Restaurant outlet density and the healthfulness of food purchases: evidence from FoodAPS.

Introduction: The average American household's diet and food purchasing patterns are out of sync with federal recommendations. Researchers have connected this with the large and growing rates of obesity, diabetes, and other diet-related ailments in the U.S. Restaurant food has been discussed a potential contributor to unhealthful diets, as it is often calorically dense. We investigate the association between household access to restaurants and diet quality using USDA FoodAPS data and NPD ReCount data. Methods: We define radii around households to measure restaurant outlet counts and apply a regression analysis incorporating household characteristics. Results: We find that neither restaurant counts nor openings share many statistically or economically significant associations with average dietary quality. Household characteristics and demographics are far more powerful in explaining variation in diet quality. Discussion: Our findings align with the large and growing body of empirical research that suggests that personal preferences and other household characteristics are more important than the food environment in explaining food choices and diet quality. Given the extant research on the importance of access to large supermarkets, our results suggest that access to food retailers is more important in explaining diet quality than access to restaurants.

An Entropy-Based Approach to Measuring Diet Adherence.

The aim of this study is to put forward an approach designed to calculate and sum up discrepancies between the actual food acquisition or intake and any standard or norm. Based on secondary analysis of cross-sectional data from the Mexican National Survey of Household Income and Expenditure, our proposed method to produce classes of entropy-based Diet Adherence Indices generates a Food Basket Adherence Index (FBAI) for Mexico City (2129 households). Findings suggest that it is possible to measure and decompose diet adherence using a cross entropy measure. Using food expenditure data and a normative food basket for Mexico City results, we show households' deviations from the suggested norm for different food groups. The average FBAI was 0.44, far above the minimum score of 0 which would indicate full adherence to the normative food basket. Our measure has a distribution wide enough to detect meaningful changes and distinguish between groups with known differences, providing important new insights on the linkages between home food environments and income distribution, and food insecurity and household distribution.

A Qualitative Study of Factors Influencing Food Choices and Food Sources Among Adults Aged 50 Years and Older During the Coronavirus Disease 2019 Pandemic.

BACKGROUND: The coronavirus disease 2019 pandemic affected food availability and accessibility for many older adults, especially those experiencing food insecurity. Food citizenship is a theoretical framework that encourages the use of alternate over industrial food sources and can characterize where foods are acquired and how food choices are made. OBJECTIVE: The purpose of this study is to explore how Iowans aged 50 years and older made choices about what foods to acquire and where to acquire foods during the coronavirus disease 2019 pandemic using food citizenship as a theoretical framework. DESIGN: We used in-depth interviews with Iowans aged 50 years and older (N = 60). PARTICIPANTS: We recruited respondents through Area Agencies on Aging, food banks, and food pantries. Individuals who contacted the research team, were aged 50 years and older, and spoke English were eligible. Half of the sample screened as food insecure. STATISTICAL ANALYSIS: We conducted a thematic analysis to identify recurring themes. RESULTS: Food costs, personal preferences, and the healthfulness of food were cited as the most influential factors. Respondents said that the pandemic had not changed how they make choices, but increased prices had made costs more salient. Respondents primarily got their food from industrial food retailers, government programs, or food pantries. More than half of the respondents also acquired food from an alternate food source, such as a farmers' market. Reasons for not using alternate food sources included cost and transportation barriers. CONCLUSIONS: It is essential to ensure that older adults have access to affordable, healthy foods, especially during crises such as the coronavirus disease 2019 pandemic. Alternate food sources provided supplementary, healthy food for many respondents, but there are opportunities to expand the use of these food sources. Incentivizing the use of alternate food sources through government programs and connecting the emergency food system to local producers could increase the consumption of healthy food.

Fresh Shelves, Healthy Pantries: A Pilot Intervention Trial in Baltimore City Food Pantries.

