Grummon Anna H, Taillie Lindsey Smith
Departments of Health Behavior and.
Carolina Population Center, University of North Carolina, Chapel Hill, Chapel Hill, NC.
Am J Clin Nutr. 2017 Jun;105(6):1433-1442. doi: 10.3945/ajcn.116.147173. Epub 2017 Apr 19.
The Supplemental Nutrition Assistance Program (SNAP), which is the largest federal nutrition assistance program in the United States, serves nearly 1 of 7 Americans. To date, few studies have examined food and beverage purchase behaviors in SNAP participants with the use of electronic purchase data. In this cross-sectional study, we examined household store purchases of key food, beverage, and nutrient groups in SNAP participants and nonparticipants. Using a data set of US households' ( = 98,256 household-by-quarter observations) packaged food and beverage purchases and SNAP status [current participant, income-eligible nonparticipant (income ≤130% of the Federal Poverty Level [FPL]), and higher-income nonparticipants (income >130% of the FPL)] from 3 quarters during 2012-2013, we estimated pooled ordinary least-squares models, clustered at the household level, to examine the association between SNAP status and purchases while controlling for sociodemographic characteristics. We examined purchases of health- and policy-relevant food and beverage groups [e.g., fruit and sugar-sweetened beverages (SSBs)] and nutrients (e.g., total calories and sodium). Regardless of SNAP status, households had low mean purchases of fruit, vegetables, and fiber and high mean purchases of junk foods, saturated fat, and sodium. After adjustment for multiple comparisons and demographic characteristics, we found significant differences by SNAP status of purchases of fruit, processed meat, salty snacks, sweeteners and toppings, SSBs, and total calories, fiber, sugar, and sodium. Several of these differences were clinically important. For example, compared with income-eligible and higher-income nonparticipants, SNAP participants purchased an additional ∼15-20 kcal · person · d from SSBs ( < 0.0001) and ∼174-195 mg total Na · person · d ( <0.0001). Results were robust to corrections for sample-selection bias and to the exclusion of observations with potentially misreported SNAP status. American households, including SNAP households, show room for improvement in the nutritional quality of store purchases. New interventions and policies may be needed to improve food and beverage purchases in both SNAP and non-SNAP households.
补充营养援助计划(SNAP)是美国最大的联邦营养援助计划,为近七分之一的美国人提供服务。迄今为止,很少有研究利用电子购买数据来考察参与SNAP计划者的食品和饮料购买行为。在这项横断面研究中,我们考察了参与SNAP计划者和未参与者家庭在商店购买关键食品、饮料和营养品类别的情况。利用一个包含美国家庭(98256个家庭按季度观测值)2012 - 2013年三个季度的包装食品和饮料购买情况以及SNAP状态[当前参与者、符合收入条件的未参与者(收入≤联邦贫困线[FPL]的130%)和高收入未参与者(收入> FPL的130%)]的数据集,我们估计了在家庭层面聚类的混合普通最小二乘法模型,以考察SNAP状态与购买之间的关联,同时控制社会人口学特征。我们考察了与健康和政策相关的食品和饮料类别[如水果和含糖饮料(SSB)]以及营养素(如总卡路里和钠)的购买情况。无论SNAP状态如何,家庭水果、蔬菜和纤维的平均购买量都较低,垃圾食品、饱和脂肪和钠的平均购买量都较高。在对多重比较和人口学特征进行调整后,我们发现按SNAP状态划分,在水果、加工肉类、咸味零食、甜味剂和配料、SSB以及总卡路里、纤维、糖和钠的购买方面存在显著差异。其中一些差异具有临床重要性。例如,与符合收入条件的未参与者和高收入未参与者相比,SNAP参与者从SSB中额外购买了约15 - 20千卡·人·天(P < 0.0001),总钠额外购买了约174 - 195毫克·人·天(P < 0.0001)。结果对于样本选择偏差的校正以及排除可能误报SNAP状态的观测值具有稳健性。美国家庭,包括参与SNAP计划的家庭,在商店购买食品的营养质量方面都有改进空间。可能需要新的干预措施和政策来改善参与SNAP计划家庭和未参与家庭的食品和饮料购买情况。