July 2019 Issue

CPE Monthly: SNAP: An Overview — The Basics of the Supplemental Nutrition Assistance Program and What’s In Store
By Debra Palmer-Keenan, PhD
Today’s Dietitian
Vol. 21, No. 7, P. 54

Suggested CDR Learning Codes: 1080, 4070, 4080, 9030
Suggested CDR Performance Indicators: 8.3.5, 12.1.1, 12.3.5
CPE Level 2

Take this course and earn 2 CEUs on our Continuing Education Learning Library

The Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamp Program (FSP), operates as a safety net to ensure that Americans and noncitizen immigrants who meet particular eligibility requirements can purchase healthful foods.1,2

This continuing education course provides a brief history of the SNAP program and describes the current program, its impacts, and its challenges, and discusses future considerations.

SNAP’s Forerunners
The first FSP dates back to 1939, when it was created during the Great Depression.1-4 Although this program was designed to assist those in need, much of the impetus behind its development was to improve farmers’ incomes by distributing excess commodities.3,4 In the 1930s, nearly 25% of the US population farmed. Export sales had fallen dramatically after World War I and continued to do so through the 1930s.4 As a result, farmers’ incomes had dropped to less than one-half of others’ mean incomes, and surpluses of commodities, such as dry beans, flour, corn meal, eggs, and specific fruits and vegetables, were abundant.4,5 The first FSP was designed to help remedy these issues by providing “needy families” with $0.50 of free blue stamps (which could be used to purchase specific commodity foods) for every $1 in orange stamps they purchased from the government.3-5 Orange stamps could be used to purchase any food. The United States’ entry into World War II boosted the economy and put an end to surplus commodities, and, soon, the corresponding end to this program, which had operated throughout the country, except in West Virginia, for four years.4

Between 1943 and 1961, much research was done on the FSP, and multiple legislative attempts were made to reinstitute it, but none succeeded until the Kennedy administration initiated a four-year pilot program. Based on research about the earlier program, the new program offered a single kind of stamp, eliminated requirements for the purchase of commodity foods, and established explicit eligibility rules for three- to six-month participant certifications.3,4 The FSP was piloted in eight low-income counties and was eventually expanded to 43.6 It required eligible participants to purchase stamps using monies roughly equivalent to their typical food expenditures; in exchange, they received food stamps in an amount that made nutritionally adequate diets for their families more affordable.3 The program was so successful that its results lent strong support to Johnson’s later request to Congress to make it a permanent part of his war on poverty.3,4,6

Congress honored Johnson’s request with the passage of the Food Stamp Act of 1964.4 While the specifics of the act closely mimicked those of the previous pilot, the legislation permanently established the Food Stamp Program, under Congressional control, to improve nutrition among the nation’s most needy and enhance the agricultural economy.3 By 1974, the program was available nationally.4

Several notable program modifications have been implemented over time. For example, the Food Stamp Act of 1977 included the following important changes:

• Food stamps were to be distributed without having to be purchased, which ensured help for the nation’s most needy.
• The eligibility guidelines became based on the US poverty threshold.
• Requirements that program participants have access to cooking facilities were repealed, which made the homeless eligible for program participation.
• A requirement for the program to hire bilingual workers and offer educational materials in other languages was added.
• The Food Distribution Program on Indian Reservations was established to serve Native Americans.4

The 1977 legislature continued a provision requiring shared (state and federal) funding and oversight responsibilities, which remains today.

The FSP remained largely unchanged for nearly two decades, except for several notable modifications. One change of particular interest to dietitians, nutritionists, and other health professionals that first appeared in the December 1981 Farm Bill amendment initiated food stamp nutrition education, stating: “To encourage the purchase of nutritious foods, the Secretary is authorized to extend food and nutrition education to reach FSP participants, using the methods and techniques developed in the expanded food and nutrition and other programs.”7 The results of this amendment are discussed in further detail below.