The objective of this study was to evaluate the impact of a multi-modal pilot intervention on the stocking and acquisition of healthy foods in urban food pantries. An intervention that consisted of three 8-week phases, each focused on promotion of one food group: (1) lean & low-sodium proteins; (2) fruits & vegetables; and (3) healthy carbohydrates was conducted in 3 intervention and 4 comparison food pantries. Food stocking variety scores measured changes in the stocking of promoted healthful foods at pantries. Food Assortment Scoring Tool (FAST) scores measured healthfulness of client bags. Intervention and comparison pantries showed an increase during the study in the total variety score for promoted options, with no significant differences between groups. Mean healthfulness scores for intervention client bags (n = 34) significantly increased from 58.2 to 74.9 (p < 0.001). This pilot trial identified logistically feasible strategies to promote healthy options effectively in food pantries, even in pantries with limited resources.

"Some are healthy and others not": Characterization of vended food products by Accra-based food retailers.

Background and objectives: Increasing the availability of healthy foods within food retail outlets can improve consumers' food environments. Such actions or inactions by food retailers may affect people's food purchasing and consumption behavior. This study explored Accra-based food retailers' perceptions and appreciation of "healthiness of food" as a concept. It also documented measures that food retailers adopt to encourage healthy food choices. Methods: In-person semi-structured interviews were conducted with owners and managers of Accra-based supermarkets (n = 7) and corner stores (n = 13) in March 2021. The interviews were recorded, transcribed, coded, and analyzed thematically. Results: The retailers' understanding of healthy food, or lack thereof, is exemplified by such expressions as "health, absence of disease, longevity, balanced diet, diversity, sanitation, and certification." A handful of retailers described what they sell as "products that meet consumer needs," "harmless," or "generally good." Very few retailers described the food they sell as "junk," high in sugar, fat, and salt, or energy-dense but nutrient poor foods, or as food that could pose some health risk to consumers. However, some retailers indicated that they advise their customers against the overconsumption of some foods. Conclusion: Overall, Accra-based retailers have a fair understanding of what constitutes healthy food - exhibiting limited knowledge of the connection between very salty, very sugary, and very fatty foods and health outcomes. Retailers in Accra require interventions that improve their food, health, and nutrition literacy. Improving retailers' food and nutrition literacy may improve the availability of healthier options in food retail outlets in Accra.

Food Acquisition during the COVID-19 Lockdown and Its Associations with the Physical-Digital Integrated Community Food Environment: A Case Study of Nanjing, China.

The COVID-19 pandemic and measures such as lockdowns affect food access, dietary choices, and food security. We conducted an online survey among 517 respondents during early 2020 in Nanjing, China to explore respondents' food acquisition behaviors before and during the pandemic and associations with the community food environment. Using geographic analysis and binary logistic models, we revealed that despite inconvenience regarding food acquisition, no food security issues occurred during lockdown in Nanjing. The pandemic changed the access and frequency of obtaining food; meanwhile, pre-pandemic habits had a strong impact on food acquisition behavior. Online and in-store food acquisition showed a substitution relationship, with online food access playing a crucial role in food acquisition. Physical and digit food outlets are highly integrated in Chinese urban communities, and both objectively measured and perceived accessibility of these food outlets had a significant association with the food acquisition methods and transportation mode chosen by people during this public health crisis.

Family Food Insecurity, Food Acquisition, and Eating Behavior Over 6 Months Into the COVID-19 Pandemic.

OBJECTIVES: Describe coronavirus disease 2019 (COVID-19)-related employment and food acquisition changes for food-secure and food-insecure households. Examine associations between food insecurity, parent food acquisition, and child eating. METHODS: A nationally representative cross-sectional survey with parents (N = 1,000) in Fall 2020. Measures included sociodemographics, food retail regulations, food insecurity, frequency of meals, changes in parent employment, food preparation, and food acquisition because of COVID-19. RESULTS: Parents that reported recent food insecurity were more likely to report COVID-19-related employment changes (eg, job loss, reduced hours) and food acquisition changes. Food insecurity was modestly associated with more frequent in-person restaurant dining (B = 0.12, t(999) = 4.02, P < 0.001), more frequent restaurant delivery (B = 0.13, t(999) = 4.30, P < 0.001), less frequent homecooked meals (B = -0.14, t(999) = 4.56, P < 0.001) but was not associated with take-out (B = 0.02, t(999) = 0.62, P = 0.54). CONCLUSIONS AND IMPLICATIONS: Food insecurity was associated with employment changes, parent food acquisition, and children's consumption of homecooked and restaurant meals during COVID-19. Future work could explore resources that help parents acquire affordable, nutritious food.

