Nutrition Assistance Program Research Articles

Association of Socioeconomic Variables with Primary Cesarean Section.

Socioeconomic characteristics may be associated with cesarean section (CS) rates. We probe the relationship between socioeconomic variables and primary cesarean section (PCS) by studying indicators of socioeconomic status (SES) in a population-based study in New York City. This was a retrospective study of all 80,506 women in New York City who gave birth to a live child during 2018, and who met inclusion and exclusion criteria. Data were drawn from the New York City Department of Health and Mental Hygiene and the US Census. The main outcome measure was performance of PCS as compared with vaginal birth. Approximately 21% of neonates were delivered by PCS. Multivariate multilevel mixed-effects logistic regression analysis showed higher odds for PCS for women with an upper-middle class median household income of US$108,500 to $380,499 (odds ratio [OR] 1.37, 95% confidence interval [CI] 1.07-1.76, P = 0.001), and the percentage enrolled in the Supplemental Nutrition Assistance Program (OR 1.01, 95% CI 1.001-1.012, P = 0.02). Lower odds for PCS occurred for all middle-class categories of per capita income: US$32,500 to $54,499 (OR 0.91, 95% CI 0.84-0.99, P = 0.02), US$54,500 to $108,499 (OR 0.76, 95% CI 0.66-0.88, P < 0.001), and US$108,500 to $380,499 (OR 0.80, 95% CI 0.66-0.96, P = 0.02). No significant association occurred for women receiving public assistance. Patient preferences in favor or against CS may be related to SES. There may be conflicts between obstetric care that is maximally beneficial and a patient's desire for delivery mode. Clinicians should be aware of the potential implications of this dilemma.

SNAP-Ed Supporting Innovative Nutrition Education for American Indian and Indigenous-Serving Organizations in Colorado

BackgroundSNAP-Education (SNAP-Ed) is the nutrition education component of the United States Department of Agriculture (USDA) Supplemental Nutrition Assistance Program (SNAP). ObjectiveTo elucidate the experiences of three Colorado-based, American Indian or Indigenous-led organizations who engaged in a SNAP-Ed pilot funding project in FY2022. MethodsAn instrumental, single case-study design was employed to conduct this evaluation. The multi-phase method evaluation included: listening sessions (n=8 Indigenous-serving organizations), invited request for proposals, pilot award funding (n=3 awarded organizations), and longitudinal, storytelling-based qualitative data collection during the funding cycle. ResultsThere are many ongoing food and nutrition education programs serving Indigenous/American Indian peoples in Colorado, which largely promote wellness and healing through traditional cultural practices and are not overtly framed as “nutrition education.” Two salient themes emerged: 1) defining and describing Indigenized, decolonized nutrition education; and 2) description of experiences working with SNAP-Ed funding during FY2022, including challenges and future opportunities. ConclusionsTo effectively address the priority area for SNAP-Ed funding to reach Tribal communities in each state, understanding the perspectives of Tribal and Indigenous-led communities who are new to SNAP-Ed funding is prudent. Next steps to continued co-creation of SNAP-Ed opportunities in Indigenous spaces include educating funders and policymakers on Indigenous ways of knowing; traditional food and nutrition practices; and importance of relationality, land, healing, and other Indigenous values. Determining the “success” of a program (e.g., program evaluation) needs to be defined by the community itself.

Lessons learned from implementing culturally sensitive adaptations to a nutrition education program in four Anishinaabe communities

