Usual Nutrient Intake of Older Adults in the U.S. Is Lower Among SNAP Participants Compared to Income-Eligible Non-Participants

Abstract Objectives Policy proposals to limit use of the Supplemental Nutrition Assistance Program (SNAP) and to allow dietary supplement (DS) purchase with SNAP benefits draw attention to knowledge gap of usual nutrient intake and adherence to the Dietary Reference Intake recommendations from foods alone and with DS (total intake) among low-income older adults. To address this gap, the estimated distributions of usual nutrient intake (from foods alone and total) and risk of inadequate intake among U.S. older adults participating in SNAP were compared with income-eligible non-participants. Methods Data from 4,791 older adults (≥60 years) from the 2007–2016 National Health and Nutrition Examination Survey were used in this cross-sectional secondary analysis. DS data from an in-home inventory and dietary data from up to two 24-hour recalls were used to estimate usual nutrient intake distributions (total and from foods alone) and the proportion of the population below the Estimated Average Requirement (EAR) using an adapted National Cancer Institute method. Pairwise t-tests compared SNAP participants and eligible non-participants with significance set at P < 0.05. Results SNAP participants had lower usual intake from foods alone compared to eligible non-participants for vitamins B6 (P = 0.046) and E (P = 0.027); the risk of inadequate intake was higher among SNAP participants compared to eligible non-participants for vitamin E (P = 0.0004). Similarly, total usual nutrient intake was lower among SNAP participants compared to eligible non-participants for magnesium (P = 0.019), zinc (P = 0.0003), vitamin C (P = 0.02) and vitamin D (P = 0.0002) and the proportion not meeting the EAR was higher among SNAP participants compared to eligible non-participants for magnesium (P = 0.044). Conclusions Older adults participating SNAP had lower usual intake and meet the EAR less compared to eligible non-participants for certain nutrients. The proportion at risk of inadequate intake was lower when all nutrients sources were examined compared to foods alone. Future policies should focus on improving nutrient intake among food assistance participants and their food security. Funding Sources Supported by University of Kentucky Center for Poverty Research through funding by the U.S. Department of Agriculture, Food and Nutrition Service, Contract Number 12319819C0006.

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Effectiveness of mobile produce markets in increasing access and affordability of fruits and vegetables among low-income seniors

Public Health Nutrition ◽

10.1017/s1368980020002931 ◽

2020 ◽

Vol 23 (17) ◽

pp. 3226-3235

Author(s):

Reece Lyerly ◽

Pasquale Rummo ◽

Sarah Amin ◽

Whitney Evans ◽

Eliza Dexter Cohen ◽

...

Keyword(s):

Rhode Island ◽

Low Income ◽

Fruits And Vegetables ◽

Economic Status ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Assistance Program ◽

Logistic Regression Models ◽

Populations At Risk ◽

Nutrition Assistance

AbstractObjective:Mobile produce markets (MPM) offering Supplemental Nutrition Assistance Program (SNAP) incentive programmes have the potential to provide accessible and affordable fruits and vegetables (FV) to populations at risk of food insecurity. The objective of this study is to characterise the customer base of an MPM and describe their participation at twelve market sites serving low-income seniors.Design:In 2018, customers from an MPM in Rhode Island (RI) participated in a cross-sectional survey (n 330; 68 % response rate), which measured dietary patterns, food security and food shopping behaviours. We compared the shopping habits and market experiences of customers who currently received SNAP benefits with those who did not currently receive SNAP benefits.Setting:An MPM in RI which offers a 50 % discount for FV purchased with SNAP benefits.Participants:This study describes current market customers at twelve market sites serving low-income seniors.Results:Market customers were mostly low-income, female, over the age of 50 years and Hispanic/Latino. Most customers received SNAP benefits, and almost half were food insecure. In addition, three quarters of SNAP customers reported their SNAP benefits last longer since shopping at the markets. Mixed logistic regression models indicated that SNAP customers were more likely to report buying and eating more FV than non-SNAP customers.Conclusions:MPM are critical resources of affordable produce and have been successful in improving access to FV among individuals of low socio-economic status in RI. This case study can inform policy and programme recommendations for MPM and SNAP incentive programmes.