Drivers of food acquisition practices in the food environment of peri-urban Hyderabad, India: A qualitative investigation.

This study investigates drivers of food acquisition practices in the food environment of peri-urban Hyderabad, India. We used a multi-method qualitative methodology that included in-depth interviews (n = 18) and an innovative qualitative geographical information systems (Q-GIS) approach, featuring participatory photo mapping and follow-up graphic-elicitation interviews (n = 22). Secondary data from eight focus group discussions (n = 94) was used to corroborate findings related to fruits and vegetables. Thematic analysis identified three primary drivers of food acquisition practices among adults: 1) Food prices and affordability; 2) Vendor and product properties, including (a) quality and freshness, and (b) adulteration and contamination; and 3) Social capital. Drivers of food acquisition and consumption among children and adolescents were a key concern for our participants, and included food availability and accessibility, desirability, and convenience. Findings reveal a need for targeted interventions in external and personal food environments to improve diets, nutrition, and health in this setting.

A Proposed Research Agenda for Promoting Healthy Retail Food Environments in the East Asia-Pacific Region.

PURPOSE OF REVIEW: This paper aimed to summarise existing literature on strategies to improve the healthiness of retail food environments in the East Asia and Pacific (EAP) region, and propose a prioritised research agenda on this topic. RECENT FINDINGS: Little research on retail food environments has been conducted in the EAP region. Several approaches for measuring retail food environments were identified, although none have been tailored to the EAP context. A small number of policies and initiatives to promote healthy retail food environments have been implemented in EAP. Lessons learnt from successful implementation of initiatives in other regions could be applied in EAP. Retail food environments have a strong influence on food choices and health outcomes. Research can contribute to efforts to improve the healthiness of retail food environments in EAP by (1) describing the current state of retail food environments to highlight areas of good practice and concern and (2) identifying policies and initiatives that are likely to be effective, and mechanisms for their successful implementation.

More Frequent Food Shopping May Promote Fruit and Vegetable Intake: A Systematic Review.

BACKGROUND: Food shopping frequency may be an important modifiable factor related to increasing fruit and vegetable (FV) intake. Because of mixed findings of individual studies of shopping frequency, a systematic review is needed to examine findings across studies and store types. OBJECTIVE: To conduct a systematic review of articles examining the relationship between frequency of food shopping and FV intake including examination of participation in federal nutrition assistance programs on FV intake, if reported. METHODS: A search, guided by the Preferred Reported Items for Systematic Reviews and Metanalyses, using terms related to FV consumption and food shopping across 4 online databases, was conducted. Studies conducted in the US and published through October, 2020, included adults, and had a cross-sectional, longitudinal, cohort, or randomized study design were eligible for inclusion. RESULTS: Twenty-four articles were included. The majority of studies found at least 1 positive finding between the frequency of food shopping and FV intake, indicating that as the frequency of food shopping increased, FV intake increased. In studies with 100% participation in government/federal nutrition assistance programs, participation was associated with FV intake. Studies that included participation as a subset found participation not associated with FV intake. IMPLICATIONS FOR FUTURE RESEARCH AND PRACTICE: The frequency of shopping may be modifiable to increase FV intake. Experimental research is needed to test the directionality and causality of the relationship. Federal nutrition assistance programs may be a logical place to test the relationship through the adjustment of fund disbursements.

Identifying a Fine Line between Food Insecurity and Food Acquisition Stress: A Mixed Methods Exploration.

This study introduces the concept of Food Acquisition Stress (FAS), stress associated with food acquisition among those who do not necessarily screen positive for food insecurity.. This study used an exploratory sequential mixed methods approach among a sample of predominantly early childhood educators to develop a 7-item tool for measuring current and retrospective FAS. Using this tool, we identified that 61% of individuals who had FAS did not meet criteria for food insecurity. Capturing FAS, even among those categorized as food secure, has the potential to identify individuals who may need supportive interventions. Future research can explore how FAS is related to health behaviors.

