Supplemental Nutrition Assistance Program Recipients Research Articles

Income and food insecurity among SNAP recipients: a consideration of the SNAP benefit formula

Abstract The Supplemental Nutrition Assistance Program (SNAP) has substantially reduced food insecurity in the USA, but almost half of the participants remain food insecure. We use the 2018 Survey of Income and Program Participation to examine the relationship between food insecurity and two components of benefit determination—gross income and deductions. For all SNAP recipients, in most specifications, gross income is inversely related to food insecurity, and deductions are positively correlated with food insecurity. When examining policy-relevant sub-categories, households with a senior or someone with a disability have positive associations between food insecurity and deductions, suggesting possible changes in benefit construction.

A Formative Evaluation of an Online Meal Kit and Grocery Platform for Supplemental Nutrition Assistance Program Recipients

ObjectiveTo assess the barriers and facilitators to online food purchasing through a meal kit and grocery shopping website titled NY SNAP Express among Supplemental Nutrition Assistance Program (SNAP) beneficiaries. MethodsA purposive sample of SNAP-eligible adults residing in New York State participated in interviews guided by the Capabilities, Opportunities, Motivations, and Behaviors Model. ResultsBarriers to online food purchasing among participants (n = 32) include physiological and health conditions, the weight of food, technology, language, the price of foods, transportation challenges, the stigma associated with SNAP, and concerns regarding the quantity and quality of meal kits. Facilitators include health and nutrition improvements, knowledge and skills, saving money, culturally relevant meals, increased efficiency in food purchases and preparation, and customization. Conclusions and ImplicationsOnline platforms such as NY SNAP Express have the potential to increase nutritious food access and resources among SNAP recipients; however, improvements are necessary to meet the needs of its audience.

Supplemental Nutrition Assistance Program Emergency Allotments and Food Security, Hospitalizations, and Hospital Capacity

Understanding how social policies shape health is a national priority, especially in the context of the COVID-19 pandemic. To understand the association between politically motivated changes to Nebraska's Supplemental Nutrition Assistance Program (SNAP) policy and public health measures during the COVID-19 pandemic. This cross-sectional study used synthetic control methods to estimate the association of Nebraska's decision to reject emergency allotments for the SNAP with food security and hospital capacity indicators. A counterfactual for Nebraska was created by weighting data from the rest of the US. State-level changes in Nebraska between March 2020 and March 2021 were included. Data were acquired from the Census Bureau's Household Pulse Survey on individual food security and mental health indicators and from the US Centers for Disease Control and Prevention on hospital-level capacity indicators. Data analysis occurred between October 2022 and June 2023. The rejection of additional SNAP funds for low-income households in Nebraska from August to November 2020. Food insecurity and inpatient bed use indicators (ie, inpatient beds filled, inpatient beds filled by patients with COVID-19, and inpatients with COVID-19). The survey data of 1 591 006 respondents from May 2020 to November 2020 was analyzed, and 24 869 (1.56%) lived in Nebraska. Nebraska's population was composed of proportionally more White individuals (mean [SD], 88.70% [0.29%] vs 78.28% [0.26%]; P < .001), fewer individuals who made more than $200 000 in 2019 (4.20% [0.45%] vs 5.22% [0.12%]; P < .001), and more households sized 1 to 3 (63.41% [2.29%] vs 61.13% [1.10%); P = .03) compared with other states. Nebraska's rejection of additional funding for SNAP recipients was associated with increases in food insecurity (raw mean [SD] difference 1.61% [1.30%]; relative difference, 19.63%; P = .02), percentage of inpatient beds filled by patients with COVID-19 (raw mean [SD] difference, 0.19% [1.55%]; relative difference, 3.90%; P = .02), and percentage of inpatient beds filled (raw mean [SD] difference, 2.35% [1.82%]; relative difference, 4.10%; P = .02). In this cross-sectional study, the association between social policy, food security, health, and public health resources was examined, and the rejection of emergency allotments in Nebraska was associated with increased food insecurity. Additionally, this intervention was associated with an increased rate of hospitalizations for COVID-19 and non-COVID-19 causes.