BackgroundThe Anishinaabe ways of eating healthy and staying physically active are not well represented in federally funded health education programs like Supplemental Nutrition Assistance Program Education (SNAP-Ed). The curricula approved for use by SNAP-Ed implementing agencies was not developed with Anishinaabe foods, cultures and traditions in mind. ObjectiveThis paper shares the process and lessons learned from a collaborative effort to adapt recipes from a SNAP-Ed-approved nutrition and cooking education program, Cooking Matters® at Home (CMAH) to reflect cultural preferences and traditions of participants from four Anishinaabe tribal communities in Michigan. MethodsUniversity Extension instructors, tribal health staff and an inter-tribal organization co-designed and implemented the adaptation. Extension instructors facilitated four separate series of cooking and nutrition classes using CMAH curriculum with four Tribes. A descriptive, cross-sectional evaluation design focused on participant engagement and recipe adaptation. Evaluation included formative interviews with tribal health staff, post-intervention community participant focus groups to assess program satisfaction and cultural acceptability of adaptations, and process interviews with Extension instructors and tribal health staff. ResultsBetween October 3 and December 7, 2022, classes reached 30 adults across four sites. Average class size was 7-8 participants. 86% of participants attended every class session offered in their community. Eight recipes were adapted to include traditional foods (e.g., wild rice, maple syrup); eleven were prepared as written. A challenge was access and availability of some traditional recipe ingredients. Participants expressed a range of food knowledge and behaviors that reflect diverse histories and cultures within each community. Tribal staff and participants suggested that Extension instructors build rapport with community members, approach activities and participants with curiosity rather than sharing "expert" advice, implement more continuous programming, and improve cultural sensitivity. ConclusionsSNAP-Ed programs should support access to local indigenous foods and make space for both community and individual traditions.

Investigation of the Link Between Food Assistance Programs and Physical Activity Among Children and Adolescents.

While the direct benefits of food assistance programs are well-documented, there is a need to explore indirect benefits like increased physical activity. This study examined whether participation in the Supplemental Nutrition Assistance Program (SNAP) was associated with improved physical activity levels in children and adolescents aged 2-17 in the United States during 2017-2018. Study Design: A cross-sectional study. This cross-sectional study used a subset of National Health and Nutrition Examination Survey (NHANES) data (n=2620). In the NHANES 2017-2018 dataset, physical activity was measured through self-report questionnaires, which captured participants' frequency, duration, and intensity of various activities. We used weighted logistic regression and the Hosmer - Lemeshow - Sturdivant forward model - building strategy to investigate this hypothesized association using SAS version 9.4. In the adjusted model, controlling for the other variables in the model, we found that children and adolescents from households that had received SNAP/Food Stamps had 1.53 times higher odds (odds ratio [OR]=1.53, 95% CI: 1.24-1.89) of achieving the recommended guidelines of 60 minutes of daily physical activity compared to those who had not received benefits. Each additional year of age resulted in 0.82 times lower odds (OR=0.82; 95% CI: 0.79, 0.85) of meeting the recommended amounts of physical activity. Additionally, each unit increase in BMI was associated with 0.96 times lower odds (OR=0.96, 95% CI: 0.93, 0.98) of engaging in recommended physical activity. These findings suggest that participation in the SNAP/Food Stamps program may indirectly benefit participants by increasing physical activity levels.

The association of increased SNAP benefits during COVID-19 with food insufficiency and anxiety among US adults: a quasi-experimental study.

The COVID-19 pandemic and subsequent policy response to mitigate disease spread had far-reaching impacts on health and social well-being. In response, the Supplemental Nutrition Assistance Program (SNAP) underwent several pandemic-era modifications, including a 15 % monthly benefit increase on January 1, 2021. Research documenting the health effects of these SNAP modifications among low-income households and minoritized groups who were most impacted by the economic fallout during the first years of the pandemic is lacking. We aimed to estimate the health effects of the 15 % SNAP benefit increase in January 2021, among SNAP-eligible US households. We estimated the effects of the SNAP increase on food insufficiency, mental health, and financial well-being using a rigorous quasi-experimental difference-in-differences (DID) analysis. August 19, 2020, to March 29, 2021. Participants were drawn from the national US Census Bureau Household Pulse Survey waves 13-27 (n 44 477). Compared with SNAP-eligible non-recipients, SNAP-eligible recipients experienced decreased food insufficiency (-1·9 percentage points (pp); 95 % CI -3·7, -0·1) and anxiety symptoms (-0·09; 95 % CI -0·17, -0·01), and less difficulty paying for other household expenses (-3·2 pp; 95 % CI -4·9, -1·5) after the SNAP benefit increase. Results were robust to alternative specifications. Expansions of federal nutrition programmes have the potential to improve health and financial well-being. This study provides timely evidence to inform comprehensive safety net nutrition policies during future economic crises and public health preparedness response plans.

