Supplemental Nutrition Assistance Program Participation Research Articles

Association of Work Requirements With Supplemental Nutrition Assistance Program Participation by Race/Ethnicity and Disability Status, 2013-2017

Increased work requirements have been proposed throughout federal safety net programs, including the Supplemental Nutrition Assistance Program (SNAP). Participation in SNAP is associated with reduced food insecurity and improved health. To determine whether SNAP work requirements are associated with lower rates of program participation and to examine whether there are racial/ethnic disparities or spillover effects for people with disabilities, who are not intended to be affected by work requirements. This nationally representative, pooled cross-sectional study examined how changes in SNAP work requirements at state and local levels in the US are associated with changes in food voucher program participation. The study combined information on state and local SNAP work requirements with repeated cross-sections from the 2012 through 2017 American Community Survey (with outcomes covering 2013 to 2017). The analytical approaches were based on difference-in-difference and triple-difference methods, after controlling for other economic and social factors. The sample included low-income adults without dependents, stratified by racial/ethnic group and disability status. The study also included parents who would otherwise meet work requirement criteria as a comparison group to estimate triple-difference models. This accounted for otherwise unobserved factors affecting trends in SNAP participation within local areas. Data were analyzed from January 2019 through March 2020. Residence in areas where SNAP work requirements apply. The primary outcome is SNAP participation measured by whether anyone in the household received food vouchers at any point over the prior 12 months. The final analytical sample included 866 000 low-income adults (weighted mean [SE] age, 33.6 [0.01] years; 42.5% [SE, 0.07%] men). The racial/ethnic breakdown was 56.5% (SE, 0.07%) non-Hispanic white respondents, 19.4% (SE, 0.06%) non-Hispanic black respondents, 17.7% (SE, 0.06%) Hispanic respondents, 2.5% (SE, 0.02%) Asian respondents, and 3.9% (SE, 0.03%) respondents of other or multiple races. In final triple-difference models, work requirements were associated with a 4.0 percentage point decrease in participation (95% CI, -0.048 to -0.032; P < .001) for childless adults without disability, equivalent to a 21.2% reduction in SNAP participation (95% CI, -25.5% to -17.0%). For childless adults with disability, work requirements were associated with a 4.0 percentage point reduction (95% CI, -0.058 to -0.023; P < .001), equivalent to 7.8% fewer SNAP participants with disability (95% CI, -11.2% to -4.4%). When the final models were stratified by race/ethnicity, benefit reductions were larger for non-Hispanic black adults (7.2 percentage points; 95% CI, -0.092 to -0.051; P < .001) and Hispanic adults (5.5 percentage points; 95% CI, -0.072 to -0.038; P < .001) than for non-Hispanic white adults (2.6 percentage points; 95% CI, -0.035 to -0.016; P < .001). Because of the association of SNAP with food security and health, work requirements that lead to benefit loss may create nutritional and health harm for low-income Americans. These findings suggest that there may be racially disparate consequences and unintended harm for those with disability.

Are SNAP benefits adequate? A geographical and food expenditure decomposition

The Supplemental Nutrition Assistance Program (SNAP) provides resources to supplement household food expenditures in order to achieve a nutritious diet. Determining the amount of support required - or extent of food expenditure poverty -- entails comparing available resources for food to a nutrition-determined threshold. Clearly the value of the threshold will affect the degree of food expenditure poverty. If the threshold value is inaccurate, the calculated degree of poverty will be inaccurate. USDA uses a threshold for setting SNAP benefits that does not vary geographically or temporally, so consequently (food expenditure) poverty may be understated or overstated in different regions and time periods. This article compares food expenditure poverty estimates for SNAP participants when geographical differences in the threshold are ignored versus not ignored. In addition, the article decomposes household food expenditures into Food-Away-From-Home (FAFH), Food-at-Home (FAH), personal funded FAH, and SNAP funded FAH in order to assess the degree to which each of these contribute to reducing food expenditure poverty. The general findings are that all food expenditure poverty measures are worse when geographical differences are taken into account. In addition, the analysis shows that FAH expenditures, and in particular SNAP FAH expenditures, contribute the most to reducing food expenditure poverty in SNAP households. The policy implications are that food expenditure poverty is currently underestimated in the US by ignoring geographical differences in thresholds, but the food expenditure poverty would be even worse without SNAP benefits. Geographical adjustments to the national threshold could help reduce food expenditure poverty across regions.

