Healthy Eating Value Systems among Supplemental Nutrition Assistance Program Participants: A Qualitative Study

Abstract

Objective

To understand how families receiving benefits from the Supplemental Nutrition Assistance Program (SNAP) conceptualize healthy eating and its relationship to child development.

Methods

This study is a secondary analysis of in-depth, in-home qualitative interviews. 30 caregivers with children between the ages of 4 and 10 years old participating in SNAP in Baltimore, MD, were asked about food purchasing resources and strategies. Two independent coders re-analyzed primary data using an iterative process to identify a priori themes related to caregivers’ conceptualization of healthy eating and emergent themes related to the ways families’ use SNAP benefits. Themes were identified via content analysis and revised until consensus was reached.

Results

Participants demonstrated knowledge of nutritious food groups, specific unhealthy nutrients, and the importance of food in managing chronic conditions. However, the importance of nutrition was balanced with the need for ready-made foods that children could safely prepare on their own, shelf stable goods, and low-cost foods. Emergent themes identified caregivers’ views of health-related impacts of food beyond nutrition, including the role of food as: a parenting tool to support child socialization and development, a means of creating experiences unique to childhood, and a mechanism for promoting family cohesion.

Conclusions

This study suggests families receiving SNAP use benefits to best serve children’s well-being while conceptualizing the child health benefits of food as extending beyond nutrition. Future policy interventions aimed at optimizing SNAP should address the potential for nutrition assistance to foster positive child social and emotional development among low-income families while meeting nutritional needs.

Introduction

Food insecurity (FI) affects millions of households in the U.S. annually.¹ In households with children, prevalence of FI is increasing.¹ Defined as limited or uncertain availability of nutritionally adequate and safe food or the ability to acquire such food,² FI negatively impacts children’s cognitive, emotional, and behavioral outcomes.³ Participation in federal nutrition programs helps alleviate FI.⁴

The Supplemental Nutrition Assistance Program (SNAP) is the largest nutrition assistance program in the U.S., serving approximately 41.8 million Americans.⁵ Originally called the Food Stamp Program, it was renamed SNAP in 2008 in part to highlight the program’s goal of improving access to nutritious foods for low-income Americans.⁶ National, evidence-based programs like SNAP-Ed have also been deployed to improve the overall health of SNAP participants.⁷ However, studies show that SNAP participants have lower dietary quality^8–10 and consume more sugar-sweetened beverages (SSBs) than non-participants.^{9, 11–12} Several potential interventions have been proposed to address these disparities, including financially incentivizing the purchase of healthier foods like fruits and vegetables^13–15 and reducing coverage of unhealthy options like SSBs and junk food.^14–16

There are conflicting viewpoints regarding methods to foster better nutrition among SNAP participants. Some studies suggest non-SNAP participants are more likely than SNAP participants to support restrictions on SSBs and junk food,¹⁷ while others suggest that SNAP participants are supportive of limited restrictions.¹⁸ To inform future policy changes to the SNAP program, it is important to better understand the opinions, barriers, and food-related values of SNAP participants. Additional research is needed to better examine how the structural constraints of FI impact feeding practices,¹⁹ and better understand the relative emphasis on nutrition versus other important functions of food among low-income families with children participating in SNAP.

This study examines food-related priorities and nutrition knowledge in a convenience sample of low-income primary caregivers of children ages 4–10 years old living in Baltimore, MD and receiving SNAP benefits. The goals of our study were twofold: 1) explore how families with children participating in SNAP think about food-related priorities as they relate to healthy eating, and 2) explore emergent themes related to how families prioritize food purchases and use of SNAP benefits.

Design

In this qualitative study, we used in-depth interviews to explore food purchasing decisions among a very low-income sample of SNAP participant households with children ages 4–10 years old living in Baltimore, MD. The primary study,²⁰ which provided the data for this secondary analysis, explored how timing of the SNAP benefit cycle impacted changes in the home food environment (HFE). The primary study²⁰ hypothesized that there would be less overall food availability and variety and more obesogenic foods at the end of the benefit cycle, when SNAP benefits were depleted, as compared to the beginning of the cycle, when SNAP benefits were replenished. Interviews were conducted during home visits at the end of the benefits cycle, when food resources were likely depleted. When clarification or elaboration of topics discussed in the initial interview were needed, a brief follow-up interview occurred during the second home visit at the beginning of the benefit cycle after a brief “washout” period.²⁰ Interviews were conducted between August 2017 and January 2018 as part of the primary study’s²⁰ mixed-methods approach that utilized qualitative findings to contextualize quantitative data. This secondary analysis is an in-depth qualitative analysis exploring broader implications of food-related priorities on child health.

