Supplemental Nutrition Assistance Program Participation Research Articles

Food insecurity and mental health among US adults during the COVID-19 pandemic: Results from National Health Interview Survey, 2020–2021

ObjectiveTo examine socio-demographic disparities in food insecurity during the COVID-19 pandemic and the association between food insecurity and mental health among US adults overall and communities vulnerable to food insecurity. MethodsA cross-sectional study was conducted using the 2020–2021 National Health Interview Survey of 57,456 US adults. Weighted multivariable logistic regression models were used to estimate the association between food insecurity and anxiety or depression symptoms in overall US adults and subgroups including young adults (18–34 years), females, Hispanic people, non-Hispanic Black people, individuals with prior COVID-19 infection, the unemployed, low-income participants, participants with children, and Supplemental Nutrition Assistance Program (SNAP) participants. ResultsYoung or middle age, female sex, Hispanic/non-Hispanic Black/other race/ethnicity, lower education level, unmarried/other marital status, unemployment, being below the federal poverty level, and greater number of persons in the household were associated with food insecurity (AOR ranged from 1.35 to 2.70, all p < 0.05). Food insecurity was independently associated with anxiety (AOR = 2.67, 99 % CI: 2.33, 3.06) or depression (AOR = 3.04, 99 % CI: 2.60, 3.55) symptoms in the overall adults. Significant associations between food insecurity and anxiety or depression symptoms were also observed in all subgroups (AOR ranged from 1.95 to 3.28, all p < 0.0001). Compared with overall adults, the magnitude of the association was greater for participants with children, females (for depression only), and non-Hispanic Black people (for depression only). LimitationsThe cross-sectional design prevents inference of causality. ConclusionsComprehensive policies are needed to ensure accessible and affordable food resources to reduce disparities in food insecurity and improve mental health, especially for those socioeconomically disadvantaged communities.

The association between unhealthy dietary behaviors and participation in the Supplemental Nutrition Assistance Program (SNAP): No evidence in support of the self-selection hypothesis

Supplemental Nutrition Assistance Program (SNAP) participants tend to have unhealthier dietary consumption compared to eligible non-participants. It has been suggested, though never empirically tested, that individuals who enroll in SNAP may have unhealthy diets prior to program participation. Using a longitudinal cohort study design, we examined the association between low-income adults' SNAP participation status and prior dietary behaviors to test the argument that individuals with unhealthier dietary consumption self-select into SNAP. A sample of households from predominantly lower-income cities were surveyed at baseline (T1) and 2–4 years later (T2). The main analyses were restricted to adults who did not participate in SNAP at T1 and with household income <200% of the federal poverty line (n = 170) at both T1 and T2. Participants were grouped into two categories, based on their SNAP participation at T2; (a) Non-participants (n = 132): no SNAP participation at T1 or T2, and (b) T2 SNAP participants (n = 38): SNAP participation at T2 but not T1. Daily consumption frequency of whole fruits, fruit juice, vegetables, sugar-sweetened beverages (SSBs), and energy dense snacks were measured through self-reports. To observe dietary differences between the two groups prior to SNAP participation, T1 behaviors were compared. There were no significant differences in dietary behaviors at T1 (prior to SNAP participation) between non-participants and T2 participants, providing no evidence of self-selection of individuals with unhealthier dietary consumption into SNAP among our study sample. Improvements in SNAP participants’ diets may benefit from focusing on policy changes that encourage healthy dietary habits during participation in the program.

Relationship between Food Security, Nutrition Security, and Diabetes: The Role of Supplemental Nutrition Assistance Program Participation

