Food insecurity and participation in food assistance programs may place families at risk for obesity. Secondary data analyses of the 2013-2014 National Health and Nutrition Examination Survey (NHANES) was conducted. Logistic regression analysis results indicated marginal food security was associated with obesity among SNAP (OR = 1.28) and NON-SNAP participants (OR = 1.54). Full food security was associated with obesity among NON-SNAP participants (OR = 1.65). Among both groups, the greater the diet quality the greater the odds of obesity. Policies and programs to improve the nutritional impact of SNAP and targeted interventions to address food security in low-income adults should be implemented.
Recommended Citation
Hill, J. E. (2020, October 1-2). Impact of food assistance programs on food insecurity, diet quality, and obesity [Poster presentation]. Walden University Research Conference 2020 (online). https://scholarworks.waldenu.edu/researchconference/2020/posters/2

Hill, Jessica E.

English

Walden University

R E S E A R C H  C O N F E R E N C E  2 0 2 0Research Leading the Way For The Next 50 YearsP O S T E RP R E S E N TAT I O NOCTOBER 1, 2020Impact of Food Assistance Programs on Food Insecurity, Diet Quality, and ObesityWA L D E N  U N I V E R S I T Y  R E S E A R C H  C O N F E R E N C E  2 0 2 0 2AuthorJessica E. Hill, DrPHGraduateSchool of Health SciencesSupervisory CommitteeMary Lou Gutierrez- ChairEgondu Onyejekwwe- Committee MemberTolulope Osoba- URRAbstractFood insecurity and participation in food assistance programs may place families at risk for obesity. The purpose of this cross-sectional study was to examine the relationship between food insecurity, diet quality and obesity among adults participating in the Supplemental Nutrition Assistance Program SNAP compared to NON-SNAP participants. Significant relationships were found among both groups. Legislators, educators, parents and other stakeholders can use the knowledge from this study to improve the nutritional impact of SNAP to address food insecurity, diet quality and obesity in low-income adults.Doctoral CapstoneWA L D E N  U N I V E R S I T Y  R E S E A R C H  C O N F E R E N C E  2 0 2 0 3ProblemThe Supplemental Nutrition Assistance Program SNAP is the largest food assistance program in the United States. This program is intended to reduce food insecurity and provide benefits to purchase nutritious foods. However, SNAP may have the opposite effect. The association between participation in food assistance programs, food insecurity, diet quality and obesity had mixed results and the association between household food insecurity and weight gain was inconclusive. The gap in knowledge about food insecurity, diet quality and obesity is not well understood.  If food insecurity and diet quality are risk factors that contribute to obesity among SNAP participants compared to NON-SNAP participants, legislators, educators, parents and other stakeholders can use the knowledge from this study to improve the nutritional impact of SNAP to address food insecurity, diet quality and obesity in low-income adults.PurposeThe purpose of this quantitative cross-sectional study was to examine the relationship between food insecurity, diet quality and obesity among SNAP participants compared to NON-SNAP participants. WA L D E N  U N I V E R S I T Y  R E S E A R C H  C O N F E R E N C E  2 0 2 0 4SignificanceObesity in the United States continues to be a significant public health issue.  The impact of food insecurity and diet quality among  adult SNAP participants compared to NON-SNAP participants is not well understood. The association between food insecurity and poor health outcomes for children are well documented; however, there is limited research on food insecurity and chronic disease among adults (Seligman, Laraia & Kushel, 2010).Few studies have examined the association  between food assistance programs, food insecurity, diet quality, and obesity (Nguyen et al., 2015).Theory or FrameworkThe conceptual framework for this study is the social-ecological model (SEM). There are multiple versions of the SEM used in various areas of research including public health adapted from research by Bronfenbrenner’s ecological systems theory.Bronfenbrenner’s 1979 framework examines the complexities of the interaction between individuals and multiple levels of their environment. The basic tenet of the SEM is there are multiple levels of influence on health behavior (Bronefenbrenner, 1979). These levels include intrapersonal, interpersonal, organizational, community, and public policy that influence health behaviors (Glanz, Rimer & Viswanath, 2015, p.48). The most effective health behavior change occurs at multiple levels (Boucher, 2011).WA L D E N  U N I V E R S I T Y  R E S E A R C H  C O N F E R E N C E  2 0 2 0 5Relevant ScholarshipThe relationship between food assistance programs and obesity is not fully understood and studies have been conducted to examine whether participation in the Food Stamp Program also known as SNAP contributes to obesity among its participants (Townsend et al., 2001; Gibson, 2003). It is not fully understood how participation in the SNAP program may increase obesity (Hilmers et al., 2014). Data from the Continuing Survey of Food intake by Individuals (CSFII) from 1994-2004 showed SNAP participants compared to nonparticipants consumed more calories from fats, alcohol and added sugars and made less healthy food choices. Few studies have examined the association  between food assistance programs, food insecurity, diet quality, and obesity (Nguyen et al., 2015).Research QuestionsRQ1: Is there an association between food insecurity and obesity among adults participating in SNAP compared to nonparticipants controlling for socioeconomic and demographic factors?RQ2: Is there an association between diet quality and obesity among adults participating in SNAP compared to nonparticipants controlling for socioeconomic and demographic factors?RQ3: Does poverty mediate the association between food insecurity and obesity among adults participating in SNAP compared to nonparticipants controlling for socioeconomic and demographic variables?RQ4: