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Keller KJM, Bruno P, Foerster S, Draper C. Thirty Years of SNAP-Ed: The Transition of the Nation's Largest Nutrition Education Program Into a Pillar of the Public Health Infrastructure. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:588-596. [PMID: 38904598 DOI: 10.1016/j.jneb.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 03/12/2024] [Accepted: 03/12/2024] [Indexed: 06/22/2024]
Abstract
This paper describes the 30-year evolution of Supplemental Nutrition Assistance Program-Education (SNAP-Ed) to provide evidence to support our perspective that SNAP-Ed has earned its position as a pillar of the public health infrastructure in the US. Legislatively designated as a nutrition education and obesity prevention program, its focus is the nearly 90 million Americans with limited income. This audience experiences ongoing health disparities and is disproportionately affected by public health crises. The SNAP-Ed program works to reduce nutrition-related health disparities at all levels of the Social-Ecological Model, follows a robust evaluation framework, and leverages strong partnerships between state-based practitioners, state agencies, and the US Department of Agriculture. The expansion of SNAP-Ed would enable the program to reach more Americans so that our nation can end hunger and reduce diet-related health disparities.
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Affiliation(s)
| | - Pamela Bruno
- Center for Excellence in Public Health, University of New England, Biddeford, ME
| | - Susan Foerster
- Network for a Healthy California, California Department of Public Health, Oakland, CA
| | - Carrie Draper
- Arnold School of Public Health, University of South Carolina, Columbia, SC
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Lu V, Zhang J, Chen G. Can nutrition interventions tackle the global insulin affordability via improving diabetes management and reducing insulin demand? Glob Health Res Policy 2022; 7:13. [PMID: 35546683 PMCID: PMC9092701 DOI: 10.1186/s41256-022-00247-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/28/2022] [Indexed: 02/07/2023] Open
Abstract
Diabetes, a global health concern, requires insulin therapy. As insulin demand and prices rise dramatically, insulin affordability has increasingly become an issue facing patients with diabetes worldwide. To cut insulin costs, many patients ration their supply, which may have dire health consequences. This particularly affects lower-income populations, who are often forced to choose between purchasing their medications or paying for other necessities. Nutrition might be one solution for this. This commentary aims to provide comprehensive insight with historical context into intersectional components of diabetes in the global arena through analyses of insulin affordability, coupled with the critical role of nutrition intervention after searching the PubMed for relevant articles. More studies in personalized nutrition, supplementations, and dietary behaviors may develop evidence-based nutrition interventions to control diabetes. We argue that alongside price regulation, a greater focus to nutrition to address issues of food insecurity and food assistance programs may help to improve insulin affordability.
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Affiliation(s)
- Victoria Lu
- Yantai Zestern Biotechnique Co. LTD, Yantai, Shandong, 264670, China
| | - Jiandi Zhang
- Yantai Zestern Biotechnique Co. LTD, Yantai, Shandong, 264670, China
| | - Guoxun Chen
- Department of Nutrition, University of Tennessee at Knoxville, 229 Jessie Harris Building, 1215 West Cumberland Avenue, Knoxville, TN, 37909, USA.
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Gender Disparities in Food Security, Dietary Intake, and Nutritional Health in the United States. Am J Gastroenterol 2021; 116:584-592. [PMID: 33443848 DOI: 10.14309/ajg.0000000000001118] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Food insecurity is associated with negative nutritional outcomes and is experienced differently by women vs men. We evaluated the effects of gender on food insecurity and dietary intake in the United States. METHODS Data from the National Health and Nutrition Examination Survey (2007-2016) were analyzed. Survey-weighted linear and logistic regression models were used to evaluate predictors of food security and the effect of food security on dietary consumption and body anthropometrics. Gender was modeled as a covariable and as an effect modifier. RESULTS A total of 30,251 respondents were included. Approximately 15.1% (95% confidence interval [CI]: 14.1%-16.1%) of participants were food insecure. This increased over time from 11.7% in 2007-2008 to 18.2% in 2015-2016. A higher proportion of women experienced food insecurity compared with men (53.3% vs 46.7%, P = 0.02), although this was not significant after adjusting for poverty and other confounders (adjusted odds ratio 1.01; 95% CI: 0.93-1.09; P = 0.81). Among food insecure women, 32.4% (95% CI: 30.0%-34.9%) received emergency food assistance and 75.0% (95% CI: 71.5%-78.2%) received supplemental nutrition assistance benefits. Relative to men, food insecure women were less likely to meet the recommended dietary allowance of most macronutrients and micronutrients. They were also significantly more likely to be obese, have a wider waist circumference, and have higher total body fat percentage (P interaction all <0.001). DISCUSSION Food insecurity represents a substantial public health challenge in the United States that differentially affects women compared with men. Alternative strategies may be required to meet the nutritional requirements for food insecure women.