Participants

Eligibility for this study required participants (1) live in Baltimore City, (2) participate in SNAP, and (3) be the primary caregiver for a child between the ages of 4–10 years old who lived with them. SNAP participation was validated by self-report. The age range of 4–10 years old was selected for the primary study²⁰ because investigators were pilot testing neurocognitive assessments appropriate for this age range. Participants who did not speak English or had a functional impairment that would impede participation, such as significant global developmental delay, language or hearing impairment, were excluded.

Thirty-two participants enrolled in the study. Twenty participants were recruited from an eligible group of extremely low-income families in Baltimore who participated in a previous study²¹ and agreed to be contacted for future research. Twelve participants were recruited via snowball sampling by asking participants to suggest other caregivers in their networks who they knew were receiving SNAP benefits and might be interested in participating. Thirty participants were included in final analyses; two participants were excluded who could not complete home visits or interviews. Written informed consent was obtained from adult participants prior to study enrollment. The Johns Hopkins Medicine Institutional Review Board approved the study.

Development of Interview Guide and Codebook

Each caregiver participated in a 40–90 minute in-depth, in-home interview. Interviews were conducted by female research assistants with bachelors or masters level training, backgrounds in public health or social sciences, and training in methods for conducting in-depth interviews. Interviewers used an in-depth interview guide developed by the project team that was revised and refined over the course of administration. The interview guide focused on understanding responses to scarcity and food purchasing decisions (Table 1) and incorporated methods and practices developed by Edin and colleagues²² to approach highly stigmatized aspects of food prioritization and decision making. Interviews were audio-recorded and transcribed verbatim by approved institutional vendors.

Table 1.

A sample of codebook themes and associated in-depth questions used to assess food purchasing priorities and allocation of limited resources primary caregivers receiving SNAP benefits in Baltimore, MD.

Interview theme category	Example questions
Specific financial expenses related to food	Let’s talk more about what you spend on food. Let’s start with last month [NAME MONTH]. Take me through that month, starting with your biggest grocery shopping and what you spent.
	A lot of people say there is a lot of month left at the end of the money. How about for you? Over the last year, how have you coped during time where money was tight? Tell me about the last time that happened? What about the time before that? How do you typically cope when the money gets tight?
Food purchasing strategies	Where do you typically get your food? What if you just need one item? How close is that to you?
	Now I’m going to ask you to use your imagination. Okay, typically you do your big shopping at what store? Alright, we’ve just arrived at that store. You are going to shop just the way you always shop—nothing fancy. Where do you head first? What do you buy. Where do you head after that? What’s next? What’s after that? Let’s make sure we didn’t miss anything. Fruits and Vegetables? Meats/Fish? Dairy? Cereals, pasta, beans, rice, other dry goods? The frozen section? Canned goods? Chips and soda? Other snacks?
	On this imaginary trip, where you are shopping just like you usually shop, is there anything you want to buy that you just can’t afford?
	What do you buy that you think you shouldn’t be buying?

Transcripts were coded using a codebook developed through discussion and consensus.The codebook was developed for the primary study²⁰ and was initially comprised of a priori themes pertaining to cyclical food variation and food purchasing strategies. The codebook was expanded to include additional codes that emerged from the interviews as part of the thematic coding process. Once study team members achieved consensus, codes were applied to interview transcripts by two independent coders using MAXQDA software. Inter-rater agreement was greater than 80%.

Data Analysis

Descriptive statistics were used to summarize demographic characteristics of study participants.

For the current secondary analysis, two researchers (AMM and AEM) identified codes from the codebook that addressed the aims of this study. Seven codes were selected (Table 2). The same two investigators independently reviewed the interview excerpts associated with these codes to identify content areas related to nutrition knowledge and food prioritization. After individual review, the two investigators reconciled coding approaches of preliminary content domains to achieve parsimony and consensus. Two other team members (RJT and RA) adjudicated any disagreements among AMM and AEM who then refined categorization of content domains until they achieved agreement on a parsimonious set of content domains reflective of key themes in transcripts. Through this process of content analysis, thematic saturation, defined by the point at which themes were recurring across the cohort without significant new themes emerging, was reached. Via an iterative consensus-building process, the full study team reviewed analytic findings to ensure agreement and face validity of key themes.