Supplemental Nutrition Assistance Program (SNAP)-Authorized Grocery, Convenience, Dollar, and Restaurant or Delivery Service Settings Are Associated With Increased Obesity Prevalence in Virginia.

United States Department of Agriculture Supplemental Nutrition Assistance Program (SNAP) participants use SNAP-authorized stores for dietary purchases. Relationships between obesity prevalence and access to grocery and varied nontraditional (eg, dollar, drug, and convenience) SNAP settings are underexplored. This research aimed to determine the association of a full range of SNAP-authorized stores with obesity prevalence in Virginia. The SNAP Retailer Locator was used to cross-sectionally identify authorized stores, and county health ranking information was applied based on store location. Virginia, United States. The SNAP-authorized stores, classified among store categories: grocery or supermarket; drug; mass merchandiser; supercenter; convenience; dollar; club; other; nonfood store; farmers markets; and independent grocery stores. County-level obesity prevalence with income and rurality as potential confounders. Multiple linear regression was used to determine associations between county-level adult obesity prevalence and available SNAP-authorized store formats (P < .05 a priori). Store format was a predictor of obesity prevalence in Virginia in simple and adjusted models (R2 = 0.035, P < .0001 and R2 = 0.434, P < .0001, respectively). Grocery store or supermarket access was associated with obesity. The SNAP-authorized convenience, dollar, and nonfood stores were associated with a 0.3, 0.5, and 1.3 increase in county obesity prevalence, respectively (P < .05). Research, practice, and health policy approaches to improve grocery, convenience, dollar, and restaurant or delivery service settings may favorably influence community obesity prevalence in Virginia.

Supplemental Nutrition Assistance Program participation and current restricted food expenditures: implications for policy.

National concerns over food insecurity and obesity have prompted legislation seeking to further restrict Supplemental Nutrition Assistance Program (SNAP) purchases. The objective of this study is to provide insight on the potential impact of proposed purchase restrictions by comparing SNAP participant and income-eligible non-participants' expenditures on current SNAP-restricted foods, that is, hot foods, prepared foods, alcohol, vitamins and meal supplements. Cross-sectional study. Bivariate analysis and multivariable regression analysis with an instrumental variables approach were employed to compare the probability of purchasing and expenditures on current SNAP-restricted foods among SNAP participants and income-eligible non-participants. National Household Food Acquisition and Purchase Survey, 2012-2013. 2513 households, of which 1316 were SNAP participants and 1197 were income-eligible non-participants. Both the share of households purchasing and household expenditures on current SNAP-restricted foods were similar among SNAP participants and income-eligible non-participants. Results provide further empirical evidence that proposed SNAP purchase restrictions on sugar-sweetened beverages, snack foods and luxury foods are unlikely to have a meaningful effect on SNAP household food purchases.

Fruit and Vegetable Incentive Programs for Supplemental Nutrition Assistance Program (SNAP) Participants: A Scoping Review of Program Structure.

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

Perceptions and Barriers to SNAP Utilization Among Asian and Pacific Islanders in Greater Los Angeles.

To examine the perceptions of and barriers to Supplemental Nutrition Assistance Program (SNAP) participation among Asian and Pacific Islander (API) immigrants. Qualitative focus groups were conducted in 4 API communities. Participants were recruited from 4 API communities (n = 68; 22 Tongan, 18 Vietnamese, 16 Filipino, and 12 Chinese) through local community-based organizations in Los Angeles and Orange Counties. Trained bilingual and bicultural researchers conducted 8 focus groups in English, Chinese, and Vietnamese. Prior to the start of each focus group, participants completed a demographic questionnaire which included a United States Department of Agriculture (USDA) Food Security Module. Audio recordings were transcribed verbatim and those in the native languages were transcribed verbatim. Transcripts in native languages were reviewed and translated into English. All transcripts were organized in ATLAS ti version 8.0 and analyzed using thematic analysis. The USDA Food Security Module results were scored and assessed for food insecurity. Median age of participants was 58 years and 59.4% (n = 38) were food insecure. Barriers to SNAP participation were identified and organized within the Social Ecological Model by the following themes: (1) unclear program information, (2) application process, (3) shame, and (4) pride. Despite commonalities found across API subgroups, unique challenges with public charge and immigration existed within the subgroups. Culturally relevant in-language SNAP materials and multilevel interventions are needed to mitigate barriers and increase SNAP participation rates among low-income API groups.