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Three-year trends in dietary behaviours among mothers, teenagers and children from SNAP-Ed (Supplemental Nutrition Assistance Program–Education) eligible households across California

Public Health Nutrition ◽

10.1017/s1368980019003197 ◽

2019 ◽

Vol 23 (1) ◽

pp. 3-12 ◽

Cited By ~ 1

Author(s):

Fred Molitor ◽

Celeste Doerr ◽

John Pugliese ◽

Lauren Whetstone

Keyword(s):

Diet Quality ◽

Low Income ◽

Vegetable Intake ◽

Age Groups ◽

Healthy Eating Index ◽

Poverty Level ◽

Cross Sectional ◽

Assistance Program ◽

Dietary Behaviours ◽

Nutrition Assistance

AbstractObjective:To examine trends from 2015 to 2017 in dietary behaviours and diet quality among low-income mothers, teenagers and children.Design:Cross-sectional telephone surveys using a validated 24 h dietary assessment.Setting:Randomly sampled households with incomes ≤185 % of the US federal poverty level across California.Participants:Survey participants were 13 247 mothers (≥18 years), 3293 teenagers (12–17 years) and 6043 children (5–11 years). Respondents were mostly Latino.Results:Over the 3-year study period, consumption of fruits and vegetables with and without 100 % fruit juice increased (P ≤ 0·05) by at least 0·3 cups/d for mothers, teenagers and children. Intake of water also increased (P ≤ 0·001) by more than 1 cup/d for mothers and children and 2 cups/d for teenagers. Sugar-sweetened beverage (SSB) consumption was unchanged over the 3 years. Overall diet quality, as assessed by the Healthy Eating Index-2015, improved (P ≤ 0·01) for mothers, teenagers and children. Covariates for the fifteen regression models (three age groups by five outcome variables) included race/ethnicity, age, education for mothers, and gender for teenagers and children.Conclusions:The observed increases in fruit and vegetable intake and improvements in overall diet quality during the 3-year period suggest that low-income Californians may have lowered their risk of preventable diseases. However, more intense or strategic SSB-reduction interventions are required. Regional- or state-level, population-based surveillance of dietary behaviours is useful for public health nutrition policy and programme decision making, and can be used to assess potential trends in future negative health outcomes and related costs associated with poor dietary behaviours within at-risk populations.

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Availability, quality and price of produce in low-income neighbourhood food stores in California raise equity issues

Public Health Nutrition ◽

10.1017/s1368980018000058 ◽

2018 ◽

Vol 21 (9) ◽

pp. 1639-1648 ◽

Cited By ~ 10

Author(s):

Wendi Gosliner ◽

Daniel M Brown ◽

Betty C Sun ◽

Gail Woodward-Lopez ◽

Patricia B Crawford

Keyword(s):

Low Income ◽

Grocery Stores ◽

Local Health ◽

High Quality ◽

Supplemental Nutrition ◽

Cross Sectional ◽

Assistance Program ◽

Food Stores ◽

Convenience Stores ◽

Nutrition Assistance

AbstractObjectiveTo assess produce availability, quality and price in a large sample of food stores in low-income neighbourhoods in California.DesignCross-sectional statewide survey.SettingBetween 2011 and 2015, local health departments assessed store type, WIC (Supplemental Nutrition Program for Women, Infants, and Children)/SNAP (Supplemental Nutrition Assistance Program) participation, produce availability, quality and price of selected items in stores in low-income neighbourhoods. Secondary data provided reference chain supermarket produce prices matched by county and month.tTests and ANOVA examined differences by store type; regression models examined factors associated with price.SubjectsLarge grocery stores (n231), small markets (n621) and convenience stores (n622) in 225 neighbourhoods.ResultsProduce in most large groceries was rated high quality (97 % of fruits, 98 % of vegetables), but not in convenience stores (25 % fruits, 14 % vegetables). Small markets and convenience stores participating in WIC and/or SNAP had better produce availability, variety and quality than non-participating stores. Produce prices across store types were, on average, higher than reference prices from matched chain supermarkets (27 % higher in large groceries, 37 % higher in small markets, 102 % higher in convenience stores). Price was significantly inversely associated with produce variety, adjusting for quality, store type, and SNAP and WIC participation.ConclusionsThe study finds that fresh produce is more expensive in low-income neighbourhoods and that convenience stores offer more expensive, poorer-quality produce than other stores. Variety is associated with price and most limited in convenience stores, suggesting more work is needed to determine how convenience stores can provide low-income consumers with access to affordable, high-quality produce. WIC and SNAP can contribute to the solution.

