For many Americans who live near or below the poverty threshold, access to healthy foods at a reasonable price is a challenge that often places a strain on already limited resources and may compel them to make food choices that are contrary to current nutritional guidance. To help alleviate this problem, the U.S. Department of Agriculture (USDA) administers a number of nutrition assistance programs with the goal of improving access to healthy foods for low-income individuals and households; USDA also promotes healthy eating through nutrition education programs designed to reach low-income populations and program participants. The largest of USDA’s nutrition assistance programs is the Supplemental Nutrition Assistance Program (SNAP), formerly called the Food Stamp Program, which today serves more than 46 million Americans with a program cost in excess of $75 billion annually. The goals of SNAP include raising the level of nutrition among low-income households and maintaining adequate levels of nutrition by increasing the food purchasing power of low-income families.
Households receive the maximum SNAP benefit if the family has no income to contribute to food purchases; households with income combine the SNAP allotment with other household resources. Currently there is debate about whether there are different ways to think about the adequacy of SNAP allotments. The purpose of this report is to assist USDA’s Food and Nutrition Service (FNS) in responding to this debate.
SNAP differs from other USDA nutrition assistance programs in that it is an in-kind program, providing monthly benefits paid by some means other than cash (e.g., an Electronic Benefit Transfer [EBT] card or a voucher) to eligible low-income families.1 The goals of the program are to improve food security and access to a healthy diet by increasing the food purchasing power of low-income households, enabling them to obtain a more nutritious diet by preparing food at home. The purpose and goals of SNAP as legislated by Congress on January 3, 2012, are shown in Box 1-1. Additional detail on the history, background, and goals of the program is in Chapter 2.
The EBT card can be used to purchase food from authorized food retailers; benefits also may be used to purchase seeds and plants with which to produce food. With certain exceptions, including alcohol and tobacco products and foods eaten in a store, the program does not directly influence what foods can be purchased using SNAP benefits. To be eligible to sell foods to SNAP participants, a store must meet one of two criteria. First, it must offer (on a continuous basis) at least three varieties of qualifying foods in each of four food categories, including perishable foods in at least two of the categories:
• meat, poultry, or fish;
• bread or cereal;
• vegetables or fruit; and
• dairy products
The second criterion is that more than 50 percent of total retail sales in the store must be from the sale of SNAP-eligible staple foods.
SNAP allotments are based on the Thrifty Food Plan (TFP), a minimal-cost model food plan for a healthy diet that is based on the cost of purchasing foods consumed by individuals in four age-gender groups: a male and female aged 19-50, a child aged 6-8, and a child aged 9-11. As noted by Carlson et al. (2007), the plan reflects the recommendations of the Dietary Guidelines for Americans (DGA). The amount of individual allotments varies because the calculation of benefit levels is based on the concept that SNAP allotments are intended to supplement, not serve as the sole resource for, food purchases. Households with a net income below 100 percent of the federal poverty level qualify for a benefit equal to the maximum amount for that household size minus 30 percent of their net income. However, rising
1For simplicity, the form in which SNAP benefits are provided is referred to throughout this report as an EBT card.
Section 2 of 7 U.S.C. 2011 states: “It is hereby declared to be the policy of Congress, in order to promote the general welfare, to safeguard the health and well-being of the Nation’s population by raising the level of nutrition among low-income households. Congress hereby finds that the limited food purchasing power of low-income households contributes to hunger and malnutrition among members of such households. Congress further finds that increased utilization of food in establishing and maintaining adequate national levels of nutrition will promote the distribution in a beneficial manner of the Nation’s agricultural abundance and will strengthen the Nation’s agricultural economy, as well as result in more orderly marketing and distribution of foods. To alleviate such hunger and malnutrition, a supplemental nutrition assistance program is herein authorized which will permit low-income households to obtain a more nutritious diet through normal channels of trade by increasing food purchasing power for all eligible households who apply for participation.”
food prices, fuel and shelter costs, and employment and income volatility all have affected the food purchasing power of the allotment.
