New Federal Program to Address Child Hunger Begins This Summer.

This JAMA Forum discusses a new summer nutrition program to address child hunger, the evidence on the effects of this and other summer programs, the role for health professionals, and the policy considerations for participation by individual states.

Comparison of Sales From Vending Machines With 4 Different Food and Beverage Messages: A Randomized Trial.

Importance: Point-of-sale food messaging can encourage healthier purchases, but no studies have directly compared multiple interventions in the field. Objective: To examine which of 4 food and beverage messages would increase healthier vending machine purchases. Design, Setting, and Participants: This randomized trial assessed 13 months (February 1, 2019, to February 29, 2020) of vending sales data from 267 machines and 1065 customer purchase assessments from vending machines on government property in Philadelphia, Pennsylvania. Data analysis was performed from March 5, 2020, to November 8, 2022. Interventions: Study interventions were 4 food and beverage messaging systems: (1) beverage tax posters encouraging healthy choices because of the Philadelphia tax on sweetened drinks; (2) green labels for healthy products; (3) traffic light labels: green (healthy), yellow (moderately healthy), or red (unhealthy); or (4) physical activity equivalent labels (minutes of activity to metabolize product calories). Main Outcomes and Measures: Sales data were analyzed separately for beverages and snacks. The main outcomes analyzed at the transaction level were calories sold and the health status (using traffic light criteria) of each item sold. Additional outcomes were analyzed at the monthly machine level: total units sold, calories sold, and units of each health status sold. The customer purchase assessment outcome was calories purchased per vending trip. Results: Monthly sales data came from 150 beverage and 117 snack vending machines, whereas 1065 customers (558 [52%] male) contributed purchase assessment data. Traffic light labels led to a 30% decrease in the mean monthly number of unhealthy beverages sold (mean ratio [MR], 0.70; 95% CI, 0.55-0.88) compared with beverage tax posters. Physical activity labels led to a 34% (MR, 0.66; 95% CI, 0.51-0.87) reduction in the number of unhealthy beverages sold at the machine level and 35% (MR, 0.65; 95% CI, 0.50-0.86) reduction in mean calories sold. Traffic light labels also led to a 30-calorie reduction (b = -30.46; 95% CI, -49.36 to -11.56) per customer trip in the customer purchase analyses compared to physical activity labels. There were very few significant differences for snack machines. Conclusions and Relevance: In this 13-month randomized trial of 267 vending machines, the traffic light and physical activity labels encouraged healthier beverage purchases, but no change in snack sales, compared with a beverage tax poster. Corporations and governments should consider such labeling approaches to promote healthier beverage choices. Trial Registration: ClinicalTrials.gov Identifier: NCT06260176.

Philadelphia Beverage Tax's Impact on Beverage Ad Expenditures and Number of Ads Purchased.

INTRODUCTION: On January 1, 2017, Philadelphia implemented a beverage excise tax. The study's objective was to determine whether beverage advertising expenditures and the number of beverage ads purchased changed in Philadelphia compared to Baltimore because of this tax. METHODS: Monthly beverage ad expenditures and the number of beverage ads purchased by brand from January 2016 through December 2019 were obtained. Ads were coded as being for taxed or not taxed beverages and analyzed in 2023. The primary outcomes were quarterly taxed beverage ad expenditures and number of ads purchased. A controlled interrupted time series design on segmented linear regression models was used. Models (aggregated and stratified by internet, spot TV, and local radio) compared whether levels and trends in the outcomes changed from pre- to post-tax in Philadelphia compared to Baltimore. RESULTS: There were no significant differences in taxed beverage advertising expenditures between Philadelphia and Baltimore for trends pretax, at implementation, or post-tax. There were 0.13 (95% CI: -0.25, -0.003) fewer quarterly taxed beverage ads purchased per 100 households in Philadelphia versus Baltimore at baseline. Among internet advertising, there were 0.42 (95% CI: -0.77, -0.06) fewer quarterly taxed beverage ads purchased per 100 households in Philadelphia versus Baltimore immediately post-tax. For spot TV ads, the percentage of taxed beverages ads purchased per quarter was greater at baseline in Philadelphia by 28.0 percentage points (95% CI: 1.9, 54.1). CONCLUSIONS: This study found little evidence of changes in mass media advertising on the examined platforms between 2016 and 2019 due to the Philadelphia beverage tax.

