Determinants of diet quality and weight status of women participating in the Supplemental Nutrition Assistance Program

The purpose of this research was to analyze the monthly dietary and food expenditure patterns of women participating in the Supplemental Nutrition Assistance Program (SNAP). The secondary goal was to identify factors that influence weight status of women in SNAP. In Study 1, a 95-item, semi-quantitative food frequency questionnaire based on a 1-week reference period was developed. It was validated against 3-day diet records in a sample of 70 female SNAP participants. The food frequency questionnaire was administered again after one month in a subgroup of 40 women to evaluate its test-retest reliability. Mean daily nutrient intakes obtained from the two tests of the 95-item food frequency questionnaire, and 3-day diet records were calculated. The average correlation and weighted Cohen’s kappa for the validity study were 0.60 and 0.39, respectively. The mean correlation and kappa statistics for the reliability study were 0.66 and 0.50, respectively. Thus, the 95-item, 1-week food frequency questionnaire effectively measured diets of women participating in SNAP. In study 2, a sample of 151 SNAP women were administered the 1-week food frequency questionnaire four times, each with an interval of one week, so that it reflected weeks 1, 2, 3 and 4 of the diets of participants. A significant decrease in intakes of fruits, vegetables, whole grains, dairy and total protein foods were observed with an increase in time since receipt of benefits. Moreover, a decline in diet quality towards the end of the SNAP month was determined. In Study 3, 160 women participating in SNAP saved their grocery receipts for one month, and were measured for height and weight. Spending patterns on 29 food categories were determined from the receipts, and compared to the Thrifty Food Plan (TFP) recommendations. Some of the food categories for which the expenditure was significantly greater than the recommendations included: refined grains, red meat, frozen entrees, soft drinks, and sodas, fruit drinks and ades. A greater amount spent on monthly groceries relative to the TFP recommended total cost was significantly associated with higher compliance of spending on low fat dairy, vegetables, whole grains and fruits to the recommendations. In Study 4, 152 women in SNAP completed the multi-dimensional home environmental scale and adult food security module and were measured for height and weight. Multi-dimensional home environmental subscales that were significantly associated with body mass index, and also differed according to food security status were: availability of unhealthy foods at home and neighborhood safety. Factors measured by this scale significantly mediated the relationship between food insecurity and body mass index