2017 RIDGE Grantees

Changes in Meal Serving Practices, Costs, and Training Experiences among Boston Family Childcare Providers Participating in the Child and Adult Care Food Program from Before to After Implementation of New Meal Patterns

Investigator: Erica Kenney

Institution: Harvard T.H. Chan School of Public Health

This study examined how revisions to the Child and Adult Care Food Program (CACFP) meal patterns impacted the nutritional quality and cost of meals served by family child care home (FCCH) providers. The CACFP revisions, designed to improve children’s diet and be cost-neutral, may present unique challenges to FCCHs due to lack of the economies of scale and fewer training opportunities. FCCH providers were surveyed about CACFP training and technical assistance, perceptions of food costs and program burden, and knowledge of the CACFP changes. Menus were collected for a 4-week period to assess the frequency of food served. Children’s dietary intake was assessed using digital photographs of children’s meals. Despite some gaps in training and knowledge, FCCH providers made positive changes to meals served, especially for whole grains, and children’s dietary intake improved. Compliance was high for limiting juice, not using frying as a preparation method, serving low-fat milk and cereals with limited sugar, and not serving grain-based desserts. Children’s intake of fruits and vegetables increased by nearly a full serving (p<0.001). No negative impact on providers’ food costs or program burden were reported. The new CACFP meal standards have the potential to improve children’s diets in family childcare settings without overburdening providers.


Kenney EL, Poole M, Cory H, Cradock A. Impact of changes to the Child and Adult Care Food Program on children’s dietary intake in family child care homes. Public Health Nutrition. 2020; 23(11): 2016-2023. doi:10.1017/S1368980019004646  

Poole MK, Cradock AL, Kenney EL. Changes in foods served and meal costs in Boston family child care homes after one year of implementing the new Child and Adult Care Food Program nutrition standards. Nutrients 2020;12(9): 2817. https://doi.org/10.3390/nu12092817

Poole MK, Cradock AL, Kenney EL. Implementing the new Child and Adult Care Food Program’s nutrition standards in Boston. Preventing chronic disease2020; 17:E44. https://doi.org/10.5888/pcd17.190426

Project Contact:
Erica Kenney, ScD
Harvard T.H. Chan School of Public Health
Department of Nutrition
665 Huntington Avenue
Boston, MA 02115
Email: ekenney@hsph.harvard.edu

RIDGE Program Spotlight: The Impact of Changes to CACFP on Food Spending and Young Children’s Dietary Intake in Urban Family Child Care Homes

April 2020: The updated nutrition standards of the Child and Adult Care Food Program (CACFP) can improve children’s diets in family child care settings based on recent findings from Dr. Erica Kenney at the Harvard T. H. Chan School of Public Health. Providers still will need additional training and technical assistance to improve children’s nutrition.

Did the Rollout of the Food Stamp Affect Retailers?

Investigators: Marianne Bitler, Timothy Beatty, Cynthia van der Werf

Institution: University of California at Davis

The Supplemental Nutrition Assistance Program (SNAP) is a cornerstone of the food economy. This study used the quasi-random rollout of the Food Stamp program during the 1960s and early 1970s to identify effects of food assistance on the retail food environment. Analyses relied on a difference-in-difference research design and the County Business Patterns (CBP) data from 1970-78, newly digitized data from the Census of Retail Trade/Census of Business on retail trade establishments from 1954 through 1977, and U.S. Decennial Census data from 1960/1970/1980. The rollout of the Food Stamp program in the early 1960s and 1970s was found to have led to about a 5-percent increase in employment in food and grocery stores, based on the 1970-78 County Business Patterns data or pooled 1960/1970/1980 Decennial Census data. This is consistent with evidence from newly digitized Census of Retail Trade data on sales, the number of establishments, and the share of establishments in these industry categories. Rollout of Food Stamps led to a 1.3–1.6-percent increase in real sales, robust to controlling for county trends. Effects on sales in eating and drinking establishments and all other establishments are smaller in magnitude and never statistically significant. The rollout of Food Stamps had substantive effects on sales and employment in food stores.


Bitler, M., Hawkins, A., Schmidt, L., & Seligman, H. Final Grant Report: Cash vs. Food? How Does Food Stamp Eligibility Affect Food Stamp Enrollment and Food and Health Outcomes of SSI Recipients?.

