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The Supplemental Nutrition Ass PDF
The Supplemental Nutrition Ass PDF
July 2015, Vol 105, No. 7 | American Journal of Public Health Nguyen et al. | Peer Reviewed | Research and Practice | 1453
RESEARCH AND PRACTICE
stamp benefits?”18 We derived 4 levels of food an ordinary least squares model with the in- of respondents’ households, marginal in
security from responses to the NHANES Food teraction coefficient of SNAP and food security. 13.2%, low in 17.2%, and very low in 10.5%.
Security Survey Module questionnaires, details Our formula was The bivariate relationship of food security
of which are available online.20 Households status to dietary quality and weight status is
with high food security reported no food access ð1ÞY ij ¼ aij þ bSNAP j þ cFoodInsec j presented in Table 2. Participants with any
problems or limitations; households with mar- þ aSNAP j · FoodInsec j þ dij X ij þ eij level of food insecurity had a significantly
ginal food security may have had anxiety over lower HEI-2010 score than those with full food
Where Y ij , the dependent variables, denoted
food sufficiency or shortage of food in the security (43.7 vs 46.6), higher intake of added
outcomes of individual i in household j; aij was
house; households with low food security sugar (22.0 vs 18.7 teaspoons), and higher
the intercept; b was a parameter estimate for
generally reported reduced quality, variety, or intake of empty calories (787.9 vs 731.5
the baseline difference between SNAP partici-
desirability of diet without changes in diet or kilocalories; P < .05 for all). Furthermore, in-
pants and SNAP nonparticipants; and c was an
food intake; and households with very low food dividuals living in households without food
estimate for the difference between 4 levels of
security generally reported multiple indications security had significantly higher BMIs and
food security. The main parameter of interest,
of disrupted eating patterns and reduced food were likelier to be obese than those with food
a, was an estimate of the cross-level interac-
intake. We considered households in the high security (38.4% vs 33.7%; P < .01). How-
tions of a household’s SNAP status and food
and marginal categories to be food secure. ever, we observed no significant differences
security.
Our key outcome variables were (1) diet (the in solid fat consumption or the probability
Other control covariates (Xij ) were age; gender;
Healthy Eating Index 2010 [HEI-2010]21 and of being underweight.
race/ethnicity (non-Hispanic White, non-Hispanic
intake of added sugar, solid fat, empty calories, The association of SNAP participation and
Black, Hispanic, other); education (< high school,
and total calories) and (2) weight (body mass food security status with dietary quality and
high school, some college, ‡ college); marital
index [BMI], defined as weight in kilograms weight status among low-income respondents
status (married, never married, divorced or
divided by the square of height in meters; is presented in Table 3. SNAP participants had
separated, widowed); poverty-to-income ratio;
overweight; and obesity). From the first-day a poorer nutrient profile (lower HEI-2010
dietary recall data (24 hours), we computed Women, Infants, and Children program par- score, higher consumption of added sugar, solid
HEI-2010 as well as other dietary indicators, ticipation in the past year; health insurance fat, and empty calories) than nonparticipants.
such as empty calorie, solid fat, and added- status (insured or not); employment status HEI-2010 scores were lowest among partici-
sugar intake, with National Cancer Institute (employed or not); whether the survey was pants who reported living in households with
methodology.22 We used HEI-2010, a tool that completed on a weekday or weekend24; and very low food security (2.59 points lower than
aims to determine compliance with the 2010 interview wave (2003---2004, 2005---2006, in the reference group, participants with high
Dietary Guidelines for Americans, to assess 2007---2008, 2009---2010). food security), followed by those with marginal
overall dietary quality.21 We calculated BMI We conducted all statistical analyses with (–2.27 points), and low (–1.63 points) food
with the standard formula and objectively STATA version 1325 and accounted for the security.