Impact of the Philadelphia Beverage Tax on Perceived Beverage Healthfulness, Tax Awareness, and Tax Opinions.

OBJECTIVE: To assess the impact of the Philadelphia Beverage Tax on perceived beverage healthfulness, and awareness and opinions of the tax. DESIGN: Natural experiment SETTING: Small independent stores in Philadelphia (n = 61) and Baltimore (untaxed control site; n = 65) PARTICIPANTS: Shoppers in Philadelphia (n = 2,731) and Baltimore (n = 4,600) pre- and post-tax implementation. MAIN OUTCOME MEASURES: Perceptions of 4 beverages (unhealthy vs healthy/neutral), tax awareness, and tax opinions (oppose vs favor/neutral). ANALYSIS: Mixed-effects linear probability models estimated changes in perceived beverage healthfulness in Philadelphia, relative to Baltimore, following a difference-in-differences approach. Mixed-effects linear probability models estimated pre-post changes in tax awareness and opinions in Philadelphia-only. RESULTS: The probability of perceiving taxed beverages as unhealthy increased 2-years post-tax relative to Baltimore (regular soda: 5.7% [95% confidence interval (CI), 0.9-10.6], P = 0.02; diet soda: 7.7% [95% CI, 1.5-13.8], P < 0.001; sports drinks: 6.4% [95% CI, 0.4-12.4], P = 0.04), with similar changes at 1-year post-tax, whereas perceived healthfulness of untaxed 100% fruit juice did not change. Tax awareness was high at baseline (72%) and increased post-implementation; however, the probability of opposing the tax (22%) also increased over time. CONCLUSIONS AND IMPLICATIONS: Decreases in the perceived healthfulness of taxed beverages suggest the tax had a health-signaling effect. Consumer awareness and health education efforts could complement tax policies to enhance understanding of health risks.

Cost Effectiveness of Calorie Labeling at Large Fast-Food Chains Across the U.S.

INTRODUCTION: Calorie labeling of standard menu items has been implemented at large restaurant chains across the U.S. since 2018. The objective of this study was to evaluate the cost effectiveness of calorie labeling at large U.S. fast-food chains. METHODS: This study evaluated the national implementation of calorie labeling at large fast-food chains from a modified societal perspective and projected its cost effectiveness over a 10-year period (2018-2027) using the Childhood Obesity Intervention Cost-Effectiveness Study microsimulation model. Using evidence from over 67 million fast-food restaurant transactions between 2015 and 2019, the impact of calorie labeling on calorie consumption and obesity incidence was projected. Benefits were estimated across all racial, ethnic, and income groups. Analyses were performed in 2022. RESULTS: Calorie labeling is estimated to be cost saving; prevent 550,000 cases of obesity in 2027 alone (95% uncertainty interval=518,000; 586,000), including 41,500 (95% uncertainty interval=33,700; 50,800) cases of childhood obesity; and save $22.60 in healthcare costs for every $1 spent by society in implementation costs. Calorie labeling is also projected to prevent cases of obesity across all racial and ethnic groups (range between 126 and 185 cases per 100,000 people) and all income groups (range between 152 and 186 cases per 100,000 people). CONCLUSIONS: Calorie labeling at large fast-food chains is estimated to be a cost-saving intervention to improve long-term population health. Calorie labeling is a low-cost intervention that is already implemented across the U.S. in large chain restaurants.

Advertising and Stocking at Small Retailers: A Sweetened Beverage Excise Tax in Philadelphia.