Qualitative Evaluation of Drivers of Eating Decisions among SNAP Participants in Mississippi

ObjectiveTo explore food-related decision patterns among Supplemental Nutrition Assistance Program (SNAP) recipients in Mississippi. DesignA qualitative design was used to conduct focus groups (n = 18) based on the Health Belief Model with low-income female caregivers of children aged under 13 years. SettingMississippi. ParticipantsCluster sampling was used to recruit participants (n = 126) from the 4 regional divisions of Mississippi State University Extension. Phenomenon of InterestDrivers of eating decisions among SNAP participants. AnalysisFocus groups were recorded, transcribed, and coded by 2 independent coders using thematic analysis. ResultsDrivers of food selection often overlapped with barriers to healthy eating. Participants used many strategies to manage costs and viewed healthy foods as out of reach and quick to perish. Cost, taste preferences, habits, and family factors were primary drivers of food selection and preparation; each of these presented barriers to healthier eating. Health was most often shared as a driver of food selection once disease was established. Participants reported a variety of strategies used in striving for healthier eating. Conclusions and ImplicationsFocusing on ways to manage the costs of healthy foods, honor taste preferences, and work within habits/families may enhance efforts to support healthy eating among SNAP participants.

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&amp;lt;.023), cost too much (p&amp;lt;0.001), and I do not like (p&amp;lt;0.029). Respondents 18-29 years reported time to prepare as a barrier more often than other age groups (p&amp;lt;0.05). Males gave a higher barrier rating for knowing how to prepare (p&amp;lt;0.044) and females for costing too much (p&amp;lt;0.034). Whites gave the lowest barrier rating for difficult to prepare (p&amp;lt;0.002) and the highest rating for cost (p&amp;lt;0.001), while Hispanics gave the highest rating for personal dislike of FVs (p&amp;lt;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&amp;lt;0.001), don't have time to prepare (p&amp;lt;0.008), hard to find where I shop (p&amp;lt;0.006), family dislikes (p&amp;lt;0.001), personal dislike (p&amp;lt;0.001), and average barrier rating (p&amp;lt;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.

Food Resource Management Skills Modify the Associations Between Household Food Insecurity and Child Feeding Practices in SNAP-Ed Eligible Head Start Families

Abstract Objectives To explore how food security (FS) and food resource management (FRM), strategies to stretch limited food resource dollars, are associated with child feeding practices in low-income preschoolers. Methods In a cross-sectional sample of 364 Head Start households, caregivers completed the 18-item FS module, 6-item FRM behavior subscale, Comprehensive Feeding Practices Questionnaire (e.g., monitoring, restriction, food as reward), and Perceived Stress scale. Households were categorized into four food environment subgroups: FS/good FRM, FS/poor FRM, food insecure/good FRM, and food insecure/poor FRM. Multivariable linear regressions were applied to examine if feeding practices differed across FS-FRM categories, adjusting for demographic and socio-economic covariates that differed significantly by FS-FRM subgroups (race, SNAP participation, parent BMI status). For all models, FS/good FRM was the referent. Lastly, we explored the effect of adding perceived stress to the model. on feeding practices. Results 37% of households were food insecure. The use of parent monitoring, modeling, involvement, and food as reward were significantly different by FS-FRM subgroups (all p-values &amp;lt;0.02). After adjusting for covariates, the FS/poor FRM group used less monitoring (–0.48, 95% CI: –0.71, –0.24), modeling (–0.42, 95CI: –0.66, –0.18), and involvement in feeding (–0.56, 95% CI: –0.80, –0.31). A similar pattern emerged for the food insecure/poor FRM group compared to referent. The use of food as reward was higher in the FS/poor FRM (0.29, 95CI: 0.03, 0.55), food insecure/good FRM (0.39, 95CI: 0.09, 0.70) and food insecure/poor FRM groups (0.33, 95% CI: 0.03, 0.64). These differences observed in feeding practices became insignificant in all but one food insecure subgroup once perceived stress was added to the model. Conclusions Suboptimal child feeding is evident in low-income caregivers with poor FRM skills with or without food insecurity. Promoting FRM skills in addition to addressing FI and stress could potentially synergistically improve child feeding practices in low-income households. Funding Sources This study was funded by USDA's Supplemental Nutrition Assistance Program (SNAP) through the PA Department of Human Services (DHS). This institution is an equal opportunity provider.

