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Acciai F, Uehara S, Ojinnaka C, Yedidia MJ, Ohri-Vachaspati P. The association between unhealthy dietary behaviors and participation in the Supplemental Nutrition Assistance Program (SNAP): No evidence in support of the self-selection hypothesis. Appetite 2024; 197:107302. [PMID: 38462052 PMCID: PMC11045168 DOI: 10.1016/j.appet.2024.107302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/21/2024] [Accepted: 03/07/2024] [Indexed: 03/12/2024]
Abstract
Supplemental Nutrition Assistance Program (SNAP) participants tend to have unhealthier dietary consumption compared to eligible non-participants. It has been suggested, though never empirically tested, that individuals who enroll in SNAP may have unhealthy diets prior to program participation. Using a longitudinal cohort study design, we examined the association between low-income adults' SNAP participation status and prior dietary behaviors to test the argument that individuals with unhealthier dietary consumption self-select into SNAP. A sample of households from predominantly lower-income cities were surveyed at baseline (T1) and 2-4 years later (T2). The main analyses were restricted to adults who did not participate in SNAP at T1 and with household income <200% of the federal poverty line (n = 170) at both T1 and T2. Participants were grouped into two categories, based on their SNAP participation at T2; (a) Non-participants (n = 132): no SNAP participation at T1 or T2, and (b) T2 SNAP participants (n = 38): SNAP participation at T2 but not T1. Daily consumption frequency of whole fruits, fruit juice, vegetables, sugar-sweetened beverages (SSBs), and energy dense snacks were measured through self-reports. To observe dietary differences between the two groups prior to SNAP participation, T1 behaviors were compared. There were no significant differences in dietary behaviors at T1 (prior to SNAP participation) between non-participants and T2 participants, providing no evidence of self-selection of individuals with unhealthier dietary consumption into SNAP among our study sample. Improvements in SNAP participants' diets may benefit from focusing on policy changes that encourage healthy dietary habits during participation in the program.
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Affiliation(s)
- Francesco Acciai
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA.
| | - Sarah Uehara
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Chinedum Ojinnaka
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Michael J Yedidia
- Center for State Health Policy, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
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Alba C, Wang X, An R. Are Supplemental Nutrition Assistance Program Restrictions on Sugar-Sweetened Beverages Effective in Reducing Purchase or Consumption? A Systematic Review. Nutrients 2024; 16:1459. [PMID: 38794697 PMCID: PMC11123964 DOI: 10.3390/nu16101459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
The participants in the Supplemental Nutrition Assistance Program (SNAP) consume greater amounts of sugar and sweetened beverages (SSBs) compared to non-eligible individuals, which could result in potential negative health outcomes. This can be attributed to the lack of restrictions on SSB purchases with SNAP benefits. In view of the increasing calls from advocates and policymakers to restrict the purchase of SSBs with SNAP benefits, we performed a systematic review to assess its impact towards SSB purchases and consumption. We searched articles from five databases-Cochrane, EBSCO, SCOPUS, Web of Science, and PubMed-and selected seven studies, four of which were randomized controlled trials (RCTs) and three were simulation modeling studies. All three simulation studies and one RCT reported outcomes in terms of consumption, while the other three RCTs reported outcomes in terms of purchases. All seven studies found that an SSB restriction led to a decrease in SSB consumption or purchases, with six studies reporting significant results. Nonetheless, limitations exist. These include limited studies on this subject, potential workarounds circumventing SSB restrictions, like making purchases using personal cash, potentially differed estimated effects when combined with incentives or other initiatives, and the limited geographical scope among the selected RCTs.