The role of public and private food assistance in supporting families’ food security and meal routines

“Backpack” food programs administered through public schools are a potentially powerful additional source of nutrition for low-income students and their families. Typically, backpack programs send non-perishable foods home with children to supplement school meals. Power Packs Project (PPP) is a unique backpack program, in that it provides fresh food alongside accompanying recipes, with the explicit goals of not only reducing food insecurity but also facilitating home cooking and improving nutrition for the whole family. Using daily, repeated surveys sent via text-message to program parents (N = 178), this study is the first to examine the effect of picking up a Power Pack in a given week on parent and child food insecurity and meal routines. Additionally, it explores whether effects differed for families who also received federal food assistance through the Supplemental Nutrition Assistance Program (SNAP). Results indicate that Power Packs is associated with lower parent and child food insecurity; this relationship is even stronger among families who did not also receive SNAP. Power Packs also promotes home cooking, but only among families who did not receive SNAP. Analyses of program usage revealed that SNAP recipients were far more likely to pick up their packs at the end of their SNAP month than they were just after SNAP benefit distribution, suggesting they use the program to smooth food consumption in tandem with SNAP. Implications of these findings for food assistance programs and policies are discussed.

“If I start panicking over having enough, then I start eating too much”: Understanding the eating behaviors of SNAP recipients in larger bodies during COVID-19

Background/objectiveLiving in a food-insecure household may increase the risk for disordered eating. Though the Supplemental Nutrition Assistance Program (SNAP) was designed to reduce food insecurity, it may increase risk for disordered eating with the frequency in which benefits are distributed. Limited research has explored the lived experiences of managing eating behaviors while on SNAP, particularly among SNAP participants in larger bodies, and during COVID-19. Thus, the purpose of this study is to examine the experiences with eating behaviors among adults with a BMI ≥ 25 kg/m2, and who received SNAP benefits during the COVID-19 pandemic. MethodsEligible adults were recruited to participate in a semi-structured interview. Interviews were transcribed verbatim and analyzed using thematic analysis and content analysis. ResultsParticipants (N = 16), had a mean (±SD) age of 43.4 ± 10.9 years, and overwhelmingly identified as female (86 %). One-third of the participants were Black. We identified 4 main themes: (1) not having enough money/benefits to cover needs; (2) navigating loss of control and emotional eating; (3) making sure the kids are alright; and (4) still feeling the pressure to manage weight. ConclusionManaging eating behaviors while also navigating SNAP benefits is complex and may exacerbate risk of disordered eating.

Abstract B096: Food insecurity and receipt of Supplemental Nutrition Assistance Program (SNAP) benefits among income-eligible US pediatric acute lymphoblastic leukemia patients enrolled on a multi-center clinical trial

