Fluent Essays

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 N u tr iti o n a n d D ie ta ry S u p p le m e n ts d o w n lo a d e d f ro m h tt p s: // w w w .d o ve p re ss .c o m / b y 4 7 .3 6 .2 5 1 .2 2 6 o n 2 0 -S e p -2 0 2 1 F o r p e rs o n a l u se o n ly . Powered by TCPDF (www.tcpdf.org) http://www.dovepress.com http://www.dovepress.com https://www.facebook.com/DoveMedicalPress/ https://twitter.com/dovepress https://www.linkedin.com/company/dove-medical-press https://www.youtube.com/user/dovepress http://www.dovepress.com/permissions.php 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 submit your manuscript | www.dovepress.com DovePress Nutrition and Dietary Supplements 2019:1120 N u tr iti o n a n d D ie ta ry S u p p le m e n ts d o w n lo a d e d f ro m h tt p s: // w w w .d o ve p re ss .c o m / b y 4 7 .3 6 .2 5 1 .2 2 6 o n 2 0 -S e p -2 0 2 1 F o r p e rs o n a l u se o n ly . Powered by TCPDF (www.tcpdf.org) http://www.dovepress.com http://www.dovepress.com 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. Dovepress Sachdev et al Nutrition and Dietary Supplements 2019:11 submit your manuscript | www.dovepress.com DovePress 21 N u tr iti o n a n d D ie ta ry S u p p le m e n ts d o w n lo a d e d f ro m h tt p s: // w w w .d o ve p re ss .c o m / b y 4 7 .3 6 .2 5 1 .2 2 6 o n 2 0 -S e p -2 0 2 1 F o r p e rs o n a l u se o n ly . Powered by TCPDF (www.tcpdf.org) http://www.dovepress.com http://www.dovepress.com 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 Sachdev et al Dovepress submit your manuscript | www.dovepress.com DovePress Nutrition and Dietary Supplements 2019:1122 N u tr iti o n a n d D ie ta ry S u p p le m e n ts d o w n lo a d e d f ro m h tt p s: // w w w .d o ve p re ss .c o m / b y 4 7 .3 6 .2 5 1 .2 2 6 o n 2 0 -S e p -2 0 2 1 F o r p e rs o n a l u se o n ly . Powered by TCPDF (www.tcpdf.org) http://www.dovepress.com http://www.dovepress.com 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) Dovepress Sachdev et al Nutrition and Dietary Supplements 2019:11 submit your manuscript | www.dovepress.com DovePress 23 N u tr iti o n a n d D ie ta ry S u p p le m e n ts d o w n lo a d e d f ro m h tt p s: // w w w .d o ve p re ss .c o m / b y 4 7 .3 6 .2 5 1 .2 2 6 o n 2 0 -S e p -2 0 2 1 F o r p e rs o n a l u se o n ly . Powered by TCPDF (www.tcpdf.org) http://www.dovepress.com http://www.dovepress.com 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 DovePress Nutrition and Dietary Supplements 2019:1124 N u tr iti o n a n d D ie ta ry S u p p le m e n ts d o w n lo a d e d f ro m h tt p s: // w w w .d o ve p re ss .c o m / b y 4 7 .3 6 .2 5 1 .2 2 6 o n 2 0 -S e p -2 0 2 1 F o r p e rs o n a l u se o n ly . Powered by TCPDF (www.tcpdf.org) http://www.dovepress.com http://www.dovepress.com 1999–2002, did not find any differences in BMI between SNAP participants and nonparticipants.66 Zagarosky et al 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. REFERENCES 1. Fox L, Mykta L. Supplemental poverty measure shows who benefits from gov- ernment programs. US Census Bureau. September 12, 2018. Available at: https:// www.census.gov/library/stories/2018/ 09/supplemental-nutrition-assistance- program-lifts-millions-out-of-poverty. html. Accessed September 24, 2019. 2. Canning P, Stacy B. The Supplemental Nutrition Assistance Program (SNAP) and the economy: new estimates of the SNAP multiplier. ERR-265. Wash- ington, DC: US Department of Agricul- ture, Economic Research Service; 2019. 3. SNAP to health: a fresh approach to strengthening the Supplemental Nutri- tion Assistance Program. Washington, DC: Center for the Study of the Presi- dency and Congress; 2012. 4. Rector R, Menon V. SNAP Reform Act offers sound basis for welfare policy. The Heritage Foundation. January 9, 2018. Available at: https://www.heritage. org/hunger-and-food-programs/report/ snap-reform-act-offers-sound-basis- welfare-policy. Accessed September 24, 2019. 5. US Department of Agriculture, Food and Nutrition Service. SNAP data tables. National level annual summary: partici- pation and costs, 1969–2018. Available at: https://www.fns.usda.gov/pd/ supplemental-nutrition-assistance- program-snap. Accessed September 24, 2019. 6. Center for Budget and Policy Priori- ties. Policy basics: the Supplemental Nutrition Assistance Program (SNAP). June 25, 2019. Available at: https://www. cbpp.org/research/policy-basics-the- supplemental-nutrition-assistance- program-snap. Accessed September 24, 2019. 7. US Department of Agriculture, Food and Nutrition Service. Supplemental Nutrition Assistance Program (SNAP). Available at: https://www.fns.usda.gov/ snap/supplemental-nutrition-assistance- program. Accessed September 24, 2019. 