BackgroundInadequate nutrition and poor diet quality are associated with a heightened risk of diabetes. The connection between food insecurity measures and diabetes has been established, with evidence indicating that Supplemental Nutrition Assistance Program (SNAP) participation contributes to reductions in food insecurity. Recently developed nutrition security measures, defined as the ability to acquire healthful foods to prevent diseases, and their association with diabetes and SNAP participation are not yet understood. ObjectivesThis study aims to assess the relationship between nutrition security and food security in relation to diabetes overall and by SNAP participation and nutrition security as potential modifiers. MethodsSecondary data analysis of cross-sectional pilot study data collected from adults in 5 US states (N = 517). Logistic regression mixed models included moderation analysis and clustering effects by state to address site-level confounding. ResultsHigher nutrition security scores among adults, after adjusting for confounders, were significantly associated with lower odds of diabetes risk (adjusted odds ratio = 0.59; 95% confidence interval: 0.40, 0.87; P value = 0.008). Statistically significant interaction effect of differences according to SNAP participation was observed for nutrition security (Phomogeneity/interaction = 0.021), adjusting for age, gender, race/ethnicity, education, employment, National School Lunch Program, Special Supplemental Nutrition Program for Women, Infants, and Children, food pantry use, household with children, survey mode, and food security. The association between food security and diabetes was not statistically significant overall. However, statistically significant interaction effect of differences according to SNAP participation was observed for food security (Phomogeneity/interaction = 0.047). Further, no interaction effect of differences in nutrition security was found between food security and self-reported diabetes/prediabetes (Phomogeneity/interaction = 0.250). ConclusionsThis study sheds light on the early exploration of the intricate relationship between nutrition security and diabetes. The findings suggest that a higher nutrition security score, after adjusting for confounders, is significantly associated with lower odds of diabetes risk. Notably, there are statistically significant interaction effects in these associations based on SNAP participation.

Measuring Food Security in University Students: A Comparison of the USDA 10-Item and Six-Item Food Security Survey Modules

ABSTRACT We examined discordant food security (FS) status classification between the USDA 10-item and six-item FS Survey Modules (FSSMs) among students at a U.S. university. A random sample reflecting the University’s sociodemographic composition was recruited by e-mail in 2020. Respondents (N = 2653) completed the FSSMs. FS status (binary: food secure/insecure; four-category: high/marginal/low/very low) was determined using the 10-item and six-item FSSMs. Seventy (2.6%) students were discordantly classified on binary FS and 238 (9%) on four-category FS. American Indian students, international students, Supplemental Nutrition Assistance Program participants, and students with child dependents or housing insecurity had higher odds of discordant classification.

Food insecurity, fruit and vegetable consumption, and use of the Supplemental Nutrition Assistance Program (SNAP) in Appalachian Ohio.

Food insecurity and inadequate nutrition are two major challenges that contribute to poor health conditions among U.S. households. Ohioans continue to face food insecurity, and rates of food insecurity in rural Southeast Ohio are higher than the state average. The main purpose of this project is to evaluate the associations between Supplemental Nutrition Assistance Program (SNAP) participation and food security in rural Ohio, and to explore the association between SNAP participation and fruit/vegetable consumption. We control for food shopping patterns, such as shopping frequency, because previous research reports a significant relationship between shopping patterns and food security. To achieve our purpose, we use novel household-level data on food insecurity and SNAP participation in rural Southeast Ohio, collected during the COVID-19 pandemic. We find that people who experience higher levels of food insecurity than others are more likely to participate in SNAP, though this is likely a function of selection bias. To correct for the bias, we employ the nearest neighbor matching method to match treated (SNAP participant) and untreated (similar SNAP nonparticipant) groups. We find that participating in SNAP increases the probability of being food secure by around 26 percentage points after controlling for primary food shopping patterns. We do not find any significant association between SNAP participation and estimated intake of fruits and vegetables. This study provides policymakers with suggestive evidence that SNAP is associated with food security in rural Southeast Ohio during the pandemic, and what additional factors may mediate these relationships.

Association of Supplemental Nutrition Assistance Program participation duration with cost-related medication non-adherence and emergency department visits.

Administrative requirements could disrupt sustained Supplemental Nutrition Assistance Program (SNAP) participation among income-eligible individuals. To meet their food needs, low-income individuals without consistent SNAP benefits may compromise on medication use, posing a risk to their health. The objective of this study is to examine the association of SNAP participation duration in a given year with cost-related medication nonadherence (CRN) and emergency department (ED) use in income-eligible individuals. Cross-sectional. Non-elderly and elderly adults who used prescription medications and participated in SNAP the previous year in 2016-2018 National Health Interview Survey. Subsamples included individuals with specific chronic conditions. CRN and ED usage. SNAP participation for<12 months in the previous year was related to increased CRN and ED use in nonelderly adults taking prescription medication, as well as in those with hypertension, cardiovascular disease and asthma. Further, <12-month SNAP participation was associated with greater odds of having at least one ED visit in nonelderly and elderly adults. Sustained SNAP participation could help income-eligible individuals better adhere to their prescribed medications and reduce health complications requiring ED visits. Findings suggest the importance of addressing SNAP participation gaps among income-eligible individuals in health care settings.