measured height and weight. We used World NHANES complex, multistage probability sam- Table 3 also shows the interaction between
Health Organization criteria to categorize par- pling design of households and individuals to SNAP participation and food security (i.e., whether
ticipants’ BMI as underweight (<18.5 kg/m2), enable nationally representative estimates.26 SNAP participation may change the associations
normal weight (18.5---< 25 kg/m2), overweight Because individuals in the mobile examination between food insecurity, dietary quality, and
(‡ 25---< 30 kg/m2), or obese (‡ 30 kg/m2).23 centers sample provided the dietary recall data, weight status among US adults). Participation in
we used the centers’ sample weights (provided SNAP was associated with higher HEI-2010
Statistical Analysis by NHANES) in all analyses. We computed scores (better nutrient profile) among individ-
We used the first-day 24-hour dietary recall HEI-2010 scores with SAS software version uals in households with marginal (+3.46
data to document participants’ sociodemo- 9.3.27 points), low (+1.98 points), and very low
graphic characteristics by participation status in (+3.84 points) food security than among re-
the SNAP program. We also examined the RESULTS spondents with corresponding food insecurity
differences in HEI-2010 score and intake of who did not receive SNAP benefits. For
added sugar, solid fat, empty calories, and total The characteristics of the study population participants with low food security, partici-
calories among those with full food security are shown in Table 1. The study sample pating in SNAP was only associated with
versus all others (i.e., participants with mar- consisted of 8333 adults. Participants had lower added-sugar (–3.88 teaspoons) and
ginal, low, and very low food security). In a mean age of 45.5 years; 55.4% were empty calorie (–67.56 kcal) intake. Although
addition, we examined the differences in per- women, 55.9% were non-Hispanic Whites, SNAP participants and respondents experi-
centage of underweight, overweight, and obe- 16.4% were non-Hispanic Blacks, 21.9% encing food insecurity each independently
sity and in BMI between these 2 groups. were Hispanics, 51.1% were married, 64.5% had a higher BMI and higher probability of
To examine the combined effect of SNAP had health insurance, and 49.2% were being obese, the combined association of
participation and food security, we estimated employed. Food security was high in 59.1% SNAP participation and food insecurity
1454 | Research and Practice | Peer Reviewed | Nguyen et al. American Journal of Public Health | July 2015, Vol 105, No. 7
RESEARCH AND PRACTICE
July 2015, Vol 105, No. 7 | American Journal of Public Health Nguyen et al. | Peer Reviewed | Research and Practice | 1455
RESEARCH AND PRACTICE
TABLE 2—Food Security, Dietary Quality, and Weight Status Among US Low-Income Adults: National Health and Nutrition Examination Survey,
2003–2010
Full Sample (n = 8333), No. or % Full Food Security (n = 4645), No. or % Food Insecurity (n = 3688), No. or % Pa
Dietary quality
Healthy Eating Index 2010, total score 45.4 46.6 43.7 < .001
Added sugar, teaspoons 20.1 18.7 22.0 < .001
Solid fat, g 399.5 398.1 401.5 .768
Empty calories, kcal 754.6 731.5 787.9 < .001
Total calories, kcal 2128.8 2103.0 2166.2 .084
Weight (BMI)
Continuous 28.8 28.5 29.2 < .001
Underweight (£ 18.5 kg/m2) 2.3 2.3 2.4 .607
Overweight (£ 25–< 30 kg/m2) 31.6 32.6 30.2 .178
Obese (‡ 30 kg/m2) 35.6 33.7 38.4 < .001
Note. BMI = body mass index. Results take survey weights into account. Not full food security group includes people living in households with marginal food security, low food security and very low
food security.
a
Difference between full food security and any category of food insecurity derived from Student t test.