INTRODUCTION: In 2017, Philadelphia enacted a $0.015 per ounce excise tax on SBs that covered both sugar-sweetened beverages and artificially-sweetened beverages, which reduced purchasing and consumption. This study assessed whether the tax also changed beverage advertising or stocking practices that could influence consumer behavior among stores in Philadelphia, Baltimore, and Philadelphia-adjacent counties not subject to the tax. METHODS: Using a longitudinal difference-in-differences approach, beverage advertising and availability changes were evaluated from 4-month pretax to 6-, 12-, and 24-month post-implementation in small independent stores in Philadelphia (n=34) and Philadelphia-adjacent counties (n=38) versus Baltimore (n=43), a demographically similar city without a tax. Mixed effects models tested whether beverage advertising/availability increased in Philadelphia and surrounding counties after implementation versus Baltimore, included store-level random intercepts, and were stratified by beverage tax status, type, size, and store ZIP code income. Data were collected from 2016 to 2018, and analyses were performed in 2022-2023. RESULTS: SB advertising increased post-tax in Philadelphia (6 months= +1.04 advertisements/store [95% CI=0.27, 1.80]; 12 months= +1.54 [95% CI=0.57, 2.52]; 24 months= +0.91 [95% CI=0.09, 1.72]) relative to Baltimore. This was driven by increased advertising of sweetened beverages in low-income ZIP codes. Marketing of SBs increased significantly in Philadelphia-adjacent counties relative to Baltimore. Although SB availability in Philadelphia did not change, it increased in surrounding county stores (6 months= +0.20 [95% CI=0.15, 0.25]; 12 months= +0.08 [95% CI=0.03, 0.12]) relative to Baltimore. CONCLUSIONS: Marketing of SBs, especially in low-income neighborhoods and in surrounding counties, increased following Philadelphia's beverage tax among small, independent retailers. These increases in advertising might have dampened the tax's effect on purchasing behaviors, although estimated effects on sales remained large.

A Descriptive Analysis of Redemption Patterns by Vendor Type Among: WIC Participants in Massachusetts.

BACKGROUND: The retail environment is an important determinant of food package redemption in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). OBJECTIVE: The objectives of this study were to describe where Massachusetts WIC households redeemed their food benefits each month and monthly variations in benefit redemption depending on a household's most frequently used vendor type each month. DESIGN: These were cross-sectional and longitudinal analyses of administrative data provided by Massachusetts WIC. PARTICIPANTS/SETTING: Monthly redemption data for 209,973 households shopping at approximately 1,000 unique vendors between January 2015 and August 2019 were analyzed. MAIN OUTCOME MEASURES: Outcomes were mean monthly percentage of households that relied on each vendor type when redeeming benefits and mean monthly percent redemption for each benefit category. STATISTICAL ANALYSES PERFORMED: For each month, households were classified as using 1 of 8 vendor types. The monthly percentage of households redeeming at each vendor type was calculated, as well as the monthly percent redemption for each benefit category by vendor type. The averages of these monthly percentages were computed for 2015 and 2019. Data from months when households did not redeem any benefits were excluded from primary analyses because it was not possible to determine their vendor type for that month. RESULTS: On average across months in 2019, the majority of Massachusetts WIC households (63%) relied on large vendors only (ie, superstores, supermarkets, and large grocery stores) when redeeming benefits, and 5% relied on small grocery or convenience stores only. Between 2015 and 2019, mean monthly reliance on small grocery and convenience stores decreased by 3.1 and 0.7 percentage points, respectively. Compared with other vendor types, households that redeemed benefits at superstores only had, in an average month, lower redemption levels for most benefit categories. For example, in the 2019 mean across months, percent redemption of breakfast cereal was 53% among households redeeming at superstores only compared with 74% for those redeeming at small grocery stores only. By contrast, households that relied on small grocery stores only had, in an average month, lower redemption levels for yogurt and cash value benefit compared with other vendor types; for example, in the 2019 mean across months, percent redemption of yogurt was 34% among households redeeming at small grocery stores only compared with 62% among those redeeming at supermarkets only. CONCLUSIONS: Results suggest that retail-based efforts to increase redemption should consider vendor-type reliance. Strategies to increase redemption may be especially important for WIC shoppers relying on superstores.

New Federal Efforts to Address Food and Nutrition Insecurity.

This JAMA Forum discusses the expansion and improvement of federal food and nutrition programs, such as the Supplemental Nutrition Assistance Program and the Special Supplemental Nutrition Program for Women, Infants, and Children, to combat food insecurity.

Simplification of Supplemental Nutrition Assistance Program Recertification Processes and Association With Uninterrupted Access to Benefits Among Participants With Young Children.

