Social Welfare Issue Policy - Social Science
5-6 pages
APA guidelines
Text: The Policy- Basted Profession by Philip R Popple and Leslie Leighninger
Grading Rubric for Social Welfare Issue and Policy Practice Paper
Due October 8th before 11:59 pm
Social Work Policies II SWK
Criteria
0 – 3.12
Non-Performance
3.13 - 6.24
Basic
6.25 - 9.38
Proficient
9.39 - 12.50
Distinguished
Clearly and thoughtfully defined and described the term social welfare policy
Not clearly and thoughtfully defined and described the term social welfare policy
Partially defined and described the term social welfare policy
Adequately defined and described the term social welfare policy
Proficiently defined and described the term social welfare policy
Clearly and thoughtfully discussed at least 3 aspects of the field of social work— (i.e., values, social work roles, social work ethics)
Not clearly and thoughtfully discussed at least 3 aspects of the field of social work
Partially discussed at least 3 aspects of the field of social work
Adequately discussed at least 3 aspects of the field of social work
Proficiently discussed at least 3 aspects of the field of social work
Clearly and thoughtfully discussed and identified ways in which social welfare policy impacts the field of social work
Not clearly and thoughtfully discussed and identified ways in which social welfare policy impacts the field of social work
Partially discussed and identified ways in which social welfare policy impacts the field of social work
Adequately discussed and identified ways in which social welfare policy impacts the field of social work
Proficiently discussed and identified ways in which social welfare policy impacts the field of social work
Clearly and thoughtfully discussed and identified ways in which the field of social work can impact social welfare policy.
Not clearly and thoughtfully discussed and identified ways in which the field of social work can impact social welfare policy.
Partially discussed and identified ways in which the field of social work can impact social welfare policy.
Adequately discussed and identified ways in which the field of social work can impact social welfare policy.
Proficiently discussed and identified ways in which the field of social work can impact social welfare policy.
Clearly and thoughtfully reflects student’s critical thinking on the topic
Does not clearly and thoughtfully reflect student’s critical thinking on the topic
Partially reflects student’s critical thinking on the topic
Adequately reflects student’s critical thinking on the topic
Proficiently reflects student’s critical thinking on the topic
Provides a well-structured and written conclusion
Does not provide a well-structured and written conclusion
Partially provides a well-structured and written conclusion
Adequately provides a well-structured and written conclusion
Proficiently provides a well-structured and written conclusion
Well written and organized, with no spelling or grammatical errors, has headings clearly identify the topic.
Not well written/organized, has spelling/ grammatical errors, headings do not identify the topic.
Partially well written and organized, some spelling/grammatical errors, headings do not clearly identify the topic.
Adequately well written and organized, with a few spelling or grammatical errors, headings identify the topic.
Well written and organized, no spelling/grammatical errors, headings clearly identify the topic.
Adheres to APA formatting; in-text citations is correct; title and references pages formatted correctly
Does not adhere to APA formatting; in-text citations is correct; title and references pages formatted correctly
Partially adheres to APA formatting; in-text citations is correct; title and references pages formatted correctly
Adequately adheres to APA formatting; in-text citations is correct; title and references pages formatted correctly
Proficiently adheres to APA formatting; in-text citations is correct; title and references pages formatted correctly
Subtotal
Total
Grading: A=90-100; B=80-89; C=70-79; D=60-69 and F=0-59 Grade: ____
R E V I E W
Supplemental Nutrition Assistance Program
(SNAP): does receiving assistance impact food
choices?
This article was published in the following Dove Press journal:
Nutrition and Dietary Supplements
Prageet K Sachdev
Mahsa Babaei
Jeanne H Freeland-Graves
Department of Nutritional Sciences,
College of Natural Sciences, The
University of Texas at Austin, Austin, TX
78712, USA
Abstract: The Supplemental Nutrition Assistance Program (SNAP) is the largest federal
program that provides assistance for the purchase of foods to low-income households in the
United States. SNAP plays a valuable role in alleviating hunger and food insecurity in poor
households; however, one consideration that remains relatively unexplored is the influence of
this program on food choices. Food choices are guided by several factors in low-income
individuals, including the cost of food, household size, nutrition knowledge, availability of
fresh foods in the neighborhood, transportation, and cultural factors. Also, the complex
relationship between SNAP participation and food choices is further confounded by the
factors of demographics, food insecurity, poverty, and self-selection. There is a lack of
quantitative investigations that directly evaluate food choices in SNAP recipients. As a
result, this review will focus on summarizing finding from studies that assessed food
purchasing patterns, diet quality, and weight gain in SNAP participants. These outcomes
may serve as proxy measures to evaluate the food choices made by SNAP participants. In
addition, this review discusses many behavioral economic strategies such as reducing the
cost of healthy foods, providing monetary benefits for purchase of healthy foods, increasing
the SNAP benefits, incentivizing small food retailers to offer more food choices in low-
income neighborhoods, increasing grocery stores and supermarkets in poor neighborhood,
and strengthening the SNAP-Ed program; some of which have been previously adopted to
promote the selection of healthy foods in SNAP participants. SNAP has the potential to
impact food choices in the society, as such longitudinal studies are needed to evaluate the
effectiveness of any reforms in SNAP benefits or restrictions, which may seem logical but
not impact food choices in reality.
Keywords: Supplemental Nutrition Assistance Program, food choices, grocery purchase,
diet, diet quality, obesity
Introduction
The Supplemental Nutrition Assistance Program (SNAP) is the largest federal
program that provides assistance for the purchase of foods to low-income house-
holds in the United States (U.S.).1 It provides food purchasing benefits to house-
holds with an annual income level of ≤130\% of the Federal Poverty Level (FPL)
and household assets of <$2000.2 The original name was the Food Stamps program
which was established in 1964. The renaming occurred in 2008 in order to increase
its focus to improve nutrition in beneficiaries.2 In the fiscal year 2018, SNAP
benefits totaled $60.6 billion, which were provided to 40.3 million Americans.
