Access to SNAP-Authorized Retailers and Diet Quality Among SNAP Recipients

IMPORTANCE Poor food environments are known to affect diet quality and health outcomes. In the US, the Supplemental Nutrition Assistance Program (SNAP) serves as a critical nutrition safety-net for millions of low-income residents; however, whether there is an association between access to SNAP-authorized retailers and diet quality among SNAP recipients remains unclear. OBJECTIVE To evaluate the association of SNAP-authorized retailer access with diet quality among SNAP recipients. DESIGN, SETTING, AND PARTICIPANTS This was a serial cross-sectional study using 24-hour dietary recall data from a nationally representative sample of SNAP-participating adults from 6 cycles of the restricted-use and public-access National Health and Nutrition Examination Survey from 2007 through 2008 to 2017 through 2018. Participants’ residential locations were linked to SNAP-authorized retailers at the coordinate-date level using the Historical SNAP Retailer Locator dataset. Generalized linear models were used that accounted for the complex survey design and adjusted for age, sex, race and ethnicity, education, and family poverty income ratio. Data analyses were performed from February to October 2024. EXPOSURES Availability of SNAP-authorized retailers within 1 mile (5 increments: 0.10, >0.10-0.25, >0.25-0.50, >0.50-1.00, and >1.00 mile) from the SNAP recipient’s residence, and the distance to the nearest SNAP-authorized retailer. MAIN OUTCOMES AND MEASURES Daily dietary quality assessed using the Healthy Eating Index-2015 (HEI-2015), a validated measure of adherence to the 2015-2020 Dietary Guidelines for Americans. HEI-2015 scores range from 0 (no adherence) to 100 (full adherence) to the guidelines. RESULTS The study analysis included 5041 participants (mean age, 43.0 years; [weighted] 58% female and 42% male), with a mean (SD) HEI-2015 score of 46.88 (25.46). Residing closer to any SNAP-authorized retailer was associated with a 3.50 higher HEI-2015 (95% CI, 1.56-5.44) for those living within 0.10 miles, and 3.50 higher (95% CI, 1.46-5.55) for those living more than 0.10 to 0.25 miles compared to those living more than 1.00 miles away. Availability of superstores and grocery stores showed a positive association, with HEI-2015 scores of 7.09 (95% CI, 3.51-11.11) and 5.21 (95% CI, 3.12-7.29) higher for those within 0.10 miles, respectively. Each additional mile from any SNAP-authorized store was associated with a HEI-2015 score decrease of 0.99 (95% CI, 0.42-1.57). Subgroup analyses showed significant associations between store access and diet quality among participants with normal weight and prediabetes, whereas associations were not statistically significant for those with diabetes. CONCLUSIONS AND RELEVANCE This cross-sectional study found that access to SNAP-authorized retailers was associated with better diet quality among SNAP recipients, with the most substantial differences observed for proximity to superstores and grocery stores. These findings highlight the potential impact of food access on diet quality, and suggest that improving the availability of SNAP-authorized retailers in low-access areas may be an important strategy for enhancing public health and reducing diet-related conditions.