FROM SCARCITY TO PROSPERITY: NUTRITION AND FOOD SPENDING GOALS AND CONSTRAINTS FOR LOW-INCOME AMERICANS

Suboptimal diet is a leading risk factor for chronic disease in the United States. Due to nutrition disparities, the double burden of suboptimal nutrition and obesity is elevated in low-income populations. The COVID-19 pandemic has shed light on the vulnerability caused by a high burden of diet-related chronic disease in the population overall, and it has also further exposed disparities across socio-economic groups related to these conditions. According to evidence from the National Health and Nutrition Examination Survey (NHANES), household food insecurity is inversely associated with diet quality for U.S. adults with low income. As noted in a recent report commemorating the 50th anniversary of the landmark 1969 White House Conference on Nutrition, 'The burden of chronic illness reduces quality-of-life and life expectancy for millions of Americans, and results in healthcare costs that are placing unprecedented strain on the budgets of federal, state and local governments, businesses, and families.'Through this study, we will answer three critical questions that are central to understanding drivers of unhealthy eating for Americans with low income:What are the food aspirations of consumers with low income, and are they similar to or different from those of consumers with higher income?,What nutrition perspectives, motivations, or theories do consumers with low income use when making food decisions?, andWhat economic and non-economic constraints prevent consumers from achieving their food aspirations?These research questions address USDA's Strategic Goal 7 (Provide All Americans Access to a Safe, Nutritious, and Secure Food Supply) and directly respond to NIFA's priority area question, 'What are the causes and consequences of food insecurity?' In designing this study, we follow the recommendation of the Council of Food, Agriculture, and Resource Economics (CFARE) for new research on 'understanding consumer preferences to enhance well-being,' recognizing the role of the consumer's state of hunger and an array of 'drivers of unhealthy eating.'The proposed project will inquire into three pillars of the food support systems for consumers with low incomes. For each of these applied program areas, the project will answer questions that will improve the health and wellbeing of participating consumers and provide insights into consumer behavior:Supplemental Nutrition Assistance Program (SNAP). SNAP is USDA's largest program, the nation's largest anti-hunger program, and a key component of the social safety net more broadly. Our study will address the question: How well do the suggested Thrifty Food Plan (TFP) diets correspond to ones to which consumers aspire?Nutrition education. The federal government supports nutrition education through the Expanded Food and Nutrition Education Program (EFNEP), the SNAP nutrition education program (SNAP-Ed), school-based nutrition education programming, and other efforts. Our study will address the question: What nutrition perspectives, motivations, or theories do consumers with low income use when making food decisions?The emergency food system. Charitable food assistance programs, including food banks and food pantries, distribute free food and non-alcoholic beverages to people in need. Our study will address the question: How do the tradeoffs between cost and desired food qualities influence decisions for both clients and managers of emergency food programs?During the current COVID-19 crisis, this intersection of food security and nutrition policy is especially important. In response to the resulting economic dislocation, the 2020 Coronavirus Aid, Recovery, and Economic Stimulus (CARES) Act provided supplementary funding for SNAP and $243 million for food distribution through TEFAP, in addition to other new commodity distribution support, and proposals for further SNAP benefit increases are under consideration at this time.For each of the three program areas, it is essential to understand the goals and constraints of low-income food consumers. The TFP, for example, does not dictate diets based on the preferences of nutrition educators, and it would be quite unsound to do so. Instead, the TFP jointly considers the diets that consumers seek to achieve, the nutrition standards that must be met to achieve a more nutritious diet, and the cost constraints that consumers face. Similarly, in research on nutrition education for low-income Americans, there is an emphasis not just on nutrition facts, but also on motivators and barriers, which affect the level of engagement with healthy eating. And for years, the charitable emergency food system has wrestled with developing methods for distributing food that promote nutrition while recognizing that clients may place great importance on autonomy and acknowledging the risk that overly restrictive food distribution policies could induce stigma.This proposed study uses a mixed-methods approach, combining quantitative analysis of nationally representative survey data (using NHANES food intake data linked by food code with a new USDA food price data source, called Purchase to Plate Price Data) and qualitative data from interviews with emergency food system clients and staff (recruited through geographically diverse partner agencies in Alabama, Maine, Massachusetts, and North Carolina) to understand client goals and constraints relevant to achieving both food security and healthy food intake. We apply a sequential explanatory design, using qualitative research methods to understand and interpret the quantitative analysis, offering greater insight in combination than could be achieved with either approach alone.