Our subgroup analysis revealed that SNAP weight status only in households with marginal groups, low-income Blacks and Hispanics often
might affect racial/ethnic groups differentially: food security. live in segregated neighborhoods, especially in
interactions between SNAP participation and One possible explanation of SNAP’s differen- inner cities.38 Studies have found that residents
food insecurity benefited dietary quality and tial modification of the association of food in- of mixed-race or solely Black neighborhoods
weight status among Whites (all food insecurity security to dietary intake and weight status is (regardless of income) are less likely than those
groups) to a much greater extent than among neighborhood disparities in access to healthy in predominantly White communities to have
Blacks. Among Hispanics, SNAP participation food.37 Although low-income Whites tend to access to healthy food choices,39 even if they
was associated with improved diet quality and live in neighborhoods with other socioeconomic have SNAP benefits.37 Many studies have
TABLE 3—Multivariable Regression Analysis on Associations of Supplemental Nutrition Assistance Program Participation and Food Insecurity
With Dietary Quality and Weight Status Among US Low-Income Adults: National Health and Nutrition Examination Survey, 2003–2010
SNAP –3.18** (0.53) 2.53** (0.74) 18.65 (11.70) 53.34** (19.70) 2.10** (0.28) –0.03 (0.02) 0.12** (0.02)
Household food security
Marginal –2.27** (0.55) 0.48 (0.77) –14.31 (12.10) –15.79 (20.36) 0.63* (0.29) –0.01 (0.02) 0.04* (0.02)
Low –1.63** (0.53) 2.35** (0.73) –3.19 (11.52) 17.44 (19.39) 0.47 (0.28) –0.03 (0.02) 0.04* (0.02)
Very low –2.59** (0.67) 4.94** (0.94) 13.31 (14.77) 102.48** (24.87) 1.02** (0.35) –0.02 (0.02) 0.05* (0.02)
SNAP · marginal food security 3.46** (0.99) –1.42 (1.37) 15.84 (21.64) 0.54 (36.43) –1.83** (0.52) 0.00 (0.03) –0.09* (0.03)
SNAP · low food security 1.98* (0.88) –3.88** (1.22) –21.50 (19.36) –67.56* (32.58) –0.98* (0.46) 0.00 (0.03) –0.05 (0.03)
SNAP · very low food security 3.84** (1.04) –2.99* (1.44) –11.59 (22.76) –65.24 (38.32) –1.17* (0.55) 0.02 (0.04) –0.06 (0.04)
Note. BMI = body mass index; FPL = federal poverty level; SNAP = Supplemental Nutrition Assistance Program; WIC = Women, Infants, and Children program. Respondents were aged 20 years or
older and had family income under 200% of the FPL. Values are coefficients derived from ordinary least squares regressions. Dependent variables were healthy eating index (maximum score = 100),
added sugar (teaspoons), solid fat (grams), empty calories (kilocalories), BMI (continuous value), overweight (dummy variable), and obesity (dummy variable). These dependent variables were
regressed on variables indicating SNAP participation, households’ food security categories (dummy variables), and SNAP participation interacted with food security categories. Control variables were
age, race/ethnicity, income (via poverty income ratio groups), marital status, education, insurance status, WIC participation, and employment status. Results take survey weights into account.
*P < .05; **P < .01.
1456 | Research and Practice | Peer Reviewed | Nguyen et al. American Journal of Public Health | July 2015, Vol 105, No. 7
RESEARCH AND PRACTICE
TABLE 4—Multivariable Regression Analysis on Racial/Ethnic Differences in Associations of Supplemental Nutrition Assistance Program
Participation and Food Insecurity With Dietary Quality and Weight Status Among US Low-Income Adults: National Health and Nutrition
Examination Survey, 2003–2010
Note. FPL = federal poverty level; SNAP = Supplemental Nutrition Assistance Program; WIC = Women, Infants, and Children program. Respondents were aged 20 years or older and had family income
under 200% of the FPL. Values are coefficients derived from ordinary least squares regressions. Dependent variables were healthy eating index (maximum score = 100), added sugar (teaspoons),
solid fat (grams), empty calories (kilocalories), BMI (continuous value), overweight (dummy variable), and obesity (dummy variable). These dependent variables were regressed on variables
indicating SNAP participation, households’ food security categories (dummy variables), and SNAP participation interacted with food security categories. Control variables were age, race/ethnicity,
income (via poverty income ratio groups), marital status, education, insurance status, WIC participation, and employment status. Results take survey weights into account.
