Public support for policies to improve the nutritional impact of the Supplemental Nutrition Assistance Program (SNAP)

OBJECTIVE

To determine public attitudes towards federal spending on nutrition assistance programmes and support for policies to improve the nutritional impact of the Supplemental Nutrition Assistance Program (SNAP).

DESIGN

Participants answered survey questions by telephone assessing support for SNAP spending and proposed programme policy changes.

SETTING USA SUBJECTS

Survey of 3024 adults selected by random digit dialling conducted in April 2012, including 418 SNAP participants.

RESULTS

A majority (77%; 95% CI 75, 79%) of all respondents supported maintaining or increasing SNAP benefits, with higher support among Democrats (88%; 95% CI 86, 90%) than Republicans (61%; 95% CI 58, 65%). The public supported policies to improve the nutritional impact of SNAP. Eighty-two per cent (95% CI 80, 84%) of respondents supported providing additional benefits to programme participants that can only be used on healthful foods. Sixty-nine per cent (95% CI 67, 71%) of respondents supported removing SNAP benefits for sugary drinks. A majority of SNAP participants (54%; 95% CI 48, 60%) supported removing SNAP benefits for sugary drinks. Of the 46% (95% CI 40, 52%) of SNAP participants who initially opposed removing sugary drinks, 45 % (95% CI 36, 54%) supported removing SNAP benefits for sugary drinks if the policy also included additional benefits to purchase healthful foods.

CONCLUSIONS

The US public broadly supports increasing or maintaining spending on SNAP. The majority of respondents, including SNAP participants, supported policies to improve the nutritional impact of SNAP by restricting the purchase of sugary drinks and incentivizing purchase of healthful foods with SNAP benefits.

Associations of food stamp participation with dietary quality and obesity in children

OBJECTIVE

To determine if obesity and dietary quality in low-income children differed by participation in the Supplemental Nutrition Assistance Program (SNAP), formerly the Food Stamp Program.

METHODS

The study population included 5193 children aged 4 to 19 with household incomes ≤130% of the federal poverty level from the 1999-2008 NHANES. Diet was measured by using 24-hour recalls.

RESULTS

Among low-income US children, 28% resided in households currently receiving SNAP benefits. After adjusting for sociodemographic differences, SNAP participation was not associated with a higher rate of childhood obesity (odds ratio = 1.11, 95% confidence interval [CI]: 0.71-1.74). Both SNAP participants and low-income nonparticipants were below national recommendations for whole grains, fruits, vegetables, fish, and potassium, while exceeding recommended limits for processed meat, sugar-sweetened beverages, saturated fat, and sodium. Zero percent of low-income children met at least 7 of 10 dietary recommendations. After multivariate adjustment, compared with nonparticipants, SNAP participants consumed 43% more sugar-sweetened beverages (95% CI: 8%-89%), 47% more high-fat dairy (95% CI: 7%, 101%), and 44% more processed meats (95% CI: 9%-91%), but 19% fewer nuts, seeds, and legumes (95% CI: -35% to 0%). In part due to these differences, intakes of calcium, iron, and folate were significantly higher among SNAP participants. Significant differences by SNAP participation were not evident in total energy, macronutrients, Healthy Eating Index 2005 scores, or Alternate Healthy Eating Index scores.

CONCLUSIONS

The diets of low-income children are far from meeting national dietary recommendations. Policy changes should be considered to restructure SNAP to improve children's health.

A qualitative study of diverse experts' views about barriers and strategies to improve the diets and health of Supplemental Nutrition Assistance Program (SNAP) beneficiaries

The Supplemental Nutrition Assistance Program (SNAP), the largest federal food assistance program, currently serves 44.7 million Americans with a budget of $75 billion in 2011. This study engaged leading experts for in-depth, semi-structured interviews to explore their opinions concerning the existing challenges and barriers to eating nutritiously in SNAP. Experts also proposed strategies for improving nutritional status among SNAP recipients. Twenty-seven individuals were interviewed from advocacy, government, industry, and research organizations. Interviews were recorded, transcribed, coded, and analyzed for thematic content. The high cost of nutrient-rich foods, inadequate SNAP benefits, limited access to purchasing healthy foods, and environmental factors associated with poverty were identified as barriers that influence nutrition among low-income households in the United States. Six themes emerged among respondents from diverse sectors about how to address these challenges, including providing SNAP participants with incentives to purchase nutrient-rich food consistent with the 2010 Dietary Guidelines for Americans, restricting the purchase of nutrient-poor foods and beverages with program benefits, modifying the frequency of SNAP benefit distribution, enhancing nutrition education, improving the SNAP retailer environment, and increasing state and federal level coordination and consistency of program implementation. Given the recent dramatic increase in SNAP enrollment, policymakers must address existing barriers as well as consider new strategies to improve nutrition policies in SNAP so that the program can continue to address food insecurity needs as well as provide a healthful diet for SNAP beneficiaries.

