Participation in the Supplemental Nutrition Assistance Program and Dietary Behaviors: Role of Community Food Environment.

The United States Department of Agriculture's Supplemental Nutrition Assistance Program (SNAP) is the country's largest nutrition assistance program for low-income populations. Although SNAP has been shown to reduce food insecurity, research findings on the diet quality of program participants are inconsistent. This study evaluated whether the community food environment is a potential moderator of the association between SNAP participation and eating behaviors. This cross-sectional study used participant data from a telephone survey of 2,211 households in four cities in New Jersey. Data were collected from two cross-sectional panels from 2009 to 2010 and 2014. Food outlet data were purchased from commercial sources and classified as supermarkets, small grocery stores, convenience stores, or limited service restaurants. Analysis is limited to 983 respondents (588 SNAP participants) with household incomes below 130% of the federal poverty level. Eating behaviors were assessed as frequency of consumption of fruit, vegetables, salad, and sugar-sweetened beverages. Interaction and stratified analyses using gamma regression determined the differences in the association between SNAP participation and eating behaviors by the presence or absence of food outlets adjusted for covariates. SNAP participation was associated with a higher frequency of consuming sugar-sweetened beverages (P<0.05) when respondents lived within ¼ to ½ mile of a small grocery store, supermarket, and limited service restaurant. SNAP participants who did not live close to a convenience store reported a lower frequency of sugar-sweetened beverage consumption (P=0.01), and those living more than ½ mile away from a supermarket reported a lower frequency of fruit consumption (P=0.03). The findings from this study suggest that the community food environment may play a role in moderating the association between SNAP participation and eating behaviors. Although SNAP participation is associated with some unhealthy behaviors, this association may only hold true when respondents live in certain food environments.

Lorts C ，Tasevska N ，Adams MA ，Yedidia MJ ，Tulloch D ，Hooker SP ，Ohri-Vachaspati P ... -  《Journal of the Academy of Nutrition and Dietetics》

Grocery Stores Are Not Associated with More Healthful Food for Participants in the Supplemental Nutrition Assistance Program.

Despite interventions to improve the nutrition of grocery store purchases, also referred to as at-home (AH) foods, by participants in the Supplemental Nutrition Program (SNAP), little is known about what proportion of participants' intake is from AH foods and how the dietary quality of AH food compares with participants' away-from-home (AFH) food. Although recent research indicates SNAP participants have dietary quality that is slightly worse than that of income-eligible nonparticipants, it is unknown whether this is attributable to AH or AFH consumption. The objective of this study is to examine differences in self-reported dietary intake by food source for SNAP participants compared with income-eligible nonparticipants using 2011-2014 data from the National Health and Nutrition Examination Survey (NHANES). This study included data from the NHANES, a cross-sectional, nationally representative survey of the United States population. This study included 2,523 adults with low incomes (≤130% of the federal poverty level) in NHANES (2011-2014). Self-reported intake of calories, solid fats, added sugars, and servings of nonstarchy vegetables, whole fruits, and whole grains was assessed by food source in SNAP participants and income-eligible nonparticipants. Multivariate linear regression was used for each outcome, controlling for relevant sociodemographic characteristics. Data were stratified by food source, including grocery stores, sit-down restaurants, and fast food. SNAP participants had a higher intake of solid fats and added sugar from AH foods than nonparticipants. Added sugar from AH food accounted for 15.3% of total calories consumed by SNAP participants, compared with 11.8% for nonparticipants (P<0.001). SNAP participants consumed fewer calories from sit-down restaurants, but both groups consumed similar amounts of calories from fast food. Consumption of nonstarchy vegetables, whole fruits, and whole grains was low for both groups. SNAP participants had poorer diet quality from consumption of AH food than did nonparticipants. Future research should focus on interventions to improve the healthfulness of grocery store purchases as a mechanism to improve dietary quality of SNAP participants.

Lacko AM ，Popkin BM ，Smith Taillie L 《Journal of the Academy of Nutrition and Dietetics》

Nutritional Profile of Purchases by Store Type: Disparities by Income and Food Program Participation.

