Assistance Program Participation Research Articles

Food insecurity and the role of food assistance programs in supporting diet quality during the COVID-19 pandemic in Massachusetts.

Economic and supply chain shocks resulting from the COVID-19 pandemic in 2020 led to substantial increases in the numbers of individuals experiencing food-related hardship in the US, with programs aimed at addressing food insecurity like the Supplemental Nutrition Assistance Program (SNAP) and food pantries seeing significant upticks in utilization. While these programs have improved food access overall, the extent to which diet quality changed, and whether they helped mitigate diet quality disruptions, is not well understood. To evaluate food insecurity, food pantry and/or SNAP participation associations with both diet quality as well as perceived disruptions in diet during the COVID-19 pandemic among Massachusetts adults with lower incomes. We analyzed complete-case data from 1,256 individuals with complete data from a cross-sectional online survey of adults (ages 18 years and above) living in Massachusetts who responded to "The MA Statewide Food Access Survey" between October 2020 through January 2021. Study recruitment and survey administration were performed by The Greater Boston Food Bank. We excluded respondents who reported participation in assistance programs but were ineligible (n = 168), those who provided straightlined responses to the food frequency questionnaire component of the survey (n = 34), those with incomes above 300% of the federal poverty level (n = 1,427), those who completed the survey in 2021 (n = 8), and those who reported improved food insecurity (n = 55). Current dietary intake was assessed via food frequency questionnaire. Using Bayesian regression models, we examined associations between pandemic food insecurity, perceived disruption in diet, diet quality, and intakes of individual foods among those who completed a survey in 2020. We assessed interactions by pantry and SNAP participation to determine whether participation moderated these relationships. Individuals experiencing food insecurity reported greater disruption in diet during the pandemic and reduced consumption of healthy/unhealthy foods. Pantry participation attenuated significant associations between food insecurity and lower consumption of unhealthy (b = -1.13 [95% CI -1.97 to -0.31]) and healthy foods (b = -1.07 [-1.82 to -0.34]) to null (unhealthy foods: -0.70 [-2.24 to 0.84]; healthy foods: 0.30 [-1.17 to 1.74]), whereas SNAP participation attenuated associations for healthy foods alone (from -1.07 [-1.82 to -0.34] to -0.75 [-1.83 to 0.32]). Results were robust to choice of prior as well as to alternative modeling specifications. Among adults with lower incomes, those experiencing food insecurity consumed less food, regardless of healthfulness, compared to individuals not experiencing food insecurity. Participation in safety-net programs, including SNAP and pantry participation, buffered this phenomenon. Continued support of SNAP and the food bank network and a focus on access to affordable healthy foods may simultaneously alleviate hunger while improving nutrition security.

Patterns and Predictors of Breast Milk Feeding from Birth to Age 4 Months among Primiparous African American Mother-Infant Dyads.

The health benefits of breast milk feeding have been well-established, yet disparities exist, with African American mothers having the lowest breast milk feeding rates in the United States. This prospective, longitudinal study examined infant feeding (breast milk and/or infant formula) from birth to age 16 weeks, predictors of any breast milk feeding by age 1 week, and predictors of cessation of any breast milk feeding by ages 3, 8, and 16 weeks among primiparous African American mothers. This secondary analysis included 185 mother–infant dyads from the Sleep SAAF (Strong African American Families) study, a randomized clinical trial testing a responsive parenting vs. child safety control intervention. Mothers reported sociodemographic and psychosocial characteristics at age 1 week and infant feeding practices at ages 1, 3, 8, and 16 weeks. Rates of any breast milk feeding decreased from 66.5% at 1 week to 23.3% at 16 weeks. Bivariate logistic regression models showed that prepregnancy BMI (OR = 1.09), working prepregnancy (OR = 2.25), and food insecurity (OR = 2.49) significantly increased the odds of mothers feeding any breast milk by 1 week, whereas Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation (OR = 0.21) significantly decreased the odds. Bivariate logistic regression models showed that Supplemental Nutrition Assistance Program (SNAP) participation (OR = 2.86) and racial discrimination (OR = 2.14) significantly increased the odds of cessation of any breast milk feeding by 3 weeks. SNAP (OR = 2.33) and WIC (OR = 2.38) participation significantly increased the odds of cessation of any breast milk feeding by 8 weeks, whereas higher prepregnancy BMI (OR = 0.95) decreased the odds. Higher mother’s age (OR = 0.92) significantly decreased the odds of cessation of any breast milk feeding by 16 weeks. The findings can be used to inform targeted interventions to promote mothers feeding any breast milk and help reduce breast milk feeding disparities among African American mothers.