Several nutrition assistance programs are available to qualifying low-income households, including the four largest (SNAP; the National School Lunch and School Breakfast Programs; and the Special Supplemental Nutrition Program for Women, Infants, and Children [WIC]), as well as other programs such as the Child and Adult Care Food Program (CACFP), the Commodity Supplemental Food Program, the Emergency Food Assistance Program, the Food Distribution Program on Indian Reservations, and the Summer Food Service Program. Participation in more than one nutrition assistance program increases low-income families’ access to a healthy diet. Yet while many families are eligible to participate in more than one such program (e.g., SNAP, School Lunch, School Breakfast, and WIC), most do not. Gothro and Trippe (2010), for example, found that fewer than half of all individuals participating in School Lunch, School Breakfast, and WIC also received SNAP benefits, even though they were eligible to do so. SNAP does differ from other federal nutrition assistance programs, such as WIC, CACFP, School Lunch, and School Breakfast, in that, with the exceptions mentioned previously, it does not limit the types of foods available to participants.
Participation in SNAP varies across demographic groups, but about half of all participants are households with children. A recent USDA-FNS report
shows that SNAP participation by children in households that are below the federal poverty threshold and are participants in Temporary Assistance for Needy Families has remained high (89 to 92 percent of all eligible individuals are in these groups), whereas participation by the elderly, low-income individuals living in households above the federal poverty threshold, and those eligible for low monthly benefits has remained low (less than 40 percent of all eligible individuals in these groups) over several decades.
Overall participation in SNAP fluctuated between 1999 and 2002 to just below and just above 18 million. It then increased steadily to 27 million in 2008. As the 2008 recession led to higher unemployment, the number of eligible individuals increased by more than 18 percent between 2008 and 2009, reaching 32 million by the end of fiscal year (FY) 2009 (Leftin et al., 2011). In FY 2012, SNAP participation reached more than 46 million, with a program cost in excess of $75 billion (FNS, 2012).
This study poses questions about whether there are different ways to think about the adequacy of SNAP allotments. Factors such as time needed to prepare foods from basic ingredients as described in the TFP, knowledge and skills needed to plan and prepare a healthy diet, the diversity of cultural food preferences, food access constraints, and regional/seasonal price fluctuations all may have an impact on the adequacy of the allotments to improve food security and access to a healthy diet. Accordingly, USDA-FNS asked the Institute of Medicine to conduct a study examining the feasibility of defining the adequacy of SNAP allotments, specifically:
• the feasibility of establishing an objective, evidence-based, science-driven definition of the adequacy of SNAP allotments consistent with the program goals of improving food security and access to a healthy diet, as well as other relevant dimensions of adequacy; and
• data and analyses needed to support an evidence-based assessment of the adequacy of SNAP allotments.
In addressing its task, the committee considered questions posed by the sponsor with respect to the above two primary dimensions of the task. Appendix E outlines these additional questions and indicates where they are addressed in the report.
The committee’s task was focused on identifying factors that evidence indicates should be considered in defining SNAP allotments that are adequate to meet the program goals, and the data and analyses needed to support such a definition. This focus did not include consideration of alternatives to SNAP; modifications to its underlying TFP; alternative disbursement
mechanisms, such as cash in lieu of EBT cards; or the impact of program changes on program costs. Nor did the committee consider the many possible questions concerning SNAP program policy on topics not related to the feasibility of defining adequate SNAP allotments or the evidence needed to support such a definition. The committee also did not evaluate the stated program goals of improving food security and access to a healthy diet.
The committee conducted a comprehensive review of the current evidence, including the peer-reviewed published literature, peer-reviewed government reports, and non-peer-reviewed publications from sources that included nongovernmental organizations and stakeholder groups. The process the committee used to review and weigh the strength of the evidence is described in detail in Appendix D. In addition to its evidence review, the committee held a data gathering workshop that tapped a range of perspectives (see Appendix C). Based on that evidence, the committee developed a framework identifying the range of factors most likely to have an impact on defining the adequacy of SNAP allotments. This framework and the supporting evidence are discussed below and in subsequent chapters.