Importance: In the Supplemental Nutrition Assistance Program (SNAP), families may temporarily lose benefits for which they are still eligible because of administrative issues. This lapse in benefits, referred to as churning, increases the risk of food insecurity for families, which is linked with poorer health. Objectives: To examine the rate of churning among SNAP participants with young children and evaluate the association of administrative policy changes with churning risk. Design, Setting, and Participants: A cross-sectional study of recertifications among 9735 SNAP-participating households with at least 1 child younger than 6 years from May to November 2019 tested whether there were sociodemographic differences in churning risk. An interrupted time series analysis of recertifications among 70 799 households from January 1, 2014, to December 31, 2019, tested whether state-level administrative policy changes were associated with churning risk. Data were analyzed between February and November 2021. Exposures: Three Massachusetts SNAP administrative policy changes. Main Outcomes and Measures: Churn episodes, defined as losing SNAP benefits after a deadline for eligibility recertification followed by receiving benefits again within 30 days, measured using state SNAP administrative data. Results: In 2019, a total of 9752 recertification events occurred among 9735 households (3841 [39.4%] Hispanic, 2138 [21.9%] non-Hispanic Black, and 3533 [36.2%] White) with at least 1 child younger than 6 years participating in SNAP. Of these households, 3984 (40.9%) experienced SNAP churning for a period of 1 to 30 days because of missed recertification forms in any given month. Churning was more common among Hispanic households (by 3.9 percentage points; 95% CI, 1.2-6.6 percentage points) than non-Hispanic White households and more common among households with more than 1 child younger than 6 years (by 5.6 percentage points; 95% CI, 3.0-8.1 percentage points) compared with smaller households. Among households that churned, non-Hispanic White households lost a mean of $10.51 (95% CI, $10.16-$10.86) in benefits per household member, and non-Hispanic Black households lost an additional $1.10 (95% CI, $0.47-$1.74) per household member. On implementation of a task-based, first-available-caseworker model, mean churn episode length was significantly shorter immediately on introduction of the model (-0.30 days per each month after the policy change; 95% CI, -0.52 to -0.07 days) and over time (-0.23 days per each month after the policy change; 95% CI, -0.26 to -0.20 days). At the addition of a second policy change to expand participants' access to simplified reporting requirements, a decrease was seen in the trend in the probability of a churn episode by -0.74 percentage points per month (95% CI, -0.87 to -0.62 percentage points). A third policy to expand online services for submitting recertification paperwork was not associated with a change in churn risk over time. Conclusions and Relevance: Churning in SNAP is common among households with young children and is disproportionately experienced by Black and Hispanic households and lower-income households. Administrative changes to simplify caseworkers' workloads and streamline eligibility reporting for participants may reduce churn.

Costs, Reach, and Benefits of COVID-19 Pandemic Electronic Benefit Transfer and Grab-and-Go School Meals for Ensuring Youths' Access to Food During School Closures.

Importance: School meals are associated with improved nutrition and health for millions of US children, but school closures due to the COVID-19 pandemic disrupted children's access to school meals. Two policy approaches, the Pandemic Electronic Benefit Transfer (P-EBT) program, which provided the cash value of missed meals directly to families on debit-like cards to use for making food purchases, and the grab-and-go meals program, which offered prepared meals from school kitchens at community distribution points, were activated to replace missed meals for children from low-income families; however, the extent to which these programs reached those who needed them and the programs' costs were unknown. Objective: To assess the proportion of eligible youths who were reached by P-EBT and grab-and-go meals, the amount of meals or benefits received, and the cost to implement each program. Design, Setting, and Participants: This cross-sectional study was conducted from March to June 2020. The study population was all US youths younger than 19 years, including US youths aged 6 to 18 years who were eligible to receive free or reduced-price meals (primary analysis sample). Exposures: Receipt of P-EBT or grab-and-go school meals. Main Outcomes and Measures: The main outcomes were the percentage of youths reached by P-EBT and grab-and-go school meals, mean benefit received per recipient, and mean cost, including implementation costs and time costs to families per meal distributed. Results: Among 30 million youths eligible for free or reduced-price meals, grab-and-go meals reached an estimated 8.0 million (27%) and P-EBT reached 26.9 million (89%). The grab-and-go school meals program distributed 429 million meals per month in spring 2020, and the P-EBT program distributed $3.2 billion in monthly cash benefits, equivalent to 1.1 billion meals. Among those receiving benefits, the mean monthly benefit was larger for grab-and-go school meals ($148; range across states, $44-$176) compared with P-EBT ($110; range across states, $55-$114). Costs per meal delivered were lower for P-EBT ($6.46; range across states, $6.41-$6.79) compared with grab-and-go school meals ($8.07; range across states, $2.97-$15.27). The P-EBT program had lower public sector implementation costs but higher uncompensated time costs to families (eg, preparation time for meals) compared with grab-and-go school meals. Conclusions and Relevance: In this economic evaluation, both the P-EBT and grab-and-go school meal programs supported youths' access to food in complementary ways when US schools were closed during the COVID-19 pandemic from March to June 2020.