Differences in Supplemental Nutrition Assistance (SNAP) Program participation among Oklahoma counties

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.

Associations between Household- and Child-Referenced Food Security Status and Dietary Intake among Low-Income Urban Black Children

ABSTRACT We examined whether dietary intake differs across household and child food security (FS) status, and Supplemental Nutrition Assistance Program (SNAP) participation among Black children (ages 9–15) in a low-income urban setting. This cross-sectional survey used the USDA 18-item Household Food Security Survey, which includes the 8-item Child Module, and a validated FFQ to assess children’s diet (n = 451). Nutrient intake differed across child FS status, but not household FS. SNAP participation was associated with better micronutrient intake (vitamin D and calcium) among food secure children. Assessing child-specific FS and nutrient adequacy clarifies children’s actual experience and informs child-targeted policies.

Society of Behavioral Medicine (SBM) does not support "Public Charge Rule" changes affecting immigrants' food security.

Federal nutrition assistance programs, especially the Supplemental Nutrition Assistance Program (SNAP), are an important safety net for households in the USA. Although few immigrant households are eligible for SNAP, those who need the program are less likely to participate than nonimmigrant households. Documented barriers to participation include language challenges and anti-immigrant rhetoric. However, previous research indicates that when immigrant households do participate in SNAP, their young children experience less food insecurity and the household as a whole makes fewer tradeoffs between food and other necessities. The Public Charge Rule limits ability to obtain a green card based on participation in public assistance programs. A recent change to this rule added programs to include some noncash programs, including SNAP. Although the vast majority of immigrants who are subject to the Public Charge Rule are not eligible for SNAP, misunderstanding of the rule and fear threaten to reduce SNAP enrollment and consequently increase food insecurity in immigrant families. Spillover effects may occur for families not targeted by changes in the Public Charge Rule as well as decreasing access to other safety net programs that are not impacted by the proposed changes, such as The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and school meals programs. In order to support the food security of immigrant families in the USA, we recommend that the Department of Homeland Security and the Department of State remove all non-cash safety net programs from the Public Charge Rule.

Public Assistance and Homeless Shelter Trajectories

We study public assistance participation among homeless shelter users, characterizing the trajectories of public assistance receipt for individuals before and after they enter shelters and analyzing the influence of public assistance participation on subsequent shelter use. Our analysis identifies three distinct groups of shelter users based on personal characteristics and prior patterns of public assistance use. These groups are differentiated by their patterns of no use, increasing use, and high use of public assistance. For all three groups, increased participation in public assistance programs following the first observed homeless shelter entry reduces subsequent shelter use. The analysis draws attention to the potential role of public assistance programs and strengthened coordination of services for the prevention of homelessness.

P61 SNAP-Ed Participants Improved and Maintained Healthy Eating and Shopping Behaviors Following the 4-Week 10 Tips Intervention

