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Gabrielli L, Alvim Matos SM, Luísa Patrão A, Góes EF, da Conceição C. Almeida M, M.S. Menezes G, dos-Santos-Silva I, Azevedo e Silva G, Teresa Bustamante-Teixeira M, Barreto ML, Vittal Katikireddi S, Leyland AH, Ferreira Campos L, Maria Dias Fernandes de Novaes E, de Almeida Pereira D, Rodrigues Santana E, Rodrigues Gonçalves Zeferino F, Cleide da Silva Dias A, Fernandes FG, Cristina de Oliveira Costa A, M.L. Aquino E. Do social protection programmes affect the burden of breast and cervical cancer? A systematic review. HEALTH POLICY OPEN 2024; 6:100122. [PMID: 38779080 PMCID: PMC11109333 DOI: 10.1016/j.hpopen.2024.100122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 04/21/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Background Socioeconomic conditions are strongly associated with breast and cervical cancer incidence and mortality patterns; therefore, social protection programmes (SPPs) might impact these cancers. This study aimed to evaluate the effect of SPPs on breast and cervical cancer outcomes and their risk/protective factors. Methods Five databases were searched for articles that assessed participation in PPS and the incidence, survival, mortality (primary outcomes), screening, staging at diagnosis and risk/protective factors (secondary outcomes) for these cancers. Only peer-reviewed quantitative studies of women receiving SPPs compared to eligible women not receiving benefits were included. Independent reviewers selected articles, assessed eligibility, extracted data, and assessed the risk of bias. A harvest plot represents the included studies and shows the direction of effect, sample size and risk of bias. Findings Of 17,080 documents retrieved, 43 studies were included in the review. No studies evaluated the primary outcomes. They all examined the relationship between SPPs and screening, as well as risk and protective factors. The harvest plot showed that in lower risk of bias studies, participants of SPPs had lower weight and fertility, were older at sexual debut, and breastfed their infants for longer. Interpretation No studies have yet assessed the effect of SPPs on breast and cervical cancer incidence, survival, or mortality; nevertheless, the existing evidence suggests positive impacts on risk and protective factors.
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Affiliation(s)
- Ligia Gabrielli
- Bahia State Centre for Diabetes and Endocrinology, SESAB, Salvador, Brazil
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
| | | | - Ana Luísa Patrão
- Centre for Psychology, Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | - Emanuelle F. Góes
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | | | | | - Isabel dos-Santos-Silva
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Mauricio L. Barreto
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | | | - Alastair H. Leyland
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Luana Ferreira Campos
- Graduate Programme on Medicine and Health, Federal University of Bahia, Salvador, Brazil
| | | | | | | | | | | | | | | | - Estela M.L. Aquino
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
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Basiry M, Surkan PJ, Ghosn B, Esmaillzadeh A, Azadbakht L. Associations between nutritional deficiencies and food insecurity among adolescent girls: A cross-sectional study. Food Sci Nutr 2024; 12:4623-4636. [PMID: 39055178 PMCID: PMC11266893 DOI: 10.1002/fsn3.4065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 07/27/2024] Open
Abstract
There is a research gap in understanding the relationship between nutrient deficiency and food insecurity among adolescent girls in Afghanistan. The objective of this study was to investigate the associations between nutrient deficiencies and food insecurity among middle and high school-aged girls in Kabul. We conducted a cross-sectional study of 380 randomly selected 11-18-year-old girls attending public schools in grades 6-12. We assessed girls' food insecurity, food and nutrient intake, socioeconomic status, and physical activity. Nutrient consumption was calculated using Nutritionist IV software. Statistical analyses, including one-way analysis of variance, Chi-square tests, and t-tests, were used to assess the association between dietary intake and food insecurity. More than half (52.9%) of the participants were food insecure, with 35.8% experiencing hunger and 17.1% without hunger. Vitamin B3, C, selenium, and iron had the highest sensitivity, specificity, and accuracy and were the best indicators of food insecurity with and without hunger. The most prevalent nutrient deficiencies were vitamin B9 and E, calcium, magnesium, and zinc inadequacies. Food security was positively associated with fruit, vitamins E and K, dairy products (e.g., milk, yogurt, and cheese), meat products (e.g., chicken, meat, red meat, and egg), and nut intake. Our findings suggest that adolescent girls in Kabul may benefit from food programs that enrich nutrients such as B9 and E, calcium, magnesium, and zinc, which were found to be the most prevalent nutrient deficiencies. These findings highlight the importance of addressing food insecurity and nutrient deficiencies among adolescent girls in Afghanistan.
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Affiliation(s)
- Mursal Basiry
- Department of NutritionGhazanfar Institute of Health and Science, Ministry of Public HealthKabulAfghanistan
- Department of Community Nutrition, School of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
| | - Pamela J. Surkan
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Batoul Ghosn
- Department of Community Nutrition, School of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
- Diabetes Research CenterEndocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical SciencesTehranIran
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
- Diabetes Research CenterEndocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical SciencesTehranIran
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Dong W, Bensken WP, Kim U, Rose J, Fan Q, Schiltz NK, Berger NA, Koroukian SM. Variation in and Factors Associated With US County-Level Cancer Mortality, 2008-2019. JAMA Netw Open 2022; 5:e2230925. [PMID: 36083583 PMCID: PMC9463612 DOI: 10.1001/jamanetworkopen.2022.30925] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The association between cancer mortality and risk factors may vary by geography. However, conventional methodological approaches rarely account for this variation. OBJECTIVE To identify geographic variations in the association between risk factors and cancer mortality. DESIGN, SETTING, AND PARTICIPANTS This geospatial cross-sectional study used county-level data from the National Center for Health Statistics for individuals who died of cancer from 2008 to 2019. Risk factor data were obtained from County Health Rankings & Roadmaps, Health Resources and Services Administration, and Centers for Disease Control and Prevention. Analyses were conducted from October 2021 to July 2022. MAIN OUTCOMES AND MEASURES Conventional random forest models were applied nationwide and by US region, and the geographical random forest model (accounting for local variation of association) was applied to assess associations between a wide range of risk factors and cancer mortality. RESULTS The study included 7 179 201 individuals (median age, 70-74 years; 3 409 508 women [47.5%]) who died from cancer in 3108 contiguous US counties during 2008 to 2019. The mean (SD) county-level cancer mortality rate was 177.0 (26.4) deaths per 100 000 people. On the basis of the variable importance measure, the random forest models identified multiple risk factors associated with cancer mortality, including smoking, receipt of Supplemental Nutrition Assistance Program (SNAP) benefits, and obesity. The geographical random forest model further identified risk factors that varied at the county level. For example, receipt of SNAP benefits was a high-importance factor in the Appalachian region, North and South Dakota, and Northern California; smoking was of high importance in Kentucky and Tennessee; and female-headed households were high-importance factors in North and South Dakota. Geographic areas with certain high-importance risk factors did not consistently have a corresponding high prevalence of the same risk factors. CONCLUSIONS AND RELEVANCE In this cross-sectional study, the associations between cancer mortality and risk factors varied by geography in a way that did not correspond strictly to risk factor prevalence. The degree to which other place-specific characteristics, observed and unobserved, modify risk factor effects should be further explored, and this work suggests that risk factor importance may be a preferable paradigm for selecting cancer control interventions compared with risk factor prevalence.
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Affiliation(s)
- Weichuan Dong
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Wyatt P. Bensken
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Uriel Kim
- Kellogg School of Management, Northwestern University, Evanston, Illinois
| | - Johnie Rose
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
- Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Qinjin Fan
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, Georgia
| | - Nicholas K. Schiltz
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, Ohio
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Nathan A. Berger
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
- Center for Science, Health, and Society, School of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Siran M. Koroukian
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
- Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, Ohio
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Oberle MM, Kinsey EW, Lipman TH, Cannuscio C, Hillier A, Stallings VA. Dietary Intake and Appetite Hormone Patterns among Mothers Participating in the Supplemental Nutrition Assistance Program: A Pilot Study. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021. [DOI: 10.1080/19320248.2019.1640826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Megan M. Oberle
- Division of Endocrinology and Diabetes, University of Minnesota, Minneapolis, USA
- Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, USA
- The Leonard David Institute of Health Economics, The University of Pennsylvania, Philadelphia, USA
| | - Eliza Whiteman Kinsey
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, USA
| | - Terri H. Lipman
- School of Nursing, University of Pennsylvania, Philadelphia, USA
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, USA
| | - Carolyn Cannuscio
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Amy Hillier
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, USA
- School of Design, University of Pennsylvania, Philadelphia
| | - Virginia A. Stallings
- School of Nursing, University of Pennsylvania, Philadelphia, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, USA
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Do EK, Bowen GA, Ksinan AJ, Adams EL, Fuemmeler BF. Sleep, Food Insecurity, and Weight Status: Findings from the Family Life, Activity, Sun, Health, and Eating Study. Child Obes 2021; 17:125-135. [PMID: 33493402 PMCID: PMC7984656 DOI: 10.1089/chi.2020.0259] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Shorter sleep duration and lower sleep quality have been previously associated with greater obesity risk among adult samples. Food insecurity has also been found to impact sleep patterns and obesity. Yet few studies have explored associations between sleep, food insecurity, and obesity in adolescent populations, who may have more irregular sleep patterns. Thus, the objectives of this study were to determine associations between measures of sleep, food insecurity, and weight status. Methods: Data were obtained from the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study, an online cross-sectional study of parent and adolescent (12-17-year old) dyads. Participants were drawn from a Consumer Opinion Panel representative of the general population of the United States with respect to sex, education, income, age, household size, and region. First, multinomial logistic regression analyses were conducted to determine associations between sleep measures (adolescent-reported average nighttime sleep duration, having a regular bedtime, and having difficulty staying asleep), food insecurity (a validated two-item parent-reported measure), and weight status (being underweight, of healthy weight, overweight, and obese). Weight status was based upon adolescent BMI z-scores using Centers for Disease Control and Prevention growth charts using information from parent report of adolescent height and weight and adolescent-reported age and sex among adolescents (N = 1544). Conditional process models were also fitted to the data to determine whether food insecurity moderates the associations between sleep measures and weight status, and to determine whether the association between food insecurity and weight status is mediated by average sleep duration. Results: Compared to those with food security, a greater percentage of those with food insecurity reported having difficulties staying asleep and a longer average sleep duration. Multinomial logistic regression models demonstrated that having a regular bedtime was associated with lower odds of having obesity, having difficulties staying asleep was associated with greater odds of being underweight, and having food insecurity was associated with greater odds of being overweight. Conditional process models demonstrated that food insecurity did not moderate associations between sleep measures and weight status and that average nighttime sleep duration did not mediate the association between food insecurity and weight status. Conclusions: This is one of the first studies to examine associations between sleep, food insecurity, and weight status among adolescents. Results provide additional support for the need to uncover mechanisms for how sleep and food insecurity affect pediatric obesity using longitudinal data.
