Nutrition Assistance Program Research Articles

The FINDING-Food Intervention: A Mixed-Methods Feasibility Study Addressing Food Insecurity

Food insecurity is an economic and social condition involving limited or uncertain access to food. The problem of food insecurity in communities is influenced by economic conditions, food deserts, and barriers to accessing healthy food. Individuals experiencing food insecurity often endure concurrent problems of financial instability, hunger, and poor mental and physical health. Public and non-profit services in the U.S., such as the federally supported Supplemental Nutrition Assistance Program (SNAP) and community food banks, provide food-related assistance to individuals who are at a high risk of experiencing food insecurity. Unfortunately, many individuals who qualify for these services still experience food insecurity due to barriers preventing them from accessing food. Effective approaches for removing barriers that prevent individuals from accessing food are needed to mitigate the increased risk of chronic disease among vulnerable populations. This study tested a novel food insecurity intervention called FINDING-Food, which stands for Frequent Informational Nudges Directing Individuals to Needed Goods. Informational nudges were used to promote food security through the removal of information barriers to accessing food. The intervention used in this mixed-methods feasibility study consisted of informational nudges in the form of weekly text messages that were sent to food pantry clients experiencing food insecurity (n = 24). The study aims were to test the efficacy and acceptability of the intervention by examining whether the informational nudges could enhance food pantry utilization, increase SNAP registration, and promote food security. Quantitative study results showed a lower prevalence of food insecurity in the intervention group than the control group at the end of the study. Qualitative findings revealed how intervention group participants who completed the study (n = 9) found the text messages to be helpful and informative. These study findings can enhance future food insecurity interventions aiming to eliminate barriers that prevent individuals who are food insecure from accessing healthy food.

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.

Measuring take-up of the California EITC with state administrative data

The Earned Income Tax Credit (EITC) is the largest cash-based means-tested transfer program in the United States. In 2021, 31 million households received $64 billion from the federal EITC. Twenty-eight states also offer eligible taxpayers a supplement to the federal program. An estimated one-fifth of eligible households fail to claim the federal credit, but little is known about take-up of these state programs. We use administrative data from California on the population of Supplemental Nutrition Assistance Program (SNAP) recipients linked to state tax records to estimate the number of households who are eligible for California’s supplement to the federal EITC (CalEITC) but do not claim it. We find that over 400,000 households who received SNAP benefits and who were eligible for the state EITC in 2017 did not receive the credit. This includes approximately 40,000 eligible households who claimed the federal EITC but not the state credit; nearly 98,000 eligible households who filed a state tax return but did not claim the state or federal credit; and roughly 270,000 eligible households who did not file a state tax return. The corresponding take-up rate for the CalEITC among eligible SNAP-enrolled households was 54%. Altogether, these households left a total of $71 million in state EITC funds on the table. If received, these credits would have increased incomes among these households by 2.7% and increased total state EITC outlays by 20%.

“Who Can Actually Live on the Amounts They Told us?”: Older adults’ Experiences with the Supplemental Nutrition Assistance Program

ABSTRACT Nearly 10% of older adults reported food insecurity in 2021. The Supplemental Nutrition Assistance Program (SNAP) aims to reduce food insecurity by providing low-income households with benefits to purchase food. Twenty-one older adults discussed their experiences with SNAP during three focus groups. Thematic analysis indicated that benefits were appreciated but insufficient. Participants identified challenges to applying, using, and maintaining benefits in part due to age-related limitations. The results provide evidence that improved nutrition among older adults will require increasing benefit amounts, reducing paperwork, and easing restrictions on the use of benefits to purchase prepared foods.

The Supplemental Nutrition Assistance Program Online Purchasing Pilot’s impact on food insufficiency

Mandated under the 2014 Farm Bill, the Supplemental Nutrition Assistance Program (SNAP) Online Purchasing Pilot (OPP) was initially intended to test the feasibility of allowing online SNAP benefit redemption for groceries. In early 2020, the OPP was rapidly expanded to address pandemic-induced barriers to food access among SNAP households in the United States. Using data from the Census Bureau's Household Pulse Survey and a difference-in-difference framework (that exploits state variation in OPP implementation), we examine the effects of the rapid initial expansion of OPP on food sufficiency among low-income families. Results obtained indicate the OPP decreased food insufficiency among low-income adults by 2 percentage points (an 8 percent decrease relative to mean food insufficiency). Additional analyses suggest online benefit redemption improved food sufficiency by mitigating food access barriers, especially affecting racial minorities and married individuals. Given the unprecedented food access barriers during the rollout period, future research should consider the effect of online benefit redemption in subsequent years on food hardship and accessibility.