Effects of artificial light at night and predator cues on foraging and predator avoidance in the keystone inshore mollusc Concholepas concholepas.

The growth of Artificial Light At Night (ALAN) is potentially having widespread effects on terrestrial and coastal habitats. In this study we addressed both the individual effects of ALAN, as well as its combined effect with predation risk on the behaviour of Concholepas concholepas, a fishery resource and a keystone species in the southeastern Pacific coast. We measured the influence of ALAN and predation risk on this mollusc's feeding rate, use of refuge for light and crawling out of water behaviour. These behavioural responses were studied using light intensities that mimicked levels that had been recorded in coastal habitat exposed to ALAN. Cues were from two species known to prey on C. concholepas during its early ontogeny: the crab Acanthocyclus hassleri and the seastar Heliaster helianthus. The feeding rates of C. concholepas were 3-4 times higher in darkness and in the absence of predator cues. In contrast, ALAN-exposed C. concholepas showed lower feeding activity and were more likely to be in a refuge than those exposed to control conditions. In the presence of olfactory predator cues, and regardless of light treatment, C. concholepas tended to crawl-out of the waterline. We provide evidence to support the hypothesis that exposure to either ALAN or predation risk can alter the feeding behaviour of C. concholepas. However, predator cue recognition in C. concholepas was not affected by ALAN in situations where ALAN and predator cues were both present: C. concholepas continued to forage when predation risk was low, i.e., in darkness and away from predator cues. Whilst this response means that ALAN may not lead to increased predation mortality in C. concholepas, it will reduce feeding activity in this naturally nocturnal species in the absence of dark refugia. Such results may have implications for the long-term health, productivity and sustainability of this keystone species.

Food Acquisition and Daily Life for U.S. Families with 4-to 8-Year-Old Children during COVID-19: Findings from a Nationally Representative Survey.

Evidence of short-term impacts of the coronavirus disease 2019 (COVID-19) pandemic on family life is emerging. Continued research can shed light on potential longer-term impacts. An online survey of U.S. parents with 4- to 8-year-old children (n = 1000) was administered in October 2020. The survey examined parent-reported impacts of COVID-19 on lifestyle (e.g., work, child-care, grocery shopping), as well as current family food acquisition and eating behaviors (e.g., cooking, restaurant use). Descriptive statistics were calculated, incorporating sampling weights based on sociodemographics. In terms of COVID-19 impacts, parents reported increases in working from home, decreased work hours, and increased child care and instruction, with most children attending school or receiving care at home. Parents reported increased home cooking and online grocery shopping; only 33% reported increased take-out or delivery from restaurants. About half of parents reported that their child dined at restaurants, 62% reported getting take-out, and 57% reported delivery from restaurants at least 2-3 times per month. About half viewed dining at restaurants as safe, while take-out and delivery were seen as safe by around three-quarters. Approximately two-thirds reported recent food insecurity. These nationally-representative results illustrate possible longer-lasting shifts in family life, with the potential to impact health and well-being. Sociodemographic differences and research and policy implications are discussed.

Food security and alternative food acquisition among US low-income households: results from the National Food Acquisition and Purchasing Survey (FoodAPS).

OBJECTIVE: To determine the characteristics of US low-income households that use alternative food acquisition strategies and to examine the association between food security and alternative food acquisition. DESIGN: Cross-sectional analysis. The ten-item Adult Food Security Survey Module was used to determine food security status. Self-reported data were used to determine food acquisition from community food sources, social networks and household food production. SETTING: The National Food Acquisition and Purchasing Survey (FoodAPS), 2012. PARTICIPANTS: The sample consisted of 2534 low-income households (≤185 % of the federal poverty line) in the USA. RESULTS: Households using alternative food acquisition strategies were more likely to have a primary respondent who was non-Hispanic White, born in the USA, and female, and more likely to live in a rural area, have higher income and own a home than households not using alternative acquisition strategies. Very low food security was positively associated with the use of community food sources (aOR = 2·26 (95 % CI 1·15, 4·46)). There was no association between food security and food acquisition from social networks or household food production. CONCLUSIONS: Use of alternative food acquisition strategies varied by specific demographic characteristics among low-income households, suggesting opportunities for outreach and promotion of alternative acquisition strategies in specific subpopulations in the USA. Future research should examine whether quantity and quality of food received from these sources are associated with food security.