Before 1983, “food stamps” constituted a literal description of the food-purchasing benefits distributed by the program; that is, benefits were distributed as paper stamps or coupons with denotations of monetary value. However, using available technological advances, a pilot project was developed in Reading, Pennsylvania, to test the viability of distributing FSP benefits electronically using a debit card-type system obtained through private vendors. This new distribution technique was dubbed “electronic benefit transfer” (EBT). While the initial study found that the distribution method wasn’t cost-effective, it became well accepted that it would likely become cost-effective over time, decrease theft and fraud, be able to be linked to other benefits distributed through state governments, and reduce unnecessary paperwork (which made it attractive to those who sought to move to a more paperless government). For these reasons, EBT use was strongly supported by Congress and became a requirement for FSP in 1996 as part of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). This act required states to adopt EBT by October 1, 2002.8

The late 1990s brought decreases in FSP participation due to PRWORA, which placed time limits on SNAP participation for unemployed able-bodied adults without dependents (ABAWDs) unless they either worked at least 20 hours per week or participated in a job training program.3,8 The act placed additional restrictions on program participation among noncitizens.3 The pendulum swung the other way with the passage and implementation of the Farm Security and Rural Investment Act of 2002. This legislation greatly expanded allowable options for states to increase program accessibility for the working poor and gave states latitude to modify some of the restrictions to participation that had been put into place regarding noncitizens and ABAWDs.3,9

The most recent legislation that resulted in substantial changes to the FSP was the 2008 Farm Bill.10 Most notably, it changed the name of the program to SNAP and replaced all references in federal law from “stamp” or “coupon” to “card” or “EBT.” The legislation also allowed for SNAP enhancement by increasing program funding, allowing full deduction of childcare costs in calculating family incomes, increasing the minimum benefit (from $10 to $14), and encouraging program participants to save for education and retirement by ensuring that retirement and educational savings accounts didn’t render potential participants ineligible for program participation.11

The SNAP Program Today
Today, the Farm Bill’s SNAP is the largest USDA Food and Nutrition Service (FNS) program. In federal fiscal year (FFY) 2016, more than $70 billion was spent providing benefits to more than 44 million people, allowing them to shop for food at any of the 26,300 retailers (eg, grocery stores, convenience stores, and farmers’ markets) that are certified to accept SNAP nationally.12,13

Federal law entitles individuals and families with gross annual incomes below 130% of the poverty level to receive SNAP benefits; however, approximately one-half of the states have higher eligibility thresholds, allowing eligibility for those with incomes as high as 200%.14 Other factors are taken into account when determining eligibility. For example, home values aren’t taken into account, nor are cars in most states, but savings are. People with more than $2,250 of countable resources, such as money in bank accounts ($3,250 for older and disabled individuals), may not be eligible. As in the 1990s, ABAWDs must either work or attend job training programs at least 20 hours weekly to maintain eligibility.15 Many immigrants who aren’t citizens are eligible to receive SNAP, but regulations governing their eligibility are complicated.2 Eligible household members can get SNAP benefits even if there are other household members who aren’t eligible. SNAP is also available for people affected by natural disasters, such as hurricanes; this is called D-SNAP (Disaster-SNAP).16

In FFY 2016, the average SNAP EBT benefit received monthly per person was $125.40.12 Each month, the USDA recalculates the cost of four food plans meant to satisfy a nutritionally adequate diet for a “reference” household composed of a 20- to 50-year-old man, a 20- to 50-year-old woman, a 9- to 11-year-old child, and a 6- to 8-year-old child.17,18 The plans still use the 2005 Dietary Guidelines for Americans and the 2005 MyPyramid to determine nutrient adequacy and are developed with the cost assumption that all meals and snacks are prepared at home.18 The lowest-cost plan is the “Thrifty Food Plan” (TFP).17,18 The amount of benefit people receive is based on the number of people living in the household and calculated using the costs associated with the TFP.