Submitted and Denied: Understanding variation in case status across Supplemental Nutrition assistance program (SNAP) applications

Our study investigates the application process for the Supplemental Nutrition Assistance Program (SNAP) and barriers to successful SNAP participation among potentially eligible households. We know that only 84 percent of eligible individuals in the United States participated in SNAP prior to the COVID-19 pandemic. Our objective is to understand continued barriers to SNAP participation among eligible applicants by analyzing Indiana households that have formally engaged in the SNAP application process. We examine census-tract-level data from Indiana’s administrator of SNAP benefits, Family and Social Services Administration (FSSA), in combination with census-tract-level socioeconomic data from 2017 to 2019. We use existing methodologies in micro- and macro-level socioeconomic analysis of SNAP participation to examine not only the terminal participation rate (approved applications) but also the dynamics of the application process that starts with a larger pool of applicants (submitted applications) and may end with a non-participation case status (denied applications). Our linear and quantile regression analyses also seek to understand these socioeconomic factors as predictors of the response distribution of SNAP case status across communities with different rates of application submissions and denials. Our analysis of Indiana SNAP applications supports anecdotal findings that one of the most difficult hurdles in the application process is timely navigation of the paperwork and interview requirements with evidence of increased time in the application process for communities with high SNAP denial rates. We also find that broader socioeconomic trends in a community are associated with application submission rates while applicants’ personal circumstances better predict denial rates.

A Review of SNAP Nutritional Incentive Programs

There are over 40 million Americans in the Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamps Program. Despite this program attempting to eliminate food insecurity for people 130% below the poverty line, it does little to prevent nutrition related health disparities between SNAP participants and people who are more financially stable. Nearly every state has nutrition incentive programs attempting to address these nutritional health disparities that SNAP does not address. To synthesize a literature review of several of these programs, a search was conducted in PubMed, PubAg, and Google Scholar databases using terms such as “SNAP” and “nutritional incentive program,” along with date restrictions for 2013 or later. This search resulted in a total of 54 articles, however only 35 were used following screening. Included articles were screened first by abstract and then article content to determine relevancy. The literature suggests that programs address nutritional health disparities by providing financial interventions for SNAP participants to make nutritionally conscious decisions about the food they purchase and consume. There were three categories of interventions that were suggested by the literature: incentives, discounts, and restrictions. Regardless of the intervention, each of these categories of intervention were praised by SNAP participants. Participants were able to purchase and consume more fruits and vegetables, focus on nutrition, and financially support local farmers markets and supermarkets. This review discusses these different interventions to allow for new or existing programs to be developed to best address nutritional health disparities using scholarly evidence.

Food Insecurity Among Aging SNAP Participants and Eligible Nonparticipants in Two Predominantly Low-Income Black Neighborhoods: Implications for SNAP Enrollment and Outreach for Older Adults

BackgroundThe Supplemental Nutrition Assistance Program (SNAP) plays a critical role in alleviating poverty and food insecurity. Despite these benefits, many older Americans who are eligible for SNAP do not participate in the program. Few studies have explored household factors and food insecurity outcomes associated with nonparticipation among older Black Americans. ObjectivesThe study aim was to explore changes in food insecurity and related financial hardship outcomes between 2020 and 2021 among SNAP participants, eligible nonparticipants, and ineligible nonparticipants; compare reasons for not participating in SNAP; and to compare household factors associated with SNAP nonparticipation. MethodsLongitudinal design examining data from 2020 and 2021 to assess changes in food insecurity over the course of the coronavirus disease 2019 pandemic. Participants/settingParticipants were 528 adults (aged 30 to 97 years) in households randomly selected from a listing of all residential addresses in two predominantly Black neighborhoods with lower incomes in Pittsburgh, PA, and surveyed between March to May 2020 and May to December 2021. Main outcome measuresFood security was measured using the validated 6-item US Department of Agriculture Adult Food Security Survey Module. Statistical analyses performedFindings are based on a descriptive analysis of food security and related indicators. Statistical testing was performed to assess differences between SNAP participation status and individual characteristics, food security, and financial hardship using Wald F test for continuous measures and Pearson χ2 test for categorical measures. A multivariable linear model was used to assess the association of SNAP participation and eligibility status with change in food insecurity. ResultsIn cross-sectional analyses of 2021 data, no differences were observed between SNAP participants and eligible nonparticipants for food insecurity, food bank use, mean weekly food spending per person, and difficulty paying for basics. However, with respect to changes in food insecurity over the course of the pandemic, SNAP participants experienced a greater improvement in mean food security scores between 2020 and 2021 (–0.52 reduction in mean food insecurity score or a 16% improvement in food security; P ≤ 0.05) relative to SNAP-eligible nonparticipants. Perceived ineligibility (71.3%) and perceived lack of need (23%) were the most common reasons for not participating in SNAP. ConclusionsMore than one-third of SNAP participants and eligible nonparticipants experienced food insecurity and financial hardship. However, there were differences in the changes in food insecurity between these groups.

