Abstract
BACKGROUND: The United States Department of Agriculture's Supplemental Nutrition Assistance Program (SNAP) is the country's largest nutrition assistance program for low-income populations. Although SNAP has been shown to reduce food insecurity, research findings on the diet quality of program participants are inconsistent. OBJECTIVE: This study evaluated whether the community food environment is a potential moderator of the association between SNAP participation and eating behaviors. DESIGN: This cross-sectional study used participant data from a telephone survey of 2,211 households in four cities in New Jersey. Data were collected from two cross-sectional panels from 2009 to 2010 and 2014. Food outlet data were purchased from commercial sources and classified as supermarkets, small grocery stores, convenience stores, or limited service restaurants. PARTICIPANTS/SETTING: Analysis is limited to 983 respondents (588 SNAP participants) with household incomes below 130% of the federal poverty level. MAIN OUTCOME MEASURES: Eating behaviors were assessed as frequency of consumption of fruit, vegetables, salad, and sugar-sweetened beverages. STATISTICAL ANALYSES PERFORMED: Interaction and stratified analyses using gamma regression determined the differences in the association between SNAP participation and eating behaviors by the presence or absence of food outlets adjusted for covariates. RESULTS: SNAP participation was associated with a higher frequency of consuming sugar-sweetened beverages (P<0.05) when respondents lived within ¼ to ½ mile of a small grocery store, supermarket, and limited service restaurant. SNAP participants who did not live close to a convenience store reported a lower frequency of sugar-sweetened beverage consumption (P=0.01), and those living more than ½ mile away from a supermarket reported a lower frequency of fruit consumption (P=0.03). CONCLUSIONS: The findings from this study suggest that the community food environment may play a role in moderating the association between SNAP participation and eating behaviors. Although SNAP participation is associated with some unhealthy behaviors, this association may only hold true when respondents live in certain food environments.