*P < .05; **P < .01.
assessed food deserts (low-income areas with in meeting the challenge of consuming a health- represent longer-term dietary intake pat-
limited access to fresh, healthy, and affordable ful diet on a limited budget.46,47 In addition, terns.49---51 In addition, we could not establish
food)40,41 and policies, such as the Healthy SNAP-Ed interventions have begun addressing a causal relationship because of the cross-
Food Financing Initiative, that have been de- environmental factors affecting dietary intake, sectional nature of the data. Furthermore, we
veloped to address these inequities.42 Fur- such as providing access to more healthful foods could not control for self-selection into SNAP,
thermore, dietary intake disparities may turn (e.g., fruits and vegetables) in local corner or which could have been affected by such un-
into discrepancies in the incidence and man- convenience stores, which are more prevalent in observed factors as personal preferences and
agement of obesity, hypertension, diabetes, and low-income neighborhoods.48 underlying health conditions. Therefore, our
other diet-sensitive chronic diseases.4,32 Thus, Our findings are consistent with the litera- identification strategy, similar to many studies
further research is needed to better understand ture suggesting that racial/ethnic groups may in the literature,11 did not permit us to identify
why and how government nutrition assistance differ in taking advantage of government as- the causal effects of SNAP participation on
programs such as SNAP can affect varying sistance programs, so interventions encourag- health behaviors and outcomes.
food-insecure populations differently and to ing increasing utilization of SNAP and SNAP-Ed Our results were derived from self-reported
assess the possible solutions. and incorporating promotion of more healthful food security and SNAP participation status,
The Department of Agriculture has continued food consumption should be tailored to ethnic which may reflect an individual’s own percep-
to make improvements to the SNAP-Education minority subgroups. These programs will help tion rather than the actual situation, and the
(SNAP-Ed) program, specifically to enhance the not only food-insecure populations, but also reported numbers were subject to possible
quality of SNAP participants’ diets.16,43,44 The the marginally food secure, to achieve a more measurement error (e.g., misreporting or mis-
main aim of SNAP-Ed is to improve the likeli- healthful diet and consequently improve classification bias).52 For example, weight sta-
hood that SNAP participants will make healthier health outcomes and well-being. tus may influence reported food insecurity:
food choices within a limited budget.43 Research obese individuals may be more likely to report
shows that nutrition education programs can Limitations food insecurity because of their habits and
lead to healthier food choices among low- As a self-reported dietary recall data set, perceptions about food consumption.28,53
income households participating in SNAP,45 NHANES may be prone to overestimation of However, although our measure of food in-
and thus SNAP-Ed could aid SNAP participants portion size and dietary intake and may not security relied on self-report,6,17 it adhered to
July 2015, Vol 105, No. 7 | American Journal of Public Health Nguyen et al. | Peer Reviewed | Research and Practice | 1457
RESEARCH AND PRACTICE
the Department of Agriculture classification, 3. Coleman-Jensen A, Nord M, Andrews M, Carlson S. 20. US Dept of Agriculture. Food security in the U.S.—
Household food security in the United States in 2010. survey tools. 2014. Available at: http://www.ers.usda.
which is regarded as the gold standard.3,6
2011. Available at: http://ssrn.com/abstract=2116606 gov/topics/food-nutrition-assistance/food-security-in-
Future research should aim to enhance un- or http://dx.doi.org. Accessed July 3, 2014. the-us/survey-tools.aspx#.U7qhOPldUSV. Accessed July
derstanding of the interrelationship of SNAP 4. Seligman HK, Laraia BA, Kushel MB. Food in-
7, 2014.
and food insecurity with health outcomes and security is associated with chronic disease among low- 21. National Cancer Institute. Applied research: cancer
income NHANES participants. J Nutr. 2010;140(2): control and population sciences. Healthy Eating Index.
account for both selection bias and measure-
304---310. 2012. Available at: http://appliedresearch.cancer.gov/
ment error, as in a few works on related tools/hei. Accessed February 4, 2014.
