Sugar-Sweetened Beverage Consumption in Children: The Interplay of Household SNAP and WIC Participation


      Although sugar-sweetened beverage (SSB) consumption is associated with Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation, no national studies have examined the interplay between these programs. This study compares children's sugar-sweetened beverage consumption across households enrolled in one, both, or neither program.


      A total of 4 waves (2009–2010 to 2015–2016) of the National Health and Nutrition Examination Survey were combined to obtain a sample of 4,772 children aged 0–19 years living in households eligible for both SNAP and WIC (households with income ≤130% of the Federal Poverty Level). Children were grouped as living in 4 household types: SNAP only; WIC only; SNAP + WIC; and neither program. Beverages with any added sugars were classified as SSBs. Two-part regression models examined the adjusted association between SSB consumption and program participation. Analyses were conducted in 2020.


      Compared with the SNAP‒only group, children in all other household types had lower odds of SSB consumption (AOR=0.44, p=0.002 for WIC only; AOR=0.69, p=0.020 for SNAP + WIC; AOR=0.61, p=0.025 for neither program). The lower probability of SSB consumption for children from WIC‒participating households was mostly driven by children aged 0–5 years, with the differences weakening for children aged 6–12 years and completely disappearing for those aged 12–19 years. No significant differences were observed for the amount of added sugar consumed by SSB consumers.


      Household WIC participation—whether jointly with SNAP or alone—may confer protection against SSB consumption. Unlike SNAP, WIC, by design, provides participating households with more information and opportunities to access and consume healthier diets. Understanding how SNAP and WIC interact can help policymakers improve the design and nutritional benefit of the U.S. food safety net.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Moshfegh AJ
        • Garceau AO
        • Parker EA
        • Clemens JC
        Beverage choices among adults: what we eat in America, NHANES 2015–2016.
        U.S. Department of Agriculture, Food Surveys Research Group, Washington, DCPublished May 2019
      1. Dietary Guidelines Advisory Committee. Scientific report of the 2020 Dietary Guidelines Advisory Committee: advisory report to the Secretary of Agriculture and the Secretary of Health and Human Services. Washington, DC: U.S. Department of Agriculture, Agricultural Research Service. Accessed 9 June 2021.

        • Sonneville KR
        • Long MW
        • Rifas-Shiman SL
        • Kleinman K
        • Gillman MW
        • Taveras EM.
        Juice and water intake in infancy and later beverage intake and adiposity: could juice be a gateway drink?.
        Obesity (Silver Spring). 2015; 23: 170-176
        • U.S. Department of Agriculture, HHS
        Dietary Guidelines for Americans, 2020–2025.
        U.S. Department of Agriculture, HHS, Washington, DCPublished December 2020 (
        • Bailey RL
        • Fulgoni VL
        • Cowan AE
        • Gaine PC.
        Sources of added sugars in young children, adolescents, and adults with low and high intakes of added sugars.
        Nutrients. 2018; 10: 102
        • Leung CW
        • DiMatteo SG
        • Gosliner WA
        • Ritchie LD.
        Sugar-sweetened beverage and water intake in relation to diet quality in U.S. children.
        Am J Prev Med. 2018; 54: 394-402
        • Bleich SN
        • Vercammen KA.
        The negative impact of sugar-sweetened beverages on children's health: an update of the literature.
        BMC Obes. 2018; 5: 6
        • Cronquist K.
        Characteristics of Supplemental Nutrition Assistance Program households: fiscal year 2018.
        U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, Alexandria, VAPublished November 30, 2019
        • Food and Nutrition Service, U.S. Department of Agriculture
        WIC fact sheet.
        Food and Nutrition Service, U.S. Department of Agriculture, Washington, DCPublished February 14, 2019
        Date accessed: January 17, 2021
      2. SNAP education (SNAP-Ed). SNAP-ed Connection, U.S. Department of Agriculture. Accessed 9 June, 2021.

        • Mabli J
        • Worthington J.
        Supplemental Nutrition Assistance Program participation and child food security.
        Pediatrics. 2014; 133: 610-619
        • Mabli J
        • Ohls J.
        Supplemental Nutrition Assistance Program participation is associated with an increase in household food security in a national evaluation.
        J Nutr. 2015; 145: 344-351
        • Koma JW
        • Vercammen KA
        • Jarlenski MP
        • Frelier JM
        • Bleich SN.
        Sugary drink consumption among children by Supplemental Nutrition Assistance Program status.
        Am J Prev Med. 2020; 58: 69-78
        • Deming DM
        • Briefel RR
        • Reidy KC.
        Infant feeding practices and food consumption patterns of children participating in WIC.
        J Nutr Educ Behav. 2014; 46 (suppl): S29-S37
        • Tester JM
        • Leung CW
        • Crawford PB.
        Revised WIC food package and children's diet quality.
        Pediatrics. 2016; 137e20153557
        • Jensen HH
        • Kreider B
        • Zhylyevskyy O.
        Investigating treatment effects of participating jointly in SNAP and WIC when the treatment is validated only for SNAP.
        Southern Economic Journal. 2019; 86: 124-155
        • Andreyeva T
        • Luedicke J
        • Henderson KE
        • Tripp AS.
        Grocery store beverage choices by participants in federal food assistance and nutrition programs.
        Am J Prev Med. 2012; 43: 411-418
      3. Liu J, Kuo T, Jiang L, Robles B, Whaley SE. Food and drink consumption among 1–5-year-old Los Angeles County children from households receiving dual SNAP and WIC v. only WIC benefits. Public Health Nutr. 2017;20(14):2478‒2485.