Food Insecurity Prevalence and Risk Factors among Persons with HIV in a Southeastern US Clinical Care Setting.

Food insecurity (FI) is associated with adverse health outcomes for persons with HIV (PWH). Little is known about FI among PWH in southern or non-urban settings. We examined FI prevalence, risk factors, and access to services in a southeastern HIV clinic. Among PWH in the UNC CFAR HIV Clinical Cohort who were screened for FI as part of HIV care between 2021 and 2022, we estimated unadjusted prevalence ratios (PRs) comparing the probability of reporting FI by demographic and clinical characteristics. The 479 PWH screened for FI were 65% cisgender men, 62% non-Hispanic Black PWH, a median of 54 years old (IQR 41-62), and 93% with an HIV viral load (VL) < 200 copies/mL. FI prevalence was 36.3% (95% CI 32.3%-40.9%). Cisgender women and transgender adults were more likely to report FI than cisgender men (PRs 1.24 [95% CI 0.97-1.59] and 2.03 [1.32-3.12], respectively). Compared with White PWH, the PR was 1.71 (1.20-2.42) for Black and 2.44 (1.56-3.82) for Hispanic PWH. The PR was 1.42 (0.98-2.05) for PWH with VL ≥ 200 versus < 200 copies/mL. Having no or public versus private health insurance was also associated with FI. PWH with FI had a high prevalence of comorbidities including hypercholesterolemia (49%) and hypertension (48%), though these were not associated with FI. Almost half of PWH with FI were not accessing a food pantry or nutrition assistance program. Identifying FI in PWH is critical as FI is common and may contribute to viral non-suppression, poor comorbidity control, and gender and racial/ethnic health disparities in PWH.

Are food and nutrition assistance programs fostering an equitable early care and education (ECE) food environment? A systematic review utilizing the RE-AIM framework

BackgroundHealth inequities related to poor diet, food insecurity, and obesity negatively affect children from low-income minority families. The USDA administers Food and Nutrition Assistance Programs (FNAPs) in Early Care and Education settings (ECEs) to safeguard the health of vulnerable children. However, the extent to which FNAPs provide an equitable food environment in ECEs remains unclear. ObjectiveExamine FNAPs’ association with young children's (2–6 years) food environment in ECE through a systematic review using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. The primary focus is to operationalize RE-AIM in ECE context and evaluate FNAPs' association with the ECE food environment using an equity lens. Measurable outcomesFood environment dimensions were assessed at three levels: ECE setting (availability, accessibility, affordability, acceptability, accommodation); ECE provider (feeding practices); and child (dietary intake, food insecurity, BMI percentile). ResultsThe review included 38 articles (cross-sectional=30, mixed method=1, pre-post=5, longitudinal=2) with Child and Adult Care Food Program (CACFP; n = 35), Farm to ECE (n = 2), and Food Bank-ECE program partnership (n = 1). No study addressed all RE-AIM indicators. CACFP participation showed positive association with healthy food availability (n = 28), feeding practices (n = 12), child dietary intake (n = 6), and reduced risk of being overweight (n = 1). Farm to ECE interventions showed increased local food affordability (n = 1) and children's acceptance of healthy foods (n = 1). No study addressed foods served in ECEs to accommodate cultural diversity, special dietary needs, developmental disabilities, or reported child food insecurity. ConclusionCACFP emerges as the most prevalent FNAP nationally for having potential to improve ECE food availability and feeding practices, but further research is needed to address equity gaps by examining its impact on child outcomes (dietary intake, BMI percentile) across diverse geographic locations (urban vs. rural), ECE organizational structures (center-based vs. home-based), and demographic characteristics of ECE providers and children.