The framework developed for this study provides a structure for showing the process by which households make food choices. The framework also identifies how SNAP program characteristics affect this process. The committee used this framework to identify the types of factors that may affect whether the SNAP goals of improving food security and access to a healthy diet are met in order to help determine the feasibility of defining allotment adequacy. The framework consists of three major parts: (1) the program goals of improving food security and access to a healthy diet; (2) major categories of factors that influence the process through which households may or may not achieve these goals; and (3) characteristics of the SNAP program that also affect this process. The committee did not focus on strategies that can be used to encourage participation in the SNAP program; rather, it focused on what is occurring among SNAP participants that may impact the adequacy of the benefits they receive.
The key goals of the SNAP program from the time of its inception have included alleviating hunger and improving eating patterns to optimize health outcomes. The statement of task for this study identified the program
goals associated with an adequate SNAP allotment as improving food security and access to a healthy diet. The maximum SNAP allotment, based on the TFP, is intended to provide participating households an amount that, together with their own resources, is sufficient to enable them to be food secure and to follow a healthy meal pattern, consistent with the recommendations of the DGA (USDA and HHS, 2010).
Food insecurity exists when there is inadequate or unsure access to enough food for active, healthy living. For the program goal of improving food security, the committee used USDA’s widely accepted definition of food security:
Access by all people at all times to enough food for an active, healthy life. Food security includes at a minimum: (1) the ready availability of nutritionally adequate and safe foods, and (2) an assured ability to acquire acceptable foods in socially acceptable ways (e.g., without resorting to emergency food supplies, scavenging, stealing, or other coping strategies). (Bickel et al., 2000)
As discussed further in Chapter 2, food insecurity in the United States is monitored by the Food Security Supplement survey, conducted by the U.S. Census Bureau and used as a source of information by the Bureau of Labor Statistics. Trends in monitoring show that food insecurity in the United States rose sharply from 2006 to 2007 and has remained at roughly the same level since. SNAP has a role as an “automatic stabilizer” for low-income households; both participation and the amount of spending increase automatically during economic downturns. Even with the dramatic rise in SNAP participation in recent years, this measure suggests that the antipoverty impact of SNAP is increasing as an outcome of the American Recovery and Reinvestment Act of 20092 (Ziliak, 2011), as well as other factors, including increasing resources for the purchase of food (see Chapter 2 for further detail).
Access to a Healthy Diet
For its definition of the program goal of access to a healthy diet, the committee relied on the recommendations of the DGA as federal nutrition policy. The TFP, which as noted is the basis for calculating the maximum
2American Recovery and Reinvestment Act of 2009, Public Law 111-5, 111th Congress (February 17, 2009).
SNAP benefit, was revised in 2006 to reflect the guidance provided by the DGA. As an outcome of this revision, the maximum amount of the SNAP allotment is now intended to provide participating households with access to a healthy meal pattern, consistent with the recommendations of the DGA. Thus, the committee defined this program goal as access to a healthy diet consistent with the recommendations of the DGA.
As discussed further in Chapter 3, several dietary indexes have been developed as comprehensive measures of a healthy diet. Examples include the USDA-developed Healthy Eating Index (HEI)-2005; the Alternate HEI-2010; the MyPyramid food guidance system; and other measures of diet quality developed by academic and other groups, such as the Recommended Food Score.
Factors Affecting Achievement of the Program Goals
A number of factors affect whether households have the opportunity to be food secure and have access to a healthy diet. Obviously, a critical factor is whether a household has sufficient total resources (financial/in-kind income and time) with which to obtain an adequate amount of nutritious food. With a given level of resources, however, various other factors, both within and outside the control of the household, influence whether those resources actually translate into food security for the household and access to a healthy diet for its members. Key among these factors are characteristics of the household and its individual members, including taste preferences, cultural influences, and special dietary needs, which may influence the types of foods obtained, as well as environmental factors, such as the household’s physical access to food and prices that may affect access. All of these factors ultimately influence the actual purchasing and consumption patterns of the household, which in turn affect whether members of the household meet the program goals, as illustrated in Figure 1-1.
A household’s ability to become food secure and have access to a healthy diet depends at a minimum on having sufficient total resources. Total household resources include two main components: financial/in-kind income and time. Financial resources may include household income, in-kind benefits received from participation in SNAP and other nutrition assistance programs (e.g., WIC), and food obtained through emergency food programs. In addition, the committee recognized that time plays a major role in ultimately determining a household’s food choices and dietary outcomes. In particular, time is needed to apply for benefits, to procure food, and to prepare meals for the household. Households take into account all
FIGURE 1-1 Factors affecting the process by which households may or may not achieve SNAP program goals.
of these resources at their disposal when they make decisions about what foods they will obtain and consume.