The Design and Impact of a Clinic-Based Community Program on Food Insecurity, Healthy Eating Behaviors, and Mood.

Food insecurity is a national issue that disproportionately impacts Louisiana citizens, contributing to the state's poor health outcomes. We know that the Supplemental Nutrition Assistance Program (SNAP) and food pantries improve access to food, but we have limited data on what interventions improve food insecurity. The Geaux Get Healthy Clinical Program at Our Lady of the Lake (GGHOLOL) is a clinic-based community program that leverages community partnerships and a clinical setting to provide education and access to resources for individuals with food insecurity. This prospective study examines the impact of GGHOLOL on food insecurity as a pre-post survey evaluation over a two-year period. A total of 57 research participants with food insecurity completed the program. Mean food security scores improved at completion of GGHOLOL, and these scores further improved 6 months after enrollment. Furthermore, participants demonstrated sustainable improvements in healthy eating, cooking, and shopping behaviors. Lastly, participants improved their overall depression scores at the completion of the program with sustainable improvement at 6 months. With the improvement in GGHOLOL on food insecurity and nutrition behaviors, GGHOLOL may serve as a model for other programs addressing food insecurity in the future.

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.

State expansion of supplemental nutrition assistance program eligibility and rates of interpersonal violence

IntroductionFood insecurity is associated with an increased likelihood of interpersonal violence. The Supplemental Nutrition Assistance Program (SNAP) is the largest program addressing food insecurity in the U.S. States can eliminate the asset test and/or increase the income limit for SNAP eligibility, expanding the number of households receiving assistance. We examined the association of state elimination of the asset test and increases in the income limit with rates of interpersonal violence, including intimate partner violence (IPV), other relationship violence (violence by a parent, friend, etc.), and stranger violence. MethodsWe used data from the SNAP Policy Database and state-level estimates of rates of interpersonal violence per 1000 population ages ≥12 years from the 2012–2014 to 2016–2018 National Crime Victimization Survey. ResultsStates that adopted both SNAP eligibility policies (eliminated the asset test and increased the income limit) had a lower rate of IPV (β = −0.4, 95% CI -0.9, 0.0) and other relationship violence (β = −2.4, 95% CI -3.8, −1.1) compared to states that did not adopt either policy. The rate of stranger violence (β = −0.5, 95% CI -2.3, 1.4) did not differ for states that adopted both policies compared to states that did not adopt either policy. Rates of IPV (β = −0.4, 95% CI -0.9, 0.2), other relationship violence (β = −1.2, 95% CI -3.2, 0.7), and stranger violence (β = −0.2, 95% CI -2.0, 1.6) did not differ for states that eliminated the asset test only compared to states that did not adopt either policy. ConclusionExpanding SNAP eligibility may help prevent interpersonal violence at the population-level.

The Design and Testing of a Text Message for Use as an Informational Nudge in a Novel Food Insecurity Intervention

Food insecurity is an ongoing problem in the U.S. with implications for health problems and social disadvantages. Past food insecurity intervention studies have targeted barriers to accessing healthy food. However, information barriers have not been adequately addressed by food insecurity interventions. This research included the first phase of a two-phase feasibility study that involved testing a text message as an informational nudge through interviews among a small, preliminary sample of adults in the southwest U.S. (n = 10). Interview questions focused on the message content, persuasiveness, relevancy, clarity, and details that participants liked and disliked. A qualitative content analysis of interview responses then highlighted any necessary modifications to the text message. Interview responses highlighted that the message conveyed details about how to access food assistance resources. The message was perceived as informative, clear, and friendly. Participants highlighted the need for better spacing in the message layout, more details about the Supplemental Nutrition Assistance Program (SNAP), and a better explanation for why SNAP is relevant. Text message readability, relevancy, and informativeness were common concerns raised during interviews. Participant-informed modifications to the text message were applied in preparation for using the message in a food insecurity intervention. This research is a novel contribution to the extant literature on nudges, as no known intervention study has used informational nudges to exclusively promote food security. Future food insecurity research efforts should similarly test novel interventions to ensure the intervention is acceptable and relevant for the target population.

