Do Poverty, Food Stamps, Food Label Use, and Nutrition Knowledge Affect Dietary Quality among Adults? Results from the 1994-96 CSFII/DHKS

Year: 2000

Research Center: Department of Nutrition at the University of California, Davis

Investigator: Pérez-Escamilla, Rafael, and Lauren Haldeman

Institution: University of Connecticut

Project Contact:
Rafael Pérez-Escamilla, Ph.D.,
and Lauren Haldeman, MS
Department of Nutritional Sciences (U-17)
University of Connecticut, Storrs CT 06269
Phone: 860-486-5073
Fax: 860-486-3674


The Food Stamp Program has enormous potential for assisting with improved dietary behaviors in low-income households. The program places very few restrictions on the types of foods that people can buy. With the exception of alcohol and hot meals, food stamp recipients are allowed to purchase any of the thousands of products available to them in the many supermarkets and food outlets that accept food stamps. The main objective of this study is to examine: (a) the relationship of dietary quality to food label use and nutrition knowledge among low-income groups, and (b) whether food stamp receipt or income level modifies this relationship.

The authors analyze recent data from the 1994-96 Diet and Health Knowledge Survey (DHKS) and the Continuing Survey of Food Intake by Individuals (CSFII). They focus on 20- to 60-year-old respondents (N=2950) and the subsample of these respondents with incomes below 130 percent of the poverty line (N=767) who were household meal preparers, meal planners, or food shoppers. They used multivariate logistic regression to estimate their model of dietary quality (measured as a Healthy Eating Index (HEI) below vs. above the median). Their main independent variables were socioeconomic and demographic characteristics, food stamp receipt, food label use, nutrition knowledge, and several interactive terms.

The authors found that dietary quality increased with the levels of income and education, and that it was also higher among White subjects and those whose interviews were conducted in Spanish. After adjusting for these factors, food label use and nutrition knowledge were independently and positively associated with dietary quality. The key finding from the interactive models was that the influence of income on dietary quality is mediated by food label use. Specifically, wealthier individuals (or population segments) who do not use food labels are as likely as low-income individuals not using the labels to have suboptimal dietary quality. In other words, dietary quality appears to be determined simply not by income, but also by the use of nutrition information tools such as food labels. The authors also found that, among food label users, income does make a difference in dietary quality and that food label use partially compensates for the influence of lower income on dietary quality. Their analyses of adults below 130 percent of the poverty line indicate that among nonusers of food labels, a significantly higher proportion of food stamp recipients than nonrecipients have an HEI score above the median. Similarly, among those not receiving food stamps, a significantly higher proportion of those using food labels have HEI scores above the median. The authors argue that nutrition information tools such as food labels are likely to be essential to making healthy food choices in the United States. They conclude that their results support a priority role for nutrition education as a component of food assistance programs like the Food Stamp Program.