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Ensuring Access to Fruits and Vegetables for the Nation’s Most Vulnerable – Contributions of WIC and SNAP

The Economists Voice ◽

10.1515/ev-2017-0005 ◽

2017 ◽

Vol 14 (1) ◽

Author(s):

Dena R. Herman

Keyword(s):

Low Income ◽

Fruits And Vegetables ◽

Eating Habits ◽

Food Choices ◽

Safety Net ◽

Supplemental Nutrition ◽

Assistance Program ◽

Supplemental Nutrition Program ◽

Nutrition Assistance ◽

The U.S

AbstractThe Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP) are critical programs in the U.S. because they form the basis of the nation’s nutrition and hunger safety net. SNAP has large effect nationwide offering nutrition assistance to 1 in 7 low-income Americans, while WIC serves more than half of all infants in the U.S. and a quarter of all children ages 1-5 years. Despite the reach of these programs, there is still room for improvement, especially when it comes to increasing access to healthy food items and improving eating habits. The objective of this paper is to make recommendations for how WIC and SNAP can work better together to continue to incentivize purchases and support low-income population’s knowledge and access to healthier food choices, particularly those foods that have traditionally been most expensive – fruits and vegetables.

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Changing Attitudes and Knowledge Toward SNAP Application

American Journal of Health Promotion ◽

10.1177/0890117117709793 ◽

2017 ◽

Vol 32 (2) ◽

pp. 312-314

Author(s):

Carolyn L. Bird ◽

Jacquelyn W. McClelland

Keyword(s):

Low Income ◽

Effective Theory ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Assistance Program ◽

Adult Participants ◽

Attitudes And Knowledge ◽

Nutrition Assistance ◽

Changing Attitudes ◽

To Receive

Purpose: To examine effectiveness of an educational intervention on attitude and knowledge related to accessing and qualifying for the Supplemental Nutrition Assistance Program (SNAP). Design: Cross-sectional survey. Setting: Community sites (38) in North Carolina. Participants: Low-income adult participants who provided data (n = 558). Intervention: Participants completed pre- and postsurveys for the 45-minute program. Measures: Theoretically based surveys measured knowledge requisite to the decision to apply for SNAP benefits. Analysis: Paired sample t tests tested the hypothesis of “no difference” in postintervention knowledge. Results: Knowledge gains were statistically significant on all questions ( P < .01) including the amount of food a minimum benefit could purchase, how to apply for SNAP, how the electronic benefit transfer card and benefits work, eligibility restrictions, and how to receive application assistance. Subsequent percentage change analyses revealed the strongest intervention effects to be how to apply and accessing application assistance. Conclusion: Effective theory-based programs can improve knowledge and dispel myths concerning SNAP participation among low-income participants.

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Nutrition-Related Policy Fundamentals for Supporting Older Adults in the Community during a Pandemic: Lessons from COVID-19

10.18278/jep.1.3.9 ◽

2021 ◽

Vol 1 (3) ◽

Author(s):

Meredith Whitmire ◽

Mary Beth Arensberg ◽

Alexandra Ashbrook ◽

Robert Blancato

Keyword(s):

Older Adults ◽

Older Adult ◽

Healthy Aging ◽

Well Being ◽

Community Dwelling ◽

Assistance Program ◽

Older Americans ◽

Nutrition Programs ◽

Nutrition Assistance ◽

The U.S

Nutrition is a key factor supporting healthy aging. Yet during the global COVID-19 pandemic, issuances of shelter-in-place orders, closures of senior centers and other congregate dining locations, losses of income, increases in grocery prices, and other changes have left many older adults struggling to maintain good nutrition. However, there are available solutions to improve the nutrition of millions of older adults who may be challenged to put food on the table. This commentary outlines the problems of older adult malnutrition and food insecurity and their strong correlation with COVID-19. It summarizes existing federal nutrition programs for older adults, including the U.S. Department of Health and Human Services’ Older Americans Act (OAA) nutrition programs and the U.S. Department of Agriculture’s means-tested nutrition programs such as the Supplemental Nutrition Assistance Program (SNAP). The commentary also contains lessons from community-based OAA nutrition programs that refocused some of their nutrition services and other supportive services during the COVID-19 pandemic to better serve socially distancing, newly homebound older adults. It explores pre- and post-COVID-19 policy actions and opportunities for improving the nutrition, health, and well-being of community-dwelling older Americans during the current pandemic and beyond, including the need for more federal funding and flexibility for older adult nutrition programs, the need for improvements to older adult access to these programs, and the need for more older adult nutrition screening and intervention.