Food Acquisition Behaviors and Perceptions of Food Pantry Use among Food Pantry Clients in Rural Appalachia.

Rates of food insecurity vary highly across and within regions in the U.S., with rural Appalachia having higher rates compared to the rest of the country, leading parts of the population to rely on food pantries as a source of food. This article explores how food pantries fit into a broader scope of food acquisition strategies of rural Appalachian households and aims to contextualize this with an understanding of how food pantry users perceive their food pantry use. Semi-structured interviews (n=20) were conducted with food pantry users in Eastern Tennessee, followed by a survey for collection of demographic data. NVivo 11.4 software was used for thematic analysis and theory formulation. In addition to pantry use, participants reported reliance on grocery stores, and reciprocal, informal, food-sharing social networks to get food. Lack of transportation, insufficient food quantity, and other factors depleted participants' food resources. Food stretching, refusing to waste food, acceptability of food pantry food, and money-saving strategies enhanced participants' food resources. Food pantries are a consistent, but not the only food source for those who use them. Food pantry users are savvy with their resources and employ multiple strategies to maintain their food supply despite high levels of food insecurity.

Globalização e Processamento de Alimentos: Consumo Alimentar no Nordeste Brasileiro / Globalization and Food Processing: Food Consumption in Northeastern Brazil

Introdução: O atual modelo globalizado de produção de alimentos acarreta homogeneização na alimentação, com diminuição no consumo de alimentos in natura e grande participação de ultraprocessados. Objetivo: Investigar os fatores associados ao consumo alimentar de adultos, considerando os níveis de processamento de alimentos. Métodos: Estudo transversal com adultos no estado de Pernambuco que avaliou o consumo alimentar e variáveis socioeconômicas, demográficas, segurança alimentar e outras relacionadas ao modo e prática de aquisição de alimentos. Foi utilizado questionário de frequência alimentar para investigação do consumo, com divisão dos alimentos conforme o nível de processamento, com posterior análise através de escores. Avaliou-se a associação entre consumo alimentar e variáveis explicativas através dos testes "U" de Mann Whitney e Kruskal Wallis, com aplicação, neste último caso, do teste "U" de Mann Whitney a posteriori. Foram consideradas estatisticamente significantes associações com valor de p<0,05. Resultados: Foram entrevistados 1.066 adultos, cuja maioria possuía baixa escolaridade, baixa renda, com participação em programa de transferência de renda e em situação de insegurança alimentar. Essas variáveis mostraram associação com o consumo de determinados grupos alimentares. Também foram observadas diferenças no consumo conforme características como local de moradia, sexo, faixa etária, modo de aquisição de alimentos, local de compra e hábito de leitura do rótulo. Conclusões: Diante do contexto globalizado de estímulo aos industrializados, aspectos como gênero, condições econômicas, local de moradia, ambiente e práticas de compra de alimentos podem se mostrar como protetores para maior consumo de alimentos minimamente processados ou de risco para o consumo de ultraprocessados.

Introduction: The current globalized model of food production leads to the homogenization of diet, with a reduction in the consumption of unprocessed foods and the considerable participation of ultra-processed foods. Objective: Investigate factors associated with food consumption among adults considering the degree of food processing. Methods: A cross-sectional study was conducted with adults in the state of Pernambuco involving the assessment of food consumption. Data were also collected on sociodemographic characteristics, food insecurity and aspects related to food acquisition. A food frequency questionnaire was used to investigate food intake, with the categorization of foods according to the degree of processing and the subsequent analysis of consumption scores. Associations between food consumption and explanatory variables were evaluated using the Mann-Whitney U test and Kruskal- Wallis test, the latter of which was complemented with the post hoc Mann-Whitney U test. Associations with a p-value <0.05 were considered statistically significant. Results: One thousand sixty-six adults were interviewed. Most had a low level of schooling and low income, were beneficiaries of the income transfer program and were in a situation of food insecurity. These variables were associated with the consumption of particular food groups. Differences in consumption were found according to place of residence, sex, age group, mode of food acquisition, place of purchase and the habit of reading food labels. Conclusions: In the globalized context that stimulates the consumption of industrialized foods, aspects such as sex, economic status, place of residence and food purchasing environment and practices can serve as protective factors that ensure the greater consumption of minimally processed foods or risk factors for the consumption of ultra-processed foods products.