SNAP benefits can be used to purchase most foods that are for human consumption and seeds for recipients to grow their own foods to maximize their benefits. Alcoholic beverages; vitamin supplements; food to be eaten in the store; hot precooked foods (except in D-SNAP situations); and live birds, fish, lobsters, etc, aren’t eligible purchases.19

As previously noted, in addition to food assistance, state SNAPs may provide nutrition education to encourage the purchase of nutritious foods by FSP participants. Initial legislation indicated that this should be done using an educational protocol mimicking that used by the Expanded Food and Nutrition Program. The Farm Bill of 1990 increased funds for the provision of nutrition education; however, states were required to commit matching funds for this purpose in their applications. This bill allowed states to subcontract the nutrition education portion of their FSP funds to organizations experienced in offering community nutrition, such as university cooperative extension services and state health departments. Seven states were provided with $661,000 in federal funds the first year this bill became operational (1992). By FFY 2007, 52 participating state and territorial agencies had approved plans for $275 million in federal funding.4

In 2010, due to the implementation of the Healthy, Hunger-Free Kids Act of 2010 (HHFKA), the program (now referred to as SNAP-Ed) shifted its aims to incorporate obesity prevention.20 Since that time, the SNAP-Ed guidance has stated that the focus of SNAP-Ed is the following:

• Health promotion to assist people who are eligible to participate in SNAP (ie, SNAP eligibles) in adopting healthful eating habits and physically active lifestyles.
• Primary prevention of diseases to help SNAP eligibles—who have risk factors for diet-related chronic disease—prevent or postpone the onset of disease by establishing more physically active lifestyles and more healthful eating habits.21

The HHFKA also replaced the requirements for states to provide matching funds for SNAP-Ed, with a funding formula that ensured that SNAP-Ed funds would be distributed according to states’ SNAP participation rates. This legislation expanded the role of SNAP-Ed not only to provide nutrition education “using community health and public health approaches” but also to facilitate changes in policies, systems, and the environment to help make healthful choices easier in low-income communities.20 In 2013, the SNAP-Ed guidance indicated that, moving forward, SNAP-Ed would include education described as “behaviorally focused, evidence-based nutrition education and obesity prevention interventions, projects, or social marketing campaigns that are consistent with FNS’ mission and the goal and focus of SNAP-Ed.”22

No nationally compiled data are available regarding SNAP-Ed’s reach and/or impact. Since the program’s inception, only four SNAP-Ed reports have been released, all limited to describing the work conducted at land-grant universities (LGUs). The most recent of these reports was released in 2016 regarding data from FFY 2015.23 That year, $407 million had been allocated to SNAP-Ed, with nearly one-half that amount ($179.9 million) having been subcontracted to 63 LGUs.

A survey was sent to the leaders of these 63 programs to gather information about their programming.23 Data from the 79% that responded (n=50, from 46 states) indicated the following:

• SNAP-Ed direct nutrition education (eg, teaching situations in which demographic data can be collected) had been provided to approximately 4.5 million SNAP-eligible people at 29,840 sites. Self-identified race/ethnicity data described participants as predominantly Hispanic (16.3%) and/or African American (19.9%); most were children (65%).
• Indirect education activities (eg, mass communications, internet education, and health fairs) numbered 18,540 and reached an estimated 103 million SNAP-eligible individuals.23

Although SNAP-Ed requirements don’t mandate the collection of behavioral change data, many of the LGU programs collected it. The following positive participant dietary changes were reported:

• increased consumption of protein-rich foods prepared without solid fats;
• increased consumption of fruits and vegetables;
• increased consumption of plain water and decreased consumption of sugary drinks;
• increased consumption of low-fat dairy products; and
• decreased consumption of foods made from refined grains.23

The report also showed that some LGU programs had conducted SNAP-Ed social marketing campaigns and that many had successfully worked toward implementing policy, systems, and/or environmental changes that would make healthful choices easier in low-income communities and thus result in future improvements in SNAP participants’ eating and physical activity behaviors.23

SNAP Impacts
Many studies have been conducted to ascertain SNAP impacts. A September 2017 Google Scholar search for the terms “SNAP food stamps” yielded more than 17,000 hits for manuscripts published since 2013. The scope of the research ranges from SNAP participation in the LGBT community24 to topics such as increasing SNAP redemption at farmers’ markets.25 Much of the research has focused on SNAP’s impact on household food security (FS).

