Supplemental Nutrition Assistance Program participation did not help low income Hispanic women in Texas meet the dietary guidelines

Federal Food Program Participation and Beverage Intake Among Families With Low Household Income

OBJECTIVE

Examine beverage intake among families with low income by household participation in federal food assistance programs.

DESIGN

Cross-sectional study conducted in fall/winter 2020 via an online survey.

PARTICIPANTS

Mothers of young children insured by Medicaid at the time of the child's birth (N = 493).

VARIABLES MEASURED

Mothers reported household federal food assistance program participation, later categorized as Supplementation Nutrition Program for Women, Infants, and Children (WIC) only, Supplemental Nutrition Assistance Program-Education (SNAP) only, both WIC and SNAP, and neither. Mothers reported beverage intake for themselves and their children aged 1-4 years.

ANALYSIS

Negative binomial and ordinal logistic regression.

RESULTS

After accounting for sociodemographic differences between groups, mothers from households participating in WIC and SNAP consumed sugar-sweetened beverages (incidence rate ratio, 1.63; 95% confidence interval [CI], 1.14-2.30; P = 0.007) and bottled water (odds ratio, 1.76; 95% CI, 1.05-2.96; P = 0.03) more frequently than mothers from households in neither program. Children from households participating in WIC and SNAP also consumed soda (incidence rate ratio, 6.07; 95% CI, 1.80-20.45; P = 0.004) more frequently than children in either program. Few differences in intake were observed for mothers or children participating in only WIC or SNAP vs both programs or neither program.

CONCLUSION AND IMPLICATIONS

Households participating in both WIC and SNAP may benefit from additional policy and programmatic interventions to limit sugar-sweetened beverage intake and reduce spending on bottled water.

Food security and diet quality in a racially diverse cohort of postpartum women in the USA

Food insecurity has been associated with poor diet, but few studies focused on the postpartum period - an important time for women's health. We examined associations between food security and diet quality in postpartum women and assessed whether participation in federal food assistance programmes modified this potential relation. Using longitudinal data, we analysed the association between food security at 3 months postpartum and a modified Alternate Healthy Eating Index-2010 (AHEI) at 6 months postpartum (excluding alcohol). We conducted multivariable linear regressions examining associations between food security and AHEI. We assessed two food assistance programmes as potential effect modifiers. The sample included 363 postpartum women from the Nurture study, located in the Southeastern USA (2013-2017). Among women, 64·4 % were Black and 45·7 % had a high school diploma or less. We found no evidence of an interaction between food security and two federal food assistance programmes. In adjusted models, marginal, low and very low food security were not associated with AHEI. However, low (β: -0·64; 95 % CI -1·15, -0·13; P = 0·01) and very low (β: -0·57; 95 % CI -1·02, -0·13; P = 0·01) food security were associated with greater trans fat intake. Food security status was not associated with overall diet quality but was associated with higher trans fat (low and very low) and more moderate alcohol (marginal) intake. Future studies should assess the consistency and generalisability of these findings.

Contributing Factors of Sugar-Sweetened Beverage Intake in the Latinx Population: A Narrative Review Using the Social-Ecological Model

Sugar-sweetened beverage (SSB) consumption in the Latinx population has been a topic of increasing interest due to higher rates of consumption in this population, as well as higher prevalence of chronic health conditions, such as diabetes and obesity. SSB behaviors are influenced by multiple factors across the socio-ecological model. Understanding these factors can inform future intervention development and improve SSB consumption and overall health. Therefore, this narrative review identifies factors contributing to SSB consumption, as well as interventions conducted to address SSB consumption in the Latinx population residing in the United States. Contributing factors that are not currently addressed in published interventions are highlighted with the intent to inform the development of future comprehensive interventions.

