Supplemental Nutrition Assistance Program Examining the Evidence to Define Benefit Adequacy (2013) / Chapter Skim
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3 Food Security and Access to a Healthy Diet in Low-Income Populations
3 Food Security and Access to a Healthy Diet in Low-Income Populations
Pages 57-96
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From page 57... ...
The chapter then describes evidence on access to a healthy diet and food insecurity among low-income SNAP-eligible as well as SNAP-participating households, including evidence on the impact of SNAP benefits. Next is a discussion of the data and analytical challenges faced in assessing the adequacy of SNAP allotments.
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From page 58... ...
ERS Food Availability (per capita) Data System, adjusted for spoilage and other waste.
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From page 59... ...
FOOD PURCHASING PATTERNS AND DIETARY INTAKE AMONG LOW-INCOME HOUSEHOLDS AND SNAP PARTICIPANTS Food Purchasing Patterns As discussed in Chapter 1, dietary intake is complex and multi dimensional and includes food preferences, cultural appropriateness, preparation methods, meal patterns, and individual health needs, among other components. The following section reviews evidence on overall expenditures on food, the marginal propensity to consume food, where SNAP 1 Food availability is defined as the total amount of food available for consumption and is calculated as the sum of annual production, beginning stocks, and imports minus exports, ending stocks, and nonfood uses.
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From page 60... ...
used data from the 2005 Consumer Expenditure Survey to examine the allocation of resources (including SNAP benefits) for household expenditures (including food)
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From page 61... ...
. The difference between the effects of cash income and SNAP benefits on food expenditures was illustrated in the "food stamp cashout" studies of the 1980s.
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From page 62... ...
Collectively, their findings support the theory that SNAP benefits decrease overall out-of-pocket food spending but increase total spending on food. The analysis also found a decrease in the tendency of SNAP participants to consume food away from home, although the overall food envionment during their study period of 1968-1978 was very dif r ferent from the food environment of today.
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From page 63... ...
Mabli and colleagues (2010b) did not directly examine what foods were purchased by SNAP participants but instead examined changes in the proportion of food expenditures going to foods identified in the 2010 DGA as "foods recommended for frequent consumption" and "foods not recommended for frequent consumption" when households spend more on food overall.
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From page 64... ...
compared with households with lower total food expenditures. Because SNAP benefits raise households' purchasing power, the implication is that the benefits at least have the potential to raise the share of a household's food expenditures going toward these recommended foods.
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From page 65... ...
The survey does include the full 18-item Core Food Security Module, as well as information on SNAP participation. Nevertheless, it is but one dataset that includes only about 5,000 persons located in 15 counties across the country each year.
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NOTES: FSP = Food Stamp Program; HEI = Healthy Eating Index. Figure 3-4.eps *
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From page 67... ...
. At the same time, environmental factors in some locales, such as limited availability of healthy foods, greater availability of highly processed foods, and limited access to outlets that offer a variety of food choices, may be key modifiable variables with an impact on food purchasing power -- a particularly important concern for participants in nutrition assistance programs such as SNAP.
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From page 68... ...
9 8 Component Score 7 6 5 4 1989 3 2 1996 1 2000 0 ty t l um ilk s it s t o ea Fa in u le rie er M Fr ra ab M di st al Va So G et le t To ho g Ve C HEI Component FIGURE 3-5 Comparison of Healthy Eating Index component scores, 1989-2000. SOURCES: Basiotis et al., 2002; Bowman et al., 1998; CNPP, 1995.
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From page 69... ...
These studies are important for understanding the methodological approach and effectiveness of the HEI as a monitoring tool for assessing diet quality and ultimately for establishing an approach to defining the adequacy of SNAP allotments. The 2005 HEI update added new components, including oils, calories from alcohol, solid fats and added sugars, whole fruit, dark green and orange vegetables, legumes, and whole grains, consistent with the 2005 DGA (Guenther et al., 2007; HHS and USDA, 2005)
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From page 70... ...
However, there is no standard approach to measuring diet quality comprehensively. As the nutrition field continues to develop more refined and nuanced measures of diet quality that are specific to various chronic diseases, work is likely to continue on developing a comprehensive diet quality index that can be used to measure an optimal diet that is linked to the DGA and can serve as an indicator of risk of chronic disease.
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From page 71... ...
In sum, the available evidence is insufficient to draw conclusions about associations between dietary intakes consistent with recommendations of the DGA and the adequacy of SNAP benefits to ensure access to a healthy diet. Impact of SNAP Benefits The committee considered the analytical challenge of self-selection of SNAP participants into the program, as well as the issue of underreporting of participation in the studies reviewed.
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From page 72... ...
examined whether SNAP participation with or without household financial stress was associated with childhood overweight and obesity. Data derived from the Survey of Household Finances and Childhood Obesity were used to compare childhood obesity outcomes among 360 SNAP-eligible children, aged 2 to 18 (70.3 percent of whom were SNAP participants)
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From page 73... ...