Abstract Background Food insecurity (FI) is an adverse social determinant of health (SDoH) prevalent among pediatric cancer patients and associated with poorer health outcomes in general pediatrics. Receipt of federal SNAP benefits reduces FI in general pediatrics, and is thus a marker of appropriate resource support to mitigate adverse SDoH. Dana-Farber Cancer Institute (DFCI) Acute Lymphoblastic Leukemia (ALL) Consortium Trial 16-001 is the first pediatric oncology clinical trial to prospectively collect parent-reported SDoH, including income, SNAP receipt, and FI. We investigated whether income-eligible pediatric ALL families were successfully receiving SNAP benefits, and whether SNAP receipt was associated with FI. Methods Secondary analysis of children aged 1-17 years with de novo ALL enrolled on the DFCI 16-001-embedded SDoH cohort study at 6 US centers from 2017-2022. We utilized parent-reported SDoH data at diagnosis (T0) and 6-mos (T1) into therapy to identify families as (1) SNAP-eligible, proxied as household income &amp;lt;130% Federal Poverty Level based on federal guidelines; and (2) food insecure, based on validated 2-item screen. McNemar’s test compared SNAP receipt at T0 vs T1 among those eligible at both timepoints. Associations between SNAP eligibility, SNAP receipt, and FI were evaluated with chi-square tests. Results At T0, among 262 evaluable families, 21% reported FI. A total of 20% (n=53) were SNAP-eligible, of whom 60% (n=32) reported FI and 53% (n=28) were receiving SNAP. Among 28 SNAP-recipient families, 61% reported FI. Similarly, at T1, among 223 evaluable families, 25% reported FI. A total of 28% (n=62) were SNAP-eligible, of whom 58% (n=36) reported FI and 58% (n=36) were receiving SNAP. Among 36 SNAP-recipient families, 56% reported FI. A significantly higher proportion of the 33 families SNAP-eligible at both T0 and T1 were receiving SNAP at T1 (70%) compared to T0 (52%) (p=0.034). Among eligible families, SNAP receipt was not associated with lower odds of FI at T0 (OR 1.03, p=0.96) or T1 (OR 0.83, p=0.73). Discussion FI, a well-defined adverse SDoH associated with inferior health outcomes, is highly prevalent among a trial-enrolled pediatric ALL population. Despite care delivery at highly resourced centers with dedicated staff to address social needs, a substantial proportion of likely eligible families (as proxied by income) were not receiving SNAP benefits 6-mos into therapy. Further, receipt of SNAP was inadequate to ameliorate FI in this cohort, with ~60% of SNAP recipients reporting concurrent FI both at T0 and T1. Ensuring successful connection of eligible families to existing benefits is an essential first step. However, high rates of FI among SNAP recipients indicate that resource navigation, though necessary, is not sufficient to address FI for this population. These data provide immediate targets for health equity interventions—including systematic benefits navigation, direct resource provision, and policy-based approaches for benefits augmentation—to address adverse SDoH and improve cancer outcomes. Citation Format: Rahela Aziz-Bose, Yael Flamand, Puja J. Umaretiya, Lenka Ilcisin, Ariana Valenzuela, Peter D. Cole, Lisa M. Gennarini, Justine M. Kahn, Kara M. Kelly, Bruno Michon, Thai-Hoa Tran, Jennifer J. G. Welch, Lewis B. Silverman, Kira Bona. Food insecurity and receipt of Supplemental Nutrition Assistance Program (SNAP) benefits among income-eligible US pediatric acute lymphoblastic leukemia patients enrolled on a multi-center clinical trial [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B096.

Understanding Impacts of SNAP Fruit and Vegetable Incentive Program at Farmers' Markets: Findings from a 13 State RCT.

Disparities in healthy food access and consumption are a major public health concern. This study reports the findings from a two-year randomized control trial conducted at 77 farmers’ markets (FMs) in 13 states and the District of Columbia that sought to understand the impact of fruit and vegetable (FV) incentive vouchers, randomly issued at varied incentive levels to Supplemental Nutrition Assistance Program (SNAP) recipients, for use at FMs. Measures included FV and overall household food purchasing; FV consumption; food insecurity; health status; market expenditure; and demographics. A repeated-measures mixed-effects analysis and the Complier Average Causal Effect (CACE) were used to examine outcomes. Despite 82% reporting food insecurity in the prior year, the findings showed that financial incentives at FMs had statistically significant, positive effects on FV consumption; market expenditures increased with added incentives. SNAP recipients receiving an incentive of USD 0.40 for every USD 1.00 in SNAP spent an average of USD 19.03 per transaction, while those receiving USD 2 for every USD 1 (2:1) spent an average of USD 36.28 per transaction. The data showed that the incentive program at the highest level (2:1) maximally increased SNAP FM expenditure and FV consumption, increasing the latter by 0.31 daily cups among those who used their incentive (CACE model).

