Did mental and emotional health of SNAP families' children improve during the COVID-19 pandemic?

The onset of the COVID-19 pandemic disproportionately affected low-income households in the United States. As part of the government's response to the pandemic, households with children participating in the Supplemental Nutrition Assistance Program (SNAP) benefited from several temporary provisions. This study examines whether the mental/emotional well-being of children in SNAP families was influenced by the SNAP temporary provisions, overall and across subpopulations by race/ethnicity and school meal programs (SMP) participation status of children. Cross-sectional data from the 2016-2020 National Survey of Children Health (NSCH) were used to study the occurrence of mental, emotional, developmental, or behavioral (MEDB) health of children (6-17 years) in SNAP families. Difference-in-Differences (DID) analyses were conducted to assess the association between MEDB health of children in SNAP families and the implementation of the SNAP provisions. Overall, finding show that between 2016 and 2020, children in SNAP families were more likely to face adverse MEDB conditions than children in non-SNAP families (p < 0.05). DID analyses indicate that children's MEDB health was not statistically affected following the first year of SNAP temporary provisions (p > 0.1). Additionally, no differential results were found by race/ethnicity of children or SMP participation (p > 0.1). Results are robust to the use of different well-being measures. These results suggest that SNAP provisions may have been associated with the reduction of the adverse effects of the pandemic on children's well-being.

Health versus income amid COVID-19: What do people value more?

Public efforts to battle COVID-19 have been portrayed as a trade-off between health and the economy in the U.S. public discourse. We investigate how the U.S. general public prioritizes the health and the income dimensions amid COVID-19 using an incentivized instrument with real monetary consequences. We also employ between-subject information treatments highlighting negative health and income consequences of the pandemic. Specifically, participants have to divide monetary contributions between two charitable organizations representing either the health or the income dimension. An overwhelming majority of participants supports both dimensions, with higher monetary contributions to the health dimension (56%) compared to income (44%), but the difference is not large. Only a small fraction of respondents contributes exclusively to the health (10%) or income (5%) dimensions. Increasing the salience of negative health outcomes of COVID-19 raises differential token allocations in favor of the health-oriented charity. This finding is important since the course of COVID-19 will be shaped by the policies governments implement and how the general public reacts to these policies.

The association between food insecurity and mental health during the COVID-19 pandemic.

OBJECTIVE: To explore the association between food insecurity and mental health outcomes among low-income Americans during the COVID-19 pandemic. METHODS: We conducted a survey of 2714 low-income respondents nationwide from June 29, 2020 to July 21, 2020. A proportional odds logit model was employed to estimate the associations between food insecurity and anxiety and between food insecurity and depression. RESULTS: Food insecurity is associated with a 257% higher risk of anxiety and a 253% higher risk of depression. Losing a job during the pandemic is associated with a 32% increase in risk for anxiety and a 27% increase in risk for depression. CONCLUSIONS: Food insecurity caused by the pandemic was associated with increased risk of mental illness. The relative risk of mental illness from being food insecure is almost three-fold that of losing a job during the pandemic. Public health measures should focus on getting direct subsidies of food purchases to poor families, especially families with children. They should also reduce the stigma and shame that is associated with accepting charitable foods.

Promoting higher social distancing and stay-at-home decisions during COVID-19: The underlying conflict between public health and the economy.

Social distancing and stay-at-home orders were implemented as a quick response to the public health crisis created by COVID-19. However, these measures led to competing concerns for public health versus the wellbeing of the economy during the pandemic. This drove polarized views and attitudes towards these measures in the US that threatened their effectiveness in controlling the spread of infections. Our study addresses this point by investigating uptake of messaging treatments that highlight the health risks of COVID-19. We also investigate how priming economic risk of COVID-19 affects responsiveness to the health information messaging. A sample of 1200 US respondents were randomly assigned to a control and four messaging treatments that included information about risks of COVID-19 on own health, public health, the economy, and combination of public health and the economy, respectively. Our results indicate a significant difference in messaging uptake based on political partisanship. Individuals identifying as Democrats increased their social distancing and stay-at-home decisions in response to all information treatments, contrary to Republicans who showed no significant change in their behavior. Using a latent class analysis model, we classify individuals into three main types (dismissive, amenable, and conscious) that differ in their perceptions of the risks associated with COVID-19. We show that only amenable individuals, who account for approximately 34% of the sample, respond significantly to the messaging treatments.