5. Laraia BA. Food insecurity and chronic disease. Adv
topics.17,54 Nutr. 2013;4(2):203---212. 22. Guenther PM, Casavale KO, Kirkpatrick SI, et al.
Update of the Healthy Eating Index: HEI-2010. J Acad
6. Coleman-Jensen A, Nord M, Singh A. Household Food
Nutr Diet. 2013;113(4):569---580.
Conclusions Security in the United States in 2012. Washington, DC: US
Dept of Agriculture, Economic Research Service; 2013. 23. World Health Organization. Global database on
We found that among the food-insecure
ERR-155. body mass index. 2014. Available at: http://apps.who.
population, SNAP participation appears to int/bmi/index.jsp?introPage=intro_3.html. Accessed July
7. US Dept of Agriculture. Supplemental Nutrition
buffer against poor dietary quality and obesity, 7, 2014.
Assistance Program (SNAP). 2013. Available at: http://
particularly among non-Hispanic Whites and www.fns.usda.gov/snap. Accessed July 10, 2014. 24. Haines PS, Hama MY, Guilkey DK, Popkin BM.
Weekend eating in the United States is linked with
marginally food-secure Hispanics. Most impor- 8. Larson NI, Story MT. Food insecurity and weight
greater energy, fat, and alcohol intake. Obes Res. 2003;
tant, our research highlights the role that SNAP status among U.S. children and families: a review of the
11(8):945---949.
literature. Am J Prev Med. 2011;40(2):166---173.
may play in helping individuals who are at risk 25. Stata, Version 13 [computer program]. College
9. Berkowitz SA, Seligman HK, Choudhry NK. Treat or
for food insecurity to obtain a healthful diet Station, TX: StataCorp LP; 2013.
eat: food insecurity, cost-related medication underuse,
and better weight status. and unmet needs. Am J Med. 2014;127(4):303---310.e3. 26. Centers for Disease Control and Prevention. Na-
tional Health and Nutrition Examination Survey. Over-
SNAP, food insecurity, obesity, dietary pat- 10. Gundersen C, Oliveira V. The food stamp program view of NHANES survey design and weights. Available
terns, food availability and access, and other and food insufficiency. Am J Agr Econ. 2001;83(4):875--- at: http://www.cdc.gov/Nchs/tutorials/environmental/
factors should be considered together rather 887. orientation/sample_design/index.htm. Accessed July 7,
11. Dinour LM, Bergen D, Yeh M-C. The food 2014.
than separately, because these factors may
insecurity-obesity paradox: a review of the literature and 27. SAS, Version 9.3 [computer program]. Cary, NC:
interact in a complex relationship. j the role food stamps may play. J Am Diet Assoc. 2007; SAS Institute Inc; 2011.
107(11):1952---1961.
28. Hanson KL, Sobal J, Frongillo EA. Gender and
12. Nord M. How much does the Supplemental Nutri- marital status clarify associations between food insecurity
About the Authors tion Assistance Program alleviate food insecurity? Evi- and body weight. J Nutr. 2007;137(6):1460---1465.
Binh T. Nguyen and Kerem Shuval are with the Intramural
dence from recent programme leavers. Public Health
Research Department, Economic and Health Policy Re- 29. Farber HS. Job Loss in the Great Recession: Historical
Nutr. 2012;15(5):811---817.
search Program, American Cancer Society, Atlanta, GA. Perspective From the Displaced Workers Survey, 1984---
Farryl Bertmann is a public health nutrition and dietetics 13. Leung CW, Villamor E. Is participation in food and 2010. Cambridge, MA: National Bureau of Economic
research consultant, South Hero, VT. Amy L. Yaroch is with income assistance programmes associated with obesity in Research; 2011. Working paper 17040.
the Gretchen Swanson Center for Nutrition, Omaha, NE. California adults? Results from a state-wide survey. Public
30. Ganong P, Liebman JB. The Decline, Rebound, and
Correspondence should be sent to Binh T. Nguyen, PhD, Health Nutr. 2011;14(4):645---652.
