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American Academy of Pediatrics
Article

Associations of Food Stamp Participation With Dietary Quality and Obesity in Children

Cindy W. Leung, Susan J. Blumenthal, Elena E. Hoffnagle, Helen H. Jensen, Susan B. Foerster, Marion Nestle, Lilian W.Y. Cheung, Dariush Mozaffarian and Walter C. Willett
Pediatrics March 2013, 131 (3) 463-472; DOI: https://doi.org/10.1542/peds.2012-0889
Cindy W. Leung
aDepartments of Nutrition, and
bEpidemiology, Harvard School of Public Health, and
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Susan J. Blumenthal
cHealth and Medicine Program, Center for the Study of the Presidency and Congress, Washington, District of Columbia;
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Elena E. Hoffnagle
cHealth and Medicine Program, Center for the Study of the Presidency and Congress, Washington, District of Columbia;
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Helen H. Jensen
dDepartment of Economics, Iowa State University, Ames, Iowa; and
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Susan B. Foerster
cHealth and Medicine Program, Center for the Study of the Presidency and Congress, Washington, District of Columbia;
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Marion Nestle
eDepartment of Nutrition, Food Studies and Public Health, New York University, New York, New York
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Lilian W.Y. Cheung
aDepartments of Nutrition, and
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Dariush Mozaffarian
bEpidemiology, Harvard School of Public Health, and
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Walter C. Willett
aDepartments of Nutrition, and
bEpidemiology, Harvard School of Public Health, and
fHarvard Medical School, Boston, Massachusetts;
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Abstract

OBJECTIVE: To determine if obesity and dietary quality in low-income children differed by participation in the Supplemental Nutrition Assistance Program (SNAP), formerly the Food Stamp Program.

METHODS: The study population included 5193 children aged 4 to 19 with household incomes ≤130% of the federal poverty level from the 1999–2008 NHANES. Diet was measured by using 24-hour recalls.

RESULTS: Among low-income US children, 28% resided in households currently receiving SNAP benefits. After adjusting for sociodemographic differences, SNAP participation was not associated with a higher rate of childhood obesity (odds ratio = 1.11, 95% confidence interval [CI]: 0.71–1.74). Both SNAP participants and low-income nonparticipants were below national recommendations for whole grains, fruits, vegetables, fish, and potassium, while exceeding recommended limits for processed meat, sugar-sweetened beverages, saturated fat, and sodium. Zero percent of low-income children met at least 7 of 10 dietary recommendations. After multivariate adjustment, compared with nonparticipants, SNAP participants consumed 43% more sugar-sweetened beverages (95% CI: 8%–89%), 47% more high-fat dairy (95% CI: 7%, 101%), and 44% more processed meats (95% CI: 9%–91%), but 19% fewer nuts, seeds, and legumes (95% CI: –35% to 0%). In part due to these differences, intakes of calcium, iron, and folate were significantly higher among SNAP participants. Significant differences by SNAP participation were not evident in total energy, macronutrients, Healthy Eating Index 2005 scores, or Alternate Healthy Eating Index scores.

CONCLUSIONS: The diets of low-income children are far from meeting national dietary recommendations. Policy changes should be considered to restructure SNAP to improve children’s health.

KEY WORDS
  • Supplemental Nutrition Assistance Program
  • Food Stamps
  • nutrition
  • diet quality
  • children
  • Abbreviations:
    AHEI —
    Alternate Healthy Eating Index
    CI —
    confidence interval
    FPL —
    federal poverty level
    HEI —
    Healthy Eating Index
    HR —
    household reference person
    OR —
    odds ratio
    RD —
    relative difference
    SNAP —
    Supplemental Nutrition Assistance Program
    SSBs —
    sugar-sweetened beverages
    USDA —
    US Department of Agriculture
    • Accepted November 2, 2012.
    • Copyright © 2013 by the American Academy of Pediatrics

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    Associations of Food Stamp Participation With Dietary Quality and Obesity in Children
    Cindy W. Leung, Susan J. Blumenthal, Elena E. Hoffnagle, Helen H. Jensen, Susan B. Foerster, Marion Nestle, Lilian W.Y. Cheung, Dariush Mozaffarian, Walter C. Willett
    Pediatrics Mar 2013, 131 (3) 463-472; DOI: 10.1542/peds.2012-0889

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    Associations of Food Stamp Participation With Dietary Quality and Obesity in Children
    Cindy W. Leung, Susan J. Blumenthal, Elena E. Hoffnagle, Helen H. Jensen, Susan B. Foerster, Marion Nestle, Lilian W.Y. Cheung, Dariush Mozaffarian, Walter C. Willett
    Pediatrics Mar 2013, 131 (3) 463-472; DOI: 10.1542/peds.2012-0889
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