Imbricadas entre as dimensões de acesso e exposição: práticas alimentares de mães na Amazônia ocidental brasileira / Intertwined between the dimensions of access and exposure: eating practices of mothers living in the western Brazilian Amazon

Resumo Este estudo investigou como as condições socioeconômicas de mães que residem na área urbana de Cruzeiro do Sul, Acre, interagem com o acesso a alimentos, tendo como foco as motivações envolvidas nas escolhas dos locais de aquisição de alimentos e dos tipos de alimentos adquiridos. Os métodos de produção de dados empregados foram a entrevista em profundidade e observação participante com 20 mulheres, posteriormente classificadas em diferentes grupos socioeconômicos. A partir de análise de conteúdo identificamos quatro principais fatores considerados pelas participantes para pensar os alimentos e seus locais de aquisição: preço, variedade, praticidade e estratégias. Nossos resultados apontam que disparidades socioeconômicas influenciam o acesso a alimentos por meio da valorização de alguns aspectos em detrimento de outros no processo de escolha alimentar, culminando em distintas motivações e formas de aquisição de alimentos. Logo, em um nível local, o acesso aos locais de compra e a aquisição de alimentos são fortemente influenciados pelas condições socioeconômicas, fazendo com que as práticas alimentares de grupos socioeconômicos díspares se diferenciem de forma polarizada, como a valorização de alimentos regionais e a distinção destes em relação aos alimentos "de fora".

Abstract This study investigated how the socioeconomic status of mothers living in Cruzeiro do Sul, Acre relates to food access, focusing on the interactions between socioeconomic status and motivations in the process of food choice and food acquisition. Thus the methodological approach chosen to collect data were in-depth interviews and participant observation with 20 women, which were later classified into different socioeconomic status groups. Through a content analysis method, we identified four main factors that mothers considered in the food choice and food acquisition processes: Price, Variety, Convenience, and Strategies. Our results emphasize that socioeconomic inequality influences food access through enhancing some aspects above others in the food choice process, ensuing in different motivations and ways to purchase food. Therefore, on a local level, access to food stores and food acquisition is deeply influenced by socioeconomic status, hence the different socioeconomic status groups' eating practices contrasting very much polarized, such phenomenon is seen by the regional food valorization and the distinction of the regional food compared to the "outside" food.

Sociodemographic Differences in the Dietary Quality of Food-at-Home Acquisitions and Purchases among Participants in the U.S. Nationally Representative Food Acquisition and Purchase Survey (FoodAPS).

Insufficient research has explored whether sociodemographic differences in self-reported, individual-level diet quality are similarly reflected by grocery purchase quality. This cross-sectional analysis of n = 3961 U.S. households from the nationally representative Food Acquisition and Purchase Survey (FoodAPS) compared Healthy Eating Index (HEI)-2015 scores from 1 week of food-at-home acquisitions across self-reported demographic factors (race/ethnicity, Supplemental Nutrition Assistance Program (SNAP) participation, food security, and household-level obesity status). Multivariable-adjusted, survey-weighted regression models compared household HEI-2015 scores across sociodemographic groups. Respondents were primarily White and female, with a mean age of 50.6 years, 14.0% were food insecure, and 12.7% were SNAP-participating. Mean HEI-2015 scores were 54.7; scores differed across all sociodemographic exposures (p < 0.05). Interactions (p < 0.1) were detected between SNAP participation and (1) food insecurity and (2) household-level obesity, and race/ethnicity and (1) household-level obesity. HEI-2015 scores were higher among food secure, non-SNAP households than among food insecure, SNAP-participating households (53.9 ± 0.5 vs. 50.3 ± 0.7, p = 0.007); non-SNAP households without obesity had significantly higher HEI-2015 scores than other households. Household-level obesity was associated with lower HEI-2015 scores in White (50.8 ± 0.5 vs. 52.5 ± 0.7, p = 0.046) and Black (48.8 ± 1.5 vs. 53.1 ± 1.4, p = 0.018) but not Hispanic households (54.4 ± 1.0 vs. 52.2 ± 1.2, p = 0.21). Sociodemographic disparities in household HEI-2015 scores were consistent with previous research on individual-level diet quality.

