A Proposal for Improvements in the Supplemental Nutrition Assistance Program

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

IMPORTANCE

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.

OBJECTIVE

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.

DESIGN, SETTING, AND PARTICIPANTS

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.

EXPOSURES

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.

MAIN OUTCOMES AND MEASURES

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.

RESULTS

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.

CONCLUSIONS AND RELEVANCE

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.

Nutritional quality of retail food purchases is not associated with participation in the Supplemental Nutrition Assistance Program for nutrition-oriented households

The Supplemental Nutrition Assistance Program (SNAP) provides millions of low-income Americans food benefits and other forms of nutrition assistance. Evidence indicates that SNAP reduces food insecurity. However, there is a concern that the food benefit may increase the demand for less healthy foods more than healthier foods, thereby reducing the overall nutritional quality of the participant's food basket. This paper aims to examine the association of SNAP participation with the nutritional quality of food-at-home purchases of low-income households and to investigate the potential heterogeneity among consumers with different levels of nutrition attitude. This analysis used food purchase data from the USDA National Household Food Acquisition and Purchase Survey (FoodAPS). Our study sample included 2,218 low-income households, of which 1,184 are SNAP participants, and 1,034 are income-eligible nonparticipants. Multivariate regressions were performed to explore the SNAP-nutritional quality association. A household's nutrition attitude was measured using its response to a question on whether the household searched for nutrition information online in the last 2 months. Households that affirmed they had an online nutrition search were treated as nutrition-oriented households (21.2% of the low-income sample), and households that did not were considered less nutrition-oriented households (78.8%). For robustness, we also created an alternative nutrition attitude measure based on reported use of the nutrition facts label. We found that among less nutrition-oriented households, SNAP participants had a statistically significant 0.097 points (p = 0.018) lower Guiding Stars rating than low-income nonparticipants. However, there was no significant SNAP-nutritional quality association among nutrition-oriented households. In conclusion, SNAP participation was associated with lower nutritional quality of food purchases among less nutrition-oriented households, but not among nutrition-oriented households. The results suggest that the intended nutritional benefits of restrictions on purchases of healthy foods may not reach the subgroup of nutrition-oriented SNAP participants.

Effect of Change in the Supplemental Nutrition Assistance Program Guidelines on Vendor Participation and Availability of Fresh Produce

Introduction

In January 2018, new vendor eligibility standards for the Supplemental Nutrition Assistance Program (SNAP) were fully implemented to increase availability of healthy staple and perishable foods. We examined changes in SNAP vendor participation and availability of fresh fruits and vegetables (FFV) both short-term (2015 vs 2018) and long term (2003 vs 2018) in an urban, low-income community.

Methods

We conducted food store assessments from late June through early September of 2003, 2009, 2012, 2015, and 2018 in Albany, New York. SNAP status was assessed by using the US Department of Agriculture’s list of SNAP-authorized stores and in-store verification.

Results

Numbers of SNAP vendors were 77 in 2003, 92 in 2009, 103 in 2012, 115 in 2015, and 109 in 2018. We observed a marginally significant (P = .049) short-term (2015, 85.9% vs 2018, 73.9%) decline in SNAP participation among convenience stores but no significant short-term changes in FFV availability among either SNAP or non-SNAP vendors. In long-term (2003 through 2018) trends, we found significant (P < .01) increases in SNAP participation among farmers markets and nonprofit organizations. The proportion of SNAP vendors stocking only 1 type of FFV also significantly increased, which was likely related to a consumer trend of favoring bananas as a grab-and-go snack.

Conclusion

Despite the decline of SNAP participation among convenience stores, which primarily came from increased program withdrawals, the new SNAP rule did not substantially alter FFV availability after 6 to 8 months of its full implementation. Long term, policy efforts increased SNAP participation among farmers markets.

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

BACKGROUND

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.

OBJECTIVE

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).

DESIGN

This study included data from the NHANES, a cross-sectional, nationally representative survey of the United States population.

STUDY PARTICIPANTS

This study included 2,523 adults with low incomes (≤130% of the federal poverty level) in NHANES (2011-2014).

MAIN OUTCOME MEASURES

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.

STATISTICAL ANALYSIS

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.

RESULTS

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.

CONCLUSIONS

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.

Can targeted policies reduce obesity and improve obesity-related behaviours in socioeconomically disadvantaged populations? A systematic review

This review synthesized evidence from controlled studies pertaining to the impact of targeted policies on anthropometric, dietary and physical activity outcomes amongst socioeconomically disadvantaged children and adults. Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity guidelines were followed. Eligible studies were published from 2004 to August 2015 and examined the impact of targeted policies on anthropometric, dietary and physical activity outcomes amongst socioeconomically disadvantaged populations. Twenty articles (18 studies) were included. Eight studies examined organizational policies within multi-component interventions in schools. Common elements of successful policy-containing interventions included nutritional standards, enhancements to physical education, additional physical activity opportunities, school self-assessments, and nutrition and physical activity education. Of the 10 studies of government policies, policies providing information/education and fruit and vegetable subsidies had positive impacts amongst children, but no impact amongst adults. Policies involving changes to built environments yielded nearly uniformly null findings in children and adults. Overall, the largest quantity of high-quality evidence of effectiveness was for comprehensive interventions that included school policies, and government policies targeting disadvantaged children in schools. None of the government policies targeting disadvantaged adults proved effective. Interventions during childhood may ameliorate negative obesity-related manifestations of socioeconomic disadvantage. Gaps in knowledge remain surrounding effective policies in adults, adolescents and very young children.