Retail Food Environment for SNAP Recipients in Rural Tennessee: A Case Study

ObjectivesThe retail food environment can contribute to high rates of obesity, especially in low-income rural areas. The objectives of this work were to 1) explore food access for Supplemental Nutrition Assistance Program (SNAP) recipients in a high-obesity rural county, and 2) create an educational resource for the county’s SNAP recipients to both understand their retail food environment and locate healthy food options covered by SNAP benefits. MethodsWe first identified all SNAP-authorized retailers in the county, using the United States Department of Agriculture data source. Later, we identified the locations of retailers, using Google Maps. We verified these data with our on-the-ground team members in the county. We then separated out the list into retailers that sell fresh produce and those that do not. Using this information, we utilized ArcGIS Online to create an interactive map of county food resources, identifying which retailers sell fresh produce. We also mapped relevant sociodemographic factors (race, income, and vehicle access) by census tract, to assess within-county differences. ResultsOur interactive GIS map provided a visualization of the county’s retail food environment and relevant sociodemographics. Median income in each census tract ranged from $34,388 to $44,688, well below the national average of $69,560. The racial composition of the county was mixed, with percentage black ranging from 8% to 51.1%. Vehicle access was low in central areas of the county, where roughly 10% of households lack access to a vehicle. In this fairly large county, with 670 square miles of area, we identified 25 stores that accept SNAP benefits (about 30% of the total retailers). Of these 25 stores, only 5 sell fresh produce. Access to these retailers, particularly those which sell fresh produce, is limited for most residents. Some residents of the county have to travel upwards of 20 miles to reach a store that both accepts SNAP and sells fresh produce. ConclusionsOur illustration of factors limiting food access can inform community development projects by identifying areas of need in the county. Also, our publicly available interactive map can educate residents about available food resources in their county. Funding SourcesCenters for Disease Control and Prevention (CDC).

Trends in 10-Year Predicted Risk of Cardiovascular Disease Associated With Food Insecurity, 2007-2016.

IntroductionConsumption of a healthy diet improves cardiovascular (CV) risk factors and reduces the development of cardiovascular disease (CVD). Food insecure (FIS) adults often consume an unhealthy diet, which can promote obesity, type 2 diabetes mellitus (T2DM), hypertension (HTN), and hyperlipidemia (HLD). The Supplemental Nutrition Assistance Program (SNAP) is designed to combat food insecurity by increasing access to healthy foods. However, there is a paucity of data on the association of SNAP participation among FIS adults and these CVD risk factors.MethodsThe National Health and Nutrition Examination Survey (NHANES) is a publicly available, ongoing survey administered by the Centers for Disease Control and Prevention and the National Center for Health Statistics. We analyzed five survey cycles (2007–2016) of adult participants who responded to the CVD risk profile questionnaire data. We estimated the burden of select CVD risk factors among the FIS population and the association with participation in SNAP.ResultsAmong 10,449 adult participants of the survey, 3,485 (33.3%) identified themselves as FIS. Food insecurity was more common among those who were younger, female, Hispanic, and Black. Among the FIS, SNAP recipients, when compared to non-SNAP recipients, had a lower prevalence of HLD (36.3 vs. 40.1% p = 0.02), whereas rates of T2DM, HTN, and obesity were similar. Over the 10-year survey period, FIS SNAP recipients demonstrated a reduction in the prevalence of HTN (p < 0.001) and HLD (p < 0.001) which was not evident among those not receiving SNAP. However, obesity decreased only among those not receiving SNAP. The prevalence of T2DM did not change over the study period in either group.ConclusionOver a 10-year period, FIS adults who received SNAP demonstrated a reduction in the prevalence of HTN and HLD, which was not seen among those not receiving SNAP. However, the prevalence of obesity and T2DM did not decline among SNAP recipients, suggesting that additional approaches are required to impact these important CVD risk factors.

Economic Hardship, Sleep, and Self-Rated Health

The Supplemental Nutrition Assistance Program (SNAP) distributes vouchers for grocery shopping to around 43 million individuals across the United States to counteract food insecurity. In this study, we take advantage of the random interview day assignment of the American Time Use Survey (ATUS) and the variation in voucher issuance dates across states to identify changes in self-rated health and sleep over the monthly SNAP payment cycle. We find that the economic hardship experienced at the end of the payout period causes a significant and sizable negative effect on self-assessed physical health and sleep quality. SNAP recipients were 18 percent more likely to report fair or poor physical health at the end of the payment cycle compared with the rest of the month. During this period of scarcity, recipients were also 50 percent more likely to report sleeplessness, with the number of minutes being sleepless more than doubling while total sleep duration remained unchanged. Drawing upon information on time use in the ATUS, we discuss evidence suggesting that higher levels of stress, changed eating patterns, and reduced sleep quality may be potential mechanisms of the adverse health effects. Our findings extend the literature on sleep quality as a mediator between low socioeconomic status and self-rated health in the short run.