Youth suicide: risk factors, assessment, and treatment of adolescent and young adult suicidal patients

One of the most difficult clinical problems facing the mental health professional is the prediction and prevention of youth suicide. Suicide is currently the third leading cause of death for young people, ages 15 to 24, in the United States. This article presents several models for understanding youth suicidal behavior including psychologic, sociologic, and biomedical explanations. It summarize what is known about risk factors for adolescent and young adult suicide, including psychiatric diagnosis, personality traits, psychosocial factors, associated medical illnesses, biologic correlates, and family history and genetics. Knowledge about these risk factors will be translated into practical considerations for the treatment of adolescent and young adult suicidal patterns, including psychotherapeutic, psychopharmacologic, and environmental interventions.

Late luteal phase dysphoric disorder (premenstrual syndromes): clinical implications

The authors present an overview of current knowledge about premenstrual syndrome (PMS), most recently classified as late luteal phase dysphoric disorder in the revision of the third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. A review of historical reports about the occurrence of PMS, pertinent diagnostic issues, and theories about etiology and treatment are presented. The article concludes with a discussion of the overlap of and relationship between PMS and specific psychiatric disorders, new research directions, and clinical implications of the syndrome.

The menstrual cycle in context, I: Affective syndromes associated with reproductive hormonal changes

In some women, mood and behavioral changes appear to be linked to the menstrual cycle. New basic science data on steroid-brain interactions have renewed interest in the menstrual cycle as a naturalistic model for assessing gonadal steroid-induced mental and behavioral changes. The authors investigate similarities and differences in affective symptoms associated with reproductive-related gonadal steroid changes that span the life cycle of women, including the menstrual cycle, oral contraceptive use, pregnancy, the postpartum period, and perimenopause. Recommendations for reporting of symptoms and implications for future research are discussed.

The menstrual cycle in context, II: Human gonadal steroid hormone variability

Menstrual cycle-related mood or behavior changes are best understood in the context of the hormonal variability that occurs in men as well as in women over different periods of time. This paper reexamines what is known and what is not known about the clinical correlates of fluctuations in gonadal and adrenal steroid hormones. The authors highlight the need for a more gender-comparative approach to the psychoneuroendocrinology of endogenous cycles.

Suicide: a guide to risk factors, assessment, and treatment of suicidal patients

This article summarizes what is known about risk factors for suicide in both adolescent and adult populations. It also translates this knowledge base into practical considerations for the physician on the assessment and treatment of suicidal patients. Since most patients who commit suicide have seen a physician in the weeks to month prior to their deaths, and many kill themselves with medications prescribed by their doctors, the physician's early detection and treatment of suicidal behaviors and associated psychiatric disorders in his or her patients becomes a major suicide prevention strategy.

Pregnancy-related affective episodes among women with recurrent depression

The authors examined 52 women with recurrent depression to determine the differences between women with and without histories of pregnancy-related affective episodes. The women with histories of such episodes (N = 24) had been significantly younger at illness onset, were more severely depressed at baseline, and tended to show less emotional stability. The EEG-recorded sleep of the women with pregnancy-related affective episodes was distinguished by longer REM sleep time and more REM activity, differences accounted for almost entirely by the women with histories of only postpartum episodes.

Influence of blood glucose on convulsive seizures from hyperbaric oxygen

Previous evidence suggests a causal relationship between blood glucose levels and the development of generalized epileptiform seizures. In the present study rats were pretreated with glucose, alloxan, or insulin prior to exposure to 6 atmospheres absolute (ATA) oxygen in a hyperbaric chamber. The results showed that the administration of glucose prior to oxygen exposure increased the time-to-seizure by 90% and alloxan by 110%, whereas in contrast insulin decreased the time-to-seizure by 55%. Blood glucose levels were consistently elevated in rats following oxygen exposure. A trend towards reduced lung damage by glucose and alloxan pretreatment was suggested by the data, although no changes were significant. Our results showed that prior administration of glucose or alloxan offered partial protection from oxygen toxicity in rats, whereas insulin generally augmented the reaction.

Myocardial adrenergic receptors and adenylate cyclase in the developing spontaneously hypertensive rat

Cardiac membrane preparations from developing spontaneously hypertensive rats (SHR) and Wistar-Kyoto (WKY) rats (0 to 125 days of age) were analyzed for the apparent numbers of alpha- and beta-adrenergic receptors and adenylate cyclase activities in an attempt to correlate biochemical changes with the reported functional changes occurring with the development of hypertension in the SHR. Although the apparent number of alpha- and beta-adrenergic receptors were similar in both strains of rats, isoproterenol-stimulated adenylate cyclase activities were significantly higher (P less than 0.05) in the prehypertensive SHRs when compared to WKY rats and declined to lower values as hypertension appeared. The percent stimulation produced by isoproterenol remained similar in cardiac membranes from normotensive WKY rats at all ages of development whereas this percent stimulation was 40% higher at birth in the SHRs and declined to approximately one half the original value by 100 days of age (P less than 0.05). The elevated adenylate cyclase activity observed during the prehypertensive state may contribute to the genesis of hypertension.