1. Lilly Nhan MPH Capstone Spring 2018
Participation in WIC, NSLP, and SBP among Children in SNAP and Dietary Quality
Introduce myself & topic
Lilly Nhan
MPH Capstone
Spring 2018

2. SNAP
WIC
NSLP/SBP
Provides food packages, nutrition education, referrals to other health services
Available to pregnant/post-partum women, infants, and children up to age 5 at nutritional risk
Provides monthly benefits for households to purchase food
Available to people of all ages
Provides nutritionally balanced meals each school day
Available to school age children
(grades PreK – 12)
Supplemental Nutrition Assistance Program (SNAP)
Special Supplemental Nutrition Program for Women, Infants and Children (WIC)
National School Lunch Program (NSLP)
School Breakfast Program (SBP)
SNAP participants automatically meet income requirements for WIC and NSLP/SBP
WIC Package Revisions, 2009:
Increase in the benefit allotment for fruits and vegetable
Expand whole grain and low-fat dairy options.
HHFKA passed in 2010
Major changes to meal nutrition standards:
Increase fruit, vegetable, low-fat dairy and whole grain offerings
Students must take a fruit or vegetable
Calorie ranges, saturated fat limits, trans fat limits

3. Research Question
Primary: Is participation in multiple federal nutrition assistance programs (i.e., WIC, NSLP, SBP) among children in SNAP associated with differences in diet quality? Secondary: For school age-children, does dietary quality differ by years pre- and post-HHFKA?
I hypothesize that participating in multiple federal nutrition assistance programs will be associated with higher dietary quality. Additionally, I predict that dietary quality in children who consume NSLP and/or SBP will be higher after implementation of HHFKA.

4. Methods
Data: National Health and Nutrition Examination Survey (NHANES)
Time Period:
Inclusion Criteria:
Children who are currently participating in SNAP
≤ 200% Federal Poverty Limit (FPL)
Participation Categories:
Children Aged 2-5: SNAP only, SNAP + WIC
Children Aged 6-18: SNAP only, SNAP + NSLP only, SNAP + NSLP + SBP
Diet Quality: Healthy Eating Index (HEI)
Measures adherence to Dietary Guidelines of Americans
Ranges from 0-100
NHANES -- Cross-sectional, nationally representative
Total score is the sum of 13 components: Total fruit, whole fruit, total vegetables, greens and beans, whole grains, dairy, total protein foods, seafood and plant proteins, fatty acids, refined grains, sodium, added sugars, and saturated fats
Higher scores reflect greater adherence to Dietary Guidelines and a more nutritious diet

5. Adjusted Mean Overall HEI-2015 Total Score by Program Participation in Children (aged 2-5)
55.1
52.9

6. Implementation of HHFKA begins SY 12-13
Adjusted Mean Weekday HEI-2015 Total Score by Program Participation and NHANES cycle in Children (aged 6-18)
Implementation of HHFKA begins SY 12-13

7. Conclusions Children aged 2-5:
No statistically significant differences in HEI-2015 total score between SNAP only participants compared to SNAP + WIC.
Children aged 6-18:
Those participating in SNAP+NSLP+SBP had 4.7 points higher weekday HEI-2015 total score compared to SNAP only participants after implementation of HHFKA ( ).
Further program policy changes are needed to increase the availability and desirability of nutritious foods to improve dietary quality of low-income children.
Overall, the low dietary quality among all children in federal nutrition programs highlight the need for policy changes to increase the availability and desirability of nutritious foods to improve dietary patterns in low-income children.

8. Strengths Limitations Nationally representative
Accounts for breakfast and lunch participation
Cross-sectional, observational study
Cannot assess temporality or individual changes in dietary quality
Diet recall data prone to error
Misreporting, social desirability
Self-selection into the programs

9. Thank you! Barbara Laraia Kris Madsen Maureen Lahiff Ryan Smith
PHN Cohort
Nutrition Policy Institute