Submitted to: Nutrients
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/9/2021
Publication Date: 10/12/2021
Citation: Chen, T.A., Retizel, L.R., Obasi, E.M., Dave, J.M. 2021. Did school meal programs and SNAP participation improve diet quality of US children from low-income households: Evidence from NHANES 2013-2014? Nutrients. 13(10). Article 3574. https://doi.org/10.3390/nu13103574.
DOI: https://doi.org/10.3390/nu13103574

Interpretive Summary: Low-income households or individuals often rely on federal and community food and nutrition assistance programs to meet their dietary needs, and it is not unusual for eligible households to participate in more than one program. Two of the largest federal nutrition assistance programs administered by the Food and Nutrition Service (FNS) of the US Department of Agriculture (USDA) are the Supplemental Nutrition Assistance Program (SNAP, formerly the Food Stamp Program) and the School Meal Programs including National School Lunch Program (NSLP) and School Breakfast Program (SBP). Several studies have examined the relationship of participation in school meal program(s) and/or SNAP alone and diet quality among different populations. However, this is among the first studies that has specifically addressed the relationship between participation in school meals, and school meals + SNAP combined and diet quality (as assessed by the Healthy Eating Index (HEI–2015)) among US children ages 5–18, using the 2013 to 2014 National Health and Nutrition Examination Survey (NHANES) data. It also assessed the differences of diet quality between participating in school meals only, school meals + SNAP, or non-participation among the sample of children. Results indicate that participation in school meals + SNAP was not associated with higher overall diet quality compared to eligible non-participants or school meals only participants. However, school meals + SNAP participants had an improved intake of total dairy, but not for added sugars or total vegetables compared to school meals only. More research is warranted to better understand the complex interplay between nutrition assistance program participation and diet quality for children from low-income families.

Technical Abstract: Nutrition assistance programs such as school meals and the Supplemental Nutrition Assistance Program (SNAP) are designed to provide a safety net for the dietary intake of children from low-income families. However, compared with eligible non-participants, the relationship of diet quality with school meals only and school meals + SNAP is not well understood. The objectives of the study include: (1) To explore whether and to what extent nutrition assistance program participation (school meals only and school meals + SNAP) is related to diet quality; and (2) to examine the differences of diet quality between participating in school meals only, school meals + SNAP, or non-participation among American children. Children aged 5 to 18 years old from income eligible households who participated in the 2013–2014 National Health and Nutrition Examination Survey (NHANES) were included in this cross-sectional study (n=1425). Diet quality was measured using the Healthy Eating Index (HEI)–2015 and its 13 subcomponents. A Rao-Scott Chi-square test, propensity scores approach, and Analysis of Covariance were performed. Covariates included age, sex, race/ethnicity, weight status, and family monthly poverty index. SAS survey procedures were used to incorporate the appropriate sample design weights. Participation in school meals + SNAP was not associated with higher diet quality compared to eligible non-participants or school meals-only participants. Participation in school meals + SNAP improved the intake of total dairy, but not added sugars or total vegetables compared to school meals only. Overall, school meal + SNAP participation did not significantly improve the overall diet quality of children in low-income households relative to comparable non-participants.