Policymakers have focused on the food retail environment for improving the dietary quality for Supplemental Nutrition Assistance Program (SNAP) participants. Yet little is known about where SNAP households make food and beverage purchases or how purchases may vary by store type, SNAP participation, and income level. The objective of this study was to examine the association between SNAP-income status (participant, income-eligible non-participant, higher-income non-participant) and healthfulness of household purchases across store types. Data included household packaged food purchases (N=76,458 unique households) from 2010 to 2014, analyzed in 2017 with multivariable adjusted models to examine the nutritional profile of purchases by store type (grocery, convenience, big box, and other stores) for SNAP participating households, income-eligible non-participants, and higher-income non-participants. Outcomes included volume and nutrients (kilocalories, total sugar, saturated fat, and sodium) and calories from food groups. All households purchased the greatest volume of foods and beverages from grocery stores, followed by big-box and other stores, with relatively little purchased from convenience stores. The largest differences between SNAP participants and non-participants were observed at grocery stores and big-box stores, where SNAP households purchased more calories from starchy vegetables, processed meat, desserts, sweeteners and toppings, total junk food, sugar-sweetened beverages, and milk, than income-eligible and higher-income SNAP non-participants. SNAP purchases also had considerably higher sodium density. Across store types, the nutritional profile of income-eligible non-participants' purchases was similar to higher-income households' purchases. More research is needed to identify strategies to improve the nutritional profile of purchases among SNAP households.

Taillie LS ，Grummon AH ，Miles DR 《-》

Grocery store beverage choices by participants in federal food assistance and nutrition programs.

Sugar-sweetened beverages are a target for reduction in the 2010 Dietary Guidelines for Americans. Concerns have been raised about sugar-sweetened beverages purchased with Supplemental Nutrition Assistance Program (SNAP) benefits. This paper describes purchases of non-alcoholic refreshment beverages among participants in the U.S. Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and SNAP. Grocery store scanner data from a regional supermarket chain were used to assess refreshment beverage purchases of 39,172 households in January-June 2011. The sample consisted of families with a history of WIC participation in 2009-2011; about half also participated in SNAP. Beverage spending and volume purchased were compared for WIC sampled households either using SNAP benefits (SNAP) or not (WIC-only). Analyses were completed in 2012. Refreshment beverages were a significant contributor to expenditure on groceries by SNAP and WIC households. Sugar-sweetened beverages accounted for 58% of refreshment beverage purchases made by SNAP households and 48% of purchases by WIC-only households. Soft drinks were purchased most by all households. Fruit-based beverages were mainly 100% juice for WIC-only households and sugary fruit drinks for SNAP households. SNAP benefits paid for 72% of the sugar-sweetened beverage purchases made by SNAP households. Nationwide, SNAP was estimated to pay at least $1.7 to $2.1 billion annually for sugar-sweetened beverages purchased in grocery stores. Considerable amounts of sugar-sweetened beverages are purchased by households participating in WIC and SNAP. The SNAP program pays for most of the sugar-sweetened beverage purchases among SNAP households. The upcoming SNAP reauthorization could be a good time to reconsider the program priorities to align public funds with public health.

Andreyeva T ，Luedicke J ，Henderson KE ，Tripp AS ... -  《-》

Nutritional profile of Supplemental Nutrition Assistance Program household food and beverage purchases.

Background: The Supplemental Nutrition Assistance Program (SNAP), which is the largest federal nutrition assistance program in the United States, serves nearly 1 of 7 Americans. To date, few studies have examined food and beverage purchase behaviors in SNAP participants with the use of electronic purchase data.Objective: In this cross-sectional study, we examined household store purchases of key food, beverage, and nutrient groups in SNAP participants and nonparticipants.Design: Using a data set of US households' (n = 98,256 household-by-quarter observations) packaged food and beverage purchases and SNAP status [current participant, income-eligible nonparticipant (income ≤130% of the Federal Poverty Level [FPL]), and higher-income nonparticipants (income >130% of the FPL)] from 3 quarters during 2012-2013, we estimated pooled ordinary least-squares models, clustered at the household level, to examine the association between SNAP status and purchases while controlling for sociodemographic characteristics. We examined purchases of health- and policy-relevant food and beverage groups [e.g., fruit and sugar-sweetened beverages (SSBs)] and nutrients (e.g., total calories and sodium).Results: Regardless of SNAP status, households had low mean purchases of fruit, vegetables, and fiber and high mean purchases of junk foods, saturated fat, and sodium. After adjustment for multiple comparisons and demographic characteristics, we found significant differences by SNAP status of purchases of fruit, processed meat, salty snacks, sweeteners and toppings, SSBs, and total calories, fiber, sugar, and sodium. Several of these differences were clinically important. For example, compared with income-eligible and higher-income nonparticipants, SNAP participants purchased an additional ∼15-20 kcal · person-1 · d-1 from SSBs (P < 0.0001) and ∼174-195 mg total Na · person-1 · d-1 (P <0.0001). Results were robust to corrections for sample-selection bias and to the exclusion of observations with potentially misreported SNAP status.Conclusions: American households, including SNAP households, show room for improvement in the nutritional quality of store purchases. New interventions and policies may be needed to improve food and beverage purchases in both SNAP and non-SNAP households.

Grummon AH ，Taillie LS 《-》