Table 2:

Selected codes and associated descriptions from the original codebook developed for the primary study²⁰ that addressed the specific aims explored in this secondary analysis.

Code Identifier	Code Description
Food selection strategy	How participants plan for optimizing their food budget/food shopping and how food plans help the family budget
Difficult food selection choices	Hard choices that participants make while selecting and purchasing food and reasons given for those choices
Dietary quality preferences	How or why participants prioritize or prefer certain food items based on their philosophy around healthy eating
Meal planning	Who plans meals, who cooks, who is responsible for getting the groceries and who pays for the groceries
Splurge	Participant’s description of acting on/executing out-of-the-ordinary expenses or special treats of any kind

Results

Participant Characteristics

Thirty primary caregivers of children ages 4–10 years old who receive SNAP benefits participated in this study. Table 3 shows the demographic characteristics of participants. The majority of caregivers were African American and female.

Table 3.

Demographic characteristics of primary caregivers and index children receiving SNAP benefits in Baltimore, MD who participated in interviews regarding food selection and prioritization strategies.

Demographics (N = 30)
	Caregivers		Children
Gender	N	%	N	%
Female	29	96.7	12	40
Male	1	2.3	18	60
Race
African American	21	70.0	Children were assumed to be race-concordant with primary caregivers.
White	6	20.0
Hispanic	1	3.3
Native American	1	3.3
Other	1	3.3
	Mean	SD	Mean	SD
Age (years)	43	9.3	7.2	2.2

A Priori Themes: Nutritional beliefs and Food Prioritization

Caregivers described how their families determined food-related priorities based on a variety of value systems, subsequently referred to as food prioritization. Analyses identified three a priori themes. Caregivers expressed how 1) general nutritional beliefs, 2) ideal prioritization of food, and 3) prioritization of food under economic constraints each contributed to food purchasing decisions. Table 4 provides exemplary quotes.

Table 4:

Key themes and sample quotes related to nutritional beliefs and food prioritization values described by primary caregivers receiving SNAP benefits in Baltimore, MD in reference to feeding their children.

Theme	Sample Quotes
General Nutrition Beliefs	“He’s a borderline diabetic, and I don’t want him—we already obese, I don’t need him to be passing out […] so our eating habits got to change.” “When I took my daughter to the clinic one time, he said fried foods weren’t good for her […] so we eat a lot of baked everything […] and I do a lot of boiling.” “I just think that maybe eating home cooked meals every day will be better for her.”
Ideal Prioritization of Food	“I get frozen, frozen vegetables and stuff because I know once it’s picked it’s compact and it’s frozen. I don’t know how long that stuff been in the can. So, most of the time canned goods that I buy will stay in the cabinet forever because I like frozen or fresh.” “Sometimes I get the canned vegetables. I try to get the frozen ones if I can, or fresh, but I get the canned goods, sometimes, too […] I don’t really like getting them, I don’t know what’s in the juice that’s in the can.”
Prioritization of Food Under Economic Constraint	“I’ll buy toaster, scrambled eggs and sausage or bacon strudels, he pops them in the toaster and then---things he can do because he can’t cook yet […] but he can use the microwave, and he can use the toaster.” “I wish that my family didn’t have to just basically eat a lot of packaged foods, but it’s so hard to keep up with cooking and it’s expensive.” “Every month [...] I’ll [set aside] at least 50 bucks to buy nonperishable items, items that will last many months in the future […] I know if anything happens, if my benefits are cut off, we’ll still have at least a little bit to bridge the gap.”

Theme 1: General Nutritional Beliefs

Participants routinely described a meal as a combination of vegetables, starch, and meat. Almost all participants believed meat was a preferred source of protein for a healthy meal. They expressed that fruits and vegetables are healthy and an essential part of a child’s diet. Caregivers often described creative methods for incorporating healthy foods into a child’s diet:

“What I’m doing with him now is I’m putting small portions of [spinach] on his plate. […] Just to have him get that, get it in him, far as for the nutrients and stuff like that.”

