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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe Supplemental Nutrition Assistance Program (SNAP) provides federal funds to low-income persons to purchase food to address food insecurity and improve nutrition and health. SNAP has had a substantial antipoverty impact, improved metabolic outcomes, and improved dietary intake and health status, as discussed in this article.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPediatric Nutrition\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENursing\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENutrition Physiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EEndocrinology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Metabolic Syndrome\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPediatric Nutrition\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENursing\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENutrition Physiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe Supplemental Nutrition Assistance Program (SNAP) provides federal funds to low-income persons to purchase food to address food insecurity and improve nutrition and health. About 1 in 7 Americans receive SNAP benefits, with a higher rate in poorer states, and the average monthly household benefit is $275 [US Dept of Agriculture (USDA), Food and Nutrition Service (FNS). \u003Cem\u003ECharacteristics of Supplemental Nutrition Assistance Program Households: Fiscal Year 2012\u003C\/em\u003E. Report No. SNAP-14-CHAR. Alexandria, VA, 2014; USDA, FNS. \u003Cem\u003EBuilding a Healthy America: A Profile of the Supplemental Nutrition Assistance Program\u003C\/em\u003E. Alexandria, VA, 2012]. SNAP has had a substantial antipoverty impact, lifting 5 million Americans higher than the poverty line, including 2 million children, stated James D. Weill, Food Research and Action Center, Washington, DC, USA. In addition to improving food security, SNAP has improved dietary intake and health status, especially among children, and improved metabolic outcomes, he stated. SNAP also has an economic impact in each community, because the funds are spent in the local markets.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ESNAP serves a diverse population, including seniors, persons with disabilities, working families, and the unemployed. About 75% of SNAP households include children, and about 20% a senior or person with disability [USDA, FNS. \u003Cem\u003ECharacteristics of Supplemental Nutrition Assistance Program Households: Fiscal Year 2012\u003C\/em\u003E. Report No. SNAP-14-CHAR. Alexandria, VA, 2014]. Of the households receiving SNAP funds, 83% have a gross income lower than 100% of the federal poverty line, and about 60% are lower than 75% of the federal poverty line.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EDespite the benefits and strengths of SNAP, improvements are needed to improve the nutrition and health of Americans in terms of sufficient food and its quality. Lisa Harnack, DrPH, RD, University of Minnesota, Minneapolis, Minnesota, USA, noted that the diet consumed by participants of SNAP is less consistent with dietary guidelines compared with the diets of other low-income and higher-income Americans, based on a number of surveys and cross-sectional analyses. Weill stated that a recent research summary from the USDA found that participants in SNAP value nutrition as much as nonparticipants, but that time and money constraints complicate the task of making healthy food choices [Mancino L, Guthrie J. \u003Cem\u003EAmber Waves\u003C\/em\u003E. 2014. \u003Ca href=\u0022http:\/\/www.ers.usda.gov\/amber-waves#.VGtOWGe-3-0\u0022\u003Ehttp:\/\/www.ers.usda.gov\/amber-waves#.VGtOWGe-3-0\u003C\/a\u003E. Accessed Nov 18, 2014].\u003C\/p\u003E\u003Cp\u003EWeill stated that strategies to improve SNAP include:\n\u003C\/p\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n               \u003Cp id=\u0022p-6\u0022\u003EEnsuring all eligible persons receive SNAP benefits (1 in 5 do not)\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n               \u003Cp id=\u0022p-7\u0022\u003EEnsuring a full entitled benefit per participant\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n               \u003Cp id=\u0022p-8\u0022\u003EIncreasing the monthly benefit\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n               \u003Cp id=\u0022p-9\u0022\u003EIncreasing the availability of stores with SNAP-eligible foods\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n               \u003Cp id=\u0022p-10\u0022\u003EProviding nutrition education\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-6\u0022\u003E\n               \u003Cp id=\u0022p-11\u0022\u003EConducting research to identify successful nutrition education programs\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\u003Cp\u003E\n      \u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EThe gains made by increasing the monthly benefit were shown by a natural demonstration project, that is, the increased SNAP benefit of 13.6% from 2009 to 2013 as a result of the American Recovery and Reinvestment Act [USDA, Economic Research Service. \u003Cem\u003EFood Security Improved Following the 2009 ARRA Increase in SNAP Benefits\u003C\/em\u003E, Economic Research Report No. 116. Washington, DC, 2011]. Food insecurity and very low food insecurity were each reduced by 2 percentage points, participants ran out of funds later in the month, the number of monthly food transactions increased, and parents reported the health of their young children was better, stated Weill. More research is needed to fully understand the impact of the increased monthly benefit.