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Affiliation(s)
- Elizabeth K. Do
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
| | - Gabrielle A. Bowen
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA.,Department of Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Albert J. Ksinan
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
| | - Elizabeth L. Adams
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
| | - Bernard F. Fuemmeler
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA.,Department of Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA.,Address correspondence to: Bernard F. Fuemmeler, PhD, MPH, Department of Health Behavior and Policy, Virginia Commonwealth University, Box 980430, Richmond, VA 23298, USA
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Chaudhuri A. Health Research in JFEI Over a Decade: 2009-2019. JOURNAL OF FAMILY AND ECONOMIC ISSUES 2020; 42:142-153. [PMID: 32921967 PMCID: PMC7475718 DOI: 10.1007/s10834-020-09707-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This article is a review of thirty health-related articles published in the Journal of Family and Economic Issues from 2009 until 2019. This review discusses how the thirty studies have addressed broad areas of concern around health care access, health utilization and health status as well as health policy and implications and contributed to the advancement of knowledge in these areas. Articles mostly focused on health outcomes for families or demographic groups within families, with an emphasis on socio-economic inequalities and inequitable burdens faced. The emphasis over the last decade has been research on chronic or non-communicable health conditions and none on communicable diseases.
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Affiliation(s)
- Anoshua Chaudhuri
- Department of Economics, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132 USA
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Gray VB, Hardman AM, Byrd SH. Qualitative Evaluation of Drivers of Eating Decisions among SNAP Participants in Mississippi. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:775-787. [PMID: 32507480 DOI: 10.1016/j.jneb.2020.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 04/03/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To explore food-related decision patterns among Supplemental Nutrition Assistance Program (SNAP) recipients in Mississippi. DESIGN A qualitative design was used to conduct focus groups (n = 18) based on the Health Belief Model with low-income female caregivers of children aged under 13 years. SETTING Mississippi. PARTICIPANTS Cluster sampling was used to recruit participants (n = 126) from the 4 regional divisions of Mississippi State University Extension. PHENOMENON OF INTEREST Drivers of eating decisions among SNAP participants. ANALYSIS Focus groups were recorded, transcribed, and coded by 2 independent coders using thematic analysis. RESULTS Drivers of food selection often overlapped with barriers to healthy eating. Participants used many strategies to manage costs and viewed healthy foods as out of reach and quick to perish. Cost, taste preferences, habits, and family factors were primary drivers of food selection and preparation; each of these presented barriers to healthier eating. Health was most often shared as a driver of food selection once disease was established. Participants reported a variety of strategies used in striving for healthier eating. CONCLUSIONS AND IMPLICATIONS Focusing on ways to manage the costs of healthy foods, honor taste preferences, and work within habits/families may enhance efforts to support healthy eating among SNAP participants.
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Affiliation(s)
- Virginia B Gray
- Department of Family and Consumer Sciences, California State University Long Beach, Long Beach, CA.
| | - Alisha M Hardman
- School of Human Sciences, Mississippi State University, Mississippi State, MS
| | - Sylvia H Byrd
- Office of Nutrition Education, Mississippi State University Extension Service, Mississippi State, MS
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Supplemental Nutrition Assistance Program participation and current restricted food expenditures: implications for policy. Public Health Nutr 2020; 23:3448-3455. [PMID: 32524927 DOI: 10.1017/s1368980020000749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE National concerns over food insecurity and obesity have prompted legislation seeking to further restrict Supplemental Nutrition Assistance Program (SNAP) purchases. The objective of this study is to provide insight on the potential impact of proposed purchase restrictions by comparing SNAP participant and income-eligible non-participants' expenditures on current SNAP-restricted foods, that is, hot foods, prepared foods, alcohol, vitamins and meal supplements. DESIGN Cross-sectional study. Bivariate analysis and multivariable regression analysis with an instrumental variables approach were employed to compare the probability of purchasing and expenditures on current SNAP-restricted foods among SNAP participants and income-eligible non-participants. SETTING National Household Food Acquisition and Purchase Survey, 2012-2013. PARTICIPANTS 2513 households, of which 1316 were SNAP participants and 1197 were income-eligible non-participants. RESULTS Both the share of households purchasing and household expenditures on current SNAP-restricted foods were similar among SNAP participants and income-eligible non-participants. CONCLUSIONS Results provide further empirical evidence that proposed SNAP purchase restrictions on sugar-sweetened beverages, snack foods and luxury foods are unlikely to have a meaningful effect on SNAP household food purchases.
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Pak TY, Kim G. Food stamps, food insecurity, and health outcomes among elderly Americans. Prev Med 2020; 130:105871. [PMID: 31678175 DOI: 10.1016/j.ypmed.2019.105871] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 08/06/2019] [Accepted: 10/12/2019] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Tae-Young Pak
- Department of Consumer Sciences, University of Alabama, Tuscaloosa, AL, United States.
| | - GwanSeon Kim
- College of Agriculture, Arkansas State University, Jonesboro, AR, United States.
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Hudak KM, Racine EF. The Supplemental Nutrition Assistance Program and Child Weight Status: A Review. Am J Prev Med 2019; 56:882-893. [PMID: 31003806 DOI: 10.1016/j.amepre.2019.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 01/31/2023]
Abstract
CONTEXT The Supplemental Nutrition Assistance Program (SNAP) is a food assistance program that helps Americans afford a healthy diet. However, its influence on children's weight status is unclear. This review examined the evidence of the relationship between SNAP participation and child weight. EVIDENCE ACQUISITION The following databases were searched: PubMed, EconLit, Web of Science, and the U.S. Department of Agriculture Economic Research Service. The last search was performed in October 2018. This systematic review gives a narrative synthesis of included studies. EVIDENCE SYNTHESIS Twenty-three studies that examined the weight outcomes of children aged 2-18 years and SNAP participation were included. Eleven studies found no significant relationship between SNAP and child weight outcomes. Nine found that SNAP participation was associated with increased weight outcomes in certain subpopulations, and four found that SNAP was linked to a predicted decrease in weight outcomes in some subpopulations. However, many of these studies did not address a key methodologic challenge: self-selection. Of those that did, five found that SNAP participation was associated with an increased risk of being overweight and elevated weight in certain subpopulations. CONCLUSIONS SNAP participation may help boys maintain a healthy body weight but can be a contributing factor in being overweight or obese in girls who are long-term participants, or who are already overweight. Food security and participation in multiple food assistance programs may be important modifiers. These findings are relevant to policymakers who are considering reducing SNAP funding or restructuring the program. Further research that utilizes strong designs is needed.
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Affiliation(s)
- Katelin M Hudak
- Department of Public Policy, University of North Carolina-Charlotte, Charlotte, North Carolina.
| | - Elizabeth F Racine
- Department of Public Health Sciences, University of North Carolina-Charlotte, Charlotte, North Carolina
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Persaud N, Steiner L, Woods H, Aratangy T, Wanigaratne S, Polsky J, Hwang S, Chahal G, Pinto A. Health outcomes related to the provision of free, tangible goods: A systematic review. PLoS One 2019; 14:e0213845. [PMID: 30893372 PMCID: PMC6426236 DOI: 10.1371/journal.pone.0213845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/03/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Free provision of tangible goods that may improve health is one approach to addressing discrepancies in health outcomes related to income, yet it is unclear whether providing goods for free improves health. We systematically reviewed the literature that reported the association between the free provision of tangible goods and health outcomes. METHODS A search was performed for relevant literature in all languages from 1995-May 2017. Eligible studies were observational and experimental which had at least one tangible item provided for free and had at least one quantitative measure of health. Studies were excluded if the intervention was primarily a service and the free good was relatively unimportant; if the good was a medication; or if the data in a study was duplicated in another study. Covidence screening software was used to manage articles for two levels of screening. Data was extracted using an adaption of the Cochrane data collection template. Health outcomes, those that affect the quality or duration of life, are the outcomes of interest. The study was registered with PROSPERO (CRD42017069463). FINDINGS The initial search identified 3370 articles and 59 were included in the final set with a range of 20 to 252 246 participants. The risk of bias assessment revealed that overall, the studies were of medium to high quality. Among the studies included in this review, 80 health outcomes were statistically significant favouring the intervention, 19 health outcomes were statistically significant favouring the control, 141 health outcomes were not significant and significance was unknown for 28 health outcomes. INTERPRETATION The results of this systematic review provide evidence that free goods can improve health outcomes in certain circumstances, although there were important gaps and limitations in the existing literature.