"Now I Feel a Little Bit More Secure": The Impact of SNAP Enrollment on Older Adult SSI Recipients.

In June 2019, California expanded Supplemental Nutrition Assistance Program (SNAP) eligibility to Supplemental Security Income (SSI) beneficiaries for the first time. This research assesses the experience and impact of new SNAP enrollment among older adult SSI recipients, a population characterized by social and economic precarity. We conducted semi-structured, in-depth interviews with 20 SNAP participants to explore their experiences with new SNAP benefits. Following initial coding, member-check groups allowed for participants to provide feedback on preliminary data analysis. Findings demonstrate that SNAP enrollment improved participants’ access to nutritious foods of their choice, contributed to overall budgets, eased mental distress resulting from poverty, and reduced labor spent accessing food. For some participants, SNAP benefit amounts were too low to make any noticeable impact. For many participants, SNAP receipt was associated with stigma, which some considered to be a social “cost” of poverty. Increased benefit may be derived from pairing SNAP with other public benefits. Together, the impacts of and barriers to effective use of SNAP benefits gleaned from this study deepen our understanding of individual- and neighborhood-level factors driving health inequities among low-income, disabled people experiencing food insecurity and SNAP recipients.

Investigating the Feasibility of a Restaurant Delivery Service to Improve Food Security among College Students Experiencing Marginal Food Security, a Head-to-Head Trial with Grocery Store Gift Cards.

Restaurant delivery services have gained in popularity among college students; however, students participating in the Supplemental Nutrition Assistance Program (SNAP) are not allowed to redeem their benefits via restaurant delivery services. This mixed-methods head-to-head crossover trial assessed whether college students experiencing marginal food security prefer benefits via a grocery store gift card (as a proxy for traditional SNAP benefits) or via a restaurant delivery service gift card of equivalent value, and which type of benefit is more effective at improving food security status. Thirty college students experiencing marginal food security were recruited to receive $80 in cash equivalent benefits to spend over a two-month period in the form of grocery store gift cards and restaurant delivery service gift cards. Participants completed surveys and interviews to measure their food security status and share their experiences with each benefit type. After four months of benefits, 48.3% of participants improved their food security status. However, neither type of benefit was statistically better at improving food security status. Most participants preferred grocery store benefits (89.7%) over restaurant delivery service benefits (10.3%). However, more research is needed to explore whether allowing SNAP recipients to redeem their benefits with restaurant delivery services is a viable mechanism to address food challenges among college students experiencing marginal food security.

Higher Fruit and Vegetable Intake Is Associated with Participation in the Double Up Food Bucks (DUFB) Program.

Incentivizing fruit and vegetable (F&V) purchases may help address barriers to healthy eating among populations with low income. In a repeated measures natural experiment study, we examined whether participation in the Double Up Food Bucks (DUFB) program increased F&V consumption among Supplemental Nutrition Assistance Program (SNAP) recipients. Two hundred and twelve participants recruited at baseline through telephone calls were informed about the availability of DUFB at their local farmers’ market (FM). F&V consumption frequency and DUFB use were obtained at baseline, mid FM, and end of FM season approximately 5 months later. Participants (N = 212) were primarily white (76.4%) women (77.3%) with an average age of 43.5 years. Only 34 participants opted to use the DUFB program. A linear mixed model showed a significant main effect of DUFB use (p = 0.001) and of time (p = 0.002), with a decrease in F&V intake over time. Compared to non-users, DUFB users had a significantly higher F&V consumption at baseline and midpoint (p = 0.02 and p = 0.02, respectively). F&V consumption was associated with participation in the DUFB program and higher F&V consumption frequency was observed prior to program use among program participants. Future interventions that specifically target SNAP recipients with low F&V intake to use the DUFB program are needed.