Fruit and Vegetable Purchasing Patterns and Supplemental Nutrition Assistance Program Participation: Findings From a Nationally Representative Survey.

BACKGROUND: Previous studies suggest that Supplemental Nutrition Assistance Program (SNAP) participants purchase less produce than nonparticipants. Whether this is due to buying smaller amounts or to being less likely to buy any produce is unclear. Purchase patterns may also differ over the monthly distribution cycle. OBJECTIVE: To examine differences in the likelihood and amounts of fruits and vegetables purchased between SNAP household compared with nonparticipant households and to determine differences in produce purchases among SNAP households at different time points in the monthly distribution cycle. DESIGN: Cross-sectional. PARTICIPANTS/SETTING: Data from 4708 households in the National Household Food Acquisition and Purchase Survey (April 2012 to January 2013). Participants recorded all foods acquired over 7 days. MAIN OUTCOME MEASURES: Fruits and vegetables acquired over a 7-day period. STATISTICAL ANALYSES PERFORMED: Weighted logistic and linear regression models adjusting for household and primary respondent characteristics were used to compare odds of purchasing fruits and vegetables and amounts purchased across 3 categories: SNAP participants, SNAP-eligible nonparticipants, and ineligible nonparticipants. SNAP participants were further subdivided according to weeks since last receiving benefits. RESULTS: In adjusted analyses, SNAP participants and nonparticipants were similarly likely to purchase fruits and vegetables. However, SNAP households within a week of receiving benefits were more likely than SNAP households later in the benefit cycle to buy fruit overall, especially frozen or canned fruit, and vegetables overall, including fresh, frozen or canned, starchy, and nonstarchy vegetables (fruit odds ratio [OR] 1.68, 95% confidence interval [CI] 1.12, 2.53; vegetable OR 1.63, 95% CI 1.04, 2.55 vs households in middle of cycle). In contrast, those in the last week of the benefit cycle were less likely to purchase fruit, especially fresh fruit, and vegetables, especially fresh and nonstarchy vegetables (fruit OR 0.58, 95% CI 0.35, 0.94; vegetable OR 0.58, 95% CI 0.42, 0.79 vs. households in middle of cycle), and when they bought vegetables, they bought significantly less. CONCLUSION: Considering all SNAP households together at different points in their distribution cycle masks substantial declines in purchasing fruits and vegetables over the monthly cycle.

Supplemental Nutrition Assistance Program participation and current restricted food expenditures: implications for policy.

OBJECTIVE: National concerns over food insecurity and obesity have prompted legislation seeking to further restrict Supplemental Nutrition Assistance Program (SNAP) purchases. The objective of this study is to provide insight on the potential impact of proposed purchase restrictions by comparing SNAP participant and income-eligible non-participants' expenditures on current SNAP-restricted foods, that is, hot foods, prepared foods, alcohol, vitamins and meal supplements. DESIGN: Cross-sectional study. Bivariate analysis and multivariable regression analysis with an instrumental variables approach were employed to compare the probability of purchasing and expenditures on current SNAP-restricted foods among SNAP participants and income-eligible non-participants. SETTING: National Household Food Acquisition and Purchase Survey, 2012-2013. PARTICIPANTS: 2513 households, of which 1316 were SNAP participants and 1197 were income-eligible non-participants. RESULTS: Both the share of households purchasing and household expenditures on current SNAP-restricted foods were similar among SNAP participants and income-eligible non-participants. CONCLUSIONS: Results provide further empirical evidence that proposed SNAP purchase restrictions on sugar-sweetened beverages, snack foods and luxury foods are unlikely to have a meaningful effect on SNAP household food purchases.