Food Spending Research Articles

974. The Effects of Changes in State-Level Policies Affecting Eligibility for the Supplemental Nutrition Assistance Program (SNAP) on Annual HIV Diagnoses in the United States

BackgroundThe connection between food insecurity and HIV outcomes is well-established. The Supplementary Nutrition Assistance Program (SNAP), the primary program in the United States that addresses food insecurity, may have collateral impacts on HIV incidence, but the extent to which it does is unknown. “Broad-based categorical eligibility” for SNAP is a federal policy that provides a mechanism for states to increase the income or asset limits for SNAP eligibility. The Department of Agriculture under the Trump Administration has proposed eliminating this policy.MethodsWe estimated the association between the number of new HIV diagnoses from 2010 to 2014 for each state and (1) state income limits for SNAP eligibility as a percentage of the federal poverty level and (2) state asset limits for SNAP eligibility (increased/eliminated vs. unchanged). We fitted multivariable negative binomial regression models with annual incidence of HIV diagnoses specified as the outcome; SNAP policies as the primary explanatory variable of interest; state and year fixed effects; and time-varying covariates related to the costs of food, health care, housing, employment, SNAP outreach, and total spending on Temporary Assistance for Needy Families (TANF) programs.ResultsFrom 2010 to 2014, 204,034 new HIV diagnoses occurred in the United States. HIV diagnoses within states had a statistically significant inverse association with state income limits for SNAP eligibility (IRR 0.94 per increase in the income limit by 35% of federal poverty level, 95% CI 0.91-0.98), but no statistically significant association with state asset limits (increased asset limit vs. no change, IRR 1.02, 95% CI 0.94-1.10; eliminated asset limit vs. no change, IRR 1.04, 95% CI 0.99-1.10) (Table).Table ConclusionState income limits for SNAP eligibility were inversely associated with the number of new HIV diagnoses for states between 2010-2014. Proposals to eliminate the use of broad-based categorical eligibility to increase the income limit for SNAP may undercut efforts to end the HIV epidemic in the United States.Disclosures All Authors: No reported disclosures

Has Household Purchasing of Confectionery Products in Turkey Changed in the Last Decade?

Although consumption of confectionery and chocolate products per capita in Turkey is considerably lower than that of the developed counties, there has recently been a rising trend in sugar consumption. The purpose of this study was to identify how and to what extent the significant changes in socio-demographic and economic structures of households in Turkey during the period of 2002-2013 influence monthly real spending on sugar, jam-marmalade, and confectionery products. The data was obtained by the annual household budget surveys of the Turkish Statistical Institute (TURKSTAT) between 2002 and 2013. These surveys are annually conducted by TURKSTAT with nearly varying ten thousand randomly selected households throughout the nation for the period between January 1 and December 31. A multivariate Tobit model was used to determine factors affecting Turkish monthly household expenditure on three foods. Cross correlation coefficients among food pairs and marginal impacts of exogenous variables were also estimated. Almost 79% of households spend on confectionery foods, followed by 73% on sugar products and low 20% on jam-marmalade foods. According to results compared to the 2002 reference year, spending on sugar and jam-like food has declined over the years, while more spending on confectionery was emerging. Over the course of twelve years period, the sample households monthly spend 13.84, 3.73 and ₺ 12.91 on sugar, jam-marmalade and confectionery foods, respectively. The correlation coefficients among the food items were all positive and statistically significant, indicating that after controlling the role of independent variables in our model, uncontrolled variables along with measurement errors and any other functional forms induce both the spending on the two food pairs. Impacts of many socio-demographic and economic factors on monthly household spending of confectionery products including sugar were identified, and also years’ impacts on spending patterns were confirmed. By years, the age variable had different effects on the food spending of the three categories. Nonetheless, it has been identified that the families whose household heads have a green card spend different amounts both for sugar and confectionery products annually. It has also been identified that while only confectionery food product spending of the families who receive in-kind and financial aids differs annually, all three categories of food spending differ significantly as the numbers of working individuals changes yearly. Results permitted us to draw relevant policy implications and to shape policy formation for future effective food programs or policies.