Individual and Household Factors
Even with a given level of total resources, different households (and individuals within them) will make different food choices. One reason for this variation is that individual and household factors greatly influence the types of foods families choose. In particular, personal preferences and cultural influences play a major role in decisions about what foods to obtain and consume. Different individuals may consume different amounts of fruits or vegetables not because of their available resources or the prices of these items, for example, but because of their taste for these foods. Other individual/household factors that may influence or constrain house-hold food choices include food and nutrition knowledge, food preparation skills and the space and equipment needed to prepare foods from basic ingredients, food budgeting abilities, and special needs for certain age groups and for the management of disease (e.g., nutrient deficiencies, infectious and chronic diseases). Because all these factors influence the amounts and types of foods obtained for a household at a given level of total resources, they may influence the feasibility of defining the adequacy of SNAP allotments. These themes are further developed in Chapter 4.
Many environmental factors may influence SNAP participants’ access to food, including factors that physically or financially facilitate or impede
the household’s ability to meet the program goals. Factors that reflect physical access include transportation, proximity to outlets providing nutritious foods, and limitations on access for those with a physical handicap. Factors that reflect financial access include food prices; gas prices; and the cost of complementary goods used in home food production and consumption, such as expenditures for housing and utilities. Also playing a role might be actual or perceived access, such as an individual’s belief that nutritious foods can be found for a reasonable price in his or her neighborhood. As with individual/household factors, the various environmental factors affecting access to food may operate independently of a household’s total resources. For households with a given level of resources, for example, those in areas in which the relative prices of fruits and vegetables are higher than average may be less likely to choose to obtain and consume those items than households in areas with less expensive fruits and vegetables. Further detail on these environmental factors related to access to food is presented in Chapter 4.
Purchasing and Consumption Patterns
As noted, the actual purchasing and consumption patterns of low-income households will ultimately be influenced by the total resources available to the household, individual and household factors, and environmental factors that affect access to or the ability to procure different types of foods. In turn, the amounts and types of foods chosen and purchased by low-income households and the foods consumed by household members will directly affect the household’s ability to meet the goals of the SNAP program. These themes are further developed in Chapters 3 and 4.
SNAP Program Characteristics
While Figure 1-1 describes the process determining households’ ability to meet the SNAP goals, it does not explicitly lay out the role of the program in this process. This section presents the logic of the SNAP intervention and explains how it may help households achieve improved food security and access to a healthy diet. Addition of the influence of the SNAP program characteristics to the process depicted in Figure 1-1 completes the framework for this study, as illustrated by Figure 1-2.
SNAP Benefit Formula
The most fundamental way in which the SNAP program intervenes in the process described above is by aiming to enhance the resources available for obtaining foods through SNAP benefits. SNAP allotments are determined by a formula that is described in detail in Chapter 2. At the heart of
FIGURE 1-2 Framework for determining the feasibility of defining the adequacy of SNAP allotments.
NOTE: Solid lines represent the food purchasing and consumption process for households participating in SNAP, independent of the program (Figure 1-1). Dashed lines represent the influence of SNAP program characteristics on this process.
this formula is a determination of the amount of total resources (financial/in-kind, and time) necessary to obtain and prepare sufficient foods for a nutritious diet. In the current program, this determination is embodied in the TFP. Calculation of the cost of the TFP is based on the average annual (across four quarters) and regional cost for each food item in the plan, taken from the Quarterly Food-at-Home Price Database (available at www.ers.usda.gov/data-products/quarterly-food-at-home-price-database.aspx). Foods from the database used in calculating the cost of the plan are chosen to be representative of foods actually consumed by low-income households. The foods identified for this hypothetical average market basket are then assessed against the recommendations of the DGA and the corresponding MyPyramid meal patterns by gender and age group. TFP is considered adequate for meeting the nutritional needs of the population based on the assumptions that SNAP beneficiaries
• purchase the foods that make up the TFP;
• are able to capitalize on the average cost per item (i.e., minimal cost fluctuation by season or region of the United States is assumed);
• have the time and knowledge to cook most of their meals from scratch; and
• have nutrient requirements consistent with Dietary Reference Intake (DRI) levels.