General Public Preferences for Allocating Scarce Medical Resources During COVID-19.

COVID-19 has overwhelmed healthcare systems across the globe with an unprecedented surge in the demand for hospitalizations. Consequently, many hospitals are facing precarious conditions due to limited capacity, especially in the provision of ventilators. The governing ethical principles of medical practice delineated in (1) favor prioritizing younger patients, largely because of their relatively higher expected life years. We conduct a survey of the general public in the United States to elicit their preferences for the allocation of a limited number of ventilators. The results show that the general public views align with the established ethical principles, which favor younger patients. JEL Classification: C91.

Do fast food restaurants surrounding schools affect childhood obesity?

In this study, we estimate the effect of fast food environment surrounding schools on childhood body mass index (BMI). We use two methods that arrive at a similar conclusion, but with different implications. Using school distance from the nearest federal highway to instrument for restaurant location, we find the surrounding restaurants to only marginally affect a student's BMI measure. The effect size also decreases with increasing radial distances from school, 0.016 standard deviations at one-third of a mile and 0.0032 standard deviations at a mile radial distance. This indicates the decreasing influence of restaurants on a child's BMI as its distance from school increases. On a subset of students who were exogenously assigned to different school food environment, we find no effect of the fast food restaurants. An important contextual aspect is that nearly all schools in this sample observed closed campus policy, which does not allow students to leave campus during lunch hours.

Information and order of information effects on consumers' acceptance and valuation for genetically modified edamame soybean.

This study examines two different strategies with respect to managing the order in which information about genetically modified (GM) technology would reach and impact consumers of edamame, often referred to as the "vegetable soybean". Edamame are soybeans harvested while the beans are young and soft. We capture consumers' willingness to pay (WTP) for unlabeled edamame, non-GM edamame, and GM edamame using a non-hypothetical random nth price auction. We elicit consumers' valuation for each edamame product before and after introducing information, and test two strategies where the order of providing positive and negative information is reversed. The results suggest that negative information affects WTP to a much greater extent than positive information. Hence a strategy to proactively deal with eventual negative press about GM technology did not lead to a different result than a strategy that would react to or attempt to thwart negative information with positive information at a later date. These findings suggest that it would be difficult to introduce new GM edamame as edible products in the market as marginally negative preconceptions about GM at the time of the experiment were easier to reinforce with negative information than to combat with positive information about GM.

Persistent disparities in obesity risk among public schoolchildren from childhood through adolescence.

INTRODUCTION: Arkansas is among the poorest states and has high rates of childhood obesity. In 2003, it became the first state to systematically screen public schoolchildren for unhealthy weight status. This study aims to examine the socioeconomic disparities in Body Mass Index (BMI) growth and the risk of the onset of obesity from childhood through adolescence. METHODS: This study analyzed (in 2015) the data for a large cohort of Arkansas public schoolchildren for whom BMIs were measured from school years 2003/2004 through 2009/2010. A linear growth curve model was used to assess how child-level sociodemographics and neighborhood characteristics were associated with growth in BMI z-scores. Cox regression was subsequently used to investigate how these factors were associated with the onset of obesity. Because children might be classified as obese in multiple years, sensitivity analysis was conducted using recurrent event Cox regression. RESULTS: Survival analysis indicated that the risk of onset of obesity rose sharply between ages of 5 and 10 and then again after age 15. The socioeconomic disparities in obesity risk persisted from kindergarten through adolescence. While better access to full service restaurants was associated with lower risk of the onset of obesity (Hazard Ratio (HR)=0.98, 95% CI=0.97-0.99), proximity to fast food restaurants was related to increased risk of the onset of obesity (HR=1.01, 95% CI=1.00-1.01). CONCLUSIONS: This analysis stresses the need for policies to narrow the socioeconomic gradient and identifies important time periods for preventative interventions in childhood obesity.

Are all GMOs the same? Consumer acceptance of cisgenic rice in India.