Correspondence: Jeanne H
Freeland-Graves
Department of Nutritional Sciences,
College of Natural Sciences, The
University of Texas at Austin, T.S Painter
Hall 5.20, 103 W 24TH ST A2703, Austin,
TX 78712, USA
Tel +1 512 471 0657
Fax +1 512 471 5844
Email [email protected]
Nutrition and Dietary Supplements Dovepress
open access to scientific and medical research
Open Access Full Text Article
submit your manuscript | www.dovepress.com Nutrition and Dietary Supplements 2019:11 19–35 19
DovePress © 2019 Sachdev et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.
php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the
work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For
permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
http://doi.org/10.2147/NDS.S177809
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The average benefit per person per month was $125.63,
with two-thirds of all SNAP participants being children,
elderly or those with a disability; the majority live below
the FPL.3 This program is based on United States
Department of Agriculture’s (USDA) Thrifty Food Plan
(TFP), a low-cost plan which suggests monthly food
expenses derived from the consumer price index.4 The
funds are distributed monthly on an electronic benefits
transfer card, which can be used to purchase most foods
and beverages, except dietary supplements, alcohol,
tobacco, and ready to eat foods.5
The SNAP plays a major role in reducing hunger and
food insecurity in low-income Americans.6 It is designed
such that the maximum benefits (92\%) are received by
households with incomes at or below the poverty line,
while 56\% go to households at or below half of the poverty
line (about $10,390 for a family of three in 2018).6 This
program acts as a safety net for the elderly, those with
disability, temporarily unemployed, and low-income wage
workers.6 In addition, it provides adequate nutrition support
to low-income groups by strengthening their power to pur-
chase foods. Finally, SNAP nutrition education programs
help to improve the food choices made by the recipients.6
However, food choices are guided by numerous factors
in low-income individuals, including the cost of food,7
household size,8 nutrition knowledge,9 transportation,10,
and cultural factors.11,12 A focus group study analyzed
the food choices among food stamp participants.8 The
conclusion was that the cost of the food was the major
consideration in deciding which items were purchased.
Family size was an additional influence, with those having
larger families preferring inexpensive foods in bulk in
order to satisfy the needs of everyone.8 Lack of nutrition
knowledge, problems in understanding food labels and less
support from the family for healthy recipes were few other
barriers reported for eating healthy.8 Lack of personal
transportation restricts grocery expenditures to the nearest
convenience store.13 Yet, an analysis of the National
Household Food Acquisition and Purchase Survey dataset
study found that a constraint in transportation did not
result in difference in types of stores, as compared to
their non-participating counterparts.14 Culture is yet
another significant factor in determining food choices.
This is especially true in Hispanic and African-American
households, as most preferred preparing traditional
recipes.8 Very few individuals declared that their food
choices were influenced by the media, nutrition knowl-
edge, and/or physician advice.8
SNAP provides food assistance to the vulnerable and
low-income populations. However, there is limited evi-
dence from quantitative studies that directly assess the
effect of participation in SNAP on food choices.
Therefore, the goal of this review is to analyze the existing
literature on outcomes of food expenditure patterns, diet
quality, and obesity in SNAP participants, with the pur-
pose of studying food choices from these proxy measures.
Potential impact of SNAP on food choices
About one in eight Americans participate in SNAP each
month.15 It serves as a valuable program to reduce food
insecurity in numerous high-risk segments of the popula-
tion. However, recent adequacy of SNAP benefits has been
debated. Reasons include geographical variations in the
cost of foods,16 problems associated with the TFP which
forms the basis of the SNAP4 and frequency of distribution
of the monthly benefits.
Geographical variations in the cost of food
SNAP benefits are fixed across the 48 states (higher in
Alaska and Hawaii); however, variations in pricing of the
food items occur in different areas of the country. At
present, SNAP benefits are not adjusted to regional differ-
ences in food prices, as it would be politically untenable.
Thrifty food plan
A problem with the TFP being the basis for the SNAP
benefits is that it is focused primarily on food items that
are raw or require significant time for preparation.4 The
underlying assumption is that individuals have sufficient
time and skills for preparation, accessibility, and afford-
ability to all food items. Furthermore, the TFP offers only
a limited variety of foods, hampering its ability to meet the
Dietary Guidelines.4
Frequency of distribution
SNAP benefits are distributed at the beginning of every
month. However, the majority of grocery shopping takes
place within the first 3 days of receipt of benefits.17,18 This
distribution leads to a pattern known as “food stamp
cycle” in which participants use their SNAP benefits
within the first 2 weeks of receipt.19 Research shows that
this infrequent distribution of benefits may have a negative
influence on participants’ nutritional status. It has been
shown that some food stamp recipients have cyclical pat-
terns of food consumption, characterized by periods of
overconsumption during the first part of the month after
receiving benefits when financial resources and food are
Sachdev et al Dovepress
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Nutrition and Dietary Supplements 2019:1120
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more abundant.20,21 This is followed by a period of under-
consumption at the end of the benefit cycle when the
quantity and quality of foods being consumed are reduced
due to the depletion of benefits.20,21
All the above factors may influence the choices for
foods selected by SNAP participants. In the absence of
studies that directly assess food choices, this review aims
to collect, analyze, and summarize the evidence on food
choices using outcomes of patterns of food expenditures,
nutrient intake and diet quality, and weight gain in the
SNAP participants.
Design
Figure 1 illustrates the process of literature review and
study selection. A search of the databases of PubMed,
Web of Science, Embase, and Cochrane Library was con-
ducted to identify prospective, case-controlled, and cross-
sectional studies investigating food purchasing patterns,
food expenditures, food choices, nutrition, and diet quality
assessment in SNAP participants from January 1963 to
December 2018. Keywords chosen were Supplemental
Nutrition Assistance Program or SNAP, low-income
households, adequacy of the SNAP, variations in SNAP
benefits, food purchasing patterns, food expenditure, diet
quality, diet analysis, and nutrient analysis.
