Supplemental Nutrition Assistance Program Education reductions during COVID-19 may have exacerbated health inequities

Gail Woodward-Lopez; Erin E Esaryk; Sridharshi C Hewawitharana; Janice Kao; Evan Talmage; Carolyn D Rider

doi:10.1016/j.ssmph.2023.101471

Supplemental Nutrition Assistance Program Education reductions during COVID-19 may have exacerbated health inequities

SSM Popul Health. 2023 Jul 23:23:101471. doi: 10.1016/j.ssmph.2023.101471. eCollection 2023 Sep.

Authors

Gail Woodward-Lopez¹, Erin E Esaryk¹, Sridharshi C Hewawitharana¹, Janice Kao¹, Evan Talmage¹, Carolyn D Rider¹

Affiliation

¹ University of California, Nutrition Policy Institute, Division of Agriculture and Natural Resources, 1111 Franklin Street, 11th Floor, Oakland, CA, 94607, USA.

Abstract

Objective: Describe, and assess disparities in, the changes in Supplemental Nutrition Assistance Program Education (SNAP-Ed) that occurred the year before vs. the year when COVID-19 restrictions were implemented.

Design: Observational study comparing reach, intensity, and dose of California Local Health Department (LHD) SNAP-Ed interventions in Federal Fiscal years 2019 and 2020 (FFY19, FFY20).

Analysis: Student t-tests determined significance of differences in the number of Direct Education (DE) programs, Policy, Systems and Environmental change (PSE) sites, people reached, and intervention intensity and dose between FFY19 and FFY20 using data reported online by LHDs. Linear regression assessed associations between census tract-level characteristics (urbanicity; percentages of population with income <185% of federal poverty level, under 18 years of age, and belonging to various racial/ethnic groups; and California Healthy Places Index) and changes in number of DE programs, PSE sites, people reached, and intervention dose between FFY19 and FFY20.

Results: From FFY19 to FFY20, the number of DE programs, PSE sites, people reached, and census tract-level intervention intensity and dose decreased. Higher census tract poverty, higher proportions of Black and Latino residents, and less healthy neighborhood conditions were associated with greater decreases in some intervention characteristics including PSE sites, PSE reach, DE programs, and DE dose.

Conclusions and implications: These reductions in LHD SNAP-Ed interventions indicate reduced access to education and environments that support healthy eating and obesity prevention during a time when this support was especially needed to reduce risk of COVID-19 infection and complications. Disproportionately reduced access, may have worsened health disparities in already-disadvantaged communities. Assuring maintenance of SNAP-Ed interventions, especially in disadvantaged communities, should be a priority during public health emergencies.

Keywords: COVID-19; Neighborhood conditions; Nutrition programs; Obesity prevention; Program equity; Supplemental Nutrition Assistance Program Education.