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Caspi CE, De Marco M, Durfee T, Oyenuga A, Chapman L, Wolfson J, Myers S, Harnack LJ. A Difference-in-Difference Study Evaluating the Effect of Minimum Wage Policy on Body Mass Index and Related Health Behaviors. OBSERVATIONAL STUDIES 2021; 7:https://obsstudies.org/wp-content/uploads/2021/02/caspi_obs_studies_published.pdf. [PMID: 33665650 PMCID: PMC7929481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Minimum wage laws are a promising policy lever to promote health equity, but few rigorous evaluations have tested whether and how minimum wage policy affects health outcomes. This paper describes an ongoing difference-in-difference study evaluating the health effects of the 2017 Minneapolis Minimum Wage Ordinance, which incrementally increases the minimum wage to $15/hr. We present: (1) the conceptual model guiding the study including mediating mechanisms, (2) the study design, and (3) baseline findings from the study, and (4) the analytic plan for the remainder of the study. This prospective study follows a cohort of 974 low-wage workers over four years to compare outcomes among low-wage workers in Minneapolis, Minnesota, and those in a comparison city (Raleigh, North Carolina). Measures include height/weight, employment paystubs, two weeks of food purchase receipts, and a survey capturing data on participant demographics, health behaviors, and household finances. Baseline findings offer a profile of individuals likely to be affected by minimum wage laws. While the study is ongoing, the movement to increase local and state minimum wage is currently high on the policy agenda; evidence is needed to determine what role, if any, such policies play in improving the health of those affected.
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Affiliation(s)
- Caitlin E Caspi
- Rudd Center for Food Policy and Obesity, University of Connecticut, 1 Constitution Plaza, Hartford, CT, 061032
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Dr., Storrs, CT 06269
- Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware St. SE, Minneapolis, MN 55445
| | - Molly De Marco
- Center for Health Promotion & Disease Prevention, University of North Carolina at Chapel Hill, 1700 M.L.K. Jr Blvd #7426, Chapel Hill, NC, 27514
- Department of Nutrition, Gillings School of Global Public Health, UNC-CH, 135 Dauer Dr, Chapel Hill, NC 27599
| | - Thomas Durfee
- The Roy Wilkins Center for Human Relations and Social Justice, Hubert H. Humphrey School of Public Affairs, University of Minnesota, 270 Humphrey Center, 301 19 Avenue South, Minneapolis, MN
- Department of Applied Economics, University of Minnesota, 231 Ruttan Hall, 1994 Buford Avenue, St. Paul, MN
| | - Abayomi Oyenuga
- Department of Applied Economics, University of Minnesota, 231 Ruttan Hall, 1994 Buford Avenue, St. Paul, MN
| | - Leah Chapman
- Center for Health Promotion & Disease Prevention, University of North Carolina at Chapel Hill, 1700 M.L.K. Jr Blvd #7426, Chapel Hill, NC, 27514
- Department of Nutrition, Gillings School of Global Public Health, UNC-CH, 135 Dauer Dr, Chapel Hill, NC 27599
| | - Julian Wolfson
- Division of Biostatistics, School of Public Health, University of Minnesota, A460 Mayo Building MMC 303, 425 Delaware St. SE, Minneapolis, MN
| | - Samuel Myers
- The Roy Wilkins Center for Human Relations and Social Justice, Hubert H. Humphrey School of Public Affairs, University of Minnesota, 270 Humphrey Center, 301 19 Avenue South, Minneapolis, MN
- Department of Applied Economics, University of Minnesota, 231 Ruttan Hall, 1994 Buford Avenue, St. Paul, MN
| | - Lisa J Harnack
- Division of Epidemiology and Community Health, Suite 300, University of Minnesota, 1300 South 2nd St, Minneapolis, MN