While fruits and vegetables were universally identified as healthy, some participants expressed the misconception that yogurt smoothies or fruit-based beverages were healthy because they contained fruit without considering sugar content. However, when considering junk food or dessert, participants described salt, sugar, and fats as nutrients that should be eaten in moderation and associated these ingredients with development of chronic diseases. Caregivers also described the additives in processed foods (e.g., pre-packaged lunch meats or canned goods) as unhealthy. Many participants described preparing home-cooked meals via a healthy cooking method (e.g., baking vs. frying) as a strategy to prepare healthier foods. However, many caregivers endorsed frying foods nonetheless.

Theme 2: Ideal Prioritization of Food

Participants described prioritizing satiating and healthy foods like meats, fruits, and vegetables over snacks and processed foods which were viewed as accessory luxury items only to be purchased if there were enough funds leftover after buying essential foods for preparing meals:

“My main focus is getting food besides snacks. I get food first. That way I know we’ll be able to eat.”

Many also described a hierarchy of healthiness where fresh food was preferred over frozen and frozen foods over canned. This ideal hierarchy was not always attainable. Caregivers often endorsed purchasing foods of less desired preparation methods depending on other considerations explored in Theme 3.

Theme 3: Prioritization of Food Under Economic Constraint

Factors other than healthiness hindered participants’ abilities to purchase preferred foods in the setting of scarce economic resources. Participants discussed buying foods they viewed as less healthy because of the low cost, prolonged shelf life, and convenience:

“I know that they’re—we shouldn’t have so many canned or processed foods. It’s just easier and a lot cheaper.”

Many participants explained that their children needed food options they could prepare on their own when parents were working. These meals often consisted of pre-made, processed foods that could be cooked in the microwave or toaster. Additionally, participants did not want to risk wasting benefits by purchasing foods that children did not like or that were highly perishable (e.g., fresh fruits and vegetables). As one participant explained:

“I’ll give [the kids] a chance of what they say they want because I don’t want the food to go to waste.”

As such, caregivers described prioritizing less healthy food options when those were the foods they knew their children would eat, particularly when managing scarce economic resources.

Emergent Themes

Analyses exploring emergent themes related to the way that families prioritize food purchases and use of SNAP benefits (Aim 2) identified ways that caregivers made connections between food priorities and promoting healthy child social and emotional development; specifically, they identified: 1) food as a tool for parenting, 2) letting a child be a child, and 3) food bringing the family together. Table 5 contains exemplary quotes.

Table 5:

Emergent themes and sample quotes regarding health-related roles of food beyond nutrition described by primary caregivers receiving SNAP benefits in Baltimore, MD in reference to feeding their children.

Theme	Sample Quotes
Food as a tool for parenting	“I normally try to do that once a month. [...] If everything, once the main thing is done, like bills.  Stuff that they need.  I might treat them to something that’s their favorite that I know that--like with him, he loves McDonald’s.  We don’t do that fast food everyday thing, because things are tight.  I’m not going to start that, because it’s really not healthy.  I do know that they are kids, so I try to treat them with things after I make sure the main things is paid.  So, I will treat them to something of their favorites, something of their choice.” “I do little things when they do good in school.  I do believe in rewarding a child that deserves to be rewarded by doing little things.   However financially I am not in a position where I am able to do it consistently so or it has to be spontaneous.”
Letting a child be a child	“You know, because other kids talk. And you go to school and they’ll be like, ‘I went here.’ So I want my kids to be able to be like, yeah, “I did this too” or “we did this too,” you know. So you—yeah, to make them feel like, you know, like everybody else. I don’t want them to feel different. I want them to feel special. I want them to feel good.” “That’s his big day.  So, I surprise him before he go to school, make him a big breakfast, and then when he come home I have balloons and his gift sitting out on the table with his cake.”
Food bringing the family together	“Sunday is kind of like a must, you know like that’s like the only day out of the week that we’re all at the table.  So, we either make dinner here at the house or we go out for dinner.  Then it’s all of us […] it’s kind of like catching up, everyone works during the week, so Sunday is kind of catching up on like the kids’ school, work and just like small stuff.  Laughing and enjoying the evening. […] it’s just the kids, grandparents and myself.  A family of seven.”

Theme 4: Food as a Tool for Parenting

Caregivers described using food to incentivize good behavior, formulate instructive experiences, and expose children to new environments. These functions were sometimes prioritized over healthfulness. Caregivers described using food to reward their children for their hard work at school or extra-curricular activities, to show appreciation for their children, and to reinforce positive behaviors. As one participant put it:

“Well you know, sometimes [we get carry out food], but it’s not often. Like [to index child] when did I send you to McDonald’s, yesterday? Yesterday and that was because he did such a great job on his Class DoJo.”