Household Food Security Status and Allostatic Load among United States Adults: National Health and Nutrition Examination Survey 2015–2020

BackgroundHousehold food insecurity has been linked to adverse health outcomes, but the pathways driving these associations are not well understood. The stress experienced by those in food-insecure households and having to prioritize between food and other essential needs could lead to physiologic dysregulations [i.e., allostatic load (AL)] and, as a result, adversely impact their health. ObjectiveTo assess the association between household food security status and AL and differences by gender, race and ethnicity, and Supplemental Nutrition Assistance Program (SNAP) participation. MethodsWe used data from 7640 United States adults in the 2015–2016 and 2017–March 2020 National Health and Nutrition Examination Survey to estimate means and prevalence ratios (PR) for AL scores (based on cardiovascular, metabolic, and immune biomarkers) associated with self-reported household food security status from multivariable linear and logistic regression models. ResultsAdults in marginally food-secure [mean = 3.09, standard error (SE) = 0.10] and food-insecure households (mean = 3.05; SE = 0.08) had higher mean AL than those in food-secure households (mean = 2.70; SE = 0.05). Compared with adults in food-secure households in the same category, those more likely to have an elevated AL included: SNAP participants [PR = 1.12; 95% confidence interval (CI): 1.03, 1.22] and Hispanic women (PR = 1.20; 95% CI: 1.05, 1.37) in marginally food-secure households; and non-Hispanic Black women (PR = 1.14; 95% CI: 1.03, 1.26), men (PR = 1.13; 95% CI: 1.02, 1.26), and non-SNAP non-Hispanic White adults (PR = 1.22; 95% CI: 1.08, 1.39) in food-insecure households. ConclusionsAL may be one pathway by which household food insecurity affects health and may vary by gender, race and ethnicity, and SNAP participation.

The association of safety-net program participation with government perceptions, welfare stigma, and discrimination

Abstract Safety-net programs in the United States offered critical support to counter food insecurity and poverty during the first year of the COVID-19 pandemic. The Supplemental Nutrition Assistance Program (SNAP) and the Earned Income Tax Credit (EITC) are both means-tested programs with significant benefits. Take-up of SNAP and EITC is lower in California than nationwide and reasons for this difference are unclear. We examined associations of participation in SNAP and receipt of the EITC and perceptions of the US government, 2 types of welfare stigma (program stigma and social stigma), and perceived discrimination. We interviewed a sample of 497 caregivers of young children from families with low income in California during the COVID-19 pandemic (August 2020-May 2021). We found that participation in SNAP (odds ratio [OR] = 1.24 [1.05, 1.47]) and receiving the EITC (OR = 1.39 [1.05, 1.84]) were both associated with greater reported perceptions of social stigma, but not with perceptions of government, program stigma, or discrimination. Among food-insecure respondents, we found that participation in SNAP was additionally associated with program stigma and discrimination. These findings suggest that perceived social stigma may be a reason that people with low income may not participate in programs for which they are eligible.