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Affiliation(s)
- Charles Alba
- Division of Computational & Data Sciences, Washington University in St Louis, St. Louis, MO 63130, USA;
| | - Xi Wang
- Brown School, Washington University in St Louis, St. Louis, MO 63130, USA;
| | - Ruopeng An
- Division of Computational & Data Sciences, Washington University in St Louis, St. Louis, MO 63130, USA;
- Brown School, Washington University in St Louis, St. Louis, MO 63130, USA;
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Hill CM, Chi DL, Mancl LA, Jones-Smith JC, Chan N, Saelens BE, McKinney CM. Sugar-sweetened beverage intake and convenience store shopping as mediators of the food insecurity-Tooth decay relationship among low-income children in Washington state. PLoS One 2023; 18:e0290287. [PMID: 37699013 PMCID: PMC10497152 DOI: 10.1371/journal.pone.0290287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/07/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION There are oral health disparities in the U.S. and children in food-insecure households have a higher burden of tooth decay. Identifying the mechanisms underlying the food insecurity-tooth decay relationship could inform public health interventions. This study examined how sugar-sweetened beverage (SSB) intake and frequent convenience store shopping mediated the food insecurity-tooth decay relationship for lower-income children. MATERIALS AND METHODS Cross-sectional study data included a household survey, beverage questionnaire, and dental examination. The sample included 452 lower-income, racially-diverse, child-caregiver dyads in 2018 from King County in Washington state. The exposure was household food insecurity, the outcome was untreated decayed tooth surfaces, and the proposed mediators were SSB intake and frequent convenience store shopping (≥2 times/week). Causal mediation analyses via the potential outcomes framework was used to estimate natural indirect and direct effects. RESULTS Fifty-five percent of participants were in food-insecure households, the mean number of decayed tooth surfaces among children was 0.87 (standard deviation [SD] = 1.99), the mean SSB intake was 17 fluid ounces (fl/oz)/day (SD = 35), and 18% of households frequently shopped at a convenience store. After adjusting for confounders, household food insecurity and log-transformed SSB intake (fluid ounces/day) were positively associated with decayed tooth surfaces, but not at the a α = 0.05 level (mean ratio [MR] 1.60; 95% confidence interval [CI] 0.89, 2.88; p = .12 and MR 1.16; 95% CI 0.93, 1.46; p = .19, respectively). Frequent convenience store shopping was associated with 2.75 times more decayed tooth surfaces (95% CI 1.61, 4.67; p < .001). SSB intake mediated 10% of the food insecurity-tooth decay relationship (p = .35) and frequent convenience store shopping mediated 22% (p = .33). CONCLUSIONS Interventions aimed at addressing oral health disparities in children in food-insecure households could potentially focus on reducing intake of SSBs and improving access to healthful foods in lower-income communities.
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Affiliation(s)
- Courtney M. Hill
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Donald L. Chi
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States of America
| | - Lloyd A. Mancl
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Jessica C. Jones-Smith
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States of America
| | - Nadine Chan
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Public Health-Seattle & King County, Assessment, Policy, Development and Evaluation Division, Seattle, WA, United States of America
| | - Brian E. Saelens
- Seattle Children’s Research Institute, Seattle, WA, United States of America
- Department of Pediatrics, University of Washington, Seattle, WA, United States of America
| | - Christy M. McKinney
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
- Seattle Children’s Research Institute, Seattle, WA, United States of America
- Department of Pediatrics, University of Washington, Seattle, WA, United States of America
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Bardach AE, Espínola N, Cairoli FR, Perelli L, Balan D, Palacios A, Augustovski F, Pichón-Riviere A, Alcaraz AO. The burden of disease and economic impact of sugar-sweetened beverages' consumption in Argentina: A modeling study. PLoS One 2023; 18:e0279978. [PMID: 36821592 PMCID: PMC9949658 DOI: 10.1371/journal.pone.0279978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 12/19/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Approximately two-thirds of Argentine adults are overweight or obese, and 11% have diabetes. Over the last two decades, all population groups have increased their consumption of ultra-processed foods and sugar-sweetened beverages (SSB). We aimed to estimate the disease burden-deaths, events, and costs to the health system-attributed to SSB consumption in Argentina. METHODS We used a comparative risk assessment framework to estimate the health and economic impacts that would be avoided in a scenario without sugar-sweetened beverage (SSB) consumption. We calculated the direct effects on diabetes, cardiovascular disease, and BMI, and then estimated the effects of BMI on disease incidence. Finally, we applied the population attributable factor to calculate the health and economic burden avoided in Argentina in 2020. RESULTS Our model estimated that about 4,425 deaths, 110,000 healthy life years lost to premature death and disability, more than 520,000 cases of overweight and obesity in adults, and 774,000 in children and adolescents would be attributed to SSB Consumption in Argentina. This disease burden corresponds to 23% of type-2 diabetes cases and other significant proportions of cardiovascular disease and cancer. The overweight and obesity costs attributable to SSB totaled approximately $47 million in adults and $15 million in children and adolescents. CONCLUSION A significant number of disease cases, deaths, and health care costs could be attributed to SSB consumption in Argentina. Implementing measures to reduce the sugar content in beverages is a pending debt for the country and could lead to measurable improvements in population health, especially among children and adolescents.