Project Contact:
Marianne Bitler
UC Davis
Department of Economics
1 Shields Avenue
Davis, CA 95616
Email: bitler@ucdavis.edu

Does SNAP Encourage Claiming Disability Insurance Benefits?

Investigator: Emmanuel Drabo

Institution: Stanford University

The objective of this study was to understand the potential effects of participation in the Supplemental Nutrition Assistance Program (SNAP) and work requirements on applications for Social Security Disability Insurance (SSDI) benefits. SNAP could discourage SSDI applications among workers with disabilities through its work requirement rule for the able-bodied adults without dependents (ABAWDs). However, SNAP may also encourage SSDI application because a significant number of people with disabilities are still considered ABAWD by USDA definitions, so they may seek SSDI more actively. The study used the Census Bureau’s SIPP Synthetic Beta data and novel causal inference techniques to estimate the causal effects of SNAP participation and work requirements on SSDI applications. Results from the instrumental variable analyses show that SNAP participation is associated with reduced likelihood of SSDI-seeking behavior. However, the HTE and CFM analyses yield consistent results, showing that SNAP’s work requirement policy for the ABAWDs may disincentivize labor force participation and incentivize SSDI-seeking behavior among those participants.

Project Contact:
Emmanuel Fulgence Drabo
Department of Health Policy and Management
Johns Hopkins Bloomberg School of Public Health
624 North Broadway, Suite 402
Baltimore, MD 21205
Email: edrabo@jhu.edu

Does Universal Free School Meals Reduce Childhood Obesity?

Investigators: Michah W. Rothbart and Amy Ellen Schwartz

Institution: Syracuse University

This project investigated the effects of the Universal Free Meals (UFM) policies, which eliminated fees for school meals for all students regardless of income. The first paper used longitudinal student data on meal transactions, academic outcomes, and student characteristics from New York City public schools to explore the impact of UFM on school lunch participation and test performance. Secondary analyses used UFM as an instrumental variable to estimate the effect of school lunch participation on obesity and test scores. UFM improved student academic achievement and increased school lunch participation among middle school students in New York City. There was no effect on attendance, but suggestive evidence of improved weight outcomes, particularly among nonpoor students. The second paper used district and school data for New York State to explore the impacts of the Community Eligibility Provision (CEP) that provides an avenue for districtwide UFM. CEP increased school meal participation, with positive consequences for student weight outcomes. CEP reduced rates of obesity and overweight among secondary school students by 2.4 percentage points and 1.6 percentage points, respectively. CEP increased proficiency rates on English-language arts exams in middle school. Both papers provided evidence to the promise of further expansions of UFM policies.


Schwartz AE, Rothbart MW. Let them eat lunch: the impact of universal free meals on student performance. Journal of Policy Analysis and Management 2020; 3(9): 376-410. doi:10.1002/pam.22175

Rothbart MW, Schwartz AE, Gutierrez E. Paying for free lunch: the impact of CEP universal free meals on revenues, spending, and student health. 2020. Center for Policy Research. 259. https://surface.syr.edu/cpr/259

Project Contact:
Michah W. Rothbart
Syracuse University
The Center for Policy Research
426 Eggers Hall
Syracuse, New York 13244
Email: mwrothba@syr.edu

December 2019: Universal Free Meals helps improve educational outcomes for middle school students in New York City, according to new research by Michah W. Rothbart and Amy Ellen Schwartz of the Maxwell School of Syracuse University.

Providing all students breakfast and lunch at no cost, or Universal Free Meals (UFM), eliminates the financial barrier to student participation in the School Breakfast Program (SBP) and National School Lunch Program (NSLP). Increased school meal participation has the potential to benefit students through improved healthier food access and school districts through streamlined administration and increased revenue. Michah W. Rothbart, a 2017 grantee of the Tufts/UConn RIDGE Program, leverages city and state administrative data to uncover the impact of UFM on both students and districts in New York.