P7 You SNAP, We Match: Improving Food Access and Stimulating a Rural, Local Food System During a Public Health Crisis

<h3>Objective</h3> The objective of this study is to evaluate the implementation of a rural farmer's market You SNAP, We Match (YSWM) program during the COVID-19 pandemic. <h3>Theory of Research</h3> In 2018, the St. Helena Healthy Communities Coalition held a forum to develop strategies to improve community health. Participants identified that a local farmer's market accepting Supplemental Nutrition Assistance Program (SNAP) benefits was no longer operational and reopening the market with SNAP would increase food access and improve community health. <h3>Target Audience</h3> SNAP recipients in a rural, majority Black parish in Louisiana. <h3>Program Description</h3> The St. Helena Farmer's Market YSWM program launched during the COVID-19 pandemic (July 2020), offering a $3 match for fresh fruit and vegetables for every $1 in SNAP benefits spent at the market. <h3>Evaluation Methods</h3> Observational data (customer counts, zip codes, and vendor sales) were collected at the market before and after the implementation of the YSWM program. <h3>Results</h3> Prior to implementation, the market averaged 33 customers per day. Five months following implementation, the market averaged 76 customers per day (+131.42%), and a total of $6,6213 SNAP and "match" dollars were reinvested into the local food system. Market reach also expanded. Prior to YSWM implementation, a majority of customers (95%) resided in the same town as the market. Following implementation, 66% of market customers resided in the market town (with 5% coming from over 30 miles away). More than half of SNAP customers reported being first time customers, with 92% reported visiting the market specifically for SNAP. <h3>Conclusion</h3> Since implementation, the YSWM program has remained successful while confronting unique challenges. YSWM Program implementation generated an increase in market customers, a wider geographical reach, and increased access to fresh produce for surrounding communities during a public health crisis.

Association of Funding and Meal Preparation Time With Nutritional Quality of Meals of Supplemental Nutritional Assistance Program Recipients

The Supplemental Nutrition Assistance Program (SNAP) is a federal program that provides food-purchasing assistance to low-income people; however, its current design does not account for the time availability of SNAP recipients to prepare meals. To evaluate the association of the availability of funding for food purchases and time for meal preparation with the nutritional quality of meals of SNAP recipients. This study used decision analytical modeling to evaluate the nutritional quality of meals of SNAP recipients. The model was developed from February 6, 2017, to December 12, 2020, using data from 2017 and is based on discrete optimization. The model describes food and grocery purchasing, in-home meal preparation, and meal plan choices of a family of SNAP participants (2 adults and 2 children) while considering food preferences, meal preparation time, and food costs. The model assumes food preferences match the foods typically purchased by SNAP households. Costs of food ingredients and prepared foods are taken from a single zip code. Time availability and total amount and type of funding were varied. Allowing prepared delicatessen foods and disallowing frozen prepared foods for purchase using SNAP funds were considered. The primary outcome was the number of home-cooked meals and the amounts of fruits, vegetables, protein, sodium, sugar, and fiber consumed from generated meal plans. Amounts were evaluated as a percentage of the quantity recommended by established dietary guidelines. Increased time availability was associated with increases in the percentage of home-cooked meals and servings of fruits/vegetables and decreased sodium consumption. Higher levels of funding were associated with increased consumption of fiber, fruits/vegetables, protein, sodium, and sugar. With 20 min/d of cooking time, $400/mo of SNAP benefits, and $100/mo of self-funding, the meal plan had a mean (SE) of 20.1% (0.3%) of meals home cooked, 0.5 (<0.1) servings/d per person of fruits/vegetables, 100.3% (0.6%) of daily recommended protein per person, 115.1% (0.8%) of daily recommended sodium per person, 241.8% (1.0%) of daily recommended sugar per person, and 31.2% (0.3%) of daily recommended fiber per person. With 20 min/d of cooking time, $400/mo of SNAP benefits, and $600/mo of self-funding, the meal plan had a mean (SE) of 23.9% (1.0%) of meals home cooked, 2.8 (0.1) servings/d per person of fruits/vegetables, 134.9% (1.6%) of daily recommended protein per person, 200.9% (3.1%) of daily recommended sodium per person, 295.1% (3.1%) of daily recommended sugar per person, and 90.1% (1.0%) of daily recommended fiber per person. With 60 min/d of cooking time, $400/mo of SNAP benefits, and $100/mo of self-funding, the meal plan had a mean (SE) of 52.7% (0.9%) of meals home cooked, 1.4 (<0.1) servings/d per person of fruits/vegetables, 109.0% (1.1%) of daily recommended protein per person, 108.7% (1.0%) of daily recommended sodium per person, 298.6% (2.0%) of daily recommended sugar per person, and 38.8% (0.4%) of daily recommended fiber per person. With 60 min/d of cooking time, $400/mo of SNAP benefits, and $600/mo of self-funding, the meal plan had a mean (SE) of 42.8% (1.2%) meals home cooked, 4.3 (0.1) servings/d per person of fruits/vegetables, 144.4% (1.8%) of daily recommended protein per person, 165.2% (2.8%) of daily recommended sodium per person, 322.4% (2.4%) of daily recommended sugar per person, and 91.0% (0.9%) of daily recommended fiber per person. In this decision analytical model, meal preparation time was associated with the ability of SNAP recipient families to consume nutritious meals, suggesting that increased funding alone may be insufficient for improving the nutritional profiles of SNAP recipients. Given the current US food supply, governmental interventions that provide the equivalence in increased time availability to achieve nutritious meals may be needed.

