Note: The estimated fruit and vegetable
consumption of the average food stamp recipient
mentioned in this article was corrected after
the article was printed. |
Improving Food Choices—Can Food Stamps Do
More?
An expanded focus on
nutrition may steer food stamp participants to better
diets
Joanne F.
Guthrie, Elizabeth
Frazão, Margaret
Andrews, and David
Smallwood
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Proposed
strategies for improving diets of Food
Stamp Program participants include restricting
the types of foods purchasable with
food stamp benefits and offering bonuses
or vouchers for buying healthful foods
such as fruits and vegetables. |
|
Offering
bonuses or vouchers for specific foods
essentially lowers their price and gives
the household additional income for
food purchases. |
|
Prices
and income can influence consumer spending
decisions, but effective policies also
need to account for the role of consumer
preferences and foods available in the
marketplace. |
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This
article is drawn from . . . |
Nutrition
and Health Characteristics of Low-Income Populations:
Volume I, Food Stamp Program Participants
and Nonparticipants, by Mary Kay
Fox and Nancy Cole. ERS project representative:
Biing-Hwan Lin, E-FAN-04014-1, USDA,
Economic Research Service, December 2004.
Understanding
Fruit and Vegetable Choices: Economic and
Behavioral Influences, by Joanne
F. Guthrie, AIB-792-1, USDA, Economic Research
Service, November 2004.
Estimation
of Food Demand and Nutrient Elasticities From
Household Survey Data, by Kuo S.
Huang and Biing-Hwan Lin, TB-1887, USDA, Economic
Research Service, September 2000.
The
Effect on Dietary Quality of Participation
in the Food Stamp and WIC Programs,
by Parke E. Wilde, Paul E. McNamara, and Christine
K. Ranney, FANRR-9, USDA, Economic Research
Service, September 2000.
|
You
may also be interested in . . . |
“Pros
and Cons of Proposed Interventions to Promote
Healthy Eating,” by Eric Finkelstein,
S. French, J.N. Variyam, and P. Haines, in
American Journal of Preventive Medicine,
Vol. 27, No. 3S, 2004.
“Food
Assistance: How Strong Is the Safety Net?”
by Michael LeBlanc, Biing-Hwan Lin, and David
Smallwood, in Amber Waves, Vol. 3,
No. 3, USDA, Economic Research Service, September,
2006. |
When the Food Stamp Program began,
its primary purpose was to enable low-income Americans
to get enough to eat, providing “stamps”
usable only for food but permitting each household
its own choices of which foods to buy. Over time,
the program has changed from primarily focusing
on getting a sufficient quantity of food
to an increased emphasis on also choosing healthful
foods with high nutritional quality. This
reflects the nutrition-related health problems now
facing more and more Americans of all income levels.
The prevalence of obesity and diabetes is growing.
Nutrition and health experts point to excessive
intakes of saturated fat and added sugars, coupled
with low intakes of healthful foods such as fruit,
vegetables, and whole grains, as major contributing
factors.
To help food stamp participants
make more nutritious food choices, USDA has expanded
its investment in nutrition education (see box,
“Nutrition Education Reaching
Out to Food Stamp Participants”). State
governments and health advocates are looking at
additional modifications to the Food Stamp Program
that could reinforce nutrition education, including
restrictions on the foods allowable for purchase
with food stamp benefits and expanded benefits to
buy more of healthful foods, such as fruit and vegetables.
The success of either restrictions
or targeted benefits depends on a number of economic
factors: the food stamp budget share (the
share of the food budget covered by food stamps);
the food spending patterns of program participants;
participants’ response to changes in food
prices and their response to increased
income; and, finally, food manufacturers’
response to Food Stamp Program changes. Research
conducted by ERS on these economic factors provides
insight into the likely effectiveness of these program
modifications in improving the diets of program
participants.
Can Limiting Food Choice Improve Diets?
Food Stamp Program benefit levels
are set to allow households to purchase a set of
low-cost foods that meet current Federal nutrition
recommendations. Program benefits are provided through
electronic debit cards that recipients can use to
buy just about any foods sold in participating grocery
stores, with the exception of hot prepared foods
such as rotisserie chicken.
Restricting food stamp participants’
purchases of foods and beverages high in calories,
fats, and/or sugars has been proposed as a strategy
to combat obesity. In 2004, the State of Minnesota
unsuccessfully requested permission from USDA to
prohibit the purchase of candy and soft drinks with
food stamp benefits. The proposed modification was
clearly intended to promote diet quality by limiting
purchase of “empty calorie” foods.
While it may seem obvious that
disallowing an “unhealthful” food item
would necessarily limit its consumption, in practice
such a policy may have limited effectiveness. The
issue turns on whether food stamp recipients would
continue to purchase the restricted items, using
their own funds. This is likely to depend on the
food stamp budget share. The larger the
share of the food budget that is covered by food
stamps, the more influence program changes can be
expected to have. For most food stamp households,
the food stamp budget share is a sizeable part of
their food budget, but it is not the whole amount.