Further Rise in SNAP Enrollment: Disentangling Business
American Cancer Society, 250 William St, Atlanta, GA 14. Webb AL, Schiff A, Currivan D, Villamor E. Food Cycle Fluctuations and Policy Changes. Cambridge, MA:
30303 (e-mail: [email protected]). Reprints can be Stamp Program participation but not food insecurity is National Bureau of Economic Research; 2013. Working
ordered at http://www.ajph.org by clicking the “Reprints” associated with higher adult BMI in Massachusetts resi- paper 19363.
link. dents living in low-income neighbourhoods. Public Health
This article was accepted January 15, 2015. 31. Schmidt L, Shore-Sheppard L, Watson T. The effect
Nutr. 2008;11(12):1248---1255. of safety net programs on food insecurity. University of
15. Leung CW, Ding EL, Catalano PJ, Villamor E, Rimm Kentucky Center for Poverty Research discussion paper
Contributors EB, Willett WC. Dietary intake and dietary quality of series, DP2012-12. Available at: http://www.ukcpr.org/
B. T. Nguyen conceptualized and designed the study, low-income adults in the Supplemental Nutrition Assis- Publications/DP2012-12.pdf. Accessed July 1, 2014.
with contributions from the other authors, analyzed the tance Program. Am J Clin Nutr. 2012;96(5):977---988. 32. Seligman HK, Schillinger D. Hunger and socioeco-
data, and drafted the article. All authors interpreted the 16. Nguyen BT, Shuval K, Njike VY, Katz DL. The nomic disparities in chronic disease. N Engl J Med. 2010;
data and reviewed and revised the article. Supplemental Nutrition Assistance Program and dietary 363(1):6---9.
quality among U.S. adults: findings from a nationally 33. Monsivais P, Drewnowski A. The rising cost of low-
Human Participant Protection representative survey. Mayo Clin Proc. 2014;89(9): energy-density foods. J Am Diet Assoc. 2007;107(12):
No protocol approval was required because the study 1211---1219. 2071---2076.
used de-identified, publicly available data. 17. Kreider B, Pepper JV, Gundersen C, Jolliffe D. 34. Maillot M, Darmon N, Darmon M, Lafay L,
Identifying the effects of SNAP (food stamps) on child Drewnowski A. Nutrient-dense food groups have high
health outcomes when participation is endogenous and energy costs: an econometric approach to nutrient pro-
References
1. US Dept of Agriculture, Economic Research Service.
misreported. J Am Stat Assoc. 2012;107(499):958---975. filing. J Nutr. 2007;137(7):1815---1820.
Definitions of food security. 2014. Available at: http:// 18. Centers for Disease Control and Prevention Na- 35. Carlson A, Frazão E. Are healthy foods really more
www.ers.usda.gov/topics/food-nutrition-assistance/food- tional Center for Health Statistics. National Health and expensive? It depends on how you measure the price.
security-in-the-us/definitions-of-food-security.aspx#. Nutrition Examination Survey. 2013. Available at: 2012. US Dept of Agriculture, Economic Research
U7VjvPldUSV. Accessed July 3, 2014. http://www.cdc.gov/nchs/nhanes.htm. Accessed May Service. Economic information bulletin 96. Available at:
2. Holben DH; American Dietetic Association. Position 12, 2013. http://www.ers.usda.gov/media/600474/eib96_1_.pdf.
of the American Dietetic Association: food insecurity in 19. Gundersen C, Kreider B, Pepper J. The economics of Accessed August 8, 2014.