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Du S, Wang H, Zhang B, Popkin BM. Dietary Potassium Intake Remains Low and Sodium Intake Remains High, and Most Sodium is Derived from Home Food Preparation for Chinese Adults, 1991-2015 Trends. J Nutr 2020; 150:1230-1239. [PMID: 31909790 PMCID: PMC7198305 DOI: 10.1093/jn/nxz332] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/28/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intervention strategies to reduce sodium intake and increase potassium intake may decrease blood pressure; however, most are focused on reducing sodium in processed food globally. OBJECTIVES We attempt to fill important gaps in understanding the dynamics of these dietary determinants of hypertension in China. METHODS We used data on 29,926 adults aged ≥20 y between 1991 and 2015 from an ongoing cohort, the China Health and Nutrition Survey. We collected detailed diet data with use of weighing methods with 3 consecutive 24-h recalls. With panel data random-effects models, we analyzed factors associated with sodium and potassium intakes and sodium to potassium (Na/K) ratios. RESULTS Sodium intake decreased from 6.3 g/d in 1991 to 4.1 g/d in 2015, still twice the tolerable upper intake recommended by the WHO. Potassium intake was 1.7 g/d in 1991 and 1.5 g/d in 2015, below half that recommended by the WHO. The Na/K ratio decreased from 4.1 (ratios in g) in 1991 to 3.1 in 2015, 5 times the recommendation of the WHO. More than two-thirds (67%) of sodium intake was from salt added during food preparation, with 8.8% from processed foods in 2015, up from 5.0% in 1991. The most at-risk populations lived in China's central region and rural areas, were middle aged, had lower educations, or were farmers. CONCLUSIONS Sodium intake is very high across all regions in China. As part of sodium reduction efforts, China should target people living in the central region and adults aged above 60 whose sodium intakes are much higher. Strategies to decrease sodium intake and increase potassium intake should be different from those applied in the Western world where the major source is processed food. Reduced sodium higher potassium salts should become a major policy initiative in China.
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Affiliation(s)
- Shufa Du
- Department of Nutrition and Carolina Population Center, CB #8120 Carolina Square, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Huijun Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bing Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Barry M Popkin
- Department of Nutrition and Carolina Population Center, CB #8120 Carolina Square, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Address correspondence to BMP (e-mail: )
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Rabaut LJ. Medically Tailored Meals as a Prescription for Treatment of Food-Insecure Type 2 Diabetics. J Patient Cent Res Rev 2019; 6:179-183. [PMID: 31414029 DOI: 10.17294/2330-0698.1693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Type 2 diabetes mellitus is an immense burden to the health of our population and to our current health care system, and the weight of this burden is only projected to multiply in coming years. A nutritious diet is an indispensable aspect of diabetes treatment, and the lack of access to food engenders poor disease-state control, which correlates with increased health care utilization. Interventions aimed at improving access to food through medically tailored meals (MTMs) have demonstrated effectiveness in improving the health of food-insecure type 2 diabetic patients and reducing health care costs. Further studies are necessary to increase the external validity of existing positive research on medically tailored meals in food-insecure diabetic patients and to provide evidence to support potential policy changes under which the costs of medically tailored meals for diabetics might be covered by insurers.
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Affiliation(s)
- Leslie J Rabaut
- Aurora Family Medicine Residency Program, Aurora Health Care, Milwaukee, WI
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Lacko AM, Popkin BM, Smith Taillie L. Grocery Stores Are Not Associated with More Healthful Food for Participants in the Supplemental Nutrition Assistance Program. J Acad Nutr Diet 2019; 119:400-415. [PMID: 30181093 PMCID: PMC6389432 DOI: 10.1016/j.jand.2018.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 06/06/2018] [Indexed: 11/25/2022]
Abstract
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.
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