Food Choices of SNAP Participants at Convenience and Large Retailers

Investigators: Grace Melo, Adam N. Rabinowitz

Institution: University of Georgia

Policy makers have considered taxes on less healthy food and/or incentives on healthy food. This debate has gained even greater attention as it applies to the Supplemental Nutrition Assistance Program (SNAP). The study examined household responses to income and price changes of healthy and less healthy foods by food retailer type using the censored Exact Affine Stone Index (EASI) demand system model and data from the USDA’s National Household Food Acquisition and Purchase Survey (FoodAPS). Foods and beverages were classified as healthy and less healthy based on the Guiding Stars Program algorithm. Households paid more for healthy food at all retailers, with the largest price gap at convenience stores. Households were more price sensitive to price changes of less healthy food at convenience stores and all other retailers while healthy food prices mattered most at large retailers. Households perceived healthy foods purchased at convenience and other stores as luxury goods and less healthy foods at all retailers as necessities. A 10-percent reduction in purchasing power due to reduced SNAP benefits would decrease total calories of large SNAP households by 3 percent and affect their food security status. The study indicates that price and income policies might be effective in changing food choices at some but not all retailers.

Project Contact:
Adam N. Rabinowitz
University of Georgia
Department of Agricultural and Applied Economics
2360 Rainwater Road
Tifton, GA 31793
Email: adam.rabinowitz@uga.edu

Multi-generational Effects of Prenatal and Early Life Access to SNAP

Investigator: Marianne Page

Institution: University of California, Davis

There is substantial evidence that health and socioeconomic inequalities persist across generations. Poor children begin life with significant health disadvantages compared to non-poor children, and the gap widens as children age. Studies suggest that differences in early life environments may causally contribute to these disparities. At the same time, there is growing evidence that federal health and nutrition policies that improve the early childhood health environment positively affect individuals’ later well-being. Studies find that childhood access to SNAP reduces health conditions associated with cardiovascular disease and improves economic self-sufficiency. Prior research predicts that the causal impacts of effective nutrition interventions should echo beyond the exposed generation. This project employed natural experiment methodologies to examine the effects of SNAP on later generations’ well-being. The results suggest that in utero and early life exposure to the Food Stamp program during its initial rollout period led to improvements in the “first generation’s” health at birth. This is consistent with evidence from previous studies. Among later offspring (the “second generation”) average birth weight was lower for treated cohorts than for untreated cohorts, but fertility was higher. These results are suggestive of “selection effects,” whereby access to SNAP during the prenatal period improves females’ later reproductive health. Future research will investigate this potential mechanism.

Project Contact:
Marianne Page
Department of Economics, UC Davis
1 Shields Avenue
Davis, CA 95616
Email: mepage@ucdavis.edu

Organizational Readiness for Knowledge Translation and Women, Infants, and Children Retention

Investigator: Naisi Zhao

Institution: Tufts University

Knowledge translation refers to action plans that promote evidence use in decision making. This study assessed the process of implementing the 2009 regulation changes in the Women, Infants, and Children (WIC) program as a case of knowledge translation. This study analyzed knowledge translation at the organizational level by focusing on organizational readiness for change and conducting retrospective, semi-structured interviews with key informants from WIC State agencies. Key informants from seven WIC State agencies (Washington, California, Arizona, Arkansas, Vermont, Maine, and Massachusetts) participated in the interviews. This study emphasized that the complex process WIC State agencies undertook to implement regulation change should not be categorized as “implementation,” but considered as a State-level knowledge translation process. Policy makers and researchers could use the organizational readiness for knowledge translation constructs discovered in this study as evaluation measures for future WIC regulation changes. Decision makers can use the axial codes discovered in this study to (1) understand the knowledge translation process of implementing evidence-informed regulation changes, (2) identify factors that could influence States’ ability to be prepared for implementing changes, and (3) gauge “practicality” of proposed Federal rules. The 2017 WIC food package review report recommends such tools and strategies, which will be key to implementing the upcoming round of WIC regulation changes.


Zhao N, Chung M, Lischko A, Koch-Weser S. Knowledge translation and WIC food package regulation change. Journal of the American College of Nutrition 2020; 1-10. https://doi.org/10.1080/07315724.2020.1810170

Project Contact:
Naisi Zhao
Tufts University
School of Medicine, Department of Public Health and Community Medicine
MV243, 136 Harrison Ave.
Boston, MA 02111
Email: Naisi.Zhao@dgroga01

RIDGE Program Spotlight: Knowledge transaction and WIC food package regulation change

January 2021: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) effectively translated nutrition evidence into regulations during the 2009 WIC regulation change process at both the national and state level, based on recent findings from Dr. Naisi Zhao at Tufts University School of Medicine, using a a framework of Organizational Readiness for Knowledge Translation.