A Mixed-Methods Study of Perceived Implementation Challenges for WIC Online Ordering and Transactions.

Federal food assistance programs are working towards online grocery shopping. Online ordering in Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is emerging following successful implementation in Supplemental Nutrition Assistance Program (SNAP). To identify anticipated challenges, potential solutions, and expected costs of WIC online ordering. Cross-sectional, mixed-methods, web-based, survey research. Data were collected from December 2020 to January 2021. Purposeful and snowball sampling included WIC stakeholders involved in developing processes and systems required for WIC online ordering. Respondents represented diverse geographic areas, levels of intraorganizational authority, and WIC benefit card types. The research team used a rapid analysis and lean coding approach to identify emergent themes from open-ended survey responses. Descriptive statistics were used to describe the distribution of responses across themes and stakeholder types. Respondents (n= 145) described 812 anticipated challenges within 20 themes grouped into five topic areas: rules and regulations; shopping experience; security, confidentiality, fraud, and WIC State agency processes; training, assistance, and education; and equitable access and buy-in. Addressing anticipated regulatory issues were among the few concrete potential solutions described. The two most frequent costs reported were increased staff time and start-up and ongoing technology costs. This study identified several, critical anticipated challenges and considerations that will help prepare WIC state agencies for opportunities to expand online ordering to WIC participants.

Medicaid And SNAP Advance Equity But Sometimes Have Hidden Racial And Ethnic Barriers.

Medicaid and the Supplemental Nutrition Assistance Program were developed during the Civil Rights era to help poor people and reduce racial and ethnic differences in health care access and food security. Although the two programs have succeeded in narrowing health and nutrition disparities, certain policies hinder goals of racial and ethnic equity, even though they do not explicitly mention race or ethnicity. These policies, including administrative policies (such as work requirements) and more basic decisions about whether to cover immigrants or expand Medicaid, can create barriers that promote racial and ethnic disparities, contrary to the programs' underlying goals.

Race And Racial Perceptions Shape Burden Tolerance For Medicaid And The Supplemental Nutrition Assistance Program.

Safety-net programs do not reach all eligible Americans, partly because of administrative burden, or experiencing bureaucratic obstacles in obtaining and maintaining program benefits. This burden often disproportionately affects historically marginalized groups, adding concerns about equity. We used a national survey to examine public thinking about the acceptability of administrative burdens imposed by states when implementing Medicaid and the Supplemental Nutrition Assistance Program and the role of race in these considerations. We found that support for state actions associated with six types of burden was unchanged when respondents were informed about disparate effects by race. Neither racial identity nor prejudice toward other racial groups was associated with support for policies imposing higher burdens. However, non-Hispanic White respondents with higher levels of racial resentment were more supportive of policies that would create burden, whereas respondents who believed that burdens had disparate effects on historically disadvantaged groups favored less burdensome alternatives. Also associated with lower support for more burdensome policies were responses indicative of respondents' empathy, concerns about ability to manage burdens, Democratic party identification, and program experience.

Promoting health equity through poverty alleviation policy: Factors associated with receipt of the 2021 U.S. Child Tax Credit in a nationwide sample

