Combined participation in the Supplemental Nutrition Assistance Program (SNAP) and Head Start is associated with healthy household dietary environments for young children in low-income families

Objective: To compare the association of participation in Supplemental Nutrition Assistance Program (SNAP) alone v. in combination with Head Start (HS), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) or both on household dietary environment (HDE) indicators: food security, nutrition security, healthfulness choice, dietary choice, perceived food store availability, utilisation barriers and healthy food access barriers in families with young children. Design: This study, part of SNAP-Ed Nebraska's Needs and Assets Assessment 'Healthy People, Healthy State', utilised a cross-sectional design. HDE indicator means were compared across the federal assistance program (FAP) participation groups using multivariate ANCOVA, controlling for significant demographics, with Benjamini-Hochberg-adjusted P values compared with α = 0·05. Setting: Nebraska's low-income households. Participants: Households (n 821) with at least one child aged 2-6 years participating in SNAP-only (n 257), SNAP + HS (n 349), SNAP + WIC (n 132) and SNAP + WIC + HS (n 83). Results: Compared with other groups, SNAP + HS reported comparatively higher levels of household food security, whereas SNAP + HS + WIC reported lower levels (P < 0·01). SNAP + HS also showed higher levels of nutrition security, dietary choices, perceived availability of healthy foods in stores, fewer healthy food access and utilisation barriers (P < 0·05). Conclusions: The findings support recent joint policy changes by Administration for Children and Families and Food and Nutrition Service, facilitating SNAP households' access to HS. HS performance standards for nutrition and family engagement can serve as a model for creating healthy HDE. Future research should employ quasi-experimental or longitudinal designs to establish causal relationships between FAP participation and HDE outcomes.