title: Improving the Nutritional Impact of the Supplemental Nutrition Assistance Program:: Perspectives From the Participants.
abstract: BACKGROUND
  The Supplemental Nutrition Assistance Program (SNAP) is the largest federal food assistance program designed to alleviate food insecurity and improve dietary intake. This study assessed the opinions of SNAP participants and food-insufficient nonparticipants on their perceptions of the program and strategies to improve its nutritional impact.
  
  
  METHODS
  This study surveyed 387 individuals via Amazon Mechanical Turk, of whom 118 were SNAP participants and 269 were food insufficient but not enrolled in SNAP (nonparticipants). Open-ended questions were coded and analyzed for thematic content. For closed-ended questions, response frequencies were compared using chi-square tests. Data were analyzed in 2016.
  
  
  RESULTS
  SNAP participants reported that the program successfully served its primary purpose: to allow individuals to buy enough food to make ends meet and reduce food insecurity. Importance was placed on buying food for their children/families and the ability to allocate money for other expenses. To improve the nutritional impact, SNAP participants suggested more nutrition education, increasing the benefit allotment, incentivizing healthful foods, and excluding unhealthful foods for purchase with SNAP. When participants and nonparticipants were asked to choose between SNAP and a nutritionally enhanced program combining healthy incentives with exclusions for sugary beverages (i.e., SNAP+), 68% of participants and 83% of nonparticipants chose SNAP+. Of those who initially chose SNAP, 68% of participants and 64% of nonparticipants chose SNAP+ if paired with a 50% increase in total benefits.
  
  
  CONCLUSIONS
  SNAP participants and food-insufficient nonparticipants support policies that facilitate purchases of healthful foods and limit purchases of unhealthful foods, specifically sugary beverages.
authors.affiliation: Center for Health and Community, University of California, San Francisco, San Francisco, California. Electronic address: cindyleung@post.harvard.edu.
authors.forename: Cindy W
authors.initials: CW
authors.lastname: Leung
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Aviva A
authors.initials: AA
authors.lastname: Musicus
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
mesh_terms: D000328:Adult; D002755:Choice Behavior; D005260:Female; D005502:Food / Q000191:economics / Q000592:standards*; D063105:Food Assistance; D005523:Food Supply / Q000191:economics*; D006266:Health Education; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D018673:Nutrition Policy; D009753:Nutritive Value; D011203:Poverty; D011795:Surveys and Questionnaires; D055815:Young Adult