Between- and within-Group Differences in Fruit and Vegetable Purchases, Consumption, and BMI among Hispanic Farmers' Market Shoppers Who Use SNAP

(1) Background: Despite considerable efforts to increase farmers' market access (FM) and improve household fruit and vegetable (FV) purchasing in low-income communities, little is known about the FV purchasing and consumption characteristics of low-income Hispanic farmers' market shoppers. (2) Methods: A secondary analysis of baseline data from a farmers' market study conducted between 2015 and 2017 (n = 2825) was performed. Participants who also received supplemental nutrition assistance program (SNAP) completed a 31-item online survey assessing demographics, health characteristics, and FV purchasing and consumption habits. Descriptive statistics and bivariate analyses were used to assess between- and within-group differences amongst Hispanic and non-Hispanic households. Regression analyses were used to examine associations among BMI, FV purchasing and consumption, and household size for Hispanic and non-Hispanic households as well as for Hispanic subgroups. (3) Results: The sample included 515 Hispanic and 2310 non-Hispanic SNAP-using FM shoppers in 13 states. Despite experiencing significantly higher food insecurity (89% vs. 81%, non-Hispanic), Hispanic shoppers consumed similar amounts of FV (3.04 cups/day) and spent less doing so. Significant subgroup differences were identified for FV purchasing. (4) Conclusions: Findings emphasize the importance of food insecurity and household size in FV interventions and underscore the capacity of Hispanic families to maintain FV consumption.

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.

Awareness and use of nutrition information predict measured and self-rated diet quality of older adults in the USA

OBJECTIVES

To examine: (1) diet quality of older adults, using the Healthy Eating Index 2010 (HEI-2010) and self-rated diet quality, (2) characteristics associated with reported awareness and use of nutrition information and (3) factors associated with HEI score and self-rated diet quality.

DESIGN

Cross-sectional study. Based on Day 1 and/or Day 2 dietary recalls, the Per-Person method was used to estimate HEI-2010 component and total scores. T-tests and ANOVA were used to compare means. Logistic and linear regressions were used to test for associations with diet quality, controlling for potential confounders.

SETTING

National Health and Nutrition Examination Survey, 2009-2014.

PARTICIPANTS

Three thousand and fifty-six adults, aged 60 years and older, who completed at least one 24-h recall and answered questions on awareness and use of nutrition information.

RESULTS

Mean HEI score for men was significantly lower than for women (56·4 ± 0·6 v. 60·2 ± 0·6, P < 0·0001). Compared with men, more women were aware of (44·8 % v. 33·7 %, P < 0·05) and used (13·7 % v. 5·9 %, P < 0·05) nutrition information. In multivariable analyses, awareness and use of nutrition information were significant predictors of both HEI and self-rated diet quality for both women and men. Groups with lower nutrition awareness included men, non-Whites, participants in nutrition assistance programmes and those with lower education and socio-economic status.

CONCLUSIONS

Nutrition awareness and use of nutrition information are associated with diet quality in adults 60 years and older. Gaps in awareness of dietary guidelines in certain segments of the older adult population suggest that targeted education may improve diet quality for these groups.

Examining disparities in diet quality between SNAP participants and non-participants using Oaxaca-Blinder decomposition analysis

Recent studies have reported that SNAP participants have poorer diet quality than non-participants. This study aimed to examine how differences in socio-demographic, household, and health-related measures explain disparities in diet quality between SNAP participants and non-participants using Oaxaca-Blinder decomposition analysis. We analyzed cross-sectional data on 14,331 adult respondents of the National Health and Nutrition Examination Survey (NHANES) 2009 - 2014. To measure diet quality, we applied the Healthy Eating Index (HEI)-2015 to respondents' 24-hour dietary recall data (scale: 0-100 points). We used Oaxaca-Blinder decomposition analysis to determine how much of the disparity in HEI-2015 total score between SNAP participants and non-participants was explained by socio-demographic (e.g., age, race/ethnicity, educational), household (e.g., household size, food security status), and health-related measures (e.g., BMI, smoking status). Analyses performed revealed significant differences in HEI-2015 total score by SNAP participation status (p < 0.001). We found that the total gap in HEI-2015 total score between SNAP participants and income-ineligible non-participants was 6.30 points. Socio-demographic measures alone explained 72.40% of the disparity. All measures together explained 86.31% of the disparity. The total gap between SNAP participants and income-eligible non-participants was 3.24 points. Socio-demographic measures alone explained 35.51% of this disparity while all measures together explained 56.86%. We observed disparities in diet quality between SNAP participants and non-participants. Socio-demographic, household, and health-related measures explained a significant amount of the disparity that existed between SNAP participants and income-ineligible non-participants; they explained less of the disparity between SNAP participants and income-eligible non-participants.