IntroductionThe 2021 temporary expansion of the U.S. Child Tax Credit (CTC) was a potent policy that addressed poverty as a critical social determinant of health. Yet policies can only have their intended effects if they are implemented appropriately, and it is well known that not all who were eligible for the CTC received it. In this study, we investigated which individual- and state-level factors were correlated with receipt of the 2021 expanded CTC among eligible families. MethodsWe used data from the U.S. Census Bureau Household Pulse Survey and included 76,994 CTC-eligible individuals. We used multivariable logistic regressions to evaluate individual- and state-level factors associated with self-reported CTC receipt during July–December 2021. ResultsRoughly two-thirds of the CTC-eligible sample reported CTC receipt. CTC receipt was higher among eligible individuals who were female, aged 35–44 years (relative to younger individuals), Black, and married. Receipt was also higher among those with at least some college education, two or more children, and family income above $25,000, and among recipients of the Supplemental Nutrition Assistance Program (SNAP) and Medicaid. For state-level factors, SNAP and Medicaid caseloads and the state earned income tax credit rate were associated with decreased receipt. ConclusionAs Congress debates whether to make the CTC expansion permanent, this study provides timely evidence to inform poverty alleviation programs to increase participation among eligible and marginalized groups and achieve health equity.

Empathy through Data? Student Exploration of Elements of Diversity through Projects in an Introductory Statistics Course

A project involving data related to socioeconomic indicators was administered in an introductory statistics course. As part of this project, student groups investigated a data set from the United States Department of Agriculture Food and Nutrition Service website with information on recipients of Supplemental Nutrition Assistance Program (SNAP) benefits. Pre/post data from the Miville-Guzman Universality-Diversity Scale (M-GUDS) short form were collected to measure changes in diversity awareness. The survey administered also included demographic information and open-ended questions. Based on study results (n = 48), there was moderate evidence of a change in the diversity of contact subscale of the M-GUDS short form. Written feedback indicated that students demonstrated empathy for individuals with potentially different lived experiences. The focus of this paper is to describe the study results and provide information on the importance of incorporating elements of diversity into curriculum.

Does Living near Public Transport Equate to Food (In)Security in the United States?—Evidence from the 2020 National Health Interview Survey (NHIS)

Food security is intrinsically related to health and well-being. This paper investigates the status quo of food insecurity among the population residing close to transit in various parts of the United States of America (USA). The data from the 2020 National Health Interview Survey (NHIS) collected by the National Center for Health Statistics (NCHS) of the USA are analyzed in this research. Logistic regression is carried out by treating food insecurity as the dependent variable and socioeconomic variables such as age, income, education, and dependency on the Supplemental Nutrition Assistance Program (SNAP) as independent variables. Food insecurity is assessed with aggregated information on four aspects of inputs from those respondents who live near a transit: (1) worry food would run out; (2) food did not last; (3) could not afford to eat balanced meals; and (4) cut the size of meals or skipped meals. Findings suggest that respondents who live close to public transit in the USA and are from large central metro counties of the Northeastern, Southern, and Western states showed an increase in food insecurity if they were under 65 years of age, had income below the country’s median income, or their educational attainment was below bachelor’s degree. There was a significant association found in food insecurity of respondents living close to transit and subscribed to using food stamps or SNAP. Policies that could alleviate food insecurity by reducing the cost of living near transit are recommended.

Low-Income Asian Americans: High Levels Of Food Insecurity And Low Participation In The CalFresh Nutrition Program.

Little is known about food insecurity and the extent of Supplemental Nutrition Assistance Program (SNAP) participation in the heterogeneous Asian American population. Using California Health Interview Survey data from the period 2011-20, we examined both issues among low-income Asian American adults from six origin groups: Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese. We found high and varied levels of overall food insecurity, with the highest burden among Filipino adults (40percent). Food insecurity by severity was also heterogenous; very low food security affected 2percent of Chinese adults but 9percent and 10percent of Filipino and Japanese adults, respectively. Participation in CalFresh (California-implemented SNAP) ranged from 11percent and 12percent among Korean and Chinese adults, respectively, to 20percent among Vietnamese adults. Compared with English-proficient low-income Asian American adults, those with limited English proficiency were no less likely to participate in CalFresh, possibly reflecting language assistance required by California law and provided by community-based organizations. These results underscore the importance of collecting and reporting disaggregated data by Asian origin group that could inform targeted outreach and interventions.