India has more than 215 million food-insecure people, many of whom are farmers. Genetically modified (GM) crops have the potential to alleviate this problem by increasing food supplies and strengthening farmer livelihoods. For this to occur, two factors are critical: (i) a change in the regulatory status of GM crops, and (ii) consumer acceptance of GM foods. There are generally two classifications of GM crops based on how they are bred: cisgenically bred, containing only DNA sequences from sexually compatible organisms; and transgenically bred, including DNA sequences from sexually incompatible organisms. Consumers may view cisgenic foods as more natural than those produced via transgenesis, thus influencing consumer acceptance. This premise was the catalyst for our study--would Indian consumers accept cisgenically bred rice and if so, how would they value cisgenics compared to conventionally bred rice, GM-labelled rice and 'no fungicide' rice? In this willingness-to-pay study, respondents did not view cisgenic and GM rice differently. However, participants were willing-to-pay a premium for any aforementioned rice with a 'no fungicide' attribute, which cisgenics and GM could provide. Although not significantly different (P = 0.16), 76% and 73% of respondents stated a willingness-to-consume GM and cisgenic foods, respectively.

Revisiting GMOs: Are There Differences in European Consumers' Acceptance and Valuation for Cisgenically vs Transgenically Bred Rice?

Both cisgenesis and transgenesis are plant breeding techniques that can be used to introduce new genes into plant genomes. However, transgenesis uses gene(s) from a non-plant organism or from a donor plant that is sexually incompatible with the recipient plant while cisgenesis involves the introduction of gene(s) from a crossable--sexually compatible--plant. Traditional breeding techniques could possibly achieve the same results as those from cisgenesis, but would require a much larger timeframe. Cisgenesis allows plant breeders to enhance an existing cultivar more quickly and with little to no genetic drag. The current regulation in the European Union (EU) on genetically modified organisms (GMOs) treats cisgenic plants the same as transgenic plants and both are mandatorily labeled as GMOs. This study estimates European consumers' willingness-to-pay (WTP) for rice labeled as GM, cisgenic, with environmental benefits (which cisgenesis could provide), or any combination of these three attributes. Data were collected from 3,002 participants through an online survey administered in Belgium, France, the Netherlands, Spain and the United Kingdom in 2013. Censored regression models were used to model consumers' WTP in each country. Model estimates highlight significant differences in WTP across countries. In all five countries, consumers are willing-to-pay a premium to avoid purchasing rice labeled as GM. In all countries except Spain, consumers have a significantly higher WTP to avoid consuming rice labeled as GM compared to rice labeled as cisgenic, suggesting that inserting genes from the plant's own gene pool is more acceptable to consumers. Additionally, French consumers are willing-to-pay a premium for rice labeled as having environmental benefits compared to conventional rice. These findings suggest that not all GMOs are the same in consumers' eyes and thus, from a consumer preference perspective, the differences between transgenic and cisgenic products are recommended to be reflected in GMO labeling and trade policies.

Obesity inequality in Malaysia: decomposing differences by gender and ethnicity using quantile regression.

OBJECTIVE: Obesity prevalence is unequally distributed across gender and ethnic group in Malaysia. In this paper, we examine the role of socioeconomic inequality in explaining these disparities. DESIGN: The body mass index (BMI) distributions of Malays and Chinese, the two largest ethnic groups in Malaysia, are estimated through the use of quantile regression. The differences in the BMI distributions are then decomposed into two parts: attributable to differences in socioeconomic endowments and attributable to differences in responses to endowments. RESULTS: For both males and females, the BMI distribution of Malays is shifted toward the right of the distribution of Chinese, i.e., Malays exhibit higher obesity rates. In the lower 75% of the distribution, differences in socioeconomic endowments explain none of this difference. At the 90th percentile, differences in socioeconomic endowments account for no more than 30% of the difference in BMI between ethnic groups. CONCLUSIONS: Our results demonstrate that the higher levels of income and education that accrue with economic development will likely not eliminate obesity inequality. This leads us to conclude that reduction of obesity inequality, as well the overall level of obesity, requires increased efforts to alter the lifestyle behaviors of Malaysians.

Improving food choices among Supplemental Nutrition Assistance Program recipients.