Food stamps, food insecurity, and health outcomes among elderly Americans

This study examined associations between very low food security and health outcomes in older adults, and tested whether participation in the Supplemental Nutrition Assistance Program (SNAP) mitigates adverse health consequences associated with very low food security. Data were drawn from the 1998-2014 waves of the Health and Retirement Study (N = 148,138 from 27,281 persons). A longitudinal analysis of the relationship between very low food security and health condition depending on SNAP participation was conducted using the individual fixed effects regression. Respondents' health status was assessed by self-rated health, grip strength, and depressive symptoms. The correlations between very low food security and physical health outcomes were negatively significant prior to SNAP enrollment (p < 0.05) but became insignificant upon participation, indicating that SNAP may have prevented poor physical health resulting from very low food security. However, results concerning mental health showed that SNAP enrollment does not modify the association between very low food security and depression; very low food security remained a significant risk factor of depressive symptoms conditional on SNAP enrollment (p < 0.001). Further analyses showed that SNAP participation is correlated with negative self-attitudes (p < 0.05), and that the correlation between SNAP and depression becomes insignificant after controlling for self-attitudes. These results suggest that a stigma effect arising from welfare use may have reduced self-esteem and resulted in depressive moods. Future research needs to delve into whether reforms to the food assistance program aimed at reducing stigma can help alleviate emotional distress among welfare recipients.

Food insecurity and dietary intake by Supplemental Nutrition Assistance Program participation status among mainland US Puerto Rican adults after the 2009 American Recovery and Reinvestment Act

OBJECTIVE

The 2009 American Recovery and Reinvestment Act (ARRA) increased monthly Supplemental Nutrition Assistance Program (SNAP) benefits and expanded SNAP eligibility, yet limited evidence exists on the potential impact of ARRA on dietary intake among at-risk individuals. We aimed to examine pre-/post-ARRA differences in food insecurity (FI) and dietary intake by SNAP participation status.

DESIGN

Pre/post analysis.

SETTING

Boston, MA, USA.

PARTICIPANTS

Data were from the longitudinal Boston Puerto Rican Health Study (2007-2015). The US Department of Agriculture ten-item adult module assessed FI. A validated FFQ assessed dietary intake. Diet quality was assessed using the Alternate Healthy Eating Index-2010 (AHEI-2010). Self-reported pre-/post-ARRA household SNAP participation responses were categorized as: sustained (n 249), new (n 95) or discontinued (n 58). We estimated differences in odds of FI and in mean nutrient intakes and AHEI-2010 scores post-ARRA.

RESULTS

Compared with pre-ARRA, OR (95 % CI) of FI post-ARRA were lower for all participants (0·69 (0·51, 0·94)), and within sustained (0·63 (0·43, 0·92)) but not within new (0·94 (0·49, 1·80)) or discontinued (0·63 (0·25, 1·56)) participants. Post-ARRA, total carbohydrate intake was higher, and alcohol intake was lower, for sustained and new participants, and dietary fibre was higher for sustained participants, compared with discontinued participants. Scores for AHEI-2010 and its components did not differ post-ARRA, except for lower alcohol intake for sustained v. discontinued participants.

CONCLUSIONS

Post-ARRA, FI decreased for sustained participants and some nutrient intakes were healthier for sustained and new participants. Continuing and expanding SNAP benefits and eligibility likely protects against FI and may improve dietary intake.

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

BACKGROUND

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.

OBJECTIVE

This study evaluated whether the community food environment is a potential moderator of the association between SNAP participation and eating behaviors.

DESIGN

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.

PARTICIPANTS/SETTING

Analysis is limited to 983 respondents (588 SNAP participants) with household incomes below 130% of the federal poverty level.

MAIN OUTCOME MEASURES

Eating behaviors were assessed as frequency of consumption of fruit, vegetables, salad, and sugar-sweetened beverages.

STATISTICAL ANALYSES PERFORMED

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.

RESULTS

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).

CONCLUSIONS

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.