Inclusion and exclusion criteria
Inclusion criteria were prospective, cross-sectional, or
case–control investigations that measured food expendi-
tures and diet or diet quality of SNAP and income-eligible
non-SNAP individuals. Exclusion criteria were the
absence of full text and not being available in English.
Data extraction
A total of 124 studies were retrieved using the keywords
listed above. Two investigators separately examined the
studies and the results were compared. Duplicate experi-
ments were removed, and any disagreement regarding
inclusion was resolved with the help of a third researcher.
Initially, 65 studies were retrieved, which were then sub-
ject to the exclusion criteria, this resulted in a total of 51
studies included in the final analysis. The main findings of
the studies were divided into three topics for assessing
evidence for food choices in SNAP participants: investiga-
tions on food expenditure; nutrient intake and diet quality;
and obesity and body mass index (BMI).
124 studies identified from pub med, embase, cochrane library and web of
science; January 1963-December 2018
key words: supplemental nutrition assistance program or SNAP, low-income
households, food purchasing patterns, food expenditure, diet quality, diet
analysis, nutrient analysis.
Full text not available = 5
Duplicate studies = 14
51 studies selected for final analysis
119 studies selected for closed review
65 studies retrieved
inclusion criteria: prospective, cross-sectional, or case-control investigation
measured food expenditure, diet and diet quality of SNAP and income-eligible
non-SNAP individuals.
Figure 1 Flowchart demonstrating the process of study selection for systematic review on the food purchasing patterns and diet quality of Supplemental Nutrition
Assistance Program (SNAP) and non-SNAP participants.
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Quality of evidence
This systematic review used the GRADE (Grading of
Recommendations Assessment, Development, and
Evaluation Working Group) to evaluate the quality of
evidence for the three different outcomes considered:
food expenditures, diet quality, and BMI/obesity in
SNAP participants.22 The GRADE uses a criterion based
on an assessment of four factors for each outcome: risk of
bias, consistency, directness, and precision.22 Table 3 illus-
trates the process of grading the evidence for the three
outcomes based on these four criteria. In this review,
randomized-controlled trials were rated as high evidence
and observational studies as low. The grade for the out-
come was reduced if there were any inconsistencies in the
results of the studies or the methods for assessment of the
outcomes, uncertainty about directness, small data sizes,
reporting bias or serious limitations in the studies.23 The
grade was increased if there was a strong or very strong
evidence of association (p<0.05) based on evidence from
observational studies, with adjustment for confounders,
with the satisfaction of internal validity.23 Based on the
above criteria, the quality of evidence was rated as high,
moderate, low, and very low.22
Results
Food choices influenced by the
inadequacies of the SNAP
Leibtag et al, showed that food prices in the West and
Northeast are above average, while those in the South and
Midwest are below the mean.16 This uneven distribution of
food costs suggests that clients in the South and Midwest
can purchase more healthy food items, as compared to those
in the West and Northeast.16 Bronchetti et al, utilized the
1999–2010 data from the National Health Interview Survey
and found that in areas with lower food prices, higher real
SNAP purchasing power was linked to a lower probability
of being food insecure in children, ages 17 and under.24
The TFP is used to calculate the benefits for the SNAP
clients. Research at the Tulane University concluded that
the recipients would need to spend 2 hrs daily for prepar-
ing meals in order to follow the TFP.4 In single adult
households with children, some are constrained by time
for food preparation. These households spend 142\% of the
TFP cost on food, as compared to two adult households
that spend 119\% of the TFP cost. Thus, SNAP benefits
may be insufficient to meet the needs of single-parent
families.4
Few studies have investigated the variations in the
utilization of the benefits over the period of a month.
Hastings et al, reported that food expenditures, relative to
non-benefit recipients, fall by 30\% in week 4 after benefit
distribution as compared to week 1.25 This uneven disse-
mination of funds leads to a decline of benefits as the
month progresses, resulting in a deterioration of nutrient
intake and diet quality over time.26 Hamrick et al, found
that the likelihood of not eating in a day increased toward
the end of the month, when the benefits are exhausted.27
Sanjeevi et al, observed a significant decrease in the con-
sumption of fruits, vegetables, and diet quality of SNAP
women participants toward the end of the monthly benefit
period.26 In 244 African-American SNAP participants, a
decrease in the diet quality occurred over time since SNAP
distribution.28 Thus, these studies provide evidence of a
decline in diet quality from the time of receipt of benefits.