A LONGITUDINAL STUDY ON SNAP PARTICIPATION AND SELF-REPORTED HEALTH AMONG DIABETIC AND NON-DIABETIC INDIVIDUALS

Abstract Self-reported health is a strong predictor of future health status, new morbidity, mobility decline, illness recovery, and healthcare utilization. Because self-reported health is rooted in social position and social comparison, it dually reflects individual health perceptions and health inequities, especially among those who experience a social struggle for resources. Food insecurity is associated with higher risk of chronic diseases and higher mortality rates. Interventions such as the supplemental nutrition assistance program (SNAP) were created to help address food insecurity. Although morbidity and mortality risks caused by food insecurity is exacerbated for those with nutrition-centered chronic disease, such as diabetes, limited research has assessed the impact of food insecurity and SNAP participation on health among diabetics. Using Health and Retirement Study data, we explore the effect of SNAP participation and food insecurity on the likelihood of reporting fair or poor health comparing 24,446 diabetes to 69,260 non-diabetics individuals aged 65 and above (2004-2020). Our analysis controls for key socioeconomic factors, including age, gender, race/ethnicity, and wealth, accounting for the complex design of HRS. Our key findings reveal that food insecure diabetics have significantly higher odds of reporting fair/poor health, and diabetic SNAP participants also had significantly higher odds of reporting fair/poor health. Our study demonstrates how food insecurity and diabetes concurrently influence health and how, despite the presence of resources, such as SNAP, there was no improvement in self-reported health. This study is important as it highlights the need for future research on the effects of SNAP participation and self-reported health.

THE RELEVANCE OF SNAP PROGRAM ACCESSIBILITY FOR FOOD INSECURITY, FOCUSING ON ADULTS WITH DISABILITIES

Abstract Individuals with disabilities are not only more likely than their peers without disabilities to experience food insecurity, but also encounter disproportionate barriers to Supplemental Nutrition Assistance Program (SNAP) enrollment. This study examined associations between state-level measures of SNAP enrollment accessibility (flexibility, efficiency, and accessibility in the enrollment process; and the presence of either broad-based categorical eligibility or the Combined Application Project) with SNAP participation and food insecurity levels among low-income participants (income ≤185% of the poverty threshold) aged ≥15 years in the 2021 Current Population Survey, both overall (n=19,895) and among those with disabilities (n=3,484). In multi-level models adjusted for individual and state characteristics, living in a state with broad-based categorical eligibility was associated with higher rates of SNAP participation among all low-income individuals (b= 0.300, 95% CI: 0.096, 0.505). Among those with disabilities, having greater flexibility in SNAP enrollment (b= 0.141, 95% CI: 0.007, 0.276) and living in a state with the Combined Application Project (b= 0.271, 95% CI: 0.017, 0.525) were associated with a higher likelihood of SNAP participation. Living in a state with more efficient SNAP enrollment was associated with lower food insecurity levels (b= -0.073, 95% CI: -0.136, -0.010) among all low-income individuals and having broad-based categorical eligibility was associated with lower food insecurity levels (b= -0.237, 95% CI: -0.451, -0.022) among those with disabilities. These findings highlight the importance of SNAP program accessibility to address food insecurity among all low-income Americans and suggest that enrollment barriers may differ for people with and without disabilities.

Effects of in-store marketing on food and beverage purchases: a longitudinal study of households with children.

Most food retailers display foods in prominent locations as a marketing strategy (i.e. 'placement promotions'). We examined the extent to which households with children change their food and beverage purchases in response to these promotions. We analysed a novel dataset of all products promoted in two supermarkets from 2016 to 2017, including promotion dates and locations (e.g. aisle endcaps and front registers). We linked promotions to all purchases from the supermarkets from 2016 to 2017 by a cohort of households with children. We calculated the number of weekly promotions in each of thirteen food and beverage groups (e.g. bread; candy) and used fixed effects regressions to estimate associations between number of weekly promotions and households' weekly food purchases, overall and by Supplemental Nutrition Assistance Program (SNAP) participation. Two large supermarkets in Maine, USA. Eight hundred and twenty-one households with children. Most promotions (74 %) were for less healthy foods. The most promoted food groups were sweet and salty snacks (mean = 131·0 promotions/week), baked goods (mean = 68·2) and sugar-sweetened beverages (mean = 41·6). Households generally did not change their food group purchases during weeks when they were exposed to more promotions for those groups, except that a 1-sd increase in endcap candy promotions (about 1 promotion/week) was associated with $0·19/week (about 14·5 %) increase in candy purchases among SNAP nonparticipants (adjusted P < 0·001). In-store placement promotions for food groups were generally not associated with purchases of promoted food groups, perhaps because exposure to unhealthy food marketing was consistently high. Substantial changes to in-store food marketing may be needed to promote healthier purchases.