SNAP office accessibility and its association with rurality

While several studies have explored geographic relationships within the Supplemental Nutrition Assistance Program (SNAP), results have been mixed. Findings have revealed an imbalanced SNAP participation rate among eligible populations in both suburban and rural areas. Studies on SNAP accessibility have often focused on store locations, but few have examined issues of traveling to SNAP offices. In this study, we focused on SNAP office accessibility and its association with rurality. Using Google Map API, we calculated road travel time and distance to the most conveniently located SNAP office for each block group in the conterminous United States. We investigated the degree to which the SNAP office accessibility is linked to rurality, participant demographics, socioeconomic characteristics, and the program's overall participation rate. Results showed that at the block-group level, the SNAP-eligible average driving time to the most convenient SNAP office is 15.28 min, while the SNAP-eligible average distance is 8.57 miles. More than 75% of the SNAP-income eligible population lives within a 20-min drive to a SNAP office, and 91.8% lives within 30 min. Every ten percentage points of increase in rurality decreases SNAP office accessibility by one additional minute of car travel time. We designed a Rurality-Travel Clock (RTC) visualization tool to provide a graphic description of the urban-rural setting and SNAP office accessibility. Other observations include a noticeable cross-relationship between population concentration (e.g., white or black) and SNAP office accessibility. The findings help us to understand the dynamic relationships between SNAP participation rate and SNAP accessibility factors, including eligibility, employment status, population, and rurality at the county and state levels.

0379 Green Space Exposure and Sleep Duration Among Supplemental Nutrition Assistance Program Participants

Abstract Introduction Emerging empirical evidence suggests green space exposure is protective against insufficient sleep. Limited studies exist, however, exploring the relationship between greenspace exposure and sleep among low income populations in the United States. Methods Using a sample of Supplemental Nutrition Assistance Program (SNAP) participants (n=104) recruited from Champaign County, Illinois, we examined the relationship between self-reported sleep duration and exposure to green space. Sleep duration was determined using the question, “On average, how many hours did you sleep each night during the past 4 weeks?” Green space exposure was determined using satellite imagery from the National Aeronautic Space Administration (NASA) normalized difference vegetation index (NDVI). An NDVI score was assigned to each participant based on residential geo-referenced data. Multiple linear regression was performed in SPSS to explore the relationship between self-reported sleep duration and green space. Results Higher number of hours of sleep within a 24-hour period was positively associated with higher scores for greenspace exposure (β=0.091, P=0.02), controlling for age, gender, smoking status, education, alcohol consumption, and sleep quality. Sleep duration was negatively associated with age (β=-0.03, P=0.007), but positively associated with sleep quality (β=0.856, P=0.008). Conclusion In a sample of SNAP participants, exposure to green space was associated with more hours of sleep per night. Additional studies with larger, and more geographically diverse samples of low income adults are needed to determine whether this relationship is robust. Support USDA UNC/DUKE BECR Center

Food assistance programs and income are associated with the diet quality of grocery purchases for households consisting of women of reproductive age or young children