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Affiliation(s)
- Nav Persaud
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Liane Steiner
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Hannah Woods
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Tatiana Aratangy
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | | | - Jane Polsky
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Stephen Hwang
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
- Division of General Internal Medicine, University of Toronto, Toronto, Canada
| | - Gurleen Chahal
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Andrew Pinto
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- The Upstream Lab, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Almada LN, Tchernis R. Measuring effects of SNAP on obesity at the intensive margin. ECONOMICS AND HUMAN BIOLOGY 2018; 31:150-163. [PMID: 30248598 DOI: 10.1016/j.ehb.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 08/15/2018] [Accepted: 08/17/2018] [Indexed: 06/08/2023]
Abstract
The effects of the Supplemental Nutrition Assistance Program (SNAP) on obesity have been the focus of much debate. However, causal interpretation of estimates from previous studies, comparing participants to non-participants, is complicated by endogeneity and possible misreporting of participation in SNAP. In this paper, we take a novel approach to examine quasi-experimental variation in SNAP benefit amount on adult obesity. Children of SNAP households qualify for free in-school meals, thus freeing some additional benefits for the household. A greater proportion of school-age children eligible for free in-school meals proxies for an exogenous increase in the amount of SNAP benefits available per adult. Using data from the National Longitudinal Survey of Youth-1979 we show that school meals represent a non-trivial part of the food budget for SNAP households. We find that increases in SNAP benefits have no effect on obesity levels for the full sample of those who report SNAP participation. To better isolate the effects of additional benefits from other potential changes we restrict our analysis to adults living in households with at least one child under 5 years of age. In this setting, we find that additional SNAP benefits reduce BMI and the probability of being obese for SNAP adults. Specifically, when one child in a household of four becomes school-aged, adult BMI is expected to decrease by 0.23 units and the probability of being obese decreases by 2.58 percentage points or by about 10%.
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Affiliation(s)
- Lorenzo N Almada
- Department of Economics, Room 458, Georgia State University, Atlanta, GA 30302, United States.
| | - Rusty Tchernis
- Department of Economics, Room 533, Georgia State University, Atlanta, GA 30302, United States; NBER, United States IZA, Germany.
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Endeweld M, Goldsmith R, Endevelt R. The demographic and morbidity characteristics of a population receiving food support in Israel. Isr J Health Policy Res 2018; 7:54. [PMID: 30165905 PMCID: PMC6389190 DOI: 10.1186/s13584-018-0238-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/20/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Food supply to poor populations is a big challenge, particularly in periods of economic stress and in an era of chronic diseases epidemics. In Israel more than 4000 poor families are currently receiving food support. Many of the food support products given to the family have low nutrient values, therefore not appropriately ensuring food security of the population. The aim of the current study was to examine for the first time the demographic, nutritional and chronic diseases profiles of food support beneficiaries, so as to aid in planning future food support components in Israel. In addition, the study examined associations between levels of food insecurity status and selected morbidities among food support recipients. METHODS In 2016, 3000 families (classified as very poor) in 24 municipalities received food support in Israel from the "National Food Security Project" (NFSP), under the guidance of the National Food Security Council. The 400 new families who joined the program in 2016 were requested to complete a questionnaire regarding the demographic and health characteristics of their families. Three hundred sixty-two of them completed the questionnaire for a response rate of 90%. The current study includes these families only. RESULTS The disposable income per capita of the surveyed families was very low - less than NIS 1100 a month ($280). About half the families were working families and 40% of them were in debt. Of the 362 responding families, about 82% of them were food insecure, with more than half severely food-insecure; this, despite receiving food support. About one-third of the families had at least one member with anemia, and a quarter of the families had a member with hyperlipidemia. Hypertension is present in about 22% of the families, diabetes in 17%, and there is a 12% incidence of at least one family member with heart disease. These rates are markedly higher than those in the general population. Higher levels of food insecurity were associated with higher levels of hyperlipidemia, heart disease and hypertension. DISCUSSION AND CONCLUSIONS The nutrition and medical status of the population receiving food support is much worse than in the general population. There is a need to improve the nutritional value of food support; this could include greater emphasis on whole grains, fruits and vegetables. There is also a need for a nationwide education program to focus on healthy nutrition and to subsidize healthy foods. Many health and nutrition promotion models show that in order to effect changes in dietary habits and behaviors related to improving nutrition, there is a need for nutrition education (Kamp et al., J Nutr Educ Behav 42:72-82, 2010).
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Affiliation(s)
- M Endeweld
- The Israel National Insurance Institute, Jerusalem, Israel.,The Hebrew University in Jerusalem, Jerusalem, Israel
| | - R Goldsmith
- The Israel Ministry of Health, Nutrition Division, Jerusalem, Israel.
| | - R Endevelt
- The Israel Ministry of Health, Nutrition Division, Jerusalem, Israel.,University of Haifa, School of Public Health, Haifa, Israel
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Food insecurity, diet quality and body mass index of women participating in the Supplemental Nutrition Assistance Program: The role of intrapersonal, home environment, community and social factors. Appetite 2018; 125:109-117. [PMID: 29427689 DOI: 10.1016/j.appet.2018.01.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 01/17/2018] [Accepted: 01/30/2018] [Indexed: 11/20/2022]
Abstract
Obesity is a public health problem that disproportionately affects low-income populations. Moreover, participation in Supplemental Nutrition Assistance Program (SNAP) has been associated with obesity among low-income women. The goal of this study was to determine the impact of intrapersonal, home environment, community and social factors on diet quality and body mass index (BMI) of low-income women participating in SNAP. This study also aimed to examine the role of these factors in mediating the relationship between food insecurity and diet quality, and BMI. A total of 152 women receiving SNAP benefits were recruited from low-income neighborhood centers and housing communities, and administered a demographics questionnaire, the United States adult food security scale, food frequency questionnaire, and multi-dimensional home environment scale (MHES). They also were measured for height and weight to calculate BMI. The Dietary Guidelines Adherence Index 2015 was used to measure diet quality. Regression analyses were conducted to determine the MHES subscales that were significant predictors of diet quality and BMI. The Preacher and Hayes mediation model was used to evaluate the mediation of the relationship between food insecurity and diet quality, and BMI by the MHES. Emotional eating resistance and favorable social eating behaviors were positively associated with diet quality; whereas emotional eating resistance, lower availability of unhealthy food at home, neighborhood safety and favorable social eating behaviors were inversely associated with BMI in women participating in SNAP. The MHES significantly mediated the relationship between food insecurity and BMI. These results emphasize the importance of intrapersonal, home environment, community and social factors in mediating the relationship between food insecurity and BMI in low-income women.
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Derose KP, Ríos-Castillo I, Fulcar MA, Payán DD, Palar K, Escala L, Farías H, Martínez H. Severe food insecurity is associated with overweight and increased body fat among people living with HIV in the Dominican Republic. AIDS Care 2018; 30:182-190. [PMID: 28681631 PMCID: PMC5725241 DOI: 10.1080/09540121.2017.1348597] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Food insecurity is an important risk factor for overweight and obesity among low-income populations in high income countries, but has not been well-studied among people living with HIV (PLHIV), particularly in resource-poor settings. To explore the association between food insecurity and overweight and obesity among PLHIV in the Dominican Republic, we conducted a cross-sectional study of 160 HIV-infected adults between March-December 2012 in four geographically-dispersed health centers (Santo Domingo, Puerto Plata, San Juan, and Higuey). We collected information on household food insecurity, anthropometric measurements, and socio-demographic data and ran descriptive and multivariate analyses, controlling for fixed effects of clinics and using robust standard errors. Mean age ± SD of participants was 39.9 ± 10.5 years; 68% were women, and 78% were on antiretroviral therapy (ART). A total of 58% reported severe household food insecurity. After controlling for age, gender, income, having children at home, education, and ART status, severe food insecurity was associated with increased body mass index (BMI) (β = 1.891, p = 0.023) and body fat (β = 4.004, p = 0.007). Age and female gender were also associated with increased body fat (β = 0.259, p < 0.001 and β = 8.568, p < 0.001, respectively) and age and ART status were associated with increased waist circumference (β = 0.279, p = 0.011 and β = 5.768, p = 0.046, respectively). When overweight was examined as a dichotomous variable (BMI ≥ 25.0), severe food insecurity was associated with an increased odds of 3.060 (p = 0.013); no other covariates were independently associated with overweight. The association of severe food insecurity with increased BMI, body fat, and overweight among PLHIV has important implications for clinical care as well as food security and nutrition interventions in resource-poor settings. Integrated programs that combine nutrition education or counseling with sustainable approaches to addressing food insecurity among PLHIV are needed to improve long-term health outcomes of this vulnerable population.
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Affiliation(s)
| | - Israel Ríos-Castillo
- Food and Agriculture Organization (FAO) of the United Nations, Sub-Regional Office for Mesoamerica, Panama City, Panama
| | - María Altagracia Fulcar
- United Nations World Food Programme, Dominican Republic Country Office, Santo Domingo, Dominican Republic
| | - Denise D. Payán
- RAND Corporation, Santa Monica, CA, USA
- UCLA Fielding School of Public Health, Los Angeles, CA USA
| | - Kartika Palar
- Division of HIV/AIDS, University of California, San Francisco, CA, USA
| | - Lisbeth Escala
- United Nations World Food Programme, Regional Bureau for Latin America and the Caribbean, Panama City, Panama
| | - Hugo Farías
- United Nations World Food Programme, Regional Bureau for Latin America and the Caribbean, Panama City, Panama
| | - Homero Martínez
- RAND Corporation, Santa Monica, CA, USA
- Hospital Infantil de Mexico “Dr. Federico Gomez”, Mexico City, Mexico
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16
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Castellari E, Cotti C, Gordanier J, Ozturk O. Does the Timing of Food Stamp Distribution Matter? A Panel-Data Analysis of Monthly Purchasing Patterns of US Households. HEALTH ECONOMICS 2017; 26:1380-1393. [PMID: 27723171 DOI: 10.1002/hec.3428] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/13/2016] [Accepted: 08/24/2016] [Indexed: 06/06/2023]
Abstract
In this paper, we examine the relationship between the timing of food stamp receipt and purchasing patterns. We combine data on state distribution dates of food stamps with scanner data on a panel of households purchases tracked between 2004 and 2011. We find that purchases of a variety of goods are meaningfully higher on receipt days, consistent with previous work that suggests that recipients are very impatient. Additionally, and importantly, estimates indicate that when food stamp receipt days fall on weekends, total monthly purchases within the same households are affected. In particular, monthly purchases of beer are higher when food stamps are distributed on a weekend rather than in months where benefits are distributed on weekdays. For these households, total beer purchases are between 4 and 5% higher in those months. Among households ineligible for food stamps, no effect is identified. These results demonstrate that the 'day-of-the-week' of SNAP treatment may have important impacts on household purchase habits. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Chad Cotti
- University of Wisconsin-Oshkosh, Oshkosh, WI, USA
- University of Connecticut, Storrs, CT, USA
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17
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Rigdon J, Berkowitz SA, Seligman HK, Basu S. Re-evaluating associations between the Supplemental Nutrition Assistance Program participation and body mass index in the context of unmeasured confounders. Soc Sci Med 2017; 192:112-124. [PMID: 28965002 PMCID: PMC5815398 DOI: 10.1016/j.socscimed.2017.09.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/22/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the association between participation in the Supplemental Nutrition Assistance Program (SNAP) and body mass index (BMI) in the presence of unmeasured confounding. METHODS We applied new matching methods to determine whether previous reports of associations between SNAP participation and BMI were robust to unmeasured confounders. We applied near-far matching, which strengthens standard matching by combining it with instrumental variables analysis, to the nationally-representative National Household Food Acquisition and Purchasing Survey (FoodAPS, N = 10,360, years 2012-13). RESULTS In ordinary least squares regressions controlling for individual demographic and socioeconomic characteristics, SNAP was associated with increased BMI (+1.23 kg/m2, 95% CI: 0.84, 1.63). While propensity-score-based analysis replicated this finding, using instrumental variables analysis and particularly near-far matching to strengthen the instruments' discriminatory power revealed the association between SNAP and BMI was likely confounded by unmeasured covariates (+0.21 kg/m2, 95% CI: -3.88, 4.29). CONCLUSIONS Previous reports of an association between SNAP and obesity should be viewed with caution, and use of near-far matching may assist similar assessments of health effects of social programs.
