Key Points
Question
Have disparities in diet quality of US adults according to participation and eligibility for food assistance persisted, improved, or worsened over the past 15 years?
Findings
This survey study found that despite an overall improvement in diet quality among US adults between 1999 and 2014, disparities persisted or worsened for most dietary components when comparing participants of the Supplemental Nutrition Assistance Program (SNAP) with income-eligible nonparticipants and higher-income individuals. For nearly all dietary components, SNAP participants do not meet recommendations for a healthful diet.
Meaning
Evidence-based nutrition policies are needed to reduce diet-related health disparities in the United States.
Objective:
Online grocery shopping could improve access to healthy food, but it may not be equally accessible to all populations—especially those at higher risk for food insecurity. This study aimed to compare the sociodemographic characteristics of families who ordered groceries online versus those who only shopped in-store.
Design:
We analyzed enrollment survey and 44 weeks of individually-linked grocery transaction data. We used univariate chi-square and t-tests and logistic regression to assess differences in sociodemographic characteristics between households that only shopped in-store and those that shopped online with curbside pick-up (online only or online and in-store).
Setting:
Two Maine supermarkets.
Participants:
863 parents or caregivers of children under 18 years old enrolled in two fruit and vegetable incentive trials
Results:
Participants had a total of 32 757 transactions. In univariate assessments, online shoppers had higher incomes (P<0.0001), were less likely to participate in WIC or SNAP (P<0.0001), and were more likely to be female (P=0.04). Most online shoppers were 30–39 years old, and few were 50 years or older (P=0.003). After controlling for age, gender, race/ethnicity, number of children, number of adults, income, and SNAP participation, female primary shoppers (OR=2.75, P=0.003), number of children (OR=1.27, P=0.04), and income (OR=3.91 for 186–300% FPL and OR=6.92 for >300% FPL, P<0.0001) were significantly associated with likelihood of shopping online.
Conclusions:
In this study of Maine families, low-income shoppers were significantly less likely to utilize online grocery ordering with curbside pick-up. Future studies could focus on elucidating barriers and developing strategies to improve access.
Berkowitz SA, Delahanty LM, Terranova J, et al. Medically tailored meal delivery for diabetes patients with food insecurity: a randomized cross-over trial.
Food and Drug Administration ($5 billion/year). Because of the established links between nutrition and health 2 and the ongoing obesity epidemic, it is important to understand how the new Farm Bill's programs and provisions may influence public health.The 2018 Farm Bill is divided into 12 thematic sections ("titles") covering food and agriculture, 1 historically combined to facilitate bipartisan congressional support for the bill, including from urban and rural regions. The Nutrition Title accounts for approximately 76% of spending. Its largest component is the Supplemental Nutrition Assistance Program (SNAP), which provides monthly benefits for food purchases at supermarkets, grocery stores, and farmers' markets to about 42 million low-income beneficiaries, about half of whom are children. SNAP is an effective program for reducing hunger in the United States, and in 2018 it survived a strong and unusually partisan challenge to reduce benefits and eligibility. This represents an important success for public health. Yet, compared with both income-eligible nonparticipants and higher-income individuals, SNAP beneficiaries have significant disparities in diet quality and diet-related health outcomes. Three advances in the 2018 Nutrition Title aim to partly address this.
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