Does racism impact healthcare quality? Perspectives of Black and Hispanic/Latino Patients.

This analysis of a 2020 nationally representative sample of 1003 U.S. Black and Hispanic/Latino households shows that experiencing racism in healthcare is associated with significantly worse quality of healthcare and lower trust in doctors reported by patients. These findings emphasize that improving healthcare for Black and Hispanic/Latino patients will require major efforts to eliminate racism on the part of health professionals and healthcare institutions.

Food Marketing Practices of Major Online Grocery Retailers in the United States, 2019-2020.

BACKGROUND: Food marketing influences consumers' preferences for and selection of marketed products. Although a substantial body of research has described food-marketing practices in brick-and-mortar stores, no research has examined food marketing in online grocery retail despite its growing importance as a source of food-at-home purchases. OBJECTIVE: To develop and apply a coding instrument to describe food marketing and the nutritional quality of marketed products in online grocery stores. DESIGN: Quantitative content analysis and review of product Nutrition Facts labels and ingredients lists to calculate nutrient density and level of processing using the NOVA classification system. PARTICIPANTS/SETTING: Foods and beverages (n = 3,473) marketed in the top revenue-generating online grocery retailers and those participating in the US Department of Agriculture Supplemental Nutrition Assistance Program Online Purchasing Pilot (n = 21) in 2019-2020. MAIN OUTCOME MEASURES: Use of marketing mix strategies (ie, product, placement, promotion, and pricing) across retailers and nutritional quality of marketed products. Products were considered of poor nutritional quality in the case that they were ultraprocessed (NOVA category 4) and excessive in sodium, saturated fat, free sugars, and/or other sweeteners. Products were also classified into 13 mutually exclusive food groups. STATISTICAL TESTS PERFORMED: The proportion of retailers using each marketing strategy, proportion of products of poor nutritional quality, and proportion of products in each food group were calculated. RESULTS: Retailers commonly used product recommendations, search result ordering, branded website content, user-generated content, and social media engagement to market products online. Candy, sweets, and snacks made up the largest percentage of marketed products (17.3%), followed by fruit, vegetables, and legumes (16.7%). Most (62%) marketed products were of poor nutritional quality. Staple food categories such as fruits, vegetables, and grains were frequently marketed, particularly through price reductions and product recommendations. CONCLUSIONS: Online grocery retailers use a variety of customizable food marketing strategies on their websites. Although most marketed products are of poor nutritional quality, there is potential for marketing of staple food categories online that is not feasible in a brick-and-mortar store.

Sustained Impact of the Philadelphia Beverage Tax on Beverage Prices and Sales Over 2 Years.

INTRODUCTION: It is unclear whether changes in beverage price and sales after beverage tax implementation can be sustained long term. This study aims to quantify the changes in beverage prices and sales in large retailers 2 years after the implementation of the 1.5 cents per ounce Philadelphia beverage tax. METHODS: Data on price and volume sales of beverages and potential food substitutes were collected from 109 supermarkets, 45 mass merchandizers, and 350 pharmacies in Philadelphia, Baltimore (control), and Pennsylvania ZIP codes bordering Philadelphia (to investigate potential cross-border shopping for tax avoidance). Difference-in-differences analyses compared beverage prices and volume sales in the year before tax implementation (2016) to 2 years after (2018). Data were analyzed in 2020-2021. RESULTS: Difference-in-differences analyses found that after tax implementation, taxed beverage prices in Philadelphia increased by 1.02 cents per ounce (95% CI=0.94, 1.11; 68% pass through), and taxed beverage volume sales in stores decreased by 50% (95% CI=36%, 61%). After accounting for cross-border shopping, taxed beverage volume sales decreased in Philadelphia by 35% in 2018. Volume sales of nontaxed beverages did not change after tax implementation (difference-in-differences=4%, 95% CI= -3%, 12%). Volume sales of nontaxed beverage concentrates increased on average by 34% (95% CI=19%, 51%), but there was no evidence of substitution to high-calorie foods. CONCLUSIONS: There was a large reduction in taxed beverage volume sales 2 years after Philadelphia tax implementation, even after accounting for cross-border shopping. Increases in nontaxed beverage concentrate sales likely partially offset this decline, but there was no evidence of post-tax food substitution.