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Affiliation(s)
- Joseph Rigdon
- Quantitative Sciences Unit, Stanford University School of Medicine, 1070 Arastradero Rd #3C3104 MC 5559, Palo Alto, CA 94304, United States.
| | - Seth A Berkowitz
- General Internal Medicine and Diabetes, Massachusetts General Hospital, 50 Staniford St., 9th Floor, Boston, MA 02114, United States.
| | - Hilary K Seligman
- Division of General Internal Medicine, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, United States.
| | - Sanjay Basu
- Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304, United States.
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18
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Franckle RL, Moran A, Hou T, Blue D, Greene J, Thorndike AN, Polacsek M, Rimm EB. Transactions at a Northeastern Supermarket Chain: Differences by Supplemental Nutrition Assistance Program Use. Am J Prev Med 2017; 53:e131-e138. [PMID: 28818413 PMCID: PMC5657566 DOI: 10.1016/j.amepre.2017.06.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 05/19/2017] [Accepted: 06/20/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Although one in seven Americans receives Supplemental Nutrition Assistance Program (SNAP) benefits, little is known about how these benefits for food are spent because individual-level sales data are not publicly available. The purpose of this study is to compare transactions made with and without SNAP benefits at a large regional supermarket chain. METHODS Sales data were obtained from a large supermarket chain in the Northeastern U.S. for a period of 2 years (April 2012-April 2014). Multivariate multiple regression models were used to quantify relative differences in dollars spent on 31 predefined SNAP-eligible food categories. Analyses were completed in 2016. RESULTS Transactions with SNAP benefit use included higher spending on less healthful food categories, including sugar-sweetened beverages ($1.08), red meat ($1.55), and convenience foods ($1.34), and lower spending on more healthful food categories, such as fruits (-$1.51), vegetables (-$1.35), and poultry (-$1.25) compared to transactions without SNAP benefit use. CONCLUSIONS These findings provide objective data to compare purchases made with and without SNAP benefits. Next steps should be to test proposed SNAP modifications to determine whether they would have the intended effect of promoting healthier purchasing patterns among SNAP beneficiaries.
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Affiliation(s)
- Rebecca L Franckle
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Alyssa Moran
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Tao Hou
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Dan Blue
- Hannaford Marketing, Hannaford Supermarkets, Scarborough, Maine
| | - Julie Greene
- Hannaford Healthy Living, Hannaford Supermarkets, Scarborough, Maine
| | - Anne N Thorndike
- General Medicine Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michele Polacsek
- School of Community and Population Health, University of New England, Portland, Maine
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Kim J, Shon C, Yi S. The Relationship between Obesity and Urban Environment in Seoul. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14080898. [PMID: 28792465 PMCID: PMC5580601 DOI: 10.3390/ijerph14080898] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 07/31/2017] [Accepted: 08/05/2017] [Indexed: 11/16/2022]
Abstract
Obesity is a global pandemic that brings about a myriad of health consequences. In the past, policies for combating obesity mainly focused on improving individual health and behavior, but nowadays some policies have changed and now concentrate on improving the built environment believing this can improve health through positive changes to health-related behaviors. We examined whether both individual and environmental factors were associated with body mass index in Seoul, the capital city of South Korea. Data from the 2011 and 2013 Community Health Surveys were used (n = 20,147 men and 25,300 women). We staged multilevel logistic regression models to estimate the effect of individual and environmental factors on obesity. Among individual covariates, high-risk drinking, the time spent watching TV and surfing the Internet, high salt intake, stress, and the negative recognition of health were significantly associated with obesity. When controlling individual covariates, the number of sports facilities, number of fried chicken stores, and food insecurity level were statistically associated with probability of obesity. Therefore, this study emphasizes that it is important not only to improve the health behavior of the individual, but also to improve the urban environment in order to reduce the obesity rates of city dwellers.
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Affiliation(s)
- Jungah Kim
- The Seoul Institute, 57 Nambusunhwan-ro, 340-gil, Seocho-gu, Seoul 06756, Korea.
| | - Changwoo Shon
- The Seoul Institute, 57 Nambusunhwan-ro, 340-gil, Seocho-gu, Seoul 06756, Korea.
| | - Seonju Yi
- Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Korea.
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Gamboa-Delgado EM, González de Cossío T, Colchero-Aragonés A. [Obesity risk in preschoolers beneficiaries of food aid programs]. Rev Salud Publica (Bogota) 2017; 18:643-655. [PMID: 28453068 DOI: 10.15446/rsap.v18n4.42444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 02/16/2016] [Indexed: 11/09/2022] Open
Abstract
Objective To review the evidence regarding the potential impact of food programs on the risk of obesity in beneficiary children. Methods The search was conducted in databases using terms in Spanish and English. Those items that included the variable of interest, cross sectional studies, cohort or community trials were selected. Results Food assistance programs could contribute to increased obesity rates in the target population due to the availability and easier access to food with high energy content, either through the delivery of provisions or cash. However, the impact of the programs on this outcome has been little studied and evaluations have been mostly in adults or school-age children. Conclusion This review contributes to knowledge about the possible effect that food programs have on the risk of obesity in beneficiary children. This review may also serve as a reference for the design, implementation and evaluation of food and nutrition programs in countries of low and middle income facing malnutrition.
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Caspi CE, Tucker-Seeley RD, Adamkiewicz G, Roberto CA, Stoddard AM, Sorensen GC. Food Hardship and Obesity in a Sample of Low-Income Immigrants. J Immigr Minor Health 2017; 19:130-137. [PMID: 26872640 PMCID: PMC4982834 DOI: 10.1007/s10903-016-0344-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Very little work has examined the relationship between food hardship (having inconsistent financial resources to buy food) and obesity among immigrant groups. A cross-sectional study was conducted in a low-income, multi-racial/ethnic adult sample in greater Boston, MA (n = 828). Modified Poisson regression models estimated the association between food hardship obesity (BMI ≥ 30) among adults reporting food hardship; interactions were tested by place of birth. Body mass index (BMI) was based on anthropometric height and weight. In adjusted models, those experiencing food hardship were more likely to be obese (RR 1.17, CI 1.07, 1.29) than those not experiencing food hardship. Participants from Haiti reporting food hardship were more likely to be obese than those not reporting hardship (RR 1.58, CI 1.23, 2.04); this was not the case among other groups (US born, Puerto Rican, Latin American, Other). The relationship between food hardship and weight may vary among immigrant subgroups.
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Affiliation(s)
- Caitlin E Caspi
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware St. SE, Minneapolis, MN, 55414, USA.
| | - Reginald D Tucker-Seeley
- Center for Community-Based Research, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington St., Boston, MA, 02215, USA
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, 677 Huntington St., Boston, MA, 02215, USA
| | - Christina A Roberto
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington St., Boston, MA, 02215, USA
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Dr., Philadelphia, PA, 19104, USA
| | - Anne M Stoddard
- New England Research Institute, 9 Galen St., Watertown, MA, 02472, USA
| | - Glorian C Sorensen
- Center for Community-Based Research, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington St., Boston, MA, 02215, USA
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Kupillas LM, Nies MA. Obesity and Poverty: Are Food Stamps to Blame? HOME HEALTH CARE MANAGEMENT AND PRACTICE 2016. [DOI: 10.1177/1084822307304952] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Sixty-six percent of adults in the United States are overweight, and 32% of Americans are obese. Although poverty is usually associated with being underfed and underweight, in the United States, the paradoxical relationship between poverty and overweight exists. This article examines the relationship between Food Stamp Program (FSP) participation, food choices, and overweight status. This article examines the practicality of an individual in New York adhering to U.S. Department of Agriculture (USDA) recommendations for a diet rich in whole grains, lean meats, fruits, and vegetables on a FSP budget. The authors concluded that a diet that consists of more processed, high-calorie foods is significantly more agreeable with a FSP budget than a diet that meets USDA recommendations.