"I don't want an App to do the work for me": A Qualitative Study on the Perception of Online Grocery Shopping from Small Food Retailers

BackgroundSmall food retailers often stock energy-dense convenience foods and are ubiquitous in low-income urban settings. With the rise in e-commerce, little is known about the acceptability of online grocery shopping from small food retailers. ObjectiveTo explore perceptions of the role of small food retailers (bodegas) in food access and the acceptability of online grocery shopping from bodegas among customers and owners in a diverse NYC urban neighborhood with low-income. DesignIn-depth interviews were conducted with bodega owners and adult customers between May-July 2022. Participants/settingBodega owners who had either implemented a locally designed online grocery system (n=4) or not (n=2). Customers (n=25) were recruited through purposive sampling and eligible if they purchased at bodegas ( > once/month), had low-income (household income ≤ 130% of the federal poverty level or Supplemental Nutrition Assistance Program (SNAP) participants), and owned smartphones. Analyses performedAll interviews were transcribed and analyzed in MAXQDA using grounded theory. ResultsTo owners and customers, bodegas were seen as good neighbors providing culturally appropriate foods and an informal financial safety net. Their perceptions concerning food cost and availability of healthy foods in bodegas diverged. Although most perceived online grocery from bodegas as a positive community resource, they also believed it was not suited to their own community due to the bodega’s proximity to customers' homes and the low digital literacy of some community members. Customers reported social norms of pride in not using online grocery shopping. Owners and customers believed the service would more likely be used if government benefits like SNAP allowed payment for online orders. Both suggested improved outreach to increase program awareness and uptake. ConclusionsOnline grocery shopping from small food retailers may be acceptable in urban communities with low-income and was perceived as a community resource. However, important barriers need to be addressed such as social norms related to pride in not using online grocery services, digital literacy, program awareness, and allowing SNAP payment for online orders from bodegas.

Association of emergency allotment discontinuation with household food insufficiency in Supplemental Nutrition Assistance Program participants: A quasi-experimental study

ObjectiveThe Supplemental Nutrition Assistance Program (SNAP) was modified to mitigate food insecurity faced by low-income families during the pandemic. These changes included enhancement of SNAP benefits via 2020 emergency allotments (EA). Despite the high food price inflation in 2022, 17 states ceased providing EA benefits by end of 2022. The objective of this research is to examine the impact of EA discontinuation on food insufficiency. MethodsUsing Household Pulse Survey data from December 2021–January 2023, SNAP participants (n = 57,556) from states that discontinued EA at some point during the study period and those from states that did not discontinue EA were included. The main analyses examined the impact of EA discontinuation on food insufficiency via staggered difference-in-difference models using two-way fixed effects (TWFE) regression. Additional analyses examined this association using Callaway-Sant'Anna approach for difference-in-difference analyses. ResultsUsing TWFE, EA discontinuation was significantly associated with increased food insufficiency in the overall sample, as well as in individuals who were non-Hispanic White and Hispanic, and who had annual family incomes of less than $25,000. Investigation of time-varying association of EA termination with food insufficiency suggested that EA discontinuation was significantly associated with greater food insufficiency in the second week following rollback. DiD analyses using Callaway-Sant'Anna approach suggested that states' rollback of EA was significantly associated with higher food insufficiency in non-Hispanic White individuals. ConclusionFindings imply that EA discontinuation, amidst the corresponding surge in inflation, could have contributed to increased rates of household food insufficiency.

Advancing Equity in the Farm Bill: Opportunities for the Gus Schumacher Nutrition Incentive Program (GusNIP)

The Gus Schumacher Nutrition Incentive Program (GusNIP) is a federally funded grant program that provides nutrition incentives—subsidies for purchasing fruits and vegetables (FV)—to Supplemental Nutrition Assistance Program (SNAP) participants. GusNIP currently advances nutrition equity by improving FV access for people with low incomes, yet inequities exist within GusNIP. We sought to identify inequities in GusNIP at the community, organization, partner, and individual levels and develop recommendations for farm bill provisions to make the program more equitable. In Spring 2021, a group of nutrition incentive experts (n = 11) from across the country convened to discuss opportunities to enhance equity in GusNIP. The iterative recommendation development process included feedback from key stakeholders (n = 15) and focus group participants with GusNIP lived experience (n = 12). Eleven recommendations to advance equity in GusNIP in the farm bill emerged across six categories: (1) increase total GusNIP funding, (2) increase funding and support to lower-resourced organizations and impacted communities, (3) eliminate the match requirement, (4) support statewide expansion, (5) expand and diversify retailer participation, and (6) expand program marketing. Including these recommendations in the upcoming and future farm bills would equitably expand GusNIP for SNAP participants, program grantees, and communities across the country.