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Accelerating Evaluation of Financial Incentives for Fruits and Vegetables: A Case for Shared Measures

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182212140 ◽

2021 ◽

Vol 18 (22) ◽

pp. 12140

Author(s):

Nadine Budd Nugent ◽

Carmen Byker Shanks ◽

Hilary K. Seligman ◽

Hollyanne Fricke ◽

Courtney A. Parks ◽

...

Keyword(s):

Low Income ◽

Financial Incentives ◽

Fruits And Vegetables ◽

Financial Incentive ◽

Evaluation Model ◽

Health Impact ◽

Dietary Quality ◽

Assistance Program ◽

Nutrition Assistance ◽

The U.S

Food insecurity, or lack of consistent access to enough food, is associated with low intakes of fruits and vegetables (FVs) and higher risk of chronic diseases and disproportionately affects populations with low income. Financial incentives for FVs are supported by the 2018 Farm Bill and United States (U.S.) Department of Agriculture’s Gus Schumacher Nutrition Incentive Program (GusNIP) and aim to increase dietary quality and food security among households participating in the Supplemental Nutrition Assistance Program (SNAP) and with low income. Currently, there is no shared evaluation model for the hundreds of financial incentive projects across the U.S. Despite the fact that a majority of these projects are federally funded and united as a cohort of grantees through GusNIP, it is unclear which models and attributes have the greatest public health impact. We explore the evaluation of financial incentives in the U.S. to demonstrate the need for shared measurement in the future. We describe the process of the GusNIP NTAE, a federally supported initiative, to identify and develop shared measurement to be able to determine the potential impact of financial incentives in the U.S. This commentary discusses the rationale, considerations, and next steps for establishing shared evaluation measures for financial incentives for FVs, to accelerate our understanding of impact, and support evidence-based policymaking.

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THE IMPACT OF FOOD INSECURITY ON THE HEALTH AND WELL-BEING OF OLDER ADULTS: THE GROUPS MOST AT RISK

Innovation in Aging ◽

10.1093/geroni/igz038.2705 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S738-S738

Author(s):

Lauren E Popham ◽

Erin McGovern

Keyword(s):

Older Adults ◽

Food Insecurity ◽

Prescription Drugs ◽

Low Income ◽

Well Being ◽

National Council ◽

Assistance Program ◽

Increased Risk ◽

Nutrition Assistance ◽

The Impact

Abstract Older adults who experience food insecurity (4.6 million) often have worse health outcomes. Food insecure older adults consume less nutrients, which puts them at greater risk of developing chronic diseases. They are at increased risk of falls due the impact of poor nutrition on muscle mass, bone density, and balance. Low-income older adults are often forced to choose between buying groceries and paying other bills. The Supplemental Nutrition Assistance Program (SNAP) plays an important role in reducing food insecurity. SNAP enables older adults to buy the nutritious food they need, while freeing up resources to pay for everyday things to meet their health needs such as prescription drugs. Research shows that medication adherence increases when low-income older adults enroll in SNAP. Despite the beneficial impact of enrolling in SNAP, it’s estimated that 55% of eligible adults age 60 and older are not participating in this critical program. To understand which older adults are missing out on SNAP, the National Council on Aging engaged researchers at Leading Age LTSS Center at UMass Boston to analyze data from the 2014 Health and Retirement Study. The results show that some of the most vulnerable older adult populations are less likely to participate in SNAP even though they are eligible (i.e., Hispanic, age 75 and older, those who are not utilizing healthcare, etc.). The findings suggest that more targeted outreach to these groups is needed to ensure that the most vulnerable populations of older adults access this critical benefit.