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Waehrer G, Deb P, Decker SL. Did the 2009 American Recovery and Reinvestment Act affect dietary intake of low-income individuals? ECONOMICS AND HUMAN BIOLOGY 2015; 19:170-83. [PMID: 26414481 PMCID: PMC7362314 DOI: 10.1016/j.ehb.2015.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 08/07/2015] [Accepted: 08/24/2015] [Indexed: 06/05/2023]
Abstract
This paper examines the relationship between increased Supplemental Nutritional Assistance Program (SNAP) benefits following the 2009 American Recovery and Reinvestment Act (ARRA) and the diet quality of individuals from SNAP-eligible compared to ineligible (those with somewhat higher income) households using data from the 2007-2010 National Health and Nutrition Examination Survey. The ARRA increased SNAP monthly benefits by 13.6% of the maximum allotment for a given household size, equivalent to an increase of $24 to $144 for one-to-eight person households respectively. In the full sample, we find that these increases in SNAP benefits are not associated with changes in nutrient intake and diet quality. However, among those with no more than a high school education, higher SNAP benefits are associated with a 46% increase in the mean caloric share from sugar-sweetened beverages (SSBs) and a decrease in overall diet quality especially for those at the lower end of the diet quality distribution, amounting to a 9% decline at the 25th percentile.
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Affiliation(s)
- Geetha Waehrer
- Pacific Institute for Research and Evaluation, United States
| | - Partha Deb
- Department of Economics Hunter College, CUNY, United States
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Dressler H, Smith C. Depression Affects Emotional Eating and Dietary Intake and Is Related to Food Insecurity in a Group of Multiethnic, Low-income Women. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2015. [DOI: 10.1080/19320248.2015.1045666] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Provenzano AM, Rifas-Shiman SL, Herring SJ, Rich-Edwards JW, Oken E. Associations of maternal material hardships during childhood and adulthood with prepregnancy weight, gestational weight gain, and postpartum weight retention. J Womens Health (Larchmt) 2015; 24:563-71. [PMID: 25902486 DOI: 10.1089/jwh.2014.5016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND We examined associations of material hardship with prepregnancy body mass index (BMI), gestational weight gain (GWG), and substantial postpartum weight retention (SPPWR; ≥5 kg at 1 year). METHODS We studied 2128 women in Project Viva, a Boston-area cohort with recruitment during1999-2002. At recruitment, women reported whether they experienced material hardship, defined as having ever received public assistance, welfare, or lacked basic necessities (food, rent, or medical care) during childhood, in adulthood before pregnancy, and/or in pregnancy. We used multivariable logistic models adjusted for age, race/ethnicity, and parity (and prepregnancy BMI for GWG and SPPWR) to examine associations of material hardship with the three weight-related outcomes (BMI, GWG, and SPPWR). RESULTS Mean age was 31.8 (standard deviation, 5.2) years; 66% of women were white, 16% were obese (prepregnancy BMI ≥30.0 kg/m(2)), 50% experienced excessive GWG, and 17% experienced SPPWR. Material hardship was most common during childhood (n=192, 9%), followed by adulthood (102, 5%), and pregnancy (41, 2%). Hardship in adulthood was associated with prepregnancy obesity (BMI ≥30 kg/m(2) vs. 18.5 to <25.0 kg/m(2)), odds ratio ([OR] 2.35, 95% confidence interval [CI] 1.29, 4.31), but hardship in childhood was not (OR 1.26, 95% CI 0.80, 1.98). Hardship in childhood was associated with excess GWG (OR 1.45, 95% CI 0.99, 2.14), but hardship in adulthood or during pregnancy was not. We saw trends among hardship in each of the periods and associations with SPPWR, but all confidence intervals included the null. CONCLUSION The timing of hardship exposure may differently influence weight before, during, and after pregnancy.
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Affiliation(s)
- Audrey M Provenzano
- 1 Kraft Fellow in Community Health Leadership, Kraft Family National Center for Leadership and Training in Community Health, Harvard Medical School , Boston, Massachusetts
| | - Sheryl L Rifas-Shiman
- 2 Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts
| | - Sharon J Herring
- 3 Center for Obesity Research and Education, Department of Medicine, Temple University , Philadelphia, Pennsylvania
| | - Janet W Rich-Edwards
- 4 Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital , Boston, Massachusetts
| | - Emily Oken
- 2 Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts
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Leung MM, Fu H, Agaronov A, Freudenberg N. Diet-related determinants of childhood obesity in urban settings: a comparison between Shanghai and New York. Public Health 2015; 129:318-26. [PMID: 25841629 DOI: 10.1016/j.puhe.2015.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the past three decades, both Shanghai and New York City (NYC), have experienced dramatic rises in childhood obesity rates. Given the role that obesity plays in the aetiology of chronic diseases such as diabetes and heart disease, the elevated rates are a major concern. Despite differences in governance systems and cultures, Shanghai and NYC have experienced rapid industrialization, a growing population and a rise in income inequality. The prevalence of childhood obesity in Shanghai and NYC is greater than their respective national rate. However, the trajectory and development of this epidemic has differed between the cities. The distribution of obesity by race and ethnicity, socio-economic status, sex, and age differs markedly between the two cities. To reduce prevalence and inequities within this complex epidemic requires an understanding of the dynamic changes in living conditions among social groups in each city and the behaviours that are influenced by such changes. By comparing changes in the influences on dietary behaviours, such as food distribution, pricing, gender values, and media and marketing, this highlights opportunities for Shanghai, NYC, and other world cities with high or rising rates of childhood obesity to inform future program and policy initiatives. It reiterates the importance of a comprehensive and multilevel approach that includes action at the individual, family, community, municipal, national, and global levels.
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Affiliation(s)
- M M Leung
- Hunter College School of Urban Public Health, 2180 Third Avenue, New York, NY, United States; City University of New York School of Public Health, New York, NY, United States.
| | - H Fu
- Fudan Health Communication Institute, School of Public Health, Fudan University, PO Box 248, 138 Yixueyuan Road, Shanghai, 200032, China
| | - A Agaronov
- Hunter College School of Urban Public Health, 2180 Third Avenue, New York, NY, United States; City University of New York School of Public Health, New York, NY, United States
| | - N Freudenberg
- Hunter College School of Urban Public Health, 2180 Third Avenue, New York, NY, United States; City University of New York School of Public Health, New York, NY, United States
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Flórez KR, Dubowitz T, Ghosh-Dastidar MB, Beckman R, Collins RL. Associations between depressive symptomatology, diet, and body mass index among participants in the supplemental nutrition assistance program. J Acad Nutr Diet 2015; 115:1102-8. [PMID: 25769748 DOI: 10.1016/j.jand.2015.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 12/31/2014] [Indexed: 10/23/2022]
Abstract
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.
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Brewis AA. Stigma and the perpetuation of obesity. Soc Sci Med 2014; 118:152-8. [DOI: 10.1016/j.socscimed.2014.08.003] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 08/04/2014] [Accepted: 08/05/2014] [Indexed: 01/30/2023]
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Sirotin N, Hoover DR, Shi Q, Anastos K, Weiser SD. Food insecurity with hunger is associated with obesity among HIV-infected and at risk women in Bronx, NY. PLoS One 2014; 9:e105957. [PMID: 25162598 PMCID: PMC4146558 DOI: 10.1371/journal.pone.0105957] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 07/31/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Food insecurity, insufficient quality and quantity of nutritionally adequate food, affects millions of people in the United States (US) yearly, with over 18 million Americans reporting hunger. Food insecurity is associated with obesity in the general population. Due to the increasing prevalence of obesity and risk factors for cardiovascular disease among HIV-infected women, we sought to determine the relationship between food insecurity and obesity in this cohort of urban, HIV-infected and -uninfected but at risk women. METHODS Using a cross-sectional design, we collected data on food insecurity, body mass index and demographic and clinical data from 231 HIV-infected and 119 HIV-negative women enrolled in Bronx site of the Women's Interagency HIV Study (WIHS). We used multivariate logistic regression to identify factors associated with obesity. RESULTS Food insecurity was highly prevalent, with almost one third of women (110/350, 31%) reporting food insecurity over the previous six months and over 13% of women reported food insecurity with hunger. Over half the women were obese with a Body Mass Index (BMI) of ≥ 30. In multivariate analyses, women who were food insecure with hunger had higher odds of obesity (Adjusted odds ratio [aOR] = 2.56, 95% Confidence Interval [CI] = 1.27, 5.20) after adjusting for HIV status, age, race, household status, income, drug and alcohol use. CONCLUSION Food insecurity with hunger was associated with obesity in this population of HIV-infected and -uninfected, urban women. Both food insecurity and obesity are independent markers for increased mortality; further research is needed to understand this relationship and their role in adverse health outcomes.
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Affiliation(s)
- Nicole Sirotin
- Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Donald R. Hoover
- Department of Statistics and Biostatistics, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, United States of America
| | - Qiuhu Shi
- Department of Epidemiology and Community Health, New York Medical College, Valhalla, New York, United States of America
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Sheri D. Weiser
- Division of HIV/AIDS, San Francisco General Hospital, University of California, San Francisco (UCSF), San Francisco, California, United States of America
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Hilmers A, Chen TA, Dave JM, Thompson D, Cullen KW. Supplemental Nutrition Assistance Program participation did not help low income Hispanic women in Texas meet the dietary guidelines. Prev Med 2014; 62:44-8. [PMID: 24530319 DOI: 10.1016/j.ypmed.2014.01.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 01/14/2014] [Accepted: 01/27/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Low-income Hispanic women are at greater risk for dietary deficiencies and obesity. We assessed the association between Supplemental Nutrition Assistance Program participation and dietary intake among 661 Hispanic women aged 26-44 years living in Texas. METHODS Cross-sectional data was collected using standard methods. Analysis of variance and logistic regression examined the influence of Supplemental Nutrition Assistance Program on diet after adjusting for household characteristics, body mass index, and food security status. RESULTS Most women did not meet recommended dietary guidelines. Supplemental Nutrition Assistance Program participants consumed higher amounts of total sugars, sweets-desserts, and sugar-sweetened beverages than Supplemental Nutrition Assistance Program nonparticipants. High sodium intakes and low dairy consumption were observed in both groups. Only 27% of low-income eligible women received Supplemental Nutrition Assistance Program benefits. DISCUSSION Low-income Hispanic women participating in Supplemental Nutrition Assistance Program reported less healthful dietary patterns than nonparticipants. This may contribute to the increased obesity prevalence and related comorbidities observed in this population. CONCLUSION Supplemental Nutrition Assistance Program should play an important role in enhancing the overall dietary quality of low-income households. Policy initiatives such as limiting the purchase of sugar-sweetened beverages and education to enable women to reduce consumption of high sodium processed foods deserve consideration as means to improve the dietary quality of Supplemental Nutrition Assistance Program participants. Effective measures are needed to increase Supplemental Nutrition Assistance Program participation rates among Hispanics.