For a family of four in fiscal year 2004, monthly
benefit amounts varied from almost nothing to as
much as $471, with the average benefit at $326.
At the same time, a four-person, low-income household
spent an average of $462 per month on food, including
both food from grocery stores and food prepared
away from home. Such a household could continue
to buy at least some of the prohibited items with
the $136 cash portion of their current food expenditures.
Even if the cash devoted to foodstore purchases
is relatively small under current policies, households
might use some of their cash income currently being
used for nonfood purchases to buy prohibited foods.
The impact of a food restriction
will also depend on the amount of banned foods consumed
by food stamp recipients. ERS research on food
spending patterns shows that of the $462 spent
on food each month by the average low-income, four-person
household, $334 was spent on food from the grocery
store. Of this, $11 was spent on sugars and sweets
and $30 was spent on nonalcoholic beverages. Depending
on how much of the spending in these categories
is devoted to potentially prohibited items, such
as candy and soft drinks, the average family might
or might not be able to buy the same mix of foods
using their cash resources. They might have to adjust
their purchasing behavior to limit prohibited items,
and shift their food stamp purchases to other items.
Low-income households
of four spend $54 per month on fruit and vegetables |
|
Average spending
for a household of four, 2004-05 |
Food expenditures
|
Low-
income
($10,000-
$29,999 |
Middle-
income
($30,000
$49,999) |
Higher-income
($50,000
and more)
|
All |
|
Dollars
per month |
Total food spending
Food away from home
Food at home
Meat/poultry/fish and seafood
Fruit and vegetables
Cereals/bakery products
Dairy products
Sugars/sweets
Fats/oils
Nonalcoholic beverages
Miscellaneous |
462
129
334
91
54
46
38
11
10
30
52 |
527
195
332
86
50
46
40
10
10
31
56 |
816
374
441
105
71
61
51
17
11
40
81 |
700
298
402
100
64
56
46 15
10
37
72 |
Note: Amounts may not add up
due to rounding.
Miscellaneous includes frozen and canned meals
and soups; chips, nuts, and other snacks;
condiments, etc.
Source: Consumer Expenditures Survey, Bureau
of Labor Statistics. |
But does it necessarily follow
that they would shift to purchasing fruits and vegetables,
low-fat milk, and other healthful foods? Consumers
who love candy might choose the natural sweetness
of fruit. Or they might switch to cakes, cookies,
chocolate-coated granola bars, or any of a number
of items that might have only minimal nutritional
differences from banned items. In denying Minnesota’s
request for authority to ban certain candies, USDA
noted that the request would prohibit the purchase
of Hershey chocolate bars but allowed Kit-Kat and
Twix candies (because they contain flour).
The effectiveness of limiting
food choices also depends on food manufacturers’
response. Limiting purchases of less-healthful
foods might encourage manufacturers and retailers
to develop more healthful products—like snack
packs of baby carrots and pre-cut apple slices—and
promote them more vigorously. Or food manufacturers
and retailers might develop or promote sweets or
snack foods very similar to the prohibited items.
For example, they might develop a sweet, fruit-flavored
drink that is very similar nutritionally to a prohibited
soft drink.
The U.S. food market is extremely
dynamic, with more than 20,000 new food and beverage
products introduced in 2006 alone. It is likely
that the market would respond with both healthful,
innovative products that nutritionists would applaud
and products that differ little from banned items.
In this dynamic food environment, implementing restrictions
on foods allowable with food stamp benefits would
require continually updating regulations, issuing
guidance, and making specific decisions where necessary
(for example, is this a prohibited candy bar or
an allowable breakfast bar?). More detailed regulations
regarding allowable foods also could make food stamp
purchases more complicated both for program participants
and for the stores that accept food stamps.
Can Expanding Benefits for Healthful Foods
Improve Choices?
Rather than restricting choice,
another policy suggestion is to encourage positive
choices through targeting food stamp benefits toward
healthful but underconsumed foods. This might be
particularly useful for fruit and vegetables, underconsumed
foods for which a perceived high cost is a commonly
cited barrier to increased consumption. In 2004-05,
on average, low-income, four-person households spent
$54 per month on fruit and vegetables, $17 less
than higher income, four-person households. Furthermore,
an ERS study found that in 2000, approximately 19
percent of low-income households bought no fruit
or vegetables in any given week, compared with 9
percent of higher income households.
Food stamp benefits can be designed
to increase fruit and vegetable consumption via
vouchers redeemable for fruit and vegetable purchases,
as is currently done in the WIC Farmers’ Market
Nutrition Program. Or bonuses tied to the purchase
of fruit and vegetables can be offered to program
participants. California has passed legislation
to conduct a “Healthy Purchase” pilot
program. Under this program, for every $1 of food
stamps spent on fresh produce, participants will
receive a specified portion back, as a bonus. These
bonus or voucher approaches could be expected to
influence food choice through a price effect—they
effectively lower the price of the targeted food—and
through an income effect—they give the participant
additional income to spend on food.
California’s approach of
tying a bonus to fruit and vegetable purchases has
the effect of lowering the cost of produce relative
to other foods. If price is the barrier to fruit
and vegetable consumption, lower prices should result
in food stamp households’ purchasing more
of the “cheaper” fruit and vegetables.