We used a principal-agent framework to examine the feasibility of two proposed modifications to the Supplemental Nutrition Assistance Program with the goal of encouraging healthier food choices among program participants. Specifically, we analyzed two types of contract: a restricted contract and an incentive contract. The restricted contract did not allow the purchase of unhealthy foods with program benefits, but compensated participants by increasing total benefits. The incentive contract provided increased benefits that varied according to the percentage of healthy foods purchased with program benefits. The theoretical results revealed the mechanisms for the two alternative contracts, the conditions under which each would be effective, and the key empirical questions to be examined for future policy analysis.

Socio-economic status, racial composition and the affordability of fresh fruits and vegetables in neighborhoods of a large rural region in Texas.

BACKGROUND: Little is known about how affordability of healthy food varies with community characteristics in rural settings. We examined how the cost of fresh fruit and vegetables varies with the economic and demographic characteristics in six rural counties of Texas. METHODS: Ground-truthed data from the Brazos Valley Food Environment Project were used to identify all food stores in the rural region and the availability and lowest price of fresh whole fruit and vegetables in the food stores. Socioeconomic characteristics were extracted from the 2000 U.S. Census Summary Files 3 at the level of the census block group. We used an imputation strategy to calculate two types of price indices for both fresh fruit and fresh vegetables: a high variety and a basic index; and evaluated the relationship between neighborhood economic and demographic characteristics and affordability of fresh produce, using linear regression models. RESULTS: The mean cost of meeting the USDA recommendation of fruit consumption from a high variety basket of fruit types in our sample of stores was just over $27.50 per week. Relying on the three most common fruits lowered the weekly expense to under $17.25 per week, a reduction of 37.6%. The effect of moving from a high variety to a low variety basket was much less when considering vegetable consumption: a 4.3% decline from $29.23 to $27.97 per week. Univariate regression analysis revealed that the cost of fresh produce is not associated with the racial/ethnic composition of the local community. However, multivariate regression showed that holding median income constant, stores in neighborhoods with higher percentages of Black residents paid more for fresh fruits and vegetables. The proportion of Hispanic residents was not associated with cost in either the univariate or multivariate analysis. CONCLUSION: This study extends prior work by examining the affordability of fresh fruit and vegetables from food stores in a large rural area; and how access to an affordable supply of fresh fruit and vegetables differs by neighborhood inequalities. The approach and findings of this study are relevant and have important research and policy implications for understanding access and availability of affordable, healthy foods.

Water quality concerns and acceptance of irradiated food: a pilot study on Mexican consumers.

BACKGROUND: Poor quality irrigation water is a major cause of disease transmission for urban inhabitants consuming fresh produce in many developing countries. Irradiation of food is an alternative approach to reducing health risks for consumers, but its implementation depends heavily on consumer acceptance. RESULTS: In this pilot study, we show that most respondents consider the water quality of Mexico City to be poor and a health risk, and would be willing to pay for irradiated food as a means of pasteurizing fresh iceberg lettuce. CONCLUSION: Irradiated food could, potentially, be accepted in developing countries that have problems with water quality. Such acceptance would presumably be due to the perception that such a novel technology would (1) alleviate water impairment, and (2) lead to economic improvement. It is then possible that the public considers that water quality is a more pressing concern than any potential side effects of food irradiation.

Parental response to health risk information: experimental results on willingness-to-pay for safer infant milk formula.

Enterobacter sakazakii, a pathogen that can be found in powdered infant milk formula, can cause adverse health effects on infants. Using Vickrey auction, this study examines parents' willingness to pay (WTP) for a quality assurance label on powdered infant milk formula. The influence of ambiguity with the incidence rate information and provision of safe-handling information on WTP are also evaluated using three experimental treatments. Our findings generally imply that parents significantly value a quality assurance label. The mean price premium parents are willing to pay for the safer and quality assurance labelled powdered infant milk formula ranges from 61 to 133 Eurocents per 100 grams (53-116% of the base price per 100 grams) depending on the treatment. While no ambiguity effects are generally found, provision of safe-handling information significantly reduced WTP to 39-69 Eurocents per 100 grams depending on the treatment.