Food Craving Increases Unhealthy Food Purchases: A Study of SNAP Households

Analysis of actual transactions in a grocery store shows that households enrolled in the U.S. government's Supplemental Nutritional Assistance Program (SNAP) purchase more unhealthy hedonic food, compared with households that do not receive SNAP benefits. SNAP households purchased more unhealthy hedonic food regardless of whether they used government funds or cash to pay for their purchases. Three follow-up simulated grocery shopping studies were designed to understand the mechanisms underlying this food consumption pattern by SNAP households. SNAP households, compared with households that do not receive SNAP benefits, reported stronger food craving. Stronger food craving was associated with lower unhealthiness perception of hedonic food. Overall, the results suggest that food cravings can reduce perceptions of unhealthiness and thus increase unhealthy food purchases. Interventions that reduce the effect of food cravings on shopping decisions might reduce unhealthy consumption.

Food stamps and America's poorest

AbstractThis paper assesses the extent to which Supplemental Nutrition Assistance Program (SNAP)—one of America's largest antipoverty programs—has reached the poorest. We compute a novel measure of the floor of income, an estimated income level of the poorest individuals in society. We measure the floor with and without SNAP benefits included in family income using 29 years of Current Population Survey (CPS) data. We correct for underreporting of SNAP participation and benefits for a subset of years and examine alternative data to assess the robustness of our findings. The analysis reveals a long‐term decline in the income floor, whereas adding SNAP to income and correcting for underreporting has reversed this decline and lifted the income floor by more than 75% on average between 2011 and 2016. The declining floor and the remarkable increase in income for the poorest Americans from SNAP are not revealed by poverty headcounts, which focus on changes at the poverty threshold.

Latent class analysis identifies a promising combination of Supplemental Nutrition Assistance Program-Education interventions for improving student cardiorespiratory fitness

ObjectiveTo inform Supplemental Nutrition Assistance Program Education (SNAP-Ed) and other school-based interventions aiming to improve youth cardiorespiratory fitness, this study aimed to identify which SNAP-Ed school-based physical activity intervention combinations were associated with better student cardiorespiratory fitness. MethodsThis study, utilizing cross-sectional secondary data, included 5th and 7th grade students who attended SNAP-Ed-eligible public schools in California (n = 442,743 students; 4271 schools) and had complete 2016–17 state-mandated fitness test results. Latent class analysis was used to identify underlying school-based intervention combinations. Propensity score methods were used to ensure comparability of intervention and comparison schools, by calculating inverse probability weights. Multilevel models, using those inverse probability weights, assessed the associations between the identified intervention combinations and student cardiorespiratory fitness, as measured by VO2max. The models were adjusted for school-level variables (urbanicity, percent of students eligible for free- or reduced-price meals, total enrollment, and school type), child-level variables (age, gender, and race/ethnicity), and for clustering of students within schools. ResultsWe found that students attending schools with interventions focusing on comprehensive policy changes along with improving opportunities for physical activity had, on average, 1.17 mL/kg/min (95% CI: 0.72, 1.62) greater VO2max than students attending schools without any intervention. They also had statistically significantly greater VO2max compared to students attending schools with any other type of intervention combination. ConclusionOur results suggest that comprehensive school-based physical activity interventions that include policy changes along with improving physical activity opportunities may be the most effective approach for improving fitness and may warrant prioritization in SNAP-Ed efforts.

Determinants of outpatient substance use disorder treatment length-of-stay and completion: the case of a treatment program in the southeast U.S

Successful outcomes of outpatient substance use disorder treatment result from many factors for clients—including intersections between individual characteristics, choices made, and social determinants. However, prioritizing which of these and in what combination, to address and provide support for remains an open and complex question. Therefore, we ask: What factors are associated with outpatient substance use disorder clients remaining in treatment for > 90 days and successfully completing treatment? To answer this question, we apply a virtual twins machine learning (ML) model to de-identified data for a census of clients who received outpatient substance use disorder treatment services from 2018 to 2021 from one treatment program in the Southeast U.S. We find that primary predictors of outcome success are: (1) attending self-help groups while in treatment, and (2) setting goals for treatment. Secondary predictors are: (1) being linked to a primary care provider (PCP) during treatment, (2) being linked to supplemental nutrition assistance program (SNAP), and (3) attending 6 or more self-help group sessions during treatment. These findings can help treatment programs guide client choice making and help set priorities for social determinant support. Further, the ML method applied can explain intersections between individual and social predictors, as well as outcome heterogeneity associated with subgroup differences.