Since 2006, the USDA has identified four levels of FS, defined as follows:

• “High FS (old label: FS): No reported indications of food-access problems or limitations;
• Marginal FS (old label: FS): One or two reported indications—typically of anxiety over food sufficiency or shortage of food in the house; little or no indication of changes in diets or food intake;
• Low FS (old label: Food insecurity without hunger): Reports of reduced quality, variety, or desirability of diet; little or no indication of reduced food intake; and
• Very low FS (old label: Food insecurity with hunger): Reports of multiple indications of disrupted eating patterns and reduced food intake.”26

In 2009, a federal stimulus package titled the American Recovery and Reinvestment Act of 2009 effectively increased SNAP participants’ food resources. Their food expenditures increased by 5.4%, and their FS levels increased by 2.2%.27 Despite this boost in benefits, participants’ FS levels remained low. When households apply for SNAP, they tend to be experiencing low to very low FS and poorer dietary quality, so even when they’re enrolled they tend to remain food insecure. Because of this, it’s difficult to assess SNAP’s impacts.28,29 Still, large studies published in the past decade have shown favorable, yet suboptimal, results. Improvements in FS have been found to range from approximately 6% to 19% among participants post enrollment.28,30-32

Geographic location plays a strong role regarding the level of FS SNAP participants can attain. For example, one study projected that when an economical store was located within 20 miles of their homes, SNAP participants could purchase foods according to the TFP, when their benefits are supplemented by 30% of their income; however, they estimated this would be the case for only 20% to 30% of participants.33 In another investigation, when urban SNAP participants’ FS improvements were compared with those of their rural counterparts, statistically significant differences favoring the urban participants were found. Proximity of grocery stores helped explain this phenomenon. Urban participants tended to have at least one supermarket located within a half mile from their homes and additional stores available in proximity, whereas rural participants typically had to travel five miles to get to the nearest store and five to 10 miles to shop at a second store.34

Geography aside, SNAP participants’ FS levels fluctuate monthly according to benefit distribution timing, the majority of which occurs at the beginning of the month. One study showed that all benefits had been expended for 59% of SNAP participants after two weeks of receiving SNAP benefits, while another found that during the same time frame an average 79% of participants’ benefits already had been used.35,36 Only 19% of participants indicated that benefits lasted throughout the month; however, when individuals participated in both SNAP and WIC, they fared better.36 For that reason, these and other researchers have recommended semimonthly benefit issuance.36

Food insecurity elicits health impacts beyond hunger. For example, one study at the University of California found that hospital admissions for hypoglycemia in the last week of the month increased by 27% compared with the first week, when benefits were distributed to low-income patients.37 While it was previously thought that participants ran out of benefits at least in part because they consumed greater volumes of food at the beginning of the month, more recent research findings have noted that the degree to which dietary quality diminishes throughout the month may be an even greater issue.38 Study analyses have consistently demonstrated that while “SNAP benefits allow families to put more food on the table … the current benefit levels are often not sufficient to sustain healthy dietary intakes through the end of the month.”39

Regarding SNAP’s effects on dietary quality, an extensive study published by the Economic Research Service in 2013 showed mixed results, both when SNAP participants’ diets were followed longitudinally as well as when they were compared with individuals nationally. The study examined Healthy Eating Index (HEI) scores derived from National Health and Nutrition Examination Survey data from 2001 to 2008, for which oversampling had been done to ensure an adequate sample of low-income individuals and families. While SNAP participants consumed less sodium and saturated fat than did their nonparticipating counterparts, their HEI scores were statistically less adequate. Differences, however, were small and predominantly related to slightly lower intakes of dark green and orange vegetables. Study authors hypothesized the decrease might be due to the participants’ avoidance of foods that required cooking due to time constraints (ie, limited time to prepare food because of SNAP’s work requirements).” Notably, SNAP participants’ consumption of whole fruit was found to exceed that of nonparticipants.40 However, a 2015 USDA study that reviewed data from 2007 to 2010 found that SNAP participants’ fruit and vegetable intake was lower than that of their counterparts, and the percentage of “empty calories” they consumed was higher. The only intake variables for which SNAP participants outperformed their SNAP-eligible counterparts pertained to their lower intakes of desserts, salty snacks, and added fats and oils.41 Regarding specific nutrients, dietitians should note that protein, fiber, calcium, zinc, iron, and magnesium intakes all have been found to be lower among SNAP participants than among other adults.29