But how much more? This depends on the extent to
which participants respond to changes in price,
as well as the size of the price change. The more
strongly food stamp participants react to lower
prices, the larger the effect on diet quality.
Consumer response to price varies
for different types of goods, and even different
types of foods. ERS research indicates that demand
for fruit and vegetables appears to be somewhat
more responsive to lower prices than other food
categories. For example, a 10-percent discount in
the price of fruit and vegetables would be expected
to increase the amount purchased by about 6 to 7
percent. Given that estimated fruit and vegetable
consumption of the average food stamp participant
is about 1.95 cups per day, a 20-percent reduction
in the price of fruit and vegetables would be estimated
to raise consumption to about 2.2 cups—an
improvement, although still below the recommendation
for typical adults of 3.5 to 5 cups per day. (The
estimation procedure does not allow extrapolation
beyond a 20-percent price reduction.)
Rather than offering a bonus, another
approach could be offering participants a voucher
that can be used only to buy fruit and vegetables,
lowering their price to zero for participants. This
approach offers an incentive even to those households
currently buying little or no fruit and vegetables.
Lowering the cost of fruit and
vegetables either by offering a bonus or by providing
a voucher also provides participants with additional
food income. Under the bonus scenario, the bonus
income adds to overall food purchasing power. Under
the voucher scenario, households would likely substitute
the vouchers for some of the fruit and vegetable
purchases they would have made with food stamps.
Again, the result is to increase household income
available for food purchases.
What effect will this increased
income have on diet quality? It depends on the choices
made—more fruit and vegetables, low-fat milk,
or whole grains? Or extra sweets and high-fat snacks?
Previous ERS research found that receiving food
stamps led participants to consume larger amounts
of added sugars and total fats, not fruit and vegetables.
Coupling a fruit and vegetable incentive program
with nutrition education may increase the likelihood
that food stamp participants use additional income
to make healthful choices. Also, to the extent that
the program provides incentives for food manufacturers
and retailers to develop and promote appealing fruit
and vegetable options, this may influence choice.
The California pilot program includes a plan to
work with small stores in low-income neighborhoods
to increase produce offerings and market them appealingly.
Changing Consumer Preferences—The
Ultimate Challenge
Given that poor diets exert heavy
costs in increased medical expenditures and lost
productivity, effective policies for promoting healthful
food choices among the 26 million low-income Americans
participating in the Food Stamp Program could yield
considerable benefits. Currently debated options
include both restrictive policies that would prohibit
buying some less-nutritious foods with food stamps
and policies that would target expanded benefits
to purchase of selected healthful foods.
Whether policies aim to restrict
or expand food stamp participants’ choices,
it is ultimately the choices participants make that
will dictate success in improving diet quality.
A restrictive policy may limit purchase of some
less nutritious foods, but, given America’s
diverse and dynamic food industry, it would still
be up to the consumer to either choose more healthful
products or ones that, although not restricted,
are essentially similar to the prohibited item.
Expanding benefits for healthful
foods such as fruit and vegetables would be likely
to increase their purchase. However, given existing
consumer preferences, the predicted increase may
not be strong enough, by itself, to bring purchases
up to levels in line with current dietary recommendations.
The challenge of changing consumer preferences remains.
Coupling targeted benefits with nutrition education
may increase effectiveness, as could a response
by food manufacturers and retailers that resulted
in more attractive, highly promoted fruit and vegetable
options.
USDA recognizes the challenge.
As part of the 2007 farm bill, USDA has recommended
strengthening the nutrition education component
of the Food Stamp Program. In particular, USDA has
proposed investing $100 million over 5 years to
develop and test solutions to the rising rates of
obesity. Potential approaches include providing
incentives to food stamp participants to buy fruit
and vegetables, as well as integrated nutrition
education programs to promote healthful diets and
physical activity. These efforts would include rigorous
independent evaluations to identify effective ways
to improve food choice.
Nutrition Education Reaching Out
to Food Stamp Participants
Food Stamp Nutrition Education
(FSNE) is an optional component of the Food
Stamp Program conducted via a partnership
and joint funding between USDA and States.
Between 1992 and 2006, total annual Federal
spending for FSNE increased from $661,076
to $247 million, and State participation expanded
from 7 States to all 50 States, 2 Territories,
and the District of Columbia.
To operate FSNE, State food
stamp offices subcontract with one or more
FSNE-implementing agencies. More than half
of these are the Cooperative Extension Service
of the State’s land-grant university.
Other implementing agencies include State
or Territorial health departments and other
public organizations.
Implementing agencies have
considerable flexibility in the types of educational
activities they conduct. Activities range
from small group classes and cooking demonstrations
for adults, to classroom activities in schools
serving predominantly low-income children,
to public service announcements in media outlets
that serve mostly low-income audiences. Within
this broad range of activities, USDA requires
that all education be behaviorally focused,
with a goal of encouraging participants to
voluntarily make healthful, economical food
choices for themselves and their families.
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