The Effects of Disability, SNAP Participation, and Changes in Benefits on Food Insecurity

Investigators: Seungyeon Cho, Ariun Ishdorj, Christian Gregory

Institution: Texas A&M University

The Supplemental Nutrition Assistance Program (SNAP) serves more than 42,000 people to reduce food insecurity and improve nutritional well-being. In November 2013, SNAP benefits decreased by around 5 percent due to the expiration of the American Recovery and Reinvestment Act. This study used the public- and restricted-access National Health Interview Survey (NHIS) 2011–2015 to examine how the effects of SNAP participation on food insecurity differ by the presence of a member(s) with a disability. The study also estimated how much the downsized benefits reduce SNAP’s effectiveness for households with and without a disabled member using a copula-based endogenous switching regression model. Overall, SNAP reduced food insecurity by 13.2 percentage points, with lower effects (11.4 percentage points) among families without a disabled member and a higher effect (15.3 percentage points) among families with disability. Downsized SNAP benefits reduced the program’s effectiveness by 3.7 percentage points for households with a member(s) with a disability and 3.9 percentage points for households without a disabled member, with very few differences between those two cohorts. SNAP participation is more effective in mitigating food insecurity for households with members with disabilities, and the effectiveness of SNAP substantially varies by who in the household has disabilities.

Project Contact:
Seungyeon Cho
Texas A&M University
600 John Kimbrough Blvd., #341
College Station, TX 77843
Email: arietta111@tamu.edu

The Impact of the Monthly SNAP Issuance Cycle on Supermarket Purchasing and Implications for Policy Change

Investigators: Eric B. Rimm and Rebecca L. Franckle

Institution: Harvard T.H. Chan School of Public Health

The Supplemental Nutrition Assistance Program (SNAP) provides financial assistance for food purchases to one in seven Americans. This mixed-methods project addressed three critical aims related to SNAP issuance and grocery purchases. Aim 1: Supermarket sales data from a panel of shoppers were analyzed using a difference-in-difference model to understand the impact of SNAP issuance on purchasing patterns. For SNAP participants, mean spending decreased significantly through the monthly SNAP benefit cycle, with a different rate of decline across food categories. Aim 2: Focus groups of adult supermarket shoppers gauged awareness of the impact of SNAP policy on shopping behaviors and perceived effects of SNAP policy changes. Four main themes emerged: (1) participant welfare (budgeting, autonomy, transportation, health, and stigma), (2) retailer impact (inventory, staffing, sales and marketing, crowding), (3) administration (cost, implementation, timing, fraud), and (4) political beliefs (distrust and the role of government). Aim 3: Questions about six possible SNAP policy changes were asked in a national telephone survey. Support for SNAP policy changes was high, varying from 63% for removing sugary drinks from SNAP allowable products to 83% for additional benefits for fruits and vegetables. Despite debate among policy makers, respondents supported proposals to improve the nutritional impact of SNAP, regardless of program participation or political ideology.


Franckle RL, Polacsek M, Bleich SN, Thorndike AN, Findling MT, Moran AJ, Rimm EB. Support for supplemental nutrition assistance program (SNAP) policy alternatives among US adults, 2018. American Journal of Public Health 2019;109(7): 993-995. https://doi.org/10.2105/AJPH.2019.305112

Franckle RL, Thorndike AN, Moran AJ, Hou T, Blue D, Greene JC, . . . Rimm EB. Supermarket purchases over the supplemental nutrition assistance program benefit month: a comparison between participants and nonparticipants. American Journal of Preventive Medicine 2019; 57(6):800-807. https://doi.org/10.1016/j.amepre.2019.07.025

Project Contact:
Eric B. Rimm
Harvard T.H. Chan School of Public Health
665 Huntington Avenue
Boston, MA 02115
Email: eric.rimm@channing.harvard.edu

RIDGE Program Spotlight: Public Support and Evidence for More Frequent SNAP Benefit Distribution

January 2020: Monthly issuance of Supplemental Nutrition Assistance Program (SNAP) benefits results in higher SNAP spending earlier in the benefit month across all food categories, and popular support exists for policy changes that could affect these spending patterns, based on new findings from Rebecca Franckle and Eric Rimm at the Harvard T. H. Chan School of Public Health.

View the Program Spotlight Video