Associations between Food Insecurity and Supplemental Nutrition Assistance Program (SNAP) participation with ultra-processed food intake in lower-income U.S. adolescents.

Ultra-processed foods (UPFs) have negative health consequences. Food insecurity and Supplemental Nutrition Assistance Program (SNAP) are associated with higher UPF intake in U.S. adults, but this has not been examined in U.S. adolescents. This study assesses associations between food security status and SNAP participation with UPF intake in 3,067 adolescents aged 12-19 years with household incomes at or below 300% of the federal poverty line from the 2007-2016 National Health and Nutrition Examination Survey. UPF is defined using the Nova classification and measured as a percentage of daily total energy intake (TEI). High food security, marginal food security, or food insecurity status was determined through the U.S. Department of Agriculture's eighteen-item Household Food Security Survey. SNAP participation was deemed affirmative if the household reported receiving SNAP benefits in the last year. Multivariable linear regressions that controlled for TEI and sociodemographic covariates and accounted for the complex survey design examined associations between food insecurity and SNAP participation with UPF intake. In the sample, the prevalence of marginal food security was 15.9%, the prevalence of food insecurity was 33.8%, and the prevalence of SNAP participation was 36.5%. After multivariate adjustment, there were no significant differences in UPF intake by food security status. Adolescents participating in SNAP consumed 2.7% higher UPF intake (95% CI: 0.1%, 5.2%, p = 0.04) compared to adolescents not participating in SNAP. Among lower-income U.S. adolescents, SNAP participation but not food security status was associated with higher UPF intake. Programs and policies promoting the intake of more healthful, minimally processed foods should be strengthened.