The nutrient profiles of children from participating SNAP households show that in some ways they’re worse off than are their nonparticipating counterparts. Children participating in SNAP consume 43% more sugar-sweetened beverages, 47% more high-fat dairy, and 44% more processed meats as well as 19% fewer nuts, seeds, and legumes than do children from other families living at <130% of the poverty level. The good news, however, is that their intakes of iron, folate, and calcium are significantly higher. But as is true for other low-income children, their intakes of potassium, fish, whole grains, fruits, and vegetables remain below recommended levels, and their consumption of saturated fat and sodium exceed recommendations.42

Researchers have found that when children participate in both SNAP and WIC, they exhibit higher mean intakes of calcium, vitamin D, and protein. Also, when older children participate in both SNAP and the National School Lunch Program (NSLP), their intakes of whole fruit and milk are higher than are those of children from SNAP households who don’t participate in the NSLP.41

In examining why SNAP participation only modestly ameliorates food insecurity and why it typically has mixed impacts regarding dietary improvement, some researchers have investigated the role of the TFP in terms of its modern-day value in serving as the basis for calculating the cost of an adequate diet. Despite the intent that SNAP should be a “supplemental” food program (ie, it never was intended to cover all food costs), SNAP participants’ food spending far exceeds their allotments.28,43 One study estimated that only 20% to 30% of SNAP participants are able to buy foods according to the TFP, even when their benefits are supplemented by 30% of their income.27 Moreover, the extra benefits provided for additional family members fall short of actual additional food costs per family member.28 Even if participants were able to purchase the TFP using the benefits provided (as well as 30% of their incomes), many experts have concluded that it’s no longer appropriate to calculate the cost of an adequate diet based on the TFP.28,39,43,44 Reasons include the following:

• The plan doesn’t include a variety of foods Americans typically consume and enjoy.39,44
• It requires far more preparation and cooking time than low-income people have available to them.39,44,45
• It fails to keep pace with costs or account for geographic variations in food prices.39

Despite its many issues and its inability to ensure FS among our nation’s poor, the current SNAP program improves FS levels. From an economic perspective, it also should be recognized that the program provides a stimulus to the American economy.46 The USDA’s Economic Research Service (ERS) examined these effects by using the Food Assistance National Input-Output Multiplier model.47 A 2010 ERS investigation calculating SNAP’s national worth revealed that every dollar of SNAP benefits distributed resulted in $1.80 of economic activity from jobs (eg, farmers, production workers, retailers).46 This estimate varied from an earlier and oft-cited investigation that suggested $9.20 of economic activity took place on account of every $5 distributed as SNAP benefits.47 Regardless of which analysis is examined, clearly the value of the SNAP program goes beyond food insecurity reductions.

What Changes May Be on the Horizon?
Federal food assistance programs often have changed in response to national needs. With food insecurity and obesity standing in the forefront of national nutrition concerns, several potential SNAP policy changes have been proposed. Among those frequently considered are placing restrictions on the purchase of less healthful foods, providing incentives for increased vegetable and fruit consumption, and revisiting the use of the TFP as the basis for benefit allocation, as noted above.