Monthly Variations in Dietary Intake of Women Participating in the Supplemental Nutrition Assistance Program

BACKGROUND

Households participating in the Supplemental Nutrition Assistance Program (SNAP) have been shown to spend the majority of their program benefits within the first 3 days of receipt. Hence, it is important to investigate dietary intakes of SNAP participants based on time since receipt of benefits.

OBJECTIVE

The objectives of this study were to investigate the dietary intake of women participating in SNAP over 1 month and to compare diet quality between food secure and food insecure women using two indices.

DESIGN

A longitudinal design was used to examine monthly dietary intake of women in SNAP. Participants were measured for height and weight. A demographics questionnaire and a food frequency questionnaire (FFQ) based on a reference period of 1 week were administered. The FFQ was completed four times, with an interval of 1 week, so that it reflected the diets of participants during weeks 1, 2, 3, and 4 of benefit receipt. Participants also completed the US adult food security module. The Healthy Eating Index-2010 and the Dietary Guidelines Adherence Index 2015 were used to assess diet quality.

PARTICIPANTS/SETTING

A total of 217 women were recruited from low-income housing and neighborhood centers in Central Texas from January to December 2015. Women enrolled in SNAP, aged 18 to 50 years, and of Hispanic, African-American, and white race or ethnicity participated in the study. Fifty-eight women were lost during follow-up. Data from eight participants was excluded due to reporting of implausible caloric intakes, thereby resulting in a final sample of 151.

MAIN OUTCOME MEASURES

Food group, nutrient intake, and diet quality were the main outcome measures of the study.

STATISTICAL ANALYSIS

A mixed linear model was conducted using week since receipt of benefits as the independent variable and food group, nutrient intake, and diet quality as the dependent variables. An analysis of variance was conducted to determine differences in diet quality based on food security status for each week of the monthly SNAP cycle.

RESULTS

A significant decrease in daily intakes of fruits, vegetables, dairy, and diet quality was observed over the month (P<0.05, with Bonferroni adjustment). Food secure women had higher diet quality than those with very low food security (P<0.05, with Bonferroni adjustment). However, a decline in diet quality was observed in all groups of women, classified according to food security status.

CONCLUSIONS

These results show that dietary intake of SNAP participants varies based on time since receipt of benefits.

Effects of Subsidies and Prohibitions on Nutrition in a Food Benefit Program: A Randomized Clinical Trial

IMPORTANCE

Strategies to improve the nutritional status of those participating in the Supplemental Nutrition Assistance Program (SNAP) are of interest to policymakers.

OBJECTIVE

To evaluate whether the proposed policy of incentivizing the purchase of fruits and vegetables and prohibiting the purchase of less nutritious foods in a food benefit program improves the nutritional quality of participants' diets.

DESIGN, SETTING, AND PARTICIPANTS

Lower income participants (n = 279) not currently enrolled in SNAP were randomized to 1 of 4 experimental financial food benefit conditions: (1) incentive (30% financial incentive for fruits and vegetables purchased using food benefits); (2) restriction (not allowed to buy sugar sweetened beverages, sweet baked goods, or candies with food benefits); (3) incentive plus restriction (30% financial incentive on fruits and vegetables and restriction of purchase of sugar sweetened beverages, sweet baked goods, or candy with food benefits); or (4) control (no incentive or restrictions on foods purchased with food benefits). Participants in all conditions were given a study-specific debit card where funds were added every 4 weeks for a 12-week period. Outcome measures were collected at baseline and in the final 4 weeks of the experimental period.

MAIN OUTCOMES AND MEASURES

Primary outcomes (from 24-hour dietary recalls) included intake of energy, discretionary calories, and overall diet quality.

RESULTS

A number of favorable changes were observed in the incentive plus restriction condition that were significantly different from changes in the control condition. These included (1) reduced intake of energy (-96 kcal/d, standard error [SE], 59.9); (2) reduced intake of discretionary calories (-64 kcal/d, SE 26.3); (3) reduced intake of sugar sweetened beverages, sweet baked goods, and candies (-0.6 servings/d, SE 0.2); (4) increased intake of solid fruit (0.2 servings/d, SE 0.1); and (5) improved Healthy Eating Index score (4.1 points, SE 1.4). Fewer improvements were observed in the incentive only and restriction only arms.

