Healthy food availability and marketing in San Francisco small food stores ‐ differences by SNAP vendor status
Authors: Leung Cindy W , Laraia Barbara A , Tester June M , Yen Irene H 
Published: November 2023

Obesity disproportionately affects low‐income communities. Leveraging federal food programs is one potential strategy that can improve the diet‐related health outcomes of low‐income individuals. Stakeholders for the Supplemental Nutrition Assistance Program (SNAP) have proposed strategies for improving the retailer food environment (e.g. stricter stocking requirements) to improve healthy food access in low‐income neighborhoods. When supermarkets and large super centers are unavailable, redemption of SNAP benefits in small food stores is more common. The availability of healthy food in these small food stores has yet to be quantified. This project aimed to: 1) assess healthy food availability and marketing in small food stores located in low‐income communities in San Francisco, and 2) compare differences by SNAP vendor status. Between May and August 2016, we conducted store audits in 101 randomly selected small grocery stores and convenience stores (i.e. small food stores) in ten low‐income San Francisco neighborhoods. Food availability and marketing were assessed using a store survey developed by the California Department of Public Health Communities of Excellence in Nutrition, Physical, and Obesity Prevention (CX3) program. We estimated differences by SNAP vendor status using Poisson regression and generalized linear models, adjusting for store volume, square footage, and store type. Robust standard errors accounted for clustering of stores by zip code. On average, SNAP vendors carried a greater variety of meat, poultry and fish (9.8 vs. 8.7 types); fruits and vegetables (26.0 vs. 15.7 types); and lower variety of dairy products (5.2 vs. 5.8). SNAP vendors had a statistically higher variety of fruits and vegetables compared to non‐SNAP vendors, after multivariate adjustment (P=0.03). Out of 90 points total, the mean overall healthy food and availability (CX3) score among SNAP vendors was 49.5, compared to 38.4 among non‐SNAP vendors. After adjustment for store characteristics, SNAP vendors had a 25% higher CX3 score compared to non‐SNAP vendors (95% CI 13%, 37%). Despite these differences, many SNAP and non‐SNAP vendors failed to score above 50% of the maximum score on individual CX3 metrics. Stores fell short in the following domains: offering sufficiently low prices for produce, having a wide range and good quality of vegetables, having a wide range of healthy foods excluding produce, providing in‐store nutrition information, and limiting marketing of unhealthy foods. In conclusion, our study found higher scores on healthy food availability and marketing for SNAP vendors, compared to non‐SNAP vendors. While this suggests that SNAP‐authorized small food stores provide a healthful food landscape, policies that continue to increase access to healthy foods and limit marketing of unhealthy foods could serve to further bolster the neighborhood food environment for SNAP participants and nonparticipants alike.Support or Funding InformationThis study was supported by a grant from the Robert Wood Johnson Foundation Health Disparities Working Group from the UCSF‐UC Berkeley Joint Program. Additional support was received from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (5K99HD84758, Dr. Leung; 5K23HD075852, Dr. Tester).