Food choices as illustrated by food
expenditure studies
The food purchasing patterns of SNAP households are
described in Table 1. Previous studies have utilized gro-
cery receipts and other food acquisition data to investigate
the food purchasing patterns of SNAP households. In a
cross-sectional study of 4826 households, Tiehen et al,
documented lower expenditure of food in SNAP house-
holds, as compared to non-SNAP households, after adjust-
ing for the household size and composition. Also, SNAP
households exhibited the highest expenditure on food
items just after receipt of the benefits.29
In a recent focus group study by Moran et al, SNAP
participants reported that they purchased ultra-processed
foods because these items have a long shelf life and could
be stored to prevent food shortage at the end of the month.30
Franckle et al, analyzed the sales data over a period of two
years and found that the SNAP participants spent greater on
sugary beverages, red meat, and convenience foods and less
on vegetables, fruits, and poultry as compared to
nonparticipants.31 In 2017, Gustafson et al, reported that
SNAP households purchased more (62\%) sugar-sweetened
beverages (SSBs) (41\%) and less milk (60\%) compared to
non-SNAP participants.32 Similar results were shown by two
other studies by Grummon et al, and Andreyeva et al, who
documented that SNAP benefits were used to purchase foods
higher in saturated fats and sodium33 and SSB, respectively.34
In contrast, a 2011 study by the USDA collected point
of sale data from grocery stores, supermarkets, and drug
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stores. For every $1, both SNAP and non-SNAP households
spent 40 cents on basic items of vegetables, milk, eggs,
bread; 20 cents on sweetened beverages, desserts, and salty
snacks; and 40 cents on cereals, rice, and beans.35 The
conclusion was that SNAP and non-SNAP households
spent a similar amount of money on sweetened beverages,
salty snacks, and prepared beverages.35 In another study by
Sanjeevi et al, higher expenditures were reported for red
meat, refined grains, whole fruits, and other vegetables in
SNAP households.36 In addition, the household percentage
expenditures for dark green and orange vegetables, and
whole grains were significantly lower than the TFP
recommendations.36
Most of the research to date has conducted secondary
analysis of national datasets to predict variations in food
choices as SNAP benefits change. Anderson et al, pre-
dicted an increase in expenditure on groceries by $19.48,
with a raise of $30 per capita in monthly SNAP benefits.37
Table 1 Characteristics of studies included in the systematic review of food purchasing patterns in the Supplemental Nutrition
Assistance Program (SNAP) and non-SNAP participants
Study, Reference Participants Methods Findings
Moran et al, 2019
30
45 SNAP and non-SNAP
households
Focus group Some SNAP clients purchased ultra-processed
foods because of longer shelf life; storage
would prevent problem of food shortage at the
end of the month
Sanjeevi et al, 2018
36
160 SNAP women
participants
Cross-sectional analysis of gro-
cery receipts
Highest expenditures were made on refined
grains, red meat, whole fruits, and other vege-
tables. Lowest expenditures were soups,
orange vegetables, whole grain breads, rice, and
pasta.
Tiehen et al, 2017
29
4826 SNAP and non-SNAP
households
Cross-sectional analysis of food
acquisition and purchase survey
data
Spending on food was lower in SNAP house-
holds than income-eligible non-SNAP, after
adjusting for household size and composition.
Daily food expenditures were higher on days
just after benefits were received.
Gustafson et al, 2017
32
1581 SNAP and 1382 non-
SNAP households
Cross-sectional analysis of Food
Acquisition and Purchase Survey
data
SNAP households purchased more sugar-
sweetened beverages than non-SNAP house-
holds (62\% vs 41\%) and less milk (54\% vs 60\%)
Franckle et al, 2017
31
188 stores across five states
(Maine, Massachusetts,
Vermont, New Hampshire,
New York)
Sales data from a chain supermar-
ket in Northeastern US over 2
years
SNAP clients spent less on fruits, vegetables,
and poultry and more on sugar-sweetened
beverages (SSB’s), red meat, and convenience
foods than nonparticipants
Grummon et al, 2017
33
98,256 SNAP and non-SNAP
households
Cross-sectional analysis of 2012–
2013 packaged food and beverage
purchases by SNAP participants.
SNAP households spent less on fruits, vegeta-
bles and fiber, but more on sugar-sweetened
beverages, salty snacks, sweeteners, and pro-
cessed meat than nonparticipants
Garasky e al, 2016
35
26.5 million SNAP and non-
SNAP households
Cross-sectional analysis of point
of sale transaction data
No major differences in expenditures between
SNAP and non-SNAP households. Proteins
were major food product purchased
Anderson et al, 2016
37
SNAP clients Cross-sectional study Analysis of
2001–2014 Food Security
Supplements of the current popu-
lation surveys
An increase in SNAP benefits by $1 would raise
food spending by 68¢ per capita; $30 would
increase expenditure by $19.48
Andreyeva et al, 2012
34
39,172 SNAP households Cross-sectional analysis of gro-
cery store scanner data from a
regional supermarket chain
72\% of sugar-sweetened beverages were pur-
chased using SNAP benefits. Expenditure on SSB’s
was higher than those on all groceries (63\%), diet
(65\%), and unsweetened beverages (59\%)
Bradbard et al, 1997
8
28 focus groups of SNAP
participants
Focus group Food purchased at beginning of month are
those that can be stored for later consumption
(canned vegetables and grains)
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It was further found that this increase in spending was
related to higher consumption of healthier foods and lower
food insecurity in the participants.37
Economic Research Service estimated the demand
elasticities using the 1987–88 Nationwide Food
Consumption Survey; it was concluded that a decline of
20\% in food price would raise fruit and vegetable con-
sumption by 2.2 cups in SNAP recipients.38 Yet, the
Consumer Expenditure Survey (CE) of the Bureau of
Labor Statistics data of 1991 and 2000 predicted no
increase in purchase of fruits and vegetables as SNAP
benefits escalated by $1.39
Finally, Castner et al, used data from the 1996 National
Food Stamp Program Survey (NFSPS) and 2001–2004
surveys to investigate associations between spending on
food and diet quality using the HEI-2005.40 A 10\%
increase in spending on food was positively associated
with a rise in a household’s HEI-2005 score of 0.33\%
via NFSPS data, and an increase of 0.30\% via NHANES
data.40 With both datasets, improvements in diet quality
were higher with an increase in benefits for fruit and
vegetables.
Food choices as illustrated by nutrient
intake and diet quality studies
The SNAP has played a major role in reducing hunger and
food insecurity in the US. Table 2 illustrates the effect of
participation in SNAP on the diet quality of individuals.