Is there an association between participating in SNAP, food insecurity, diet quality and obesity?WA L D E N  U N I V E R S I T Y  R E S E A R C H  C O N F E R E N C E  2 0 2 0 6ParticipantsThe final sample size was 10,175 adults 25 years and older. NHANES uses a multistage, cross-sectional sampling design to collect data on the health and nutrition.AnalysisUnivariate analysis was conducted to describe the study population. Bivariate analysis was conducted with obesity as the dependent or outcome variable to identify potential associations among the independent or predictor variables and covariates.Hypothesis testing was conducted using effect modification in RQ 1-3 and  multivariate logistic regression. Hypothesis testing was conducted using multivariate logistic regression for RQ4ProceduresData were obtained from the National Health and Nutrition Examination  Survey (NHANES) conducted between 2013-2014.The independent variables were food insecurity and diet quality. The dependent variable was obesityThe covariates examined were age, sex, race and education.WA L D E N  U N I V E R S I T Y  R E S E A R C H  C O N F E R E N C E  2 0 2 0 7FindingsRQ1: In both SNAP and NON-SNAP participants, there was an association between marginal food security and obesity.RQ2: There is an association between diet quality, and obesity, although this association was not modified by SNAP controlling for socioeconomic and demographic variables.RQ3: No associations were found in the SNAP strata in the poverty levels < 1.31 and 1.31 to 1.85. The multivariate analysis further showed there were no significant interactions in the NON-SNAP strata for poverty levels < 1.31 and 1.31 to 1.85. Finally, an association was found between marginal food security and obesity in poverty level > 1.85 compared to very low food security in the NON-SNAP category compared to the SNAP category controlling for socioeconomic and demographic variables. RQ4: There is an association between participating in SNAP, food insecurity, diet quality and obesity controlling for socioeconomic and demographic variables.WA L D E N  U N I V E R S I T Y  R E S E A R C H  C O N F E R E N C E  2 0 2 0 8InterpretationThe results of this study suggest food insecurity, diet quality and poverty is associated with  obesity among SNAP participant compared with NON-SNAP participants and legislators, educators, parents and other stakeholders can use the knowledge from this study to improve the nutritional impact of SNAP to address food insecurity, diet quality and obesity in low-income adults. LimitationsCross-sectional studies are not able to control for selection bias and confounding variables (DeBono et al., 2012). Since selection of more needy households are enrolled in SNAP, it is difficult to determine causality between SNAP participation and food insecurity Ratcliff et al. (2011).Another limitation to this study was the use of self-reported data. NHANES utilized interviews and physical examinations to access the health of the U.S. population.WA L D E N  U N I V E R S I T Y  R E S E A R C H  C O N F E R E N C E  2 0 2 0 9RecommendationsFurther studies are needed to examine the complex relationship between food insecurity, SNAP participation, diet quality, poverty, and obesity.More longitudinal studies be conducted to address this issue. Some longitudinal studies were able to control for selection bias, SES, and demographic characteristicsSocial Change ImplicationsAdditional knowledge about food insecurity, diet quality and obesity among SNAP participants compared to NON-SNAP participants could lead to positive social change by improving food assistance programs and interventions to address obesity among adults participating in SNAP.WA L D E N  U N I V E R S I T Y  R E S E A R C H  C O N F E R E N C E  2 0 2 0 10BibliographyBoucher, J.L. (2011). The obesity and diabetes epidemic: How do we turn the tide? Diabetes Spectrum, 24(3), 123-124. https://doi.org/10.2337/diaspect.24.3.123Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press DeBono, N.L., Ross, N.A., & Berrang-Ford, L. (2012). Does the Food Stamp Program cause obesity? A realist review and a call for place-based research. Health & Place 18, 747-756. doi:10.1016/j.healthplace.2012.03.002Gibson, D. (2003). Food stamp participation is positively related to obesity in low income women. The Journal of Nutrition, 133(7), 2225-2231. Retrieved from http://jn.nutrition.org/content/133/7/2225.longGlanz, K., Rimer, B. K. , & Viswanath, K. (2015). Health behavior: Theory, Research, and Practice (5th ed.). San Francisco, CA: Jossey-Bass.Hilmers, A., Chen, T. A. , Dave, J. M., Thompson, D., & Cullen K. W. (2014). Supplemental Nutrition Assistance Program participation did not help low income Hispanic women in Texas meet the dietary guidelines. Preventive Medicine, 62, 44-48. https:// doi:1016/jypmed.2014.01.016Nguyen, B. T. , Shuval, K., Bertmann, F., & Yaroch, A. L. (2015). The Supplemental Nutrition Assistance Program, food insecurity, dietary quality, and obesity among US adults. American Journal of Public Health 105(7), 1453- 1459.doi:10.2015/AJPH.2015.302580 WA L D E N  U N I V E R S I T Y  R E S E A R C H  C O N F E R E N C E  2 0 2 0 11BibliographySeligman, H. K. , Laraia, B. A. , & Kushel, M. B. (2010). Food insecurity is associated with chronic disease among low-income NHANES participants. Journal of Nutrition, 140(2), 304-310. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2806885/Ratcliffe, C., McKernan, S. M. , & Zhang, S. (2011). How much does the Supplemental Nutrition Assistance Program reduce food insecurity? American Journal of Agricultural Economics, 93(4), 1082-1098. doi:10.1093/ajae/aar026 Townsend, M. S. , Peerson, J., Love, B., Achterberg, C., & Murphy, S. P. (2001). Food insecurity is positively related to overweight in women. The Journal of Nutrition, 131, 1738-1745. https://jn.nutrition.org/content/131/6/1738.long

Impact of Food Assistance Programs on Food Insecurity, Diet Quality and Obesity

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Impact of Food Assistance Programs on Food Insecurity, Diet Quality and Obesity

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