A qualitative study on retailer experiences with Philadelphia's sweetened beverage tax.

The Philadelphia Beverage Tax was implemented on January 1, 2017 for some sugar- and artificially-sweetened beverages. Few qualitative studies have assessed retailers' reactions to beverage taxes. We aimed to understand food retailers' knowledge and attitudes about the Philadelphia beverage tax and how they responded to it with the goal of informing the framing and implementation of beverage taxes in other interested jurisdictions. Researchers conducted semi-structured interviews with retailers within Philadelphia before (n = 15) and after (n = 11) the Philadelphia Beverage Tax was implemented. Purposeful sampling was used to recruit participants with different store locations and customer base characteristics. A priori codes based on the interview guide were used to organize data, and analytic memos were developed and reviewed to identify themes that emerged within the data using a grounded theory approach. Five themes emerged: (a) concerns about the tax purpose, amount, and use of revenue; (b) concerns about the tax's impact on finances and business operations; (c) business strategies implemented to lessen financial burden of the tax; (d) perceptions of customer responses to the tax based on income; and (e) confusion around tax implementation. Results highlighted ways to improve implementation. Retailers in Philadelphia implemented various strategies to offset negative effects on taxed beverage sales. Cities implementing a beverage tax would benefit from investment in educational outreach and support to business owners prior to tax implementation and ensure transparency in how tax revenue will be spent.

Prior research has shown that while retailers worry about the impact a beverage tax would have on sales, many pass the tax onto consumers as a strategy to mitigate loss. This paper uncovers additional retailer concerns that can inform the framing and implementation of beverage taxes in other interested jurisdictions. Retailers especially desired transparency in governmental tax revenue spending. Increased investment in educational outreach to retailers about the tax may help address misconceptions and improve implementation.

Analysis of Public Testimony About Philadelphia's Sweetened Beverage Tax.

INTRODUCTION: Although interest in beverage taxes has increased in recent years, industry opposition and other challenges have limited their spread in the U.S. Because beverage tax proposals are often unsuccessful, there is limited empirical evidence to inform advocacy efforts. Philadelphia's 1.5 cent-per-ounce tax on sweetened beverages provides an opportunity to understand how public testimony for and against the tax was framed in a city that ultimately passed the policy. METHODS: A content analysis of all public testimony about the beverage tax presented to the Philadelphia City Council in 2016 was conducted. Testimonies were coded for policy stance (protax or antitax), speaker type, and specific protax or antitax arguments. Quantitative data were analyzed in 2018-2019 using chi-square tests. RESULTS: A total of 177 unique testimonies were identified, which included 40 protax arguments (grouped into 11 themes) and 31 antitax arguments (grouped into 10 themes). Most testimonies were delivered orally, and most speakers argued in favor of the tax (58%). Among tax supporters, funding early childhood education was the most common argument (71%), whereas tax opponents most frequently argued that sugar-sweetened beverages were the wrong target for the tax (50%). CONCLUSIONS: This analysis of public testimony revealed that protax advocacy efforts highlighted the revenue benefits for early childhood education and community infrastructure rather than the tax's potential to reduce sweetened beverage consumption and improve health. By contrast, antitax arguments centered on the unfairness of targeting a single industry, potential negative economic impacts, and the perceived lack of evidence that the tax would influence consumer behavior.

Purchases of Nontaxed Foods, Beverages, and Alcohol in a Longitudinal Cohort After Implementation of the Philadelphia Beverage Tax.