Diet quality refers to both the quality and variety of the diet
as measured by assessing the extent of alignment of food
patterns with dietary guidelines.41 The results from studies
investigating diet quality in SNAP recipients have been
inconsistent, with some investigations observing none to
negative42–44 impact on diet quality. For example, Lacko
et al, documented comparable consumption of calories from
fast-foods, and lower consumption of whole fruits and
whole grain in both participants and nonparticipants.45
Yet, Zhang et al, analyzed NHANES data of 38,696 adults
from 1999 to 2014 and found lower diet quality scores of
SNAP participants as compared to the nonparticipants over
the years.43 Furthermore, results from a secondary analysis
of NHANES data from 1999–201246 and 2007–201044
showed that SNAP participants had lower diet quality as
compared to income-eligible nonparticipants. Taille et al,
documented that SNAP households consumed greater
energy from SSBs, desserts, processed meats as compared
to their counterparts.47 A systematic review documented
that adult SNAP participants had poor diet quality as com-
pared to the nonparticipants. However, intake of total kilo-
calories, macro and micronutrients did not differ
significantly between participants and income-eligible
nonparticipants.48 Finally, Nguyen et al, found that SNAP
participation improved diet quality in the food insecure
groups.49
In the analyses of a national dataset, participation in
SNAP was associated with an increased probability of
consumption of whole fruits by 23\%.50 This increase
may be because of the extra income through SNAP and
the convenience factor associated with eating fruits that
require no preparation time.50 Similar consumption of
fruits and vegetable has been documented in both partici-
pants and nonparticipants.42,51,52 In contrast, consumption
of dark green/orange vegetables was found to be low in
SNAP participants.50
The evidence on the consumption of SSBs in SNAP vs
the nonparticipants is mixed; with few reporting higher
consumption42,53,54 to no differences.55,56 However, two of
the investigations showing higher consumption in SNAP
participants analyzed regional data sets34,57 and one did
not report any difference for men.42 The evidence of
SNAP on other food choices such as whole grains is also
mixed. A study by Caster et al, found that SNAP recipients
used more whole grains and grains that were more nutrient
dense, as compared to income-eligible participants.40 In
contrast, in a secondary analysis of the NHANES data
involving 3142 women, Jun et al, reported no differences
in whole grain intake between low-income and high-
income women groups. The Hilmers et al, study on low-
income women, consumption of whole grains was found
to be lower both in participants and non-SNAP partici-
pants relative to the dietary guidelines.58 Few other studies
have documented similar consumption of total grains
among both groups.51,56
Food choices from weight and BMI studies
Previous research has documented higher weight gain and
obesity in adult women SNAP participants20,59–61 and
female children,62,63 but a decrease in obesity for male
children.62 Analysis of the data from 2003 to 2006
NHANES showed that the SNAP participation was
directly related to obesity [prevalence ratio: 1.58] in both
adult men and women participants.64 In Los Angeles,
SNAP participants were found to have twice the higher
odds of obesity, as compared to nonparticipants.65 In con-
trast, analysis of the NHANES data from an earlier period,
Sachdev et al Dovepress
submit your manuscript | www.dovepress.com
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1999–2002, did not find any differences in BMI between
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found that BMI of women SNAP participants was greater
than one unit higher as compared to nonparticipants with
…
The Supplemental Nutrition Assistance Program
(SNAP): History, Politics, and Public Health
Implications
This commentary introduces a
special section of AJPH on the
Supplemental Nutrition Assis-
tance Program (SNAP), the US
government’s largest antihunger
program and third-largest anti-
poverty program. SNAP demon-
strably lifts adults, children, and
families out of poverty, thereby
constituting a vital component
of this nation’s public health
safety net.
Despite its well-documented
benefits, SNAP is under political
and budgetary siege, mainly
from congressional represen-
tatives and lobbying groups
opposed to a federal role in
welfare. In part, SNAP is pro-
tected from total annihilation
by its unusual authorizing
legislation—the Farm Bill.
This commentary provides a
brief overview of the political
history of SNAP and its Farm
Bill location as background to
the deeper analyses provided in
this series of articles. (Am J Public
Health. 2019;109:1631–1635. doi:
10.2105/AJPH.2019.305361)
Marion Nestle, PhD, MPH
See also the AJPH Supplemental Nutrition Assistance Program section, pp. 1636-1677.
The Supplemental NutritionAssistance Program (SNAP),
formerly known as food stamps,
is by far the largest antihunger
program in the United States and,
therefore, is a vital component of
the welfare safety net for low-
income Americans. SNAP is de-
monstrably effective in reducing
hunger, food insecurity, and pov-
erty,therebyreducingtheeffectsof
these conditions on public health
(see Table 1 for definitions). In
2017, SNAP alone is said to have
lifted 3.4 million people out of
poverty, nearly half of them chil-
dren, and it ranks third only to
Social SecurityandEarned Income
Tax Credits in its effectiveness in
reducing poverty.1 It also benefits
the economy with a multiplier
effectthat makes every$1 billion in
SNAP benefits worth $1.5 billion
in gross domestic product.2
Despite the evident value of
SNAP to public health and to the
economy, it is the target of critics
across the political spectrum.
Antihunger and public health
supporters of SNAP want the
program to do more and better:
to increase enrollments and
benefits and improve diet
quality.3 But opponents of
government-supported welfare
want SNAP to do less. They view
the program as too bloated and
expensive, and they charge that
it encourages idleness, depen-
dency, and fraud.4 Although
these charges do not hold up
under scrutiny, opponents of
SNAP control the power in to-
day’s political environment.
Even so, the program is protected
against total destruction by the
peculiar location of its authoriz-
ing legislation—in the Farm Bill
(Pub L 115-334), the law prin-
cipally designed to protect the
interests of agribusiness. Congress
cannot get the votes to pass agri-
cultural supports unless it simul-
taneously authorizes SNAP.
But before exploring the his-
tory of SNAP and its contested
politics, it is worth reviewing
some basic facts. SNAP is indeed
large and expensive: in 2018, it
provided 40.3 million adults and
children (one in eight Americans)
with an average benefit of $125
per month—at a total cost of
$60.8 billion in benefits and $4.4
billion in administrative ex-
penses.5 SNAP is administered by
the US Department of Agricul-
ture (USDA) but dominates ex-
penditures; it accounts for about
65\% of the agency’s budget—and
nearly 80\% of total Farm Bill
expenditures. SNAP is an enti-
tlement; anyone who qualifies on
the basis of income and assets can
obtain benefits, and enrollments
rise and fall with changes in the
poverty rate.6 Participants receive
SNAP benefits via Electronic
Benefit Transfer (EBT) debit
cards administered through con-
tracts between USDA and banks.