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Participants’ Experiences of the 2018–2019 Government Shutdown and Subsequent Supplemental Nutrition Assistance Program (SNAP) Benefit Disruption Can Inform Future Policy

Nutrients ◽

10.3390/nu12061867 ◽

2020 ◽

Vol 12 (6) ◽

pp. 1867

Author(s):

Wendi Gosliner ◽

Wei-Ting Chen ◽

Cathryn Johnson ◽

Elsa Michelle Esparza ◽

Natalie Price ◽

...

Keyword(s):

Customer Service ◽

Low Income ◽

Small Sample ◽

Supplemental Nutrition Assistance Program ◽

Supplemental Nutrition ◽

Cross Sectional ◽

Assistance Program ◽

Cascading Effects ◽

Nutrition Assistance ◽

Government Shutdown

The federal government shutdown from 22 December 2018 to 25 January 2019 created an unprecedented disruption in Supplemental Nutrition Assistance Program (SNAP) benefits. We conducted a cross-sectional qualitative study to begin to capture how the disruption affected food security and wellbeing among a small sample of California SNAP participants. We collected data from 26 low-income adults in four focus groups in four diverse California counties. We found that participants routinely struggle to secure an adequate and healthy diet in the context of high costs of living, the shutdown and benefit disruption added to participants’ stress and uncertainty and exacerbated food insecurity, and it diminished some participants’ faith in government. Participants reported that, while having additional benefits in January felt like a relief from typical end-of-month deprivation, the subsequent extended gap between benefit distributions and a lack of clarity about future benefits caused cascading effects as participants later had to divert money from other expenses to buy food and faced added uncertainty about future economic stability. Additionally, the shutdown highlighted challenges related to the availability, timing, and tone of communications between participants and SNAP agencies. Participants recommended that SNAP adjust benefit and eligibility levels to better address costs of living, improve customer service, and avoid future disruptions.

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Child Compared with Parent Perceptions of Child-Level Food Security

Current Developments in Nutrition ◽

10.1093/cdn/nzz106 ◽

2019 ◽

Vol 3 (10) ◽

Author(s):

Matthew J Landry ◽

Alexandra E van den Berg ◽

Fiona M Asigbee ◽

Sarvenaz Vandyousefi ◽

Reem Ghaddar ◽

...

Keyword(s):

Food Security ◽

Food Insecurity ◽

Low Income ◽

Controlled Trial ◽

Parent Perceptions ◽

Household Food Security ◽

Security Assessment ◽

Cross Sectional ◽

Assistance Program ◽

Nutrition Assistance

ABSTRACT Background There is a need to directly and accurately conceptualize and measure food insecurity in children as part of surveillance and public health efforts. Objective The aim of this study was to compare parent and child perceptions of child-level food security status via questionnaires within a large, ethnically diverse population. Methods Cross-sectional baseline data from a cluster-randomized controlled trial involving primarily low-income, Hispanic third- to fifth-grade students and their parents were used for analysis. The sample consisted of 2408 dyadic (parent and child) pairs. Parents completed the 8-item child-referenced Household Food Security Survey Module and their responses were compared with an adaption of the 5-item Child Food Security Assessment completed by their child. Levels of association between child and parent perceptions within dyads were calculated using Goodman and Kruskal's γ statistic. A mixed-effects binomial logistic regression model was used to model discordance as a function of child, parent, and household sociodemographic characteristics. Results The child sample was 53% girls, mean age of 9 y, and 63% were Hispanic. The parent sample was 86% women and 65% Hispanic. Child and parent perceptions of child-level food security agreed only 21.7% of the time. There was a weak positive association between child and parent perceptions of child-level food security (γ = 0.162, P < 0.001). Children perceived themselves as less food secure than their parents’ perception 70.1% of the time. Household receipt of Supplemental Nutrition Assistance Program benefits was associated with greater odds of discordant food security perceptions, whereas female children, older children, and parents not working were characteristics associated with lower odds of discordant perceptions. Conclusions Results, in combination with the existing literature, suggest that parent perceptions of child-level food insecurity may underestimate child-level food insecurity experiences. Inaccurate estimations or underestimations of the true prevalence of child-level food insecurity could be detrimental to maternal and child health efforts. This trial was registered at clinicaltrials.gov as NCT02668744.

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