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Affiliation(s)
- Angela Hilmers
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 N Wolfe St., Baltimore, MD 21205, USA.
| | - Tzu-An Chen
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Houston, TX 77030-2600, USA
| | - Jayna M Dave
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Houston, TX 77030-2600, USA
| | - Deborah Thompson
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Houston, TX 77030-2600, USA
| | - Karen Weber Cullen
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Houston, TX 77030-2600, USA
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Kharmats AY, Jones-Smith JC, Cheah YS, Budd N, Flamm L, Cuccia A, Mui Y, Trude A, Gittelsohn J. Relation between the Supplemental Nutritional Assistance Program cycle and dietary quality in low-income African Americans in Baltimore, Maryland. Am J Clin Nutr 2014; 99:1006-14. [PMID: 24622807 PMCID: PMC3985207 DOI: 10.3945/ajcn.113.075994] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There has been limited research regarding the Supplemental Nutritional Assistance Program (SNAP) and recipients' dietary quality during the days and weeks after benefit disbursement. OBJECTIVE We examined the relation between participants' stages in the SNAP cycle and their macronutrient consumption, Healthy Eating Index (HEI) scores, and fruit and vegetable intake. DESIGN In this cross-sectional study, we analyzed single 24-h dietary recalls collected from 244 African American SNAP participants recruited near 24 corner stores in Baltimore City. A multiple linear regression analysis and bootstrapping were used. RESULTS Among participants who received a SNAP benefit ≤15 d before being surveyed, energy intake adjusted for minimum energy requirements (-4.49%; 95% CI: -8.77%, -0.15%) and HEI dairy scores (-0.12; 95% CI: -0.22, -0.01) were lower for each 1-d increase in the time since SNAP distribution (TSSD). Among participants who received SNAP benefits >15 d before being surveyed, energy intake (1.35%; 95% CI: 0.01%, 2.73%), energy intake adjusted for minimum energy requirements (3.86%; 95% CI: 0.06%, 7.96%), total fat intake (1.96%; 95% CI: 0.29%, 3.8%), saturated fat intake (2.02%; 95% CI: 0.23%, 4.01%), and protein intake (2.09%; 95% CI: 0.70%, 3.62%) were higher per each 1-d increase in the TSSD. CONCLUSIONS These findings suggest that the relation between the TSSD and macronutrient intake might be U-shaped, with higher intake of calories, fat, and protein in individuals in the very early and late stages of their SNAP cycles. Foods high in these nutrients might be cheaper, more accessible, and have a longer shelf-life than healthier options, such as fruit, vegetables, and whole grains, for SNAP participants when their benefits run out. Additional efforts are needed to investigate the effect of the TSSD on dietary intake by using a longitudinal design and to improve the quality of dietary intake in African American SNAP participants.
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Affiliation(s)
- Anna Y Kharmats
- Departments of International Health (AYK, JCJ-S, YSC, NB, AC, YM, and JG) and Health, Behavior, and Society (LF), Johns Hopkins School of Public Health, Baltimore, MD, and the Health Science Department, Federal University of Sao Paulo, São Paulo, Brazil (AT)
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Personal Weight Status Classification and Health Literacy Among Supplemental Nutrition Assistance Program (SNAP) Participants. J Community Health 2013; 39:446-53. [DOI: 10.1007/s10900-013-9796-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lusk JL, Ellison B. Who is to blame for the rise in obesity? Appetite 2013; 68:14-20. [DOI: 10.1016/j.appet.2013.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 03/23/2013] [Accepted: 04/02/2013] [Indexed: 10/27/2022]
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Richards MR, Sindelar JL. Rewarding healthy food choices in SNAP: behavioral economic applications. Milbank Q 2013; 91:395-412. [PMID: 23758515 DOI: 10.1111/milq.12017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
CONTEXT American obesity rates continue to escalate, but an effective policy response remains elusive. Specific changes to the Supplemental Nutrition Assistance Program (SNAP) have been proposed as one way to improve nutrition and combat obesity among lower-income populations. While current SNAP proposals hold promise, some important challenges still remain. METHODS We discuss the four most common recommendations for changes to SNAP and their benefits and limitations. We then propose three new delivery options for SNAP that take advantage of behavioral economic insights and encourage the selection of healthy foods. FINDINGS Although the existing proposals could help SNAP recipients, they often do not address some important behavioral impediments to buying healthy foods. We believe that behavioral economics can be used to design alternative policies with several advantages, although we recognize and discuss some of their limitations. The first proposal rewards healthy purchases with more SNAP funds and provides an additional incentive to maintain healthier shopping patterns. The second proposal uses the opportunity to win prizes to reward healthy food choices, and the prizes further support healthier habits. The final proposal simplifies healthy food purchases by allowing individuals to commit their SNAP benefits to more nutritious selections in advance. CONCLUSIONS Reforming the delivery structure of SNAP's benefits could help improve nutrition, weight, and overall health of lower-income individuals. We advocate for more and diverse SNAP proposals, which should be tested and, possibly, combined. Their implementation, however, would require political will, administrative capacity, and funding.
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Richards R, Smith C, Eggett DL. Correlates of energy intake and body mass index among homeless children in Minnesota. Child Obes 2013; 9:240-51. [PMID: 23705886 DOI: 10.1089/chi.2012.0026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study evaluated environmental, personal, and behavioral correlates of BMI-for-age percentiles, dietary intake (kilocalories, carbohydrates, protein, fat, and Food Guide Pyramid food groups), and physical activity variables among homeless children. METHODS A 74-item survey, using social cognitive theory as the theoretical framework, height, weight, and one 24-hour recall were collected from homeless children aged 9-13 (n=159) at two shelters in Minneapolis, MN. Principal component analysis was performed on the subsections of the survey. Independent t-tests, Fisher exact tests, and chi-squared statistics evaluated sociodemographic and BMI percentile variables. Nonparametric tests evaluated dietary data. Stepwise regression models evaluated correlates of BMI percentiles, physical activity, and dietary intake variables. RESULTS Approximately 45% were overweight or obese (≥85(th) percentile). Dietary data represented intake on a given day, with children consuming a median 1.2 servings from the fruits and vegetables food group, 17.3 servings from the fats and sweets food group (one serving=grams in 1 Tbsp. fat/1 tsp. sugar), and the percent of calories from fat varying significantly between shelter 1 (S1) versus shelter 2 (S2) boys (37.1% vs. 31.7%, p<0.001). Factors identified from survey items and sociodemographic variables accounted for between 6% and 14% of the variance in energy intake and other dietary and physical activity variables (p range, 0.008 to <0.001). CONCLUSIONS Parental role modeling of eating behaviors and getting enough food were associated with less favorable food choices among homeless children. Policy interventions and program initiatives in the homeless environment could promote healthier food choices among children.
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Affiliation(s)
- Rickelle Richards
- Department of Nutrition, Dietetics, and Food Science, Brigham Young University, Provo, UT, USA
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Varea A, Malpeli A, Disalvo L, Apezteguía M, Falivene M, Ferrari G, Pereyras S, Carmuega E, Etchegoyen G, Vojkovic M, González HF. Evaluation of the impact of a food program on the micronutrient nutritional status of Argentinean lactating mothers. Biol Trace Elem Res 2012; 150:103-8. [PMID: 23111948 DOI: 10.1007/s12011-012-9512-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 09/24/2012] [Indexed: 10/27/2022]
Abstract
This study was conducted to evaluate the impact of a food aid program (Plan Más Vida, PMV) on the micronutrient nutritional condition of lactating mothers 1 year after its implementation. The food program provided supplementary diets (wheat- and maize-fortified flour, rice or sugar, and fortified soup) to low-income families from the province of Buenos Aires, Argentina. A prospective, non-experimental study was carried out to evaluate the micronutrient nutritional status of lactating mothers (n = 178 at baseline and n = 151 after 1 year). Biochemical tests (hemoglobin, ferritin, zinc, vitamin A, and folic acid), anthropometric assessments (weight and height) and dietary surveys (24-h recall) were performed. We found no significant changes in anthropometric values 1 year after the intervention. The risk for vitamin A (retinol 20-30 μg/dl) and folate deficiency significantly decreased 1 year after PMV implementation (56.3 vs. 29.9 and 50.3 vs. 3.4 %, respectively; p < 0.001). Anemia was seen in 25.8 % of lactating mothers at baseline, without statistically significant differences 1 year after (p = 0.439). The nutritional data obtained after assessing the early impact of PMV actions may be useful to provincial health authorities to perform periodic evaluations in the future.