Can Stimulus Checks Boost an Economy Under Covid-19? Evidence from South Korea

ABSTRACT Various countries have implemented transfer programs to individuals since the Covid-19 outbreaks. However, the extent to which such transfers alleviate economic recessions is unclear. This paper analyzes a South Korean program, which provided vouchers redeemable only at small local businesses. We find that, due to the program, over 30% of households across all income groups increased their food and overall household spending, but the usage restriction may have affected consumer choice as well as competition among businesses. While the employment and sales of small businesses improved, the program’s fiscal sustainability is in question because of the large tax exemption.

A Randomized Controlled Trial Measuring Effects of Extra Supplemental Nutrition Assistance Program (SNAP) Benefits on Child Food Security in Low-Income Families in Rural Kentucky

BackgroundTo reduce childhood hunger, the US Department of Agriculture funded several innovative demonstration projects, including the Kentucky Ticket to Healthy Food project. ObjectiveThe study tested the hypothesis that Ticket to Healthy Food would reduce child food insecurity (FI-C) among rural, low-income households. DesignThe study used a randomized controlled trial in which households were randomly assigned to treatment and control groups. Outcomes were measured using household surveys and administrative data. Survey data were collected at baseline (n=2,202) and follow-up (n=1,639) 8 to 11 months into the project. Participants/settingHouseholds in 17 counties in southeastern Kentucky that had at least 1 child younger than 18 years and received a Supplemental Nutrition Assistance Program (SNAP) benefit amount less than the maximum at baseline. InterventionBetween January 2017 and March 2018, treatment households on SNAP received additional monthly benefits ranging from $1 to $122 based on distance to grocery store and earned income. Main outcome measuresKey outcomes included FI-C (primary), food insecurity among adults and households, and food expenditures (secondary). Statistical analyses performedLogistic and linear regression models were used to estimate differences between the treatment and control groups, controlling for baseline characteristics. Socioeconomic subgroups were also analyzed. ResultsThe Kentucky Ticket to Healthy Food project did not reduce the primary outcome, FI-C (treatment=37.1%, control=35.2%; P=0.812), or secondary outcomes of very low food security among children (treatment=3.7%, control=4.4%; P=0.204) or food insecurity among adults (treatment=53.9%, control=53.0%; P=0.654). The project increased households’ monthly food spending by $20 (P=0.030) and led more households to report that monthly benefits lasted at least 3 weeks (treatment=65%, control=56%; P=0.009). ConclusionA demonstration project to reduce FI-C by raising SNAP benefits for Kentucky households with children did not reduce FI-C or other food insecurity measures. Future research should explore the effect of different increases in SNAP benefits and collect repeated measures of FI-C to assess whether intervention effects change over time. Funding/SupportThis article is published as part of a supplement supported by the US Department of Agriculture, Food and Nutrition Service.

The Development, Implementation, and Evaluation of Innovative Strategies to Reduce Food Insecurity among Children in the United States

The Development, Implementation, and Evaluation of Innovative Strategies to Reduce Food Insecurity among Children in the United States

Characterising percentage energy from ultra-processed foods by participant demographics, diet quality and diet cost: findings from the Seattle Obesity Study (SOS) III.

Higher consumption of 'ultra-processed' (UP) foods has been linked to adverse health outcomes. The present paper aims to characterise percentage energy from UP foods by participant socio-economic status (SES), diet quality, self-reported food expenditure and energy-adjusted diet cost. Participants in the population-based Seattle Obesity Study III (n 755) conducted in WA in 2016-2017 completed socio-demographic and food expenditure surveys and the FFQ. Education and residential property values were measures of SES. Retail prices of FFQ component foods (n 378) were used to estimate individual-level diet cost. Healthy Eating Index (HEI-2015) and Nutrient Rich Food Index 9.3 (NRF9.3) were measures of diet quality. UP foods were identified following NOVA classification. Multivariable linear regressions were used to test associations between UP foods energy, socio-demographics, two estimates of food spending and diet quality measures. Higher percentage energy from UP foods was associated with higher energy density, lower HEI-2015 and NRF9.3 scores. The bottom decile of diet cost ($216·4/month) was associated with 67·5 % energy from UP foods; the top decile ($369·9/month) was associated with only 48·7 % energy from UP foods. Percentage energy from UP foods was inversely linked to lower food expenditures and diet cost. In multivariate analysis, percentage energy from UP foods was predicted by lower food expenditures, diet cost and education, adjusting for covariates. Percentage energy from UP foods was linked to lower food spending and lower SES. Efforts to reduce UP foods consumption, an increasingly common policy measure, need to take affordability, food expenditures and diet costs into account.

