New study moves beyond food security to advance nutrition security by bolstering SNAP incentive programs

(Press-News.org) Exercise science assistant professor Elizabeth Adams is using her expertise in healthy dietary patterns among children and families to lead a five-year study focused on improving nutrition through the Supplemental Nutrition Assistance Program (SNAP). With support from a $3.2 million National Institutes of Health grant, Adams is working to increase SNAP recipients’ use of fruit and vegetable incentive programs to improve long-term wellness and reduce health care costs.

Across the United States, more than 34 million individuals (nine million of them children) experience food insecurity, which is strongly linked to suboptimal diet quality and its increased risk of chronic diseases, such as type 2 diabetes, cancer, obesity, and heart disease. Families with food insecurity incur 20% higher health care spending – contributing to the estimated $1.1 trillion in annual costs to the U.S. economy derived from suboptimal dietary patterns.

As the largest federal nutrition assistance program, SNAP provides monthly benefits for purchasing eligible food items to over 40 million Americans, approximately half of whom are food insecure. Though intended to help low-income individuals and families afford a nutritionally adequate diet, previous research has shown that SNAP recipients have lower fruit and vegetable intake compared to both income-eligible non-participants and higher-income families. The high cost of fruits and vegetables is often cited as a barrier to its procurement and consumption, which has led to incentive programs aimed at reducing this expense.

“There are several policies and programs designed to reduce food insecurity, but for greater impact, we need to simultaneously work towards nutrition security,” Adams says. “This means increasing equitable access to nutrient-rich foods like fruits and vegetables over calorie-dense foods like sugary beverages and ultra processed snacks, which may provide sufficient calories but very little nutritional value.”

While SNAP is a national-level initiative, the various incentive programs aimed at redirecting food selections to healthier options are funded by federal grants, state, local and tribal governments as well as private retailers, both for- and non-profit organizations. Prior research has shown that the programs do increase fruit and vegetable consumption, and simulation studies show the potential to save billions in health care costs.

In South Carolina, the SNAP Healthy Bucks program offers fruits and vegetables at half price or less at partnering locations (e.g., farmers markets, community food organizations). For example, at FoodShare, SNAP recipients can use their EBT card to purchase 15-18lb boxes of fruits and vegetables for only $5 (normally $20) or 18-22lb boxes for $10 (usually $25). Though this program addresses the high-cost barrier of purchasing fruits and vegetables, many SNAP recipients do not take advantage of it. Adams’ initial pilot study, funded by the USC Prisma Health Seed Grant Program, revealed that fewer than 25% of eligible families knew about the SNAP Healthy Bucks program.

To address this knowledge gap, Adams and her team at the Research Center for Child Well-Being and Arnold Healthy Kids Initiative are partnering with pediatric clinics who serve large patient populations to increase awareness of the SNAP Healthy Bucks program among families who are receiving SNAP benefits and who experience food insecurity. As trusted sources of health information who already conduct social determinants of health screenings and make referrals to programs like SNAP, pediatricians are perfectly positioned yet underutilized partners for promoting fruit and vegetable incentive programs.

Adams’ team will train pediatricians to educate eligible patients about the SNAP Healthy Bucks program. Each family will then be randomly assigned to one of two groups: 1) those who receive education as well as vouchers for a free trial of the program and 8 months of free home delivery on all fruit and vegetable boxes ordered and 2) those who receive only education but still have access to the incentive program.

By collecting follow-up information with these families, the researchers will determine whether the free trial and free home delivery improves parent and child dietary quality and household nutrition security. They will also assess the intervention’s effectiveness in increasing participation in the SNAP Healthy Bucks program and barriers and facilitators to its implementation and sustainability.

“Interventions like these can improve nutrition for children and families – making their SNAP benefits go further while improving health,” Adams says. “The concept of nutrition security serves as a promising framework to reduce food insecurity and health care costs, while improving diet quality and promoting health equity.”

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