Other caregivers similarly indicated the importance of using small rewards in parenting and highlighted the limitations they have in doing so given their economic constraints, making food an affordable way to provide rewards.

Caregivers also expressed how food served as a conduit to new experiences constituting an important component of children’s socialization. Many participants described taking their children out to eat so children could have more experiences navigating new situations and learn how to behave in more structured settings. For example, one participant described taking her children to a restaurant as a teachable moment:

“Sometimes you need a different environment than in the house.  […] Like know how to conduct yourself both ways, in the home and out in public and having those experience too, you know what I mean, broadens your horizons.”

Additionally, caregivers described eating out as an opportunity to expose children to new foods and as an opportunity to allow children to make decisions.

Theme 5: Letting a Child Be a Child

Caregivers expressed that childhood should be a time when children enjoy experiences unique to childhood and are protected from hardship. Participants described food as playing an integral role in maintaining the fun and carefree nature of childhood. For example, caregivers used food to treat children, provide quintessential childhood experiences, celebrate special occasions, and to shield children from recognizing the family’s financial constraints.

Many caregivers emphasized that children periodically deserved food treats, even if sometimes unhealthy. Unlike food rewards which were given in recognition of specific achievements, food treats were given randomly to make a child smile and create memories. Food treats were foods caregivers associated with childhood like a pretzel at the mall or a child’s favorite foods such as candy or pizza.

Additionally, many caregivers wanted to hide adult worries from children and create an environment where children could happily thrive, grow, and develop. Beyond treats, participants described purchasing certain foods and eating out to mask the family’s financial hardship from children. As one participant put it:

“I try to make them be, stay in the kid’s place. […] Y’all can’t stress about stuff like this. That’s for adults to do.”

Another way participants described letting children be children was by prioritizing occasions and accompanying foods that were associated with celebrating childhood. These included providing food for birthday parties, cookouts, and holidays. The importance of maintaining these celebrations oftentimes required that caregivers plan ahead or simply bear the financial consequences of spending extra money on the celebrations.

Many caregivers expressed a desire to provide their children the same types of experiences as children in families with more resources. This ranged from wanting to provide children basic opportunities for self-expression through food such as occasionally bringing their own home-packed lunch to school to more elaborate things like having a custom-themed birthday cake:

“Planning for her birthday and getting her cake and everything that kind of put me back a little bit with buying food and stuff. [...] I wanted her to--like every other kid, they want to have a little party, a little gathering. So we did something at the school, and just made her happy so she could celebrate with her friends.”

In this way, certain foods or expressions involving food were seen by caregivers as hallmarks of childhood that they wanted their children to experience, despite limited resources.

Theme 6: Food Bringing the Family Together

Participants almost universally described food as the centerpiece of events and traditions that brought families together. Mealtimes were described as designated opportunities for family bonding:

“We all eat together, you know, it’s family time.  […] Bringing the family to eat is more like, basically getting to know each other, you know.  You know with how our day was, how her day was in school and we ask her what she ate at school [...] That’s what it means to us […]  That’s a good part about eating together, bringing us together.”

For special events centered around food, participants described spending extra money and preparing special foods, even if unhealthy, because the emotional benefits of these meals outweighed the cost and nutritional value:

“I try to get them a pizza once a week. […] We get a good movie and everybody just sits around and we laugh […] even my oldest daughter, like, she, I don’t see her […] she’s in her room.  But when [the pizza] comes, she’s down there with us.”

Thus, food was seen as serving a purpose of preserving and fortifying family and bringing people together to share experiences.

Discussion

The goals of this study were twofold: 1) explore how families with children participating in SNAP think about food-related priorities as they relate to healthy eating, and 2) explore emergent themes related to how families prioritize food purchases and use of SNAP benefits.

In our sample, families with children participating in SNAP demonstrated general nutrition knowledge consistent with findings in other studies.^23–26 Participants considered balanced nutrition, low sodium and sugar content, and healthy preparation methods as factors that contributed to a healthy diet. However, similar to existing literature, ^{19, 23–24, 26–27} economic factors including consideration of child food preferences to minimize waste, shelf stability of foods, and ready-made foods children could prepare on their own oftentimes superseded choosing healthier foods.