CONCLUSIONS AND RELEVANCE

A food benefit program that pairs incentives for purchasing more fruits and vegetables with restrictions on the purchase of less nutritious foods may reduce energy intake and improve the nutritional quality of the diet of participants compared with a program that does not include incentives or restrictions.

CLINICAL TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT02643576.

SNAP-Ed (Supplemental Nutrition Assistance Program-Education) Increases Long-Term Food Security among Indiana Households with Children in a Randomized Controlled Study

BACKGROUND

Food insecurity is negatively associated with US children's dietary intake and health. The Supplemental Nutrition Assistance Program-Education (SNAP-Ed) aims to alleviate food insecurity by offering nutrition, budgeting, and healthy lifestyle education to low-income individuals and families.

OBJECTIVE

The objective of this study was to evaluate the long-term impact of the Indiana SNAP-Ed on food security among households with children.

METHODS

A randomized, controlled, parallel study design with SNAP-Ed as an intervention was carried out during a 4- to 10-wk intervention period. Intervention group participants received the first 4 Indiana SNAP-Ed curriculum lessons. Study participants (n = 575) were adults aged ≥18 y from low-income Indiana households with ≥1 child living in the household. Both treatment groups completed an assessment before and after the intervention period and 1 y after recruitment. The 18-item US Household Food Security Survey Module was used to classify the primary outcomes of food security for the household and adults and children in the household. A linear mixed model was used to compare intervention with control group effects over time on food security.

RESULTS

Mean ± SEM changes in household food security score and food security score among household adults from baseline to 1-y follow-up were 1.2 ± 0.4 and 0.9 ± 0.3 units lower, respectively, in the intervention group than in the control group (P < 0.01). The mean change in food security score from baseline to 1-y follow-up among household children was not significantly different in the intervention group compared with the control group.

CONCLUSIONS

SNAP-Ed improved food security over a longitudinal time frame among low-income Indiana households with children in this study. SNAP-Ed may be a successful intervention to improve food security.

Impact of Food Assistance Programs on Obesity in Mothers and Children: A Prospective Cohort Study in Peru

OBJECTIVES

To assess obesity risk among mothers participating in Community Kitchens and children participating in Glass of Milk (Peru food assistance programs).

METHODS

We analyzed prospective data from the Young Lives study. The exposure consisted in varying degrees of benefit from any of the programs (no participation in any of the programs, program participation for some months, or program participation nearly every month) at baseline (2006-2007). The outcome was overweight and obesity in mothers and children at follow-up (2009-2010).

RESULTS

Prevalence of childhood overweight and obesity was 15.5% and 5.1%, respectively; the corresponding figures for mothers were 40.5% and 14.6%. Children exposed nearly every month to the Glass of Milk program had a 65% lower risk of becoming obese compared with children not participating in the program (relative risk [RR] = 0.35; 95% confidence interval [CI] = 0.18, 0.66). Mothers participating frequently in the Community Kitchens program had almost twice the risk of becoming obese compared with those who did not participate (RR = 1.93; 95% CI = 1.18, 3.15).

CONCLUSIONS

Participating in food assistance programs in Peru was associated with a lower risk of obesity in children and greater risk of obesity in mothers.

Implications of the Supplemental Nutrition Assistance Program Tax Exemption on Sugar-Sweetened Beverage Taxes

US state and local governments are debating sugar-sweetened beverage excise taxes to support public health. A related issue is whether such taxes would apply to beverage purchases made by Supplemental Nutrition Assistance Program (SNAP) participants. Federal law proscribes states from collecting excise taxes on SNAP purchases, but the law is confined to taxes at the point of sale. I provide legal analysis and recommendations for policymakers to enact taxes that are not subject to the SNAP tax exemption to potentially deter consumption by all consumers.

Dietary Quality of Americans by Supplemental Nutrition Assistance Program Participation Status: A Systematic Review

CONTEXT

The Supplemental Nutrition Assistance Program (SNAP) is an effective component in reducing food insecurity in the U.S. In the discussion of strategies to also help SNAP participants maximize diet quality, it is important to know their current dietary patterns and food choices. This paper provides a systematic review of recent U.S. studies on dietary quality, food consumption, and spending among SNAP participants as compared to income-eligible and higher-income nonparticipants.