Inequities in Self-Reported Social Risk Factors by Sexual Orientation and Gender Identity

Sexual minority (ie, people who self-identify as gay, lesbian, bisexual, and other nonheterosexual identities) and gender minority (ie, people who self-identify as transgender, nonbinary, or other noncisgender identities) adults report worse health outcomes compared with heterosexual and cisgender adults, respectively. Although social risk factors (SRFs; eg, housing instability) are associated with health outcomes, little is known about the prevalence of SRFs among sexual and gender minority adults. To examine differences in the prevalence of SRFs by sexual orientation and gender identity among adults. This cross-sectional study used Behavioral Risk Factor Surveillance System data collected from January 2022 to February 2023 for adults aged 18 years or older residing in 22 US states. Self-reported sexual orientation and gender identity. Outcome measures were dissatisfaction with life, lack of emotional support, social isolation, employment loss in the past 12 months, Supplementary Nutrition Assistance Program participation in the past 12 months, insufficient food, inability to pay bills, inability to pay utilities, lack of transportation, and stress. Survey weights were applied. Multivariable linear regression models were used to measure the association between sexual orientation and gender identity for each outcome. The study sample comparing outcomes by sexual orientation included 178 803 individuals: 84 881 men (48.5%; 92.9% heterosexual; 7.1% sexual minority) and 93 922 women (51.5%; 89.4% heterosexual; 10.6% sexual minority). The study sample comparing outcomes by gender identity included 182 690 adults (99.2% cisgender; 0.8% gender minority). Of sexual minority women, 58.1% reported at least 1 SRF compared with 36.5% of heterosexual women. Sexual minority women were significantly more likely to report social isolation (difference, 7.4 percentage points [PP]; 95% CI, 4.9-10.0 PP) and stress (difference, 12.2 PP; 95% CI, 9.8-14.7 PP) compared with heterosexual women. A greater proportion of sexual minority men (51.1%) reported at least 1 SRF than heterosexual men (34.0%); the largest magnitudes of inequity were in dissatisfaction with life (difference, 7.9 PP; 95% CI, 5.8-10.1 PP) and stress (difference, 6.7 PP; 95% CI, 4.5-8.9 PP). Of gender minority adults, 64.1% reported at least 1 SRF compared with cisgender adults (37.1%). Gender minority adults were significantly more likely to report social isolation (difference, 14.8 PP; 95% CI, 9.9-19.7 PP) and stress (difference, 17.0 PP; 95% CI, 11.9-22.1 PP). In this cross-sectional study, sexual and gender minority adults were significantly more likely to report multiple SRFs. These findings suggest that policies and community-based systems to advance socioeconomic equity among sexual and gender minority adults are critical.

Using technology to reduce learning costs and improve program comprehension: Lessons from a survey experiment on Supplemental Nutrition Assistance Program

AbstractThe Supplemental Nutrition Assistance Program (SNAP) provides food assistance to those in need, and while the program reaches many who are eligible, program participation falls short of reaching all who are eligible. One factor contributing to this gap in participation is difficulty understanding program eligibility, a common challenge with means‐tested benefit programs. Governments have attempted to improve public understanding of these complex programs using a range of tools to reduce learning costs, yet we know little about the extent to which these tools work and why. This preregistered survey experiment tests three commonly used methods of communicating SNAP program information, including a flyer, screening tool, and video. Cumulatively, our findings demonstrate that efforts to reduce SNAP learning costs are generally effective at improving comprehension recall and that the type of intervention matters, with the video increasing comprehension scores more than the flyer and screening tool. However, the impact of the intervention does not vary substantially according to household income.

Barriers and Facilitators to Online Grocery Shopping Among Supplemental Nutrition Assistance Program (SNAP) Participants: A Mixed Method Study

ABSTRACT This mixed methods study explored online grocery shopping perceptions by surveying individuals who do and do not receive SNAP benefits (n = 129) and by conducting interviews with SNAP recipients (n = 26) who have grocery shopped online. T-tests assessed survey findings, codebook thematic analysis was used to identify qualitative themes, and results were interpreted collectively. Survey results found no differences in perceptions of online grocery shopping between SNAP and non-SNAP recipients (p-values = 0.2-1.0) and that 97% of SNAP recipients felt comfortable using SNAP online. Five qualitative themes were identified and provided context to the survey results. The study findings can inform policy actions within SNAP.