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Affiliation(s)
- Ana Varea
- Instituto de Desarrollo e Investigaciones Pediátricas Prof. D. Fernando E. Viteri (IDIP), Hospital de Niños de La Plata, (MS/CIC-PBA), 63 No. 1069, 1900, La Plata, Argentina
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Leung CW, Ding EL, Catalano PJ, Villamor E, Rimm EB, Willett WC. Dietary intake and dietary quality of low-income adults in the Supplemental Nutrition Assistance Program. Am J Clin Nutr 2012; 96:977-88. [PMID: 23034960 PMCID: PMC3471209 DOI: 10.3945/ajcn.112.040014] [Citation(s) in RCA: 153] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 08/02/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Supplemental Nutrition Assistance Program (SNAP) aims to alleviate hunger among its beneficiaries by providing benefits to purchase nutritious foods. OBJECTIVE We conducted a comprehensive dietary analysis of low-income adults and examined differences in dietary intake between SNAP participants and nonparticipants. DESIGN The study population comprised 3835 nonelderly adults with a household income ≤130% of the federal poverty level from the 1999-2008 NHANES. The National Cancer Institute method was used to estimate the distributions of usual intake for dietary outcomes. Relative differences in dietary intake by SNAP participation were estimated with adjustment for sociodemographic characteristics and household food security. RESULTS Few low-income adults consumed recommended amounts of whole grains, fruit, vegetables, fish, and nuts/seeds/legumes. Conversely, many low-income adults exceeded recommended limits for processed meats, sweets, and bakery desserts and sugar-sweetened beverages. Approximately 13-22% of low-income adults did not meet any food and nutrient guidelines; virtually no adults met all of the guidelines. Compared with nonparticipants, SNAP participants consumed 39% fewer whole grains (95% CI: -57%, -15%), 44% more 100% fruit juice (95% CI: 0%, 107%), 56% more potatoes (95% CI: 18%, 106%), 46% more red meat (95% CI: 4%, 106%), and, in women, 61% more sugar-sweetened beverages (95% CI: 3%, 152%). SNAP participants also had lower dietary quality scores than did nonparticipants, as measured by a modified Alternate Healthy Eating Index. CONCLUSION Although the diets of all low-income adults need major improvement, SNAP participants in particular had lower-quality diets than did income-eligible nonparticipants.
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Affiliation(s)
- Cindy W Leung
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
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Abstract
Food insecurity has been associated with weight status in children and adults although results have been mixed. We aimed to identify whether food insecurity was associated with BMI in young adults and whether this association differed by gender and was modified by food stamp use and the presence of children in the home. Cross-sectional data from wave 4 (2007-2008) of the National Longitudinal Study of Adolescent Health were analyzed. Multiple linear regression was used to investigate the association between food insecurity and BMI in gender stratified models of young adult women (n = 7,116) and men (n = 6,604) controlling for age, race/ethnicity, income, education, physical activity, smoking, alcohol use, the presence of children in the home, and food stamp use in young adulthood and/or adolescence. Food insecurity was more common in young adult women (14%) than young adult men (9%). After controlling for a variety of individual variables, food insecure women had a BMI that was on average 0.9 kg/m(2) units higher than women who were food secure. This difference in BMI persisted after controlling for recent or past food stamp use and was not different among women with or without children in the household. No relationship was found between food insecurity and BMI in young adult men. Providers should inquire about food insecurity, especially when treating obesity, and policy initiatives should address the role of access to healthy food in those facing food insecurity.
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Affiliation(s)
- Holly C Gooding
- Division of Adolescent and Young Adult Medicine, Department of Medicine, Children's Hospital Boston, Boston, Massachusetts, USA.
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You W, Mitchell PD, Nayga RM. Improving food choices among Supplemental Nutrition Assistance Program recipients. HEALTH ECONOMICS 2012; 21:852-864. [PMID: 21656606 DOI: 10.1002/hec.1758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 03/04/2011] [Accepted: 04/26/2011] [Indexed: 05/30/2023]
Abstract
We used a principal-agent framework to examine the feasibility of two proposed modifications to the Supplemental Nutrition Assistance Program with the goal of encouraging healthier food choices among program participants. Specifically, we analyzed two types of contract: a restricted contract and an incentive contract. The restricted contract did not allow the purchase of unhealthy foods with program benefits, but compensated participants by increasing total benefits. The incentive contract provided increased benefits that varied according to the percentage of healthy foods purchased with program benefits. The theoretical results revealed the mechanisms for the two alternative contracts, the conditions under which each would be effective, and the key empirical questions to be examined for future policy analysis.
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Affiliation(s)
- Wen You
- Virginia Tech, Blacksburg, USA.
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Hernandez DC. Gestational weight gain as a predictor of longitudinal body mass index transitions among socioeconomically disadvantaged women. J Womens Health (Larchmt) 2012; 21:1082-90. [PMID: 22694763 DOI: 10.1089/jwh.2011.2899] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Socioeconomically disadvantaged women are at greater risk for gestational weight gain and postpartum weight retention compared to socioeconomically advantaged women. This study examines the effect of gestational weight gain on body mass index (BMI) transitions 5 years after pregnancy in socioeconomically disadvantaged women. METHODS Gestational weight gain was assessed in 2136 postpartum women participating in the Fragile Families and Child Well-being study who experienced full-term, singleton gestations. Longitudinal BMI transitions were defined as a change or stability in BMI category between two time points: BMI before the index pregnancy and BMI 5 years after the index pregnancy. Logistic regression models estimated the association between gestational weight gain and longitudinal BMI transitions, controlling for health before the index pregnancy, pregnancy history, and sociodemographic characteristics. RESULTS Excessive gestational weight gain was related to transitioning to a higher BMI category 5 years after the index pregnancy. Compared to white women, black and Hispanic women were more likely to transition or maintain a higher BMI category. Pregnancy history (i.e., parity at index pregnancy, interim pregnancy) and public assistance participation were associated with transitioning to a higher BMI category. CONCLUSIONS Among socioeconomically disadvantaged women, excessive gestational weight gain is related to transitioning to, but not maintaining, a higher weight category 5 years after the index pregnancy. Black and Hispanic women who are also socioeconomically disadvantaged and overweight or obese before conception may benefit from preconception or postpartum counseling about the long-term effect of gaining excessive weight during pregnancy and in the years immediately after childbirth.
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Affiliation(s)
- Daphne C Hernandez
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA.
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Abstract
Abstract
The disproportionate number of individuals who are obese or overweight in the low-income U.S. population has raised interest in the influence of neighborhood conditions and public assistance programs on weight and health. Generally, neighborhood effects and program participation effects have been explored in separate studies. We unite these two areas of inquiry, using the 1968–2005 Panel Study of Income Dynamics (PSID) to examine the long-term effects of childhood Supplemental Nutrition Assistance Program (SNAP) participation, neighborhood conditions, and the interaction of these two, on adult body mass index (BMI). Using sibling fixed-effects models to account for selection bias, we find that relative to children in other low-income families, children in SNAP-recipient households have higher average adult BMI values. However, the effects of childhood SNAP usage are sensitive to both residential neighborhood and age at receipt. For those growing up in advantaged neighborhoods, projected adult BMI is higher for children in SNAP-recipient households than for children in low-income, nonrecipient households. In contrast, for those growing up in less-advantaged areas, adult BMI differences between children in SNAP-recipient and those in low-income, nonrecipient households are small. SNAP usage during preschool years (0 to 4) has no impact on adult BMI scores. However, at later childhood ages, the time elapsed receiving SNAP income increases adult BMI values relative to a condition of low-income nonreceipt.
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Epstein LH, Jankowiak N, Nederkoorn C, Raynor HA, French SA, Finkelstein E. Experimental research on the relation between food price changes and food-purchasing patterns: a targeted review. Am J Clin Nutr 2012; 95:789-809. [PMID: 22378726 PMCID: PMC3302358 DOI: 10.3945/ajcn.111.024380] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
One way in which to modify food purchases is to change prices through tax policy, subsidy policy, or both. We reviewed the growing body of experimental research conducted in the laboratory and in the field that investigates the following: the extent to which price changes influence purchases of targeted and nontargeted foods, total energy, or macronutrients purchased; the interaction of price changes with adjunctive interventions; and moderators of sensitivity to price changes. After a brief overview of economic principles and observational research that addresses these issues, we present a targeted review of experimental research. Experimental research suggests that price changes modify purchases of targeted foods, but research on the overall nutritional quality of purchases is mixed because of substitution effects. There is mixed support for combining price changes with adjunctive interventions, and there are no replicated findings on moderators to price sensitivity in experiments. Additional focused research is needed to better inform food policy development with the aim of improving eating behavior and preventing obesity.
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Affiliation(s)
- Leonard H Epstein
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY 14214-3000, USA.
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Schmeiser MD. The impact of long-term participation in the supplemental nutrition assistance program on child obesity. HEALTH ECONOMICS 2012; 21:386-404. [PMID: 21305645 DOI: 10.1002/hec.1714] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 09/28/2010] [Accepted: 12/16/2010] [Indexed: 05/30/2023]
Abstract
Participation in the Supplemental Nutrition Assistance Program (SNAP) reached an all-time high of 40.2 million persons in March 2010, which means the program affects a substantial fraction of Americans. A significant body of research has emerged suggesting that participation in SNAP increases the probability of being obese for adult women and has little effect on the probability for adult men. However, studies addressing the effects of participation on children have produced mixed results. This paper examines the effect of long-term SNAP participation on the Body Mass Index (BMI) percentile and probability of being overweight or obese for children ages 5-18 using data from the National Longitudinal Survey of Youth 1979 Children and Young Adults data set. An instrumental variables identification strategy that exploits exogenous variation in state-level program parameters, as well as state and federal expansions of the Earned Income Tax Credit (EITC), is used to address the endogeneity between SNAP participation and obesity. SNAP participation is found to significantly reduce BMI percentile and the probability of being overweight or obese for boys and girls ages 5-11 and boys ages 12-18. For girls ages 12-18, SNAP participation appears to have no significant effect on these outcomes.
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Han E, Powell LM, Isgor Z. Supplemental nutrition assistance program and body weight outcomes: the role of economic contextual factors. Soc Sci Med 2012; 74:1874-81. [PMID: 22486839 DOI: 10.1016/j.socscimed.2012.02.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Revised: 02/23/2012] [Accepted: 02/28/2012] [Indexed: 11/27/2022]
Abstract
We explored the extent to which economic contextual factors moderated the association of Supplemental Nutrition Assistance Program (SNAP) participation with body mass index (BMI) among low-income adults whose family income (adjusted for family size) is less than 130% of the federal poverty guideline. We drew on individual-level data from the Panel Study of Income Dynamics in the United States, including three waves of data in 1999, 2001, and 2003. Economic contextual data were drawn from the American Chamber of Commerce Researchers Association for food prices and Dun & Bradstreet for food outlet measures. In addition to cross-sectional estimation, a longitudinal individual fixed effects model was used to control for permanent unobserved individual heterogeneity. Our study found a statistically significant joint moderating effect of the economic contextual factors in longitudinal individual fixed effects model for both women (BMI only) and men (both BMI and obesity). For both women and men, SNAP participants' BMI was statistically significantly lower if they faced increased numbers of available supermarkets/grocery stores in the longitudinal model. A simulated 20% reduction in the price of fruits and vegetables resulted in a larger decrease in BMI among SNAP participants than non-participants for women and men, whereas a simulated 20% increase in the availability of supermarkets and grocery stores resulted in a statistically significant difference in the change in BMI by SNAP participation for women but not for men. Policies related to economic contextual factors, such as subsidies for fruits and vegetables or those that would improve access to supermarkets and grocery stores may enhance the relationship between SNAP participation and body mass outcomes among food assistance program participants.