BACKGROUND: Evidence suggests that sweetened beverage taxes reduce taxed beverage purchases, but few studies have used individual-level data to assess whether these taxes affect purchases of nontaxed foods, beverages, and alcohol. Additionally, research has not examined whether sweetened beverage taxes influence restaurant purchases. OBJECTIVES: We assessed changes in individuals' purchases of taxed beverage types; low-calorie/low-added-sugar nontaxed beverages; high-calorie/high-added-sugar nontaxed beverages, foods, and alcohol; and beverages from restaurants following implementation of the 1.5 cent-per-ounce Philadelphia sweetened beverage tax. METHODS: A longitudinal cohort of adult sugar-sweetened beverage consumers in Philadelphia (n = 306; 67% female; mean age: 43.9 years) and Baltimore (n = 297; comparison city without a beverage tax; 58% female; mean age: 41.7 years) submitted all food and beverage receipts during 2-week periods at baseline and at 3, 6, and 12 months posttax. Difference-in-differences analyses compared changes in purchases from pre- to posttax in Philadelphia to changes in Baltimore. RESULTS: Purchases of taxed juice drinks [ratio of incidence rate ratios (RIRR) = 0.62; 95% CI, 0.42-0.91], but not other taxed beverage types, decreased in Philadelphia compared to Baltimore following the tax. Analyses did not find changes in purchases of low-calorie/low-added-sugar nontaxed beverages, such as water or milk. Additionally, analyses did not find increases in purchases of most high-calorie/high-added-sugar nontaxed products, including alcohol, juice, candy, sweet snacks, salty snacks, and desserts. Purchases of beverage concentrates increased in Philadelphia (RIRR = 2.22; 95% CI, 1.39-3.54). CONCLUSIONS: In this difference-in-differences analysis, the Philadelphia beverage tax was associated with reduced purchases of taxed juice drinks. Purchases of beverage concentrates increased after the tax, but no increases were observed for other high-calorie/high-added-sugar nontaxed foods, beverages, or alcohol.

Prevalence and nutritional quality of free food and beverage acquisitions at school and work by SNAP status.

BACKGROUND: The dual burden of poor diet quality and food insecurity makes free food-food acquired at no cost-a very important part of the nutrition safety net for low-income families. The goal of this study was to determine the national prevalence and nutritional quality of free food acquired separately in two settings: 1) by children at school; and 2) by employees at work; both stratified by participation in the Supplemental Nutrition Assistance Program (SNAP). METHODS: Using National Household Food Acquisition and Purchase Survey data (2012; n = 4,826 U.S. households containing 5,382 employed adults and 3,338 school-aged children), we used survey-weighted proportions to describe free food acquisition and linear regression to compare the 2010 Healthy Eating Index (HEI-2010) for free/non-free food acquisition events (i.e., meals) by SNAP status. Analyses were conducted in 2019-2020. RESULTS: SNAP households had more free acquisition events (29.6%) compared to non-SNAP households (<185% federal poverty level (FPL) = 22.3%; ≥185%FPL = 21.0%, p's<0.001). For SNAP-participant children, free acquisition events at school had a higher mean HEI-2010 compared to non-free acquisition events at school (50.3 vs. 43.8, p = 0.033) and free acquisition events by SNAP-non-participant children ≥185%FPL at school (50.3 vs. 38.0, p = 0.001). Free and non-free acquisition events at work had relatively low HEI-2010s, with no differences by SNAP status. CONCLUSIONS: Over one fifth of all food acquisition events were free, but free food acquisitions at school and work were relatively unhealthy. For children participating in SNAP, free food acquired at school had higher nutritional quality. Improving the dietary quality of free foods could improve the health of families, especially those participating in SNAP.

Nationwide Assessment of SNAP Online Purchasing Pilot State Communication Efforts During the COVID-19 Pandemic.

OBJECTIVE: To conduct a nationwide assessment of communication by participating states and Washington DC about the Supplemental Nutrition Assistance Program (SNAP) Online Purchasing Pilot expansion. DESIGN: Systematic coding of official communication from state and DC SNAP administrating agencies. PARTICIPANTS: Forty-six states and DC approved to participate in the pilot as of October 2020 (n = 47). Data were collected from official SNAP administrating agency websites, state press releases, and state emergency coronavirus disease 2019 websites. VARIABLES MEASURED: Four domains were collected from communication materials: (1) program information, (2) retailer information, (3) health and nutrition information, and (4) communication accessibility. ANALYSIS: Qualitative content analysis, descriptive statistics. RESULTS: Thirty-four (72%) states issued an official press release about the pilot that was easily accessible through online searches (15 available in multiple languages), 21 (45%) included information on their SNAP agency website, and 15 (32%) included information on their official coronavirus disease 2019 website. Most states identified authorized retailers (n = 37; 79%), provided information about pickup/delivery (n = 31; 66%), and stated the SNAP online start date (n = 29; 62%). About a quarter of states (n = 12; 26%) provided information about nutrition and health. CONCLUSIONS AND IMPLICATIONS: State communication about the SNAP online pilot mostly focused on basic program and retailer information and included limited information about nutrition and health.