Does enrollment in the Supplemental Nutrition Assistance Program (SNAP) encourage families to purchase healthier foods and thereby increase the nutrition of those families enrolled in the program?

To answer this central question, this study will use an event-study design coupled with new, high-scale commercial transaction data from a grocery retailer to provide precise evidence on the effect of SNAP receipt on the amount and composition of food purchases. The study will generate evidence on the effects of SNAP enrollment from early childhood through adulthood.

Medicaid and the Supplemental Nutrition Assistance Program (SNAP) currently comprise nearly a quarter of US expenditures on children. The programs have the potential to significantly reduce health and socioeconomic disparities, yet little is known about the impact of these programs on later generations’ health and well-being. 

This study will investigate multi-generational health impacts of the Medicaid and SNAP programs, focusing on the incidence of obesity and other conditions related to metabolic syndrome, asthma, and immune system functionality. These conditions disproportionately affect low-income children and are some of the most expensive in terms of medical bills.

The researchers will use cross-county variation in the timing of SNAP’s initial roll-out (between 1961 and 1975), and variation across states in the expansion of Medicaid eligibility during the 1980 and 1990s, to identify the multi-generational effects of each program.

If access to Medicaid and SNAP can mitigate the intergenerational transmission of these conditions, it would suggest that current cost-benefit analyses substantially underestimate the true value of these programs.

In response to research on food deserts across the country, scholars and public health practitioners are encouraging limited service food stores, like discount stores, to expand their healthy food selections and accept SNAP and WIC benefits. By becoming WIC-authorized, these stores would be required to carry a certain number of healthy food items, which can improve food access in low-income communities that may lack a full-line grocery store.

In spring 2017, a discount variety store chain began piloting WIC-authorization for 10 of its stores in North Carolina. Interested in learning if this could be an economically viable corporate policy, the chain partnered with researchers at the University of North Carolina at Charlotte to evaluate three key questions:

1. What are the barriers and facilitators to WIC-authorization experienced by the stores?
2. How does WIC-authorization affect the sales of healthy foods and beverages? Do sales patterns vary by tender (WIC, SNAP, cash, credit)?
3. How does WIC-authorization affect the sales of other non-WIC approved items? Do sales patterns vary by tender (SNAP, cash, credit)?

Thousands of discount stores sell food and operate in low-income urban and rural areas with insufficient access to healthy food. If adopting a corporate policy to implement a federal nutrition assistance program presented a sustainable business practice, discount stores could radically improve access to healthy food and beverages for low-income communities.

In 2015, the North Carolina legislature passed “The Healthy Food Small Retailer Program” (HFSRP), allocating $750,000 over three years to small food retailers located in USDA-defined food deserts. These funds could be used to purchase and install refrigeration equipment, display shelving, and other equipment necessary for stocking nutrient-dense foods, including fresh vegetables and fruits, whole grains, lean meats, and seafood.

Despite the policy’s potential to improve individuals’ dietary habits, current evaluation efforts are currently limited to impact on sales. To understand the potential of this policy to improve community-level health outcomes, the research team will conduct a rigorous quasi-experimental study to evaluate:

1. The public health impact of the HFSRP on the food retail environment and weight-related dietary outcomes among customers; and,
2. Store and community-level economic impacts, and overall potential for sustainability.

Healthy small store initiatives are one strategy to provide healthy options in underserved areas, including rural communities. Such initiatives could potentially address the obesity epidemic by providing healthier foods and beverages in small food stores where candy, sugary beverages, and processed foods are often purchased. Evidence on these policies’ effectiveness is critical to determine sustainability for future state-level initiatives.