Other SNAP Program Characteristics
Aside from the SNAP benefit formula, other characteristics of the program may affect households’ food purchasing and consumption behavior. There are program components that affect or at least have the ability to affect each aspect of the conceptual framework that ultimately influences achievement of the program goals, as described below.
Nutrition education Although most individual and household factors that affect purchasing and consumption patterns are independent of participation in SNAP, the program’s nutrition education program (SNAP-Ed) has the potential to influence some of these factors and thereby have an impact on the purchasing power of SNAP allotments. For example, although SNAP-Ed has a limited reach, nutrition education may influence the dietary knowledge and attitudes of household members, food preparation techniques, budgeting, and planning. Ultimately, it could indirectly affect participants’ tastes and preferences for foods (see Chapter 4 for further discussion).
Allowed retail outlets As noted earlier, the SNAP program sets requirements for retail outlets to qualify to accept SNAP benefits: they must sell food for home preparation, and they must offer a specified variety of food items, or at least 50 percent of their total sales volume must be in staple foods. The SNAP program also does not allow the use of benefits for hot prepared meals in approved outlets or, with the exception of the elderly and disabled, in community feeding centers. The specification of approved outlets may affect the range of access to healthy foods (see Chapter 5 for further discussion).
Restrictions and incentives As with access to retail food outlets, policies regarding restrictions on foods that can be purchased with SNAP benefits often involve a trade-off between competing goals of trying to boost participants’ access to all foods and trying to encourage participants to obtain healthy foods. To circumvent this trade-off, options such as providing incentives (e.g., a rebate for each targeted item that is purchased) have been considered to guide participants toward purchasing healthier foods with their benefits (see Chapter 5 for further discussion).
The committee used the framework to understand the process by which households participating in SNAP may or may not achieve the program goals, as well as how program characteristics affect this process. Nonetheless, the framework has some important limitations. As discussed above, it focuses only on the proximal goals of improving food security and access to a healthy diet and does not explicitly cover longer-term outcomes that may be most important, including health outcomes such as chronic disease. A related issue is that the framework represents the program goals simply as binary measures, with participants either achieving or failing to achieve them. Especially in the case of access to a healthy diet, this representation fails to capture the multiple dimensions of the complex relationship between diet and health.
Another limitation of the framework is its linearity; it represents complex household processes for purchasing and consuming specific foods as resulting in a straightforward way from a set of exogenous influences (total resources, individual/household factors, and environmental factors). In reality, the process probably is not entirely linear, and there are likely various feedback mechanisms at work. For example, not only may the foods participants consume be affected by their individual tastes and preferences, but their tastes and preferences themselves may be affected by the foods they consume. Similarly, food insecurity and lack of a healthy diet increase the risk for chronic diseases, such as diabetes and hypertension, that in turn affect participants’ consumption choices and even their access to foods needed to meet their needs.
Despite the framework’s limitations in capturing subtleties in how households make decisions about what foods to purchase and consume, the committee believes it provides an adequate overview of this process. This overview serves as a useful way to understand the factors that affect food security and access to a healthy diet, how SNAP allotments affect household choices, and how the allotments may or may not be adequate for allowing participants to achieve the program goals.
The remainder of this report is structured according to the framework depicted in Figure 1-2. First, however, Chapter 2 provides historical information about the development of the SNAP program, as well as background on the program and its goals. Chapter 3 presents evidence on the extent to which SNAP participants achieve the program goals, as well as on household purchasing patterns. Chapter 4 addresses the individual and household factors that affect participants’ food choices, along with some
of the environmental factors that may limit their access to low-cost healthy foods. Chapter 5 describes the structure of SNAP and how various program characteristics affect participating households’ purchasing and consumption patterns. Particular attention is paid to the additional resources provided to households through SNAP allotments and the formula used to determine the amount of the allotments. Lastly, the committee’s conclusions and recommendations are presented in Chapter 6. The appendixes provide additional material, including a description of the committee’s review and evaluation of the relevant literature.
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