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Affiliation(s)
- Ariel Esteban Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- * E-mail:
| | - Natalia Espínola
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | | | - Lucas Perelli
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Darío Balan
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Alfredo Palacios
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Federico Augustovski
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Andrés Pichón-Riviere
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Andrea Olga Alcaraz
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
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Thapa K, Rajbhandari-Thapa J, Hanks A, Lee JS, Zhen C. Sugar sweetened beverage restriction or fruit and vegetable purchase incentive in Supplemental Nutrition Assistance Program (SNAP): Participant’s voice and choice behavior. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2023. [DOI: 10.1080/19320248.2023.2179448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- Kiran Thapa
- Department of Health Policy and Management, University of Georgia, Athens, GA, USA
| | | | - Andrew Hanks
- Department of Human Sciences, Ohio State University, Columbus, GA, USA
| | - Jung Sun Lee
- Department of Family and Consumer Sciences, University of Georgia, Athens, GA, USA
| | - Chen Zhen
- Department of Agriculture and Applied Economics, University of Georgia, Athens, GA, USA
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Abstract
PURPOSE OF REVIEW In 2020, obesity prevalence among US children reached 19.7%, impacting about 14.7 million children and adolescents. Food insecurity among children is also a public health concern but has largely decreased or remained stable over the past decade, reaching 6.2% of US households with children in 2021. Given food insecurity and obesity's interconnected nature and their negative consequences on children's health, it is of interest to assess the Supplemental Nutrition Assistance Program's (SNAP's) impact on childhood food security, dietary quality, disease risk, and health outcomes. RECENT FINDINGS Evidence suggests that SNAP participants, including children, struggle to meet key dietary guidelines and perform poorly on key health indicators when compared with income-eligible and higher income nonparticipants. Children participating in SNAP were more likely to have elevated disease risk and consume more sugar-sweetened beverages (SSBs), more high-fat dairy, and more processed meats than income-eligible nonparticipants. However, research suggests that federal food assistance programs with more stringent nutrition standards - the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and the National School Lunch Program (NSLP) and School Breakfast Program (SBP) - improve dietary quality, increase birth weight and gestation periods, and reduce childhood obesity, infant mortality and healthcare costs. SUMMARY After reviewing the evidence on SNAP's impacts on food insecurity, dietary quality, and health as well as research on the health impacts of other more successful federal food assistance programs, we provide three policy recommendations to strengthen SNAP's effectiveness as a health intervention for children and families.
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Smith NR, Grummon AH, Ng SW, Wright ST, Frerichs L. Simulation models of sugary drink policies: A scoping review. PLoS One 2022; 17:e0275270. [PMID: 36191026 PMCID: PMC9529101 DOI: 10.1371/journal.pone.0275270] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/13/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Simulation modeling methods are an increasingly common tool for projecting the potential health effects of policies to decrease sugar-sweetened beverage (SSB) intake. However, it remains unknown which SSB policies are understudied and how simulation modeling methods could be improved. To inform next steps, we conducted a scoping review to characterize the (1) policies considered and (2) major characteristics of SSB simulation models. METHODS We systematically searched 7 electronic databases in 2020, updated in 2021. Two investigators independently screened articles to identify peer-reviewed research using simulation modeling to project the impact of SSB policies on health outcomes. One investigator extracted information about policies considered and key characteristics of models from the full text of included articles. Data were analyzed in 2021-22. RESULTS Sixty-one articles were included. Of these, 50 simulated at least one tax policy, most often an ad valorem tax (e.g., 20% tax, n = 25) or volumetric tax (e.g., 1 cent-per-fluid-ounce tax, n = 23). Non-tax policies examined included bans on SSB purchases (n = 5), mandatory reformulation (n = 3), warning labels (n = 2), and portion size policies (n = 2). Policies were typically modeled in populations accounting for age and gender or sex attributes. Most studies focused on weight-related outcomes (n = 54), used cohort, lifetable, or microsimulation modeling methods (n = 34), conducted sensitivity or uncertainty analyses (n = 56), and included supplementary materials (n = 54). Few studies included stakeholders at any point in their process (n = 9) or provided replication code/data (n = 8). DISCUSSION Most simulation modeling of SSB policies has focused on tax policies and has been limited in its exploration of heterogenous impacts across population groups. Future research would benefit from refined policy and implementation scenario specifications, thorough assessments of the equity impacts of policies using established methods, and standardized reporting to improve transparency and consistency.