Women's diet quality during reproductive years and children's diet quality during early life influence long term health. Few studies have evaluated the impact of food assistance programs and income on the diet quality of grocery purchases made by households consisting of women of reproductive age and young children. We used data from the Food Acquisition and Purchase Survey 2012–2013 (FoodAPS) to evaluate how household income, Special Supplemental Nutrition Assistance Program for Women, Infants and Children (WIC) participation, and Supplemental Nutrition Assistance Program (SNAP) participation are related to the diet quality of grocery purchases made by households that include women of reproductive age or young children (n = 2436). The diet quality of household grocery purchases was assessed with the Healthy Eating Index (HEI) 2015. HEI-2015 total score (0−100) and component scores were evaluated according to household income (eligible for WIC: income-to-poverty ratio ≤ 185%; ineligible for WIC: income-to-poverty ratio > 185%) and WIC, SNAP, and WIC + SNAP participation. Median HEI-2015 total score was lowest among SNAP households and highest among income ineligible for WIC and WIC households (47.2 and 54.1, respectively). Compared to income ineligible for WIC households, WIC + SNAP and SNAP households had lower HEI-2015 whole fruit (β = −0.30, 95% CI: −0.59, −0.01 and β = −0.41, 95% CI: −0.63, −0.20, respectively) and total vegetable scores (β = −0.58, 95% CI: −0.83, −0.32 and β = −0.27, 95% CI: −0.45, −0.08, respectively). The diet quality of grocery purchases in this population varies according to household income and food assistance participation.

Strengthening the Public Health Impacts of the Supplemental Nutrition Assistance Program Through Policy.

The US Department of Agriculture (USDA) Supplemental Nutrition Assistance Program (SNAP) is the cornerstone of the US nutrition safety net. Each month, SNAP provides assistance to 40 million low-income Americans-nearly half of them children. A number of changes could strengthen the public health impacts of SNAP. This review first presents a framework describing the mechanisms through which SNAP policy can influence public health, particularly by affecting the food security, the diet quality, and, subsequently, the health of SNAP participants. We then discusspolicy opportunities with the greatest potential to strengthen the public health impacts of SNAP, organized into three areas: (a) food production and distribution, (b) benefit allocation, and (c) eligibility and enrollment. For each section, we describe current policy and limitations of the status quo, suggest evidence-based opportunities for policy change to improve public health, and identify important areas for future research.

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.

Crowdsourcing: A Critical Reflection on This New Frontier of Participant Recruiting in Nutrition and Dietetics Research

Crowdsourcing: A Critical Reflection on This New Frontier of Participant Recruiting in Nutrition and Dietetics Research

Racial/Ethnic Differences in the Shopping Behaviors and Fruit and Vegetable Consumption of Farmers' Market Incentive Program Users in Illinois.

Farmers' market incentive programs, such as Link Match, provide monetary incentives to Supplemental Nutrition Assistance Program (SNAP) participants to promote their use of local farmers' markets. Information on racial/ethnic differences in the shopping behaviors and fruit and vegetable (FV) consumption of farmers' market incentive program users is scarce. This research aimed to address this need by examining users of the Link Match incentive program in Illinois. A cross-sectional survey of 328 Link Match users (39.6% non-Hispanic White; 45.4% non-Hispanic Black; and 15.0% other) was conducted in 2016 and 2017. Information on each participant's demographics, farmers' market shopping behaviors, and monthly frequency of FV consumption was collected from Link Match users. Chi-square and ANOVA tests were used to assess differences in farmers' market shopping measures by race/ethnicity. Logistic regression models were used to examine the association between race/ethnicity and frequency of FV consumption. A significantly higher percentage of non-Hispanic Black participants reported being an infrequent farmers' market user (ie, shopping ≤ once a month) compared with non-Hispanic White and other participants (P=.01). After adjusting for covariates, non-Hispanic Black participants had lower odds of consuming fruit daily (OR: .44; 95% CI:.22-.86) compared with non-Hispanic White participants. Other participants had lower odds of consuming both fruit and vegetables compared with non-Hispanic White participants (OR: .30; 95% CI:.12-.71). Differences in shopping behaviors and FV consumption were observed by race/ethnicity among Link Match users. Future research should examine the nutritional implications of these differences.

Is there a relationship between welfare-state policies and suicide rates? Evidence from the U.S. states, 2000–2015

Suicide is one of the leading causes of death in the United States. The rise in suicide rates is contributing to the recently observed decline in life expectancy. While previous research identified a solid association between economic strain and suicide, little attention has been paid to how specific welfare policies that are designed to alleviate economic strain may influence suicide rates. There is a growing body of research that is using an institutional approach to demonstrate the role of welfare-state policies in the distribution of health. However, this perspective has not been applied yet to the investigation of suicide. In this study, I combine these approaches to analyze the association between two specific policies, Supplemental Nutrition Assistance Program (SNAP) and Earned Income Tax Credit (EITC), and overall and gender-specific suicide rates across the 50 U.S. states between 2000 and 2015. I estimate two-way fixed-effects longitudinal models and find evidence of a robust association between one of these policies – SNAP – and overall and male suicide. After adjusting for a number of confounding factors, higher participation in SNAP is associated with lower overall and male suicide rates. Increasing SNAP participation by one standard deviation (4.5% of the state population) during the study period could have saved the lives of approximately 31,600 people overall and 24,800 men.

