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Table 1.  
Availability of Grocery Delivery Among Urban Food Desert Census Tracts and SNAP Households
Availability of Grocery Delivery Among Urban Food Desert Census Tracts and SNAP Households
Table 2.  
Availability of Grocery Delivery Among Rural Food Desert Census Tracts and SNAP Households
Availability of Grocery Delivery Among Rural Food Desert Census Tracts and SNAP Households
1.
Mabli  J; Mathematica Research.  SNAP participation, food security, and geographic access to food. https://fns-prod.azureedge.net/sites/default/files/SNAPFS_FoodAccess.pdf. Accessed October 22, 2019.
2.
US Department of Agriculture.  Food Access Research Atlas. https://www.ers.usda.gov/data-products/food-access-research-atlas/. Accessed October 22, 2019.
3.
Office of Policy Development and Research.  HUD USPS ZIP Code Crosswalk Files. https://www.huduser.gov/portal/datasets/usps_crosswalk.html. Accessed October 22, 2019.
4.
Lewis  M, Singh  V, Fay  S.  An empirical study of the impact of nonlinear shipping and handling fees on purchase incidence and expenditure decisions.  Mark Sci. 2006;25(1):51-64. doi:10.1287/mksc.1050.0150Google ScholarCrossref
5.
Jilcott Pitts  SB, Ng  SW, Blitstein  JL, Gustafson  A, Niculescu  M.  Online grocery shopping: promise and pitfalls for healthier food and beverage purchases.  Public Health Nutr. 2018;21(18):3360-3376. doi:10.1017/S1368980018002409PubMedGoogle ScholarCrossref
6.
Mozaffarian  D, Liu  J, Sy  S,  et al.  Cost-effectiveness of financial incentives and disincentives for improving food purchases and health through the US Supplemental Nutrition Assistance Program (SNAP): a microsimulation study.  PLoS Med. 2018;15(10):e1002661. doi:10.1371/journal.pmed.1002661PubMedGoogle Scholar
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    Research Letter
    Health Policy
    December 2, 2019

    Availability of Grocery Delivery to Food Deserts in States Participating in the Online Purchase Pilot

    Author Affiliations
    • 1National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut
    • 2Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
    • 3Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
    • 4Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
    • 5Yale School of Nursing, Yale University, Orange, Connecticut
    • 6Section of General Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
    • 7Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
    • 8Center for Outcomes Research and Evaluation, Yale-New Haven Health System, New Haven, Connecticut
    JAMA Netw Open. 2019;2(12):e1916444. doi:10.1001/jamanetworkopen.2019.16444
    Introduction

    The US Department of Agriculture (USDA) Supplemental Nutrition Assistance Program (SNAP) provides federally funded nutritional support to qualifying low-income persons.1 To increase SNAP beneficiaries’ access to grocers, the 2014 Farm Bill included an Online Purchase Pilot (OPP) that allows beneficiaries in 8 states to use SNAP to purchase groceries online. The 2018 Farm Bill extends this benefit nationwide after OPP completion. Delivery of online-purchased groceries offers an opportunity to expand food access where it is otherwise limited. However, to our knowledge, there are no studies assessing the availability of grocery delivery in USDA-designated food deserts, defined as low-income communities with limited vehicular access and grocer availability. To inform on the potential effect of delivery in these areas, we quantified the proportion of both rural and urban USDA-designated food deserts currently serviceable by online grocery purchase and delivery in the 8 OPP states.

    Methods

    This study was deemed exempt from institutional review board review by Yale University. Informed consent was not required because this study did not involve human subjects. This study is reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

    In this cross-sectional study, we used 2015 USDA Economic Research Service Food Access Research Atlas2 data to identify USDA-defined food deserts in OPP states. We converted census tracts to zip codes using US Housing and Urban Development US Postal Service zip Code Crosswalk Files3 data from September 2018. We identified retailers accepting SNAP using the Nielsen TD-Linx database. From December 2018 through March 2019, we identified corresponding retailer websites through Google (Alphabet) to determine participation in online purchasing and corresponding delivery areas by zip codes. Outcomes were the proportion of food desert census tracts and corresponding SNAP households classified as fully, partially, or not deliverable, according to whether all, some, or no corresponding zip codes were located within grocery delivery areas. We stratified results by urban vs rural status and state, then we compared strata using Monte Carlo simulations to enable comparisons using Fisher exact test owing to many cases of small cell-counts. Data were analyzed using SAS statistical software version 9 (SAS Institute). P values were 2-tailed, and statistical significance was set at less than .05.

    Results

    In the 8 OPP states, food deserts composed 1250 of 13 134 total census tracts (9.5%), within which 506 863 of 2 760 482 SNAP households (18.4%) were located. Among 1191 urban food desert census tracts, 1108 census tracts (93.0%) were fully deliverable through online grocery purchase and delivery, 13 census tracts (1.1%) were partially deliverable, and 70 census tracts (5.9%) were not deliverable (Table 1). Among 59 rural food desert census tracts, no census tracts were fully deliverable, 18 census tracts (30.5%) were partially deliverable, and 41 census tracts (69.5%) were not deliverable (Table 2). Results were similar for SNAP households within food deserts: 456 263 urban households (92.9%) were fully deliverable, 6466 urban households (1.3%) were partially deliverable, and 28 472 urban households (5.8%) were not deliverable (Table 1), whereas no rural households were fully deliverable, 6121 rural households (39.1%) were partially deliverable, and 9541 rural households (60.9%) were not deliverable (Table 2).