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EIncreasing the consumption of fruits and vegetables is a goal to increase the nutrition and health of participants of SNAP. Among the programs evaluating such strategies is the Healthy Incentives Pilot (HIP) by the USDA and the Grocery Assistance Program Study (GAPS) by the University of Minnesota.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EHIP tested whether financial incentives at the point of sale increased the consumption of targeted fruit and vegetables (TFV) [USDA, FNS. \u003Cem\u003EEvaluation of the Healthy Incentives Pilot (HIP): Final Report\u003C\/em\u003E. Alexandria, VA, 2014]. Participants received a 30% incentive as a credit to their SNAP account for the purchase of TFV, defined as fresh, frozen, canned, or dried fruits and vegetables without added sugar, salt, or oils. Juice, white potatoes, and mature legumes were excluded. HIP randomized 9286 adults to the HIP group and 59 652 adults to the non-HIP group, and interviews were conducted with a subset from each group at 3 different times during the study that was conducted between July 2001 and December 2012.\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EThe HIP group, compared with the non-HIP group, consumed 0.24 more cup-equivalents per day of TFV (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .01). This modest effect was a substantial relative increase when considered in relation to the low TFV intake by Americans and participants of SNAP in general, stated Parke Wilde, PhD, Tufts University, Medford, Massachusetts, USA. Based on purchases of TFV at SNAP-participating centers, the average incentive was $3.65, which was lower than anticipated. However, participants in the HIP group reported an overall increase in FV purchases (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E); thus, it is believed that purchases were also made at SNAP nonparticipating centers. Regardless of the proximity of supermarkets, where 78.6% of the SNAP funds in HIP were spent, the purchase of TFV increased by about $11 to $13.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/47\/22\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Monthly Purchases of Fruit and Vegetables by HIP Participants\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-699704243\u0022 data-figure-caption=\u0022Monthly Purchases of Fruit and Vegetables by HIP Participants\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/47\/22\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/47\/22\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/47\/22\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15553\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-16\u0022 class=\u0022first-child\u0022\u003EMonthly Purchases of Fruit and Vegetables by HIP Participants\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EEBT, electronic benefit transfer; HIP, Healthy Incentives Pilot; SNAP, Supplemental Nutrition Assistance Program; TFV, targeted fruits and vegetables.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EUnited States Department of Agriculture. Food and Nutrition Service. \u003Cem\u003EHealthy Incentives Pilot Final Evaluation Report\u003C\/em\u003E. Exhibit. ES.2, page 5. September 18, 2014. \u003Ca href=\u0022http:\/\/www.fns.usda.gov\/healthy-incentives-pilot-final-evaluation-report\u0022\u003Ehttp:\/\/www.fns.usda.gov\/healthy-incentives-pilot-final-evaluation-report\u003C\/a\u003E. Accessed November 26, 2014.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-17\u0022\u003EThe ongoing GAPS is evaluating the independent and combined effects on dietary intake of prohibiting the purchase of foods high in discretionary calories (sugar-sweetened beverages, sweet baked goods, and candy) with SNAP benefits and incentivizing (30% credit) the purchase of FV.\u003C\/p\u003E\u003Cp id=\u0022p-18\u0022\u003EA total of 320 low-income adults who are not SNAP participants will be randomized in 3 different waves after a 1-month baseline period to 1 of 4 study arms: control (usual SNAP usage), restricted benefit, FV incentive, and restricted benefit plus FV incentive. The follow-up is 3 months.\u003C\/p\u003E\u003Cp id=\u0022p-19\u0022\u003EOf the 135 participants to date, 80.3% are women, 53% are African American, and 9% are Hispanic or Latino. The proportions who are overweight or obese is 26% and 55%, respectively. The proportion with low and very low food security is 33% and 48%; past participation in SNAP is 52%, and it is 12% for the Women, Infants, and Children nutrition program (current participation is 10%). Emergency food assistance was used by 54% in the previous 12 months. Adherence to the experimental procedures is fair, with the mean number of infractions reduced from 1.18 for month 1 to 0.87 for month 3.\u003C\/p\u003E\u003Cp id=\u0022p-20\u0022\u003EThe feasibility of the GAPS methodology of a mock food-assistance program to study proposed modifications to SNAP has been demonstrated, said Dr Harnack. However, some methodology issues may be the external validity of the study, because the sample may not be representative of households that participate in SNAP. Also, only 1 benefit level is being studied, but SNAP has lower and higher levels. The short duration of exposure (3 months) is limited, and long-term results may differ.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/47\/22.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlw42\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlw42\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}