Elevated Dietary Inflammation Among Supplemental Nutrition Assistance Program Recipients Provides Targets for Precision Public Health Intervention

The Supplemental Nutrition Assistance Program was designed to prevent food insecurity among low-income Americans and has been linked to improvements in pregnancy health, long-term child development, and criminal recidivism. However, the pursuit of food security does not ensure nutritional sufficiency, and the program has not improved diet quality or cardiometabolic mortality (i.e., heart disease, stroke, diabetes). In this study, longitudinal cohort data are used to identify by Supplemental Nutrition Assistance Program status the proinflammatory characteristics that predispose to chronic disease. Between 2015 and 2018, annual 24-hour dietary recalls were conducted with 409 residents from low-income, urban neighborhoods in Columbus and Cleveland, Ohio (statistical analysis started in 2019). The Dietary Inflammatory Index was calculated. It provides empirically validated estimates of the internal inflammation that each diet should produce; higher Dietary Inflammatory Index scores have been associated with elevated inflammatory biomarkers. Finally, associations between Supplemental Nutrition Assistance Program and Dietary Inflammatory Index were evaluated, and dietary components that differed by Supplemental Nutrition Assistance Program status were identified. Supplemental Nutrition Assistance Program recipients had higher Dietary Inflammatory Index scores (+0.40, 95% CI=0.09, 0.70) and a consistently lower intake of 4 anti-inflammatory nutrients (dietary fiber, β-carotene, magnesium, vitamin E) than nonrecipients. Vitamin D intake did not differ by Supplemental Nutrition Assistance Program status but was well below the Recommended Daily Allowance in this sample. Supplemental Nutrition Assistance Program recipients had elevated Dietary Inflammatory Index scores, implying higher diet-driven inflammation. This was due, in part, to low intake of 4 anti-inflammatory food components, which were higher yet still nutritionally insufficient among nonrecipients. Findings highlight specific nutritional targets for improving public health through dietary change.

Working for Your Bread: The Labor Supply Effects of SNAP

The Supplemental Nutrition Assistance Program (SNAP), the only universal US means-tested safety net program, has a low benefit-reduction rate. Thus, many SNAP recipients are working. We apply recent methods to study whether there is evidence of moral hazard among SNAP recipients. We see if individuals respond to incentives in SNAP eligibility by bunching near kink points in the budget set. While this responsiveness has been shown for various taxes and tax credits, little work has examined responsiveness of safety net program participants to kinks in their eligibility formulae. We use novel administrative data on eligibility determination and find little evidence of responsiveness around these kinks.