Objective To assess the impact of 10 Tips for Adults on healthy eating and shopping behaviors. Use of Theory or Research The Social Cognitive Theory states behavior change is predicted by knowledge of health risks and benefits and perceived self-efficacy. 10 Tips aims to increase the likelihood participants will make healthy choices on a budget. Target Audience Adults in Maine eligible for Supplemental Nutrition Assistance Program Education (SNAP-Ed). Program Description 10 Tips includes 2 independent nutrition education series (Series A: Choose MyPlate and Series B: Eating Better on a Budget), each consisting of four 30–60 minute lessons. Evaluation Methods Retrospective pre/post and follow-up surveys (6–8 weeks later) were completed by the intervention group. Baseline and follow-up surveys were completed online by a comparison group comprised of randomly selected SNAP recipients. Outcome variables, measured using a 5-point Likert scale, were treated as continuous for analysis. Longitudinal analysis was conducted comparing groups using linear mixed models controlling for food security and baseline value of the outcome. Results Intervention (n = 295) and comparison (n = 410) groups were demographically similar, but the comparison group had higher food insecurity and participation in assistance programs. Adjusted mean frequencies improved significantly among 10 Tips participants from baseline to follow-up for fruit consumption (P Conclusions Participants of 10 Tips, a 4-lesson series, reported significant improvements in healthy eating and shopping behaviors 6–8 weeks after the intervention, offering an attractive option to potential participants hesitant to commit to a longer program. Funding Supplemental Nutrition Assistance Program - Education.

Abstract A033: Barriers to eating fruits and vegetables among a low-income ethnically diverse population

Abstract A high-quality diet that includes recommended daily amounts of fruits and vegetables (FV) is associated with reduced risk for cancer and improved health outcomes for cancer survivors. There is evidence that some cancer disparities among minorities are associated with diet quality, and there is persistent evidence of poor nutrition and food insecurity among low-income minorities in the U.S. This has led to federal efforts to increase fresh fruit and vegetable consumption among Supplemental Nutrition Assistance Program (SNAP) participants. As part of an evaluation of an intervention to increase fresh fruit and vegetable (FFV) consumption in SNAP households, this study asked: How do perceived barriers to eating more FVs vary by age, gender, race/ethnicity, and level of education? The AARP Foundation implemented the United States Department of Agriculture (USDA)'s Food Insecurity Nutrition Incentive (FINI) Grant Program in two southeastern states. SNAP participants could receive financial incentives through their SNAP cards in the form of coupons or tokens for purchasing FFVs or SNAP items at grocery stores and farmers' markets in selected communities. Individual households in these communities were randomly selected and invited to respond to an evaluation survey via the internet or a telephone survey. The survey included seven questions from the National Cancer Institute Food Attitudes and Behaviors Study about barriers to eating FVs, with ratings on a scale of strongly agree to strongly disagree. Responses were summed to create composite barriers scores. Completed baseline surveys were received from 1,459 households in Tennessee and Mississippi. There were significant age differences for three barriers, with survey respondents aged 65 and older being more likely to report the following barriers: hard to find FVs where I shop (p<.023), cost too much (p<0.001), and I do not like (p<0.029). Respondents 18-29 years reported time to prepare as a barrier more often than other age groups (p<0.05). Males gave a higher barrier rating for knowing how to prepare (p<0.044) and females for costing too much (p<0.034). Whites gave the lowest barrier rating for difficult to prepare (p<0.002) and the highest rating for cost (p<0.001), while Hispanics gave the highest rating for personal dislike of FVs (p<0.006). Those with high school or less education tended to rate the following barriers higher than participants who had gone to college: don't know how to prepare (p<0.001), don't have time to prepare (p<0.008), hard to find where I shop (p<0.006), family dislikes (p<0.001), personal dislike (p<0.001), and average barrier rating (p<0.001). Across all demographic groups, cost was reported as the biggest barrier. Conclusions: The results suggest that interventions to increase FV consumption for cancer prevention and improved outcomes for minority cancer survivors may need to be tailored to address different needs based on age, gender, ethnicity, and level of education. Citation Format: Caprice Brown, Pam Hull, Rebecca Selove, David G. Schlundt, Joscelyn Silsby. Barriers to eating fruits and vegetables among a low-income ethnically diverse population [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A033.

