Using Propensity Score Analysis to Examine Participation in CalFresh and Its Association with Dietary Intake among Californian Adults in Poverty

Background: CalFresh, also known as the Supplemental Nutrition Assistance Program (SNAP) in California, seeks to meet the dietary needs and improve the health and well-being of Californians, especially those living in poverty. The SNAP participation rate in California remains lower than the national average. Research that identifies the determinants of CalFresh participation among adults in poverty is needed to improve the reach and utilization of the program. In addition, the association between CalFresh participation and dietary intake is unknown among adults in poverty. Objectives: (1) To examine the determinants of participation in CalFresh; (2) To examine the association between CalFresh and dietary intake. Participants: Data came from the 2012 California Health Interview Survey.The sample included 2,637 non-institutionalized Californian adults with income below the federal poverty level income. Statistical analysis: Logistic regression was used to examine the individual, household, and neighborhood-level determinants of CalFresh participation. Propensity score matching was used to investigate the association between CalFresh and intake of fruits, vegetables, soda, fries, and fast food in the past week. Results: CalFresh participation was significantly associated with age, income, employment status, family type, and house tenure (P < 0.001). CalFresh participants had 26% higher intake of fries than non-participants (P < 0.05). Conclusions: Future research should address the barriers of CalFresh participation among underserved populations to improve its reach. Food assistance program should be accompanied with community nutrition inventions to improve dietary quality among recipients