SNAP is relatively permissive:
participants may use EBT cards to
buy any food, beverage, or food
seed or plant but may not use
those funds to buy alcoholic
beverages, tobacco products, pet
foods, dietary supplements, hot
foods, or nonfood items (they can
buy these items with their own
money). The USDA requires
retailers authorized to sell foods
to SNAP participants to stock
specific categories and amounts of
staple foods.7 Most SNAP funds
(82\%) are spent at supermarkets or
superstores, making retailers the
program’s greatest beneficiaries and
defenders of the status quo.8 A
smaller percentage (15\%) is spent at
convenience or small grocery stores
and, despite substantial promotion
and incentive efforts, only 0.02\% is
spent at farmers markets.9 In 2019,
a USDA pilot project permitted
New York State participants to use
SNAP benefits to shop online
through Amazon, Walmart, and
ShopRite; other states and online
retailers are expected to follow.10
SNAP unquestionably reaches
the poor and vulnerable. In 2017,
ABOUT THE AUTHOR
Marion Nestle is with the Department of Nutrition and Food Studies, New York University,
New York, NY.
Correspondence should be sent to Marion Nestle, Department of Nutrition and Food Studies,
411 Lafayette, 5th Floor, New York, NY 10003-7035 (e-mail: [email protected]).
Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link.
This article was accepted August 20, 2019.
doi: 10.2105/AJPH.2019.305361
December 2019, Vol 109, No. 12 AJPH Nestle Peer Reviewed Commentary 1631
AJPH SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM
mailto:[email protected]
http://www.ajph.org
the average SNAP household
income was just 63\% of the
poverty line. SNAP households
include children (43.5\%), the
elderly (13\%), and the disabled
(11\%). SNAP participants are
36\% White (compared with 61\%
of the general population11), 25\%
African American (compared
with 13\%), and 16.5\% Hispanic
(compared with 18\%). Able-
bodied adults without de-
pendents are required to work or
to be enrolled in employment
programs for at least 20 hours per
week; otherwise, they cannot
receive more than 3 months of
benefits in a 36-month period
(some states have waived these
requirements). In 2017, 25\% of
SNAP recipients worked, al-
though these jobs did not raise
their incomes high enough to
disqualify them for benefits.12
To introduce the series of
articles about SNAP in this issue
of AJPH, this commentary deals
with how this program, which
started out in the Great De-
pression of the 1930s as a means
to alleviate hunger while also
helping farmers, evolved to be-
come the primary means of US
food assistance, embedded in the
Farm Bill, and the flash point for
political battles about whether
and how to deal with American
poverty. Current efforts to “re-
form” SNAP (in quotes because
the term is often a euphemism for
budget cuts, enrollment re-
ductions, work requirements,
and, these days, keeping even
legal immigrants off the rolls), are
deeply rooted in this country’s
history of welfare, food assis-
tance, and policy compromise.
WELFARE HISTORY:
ATTITUDES TOWARD
THE POOR
To anyone who has studied
the English Poor Laws dating
back to the 1600s, the current
rationale for opposition to SNAP
sounds remarkably familiar.
Those laws derived from views of
the poor as inherently unworthy,
and of poverty as a matter of
personal choice—not as the result
of misfortune or a rapidly in-
dustrializing economic system.
Through public taxes, the Poor
Laws authorized local provision
of benefits. Out of fear of
inducing dependency, the laws
kept benefits at levels barely ad-
equate to prevent overt starvation
or rebellion. They required re-
cipients to work and to be pun-
ished for not working; they
created poorhouses, authorized
imprisonment, and encouraged
child labor. Although their os-
tensible purpose was to relieve
hunger, they also had underlying
political goals: to maintain public
order, control the poor, and
maintain a low-wage work force,
and, for politicians, to gain
power.13
The punitive nature of these
laws and their failure to relieve
poverty are well known from the
writings of Charles Dickens and
others. Nevertheless, the colo-
nists brought them to America
where they have influenced
policy ever since. As in England,
local governments could not
keep up with the demands,
even when supplemented by
churches, fraternal orders, and
private charities. A federal role in
poor relief only became possible
in 1913 when Congress passed
the income tax law. Federal in-
volvement in food assistance
began later, in the 1930s, when
massive unemployment and
devastating poverty became a
political problem that could not
be ignored.14
Then and now, government
interventions elicited fierce de-
bates. How should societies bal-
ance compassion for the poor
against fears that tax-supported
relief measures would induce
dependency? What level of
benefit is appropriate? Should
benefits be provided in the form
of cash or ways that enable
agencies to control what bene-
ficiaries can buy? Should benefits
be tied to work requirements? It
is fair to say that positions on these
arguments have far more to do
with politics than public health.
FOOD ASSISTANCE
HISTORY: SURPLUSES
VS HUNGER
SNAP may be the third-
largest welfare program in the
United States, but it is by far
the largest of the USDA’s
food assistance programs.15
Table 2 summarizes key events
in its history. The origins of
SNAP date back to the unem-
ployment-induced poverty of
the Great Depression, when
farmers were producing surplus
food but masses of people
could not afford to buy it. Some
farmers went bankrupt, but
others deliberately destroyed
their animals, grains, or fruit.
That so many people were
relying on soup kitchens or
breadlines while farmers—and
sometimes the government—
destroyed unsold food created a
political crisis. The government’s
win–win solution: distribute
surplus commodities to the poor
while also—and politically
more important—paying farmers
a fair price for what they
produced.16
TABLE 1—Basic Definitions of Supplemental Nutrition Assistance Program (SNAP) Policy Terms
Term Definition
Hunger The highly unpleasant sensation elicited by acute or chronic lack of sufficient food.