Dietary Intake and Appetite Hormone Patterns among Mothers Participating in the Supplemental Nutrition Assistance Program: A Pilot Study

ABSTRACT Supplemental Nutrition Assistance Program (SNAP) participation has been associated with obesity in women. The objective of this pilot study was to describe the caloric intake and dietary quality at the beginning, middle, and end of a SNAP cycle among food insecure, African-American female head-of-households with overweight/obesity (n = 12). The feasibility of obtaining appetite-regulating hormones to assess the associations between appetite regulation and caloric intake was explored as a secondary aim. Mean caloric intake and dietary quality, as measured by HEI-2010 score, did not differ among study visits. Four patterns of caloric intake among the twelve subjects were reported in which all subjects reported caloric intake less than their daily requirements for weight maintenance. Appetite-stimulating hormone, neuropeptide Y concentrations, was positively associated with percent of Estimated Energy Requirements (%EER) consumed.

Abstract P291: Racial/Ethnic Differences in the Shopping Behaviors and Fruit and Vegetable Consumption of Low-Income Farmers Market Incentive Program Users in Illinois

Introduction: Studies have shown that low-income populations in the US often consume fewer servings of fruits and vegetables (FVs) per day compared to higher income populations. Farmers market incentive programs provide monetary incentives to Supplemental Nutrition Assistance Program (SNAP) participants to support their procurement of fresh FVs. Information on the racial/ethnic differences in FV consumption among SNAP participants who utilize farmers market incentive programs is scarce. This research aimed to address this need by examining racial/ethnic differences in the farmers market shopping behaviors and frequency of FV consumption among users of the Link Match program in Illinois. We hypothesized that Non-Hispanic Black program users will consume FVs less frequently than Non-Hispanic White users. Methods: A cross-sectional evaluation of 328 Link Match users (39.6% Non-Hispanic White; 45.4% Non-Hispanic Black; and 15.0% Other) was conducted during the 2016 and 2017 farmers market seasons in Illinois. Information on user demographics, farmers market shopping behaviors, and frequency of FV consumption in the prior month was collected. Chi-square and ANOVA tests were used to assess racial/ethnic differences in farmers market shopping behaviors. Multivariable-adjusted logistic regression models were used to examine the association between race/ethnicity and daily consumption of FVs among program users. Results: A significantly higher percentage of Non-Hispanic Black Link Match users reported being an infrequent farmers market user (i.e., shopping ≤ once a month) compared to Non-Hispanic White and Other users (p = 0.01). After adjusting for covariates (i.e., demographics, market location), Non-Hispanic Black users had lower odds of consuming fruit daily (OR: 0.44; 95% CI: 0.22-0.86) compared to Non-Hispanic White users. Other users had lower odds of consuming vegetables daily (OR: 0.30; 95% CI: 0.12-0.71) compared to Non-Hispanic White users. Conclusions: Significant racial/ethnic differences in shopping behaviors and FV consumption were observed among Link Match users in Illinois. Future research should examine the nutritional and health implications of these differences.

Abstract P097: Sociodemographic Differences in the Dietary Quality of Food Purchases Among Participants in the Nationally-Representative Food Acquisition and Purchase Study (FoodAPS)