The impact of three weeks of pre-quit varenicline on reinforcing value and craving for cigarettes in a laboratory choice procedure.

Varenicline, a partial nicotinic agonist, is theorized to attenuate pre-quit smoking reinforcement and post-quit withdrawal and craving. However, the mechanisms of action have not been fully characterized, as most studies employ only retrospective self-report measures, hypothetical indices of reinforcing value, and/or nontreatment-seeking samples. The current research examined the impact of pre-quit varenicline (vs. placebo) on laboratory measures of smoking and food (vs. water) reinforcement and craving. Participants were 162 treatment-seeking smokers enrolled in a randomized controlled trial of smoking cessation ( clinicaltrials.gov ID: NCT03262662). Participants completed two laboratory sessions: a pre-treatment session, ~ 1 week prior to beginning varenicline or placebo, and an active treatment session, after ~ 3 weeks of treatment. At each session, participants completed a laboratory choice procedure; on each of 36 trials, a lit cigarette, food item, or cup of water was randomly presented. Participants reported level of craving and spent $0.01-0.25 to have a corresponding 5-95% chance to sample the cue. As predicted, spending was significantly higher on cigarette trials than water trials, and varenicline resulted in a greater between-session decline in spending on cigarette trials (but not water) than did placebo. Cigarette craving was enhanced in the presence of smoking cues compared to water, but neither average (tonic) cigarette craving nor cue-specific cigarette craving was significantly influenced by varenicline. Food spending and craving were generally unaffected by varenicline treatment. These laboratory data from treatment-seeking smokers provide the strongest evidence to date that varenicline selectively attenuates smoking reinforcement prior to quitting.

Association between Food Spending and Dietary Intake in Workers

Association between Food Spending and Dietary Intake in Workers

Small increments in diet cost can improve compliance with the Dietary Guidelines for Americans.

Adherence to the Dietary Guidelines for Americans (DGA) may involve higher diet costs. This study assessed the relation between two measures of food spending and diet quality among adult participants (N=768) in the Seattle Obesity Study (SOS III). All participants completed socio-demographic and food expenditure surveys and the Fred Hutch food frequency questionnaire. Dietary intakes were joined with local supermarket prices to estimate individual-level diet costs. Healthy Eating Index (HEI- 2015) scores measured compliance with DGA. Multiple linear regressions using Generalized Estimating Equations with robust standard errors showed that lower food spending was associated with younger age, Hispanic ethnicity, and lower socioeconomic status. Even though higher HEI-2015 scores were associated with higher diet costs per 2000kcal, much individual variability was observed. A positive curvilinear relationship was observed in adjusted models. At lower cost diets, a $100/month increase in cost (from $150 to $250) was associated with a 20.6% increase in HEI-2015. For higher levels of diet cost (from $350 to $450) there were diminishing returns (2.8% increase in HEI- 2015). These findings indicate that increases in food spending at the lower end of the range have the most potential to improve diet quality.

The effects of food sales taxes on household food spending: An application of a censored cluster model

AbstractThis study proposes a model of household food spending that accounts for zero censoring and can be applied to data collected through a clustered survey design to investigate the impact of food sales taxes on three groups: households who are eligible for and participate in the Supplemental Nutrition Assistance Program (SNAP), households who are eligible but do not participate in the program, and households who are not eligible for the program. We find that SNAP participating households are largely insensitive to grocery taxes and respond to restaurant taxes by shifting more of their food dollars towards at‐home foods. Among households who are eligible for SNAP but do not participate in the program, grocery taxes reduce spending on foods purchased for at‐home consumption, and thereby increase the amount of the total food budget allocated to away from home foods. This is concerning from a nutrition and health standpoint since away from home foods tend to be more calorie dense and nutritionally poorer than at home foods.