        • Chang K-L
        • Zastrow M
        • Zdorovtsov C
        • Quast R
        • Skjonsberg L
        • Stluka S.
        Do SNAP and WIC programs encourage more fruit and vegetable intake? A household survey in the Northern Great Plains.
        J Fam Econ Iss. 2015; 36: 477-490
        • National Health and Nutrition Examination Survey
        NCHS Research Ethics Review Board (ERB) approval.
        Centers for Disease Control and Prevention, Updated November 29, 2017
        Date accessed: January 17, 2021
        • Ver Ploeg M
        Do benefits of U.S. food assistance programs for children spillover to older children in the same household?.
        J Fam Econ Issues. 2009; 30: 412-427
        • Robinson C.
        Younger siblings can be good for your health: an examination of spillover benefits from the Supplemental Nutrition Program for Women, Infants, and Children (WIC).
        J Fam Econ Issues. 2013; 34: 172-184
        • Steeves S
        • Acciai F
        • Tasevska N
        • DeWeese RS
        • Yedidia MJ
        • Ohri-Vachaspati P.
        The Special Supplemental Nutrition Program for Women, Infants, and Children spillover effect: do siblings reap the benefits?.
        J Acad Nutr Diet. 2020; 120: 1288-1294
        • Vercammen KA
        • Moran AJ
        • Soto MJ
        • Kennedy-Shaffer L
        • Bleich SN.
        Decreasing trends in heavy sugar-sweetened beverage consumption in the United States, 2003 to 2016.
        J Acad Nutr Diet. 2020; 120 (e5): 1974-1985
        • Fang Zhang F
        • Liu J
        • Rehm CD
        • Wilde P
        • Mande JR
        • Mozaffarian D
        Trends and disparities in diet quality among U.S. adults by Supplemental Nutrition Assistance Program participation status.
        JAMA Netw Open. 2018; 1e180237
        • Belotti F
        • Deb P
        • Manning WG
        • Norton EC.
        Twopm: two-part models.
        Stata J. 2015; 15: 3-20
        • Litvak J
        • Parekh N
        • Juul F
        • Deierlein A.
        Food assistance programs and income are associated with the diet quality of grocery purchases for households consisting of women of reproductive age or young children.
        Prev Med. 2020; 138106149
        • Added sugars on the new nutrition facts label
        U.S. Food and Drug Administration.
        Updated November 3, 2020 (Accessed March 22, 2021)
        • Twarog JP
        • Peraj E
        • Vaknin OS
        • Russo AT
        • Woo Baidal JA
        • Sonneville KR
        Consumption of sugar-sweetened beverages and obesity in SNAP-eligible children and adolescents.
        Prim Care Diabetes. 2020; 14: 181-185
        • National Commission on Hunger
        Freedom from hunger: an achievable goal for the United States of America: recommendations of the National Commission on Hunger to congress and the secretary of the Department of Agriculture.
        National Commission on Hunger, Washington, DCPublished 2015
        • Bipartisan Policy Center
        Leading with nutrition: leveraging federal programs for better health: recommendations from the BPC SNAP Task Force.
        Bipartisan Policy Center, Washington, DCPublished March 2018
        • Pearson-Stuttard J
        • Bandosz P
        • Rehm CD
        • et al.
        Reducing U.S. cardiovascular disease burden and disparities through national and targeted dietary policies: a modelling study.
        PLoS Med. 2017; 14e1002311
        • Choi SE
        • Wright DR
        • Bleich SN.
        Impact of restricting sugar-sweetened beverages from the Supplemental Nutrition Assistance Program on children's health.
        Am J Prev Med. 2021; 60: 276-284
        • Gundersen C.
        Chapter 6: SNAP and obesity.
        in: Bartfeld J Gundersen C Smeeding T Ziliak JP SNAP Matters: How Food Stamps Affect Health and Well-Being. Stanford University Press, Redwood City, CA2015: 161-185
        • Engel K
        • Ruder EH.
        Fruit and vegetable incentive programs for Supplemental Nutrition Assistance Program (SNAP) participants: a scoping review of program structure.
        Nutrients. 2020; 12: 1676
        • Rummo PE
        • Lyerly R
        • Rose J
        • Malyuta Y
        • Cohen ED
        • Nunn A.
        The impact of financial incentives on SNAP transactions at mobile produce markets.
        Int J Behav Nutr Phys Act. 2021; 18: 26
        • Olsho LE
        • Klerman JA
        • Wilde PE
        • Bartlett S.
        Financial incentives increase fruit and vegetable intake among Supplemental Nutrition Assistance Program participants: a randomized controlled trial of the USDA Healthy Incentives Pilot.
        Am J Clin Nutr. 2016; 104: 423-435
        • Bitler MP
        Chapter five: the health and nutrition effects of SNAP selection into the program and a review of the literature on its effects.
        (eds.)in: Bartfeld J Gundersen C Smeeding T Ziliak JP SNAP Matters: How Food Stamps Affect Health and Well-Being. Stanford University Press, Redwood City, CA2015: 134-160
      4. Key concepts about measurement error. NIH, National Cancer Institute, Dietary Assessment Primer. Accessed 9 June 2021.

      5. Meyer BD, Mok WK, Sullivan JX. The under-reporting of transfers in household surveys: its nature and consequences. Cambridge, MA: NBER Working Paper Series.