Association for Public Policy Analysis & Management

In the US, federal policy has begun to focus on the food environment as a mediating factor in health and diet.  Included in policy efforts are those that explicitly link the food environment to diet, such as the Food Insecurity Nutrition Incentive Program and Healthy Food Incentive Financing Program.  Food environments have gained attention primarily as a result of low-income communities have less access to healthy foods, predominately due to fewer supermarkets and more convenience stores, resulting in higher prices as well as a lower quantity and quality of available foods. These food environments have been associated with poor mental and physical health outcomes, such as greater levels of stress and obesity.  Recent research has demonstrated links between SNAP participation and better dietary and health-related outcomes (C. Gregory, Ver Ploeg, Andrews, & Coleman-Jensen, 2013; C. A. Gregory & Deb, 2015).  But research demonstrating that the food environment is a mediating factor in diets and health outcomes has been mixed.  

That leads us to our research question:   What is the impact of the immediate food environment on the sourcing of food and resultant diet and nutrition intake?  To answer our question, we use the 2011-2012 NHANES geocoded database which contains the location and dietary recall data for 4,801 adults.  We evaluate the 24-hour dietary recall data to assess the food sources (including 10 retail, non-retail and institutional food source types) and quantities of nutrients consumed by USDA food categories. The 15 food categories are based on the What We Eat in America (WWEA) categories, providing a method to analyze American diets.  We report the proportional contribution of food sources to energy, discretionary solid fats and added sugars by SNAP participation status (SNAP participants, SNAP-eligible non-participants, and non-eligible).  Next, using two standard measures of the food environment at the census tract level -- the USDA Food Access Research Atlas and the CDC Modified Retail Food environment index – we statistically examine through hierarchical modeling the contribution of the environment to overall diet and sourcing of foods.

Our work contributes to the on-going debate around SNAP, including what should be an eligible food sources (e.g., should convenience stores qualify to be SNAP authorized) and the role of the food environment in the diets of SNAP participants.  We do this analyzing the What We Eat in America food categories which, we believe, provides s a more realistic way of describing food behavior than a nutrient-reductionist approach.  THE WWEA categories also better align with the dietary patterns approach advocated by the Dietary Guidelines committee.  Finally, we examine diet patterns across the full range of food sources instead of focusing on just one (e.g., supermarkets or supercenters) allowing for a better understanding of food source points of intervention.