ICE Detainer Requests Were Associated With Lower Medicaid And SNAP Enrollment Among Eligible Adults, 2011-19.

Legislative policies that criminalize immigrants have a "chilling effect" on public program participation among eligible immigrants. However, little is known about the effect of local enforcement actions by Immigration and Customs Enforcement (ICE). In this study, we linked county-level data on the number of detainer requests (or immigration holds) issued by ICE to individual-level data from the 2011, 2016, and 2019 American Community Surveys. We fit adjusted logistic regression models to assess the association between detainer requests and enrollment in Medicaid and the Supplemental Nutrition Assistance Program (SNAP) among those likely eligible for each program in US-born versus immigrant households. A higher volume of detainer requests was associated with lower enrollment in both Medicaid and SNAP, particularly among adults in households with at least one immigrant relative to US-born households. We observed the most pronounced effects in 2011 and 2019.

Parental incarceration and adolescent food insecurity.

There is a causal relationship between parental incarceration (PI) and childhood food insecurity (FI). This is a pressing policy issue given that public assistance designed to curb hunger (i.e., Supplemental Nutrition Assistance Program) is often revoked due to incarceration which, on top of the removal of a household income source, can significantly alter children's food access. Yet questions remain regarding the prevalence of FI among youth with incarcerated parents, as well as the interplay of parent-child coresidence, race/ethnicity, and geographic region. Data come from the 2019 Minnesota Student Survey, a statewide sample of adolescents (N = 112,554). Youth self-reported experiences of PI, parent-child coresidence at the time of incarceration, past-month FI, and race/ethnicity. Based on school districts, regions were classified as city, suburb, town, or rural. Youth with currently and formerly incarcerated parents reported significantly higher rates of FI (18.11% and 10.41%, respectively) compared to peers who never experienced PI (2.84%; ORs = 7.56 and 3.97, respectively). Among youth with currently incarcerated parents, rates of FI were highest among those who lived with the parent at the time of incarceration (21.79%) compared to those who did not (13.98%). Youth of color and city youth were more likely to experience FI in contexts of PI. Findings extend the link between PI and child FI. The evidence is concerning given FI's heightened risk for chronic health conditions, which may be compounded by trauma and systemic injustice. This work has implications for policies that expand, rather than reduce, food access and financial assistance. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The devastating dance between opioid and housing crises: Evidence from OxyContin reformulation

Housing instability and drug misuse are two of the United States' most pressing challenges, each bearing profound health and societal consequences. A crucial yet largely underexplored question is the extent to which the opioid crisis has intensified housing instability. Our study ventures into this relatively uncharted nexus, investigating how the OxyContin reformulation, a pivotal moment in the U.S. opioid epidemic, impacted eviction rates. Employing a dose-response Difference-in-Differences model and analyzing eviction data from 2004 to 2016, we demonstrate that the OxyContin reformulation precipitated a significant increase in evictions, especially in areas with weak eviction protections or limited access to psychiatric treatment resources. Channel analyses reveal increased marijuana initiation and heightened mental and physical health issues following the reformulation. Moreover, the OxyContin reformulation leads to greater reliance on the Supplemental Nutrition Assistance Program, signaling an escalated financial strain on governmental resources. Finally, we find evidence of increased marital disruption post-reformulation. Our findings underscore the urgent need for collaborative efforts between public health and housing authorities to address both the opioid and housing crises.