SNAP, the largest among US nutrition programs, is the only program that has no guidelines intent on bringing consistency between foods purchased and the Dietary Guidelines for Americans. Proponents of adding nutrition restrictions cite this discrepancy, voicing concerns that federal dollars shouldn’t be spent on foods and drinks that have little to no nutritive value. Those against the addition of such restrictions have concerns that if SNAP participants are denied the purchase of foods they typically consume, particularly when it happens at the checkout counter in front of others, they’ll feel stigmatized and less likely to continue participation in the program. Furthermore, it would be exceptionally difficult to develop and implement standards for allowable foods, given the size of the food and beverage market.48,49

An alternative that’s been considered for improving participants’ selection of healthful foods involves incentives. The SNAP program first considered incentivizing the purchase of fruits and vegetables in response to the Food Conservation and Energy Act of 2008, which included funding for “Healthy Incentives Pilots.” SNAP participants who participated in a pilot program received an immediate EBT credit of $0.30 for every $1 they spent on fruits and vegetables. When compared with their nonparticipating counterparts, those in the pilot program spent more on produce, had more produce in their homes than they did when not participating in the pilot, consumed about 1/4 cup more produce (mostly vegetables) each day, and improved their HEI scores by about seven points. Furthermore, participating retailers didn’t experience any difficulties in implementing the pilot program. From a nutritional standpoint, the pilot elicited favorable results (eg, statistically significant increases in the purchase of fruits, vegetables, and vegetables from underconsumed subgroups, to include dark green, and red and orange varieties).50 While it was estimated that national implementation of the program would cost a prohibitive $90 million over a five-year period,51 as a result of this pilot program’s success, Title IV of the Agricultural Act of 2014 resulted in the provision of $31.5 million in matching fund grants for the following five years to organizations willing to expand similar fruit and vegetable incentive programs to additional communities, according to the USDA.

Last, many have advocated for the development of a new benefits formula (ie, one that doesn’t use the TFP as its basis) and/or a semimonthly benefit distribution to improve SNAP participants’ ability to continuously eat better. Because of the aforementioned issues surrounding the use of the TFP, those in favor of this type of change have indicated that while “it is theoretically possible to purchase and prepare an adequate diet with the plan,” using the TFP as the basis for SNAP allocation is “impractical and inadequate.”52 Drewnowski and Eichelsdoerfer caution, “Working mothers can follow the TFP guidelines and prepare low-cost nutritious foods, or can have a paying job outside the home, but may find it difficult to do both. … Good nutrition goes beyond mere survival and should include taste, convenience, and variety and be consistent with societal norms.”44 At a minimum, it’s been suggested that the USDA’s “Low-Cost Food Plan,” which is the next level up on the continuum of dietary plans, be used instead.52 In addition, to reduce monthly dietary fluctuations, some health professionals and economists have recommended that the legislature allow benefits to be distributed more than once per month.36

Putting It Into Practice
To help their clients, RDs should identify the issues and dietary challenges facing their clients, including those who may be eligible for, or who already participate in, the SNAP program. For example, given that benefits are based on a reference family that includes young children, they should understand that two-parent families with multiple teens may face more extreme food security issues than do single-parent households with infants and toddlers who participate not only in SNAP but also in WIC and Head Start, a preschool education program that offers meals and snacks that provide one-third to one-half of children’s daily nutritional needs in programs less than six hours in duration, and meals and snacks that provide one-half to two-thirds of the children’s daily nutritional needs in programs lasting six hours or more.53 Whereas the family with the teens may need referrals to local food pantries to meet their food sufficiency needs as well as recommendations to participate in SNAP and School Breakfast and Lunch programs, the family with the younger children may benefit most from education regarding optimal child feeding practices.

Dietitians also can help improve their low-income clients’ nutritional opportunities by advocating for SNAP policy improvements and by staying abreast of the policies that govern SNAP. Those interested also can play a role in advocacy to support better legislature through active participation in the Academy’s Legislative and Public Policy Committee or the Academy of Nutrition and Dietetics Political Action Committee. At a minimum, when dietitians recognize a policy need, they can make recommendations to be passed on to these groups through their dietetic practice groups and/or member interest groups. By virtue of their first-hand knowledge of the issues their clients face and their expertise in nutrition, dietitians are well positioned to help improve the diets of America’s most nutritionally vulnerable residents through a better understanding of SNAP entitlements and their participation in SNAP policy advocacy.