It then examines the relationship between food security and measures of the quantity and type of food available for consumption, as well as the health effects associated with food insecurity. The discussion includes a summary of the evidence on the impact of SNAP benefits on food insecurity among participants.
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From page 74... ...
. Previously, these households were classified as food secure; however, a number of studies have demonstrated that individuals from marginally food secure households have demographic and socioeconomic characteristics similar to those from households with low food security (Coleman-Jensen, 2010;
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SOURCE: Coleman-Jensen et al., 2012a. Calculated using data from the December 2011 Current Population Survey Food Security Supplement.
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76 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM FIGURE 3-9 Composition and characteristics of food insecure households, 2010-2011. SOURCE: Coleman-Jensen et al., 2012a.
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All Security Security Received SNAP benefits in previous 12 months 48.3 51.7 28.7 23.0 Received SNAP benefits in all 12 months 50.9 49.1 26.8 22.3 Received SNAP benefits in 1 to 11 months 44.0 56.0 31.8 24.2 Did not receive SNAP benefits 72.3 27.7 16.4 11.3 NOTE: SNAP = Supplemental Nutrition Assistance Program (formerly the Food Stamp Program)
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From page 78... ...
Between the federal data sources on emergency food use and the F eeding America survey data, it is clear that while federal nutrition assistance programs, including SNAP, provide substantial support to improve the food security of many households, a considerable number of people remain food insecure and must seek additional food from other sources, such as the emergency food system. The far-reaching and pervasive use of food pantries and soup kitchens provides anecdotal support for the proposition that SNAP may not be meeting the food/food security needs of the low-income population.
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From page 79... ...
Parents who were food insecure were more likely to report little variety in fruit and vegetable choices, poor condition of fruits and vegetables in their food stores, low acceptance of fruits and vegetables by family members, and lack of time for food preparation. Associations Between Food Security and Diet Quality Food insecurity, as noted above, can be associated with the quantity and types of food available to households.
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, although this differential was not significant in a regression analysis. Many of the studies reviewed by the committee that evaluate associations between household food security and nutritional status in population subgroups are inconsistent in both design and quality.
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Olson and Strawderman (2008) examined food insecurity in early pregnancy but did not find an association with increased risk for obesity in food insecure women up to 2 years postpartum.
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examined breastfeeding duration in infants from food secure and food insecure households using data from NHANES (1999-2000 and 2001-2002)
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Self-Reported Health or Health Status Various studies examining food insecurity have found that individuals who are food insecure often report poorer health. To illustrate, self-reported health status in food secure and food insecure women was reported in a study using data from the 1999 Panel Study of Income Dynamics (Jones and Frongillo, 2006)
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From page 84... ...
, several other studies examining whether SNAP participation improves food security while accounting for self-selection bias found that the benefits either had no effect or were associated with higher levels of food insecurity (Gibson-Davis and Foster, 2006; Gundersen and Oliveira, 2001; Jensen, 2002; Wilde and Nord, 2005)
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From page 85... ...
While there have been no randomized controlled trials that can shed light on how SNAP affects household food insecurity, the nonexperimental studies examining this question have made serious efforts to account for the possibility of selection bias in the impact estimates. In particular, these studies have used various methods to account for observed and unobserved factors that lead some households to receive SNAP benefits and others to not participate.
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From page 86... ...
Given these limitations, NHANES is currently the best dataset available for examining diet quality in low-income, including SNAP, populations because it is based on state-of-the-art data collection on dietary intake, includes the full 18-item Core Food Security Module, and includes information on SNAP participation. Nevertheless, NHANES is only one dataset, and although it examines a nationally representative sample, only about 5,000 persons located in 15 counties across the country are sampled each year.
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From page 87... ...
While assess ent of the adequacy of SNAP allotments may be based on ex m amining whether program participants appear to be meeting the goals of improving food security and access to a healthy diet, it is not clear what standards should be used to determine whether food security has been sufficiently improved or whether participants truly have access to a healthy diet. For example, what level of food security among participants would be required to determine that SNAP benefits are adequate?
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From page 88... ...
. Although the prevalence of food insecurity is relatively high among SNAP participants, the most recent research suggests that it would be even higher absent SNAP benefits -- in other words, that SNAP benefits have positive impacts on participants' food security (i.e., reducing households' likelihood of food insecurity)
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From page 89... ...
In addition, significant methodological challenges arise in assessing diet quality in the SNAP population. Along with these challenges, the lack of evidence on this issue may be due to the time lag between receipt of the SNAP benefits and subsequent dietary intake and the failure of many studies to account for selection bias.
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2005. Assessing the food security and diet quality impact of FNS program participation: Final report.
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2012. Effect of the Supplemental Nutrition Assistance Program (SNAP)
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2011a. Associations be tween food insecurity, Supplemental Nutrition Assistance Program (SNAP)
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2006. The modifying effects of Food Stamp Program partici pation on the relation between food insecurity and weight change in women.
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2011. Food security improved following the 2009 ARRA increase in SNAP benefits, ERR-116.
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2010. Food security and meta bolic syndrome in U.S.
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2005. The effect of food stamps on food security: A panel data approach.
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