EVIDENCE ACQUISITION

The review, completed in 2014, summarized studies that were peer-reviewed, published between January 2003 and August 2014, and provided data on dietary quality and intake of SNAP participants and nonparticipants.

EVIDENCE SYNTHESIS

Twenty-five studies were included in this review. Daily caloric, macronutrient, and micronutrient intake of SNAP participants did not differ systematically from those of income-eligible nonparticipants; however, differences in dietary quality emerged. Adult SNAP participants scored lower on the Healthy Eating Index than either group of nonparticipants. Children's diets were similar among SNAP participants and low-income nonparticipants, but were less nutritious than diets of higher-income children. The evidence regarding sugar-sweetened beverage consumption was mixed, with most studies indicating significantly higher beverage intake among SNAP participants compared with higher-income nonparticipants, but no difference compared to income-eligible nonparticipants.

CONCLUSIONS

SNAP effectively alleviates food insecurity in terms of caloric, macronutrient, and micronutrient intake. Still, SNAP participants are struggling more than income-eligible and higher-income nonparticipants to meet key dietary guidelines. Future policies should ensure that this vital food assistance program addresses diet quality while reducing food insecurity.

The Supplemental Nutrition Assistance Program: Analysis of Program Administration and Food Law Definitions

Under the current version of the Supplemental Nutrition Assistance Program (SNAP), participants can purchase virtually any food or beverage (collectively, food). Research indicates that SNAP recipients may have worse dietary quality than income-eligible nonparticipants. Policymakers have urged the U.S. Department of Agriculture (USDA) to pilot SNAP purchasing restrictions intended to support a healthier diet, and state legislators have proposed similar bills. The USDA rejected these invitations, stating that it would be administratively and logistically difficult to differentiate among products, amid other concerns. However, the USDA's Dietary Guidelines for Americans and the Supplemental Nutrition Program for Women, Infants, and Children (WIC) do just that. Further, state governments define and differentiate among foods and beverages for tax purposes. This paper reviews several factors intended to inform future policy decisions: the science indicating that SNAP recipients have poorer diet quality than income-eligible nonparticipants; the public's support for revising the SNAP program; federal, state, and city legislators' formal proposals to amend SNAP based on nutrition criteria and the USDA's public position in opposition to these proposals; state bills to amend eligible foods purchasable with SNAP benefits; state retail food tax laws; and the retail administration and program requirements for both WIC and SNAP. The paper finds that the government has a clear ability to align SNAP benefits with nutrition science and operationalize this into law.

The Impact of the 2009 Special Supplemental Nutrition Program for Women, Infants, and Children Food Package Revisions on Participants: A Systematic Review

For the first time since 1980, the US Department of Agriculture Food and Nutrition Service Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package policies were revised in 2009 to meet the Institute of Medicine's nutrition recommendations. These changes included increases in fruits, vegetables, whole grains, and low-fat dairy to improve nutrition and health of WIC participants. Our systematic review of the literature assessed the influence that the 2009 WIC food package revisions have had on dietary intake, healthy food and beverage availability, and breastfeeding participation. The systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Four electronic databases were searched between April 1 and 30, 2014, for peer-reviewed research. Two reviewers screened the articles, extracted the data, and established inter-rater reliability by discussing and resolving discrepancies. Twenty articles were included that met our inclusion criteria. Nine of the studies analyzed changes in dietary intake, eight examined changes in healthy food and beverage availability, and three evaluated breastfeeding participation exclusively. The review demonstrated an improved dietary intake and an increase in the availability of healthier foods and beverages in authorized WIC stores. The revised food package was also associated with improved dietary intake of WIC participants. Mixed results were demonstrated in regard to improved breastfeeding outcomes. Further research is needed to assess the influence of WIC 2009 food package revisions on breastfeeding outcomes and to make conclusions about broad nutrition-related implications.

Food Resource Management Education With SNAP Participation Improves Food Security

OBJECTIVE

To determine the influence of Supplemental Nutrition Assistance Program (SNAP) and participant demographics on nutrition education outcomes.