— Debra Palmer-Keenan, PhD, is an associate professor/extension specialist at Rutgers University, where she oversaw New Jersey’s Supplemental Nutrition Assistance Program Education from 1997 to 2017 and continues to serve as the state’s Expanded Food and Nutrition Education Program state coordinator.

Learning Objectives

After completing this continuing education course, nutrition professionals should be better able to:
1. Assess and discuss the Supplemental Nutrition Assistance Program (SNAP), the changes the program has undergone since its inception, and potential future policy changes.
2. Interpret how SNAP benefits are determined and distributed.
3. Evaluate the needs of clients participating in the SNAP program.
4. Account for differences among SNAP clients’ ability to access healthful foods on a budget.
5. Participate in advocacy to improve SNAP’s ability to improve their low-income clients’ nutritional intakes.

CPE Monthly Examination

1. Supplemental Nutrition Assistance Program (SNAP) benefits are calculated based on which of the following?
a. Low-Cost Food Plan
b. Thrifty Food Plan
c. Frugal Food Plan
d. Moderate-Cost Food Plan

2. Over the years, Food Stamp and SNAP benefits have been distributed in different ways, including which of the following?
a. Stamps and electronic benefits
b. Stamps, coupons, and vouchers
c. Stamps, vouchers, and electronic benefits
d. Stamps, coupons, and electronic benefits

3. According to federal law, families living below what percentage of the federal poverty level are eligible to receive program nutrition assistance?
a. 100%
b. 130%
c. 185%
d. 200%

4. Nutrition education became an allowable program expenditure as a result of which of the following pieces of legislation?
a. Food Stamp Act of 1964
b. A 1981 Farm Bill amendment
c. Personal Responsibility and Work Opportunity Reconciliation Act of 1996
d. The Healthy, Hunger-Free Kids Act of 2010

5. Today’s SNAP-Ed (SNAP Education) provides evidence-based interventions to help SNAP participants make nutritious choices on a budget and works toward which of the following?
a. Improving local policies to improve the food environment in low-income communities
b. Reducing food waste in SNAP participants’ homes and communities
c. Encouraging research that will improve participants’ learning outcomes
d. Having SNAP educators lead weekly walking groups

6. Based on the research suggesting that SNAP participants experience lower food security levels when they reside in ___ areas, in addition to providing dietary counseling, practitioners working in these regions may need to provide information on how to ___ to best help these clients improve their diets.
a. Rural; purchase more nutrient-dense foods at their neighborhood stores or bodegas
b. Urban; purchase more nutrient-dense foods at their neighborhood stores or bodegas
c. Rural; improve their access to food (eg, provide information on charities that offer transportation to grocery stores or about the fact that SNAP benefits can be used to purchase seeds to grow food at home or in community gardens)
d. Urban; improve their access to food (eg, provide information on charities that offer transportation to grocery stores or about the fact that SNAP benefits can be used to purchase seeds to grow food at home or in community gardens)

7. In 2016, the monthly SNAP benefits per person were approximately how much?
a. $125
b. $175
c. $200
d. $225

8. As compared with other children from households living below 130% of the poverty level, children from SNAP households do which of the following?
a. Consume more iron and calcium and less high-fat dairy and sugar-sweetened beverages.
b. Consume more iron and calcium and less high-fat dairy and processed meats.
c. Consume more iron, calcium, sugar-sweetened beverages, and high-fat dairy and fewer processed meats.
d. Consume more iron, calcium, sugar-sweetened beverages, high-fat dairy, and processed meats

9. Research has shown that SNAP participants have used most of their benefits by the end of which week after they receive them?
a. First
b. Second
c. Third
d. Fourth

10. Which idea has been proposed as a way to change the legislation governing the SNAP program to improve the program?
a. Base the program on the moderate-cost food plan.
b. Remove work requirements for women with children to allow them more time to cook healthful meals.
c. Distribute SNAP benefits more often than once per month.
d. Allow purchases of hot, cooked foods.

