title: The Supplemental Nutrition Assistance Program and dietary quality among US adults: findings from a nationally representative survey.
abstract: OBJECTIVE
  To examine the association of the Supplemental Nutrition Assistance Program (SNAP) and diet quality among low-income adults.
  
  
  METHODS
  We examined US nationally representative data from the National Health and Nutrition Examination Surveys 2003-2004, 2005-2006, 2007-2008, and 2009-2010. The data were analyzed from October 7, 2013, to March 1, 2014. The analytic sample consisted of 4211 low-income adults aged 20 to 64 years, of whom 1830 participate in SNAP. We adhered to the National Cancer Institute method in calculating the Healthy Eating Index 2010 and other dietary indicators, such as empty calorie intake. Bivariate and multivariable regression was used to compare SNAP participants and income-eligible nonparticipants among the full sample and subsamples of age, sex, race/ethnicity, and food insecurity.
  
  
  RESULTS
  Compared with low-income nonparticipants, adjusted analyses reveal that SNAP participants had lower dietary quality scores overall (42.58 vs 44.36, P≤.0001) and lower scores for fruits and vegetables, seafood and plant proteins (1.55 vs 1.77, P≤.0022), and empty calories (9.03 vs 9.90, P≤.0001), but they exhibited comparable scores on whole grain, refined grain, total dairy, total protein, fatty acid, and sodium intakes. The association between SNAP participation and lower dietary quality was statistically significant among women, Hispanics, young adults, and individuals who were food secure.
  
  
  CONCLUSIONS
  Our analyses suggest that SNAP participants have lower dietary quality than their income-eligible nonparticipant counterparts. Although SNAP has an important role in providing nutrition assistance to eligible low-income individuals, interventions are warranted to improve the dietary quality of participants.
authors.affiliation: Intramural Research Department, Economic and Health Policy Research Program, American Cancer Society, Atlanta, GA. Electronic address: binh.nguyen@cancer.org.
authors.forename: Binh T
authors.initials: BT
authors.lastname: Nguyen
authors.affiliation: Intramural Research Department, Economic and Health Policy Research Program, American Cancer Society, Atlanta, GA.
authors.forename: Kerem
authors.initials: K
authors.lastname: Shuval
authors.affiliation: Yale University Prevention Research Center, Grifﬁn Hospital, Derby, CT.
authors.forename: Valentine Y
authors.initials: VY
authors.lastname: Njike
authors.affiliation: Yale University Prevention Research Center, Grifﬁn Hospital, Derby, CT.
authors.forename: David L
authors.initials: DL
authors.lastname: Katz
mesh_terms: D000328:Adult; D004032:Diet / Q000592:standards / Q000706:statistics & numerical data*; D004435:Eating; D005260:Female; D063105:Food Assistance / Q000706:statistics & numerical data; D063427:Food Quality; D005523:Food Supply / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D009765:Obesity / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology; D011203:Poverty / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D055815:Young Adult