A forensic statistical analysis of fraud in the federal food stamp program

A forensic statistical analysis of fraud in the federal food stamp program

SNAP for U: Food insecurity and SNAP use among college students, including institution type differences

The objective of this study was to examine food insecurity and knowledge of the Supplemental Nutrition Assistance Program (SNAP), including barriers to and facilitators for enrolling in SNAP among college students in the Midwest. An obser­vational, cross-sectional online survey was admini­stered during Fall 2021 to Spring 2022. Participants included 844 college students from nine higher education institutions across Missouri. Of students who participated, 44.9% reported being food insecure, 67.9% reported knowing what SNAP was, and only 34.3% knew if they were eligible for SNAP. Students at private colleges [unadjusted odds ratio (OR) and 95% confidence interval (CI) = 4.79 (2.45-9.36), p&lt;0.001)], community colleges [OR 3.21 95% CI (2.26-4.56), p&lt;0.001)], technical schools [OR 2.21 95% CI (1.08-4.53), p=0.031], and Historically Black Colleges and Universities (HBCUs) [OR 2.05 95% CI (1.37-3.07)., p&lt;0.001] reported higher odds of food security compared to public institutions. College students reported lack of knowledge of SNAP in general as the main barrier for enrollment and campus assistance as the main facilitator. Food insecurity is highly prevalent in Missouri college students, where SNAP knowl­edge and enrollment barriers persist. Findings sup­port a need for increased attention and resources to target college food insecurity.

SNAP Emergency Allotments, Emergency Rent Assistance, Rent Burden, and Housing and Food Security, June 2022-May 2023.

During the COVID-19 pandemic, Supplemental Nutrition Assistance Program (SNAP) emergency allotments and emergency rent assistance provided support to low-income households. Rent burden, a form of housing insecurity, can severely limit household resources, which, in turn, affects health equity. We explored whether these policy interventions equitably supported households that were or were not experiencing rent burden. We used data from the US Household Pulse Survey (June 2022-May 2023) to examine whether associations between emergency support policies and indicators of food and housing security differed according to household rent burden status. We modeled each outcome (food sufficiency or being current on rent) as a function of policy exposure (SNAP emergency allotments or emergency rent assistance), rent burden, and their interaction. We included demographic characteristics, state of residence, and survey cycle as covariates. We modeled each outcome and policy exposure combination separately. Receiving emergency allotments (72.4% vs 67.2% for SNAP participants in states with and without emergency allotments, respectively) and emergency rent assistance (64.5% vs 57.6% for households that received and were waitlisted/denied assistance, respectively) were associated with greater food sufficiency. The relationship between emergency allotments and food sufficiency was stronger in rent-burdened households; however, emergency rent assistance supported food sufficiency to a greater extent in non-rent-burdened households. Emergency rent assistance supported households in being current on rent (78.7% vs 56.4% for households that received and were waitlisted/denied assistance, respectively) and supported being current on rent to a greater extent in non-rent-burdened households than in rent-burdened households. The relationship between emergency support policies and food or housing security differed according to whether households were experiencing rent burden. Associations were sometimes stronger in less economically constrained conditions. These results indicate an opportunity to better design policies to support low-income households, address food and housing security, and ultimately decrease the prevalence of chronic disease.

The effects of SNAP emergency allotments on state-level SNAP benefits and enrollment during the COVID-19 pandemic.

During the COVID-19 pandemic, all US states provided emergency allotments (EA) to enrollees of the Supplemental Nutrition Assistance Program (SNAP) to alleviate rising food insecurity. However, 18 states opted out of the SNAP-EA program before its official expiration in February 2023. Using a staggered difference-in-differences model to account for state-level variation in the timing of the SNAP-EA opt-out decisions, we analyzed SNAP and SNAP-EA data from the US Department of Agriculture Food and Nutrition Service to quantify the impact of state opt-out decisions on SNAP benefit size and enrollment. We found that the average SNAP monthly benefit among 18 SNAP opt-out states was reduced by $183 (95% confidence interval [CI]: -$214, -$152) per beneficiary. The percentage of the state population enrolled in the SNAP program among the opt-out states modestly decreased by 0.35 (95% CI: -0.61, -0.10) percentage points. Additionally, we employed logistic regression models to associate state opt-out decisions with state-level characteristics. We found that the state governor's political party being Republican was the only significant predictor for the state's opt-out decisions. Our findings help explain why opting out of SNAP-EA has been associated with higher food insufficiency and shed light on the impact of political decisions to opt out of SNAP-EA on the lives of millions of Americans.