the United States. J Am Diet Assoc. 2010;110(9):1368--- food insecurity in the United States. Appl Econ Perspect 36. Coveney J, O’Dwyer LA. Effects of mobility and
1377. Pol. 2011;33(3):281---303. location on food access. Health Place. 2009;15(1):45---55.
1458 | Research and Practice | Peer Reviewed | Nguyen et al. American Journal of Public Health | July 2015, Vol 105, No. 7
RESEARCH AND PRACTICE
37. Larson NI, Story MT, Nelson MC. Neighborhood 53. Kaiser LL, Townsend MS, Melgar-Quiñonez HR,
environments: disparities in access to healthy foods in the Fujii ML, Crawford PB. Choice of instrument influences
U.S. Am J Prev Med. 2009;36(1):74---81. relations between food insecurity and obesity in Latino
38. Galvez MP, Morland K, Raines C, et al. Race and women. Am J Clin Nutr. 2004;80(5):1372---1378.
food store availability in an inner-city neighbourhood. 54. Gundersen C, Kreider B. Bounding the effects of
Public Health Nutr. 2008;11(6):624---631. food insecurity on children’s health outcomes. J Health
39. Baker EA, Schootman M, Barnidge E, Kelly C. The Econ. 2009;28(5):971---983.
role of race and poverty in access to foods that enable
individuals to adhere to dietary guidelines. Prev Chronic
Dis. 2006;3(3):A76.
40. US Dept of Agriculture, Agricultural Marketing
Service. Food deserts. 2014. Available at: http://apps.
ams.usda.gov/fooddeserts/foodDeserts.aspx. Accessed
February 6, 2014.
41. Walker RE, Keane CR, Burke JG. Disparities and
access to healthy food in the United States: a review of
food deserts literature. Health Place. 2010;16(5):876---
884.
42. Administration for Children and Families, Office of
Community Services. Healthy Food Financing Initiative.
2011. Available at: http://www.acf.hhs.gov/programs/
ocs/resource/healthy-food-financing-initiative-0.
Accessed August 5, 2014.
43. US Dept of Agriculture. Supplemental Nutrition
Assistance Program education guidance: Nutrition
Education and Obesity Prevention Grant Program.
Available at: http://snap.nal.usda.gov/snap/Guidance/
FinalFY2015SNAP-EdGuidance.pdf. Accessed August 9,
2014.
44. Guthrie JF, Frazão E, Andrews M, Smallwood D.
Improving food choices—can food stamps do more?
Amber Waves. 2007;5(2):22---28.
45. Long V, Cates S, Blitstein J, et al. Supplemental
Nutrition Assistance Program Education and Evaluation
Study (Wave II). Washington, DC: Dept of Agriculture,
Food and Nutrition Service; 2013.
46. McLaughlin C, Tarasuk V, Kreiger N. An examina-
tion of at-home food preparation activity among low-
income, food-insecure women. J Am Diet Assoc. 2003;
103(11):.
47. Rose D. Food Stamps, the Thrifty Food Plan, and
meal preparation: the importance of the time dimension
for US nutrition policy. J Nutr Educ Behav. 2007;39(4):
226---232.
48. US Dept of Agriculture. SNAP-ED strategies and
interventions: an obesity prevention toolkit for states.
Available at: http://snap.nal.usda.gov/snap/SNAP-
EdInterventionsToolkit.pdf. Accessed December 9,
2014.
49. Faggiano F, Vineis P, Cravanzola D, et al. Validation
of a method for the estimation of food portion size.
Epidemiology. 1992;3(4):379---382.
50. Mertz W, Tsui JC, Judd J, et al. What are people
really eating? The relation between intake derived from
estimated diet records and intake determined to maintain
body weight. Am J Clin Nutr. 1991;54(2):291---295.
51. Briefel RR, Sempos CT, McDewell MA, Chien S,
Alaimo K. Dietary methods research in the Third Na-
tional Health and Nutrition Examination Survey: under-
reporting of energy intake. Am J Clin Nutr. 1997;
65(4 suppl):1203S---1209S.
52. Gundersen C, Kreider B. Food stamps and food
insecurity what can be learned in the presence of non-
classical measurement error? J Hum Resour. 2008;
43(2):352---382.
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