1. Supplemental Nutrition Assistance Program (SNAP). US Department of Agriculture, Food and Nutrition Service website. https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program-snap. Updated April 25, 2018.

2. US Department of Agriculture, Food and Nutrition Service. Supplemental Nutrition Assistance Program: guidance on non-citizen eligibility. https://fns-prod.azureedge.net/sites/default/files/snap/Non-Citizen_Guidance_063011.pdf. Published June 2011. Accessed September 5, 2017.

3. A short history of SNAP. US Department of Agriculture, Food and Nutrition Service website. https://www.fns.usda.gov/snap/short-history-snap. Updated November 28, 2017.

4. Landers PS. The Food Stamp Program: history, nutrition education, and impact. J Am Diet Assoc. 2007;107(11):1945-1951.

5. Coppock JD. The Food Stamp Plan: moving surplus commodities with special purpose money. Trans Am Philos Soc. 1947;37(2):131-200.

6. Hoynes HW, Schanzenbach DW. U.S. food and nutrition programs. UC Berkeley eScholarship website. https://escholarship.org/uc/item/4246d63n#main. Published March 1, 2015.

7. Agriculture and Food Act of 1981, S 884, 97th Cong (1981).

8. Personal Responsibility and Work Opportunity Reconciliation Act of 1996, H R 3734, 104th Cong (1996).

9. Farm Security and Rural Investment Act of 2002, H R 2646, 107th Cong (2002).

10. 2008 Farm Bill. US Department of Agriculture, Food and Nutrition Service website. https://www.fns.usda.gov/snap/2008-farm-bill. Updated November 17, 2013. Accessed August 25, 2017.

11. Stegman MA, Lobenhofer JS, Quinterno J; The University of North Carolina at Chapel Hill, Center for Community Capitalism. The state of Electronic Benefit Transfer (EBT). https://communitycapital.unc.edu/files/2003/12/StateofEBT.pdf. Published December 2003.

12. US Department of Agriculture, Food and Nutrition Service. Supplemental Nutrition Assistance Program participation and costs. https://fns-prod.azureedge.net/sites/default/files/pd/SNAPsummary.pdf. Updated August 3, 2018.

13. US Department of Agriculture, Food and Nutrition Service. Fiscal year 2016 at a glance. https://fns-prod.azureedge.net/sites/default/files/snap/2016-SNAP-Retailer-Management-Year-End-Summary.pdf

14. Lynch V, Loprest P, Wheaton L. Research report: joint eligibility and participation in SNAP and Medicaid/CHIP, 2011, 2013, and 2015. Urban Institute website. https://www.urban.org/sites/default/files/publication/93031/joint_elig_participation_1.pdf. Published 2017.

15. Am I eligible for SNAP? US Department of Agriculture, Food and Nutrition Service website. https://www.fns.usda.gov/snap/eligibility. Updated June 27, 2018.

16. US Department of Agriculture, Food and Nutrition Service, Office of Emergency Management. Disaster Supplemental Nutrition Assistance Program (D-SNAP). https://fns-prod.azureedge.net/sites/default/files/D-SNAP_Disaster.pdf. Published September 23, 2013. September 29, 2017.

17. Carlson A, Lino M, Juan WY, Hanson K, Basiotis PP; US Department of Agriculture, Center for Nutrition Policy and Promotion. Thrifty Food Plan, 2006. https://www.cnpp.usda.gov/sites/default/files/usda_food_plans_cost_of_food/TFP2006Report.pdf. Published April 2007. Accessed August 28, 2017.

18. USDA food plans: cost of food. US Department of Agriculture, Center for Nutrition Policy and Promotion website. https://www.cnpp.usda.gov/USDAFoodPlansCostofFood. Accessed August 28, 2017.

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