Emergent themes highlighted that optimal nutrition is not the only goal caregivers have when determining how best to use SNAP benefits. Findings showed that caregivers are interested in rewarding good behavior and achievements, fostering new experiences, preserving childhood experiences, and bringing their families together in support of healthy child social and emotional development.

Considering how caregivers with children who participate in SNAP both prioritized food choices and used food to serve children’s other developmental needs, this study raises new questions regarding how best to design future interventions to influence use of public benefits to improve health. Though there is wide support for incentivizing healthy foods like fruits and vegetables, evidence suggests incentives alone are insufficient to improve the dietary quality of SNAP participants.^28–29 Some studies have suggested that combining incentives on healthy items and restrictions on unhealthy items provides an optimal solution.^30–31 While industry, academic, and research stakeholders are more likely to support restrictions,³² the advocacy and non-profit sectors have voiced concerns that restrictive changes could be patronizing and infringe upon the autonomy of those who participate in public benefits¹⁴ since these policies would not impact families that utilize their own financial resources for food purchasing. In addition to these concerns, our findings suggest that restricting caregivers’ access to certain foods has implications for child health in the larger context of poverty. In particular, if interventions focus solely on the nutritional aspect of foods, critical socioemotional functions that food serves for these families and their children may be overlooked.

Moreover, how a family’s access to resources plays into how caregivers use food and the types of food they select requires reflection. For example, while rewarding children with less healthy foods is considered an obesogenic practice,³³ low-income families with limited resources turn to the most affordable items to meet their needs. Studies have shown that limited financial resources restrict food choices oftentimes reducing caregivers’ ability to control access to unhealthy foods^{34, 35} due in part to structural constraints of FI like proximity to healthy food, time, and the cost of food.¹⁹ Though caregivers in our study expressed basic nutrition knowledge, they did not always prioritize healthy options at times due to competing economic considerations and at others because of special events or small amounts of excess income secured as a disposable resource caregivers used to serve their children’s healthy development beyond nutrition. Though there are many potential childhood experiences that caregivers might want to create for their children, food-related experiences may simply be most feasible for SNAP participants. As these benefits can only be redeemed for food, SNAP benefits become a resource that support caregivers in creating memorable childhood experiences. This may, in part, explain why the low-income families in this study identified food as having multiple functions. It is unclear whether families used food in these additional roles because they wanted to or because SNAP provided tangible resources at their disposal in a setting of economic scarcity.

This study has several key strengths including the rich contextual analysis focused on the lived experiences of participants. Interviews were conducted on caregivers’ terms in the familiar environment of their own homes.

Limitations of our study include the small sample size. This work focused on food-related priorities and did not extensively explore positive versus negative feeding behaviors. Moreover, during in-depth interviews, discussions with caregivers were not limited to the index child. Although age ranges of other children living in the household were not collected, considerations for older children in the household likely impacted caregivers’ food purchases. Because this work is a secondary analysis, the data analyzed was not originally collected to address the questions explored in this work. As such, these findings merit further examination in future research. This study explored food-related priorities among a group of English-speaking caregivers who represent a subset of cultural backgrounds and experiences, which may limit the relevance of these findings to caregivers from other cultural backgrounds or geographies including Latinx or Spanish-speaking families among others. Also, because interviews were conducted in 2017, this study does not explore changes to the home food environment during the COVID-19 pandemic. Finally, this study relies on self-reported behavior and is subject to social desirability bias, particularly because interviews focused on potentially stigmatizing topics such as FI. Nonetheless, our findings identify important areas for further inquiry and suggest that primary care providers, clinicians, and policymakers need to keep in mind the many competing priorities that families and caregivers with limited economic resources must balance in the allocation of nutrition benefits and other resources for food purchases.

Conclusions

SNAP participants utilize benefits to feed their families, but the role of SNAP in enhancing access to food among low-income families extends beyond meeting basic nutritional needs. It is critical for future research to further explore the role of SNAP in supporting social and emotional development among low-income children to guide policy recommendations that best support and advance caregivers’ efforts to meet both their children’s nutritional and developmental needs.

What’s New.

Families with children receiving SNAP benefits possess basic nutrition knowledge and value healthy meals but often balance conflicting priorities when purchasing food. This study explores how food impacts aspects of family and child development in emotional, social, and developmental ways.