Background: Self-reported dietary data may not accurately represent usual dietary intake. Grocery purchase records provide an objective measure of diet, but little research has explored whether the diet quality of grocery purchases reflects individual-level diet quality and whether it differentiates between groups with known differences in dietary quality. This study evaluated whether there are sociodemographic differences in the dietary quality of grocery purchases akin to those observed in existing individual-level national data. Hypothesis: The diet quality of grocery purchases will reflect trends observed with individual-level diet quality. Methods: Grocery purchasing data from 3,961 households in the nationally-representative Food Acquisition and Purchase Study (FoodAPS) were used. Dietary data was collected using hand scanners over 7-days, and demographic data was self-reported. The Healthy Eating Index (HEI) 2015 was used to determine grocery purchase quality, and multivariable-adjusted regression with Tukey adjustment or planned contrasts were used to determine whether HEI-15 scores differed according to food insecurity, Supplemental Nutrition Assistance Program (SNAP) participation, obesity within a household, race/ethnicity, and interactions between these variables. FoodAPS sample weights and Taylor series linearization method for variance estimation accounted for the complex sample design. Results: Primary respondents were, on average, 50.6 years, non-Hispanic White (70.3%), female (70.2%) and had attended some college (57.8%). The mean HEI-15 score was 54.7; 14.0% of households were food insecure and 12.7% received SNAP benefits. HEI-15 scores differed across all sociodemographic predictors (p<0.05). Additionally, interactions (p<0.1) were detected between SNAP participation and (1) food insecurity and (2) obesity within the household as well as race/ethnicity and obesity within the household. Food secure, non-SNAP households had higher HEI-15 scores than food insecure, SNAP participating households (53.9±0.5 vs. 50.3±0.7, p=0.007) in models adjusted for age, income, smoking, and education. Similarly, non-SNAP households without obesity present had significantly higher HEI-15 scores than all other households. Obesity presence within a household was associated with lower HEI-15 scores in non-Hispanic White (50.8±0.5 vs. 52.5±0.7, p=0.046), and Black households (48.8±1.5 vs. 53.1±1.4, p=0.018), but not Hispanic households (54.4±1.0 vs. 52.2±1.2, p=0.21). Conclusions: Disparities in the diet quality of grocery purchases reflect individual-level trends and vary based on sociodemographic factors. This analysis highlights the interrelationships between SNAP, food insecurity, race/ethnicity, and obesity within a household, demonstrating how the co-occurrence of risk factors may modify associations with diet quality.

Factors Associated with Fruit and Vegetable Purchases of SNAP Recipients Residing in Multi-Person Households within a Food Desert

ABSTRACT Fruit and vegetable (F&V) intake is inversely associated with obesity, which is disproportionately high in urban food deserts and low-income populations, including Supplemental Nutrition Assistance Program (SNAP) participants. This cross sectional study sought to examine factors associated with food desert SNAP recipients’ F&V purchases and weight status in multi-person households. Socio-demographic characteristics, access to healthy foods and stores, affordability, purchasing practices, use of food assistance and weight status were analyzed. A convenience sample of seventy-one SNAP recipients were recruited from a Detroit, MI food desert. Participants were 45–54 years of age (33.8%), average BMI = 30.33. Multiple linear regression determined if socio-demographic and household factors were associated with fruit and vegetable purchases and BMI. Results showed that those who were more likely to limit F&V purchases were not getting enough food to eat (p = 0.009), and males who indicated limited finances (p = 0.043). BMI was negatively associated with participants not getting enough food to eat within the household (p = .04). SNAP recipients, living in food deserts can benefit from public health interventions, policies and education that can influence F&V purchases and likely consumption.

The impact of the recession on food insecurity among households who were low income: findings from the 2005 - 2014 national health and nutrition examination surveys

ABSTRACTThis article aims to investigate the impact of recession on food insecurity among households who are low income. Guided by family stress theory, this article uses data from the National Health and Nutrition Examination Survey (NHANES) (N = 3,701). Results suggest that prevalence of food insecurity continued to increase during and after the recession, with the most dramatic increase from 2008 to 2010. The changes in food insecurity prevalence overtime varied by gender, race, and Supplemental Nutrition Assistance Program (SNAP) participation. Program and policy implications are discussed.

결혼이주여성의 공적개발원조 사업 참여를 위한 탐색적 연구

결혼이주여성의 공적개발원조 사업 참여를 위한 탐색적 연구

Abstract 01: Supplemental Nutrition Assistance Program (SNAP) Participants Exhibit Higher Rates of Cardiometabolic Mortality Compared to SNAP Eligible Non-participants and SNAP Ineligible Americans

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.