The Cost of Nutritious Diets for Individuals and Households in Rural Malawi

Abstract Objectives The affordability of healthy diets is a key concern for policymakers and an active area of research. To the best of our knowledge, ours is the first study to examine the cost of nutritionally adequate diets for all population age and sex subgroups at subnational disaggregation over a 10-year monthly time series as well as to extend the least-cost diet framework from individuals to household units who consume shared meals. Methods We use household survey panel data matched with local food composition data, human nutrient requirements (EARs, ULs and AMDRs), and monthly market food prices. The food price data include a standardized list of 51 items comprising those foods accounting for the vast majority of household food spending, covering all food groups. Household data are from the Integrated Household Panel Survey (IHPS) 3-round panel (2010–2017). Using linear programming, we identify the combination of available foods and quantities that meet the specified nutrient requirements at the lowest total cost. Results Local markets can supply an adequate diet most of the time for some groups but much less often for breastfeeding women and young children, and not at al for children 6–36 months. Where possible, we find that the least-cost individual diet costs 32% of current per capita food spending. For whole households, the local market can meet aggregate nutrient needs 30% of the time. Where possible, it costs 1.8 times household food spending or all total expenditure. Food group analysis reveals households spend more on cereals, meat and roots/tubers, compared to the least-cost adequate diet, but may be under-spending on legumes, milk, fats, and vitamin A-rich fruits. Conclusions Finding a healthy diet in Malawi's local markets is not always possible for all types of individuals or families of varying composition. Children 6–36 months require immediate attention, including increasing access to complete complementary foods. Guiding households to make smart shifts in their food spending could improve diet quality but is insufficient alone given that adequate shared meals are unaffordable for most families. Year-round access to nutritious, affordable diets will require an increase in availability and lower cost of nutrient-dense foods and economic growth to raise incomes. Funding Sources Bill & Melinda Gates Foundation, CANDASA project.

Would You Want to Be What You Eat? Food Behaviors Associate with Diabetes Status in U.S. Adults

Abstract Objectives Diabetes and prediabetes are a major public health concern in the United States. It is unknown how food-related behaviors are influenced by diabetes status. Therefore this study assessed the association between diabetes status and food behaviors (meal preparation, food procurement, and food spending) among U.S. adults. Methods Data from 8799 adults from the 2005–2016 National Health and Nutrition Examination Survey were categorized by glycated hemoglobin levels (A1c%): nondiabetes (<5.7%; n = 5455), prediabetes (5.7–6.4%; n = 2273), and diabetes (>6.5%; n = 1071). A1c levels were compared with meal preparation, food procurement, and spending data. Age-adjusted analyses for total and by sex (n = 4481 females and n = 4318 males) were performed. Results All adults (P = 0.002) and males (P = 0.001) with diabetes and prediabetes spent less money dining out than those without diabetes. Those with diabetes had a significantly further distance to grocery stores among the adult (P = 0.018) and male samples (P = 0.032). Females with diabetes spent more on carryout/delivered foods (P = 0.025) and ate fewer meals per week with family (P = 0.039) than those without diabetes. Females with diabetes were less likely to serve as the main food shoppers (P = 0.012) and males with diabetes were less likely to share meal planning/preparation responsibilities (P = 0.034). Conclusions Diabetes status associates with meal preparation, food procurement, and spending behaviors, and differs for males and females. These findings support the importance of addressing the behavioral context of food choices to help support a healthier diet and lifestyle for all adults. Funding Sources Abbott Nutrition.

Americans' Food Spending Patterns Explain Devastating Impact of COVID-19 Lockdowns on Agriculture

First paragraph: The U.S. Department of Agriculture Economic Research Service’s Food Expenditures by Outlet data provide insight as to why the lockdowns related to COVID-19 have been so devastating for U.S. farmers. In 2018, American consumers bought a total of $628bn[1] worth of food, of which $460bn was spent at grocery stores and $168bn at warehouse clubs and supercenters (see Figure 1 and Table 1). But expenditures on food away from home exceeded that amount: $680bn was spent at restau­rants, $337.8bn at full-service restaurants and $340.2bn at limited-service restaurants.[2] The social distancing and stay-at-home orders related to the COVID-19 pandemic have forced many restaurants to close and those remaining in business to switch to pick-up or delivery only options. Because restaurant supply chains are highly specialized and time sensitive, reallocation of these supply chains has not come quickly enough to accommodate the shifts in consumption toward at-home eating patterns. . . . [1] All amounts are in U.S. dollars. [2] Not all of this represents the value of agricultural products; a large share of this is value-added in the form of rents and wages.

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.