Online Grocery Shopping Knowledge, Attitudes, and Behaviors Among SNAP Participants

ObjectiveTo inform policy proposals to allow online grocery shopping with Supplemental Nutrition Assistance Program (SNAP) benefits by examining relevant behaviors, knowledge, and attitudes of SNAP recipients. MethodsThis qualitative study used a purposive recruitment strategy to conduct 4 1-hour focus groups in Las Cruces, NM. Participants were SNAP recipients who do the grocery shopping for their families. Focus groups were video and audio recorded, transcribed, and coded. ResultsFew participants had shopped for groceries online, and participants were generally uninterested in grocery shopping online. Identified barriers were cost, quality control for perishable foods in particular, and distrust of the overall process. Participants expressed interest in suggested services aimed at increasing the benefits of shopping online. Conclusions and ImplicationsSNAP recipients in this study have not adopted online grocery shopping for various reasons. Additional research could inform policy by investigating which participants would benefit from using SNAP benefits online and strategies for facilitating use.

Heterogeneous Impact of Supplemental Nutrition Assistance Program Benefit Changes on Food Security by Local Prices

The Supplemental Nutrition Assistance Program benefit amount is fixed across all 48 states (except Hawaii and Alaska), although food prices vary widely. Hence, the real value of Supplemental Nutrition Assistance Program benefits can directly affect the purchasing power of Supplemental Nutrition Assistance Program participants and subsequently their food insecurity. Using the 2 most recent changes to the Supplemental Nutrition Assistance Program benefit formula in 2009 and 2013, this study examines whether the changes in benefit level affected food security of participants differentially depending on local food prices. Data from the Current Population Survey-Food Security Supplement 2008-2009 and 2012-2013, merged with the Regional Price Parities from the Bureau of Economic Analysis, were used. Linear regression with a differences-in-differences strategy estimated the effects of Supplemental Nutrition Assistance Program benefit changes on the food security of Supplemental Nutrition Assistance Program households, separately by those in high- and low-cost areas. The analyses were completed in 2019. After the benefit increase, the prevalence of low food security among Supplemental Nutrition Assistance Program households living in high-cost areas declined by 11.2 percentage points (95% CI=1.6, 20.8). Following the benefit decrease, the prevalence of very low food security among Supplemental Nutrition Assistance Program households increased by 8.7 percentage points (95% CI=3.6, 13.8) in high-cost areas. In contrast, there was no statistically significant difference between Supplemental Nutrition Assistance Program and non-Supplemental Nutrition Assistance Program households in low-cost areas in response to the benefit changes. Given the heterogeneous effects of the Supplemental Nutrition Assistance Program benefit changes on food security by local food prices, this study provides additional evidence for the ongoing policy debate regarding whether the Supplemental Nutrition Assistance Program benefit amounts should be adjusted to the cost of living.

Links of the Supplemental Nutrition Assistance Program With Food Insecurity, Poverty, and Health: Evidence and Potential.

The Supplemental Nutrition Assistance Program (SNAP) is a highly effective program, vital to our nation's health and well-being. SNAP's entitlement funding structure allows it to provide benefits to anyone who meets the program's eligibility requirements, and this structure also enables SNAP to respond quickly when need increases. Research shows that SNAP reduces poverty for millions, improves food security, and is linked with improved health.Despite SNAP's successes, there is room to build on its considerable accomplishments. Evidence suggests that current benefit levels are not adequate for many households. Some vulnerable groups have limited SNAP eligibility, and some eligible individuals face barriers to SNAP participation.Policymakers should address these shortcomings by increasing SNAP benefits and expanding SNAP eligibility to underserved groups. The federal government and states should also continue improving policies and procedures to improve access for eligible individuals.