8. Simon M. Food stamps follow the money: are corporations profiting from hungry Americans? Eat, Drink, Politics. June 2012. Available at: http://www. eatdrinkpolitics.com/wp-content/ uploads/FoodStampsFollowtheMoney Simon.pdf. Accessed September 24, 2019. 9. US Department of Agriculture. SNAP retailer data: 2017 year end summary. Available at: https://fns-prod.azureedge. net/sites/default/files/snap/2017- SNAP-Retailer-Management-Year- End-Summary.pdf. Accessed September 24, 2019. AJPH SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM 1634 Commentary Peer Reviewed Nestle AJPH December 2019, Vol 109, No. 12 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 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.heritage.org/hunger-and-food-programs/report/snap-reform-act-offers-sound-basis-welfare-policy https://www.heritage.org/hunger-and-food-programs/report/snap-reform-act-offers-sound-basis-welfare-policy https://www.heritage.org/hunger-and-food-programs/report/snap-reform-act-offers-sound-basis-welfare-policy https://www.heritage.org/hunger-and-food-programs/report/snap-reform-act-offers-sound-basis-welfare-policy https://www.fns.usda.gov/pd/supplemental-nutrition-assistance-program-snap https://www.fns.usda.gov/pd/supplemental-nutrition-assistance-program-snap https://www.fns.usda.gov/pd/supplemental-nutrition-assistance-program-snap https://www.cbpp.org/research/policy-basics-the-supplemental-nutrition-assistance-program-snap https://www.cbpp.org/research/policy-basics-the-supplemental-nutrition-assistance-program-snap https://www.cbpp.org/research/policy-basics-the-supplemental-nutrition-assistance-program-snap https://www.cbpp.org/research/policy-basics-the-supplemental-nutrition-assistance-program-snap https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program http://www.eatdrinkpolitics.com/wp-content/uploads/FoodStampsFollowtheMoneySimon.pdf http://www.eatdrinkpolitics.com/wp-content/uploads/FoodStampsFollowtheMoneySimon.pdf http://www.eatdrinkpolitics.com/wp-content/uploads/FoodStampsFollowtheMoneySimon.pdf http://www.eatdrinkpolitics.com/wp-content/uploads/FoodStampsFollowtheMoneySimon.pdf https://fns-prod.azureedge.net/sites/default/files/snap/2017-SNAP-Retailer-Management-Year-End-Summary.pdf https://fns-prod.azureedge.net/sites/default/files/snap/2017-SNAP-Retailer-Management-Year-End-Summary.pdf https://fns-prod.azureedge.net/sites/default/files/snap/2017-SNAP-Retailer-Management-Year-End-Summary.pdf https://fns-prod.azureedge.net/sites/default/files/snap/2017-SNAP-Retailer-Management-Year-End-Summary.pdf 10. US Department of Agriculture, Food and Nutrition Service. USDA launches SNAP online purchasing pilot. April 18, 2019. Available at: https://www.fns.usda. gov/pressrelease/2019/fns-000319. Accessed September 24, 2019. 11. US Census Bureau. Quick facts: United States. Population estimates, July 1, 2018. Available at: https://www. census.gov/quickfacts/fact/table/US/ PST045218. Accessed September 24, 2019. 12. Cronquist K, Lauffer S. Characteristics of Supplemental Nutrition Assistance Program households: fiscal year 2017. February 2019. Available at: https://fns- prod.azureedge.net/sites/default/files/ ops/Characteristics2017.pdf. Accessed September 24, 2019. 13. Quigley WP. Five hundred years of English Poor Laws, 1349–1834: regulat- ing the working and nonworking poor. Akron Law Rev. 1997;30(1):4. 14. Katz MB. In the Shadow of the Poorhouse: A Social History of Welfare in America. New York, NY: Basic Books; 1986. 15. Oliveira V. The food assistance landscape: FY 2018 annual report. US Department of Agriculture. 2019. Avail- able at: https://www.ers.usda.gov/ publications/pub-details/?pubid=92895. Accessed September 24, 2019. 16. Poppendieck J. Breadlines Knee-Deep in Wheat: Food Assistance in the Great De- pression. Berkeley, CA: University of California Press; 2014. 17. Moran RL. Consuming relief. Food Stamps and the new welfare of the New Deal. J Am Hist. 2011;97(4):1001–1022. 18. Richardson J. A concise history of the Food Stamp program. Congressional Research Service Report No. 79-244. November 16, 1979. Available at: https:// digital.library.unt.edu/ark:/67531/ metacrs8857. Accessed September 24, 2019. 19. Ripley RB. Legislative bargaining and the Food Stamp Act, 1964. In: Cleaveland FN, ed. Congress and Urban Problems: A Casebook on the Legislative Process. Washington, DC: Brookings In- stitution; 1969:279–310. 20. Nestle M, Guttmacher S. Hunger in the United States: rationale, methods, and policy implications of state hunger sur- veys. J Nutr Educ. 1992;24(1):18S–22S. 21. Congressional Research Service. Short history of the 1996 Welfare Reform Law. February 7, 2001. Available at: …