The Association between Federal Nutrition Assistance Programs and Adolescent Food Security during the COVID-19 Pandemic: Evidence from Baltimore, Maryland.

Given the lack of attention on adolescent food insecurity, the primary objective of this study was to assess the association of household participation in federal food assistance programs with food security status among adolescents in Baltimore during the COVID-19 pandemic. Adolescents, ages 14-19 years, were invited to participate in two online surveys. The baseline was implemented between October 2020 and January 2021, while the follow-up took place one year later from November 2021 to January 2022 after schools had re-opened. We then matched survey participants with household participation in food nutrition assistance programs using data obtained from the Maryland Department of Social Services. We used logistic regression to examine the association between food assistance program participation status and food insecurity. Additionally, to examine whether the impact of program participation on food insecurity changed between the baseline survey and one year later at follow-up when schools re-opened, a difference-in-differences analysis was conducted. The results showed no significant associations between adolescent food security and participation in any of the federal nutrition assistance programs. Increased attention on how best to improve adolescent food security in low-income households that can respond to the unique needs of adolescents is clearly warranted.

Assessing the Impact of SNAP-Ed: A Comprehensive Evaluation Framework for Healthy Living Promotion in the United States

The Supplemental Nutrition Assistance Program Education (SNAP-Ed) plays a crucial role in promoting healthy food choices and physically active lifestyles among low-income populations. This article proposes a comprehensive evaluation framework for SNAP-Ed initiatives to assess the program's reach, implementation, outcomes, and cost-effectiveness. The framework incorporates key components such as needs assessment, process evaluation, outcome evaluation, and economic evaluation. By integrating various data sources and methods, the proposed framework enables a holistic understanding of the program's strengths, challenges, and opportunities for improvement. It emphasizes the importance of rigorous evaluation methods to measure the impact of SNAP-Ed interventions on nutrition knowledge, attitudes, behaviors, and overall health outcomes. The framework aims to provide a structured approach for SNAP-Ed Implementing Agencies to demonstrate the program's effectiveness and guide decision-making for continuous improvement.

Association Between Food Insecurity and Developmental Delay and Behavioral Problems in US Children 2 to 5 Years of Age.

To investigate the relationship between food insecurity and developmental delay and/or behavior problems (DD/PB) in US children aged 2 to 5 years before the COVID-19 pandemic. Data from 14,464 children aged 2 to 5 years from the National Survey of Children's Health from 2016 to 2017 were analyzed. Children with food insecurity came from families reporting they sometimes or often could not afford nutritious meals. Diagnosis of DD/PB by a professional was obtained through a caregiver report. A quarter of children aged 2 to 5 years lived in food insecure homes, and 9% were diagnosed with DD/PB. Children in food insecure households were more likely to be from minoritized populations publicly insured, with single parents, without high school education, living =< 130% Federal poverty line, and receiving supplemental nutrition assistance program (SNAP) benefits (all p < 0.001). Adjusting for age, sex, race, ethnicity, poverty, family structure, and parent education, children in food insecure households had 1.57 times the odds of being diagnosed with DD/PB compared with children in food secure households. In similarly adjusted models excluding poverty and stratified by SNAP use, homes not receiving SNAP maintained this association between food insecurity and diagnosis of DD/PB, whereas in homes receiving SNAP, the association was not significant. In this population-based study, US children aged 2 to 5 years in food insecure households were more likely to be diagnosed with DD/PB compared with those in food secure households. When stratified, there was no association between food insecurity and DD/PB among those receiving SNAP; the association remained for those not receiving SNAP. The potential long-term impact of this safety net program on our most vulnerable citizens must be considered as policymakers contemplate federal spending priorities.