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Affiliation(s)
- Euna Han
- Gachon University, College of Pharmacy, 534-2 Yeonsu-Dong, Yeonsu-Gu, Inchon, 406-799, South Korea.
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Does the Food Stamp Program cause obesity? A realist review and a call for place-based research. Health Place 2012; 18:747-56. [PMID: 22464979 DOI: 10.1016/j.healthplace.2012.03.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 03/03/2012] [Accepted: 03/05/2012] [Indexed: 11/23/2022]
Abstract
The high prevalence of obesity among low income groups has led some to question the role of food assistance programs in contributing to the problem. The USDA's Food Stamp Program (now known as the Supplemental Nutrition Assistance Program - SNAP) is the largest food assistance program in the United States with over 40 million participants. This paper employed systematic realist review methods to determine whether participation in the Food Stamp Program causes obesity and the causal pathways through which this relationship may exist. Findings indicate a more consistent positive relationship for women than for men, especially for women who are long term users of the program. All studies discussed the "food stamp cycle" and an "income effect" as explanations for the role of food stamps in increased obesity yet evidence for these factors is limited. Curiously, the research in this field does not address obesogenic environments and we suggest that the absence of an understanding of household behavior in local contexts is a significant impediment to the reform of the Food Stamp Program.
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Severe food insecurity is associated with obesity among Brazilian adolescent females. Public Health Nutr 2012; 15:1854-60. [DOI: 10.1017/s1368980011003582] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo determine whether household food insecurity (HFI) is associated with a higher prevalence of excessive weight (EW) in a large random sample of Brazilian female adolescents.DesignNationally representative cross-sectional study. EW was the outcome variable (BMI ≥ 85th percentile of WHO reference for adolescents aged 15–18 years and BMI ≥ 25 kg/m2 for those aged 19 years). HFI was measured with the Brazilian Food Insecurity Scale. Associations were measured using crude and adjusted prevalence ratios (PR) with 95 % confidence intervals through Poisson regression models taking into account the complex sampling design.SettingData were derived from the third wave of the Demographic and Health Survey conducted in 2006–2007, in Brazil.SubjectsThe sample included 1529 female adolescents aged 15–19 years.ResultsThe prevalence of any level of HFI was 40·8 %, with 26·6 % of households experiencing mild, 9·4 % moderate and 4·8 % severe food insecurity. The overall prevalence of EW was 21·9 % (12·9 % were overweight and 9·0 % obese). EW prevalence among those living in severely, moderately and mildly food-insecure households was 36·8 %, 14·9 % and 16·5 %, respectively (P for the overall association = 0·036). Women living in severely food-insecure households had an increased prevalence of EW compared with their food-secure counterparts (PR = 1·96; 95 % CI 1·18, 3·27; P = 0·007), after adjusting for important confounders.ConclusionsThe study suggests that severe but not mild or moderate HFI is independently associated with EW among adolescents residing in Brazil, a middle-income country undergoing the nutrition transition.
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Leung CW, Willett WC, Ding EL. Low-income Supplemental Nutrition Assistance Program participation is related to adiposity and metabolic risk factors. Am J Clin Nutr 2012; 95:17-24. [PMID: 22170370 PMCID: PMC3238460 DOI: 10.3945/ajcn.111.012294] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Supplemental Nutrition Assistance Program (SNAP) is the largest federal nutrition assistance program. In recent years, SNAP participation rates increased during times of economic hardship. OBJECTIVE We examined whether household SNAP participation was associated with adiposity and metabolic risk factors in a representative sample of low-income US adults. DESIGN A cross-sectional analysis was performed with the use of data from the 2003-2006 National Health and Nutrition Examination Surveys. The study population was restricted to nonelderly adults whose household incomes fell to or <130% of the federal poverty level. Multinomial logistic and Poisson regression models were fit to examine the associations between SNAP participation and BMI, waist circumference, and metabolic risk factors among 2250 low-income adults. RESULTS In the previous 12 mo, 32.8% of adults received household SNAP benefits. SNAP participation was positively associated with obesity [prevalence ratio (PR): 1.58; 95% CI: 1.08, 2.31], waist circumference in men (PR for top compared with bottom quartile: 2.04; 95% CI: 1.15, 3.62; P = 0.02), and waist circumference in women (PR: 2.95; 95% CI: 1.51, 5.77; P = 0.003; P-interaction with sex = 0.11), independent of sociodemographic characteristics. SNAP participation was also related to elevated triglycerides (PR: 1.71; 95% CI: 1.33, 2.20), lower HDL cholesterol (PR: 1.23; 95% CI: 1.08, 1.41), elevated fasting glucose (≥110 mg/dL; PR: 1.63; 95% CI: 1.05, 2.52), and metabolic syndrome (PR: 1.49; 95% CI: 1.13, 1.95). Associations with triglycerides and HDL cholesterol persisted after adjustment for BMI. CONCLUSION Household SNAP participation was positively associated with BMI, waist circumference, and metabolic risk factors among low-income adults. These associations may be mediated by dietary intake and warrant further investigation.
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Affiliation(s)
- Cindy W Leung
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
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Martin MA, Lippert AM. Feeding her children, but risking her health: the intersection of gender, household food insecurity and obesity. Soc Sci Med 2011; 74:1754-64. [PMID: 22245381 DOI: 10.1016/j.socscimed.2011.11.013] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 10/08/2011] [Accepted: 11/14/2011] [Indexed: 01/22/2023]
Abstract
This paper investigates one explanation for the consistent observation of a strong, negative correlation in the United States between income and obesity among women, but not men. We argue that a key factor is the gendered expectation that mothers are responsible for feeding their children. When income is limited and households face food shortages, we predict that an enactment of these gendered norms places mothers at greater risk for obesity relative to child-free women and all men. We adopt an indirect approach to study these complex dynamics using data on men and women of childrearing age and who are household heads or partners in the 1999-2003 waves of the Panel Study of Income Dynamics (PSID). We find support for our prediction: Food insecure mothers are more likely than child-free men and women and food insecure fathers to be overweight or obese and to gain more weight over four years. The risks are greater for single mothers relative to mothers in married or cohabiting relationships. Supplemental models demonstrate that this pattern cannot be attributed to post-pregnancy biological changes that predispose mothers to weight gain or an evolutionary bias toward biological children. Further, results are unchanged with the inclusion of physical activity, smoking, drinking, receipt of food stamps, or Women, Infants and Children (WIC) nutritional program participation. Obesity, thus, offers a physical expression of the vulnerabilities that arise from the intersection of gendered childcare expectations and poverty.
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Affiliation(s)
- Molly A Martin
- Pennsylvania State University, 211 Oswald Tower, University Park, PA 16802, USA.
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Dammann KW, Smith C. Food-related environmental, behavioral, and personal factors associated with body mass index among urban, low-income African-American, American Indian, and Caucasian women. Am J Health Promot 2011; 25:e1-e10. [PMID: 21721954 DOI: 10.4278/ajhp.091222-quan-397] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine racial/ethnic differences in relationships between food-related environmental, behavioral and personal factors and low-income women's weight status using Social Cognitive Theory (SCT) as a framework. DESIGN Cross-sectional survey. SETTING Community sites and low-income housing developments in the Twin Cities metropolitan area. SUBJECTS Low-income African-American, American Indian, and Caucasian women ≥18 years old (n = 367). MEASURES Participants completed a survey including demographic, food security, and theoretically based questions. Heights and weights were measured to determine body mass index (BMI). ANALYSIS Data were split by race/ethnicity and reduced by examining Pearson coefficients for SCT survey questions significantly correlated with BMI (p < .05). Separate environmental, behavioral, and personal multiple linear regression models for each racial/ethnic group were run to explore the proportion of variance in BMI explained by each SCT construct and which questions were significant predictors. RESULTS All regression models were statistically significant, although the personal regression models predicted the greatest proportion of the variance in BMI for African-American (15% of the variance), American Indian (22% of the variance), and Caucasian women (37% of the variance). CONCLUSION Effective nutrition education and intervention efforts to control the obesity epidemic among urban, low-income women may call for a tailored approach with noted consideration of their racial/ethnic identity. Although broader changes to the food environment are necessary, the importance of addressing personal factors such as nutrition knowledge, self-efficacy, and emotional coping responses to stress, in the context of income constraints, food insecurity, and health beliefs, is also implicated.
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Affiliation(s)
- Kristen Wiig Dammann
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, Minnesota, USA
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Kimbro RT, Rigby E. Federal food policy and childhood obesity: a solution or part of the problem? Health Aff (Millwood) 2011; 29:411-8. [PMID: 20194981 DOI: 10.1377/hlthaff.2009.0731] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Amid growing concern about childhood obesity, the United States spends billions of dollars on food assistance: providing meals and subsidizing food purchases. We examine the relationship between food assistance and body mass index (BMI) for young, low-income children, who are a primary target population for federal food programs and for efforts to prevent childhood obesity. Our findings indicate that food assistance may unintentionally contribute to the childhood obesity problem in cities with high food prices. We also find that subsidized meals at school or day care are beneficial for children's weight status, and we argue that expanding access to subsidized meals may be the most effective tool to use in combating obesity in poor children.
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