O2 Reach of PSE Sites in Relation to Dietary Behaviors and Diet Quality Among Caregivers from SNAP-Ed Eligible Households

Abstract

Background Previous research has found associations between levels of SNAP-Ed direct education reach and healthful and unhealthful dietary behaviors. In the intervening 4 years, California SNAP-Ed local implementing agencies have decreased direct education interventions by 32% and increased policy, systems, and environmental (PSE) change approaches by 130%. In 2018, there were 1,276 PSE sites in California. Objective At the census-tract level, examine associations between number of PSE sites and dietary behaviors among caregivers from SNAP-Ed eligible households. Study Design, Setting, Participants Cross-sectional survey of adults screened as the caregiver of children 5 to 17 years from randomly sampled SNAP-Ed eligible households in 30 California counties. The 2018 sample was 1,752 female and 470 male. The majority (69.1%) of survey participants were Latino. Measurable Outcome/Analysis Outcomes were selected based on California SNAP-Ed program objectives: diet quality, operationalized by Healthy Eating Index (HEI)-2015 scores; cups of fruits and vegetables; teaspoons of added sugar; cups of water; and cups of sugar-sweetened beverages (SSBs), all derived from administration of the ASA24. The independent variable was number of PSE sites (0, 1, 2+) per census tract where survey respondents lived. Regression analyses controlled for race/ethnicity, age, and SNAP-Ed direct education per census tract. Results PSE sites in one's neighborhood was significantly associated with HEI-2015 scores (B = .802; P = .048), teaspoons of added sugar (B = −.850; P = .019) and cups of SSBs (B = −.116; P = .03). Conclusions Among caregivers living in SNAP-Ed eligible households, PSE reach was associated with improved diet quality and decreased intake of added sugar and SSBs, regardless of demographics and direct education activities. Our findings lend support for the increased reliance on PSEs over direct education to address the dietary behaviors among the SNAP population. Limitations to our ecological study include the temporal sequence between PSEs and the selected outcome variables. Funding California Department of Social Services.