Hispanic Adults Attending English as a Second Language (ESL) Classes at an Adult School Are Food Insecure

Food insecurity in the United States is associated with poverty and ethnicity. Rates of food insecurity among groups who may not qualify for government assistance programs such as Supplemental Nutrition Assistance Program (SNAP) are lacking. Hispanic adults taking English as a second language (ESL) day and evening classes in an affluent area of Northern California were surveyed in Spanish to determine the prevalence of food insecurity and respondents’ knowledge and use of food assistance programs. Of 107 respondents (57% male), 58.9% had a steady job. Yet, 68% were food insecure. Many (79%) respondents purchased inexpensive staple foods when money was limited. Gender, household size, time of day attending classes, and employment status had no effect on food security status. Eighteen percent (n = 13) of food insecure respondents accessed food assistance programs but the reminder (82%, n = 60) reported lack of access, primarily due to lack of program awareness. This study suggests that food insecurity is widespread among working immigrants living in an affluent area. Action plans are needed to address the awareness gap and other potential barriers to participation in food assistance programs to improve food security among working and nonworking Hispanic immigrants.

An Examination of Organizational and Statewide Needs to Increase Supplemental Nutrition Assistance Program (SNAP) Participation

This study examined Supplemental Nutrition Assistance Program (SNAP) outreach efforts among representatives of community organizations, as well as local and statewide needs for increasing SNAP participation. We conducted qualitative interviews with 34 SNAP outreach workers across 27 states; participants reported working at food banks, social services agencies, antihunger nonprofits, legal aid agencies, faith-based nonprofits, and health clinics. Four major needs emerged as themes for community-level organizations: increased personnel, increased funding, improved application process, and increased community awareness. For broader, statewide needs, 3 themes emerged: increased staffing of state caseworkers, decreased stigma and negative perceptions, and improved application processing capacity and infrastructure. The findings of this qualitative study suggest that community organizations and state SNAP-administering offices should work together more closely to share best practices, improve SNAP application-related technology, and develop tailored outreach plans.

Associations between Body Mass Index, Shopping Behaviors, Amenity Density, and Characteristics of the Neighborhood Food Environment among Female Adult Supplemental Nutrition Assistance Program (SNAP) Participants in Eastern North Carolina

We examined associations between body mass index (BMI) and the food environment among adult female Supplemental Nutrition Assistance Program (SNAP) participants (N = 197) in eastern North Carolina. Food venue proximity to residential addresses was calculated using a geographic information system. Walk Score was used as a measure of amenity density. Correlation and linear regression analyses were used to examine associations between BMI and distance to and use of food venues, and residential amenity density. Frequency of supercenter use was significantly inversely associated with distance to supercenters. Walk Score was significantly inversely associated with BMI. BMI was not associated with distance to or use of any particular food venue. Future studies should examine specific health-promoting elements of amenity-dense neighborhoods accessible to limited-income populations.

Trends and Determinants of Food Insecurity Among Adults in Low-Income Households in California

Data from 66 446 low-income adults who participated in the California Health Interview Survey are used to describe trends in food insecurity between 2001 and 2009. Food security was assessed using the short form of the Household Food Security Survey Module. There was a statistically significant increase in food insecurity between 2001 and 2009, from 28.6% to 40.5%. During the same time period, the prevalence of very low food security nearly doubled, from 8.3% to 15%. The increase in food insecurity remained significant even after controlling for differences in income, employment status, participation in food assistance programs, and other sociodemographic factors.

Use of Traditional and Nontraditional Food Venues Among Female Participants in the Supplemental Nutrition Assistance Program (SNAP)

We examined food venues used, food shopping frequency, types of foods purchased, and associations with body mass index (BMI) among 207 female Supplemental Nutrition Assistance Program (SNAP) participants in eastern North Carolina. The majority reported using supermarkets (96%) and supercenters (86%) and reported using these venues most often. Drug stores (13%), convenience stores (30%), the homeless shelter (17%), gardens (30%), and farmers' markets (27%) were used by fewer participants. Women purchased healthier food at supermarkets and supercenters and less healthy food at drug stores and convenience stores. Future work should examine the association between venue type and specific food items purchased.