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Affiliation(s)
- Natalie Riva Smith
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Anna H. Grummon
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States of America
- Department of Population Medicine, Harvard Medical School / Harvard Pilgrim Health Care Institute, Boston, MA, United States of America
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, Chapel Hill, NC, United States of America
- Carolina Population Center, UNC Chapel Hill, Chapel Hill, NC, United States of America
| | - Sarah Towner Wright
- Health Sciences Library, UNC Chapel Hill, Chapel Hill, NC, United States of America
| | - Leah Frerichs
- Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill, NC, United States of America
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Acciai F, Srinivasan M, Ohri-Vachaspati P. Sugar-Sweetened Beverage Consumption in Children: The Interplay of Household SNAP and WIC Participation. Am J Prev Med 2021; 61:665-673. [PMID: 34686300 DOI: 10.1016/j.amepre.2021.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although sugar-sweetened beverage (SSB) consumption is associated with Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation, no national studies have examined the interplay between these programs. This study compares children's sugar-sweetened beverage consumption across households enrolled in one, both, or neither program. METHODS A total of 4 waves (2009-2010 to 2015-2016) of the National Health and Nutrition Examination Survey were combined to obtain a sample of 4,772 children aged 0-19 years living in households eligible for both SNAP and WIC (households with income ≤130% of the Federal Poverty Level). Children were grouped as living in 4 household types: SNAP only; WIC only; SNAP + WIC; and neither program. Beverages with any added sugars were classified as SSBs. Two-part regression models examined the adjusted association between SSB consumption and program participation. Analyses were conducted in 2020. RESULTS Compared with the SNAP‒only group, children in all other household types had lower odds of SSB consumption (AOR=0.44, p=0.002 for WIC only; AOR=0.69, p=0.020 for SNAP + WIC; AOR=0.61, p=0.025 for neither program). The lower probability of SSB consumption for children from WIC‒participating households was mostly driven by children aged 0-5 years, with the differences weakening for children aged 6-12 years and completely disappearing for those aged 12-19 years. No significant differences were observed for the amount of added sugar consumed by SSB consumers. CONCLUSIONS Household WIC participation-whether jointly with SNAP or alone-may confer protection against SSB consumption. Unlike SNAP, WIC, by design, provides participating households with more information and opportunities to access and consume healthier diets. Understanding how SNAP and WIC interact can help policymakers improve the design and nutritional benefit of the U.S. food safety net.
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Affiliation(s)
- Francesco Acciai
- College of Health Solutions, Arizona State University, Phoenix, Arizona.
| | - Mithuna Srinivasan
- Health Care Evaluation Department, NORC at the University of Chicago, Bethesda, Maryland
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Mertens E, Genbrugge E, Ocira J, Peñalvo JL. Microsimulation Modelling in Food Policy: A Scoping Review of Methodological Aspects. Adv Nutr 2021; 13:S2161-8313(22)00080-1. [PMID: 34694330 PMCID: PMC8970827 DOI: 10.1093/advances/nmab129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Food policies for the prevention and management of diet-related non-communicable diseases (NCDs) have been increasingly relying on microsimulation models (MSMs) to assess effectiveness. Given the increased uptake of MSMs, this review aims to provide an overview of the characteristics of MSMs that link diets with NCDs. A comprehensive review was conducted in PubMed and Web of Knowledge. Inclusion criteria were: (i) findings from a MSM, (ii) diets, foods or nutrients as main exposure of interest, (iii) NCDs, such as overweight/obesity, type 2 diabetes, coronary heart disease, stroke or cancer as disease outcome for impact assessment. This review included information from 33 studies using MSM in analyzing diet and diverse food policies on NCDs. Hereby, most models employed stochastic, discrete-time, dynamic microsimulation techniques to calculate anticipated (cost-)effectiveness of strategies based on food pricing, food reformulation or dietary (lifestyle) interventions. Currently available models differ in the methodology used for quantifying the effect of the dietary changes on disease, and in the method for modelling disease incidence and mortality. However, all studies provided evidence that the models were sufficiently capturing the close-to-reality situation by justifying their choice of model parameters and validating externally their modelled disease incidence and mortality with observed or predicted event data. With the increasing use of various MSMs, between-model comparisons, facilitated by open access models and good reporting practices, would be important for judging model's accuracy, leading to continued improvement in the methodologies for developing and applying MSMs, and subsequently a better understanding of the results by policymakers. A STATEMENT OF SIGNIFICANCE Given the advancement in the application of microsimulation modelling in evaluating food policies and measuring diet-related disease burdens, the present scoping review serves as an exercise to inform future modelling, hereby highlighting the need for transparency in model development, application and dissemination to advance and safeguard accuracy and relevance in modelling efforts.
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Affiliation(s)
| | - Els Genbrugge
- Unit of Non-communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Junior Ocira
- Unit of Non-communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - José L Peñalvo
- Unit of Non-communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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