Malnutrition The longer-term physiological or cognitive signs of chronically deficient intake of
energy or nutrients.
Food insecurity Inadequate access to reliable sources of food or to resources to obtain food. By this
definition, people are considered food insecure even when they have enough but
acquired it through food banks, private charity, or means that are socially
unacceptable or illegal.
Poverty The lack of resources to obtain food, clothing, housing, and other necessities of life.
In 2017, the United States defined the poverty threshold as $12 488 for an
individual and $25 094 for a household of four people (http://bit.ly/2lVcHRn).
Public health consequences of poverty and
food insecurity
Children and adolescents: higher risk of low birth weight, short stature, poor oral
health, asthma, developmental delays, learning disabilities, behavioral and
emotional problems, high-risk behaviors.
Adults: higher risk of obesity, type 2 diabetes, heart disease, stroke, depression,
disability, poor oral health, reduced life expectancy (http://bit.ly/2kJPzoT).
AJPH SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM
1632 Commentary Peer Reviewed Nestle AJPH December 2019, Vol 109, No. 12
http://bit.ly/2lVcHRn
http://bit.ly/2kJPzoT
The USDA’s food distribu-
tion programs did indeed help
farmers more than the poor.
They also excluded food retailers
and wholesalers, who lobbied for
the first food stamp program in
1939. The USDA sold orange
stamps that low-income partici-
pants could exchange at retail
stores for any food except alco-
holic beverages, tobacco, and
items eaten on premises (soft
drinks were added to the ex-
clusions in 1941, but later re-
instated). For each dollar spent on
orange stamps, the USDA gave
participants blue stamps worth 50
cents that had to be spent on
surplus commodities—beans,
eggs, and fruit, for example.
During the 4 years of its
existence, this program reached 4
million people. Food stamps
converted participants into con-
sumers. It was popular with retail
grocers and with participants
who had enough money to invest
in the stamps. It ended in 1943
during World War II when un-
employment declined along with
agricultural surpluses.17
Poverty and hunger contin-
ued after the war, but attempts to
reinstate food stamps failed until
1961 when President John F.
Kennedy initiated pilot programs
in several states. Participants still
had to buy the stamps but did
not have to use the bonus stamps
for surplus commodities. This
change further entrenched food
stamps as a consumer program
with benefits for retailers and the
makers of processed foods. By
1964, 370 000 participants in
22 states were participating in
pilot programs at an annual cost
of $30.5 million.18
POLITICAL
LOGROLLING: SNAP IN
THE FARM BILL
SNAP may be critical to the
health of participants, but it has
always been subject to rules and
funding set by congressional ag-
riculture committees whose pri-
mary mandate is to promote
agribusiness. This odd situation is
attributable in part to SNAP’s
origins in USDA-managed food
distribution programs but also
to the program’s increasing in-
tegration into Farm Bills.
From 1954 to 1964, members
of Congress introduced legisla-
tion for national food stamp
programs. These bills were
largely supported by urban
Democrats who viewed food
stamps as public welfare, distinct
from commodity agriculture.
The bills were largely opposed
by Republicans and Southern
Democrats uncomfortable with
their cost and lack of benefit to
farmers, but also politically op-
posed to fostering dependency,
expanding USDA’s mission,
and promoting civil rights for
Southern participants.
Although Congress passed
food stamp legislation in 1959,
the program was not imple-
mented until 1964 when Presi-
dent Lyndon B. Johnson
orchestrated classic political
“logrolling.” Urban Democrats
agreed to vote for wheat and
cotton legislation only if rural
Democrats would agree to vote
for food stamps (Republicans
generally disapproved of both
measures).19 As passed, the pur-
pose of the Food Stamp Act of
1964 (Pub L 88–525) was to
permit low-income households
to “receive a greater share of the
Nation’s food abundance.” The
act eliminated the surplus com-
modity requirement, excluded
imported foods, and required
participants to use the stamps
only at qualified grocery stores at
prevailing retail prices—a loss for
farmers, but a win for retailers.
After 1964, as the program
grew in coverage and cost,
Congress responded by intro-
ducing tighter eligibility stan-
dards, work requirements,
penalties for nonworking par-
ticipants, and measures to ensure
accountability and prevent fraud.
Congress also increasingly
TABLE 2—Selected Events in the History of the Supplemental Nutrition Assistance Program (SNAP):
United States, 1939–2019
Date Event
1939–1943 USDA’s first food stamp program. People on relief can buy orange stamps to exchange for food at participating
retailstores;foreach dollarstamppurchased,USDAprovidesabluestampworth50centsfor surpluscommodity
foods at those stores.
1961–1964 Pilot food stamp programs. Participants in 22 states can buy subsidized stamps to exchange for eligible foods and
beverages at retail stores.
1964 Food Stamp Act authorizes recipients to purchase subsidized stamps usable for eligible retail foods and
beverages.
1973 Farm Bill: Agriculture and Consumer Protection Act amends the Food Stamp Act of 1964 to require state plans for
food stamp programs; adds imported foods and food-producing seeds and plants to SNAP-eligible items.
1977 Farm Bill: Food and Agriculture Act incorporates the Food Stamp Act of 1977 as Title XIII; eliminates purchase
requirements for the stamps.
1990 Mickey Leland Memorial Domestic Hunger Relief Act authorizes use of EBT cards.
1996 Personal Responsibility and Work Opportunity Reconciliation Act restricts food stamp eligibility, reduces
benefits, tightens work requirements, and expands penalties.