Análisis comparativo de la pobreza en las fronteras de México: aplicación del coeficiente de Engel

This article provides a comparative analysis of the norcoefficient on two different poverty lines: affordance and wealth. This coefficient allows observing the proportion of food spending as compared to other goods and the total available expenditures. Thus, it provides obtained from the National Income and Expenditure Survey to Mexican Households (ENIGH) 2016. The work is quite relevant since in the scholarly literature available, there is not any analysis endeavor like this one addressing the poverty in Mexico and based on this method. The main results showed that opposed to facts indicated by the theory and literature review about a better performance in the creation and distribution of wealth in the northern border there is little difference between these two borders regarding the poverty line. However, the poverty line of wealth shows a strong difference. It is concluded that the access to non-food goods like the housing, clothes and transport is a determining factor for the differentiated poverty in the study regions

Do recipients of cash transfer scheme make the right decisions on household food expenditure? A study from a rural district in Pakistan.

To assess spending by beneficiaries of Benazir Income Support Programme on monthly food commodities, and contribution of the cash grant programme on purchase of nutritious foods. The descriptive cross-sectional survey of households enrolled in the Benazir Income Support Programme was conducted during July and August, 2013, in Matiari district of the Sindh province of Pakistan. Monthly household food expenditure on food commodities and use of the cash grant on type of food purchased was assessed through structured interviews of the beneficiaries. Results were computed in 2013 Pak rupees and converted to 2018 United States dollar. Women beneficiaries were also interviewed on decision-making regarding the use of the cash grant and on household food expenditure. The survey comprised 421 households. with a mean monthly expenditure on food of Rs 7,577, r 80.73 dollars. Women made decisions on food spending in only 135(32%) households, but in 235(56%) households, women were the primary decision-makers on cash grant spending. Unconditional cash grant did not meaningfully translate into the purchase of nutritious foods even though it played an important role in increasing women's agency.

Can Stimulus Checks Boost an Economy Under COVID-19? Evidence from South Korea

Various countries have implemented transfer programs to individuals since the Covid-19 outbreaks. However, the extent to which such transfers alleviate economic recessions is unclear. This paper analyzes a South Korean program, which provided vouchers redeemable only at small local businesses. We find that, due to the program, over 30% of households across all income groups increased their food and overall household spending, but the usage restriction may have affected consumer choice, distorting business competition. While the employment and sales of small businesses improved, the program's fiscal sustainability is in question because of the large tax exemption.

SOCIO-ECONOMİC FACTORS AFFECTING HOUSEHOLD FOOD CONSUMPTION AWAY FROM HOME IN ISPARTA

Bu çalışmada, hanehalklarının ev dışı gıda tüketimi tercihini etkileyen başlıca sosyo-ekonomik faktörlerin analizi amaçlanmıştır. Bu amaçla, Logit Modeli kullanılmış ve hanehalklarıyla yüz yüze görüşme yoluyla yapılan anketlerden elde edilen veriler analiz edilerek model tahmin edilmiştir. Araştırma sonuçlarına göre incelenen hanehalklarının ortalama aylık geliri 5.642,35 TL, aylık ortalama tüketim harcaması 5.169,22 TL, aylık ortalama gıda harcaması 1.396,58 TL ve aylık ortalama ev dışı gıda harcaması ise 393,71 TL olarak belirlenmiştir. İncelenen hanehalklarının %45,45’inin ev dışı gıda tüketiminde bulundukları tespit edilmiştir. Analiz sonuçlarına göre, modele dahil edilen açıklayıcı değişkenlerden çalışan eş unsuru dışındaki değişkenlerin tamamının beklenen işarete sahip olduğu tespit edilmiştir. Değişkenlerin ev dışı gıda tüketimi olasılığına etkileri teorik beklentiyle uyumlu olarak sırasıyla hane büyüklüğü (-%3), medeni durum (-%36), eğitim durumu (%1), ikinci gelir grubu (%32), üçüncü gelir grubu (%49), sağlık (-%58), ekonomiklik (-%50), hijyeniklik (%16) ve evdeki gıda tüketimi harcamaları (-%0,02) olarak hesaplanmıştır.