Changes in key food purchasing practices of Supplemental Nutrition Assistance Program (SNAP)-eligible older adults following SNAP benefit receipt.

Little is known about how the utilization of Supplemental Nutrition Assistance Program (SNAP), the largest federal food assistance program, affects food purchasing practices (FPP) among low-income older adults who typically have low SNAP participation rates. This study examined changes in FPP of SNAP-eligible non-participating older adults as they became SNAP recipients. A longitudinal mixed-methods approach was employed to assess six key FPP constructs among 10 SNAP-eligible non-participating older Georgians (median age: 65.5 [IQR 62.5, 73.25], 80% female, 100% African American) at three time points: (a) before SNAP benefit receipt, (b) 1 month after SNAP benefit receipt, and (c) 3 months after SNAP benefit receipt. Data were collected using individual in-depth interviews, interviewer-administered surveys, food purchase receipt collection, and grocery shopping trip observations. Appropriate exploratory and descriptive data analyses were conducted. Changes occurred in all six FPP constructs following SNAP benefit receipt. Participants shopped primarily at supermarkets, reporting shopping fewer times per month, while increasing the number of purchases per trip. Participants supplemented their SNAP benefits with their own money, reported spending more on groceries, purchased more types of foods, and employed strategies like comparison shopping. The findings suggest that SNAP benefit receipt affects FPP of low-income older adults and that identifying changes in key FPP related to SNAP benefit receipt could inform strategies to maximize the impact of SNAP benefits on improving food security and nutrition of low-income older Americans.

A Consideration of the Evaluation of Demonstration Projects to End Childhood Hunger (EDECH)

A Consideration of the Evaluation of Demonstration Projects to End Childhood Hunger (EDECH)

The Use of Charitable Food Assistance Among Low-Income Households in the United States

BackgroundAbout 11% of US households are food insecure, and many of those households seek charitable food assistance (CFA). However, little is understood about the nutritional composition of the diets of households receiving CFA, or the relationship between CFA and Supplemental Nutrition Assistance Program (SNAP) usage among low-income households. ObjectiveThe aim of the study was to compare the nutritional quality of foods obtained by CFA clients to those of similar nonclients. Furthermore, the study examined the timing of CFA use relative to the timing of SNAP use among CFA clients during the week. Design/participantsAnalyses were conducted using 2012 US Department of Agriculture National Household Food Acquisition and Purchase Survey (FoodAPS), which collected data for 4826 households’ food acquisitions during a 7-day survey week. Sixty-seven households reported using CFAs during the survey week. Main outcomes measureThe nutritional quality of food was measured by the ratios between food acquisition quantities and the US Department of Agriculture Thrifty Food Plan consumption recommendations. The date of SNAP use was compared with that of CFA use for CFA clients who were also SNAP recipients. Statistical analyses performedPropensity score matching was utilized to construct a matching sample of CFA clients and nonclients. T tests were used to compare the means of variables. ResultsCFA clients were more likely to be food insecure (48% vs 28%, P < .001) and less likely to have access to a car (61.2% vs 84.8%, P < .001) than CFA nonclients. CFAs represent an important source of foods for CFA clients, taking up 28% of their total food at home acquisitions. CFA clients obtained more nonstarchy vegetables than matched nonclients. Furthermore, among the 45% of CFA clients who also participated in SNAP, the majority (52.4%) of them used SNAP benefits within 10 days of SNAP benefits distribution while most (67.9%) of those households used CFAs starting on day 11 or later after SNAP benefits were allocated. ConclusionsCFAs provide a substantial portion of the diets of their clients and, in particular, for foods that constitute components of healthy diets. For the proportion of CFA clients who received SNAP, this study finds evidence that CFA clients relied more on CFAs when their SNAP benefits were likely to run low.