2008 Farm Bill: Food, Conservation, and Energy Act. Title IV Nutrition renames the program SNAP.
2014 Farm Bill: Agricultural Act. Title IV Nutrition tightens SNAP eligibility and verification requirements.
2018 Farm Bill: Agriculture Improvement Act. Despite attempts to introduce more stringent work requirements, Title
IV Nutrition remains relatively unchanged. Department of Homeland Security proposes to refuse admission to
the United States of aliens likely to use public benefits, including food assistance. White House proposes to
introduce “harvest boxes” of commodities to replace some SNAP benefits and to eliminate state waivers for
SNAP work requirements.
2019 USDA implements congressionally mandated pilot projects for online purchases; finalizes “public charge”
measures to discourage immigrants from using SNAP and other services. Supreme Court rules that retailers do
not have to reveal data on in-store SNAP purchases. Administration proposes to end categorical eligibility for
participants qualifying for other federal and state assistance.
Notes. EBT = Electronic Benefit Transfer; USDA = US Department of Agriculture.
AJPH SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM
December 2019, Vol 109, No. 12 AJPH Nestle Peer Reviewed Commentary 1633
embedded food stamps in Farm
Bills. The 1973 Farm Bill
amended the 1964 Food Stamp
Act, addingimported foods to the
list of eligible items. The 1977 bill
incorporated the entire Food
Stamp Act as a separate title for
“raising levels of nutrition among
low-income households,” and
the 2008 bill renamed the program
SNAP in view of its nutritional
purpose and the replacement of
stamps by EBT cards.
During the 1970s, budget
reductions and more restrictive
welfare policies reduced program
participation. In the early 1980s,
local communities and states
began to document the failure of
both the federal safety net and
private charity to meet the in-
come and food needs of the
poor.20 The program grew again
and, by 1994, more than 27
million people were enrolled.
Two years later, President
Clinton signed the Personal
Responsibility and Work Op-
portunity Reconciliation Act
(Pub L 104–193) to “end welfare
as we know it.”21 This act further
restricted program eligibility,
tightened work requirements,
reduced benefits, and expanded
penalties. Food stamp enroll-
ments fell, setting a precedent for
how such measures could be used
to weaken the program.
SNAP UNDER SIEGE:
“REFORM” VS SAFETY
NET
Although food insecurity has
now declined from peak levels,
it still affects 12\% of the pop-
ulation.22 Public health advocates
continue to urge improvement of
SNAP’s outreach, eligibility, and
benefits. They also call for efforts
to promote healthier diets among
SNAP participants and urge the
USDA to release store data on
SNAP food purchases. Although
limited information from one
retailer suggests that SNAP par-
ticipants use their benefits to buy
more highly processed foods and
sugar-sweetened beverages than
does the general population,23
most retailers have refused to
disclose this information. The
USDA says it cannot compel
retailers to share such data
without a congressional mandate,
and, as discussed by Jennifer
Pomeranz in this issue (p. 1659),
the Supreme Court has ruled
that retailers do not have to dis-
close this information. The
USDA did establish an obesity-
prevention grant program in
201624 but has rejected attempts
by cities and states to conduct
pilot projects to remove sugary
drinks and other highly processed
(“junk”) foods from SNAP pur-
chase eligibility.
In the current political cli-
mate, concerns about cost and
dependency far outweigh con-
cerns about the nutritional health
of the poor. Thus, the govern-
ment’s recent “reform” efforts
have included more stringent
work requirements, a proposal to
partially replace SNAP benefits
with “harvest boxes” of surplus
commodities, enforcement of
“public charge” measures to deny
admissibility or deport immi-
grants—even those legally ad-
mitted—who use federal food
assistance, a requirement that
sponsors of immigrants reimburse
the costs of public assistance, and
a proposal to eliminate automatic
SNAP eligibility for people who
qualify for other federal and state
benefits. USDA Secretary Sonny
Perdue justifies such measures as
promoting personal responsibil-
ity: “government dependency
has never been the American
dream.”25 As was their true
purpose, these measures have
succeeded in reducing SNAP
enrollments.
The articles in this special
section of AJPH address these
issues head on. They begin
with analyses of SNAP’s overall
importance and accomplish-
ments (Keith-Jennings et al.,
p. 1636) in settings both rural
(Harnack et al., p. 1641) and
urban (Cohen, p. 1646) and,
in a relatively new develop-
ment, among college students
(Freudenberg et al., p. 1652).
Pomeranz (p. 1659) provides an
analysis of why SNAP expen-
diture data are essential for ef-
fective advocacy for program
improvements. As for alterna-
tive ways to address poverty,
Gaines-Turner et al. (p. 1664)
explore how SNAP partici-
pants themselves view pro-
gram and policy needs, and
Fernald and Gosliner (p. 1668)
examine how other countries
have chosen to address poverty
and food insecurity, often more
effectively than in the United
States.
Together, these articles com-
prise a textbook case study of a
food assistance program that
could do far more to address both
poverty and food insecurity—if
only it were not blocked by
partisan politics. Similarly
blocked are other policies known
to reduce poverty and its public
health consequences: adequate
minimum wages, tax credits,
subsidies for housing, health care,
child care, job training. Objec-
tions that the costs of food assis-
tance and other public health
antipoverty policies are too high
are clearly not based on resource
availability but rather derive
from dismissive attitudes toward
the poor, politics, and lack of
political will, as the articles in
this AJPH section so clearly
demonstrate.
ACKNOWLEDGMENTS
The author thanks Daniel Bowman
Simon for comments on an earlier version
of this article.
CONFLICTS OF INTEREST
The author receives royalties from books
and honoraria from lectures about matters
relevant to this commentary.
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https://www.census.gov/library/stories/2018/09/supplemental-nutrition-assistance-program-lifts-millions-out-of-poverty.html
https://www.census.gov/library/stories/2018/09/supplemental-nutrition-assistance-program-lifts-millions-out-of-poverty.html
https://www.census.gov/library/stories/2018/09/supplemental-nutrition-assistance-program-lifts-millions-out-of-poverty.html
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