Supermarket Purchases Over the Supplemental Nutrition Assistance Program Benefit Month: A Comparison Between Participants and Nonparticipants

The Supplemental Nutrition Assistance Program provides financial assistance for food and beverage purchases to approximately 1 in 7 Americans, with benefits distributed once monthly. Most Supplemental Nutrition Assistance Program benefits are spent early in the month, leading to decreased caloric intake later in the month. The effects of this early benefit depletion on the types of foods and beverages purchased over the course of the month is unclear. Using individually tracked sales data from 950 participants enrolled in 2 supermarket-based RCTs in Maine (October 2015-April 2016 and October 2016-June 2017), purchases of selected food categories by Supplemental Nutrition Assistance Program participants (n=248) versus nonparticipants (n=702) in the first 2 weeks compared with the last 2 weeks of the Supplemental Nutrition Assistance Program benefit month were examined. Analyses were completed in 2019. For Supplemental Nutrition Assistance Program participants, adjusted mean food spending decreased 37% from the first 2 weeks to the last 2 weeks of the Supplemental Nutrition Assistance Program benefit month (p<0.0001) compared with a 3% decrease (p=0.02) for nonparticipants. The decline in spending by Supplemental Nutrition Assistance Program participants occurred in all examined categories: vegetables (-25%), fruits (-27%), sugar-sweetened beverages (-30%), red meat (-37%), convenience foods (-40%), and poultry (-48%). Difference-in-difference estimators comparing Supplemental Nutrition Assistance Program participants with nonparticipants were statistically significant (p<0.05) for all examined categories. In the second half of the Supplemental Nutrition Assistance Program benefit month, individuals reduced purchases of all examined categories. More research is needed to understand the impact of these fluctuations in spending patterns on the dietary quality of Supplemental Nutrition Assistance Program participants.

A household-level score to predict the risk of tuberculosis among contacts of patients with tuberculosis: a derivation and external validation prospective cohort study

SummaryBackgroundThe epidemiological impact and cost-effectiveness of social protection and biomedical interventions for tuberculosis-affected households might be improved by risk stratification. We therefore derived and externally validated a household-level risk score to predict tuberculosis among contacts of patients with tuberculosis.MethodsIn this prospective cohort study, we recruited tuberculosis-affected households from 15 desert shanty towns in Ventanilla and 17 urban communities in Callao, Lima, Peru. Tuberculosis-affected households included index patients with a new diagnosis of tuberculosis and their contacts who reported being in the same house as the index patient for more than 6 h per week in the 2 weeks preceding index patient diagnosis. Tuberculosis-affected households were not included if the index patient had no eligible contacts or lived alone. We followed contacts until 2018 and defined household tuberculosis, the primary outcome, as any contact having any form of tuberculosis within 3 years. We used logistic regression to identify characteristics of index patients, contacts, and households that were predictive of household tuberculosis, and used these to derive and externally validate a household-level score.FindingsBetween Dec 12, 2007, and Dec 31, 2015, 16 505 contacts from 3 301 households in Ventanilla were included in a derivation cohort. During the 3-year follow-up, tuberculosis occurred in contacts of index patients in 430 (13%, 95% CI 12–14) households. Index patient predictors were pulmonary tuberculosis and sputum smear grade, age, and the maximum number of hours any contact had spent with the index patient while they had any cough. Household predictors were drug use, schooling of the female head of a household, and lower food spending. Contact predictors were if any of the contacts were children, number of lower-weight (body-mass index [BMI] <20·0 kg/m2) adult contacts, number of normal-weight (BMI 20·0–24·9 kg/m2) adult contacts, and number of past or present household members who previously had tuberculosis. In this derivation cohort, the score c statistic was 0·77 and the risk of household tuberculosis in the highest scoring quintile was 31% (95% CI 25–38; 65 of 211) versus 2% (95% CI 0–4; four of 231) in the lowest scoring quintile. We externally validated the risk score in a cohort of 4248 contacts from 924 households in Callao recruited between April 23, 2014, and Dec 31, 2015. During follow-up, tuberculosis occurred in contacts of index patients in 120 (13%, 95% CI 11–15) households. The score c statistic in this cohort was 0·75 and the risk of household tuberculosis in the highest scoring quintile was 28% (95% CI 21–36; 43 of 154) versus 1% (95% CI 0–5; two of 148) in the lowest scoring quintile. The highest-scoring third of households captured around 70% of all tuberculosis among contacts. A simplified risk score including only five variables performed similarly, with only a small reduction in performance.InterpretationThis externally validated score will enable comprehensive biosocial, household-level interventions to be targeted to tuberculosis-affected households that are most likely to benefit.FundingWellcome Trust, Medical Research Council, Department of Health and Social Care, Department for International Development, Joint Global Health Trials consortium, Bill & Melinda Gates Foundation, Innovation for Health and Development.