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SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM Examining the Evidence to Define Benefit Adequacy Committee on Examination of the Adequacy of Food Resources and SNAP Allotments Food and Nutrition Board Committee on National Statistics Julie A. Caswell and Ann L. Yaktine, Editors

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THE NATIONAL ACADEMIES PRESS  500 Fifth Street, NW  Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Govern- ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer- ing, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropri- ate balance. This study was supported by Contract No. USDA-AG-3198-G-11-0011, between the National Academy of Sciences and the U.S. Department of Agriculture, Food and Nutrition Service. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13:  978-0-309-26294-1 International Standard Book Number-10:  0-309-26294-1 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Room 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2013 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent a ­ dopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine) and NRC (National Research Coun- cil). 2013. Supplemental Nutrition Assistance Program: Examining the evidence to define benefit adequacy. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding e ­ ngineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sci- ences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON EXAMINATION OF THE ADEQUACY OF FOOD RESOURCES AND SNAP ALLOTMENTS JULIE A. CASWELL (Chair), Professor, Department of Resource Economics, University of Massachusetts Amherst SARA N. BLEICH, Assistant Professor, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland NOEL CHAVEZ, Associate Professor, School of Public Health, University of Illinois at Chicago JAMIE DOLLAHITE, Associate Professor, Division of Nutritional Sciences, Cornell University, Ithaca, New York PHILIP GLEASON, Senior Fellow, Mathematica Policy Research, Geneva, New York BARBARA A. LARAIA, Associate Professor, School of Public Health, University of California, Berkeley SHEILA MAMMEN, Professor, Department of Resource Economics, University of Massachusetts Amherst MARY K. MUTH, Director, Food and Nutrition Policy Research Program, RTI International, Research Triangle Park, North Carolina BONNY O’NEIL, Retired, USDA Food and Nutrition Service, Alexandria, Virginia DIANE W. SCHANZENBACH, Associate Professor, School of Education and Social Policy, Northwestern University, Evanston, Illinois JAMES P. ZILIAK, Professor and Carol Martin Gatton Endowed Chair in Microeconomics, Department of Economics, University of Kentucky IOM Staff ANN L. YAKTINE, Study Director JULIA HOGLUND, Research Associate ANTON BANDY, Financial Officer GERALDINE KENNEDO, Administrative Assistant LINDA D. MEYERS, Director, Food and Nutrition Board GOOLOO S. WUNDERLICH, Senior Program Officer (Committee on National Statistics) v

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Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: MARIANNE P. BITLER, University of California, Irvine GEORGE BRALEY, Retired, U.S. Department of Agriculture, Oakton, Virginia GEORGE DAVIS, Virginia Polytechnic Institute and State University, Blacksburg EDWARD FRONGILLO, University of South Carolina, Columbia HILARY HOYNES, University of California, Davis HELEN H. JENSEN, Iowa State University, Ames JACOB KLERMAN, Abt Associates, Inc., Cambridge, Massachusetts DARREN LUBOTSKY, University of Illinois at Urbana-Champaign SUZANNE P. MURPHY, University of Hawaii at Manoa HILARY K. SELIGMAN, University of California, San Francisco VALERIE TARASUK, University of Toronto, Ontario vii

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viii REVIEWERS Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the report’s con- clusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by NANCY E. ADLER, University of California, San Francisco, and JOHANNA DWYER, Office of Disease Prevention, National Institutes of Health. Appointed by the National Research Council and Institute of Medicine, they were respon- sible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Preface The Supplemental Nutrition Assistance Program (SNAP) touches the lives of millions of people in the United States in good and particularly in bad economic times. Over the last decade participation in the program has increased from less than 20 million to 46 million in 2012 in the wake of the post-2008 recession. As administered by the U.S. Department of Agriculture’s Food and Nutrition Service (USDA-FNS), SNAP is intended to supplement the ability of individuals and households to purchase food for consumption at home with a benefit allotment that is delivered to them most commonly in the form of Electronic Benefit Cards that they can spend in food stores. With one in seven people in the United States currently receiving SNAP benefits, an assessment of the science and evidence base for defining adequate allotments is important to the well-being of these participants, as well as to the functioning of the program. Two intertwined aspects of SNAP allotments affect the definition of an adequate benefit that supports the opportunity for participants to attain the program goals of food security and access to a healthy diet. First, a SNAP allotment may be more or less adequate for any given participant or household, depending on their circumstances. Does a particular participant have sufficient time to shop for and prepare nutritious meals, particularly from basic ingredients? How are the time and cost entailed in preparing meals affected by store availability, transportation, and the prices of foods in the participant’s shopping area? How does a participant’s nutrition knowledge and budgeting skills affect the definition of adequacy? Second, the program’s formula for calculating the dollar amount of the SNAP allot­ ent itself directly affects adequacy. For example, does the formula m ix