The distributional impact of SNAP on dietary quality

AbstractThe Supplemental Nutrition Assistance Program (SNAP) is the nation's largest domestic food and nutrition assistance program for low‐income Americans. Recent studies that examined the effect of SNAP on dietary quality focus on the average effects. Using the USDA's 2012 National Household Food Acquisition and Purchase Survey (FoodAPS) and an unconditional quantile estimator, we examine the distributional impacts of SNAP on dietary quality as measured by Healthy Eating Index‐2010 (HEI‐2010). To identify the differential impacts of SNAP across the distribution of dietary quality, we exploit exogenous variation in state's maximum weekly unemployment insurance benefits and state outreach spending per capita as instrumental variables. We find that SNAP has no significant impact on households’ dietary quality on average. However, for households with initially low‐to‐intermediate dietary quality, SNAP participation reduces their HEI scores by over 17% or more than 7 points out of a total score of 100. The negative impacts of SNAP on these HEI quantiles are mainly driven by an increased acquisition of empty calories.

Do Household Headship and Gender Affect Diet Quality under the Supplemental Nutrition Assistance Program (SNAP)?

Examine whether the association between Supplemental Nutrition Assistance Program (SNAP) participation and diet quality is different by gender and household headship. Quantitative, cross-sectional. The 2007-2018 waves of the National Health and Nutrition Examination Survey (NHANES). 6180 individuals aged 20 to 65 with household annual income below 130% of the poverty level. The outcome of diet quality was measured using the 2015 Healthy Eating Index (HEI) based on dietary intake from 24-hour diet recall. The exposures were self-reported participation in SNAP and socio-demographic variables. Ordinary Least Square (OLS) regression models. The study found that female household heads had higher average total HEI scores relative to their male and non-head counterparts (β = 1.81, 95% CI: -.27, 3.88). However, for SNAP participants, female household heads had lower average total HEI scores (β = -3.67, 95% CI: -7.36, .11). Female household heads are more likely to experience difficulty in maintaining diet quality relative to their counterparts. The study suggests that intra-household effort allocation may play an important role in differentiating and maintaining diet quality.

SNAP Participation Moderates Fruit and Vegetable Intake Among Minority Families With Low Income

ObjectiveTo examine the moderation effect of Supplemental Nutrition Assistance Program (SNAP) participation on the baseline fruit and vegetable (FV) intake of Hispanic/Latino and African American children and parents participating in the Brighter Bites program. DesignCross-sectional. SettingHouston, Austin, and Dallas, TX; Washington, DC; and Southwest Florida. ParticipantsSelf-reported surveys (n = 6,037) of Hispanic/Latino and African American adult-child dyads enrolled in Brighter Bites in Fall 2018. Variables MeasuredDependent variable, child FV intake; Independent variable, parent FV intake, and FV shopping behavior; Effect Measure Modifier, SNAP participation. AnalysisQuantitatively used mixed effects linear regression models to test if the effect of parental baseline FV intake and shopping behavior on a child's baseline FV intake differed by SNAP participation. Analyses were performed using STATA with significance set at P < 0.05 and 95% confidence intervals (CIs). ResultsFor parents that consumed FV ≥ 2 times/d at baseline, there was a 0.1 times increase in child FV intake at baseline among those who participated in SNAP as compared with those who did not participate in SNAP (ß = 0.1; 95% CI, 0.1–0.2; P = 0.001), and for parents who shopped at convenience stores ≥ 2 times/wk for FV, there was 0.6 times increase in child FV intake at baseline for those who participated in SNAP as compared with those that did not participate in SNAP (ß = 0.6; 95% CI, 0.3–0.9; P < 0.001). Conclusions and ImplicationsSupplemental Nutrition Assistance Program participation moderated the associations between FV intake among African American and Hispanic/Latino parents and children and FV shopping at convenience stores and child FV intake. Findings indicate a need for future interventions to promote SNAP participation among those eligible and improve access to FV.