title: Moderation of the Relation of County-Level Cost of Living to Nutrition by the Supplemental Nutrition Assistance Program.
abstract: To examine the association of county-level cost of living with nutrition among low-income Americans.
  
  
  
  We used the National Household Food Acquisition and Purchase Survey (2012-2013; n = 14 313; including 5414 persons in households participating in the Supplemental Nutrition Assistance Program [SNAP]) to examine associations between county-level cost-of-living metrics and both food acquisitions and the Healthy Eating Index, with control for individual-, household-, and county-level covariates and accounting for unmeasured confounders influencing both area of living and food acquisition.
  
  
  
  Living in a higher-cost county-particularly one with high rent costs-was associated with significantly lower volume of acquired vegetables, fruits, and whole grains; greater volume of acquired refined grains, fats and oils, and added sugars; and an 11% lower Healthy Eating Index score. Participation in SNAP was associated with nutritional improvements among persons living in higher-cost counties.
  
  
  
  Living in a higher-cost county (particularly with high rent costs) is associated with poorer nutrition among low-income Americans, and SNAP may mitigate the negative nutritional impact of high cost of living.
authors.affiliation: Sanjay Basu is with the Department of Medicine at Stanford University, Palo Alto, CA. Christopher Wimer is with the Center on Poverty and Social Policy, Columbia University, New York, NY. Hilary Seligman is with the University of California San Francisco's Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Basu
authors.affiliation: Sanjay Basu is with the Department of Medicine at Stanford University, Palo Alto, CA. Christopher Wimer is with the Center on Poverty and Social Policy, Columbia University, New York, NY. Hilary Seligman is with the University of California San Francisco's Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Wimer
authors.affiliation: Sanjay Basu is with the Department of Medicine at Stanford University, Palo Alto, CA. Christopher Wimer is with the Center on Poverty and Social Policy, Columbia University, New York, NY. Hilary Seligman is with the University of California San Francisco's Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA.
authors.forename: Hilary
authors.initials: H
authors.lastname: Seligman
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D004032:Diet / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D063105:Food Assistance / Q000706:statistics & numerical data*; D005523:Food Supply / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data*