METHODS

At program enrollment (pre) and 1 month later (post), a statewide convenience sample of adults, who participated in the Plan, Shop, Save, and Cook program, completed a 7-item questionnaire to evaluate change in resource management skills (RMS) and running out of food before the end of the month.

RESULTS

Percent of participants (n = 3,744) who reported behavioral improvements in RMS ranged from 38.8% in comparing prices to 54% in reading labels. Female gender and Hispanic ethnicity were positively related to pre-post RMS change (P = .001). Participants who received SNAP food assistance and made greater pre-post improvement in RMS reported the greatest decrease in running out of food (P = .001).

CONCLUSIONS AND IMPLICATIONS

Both food assistance and education on nutrition and resource management are needed to reduce food insecurity in SNAP-eligible audiences.

Identifying the effects of environmental and policy change interventions on healthy eating

Obesity has been characterized as a disease. Strategies to change the incidence and prevalence of this disease include a focus on changing physical and social environments, over and above individual-level strategies, using a multilevel or systems approach. We focus our attention on evidence published between 2008 and 2013 on the effectiveness of interventions in nutrition environments, i.e., environmental interventions designed to influence the intake of healthful foods and amount of energy consumed. An overarching socioecological framework that has guided much of this research was used to characterize different types of environmental strategies. Intervention examples in each area of the framework are provided with a discussion of key findings and related conceptual and methodological issues. The emphasis in this review is on adults, but clearly this literature is only one part of the picture. Much research has been focused on child-specific interventions, including environmental interventions. Some evidence suggests effectiveness of policy-based or other types of interventions that aim to regulate or restructure environments to promote healthy dietary choices, and these strategies would apply to both children and adults. Opportunities to evaluate these policy changes in adults' social and physical environments are rare. Much of the existing research has been with children. As conceptual and methodological issues continue to be identified and resolved, we hope that future research in this domain will identify environmental strategies that can be included in intervention toolboxes to build healthy nutrition environments for both adults and children.

Associations between depressive symptomatology, diet, and body mass index among participants in the supplemental nutrition assistance program

BACKGROUND

Participation in the Supplemental Nutrition Assistance Program (SNAP) has been shown to increase food security, or access to adequate food; however, SNAP participation has also been associated with obesity among certain demographic groups (eg, women, but not men and children), possibly due to poorer dietary quality. Depressive symptomatology is an understudied factor, which is associated with obesity across the lifespan.

OBJECTIVE

This study examined the relationship between depressive symptomatology, dietary quality, and body weight among a sample of SNAP participants (n=639).

DESIGN

The analysis was cross-sectional; survey data were collected in May to December 2011 by trained data collectors.

PARTICIPANTS/SETTING

Adults who self-identified as the primary food shopper of the household in two predominantly low-income African-American neighborhoods characterized as "food deserts" in Pittsburgh, PA, were recruited to participate in this study.

MEASURES

Dietary quality was calculated using the US Department of Agriculture's Healthy Eating Index-2005. Body mass index (BMI; calculated as kg/m(2)) was based on objective measurements taken by the interviewer. Current depressive symptomatology was assessed by a trained interviewer using the Patient Health Questionnaire-2.

STATISTICAL ANALYSES PERFORMED

Descriptive statistics (means and percentages); two multivariate ordinary least-square regression analyses predicting BMI and dietary quality from depressive symptomatology while controlling for sociodemographic factors and food insecurity were performed.

RESULTS

Depression was a strong and statistically significant predictor of both dietary quality and BMI; higher score in depressive symptomatology was associated with lower scores in dietary quality (β=-1.26; P<0.0001). A higher score in depressive symptomatology was associated with higher BMI (β=.63; P=0.0031).

CONCLUSIONS

These findings show that depressive symptomatology is significantly associated with weight-related outcomes and suggests that understanding the risk of depression among SNAP participants could be important to understanding the relationships among SNAP participation, diet, and weight. The association between depressive symptomology, elevated BMI, and lower dietary quality among low-income, primarily African-American residents living in a food desert suggests the potential for mental health interventions to have broader benefits in this population. However, the directionality of this association is unclear and improving diet and reducing weight might also improve mental health symptoms. Additional longitudinal studies should assess these possibilities.