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x PREFACE account realistically for participants’ ability to devote their own income to food purchases? The circumstances in which foods are purchased and prepared and the food budget, including the SNAP benefit, are intertwined because they both are constraints on the opportunity of a SNAP individual or household to attain the outcomes of food security and access to a healthy diet. The definition of adequacy of SNAP allotments must weigh the importance of both aspects in affecting these outcomes. The committee members’ reasoned assessment about the evidence on these two aspects resulted in its focus on defining adequacy based on individual, household, and environmental fac- tors, as well as program factors; instituting systems to monitor the program outcomes of food security and access to a healthy diet over time, as well as to facilitate future adjustments to the definition of adequacy; and conduct- ing research on the impacts on adequacy of nutrition knowledge and buying skills and access to retail outlets. The day-to-day diets of millions of people in the United States are supported by the SNAP program; its impact is particularly prominent in periods of economic downturn. The committee offers its recommendations for defining and monitoring SNAP benefit allotment adequacy based on its review and analysis of a broad range of evidence, with the goal of pro- viding USDA-FNS with a road map to establish an objective definition of the adequacy of SNAP allotments and to assist with identification of data requirements to support that effort. Ultimately this effort is aimed at pro- viding SNAP participants with greater opportunities to become more food secure and to have access to a healthy diet. I am deeply appreciative of the dedication and effort of the 10 com- mittee members who worked together over a short period of time from January to December 2012 to evaluate the evidence on the multiple factors that may be important in defining the adequacy of SNAP allotments. We r ­ eceived outstanding support in our work from Ann Yaktine, study direc- tor. I thank her for her knowledge, skill, and tireless care devoted to this project. As research associate, Julia Hoglund provided excellent scientific support to the project. Geraldine Kennedo served as administrative assistant with ­fficiency and warmth. I also appreciate the consultation provided e by ­ ooloo Wunderlich, senior program officer with the Committee on G National Statistics. Finally, I thank Linda Meyers, director of the Food and Nutrition Board of the Institute of Medicine, for her wisdom in guiding the project. Julie A. Caswell, Chair Committee on Examination of the Adequacy of Food Resources and SNAP Allotments

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Contents SUMMARY 1 1 INTRODUCTION AND CONCEPTUAL FRAMEWORK 13 Overview of the Program, 14 The Committee’s Task, 16 Approach to the Task, 17 The Framework and Its Components, 17 Organization of the Report, 24 References, 25 2 HISTORY, BACKGROUND, AND GOALS OF THE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM 27 Milestones in the History of the Supplemental Nutrition Assistance Program, 27 SNAP Benefit Formula and Eligibility, 33 Definition of the SNAP Allotment, 37 Trends in Program Participation and Costs, 44 Trends in Food Insecurity and Poverty, 47 Summary, 51 References, 52 3 FOOD SECURITY AND ACCESS TO A HEALTHY DIET IN LOW-INCOME POPULATIONS 57 Food Production, Availability, and Consumption at the Population Level, 57 xi

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xii CONTENTS Food Purchasing Patterns and Dietary Intake Among Low-Income Households and SNAP Participants, 58 Access to a Healthy Diet, 67 Food Insecurity, 73 Data and Analytical Challenges to Assessing the Adequacy of SNAP Allotments, 85 Findings and Conclusions, 87 References, 89 4 INDIVIDUAL, HOUSEHOLD, AND ENVIRONMENTAL F ­ ACTORS AFFECTING FOOD CHOICES AND ACCESS 97 Household Production Theory as an Organizing Framework, 98 Individual and Household Factors, 99 Environmental Factors, 113 Data and Analytical Challenges, 135 Summary of Findings and Conclusions, 136 References, 138 5 IMPACT OF PROGRAM DESIGN ON ALLOTMENT ADEQUACY 147 Evidence on the Components of the SNAP Benefit Formula, 147 Impact of Restrictions and Incentives on the Purchasing Power of SNAP Benefits, 161 Summary of Findings and Conclusions, 166 References, 168 6 CONCLUSIONS AND RECOMMENDATIONS 175 Conclusions, 176 Recommendations, 180 Other Research Considerations, 184 Summary, 185 APPENDIXES A ACRONYMS, ABBREVIATIONS, AND TERMS 187 B OPEN SESSION WITH SPONSORS 193 C WORKSHOP AGENDA 195 D APPROACH TO LITERATURE REVIEW 199 E QUESTIONS RELATED TO THE STATEMENT OF TASK 205 F QUESTIONS ON THE CORE FOOD SECURITY MODULE 209 G KEY RECOMMENDATIONS OF THE DIETARY GUIDELINES FOR AMERICANS 213 H BIOGRAPHICAL SKETCHES OF COMMITTEE MEMBERS 217