoH and improve cancer outcomes. Citation Format: Rahela Aziz-Bose, Yael Flamand, Puja J. Umaretiya, Lenka Ilcisin, Ariana Valenzuela, Peter D. Cole, Lisa M. Gennarini, Justine M. Kahn, Kara M. Kelly, Bruno Michon, Thai-Hoa Tran, Jennifer J. G. Welch, Lewis B. Silverman, Kira Bona. Food insecurity and receipt of Supplemental Nutrition Assistance Program (SNAP) benefits among income-eligible US pediatric acute lymphoblastic leukemia patients enrolled on a multi-center clinical trial [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B096.

SNAP-Ed Improves Long-Term Household Food Security Despite Participation in SNAP or WIC at Recruitment

The low intake of fruits/vegetables (FV) by Supplemental Nutrition Assistance Program (SNAP) participants is a persistent public health challenge. Fruit and vegetable incentive programs use inducements to encourage FV purchases. The purpose of this scoping review is to identify structural factors in FV incentive programs that may impact program effectiveness, including (i.) differences in recruitment/eligibility, (ii.) incentive delivery and timing, (iii.) incentive value, (iv.) eligible foods, and (v.) retail venue. Additionally, the FV incentive program impact on FV purchase and/or consumption is summarized. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews, a search of four bibliographic databases resulted in the identification of 45 publications for consideration; 19 of which met the pre-determined inclusion criteria for full-length publications employing a quasi-experimental design and focused on verified, current SNAP participants. The data capturing study objective, study design, sample size, incentive program structure characteristics (participant eligibility and recruitment, delivery and timing of incentive, foods eligible for incentive redemption, type of retail venue), and study outcomes related to FV purchases/consumption were entered in a standardized chart. Eleven of the 19 studies had enrollment processes to receive the incentive, and most studies (17/19) provided the incentive in the form of a token, coupon, or voucher. The value of the incentives varied, but was usually offered as a match. Incentives were typically redeemable only for FV, although three studies required an FV purchase to trigger the delivery of an incentive for any SNAP-eligible food. Finally, most studies (16/19) were conducted at farmers’ markets. Eighteen of the 19 studies reported a positive impact on participant purchase and/or consumption of FV. Overall, this scoping review provides insights intended to inform the design, implementation, and evaluation of future FV incentive programs targeting SNAP participants; and demonstrates the potential effectiveness of FV incentive programs for increasing FV purchase and consumption among vulnerable populations.