    The percentage of urban census tracts that were fully deliverable ranged across states from 80.7% in Alabama to 100% in New Jersey (P < .001) and from 81.1% in Alabama to 100% in New Jersey for urban SNAP households (P < .001) (Table 1). Iowa and New Jersey had no rural food desert census tracts, and no rural census tracts were fully deliverable. However, the percentage of partially deliverable census tracts ranged from 0% in Maryland and Nebraska to 72.7% in New York (P = .006) and the percentage of rural SNAP households that were partially deliverable ranged from 0% in Maryland and Nebraska to 72.9% in New York (P < .001) (Table 2).

    Discussion

    Among 8 states participating in the USDA’s OPP, online grocery purchasing and delivery services were available to more than 90% of urban food desert census tracts and SNAP households within them, but these services were rarely available in rural food desert census tracts. Our results suggest that existing grocery delivery networks, when combined with online grocery-purchasing, could potentially strengthen access to groceries in many areas where it is most lacking. However, grocery delivery fees are not covered by SNAP and may deter online purchasing.4 To help maximize OPP benefits in food desert census tracts, the USDA could consider extending SNAP benefits for both online grocery purchasing (as in the OPP) and delivery, although rural areas may be least affected.

    This study has limitations. First, our results pertain to food desert census tracts in OPP states and may not be generalizable elsewhere. Second, we may have undercounted delivery services not connected to brick-and-mortar grocery stores or their websites, thereby underestimating delivery availability. Third, we examined grocery delivery areas and not the types or quality of food available for delivery or covered under SNAP. Online ordering could increase or decrease healthy food choices, depending on how platforms are designed.5

    Online purchasing provides an opportunity to integrate known incentives and disincentives that promote high-quality food purchasing by SNAP beneficiaries.6 Delivery might extend these benefits in areas of highest need. Future studies should evaluate how best to leverage and finance online grocery purchasing and delivery to enhance dietary quality, especially among SNAP recipients.

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    Article Information

    Accepted for Publication: October 10, 2019.

    Published: December 2, 2019. doi:10.1001/jamanetworkopen.2019.16444

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2019 Brandt EJ et al. JAMA Network Open.

    Corresponding Author: Eric J. Brandt, MD, Yale University School of Medicine, Section of Cardiovascular Medicine, Department of Internal Medicine, PO Box 208088, Courier SHM IE-66, 333 Cedar St, New Haven, CT 06519 (eric.j.brandt.md@gmail.com).

    Author Contributions: Dr Brandt had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Brandt, Silvestri, Mande.

    Acquisition, analysis, or interpretation of data: Brandt, Silvestri, Holland, Ross.

    Drafting of the manuscript: Brandt, Silvestri.

    Critical revision of the manuscript for important intellectual content: All authors.

    Statistical analysis: Brandt.

    Administrative, technical, or material support: Brandt.

    Supervision: Silvestri, Ross.

    Conflict of Interest Disclosures: Dr Ross reported receiving grants paid to Yale University from the Food and Drug Administration, Center for Medicare & Medicaid Services, Johnson and Johnson, Medtronic, Blue Cross Blue Shield Association, Agency for Healthcare Research, National Heart, Lung, and Blood Institute, National Institutes of Health, and Laura and John Arnold Foundation and outside the submitted work. No other disclosures were reported.

    Funding/Support: This publication was made possible by a Clinical and Translational Science Award from the National Center for Advancing Translational Science, a component of the National Institutes of Health (NIH) (grant TL1 TR001864).

    Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    Disclaimer: The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of NIH. The conclusions drawn from the Nielsen data are those of the authors of this article and do not reflect the views of Nielsen. Nielsen is not responsible for, had no role in, and was not involved in analyzing and preparing the results reported herein.

    References
    1.
    Mabli  J; Mathematica Research.  SNAP participation, food security, and geographic access to food. https://fns-prod.azureedge.net/sites/default/files/SNAPFS_FoodAccess.pdf. Accessed October 22, 2019.
    2.
    US Department of Agriculture.  Food Access Research Atlas. https://www.ers.usda.gov/data-products/food-access-research-atlas/. Accessed October 22, 2019.
    3.
    Office of Policy Development and Research.  HUD USPS ZIP Code Crosswalk Files. https://www.huduser.gov/portal/datasets/usps_crosswalk.html. Accessed October 22, 2019.
    4.
    Lewis  M, Singh  V, Fay  S.  An empirical study of the impact of nonlinear shipping and handling fees on purchase incidence and expenditure decisions.  Mark Sci. 2006;25(1):51-64. doi:10.1287/mksc.1050.0150Google ScholarCrossref
    5.
    Jilcott Pitts  SB, Ng  SW, Blitstein  JL, Gustafson  A, Niculescu  M.  Online grocery shopping: promise and pitfalls for healthier food and beverage purchases.  Public Health Nutr. 2018;21(18):3360-3376. doi:10.1017/S1368980018002409PubMedGoogle ScholarCrossref
    6.
    Mozaffarian  D, Liu  J, Sy  S,  et al.  Cost-effectiveness of financial incentives and disincentives for improving food purchases and health through the US Supplemental Nutrition Assistance Program (SNAP): a microsimulation study.  PLoS Med. 2018;15(10):e1002661. doi:10.1371/journal.pmed.1002661PubMedGoogle Scholar
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