Retailers in neighborhoods with high Supplemental Nutrition Assistance Program (SNAP) enrollment increase their marketing of sugar-sweetened beverages during SNAP benefit issuance days, possibly exacerbating disparities of diet quality in poorer households, according to the results of a study published in the American Journal of Preventive Medicine.

SNAP is a $67 billion food assistance program that provides benefits to 44 million low-income individuals annually. Evidence indicates that shoppers using SNAP benefits tend to buy more sugar-sweetened beverages, more red and processed meats, and fewer fruits and vegetables than shoppers using other methods to pay for their groceries.

Alyssa J. Moran, MPH, RD, from the Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, and colleagues conducted a census of SNAP-authorized beverage retailers in 3 cities in New York State (Albany, Syracuse, and Buffalo) from November to September 2011. Investigators used multilevel regression models controlling for store type, county, percentage of SNAP enrollment, poverty, and non-Hispanic white population to calculate the odds of retailers conducting in-store marketing during SNAP benefit days.

The investigators found that the odds of in-store sugar-sweetened beverage marketing were higher during SNAP issuance days than other days for sugar-sweetened beverage advertisements (odds ratio, 1.66) and displays (odds ratio, 1.88). Within census tracts that had a SNAP enrollment greater than 28%, retailers were 4.35 times more likely to have sugar-sweetened beverage displays during days when SNAP was issued than on days when it was not. In contrast, the investigators found no differences in the marketing for low-calorie or unsweetened beverages.

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The authors note a number of limitations. They assessed retailers only once and did not compare the same retailers on issuance days and on nonissuance days, although the stores and neighborhoods compared were similar in characteristics. Detailed information about marketing efforts were not captured, nor were purchases and consumption measured, so the potential effects on health of the marketing campaigns could not be evaluated. Although the census tracts were characterized demographically, it is likely that people from high SNAP enrollment areas crossed into low SNAP areas to shop and vice versa, possibly affecting the outcomes.

The authors suggest a number of approaches to remediate the situation. States could spread the issuance of SNAP benefits across the entire month, or they could attempt to regulate point-of-sale marketing of sugar-sweetened beverages. Alternatively, they could require warning labels regarding health risks on sugar-sweetened beverage packaging. The authors call for further research to evaluate the influence of issuance-related changes to food marketing on purchases made by SNAP households.

Reference

Moran AJ, Musicus A, Gorski Findling MT, et al. Increases in sugary drink marketing during supplemental nutrition assistance program benefit issuance in New York. Am J Prev Med. 2018;55:55-62.