Food, health, and nutrient supplements: beliefs among food stamp-eligible women and implications for food stamp policy

Family Economics and Nutrition Review, Spring, 2002 by Vivica Kraak, David L. Pelletier, Jamie Dollahite

Many U.S. organizations that develop research-based national dietary recommendations support the position that nutrients required by healthy people can be obtained by consuming a balanced diet (Pelletier & Kendall, 1997). The American Dietetic Association maintains that "the best nutrition strategy for promoting optimal health and reducing the risk of chronic disease is to obtain adequate nutrients from a wide variety of foods" (Hunt, 1996). The Food Guide Pyramid and the Dietary Guidelines for Americans, 2000 also support this perspective by promoting a food-based approach for U.S. consumers to achieve optimal health (Johnson & Kennedy, 2000). The use of supplements, (1) however, is a growing trend, which suggests that Americans are becoming more receptive to nonfood sources of nutrition for health promotion.

A recent biannual nationwide survey conducted by the American Dietetic Association (2002), which tracks public attitudes, beliefs, knowledge, and practices related to food, nutrition, and health, found that nearly half(49 percent) of the adults surveyed took supplements daily, and more than a third (38 percent) believed that taking supplements is necessary to ensure good health. The high prevalence of supplement use has been confirmed in other national surveys (Balluz, Kieszak, Philen, & Mulinare, 2000; Bender, Levy, Schucker, & Yetley, 1992; Slesinski, Subar, & Kahle, 1995; Subar & Block, 1990). Further analyses suggest that users of nutrient supplements tend to have higher incomes and education and more healthful lifestyles than do nonusers (Nayga & Reed, 1999; Neuhouser, Patterson, & Levy, 1999), although supplement use also is associated with having one or more health problems (Bender et al., 1992; Newman et al., 1998). Many studies have reported that vitamin and mineral intakes from food tend to be higher among supplement users than nonusers, but analysis of data from the 1989-91 Continuing Survey of Food Intakes by Individuals revealed that this relationship can vary across sociodemographic groups and is influenced by the motivations and beliefs for using supplements (Pelletier & Kendall, 1997).

In 1995 and 1999, Congress considered legislation to permit food stamp recipients to use their benefits to purchase dietary supplements (H.R. 104-236 and S. 1307, respectively) (Thomas, 2000). This legislation was opposed by many organizations that monitor public health and hunger, including the American Academy of Pediatrics; American Heart Association; USDA; and the Food, Research, and Action Center (Pelletier & Kendall, 1997; Porter, 1995; Skolnick, 1995). These organizations voiced a range of concerns: Most important was that a policy change would depart from the original intent of the Food Stamp Program (FSP), and supplements would not provide the calories needed or full range of nutritional benefits by children to avoid health problems and maximize learning potential in school (Porter, 1995). The proposed change was also seen as an attempt by a billion-dollar supplement industry to widen its market (Skolnick, 1995). USDA's position on this issue was stated in these terms:

   Because vitamins and minerals
   occur naturally in foods, a good
   diet will include a variety of foods
   that together will supply all the
   nutrients needed.... Because
   these products serve as deficiency
   correctors or therapeutic agents
   to supplement diets deficient in
   essential nutrition rather than as
   foods, they are not eligible for
   purchase with food coupons.
   (Porter, 1995)

Those favoring the proposed legislation maintained that the bill would expand dietary choices by giving food stamp recipients the option of improving their diet through additional nutrients. The Council for Responsible Nutrition, a trade organization representing the food supplement industry, testified in Congress:

   When critical food choices
   are necessary, spending a few
   cents a day for a vitamin and
   mineral supplement may
   actually be the best and most
   economical choice available
   to a person at nutrition risk.
   (Dickinson, 1998)

Thus, supporters framed the issue in terms of improving nutrition and maintaining personal choice.

A report prepared by USDA at the request of Congress examined issues related to this proposal (U.S. Department of Agriculture [USDA], 1999). Among other findings, the report noted vitamin and mineral intake from food differs little across income levels, food stamp recipients tend to have nutrient profiles that are comparable to nonrecipients, and a third (35 percent) of food stamp recipients already purchase supplements with other income sources. The current policy, therefore, may not restrict individual choice as some have suggested.

There is a paucity of research elucidating attitudes, beliefs, and supplement-use practices of low-income, ethnically diverse Americans. One study suggested that food stamp recipients are less likely to take dietary supplements than are nonrecipients. However, it analyzed neither the reasons for this practice nor the relationship to nutritional quality of the diets, health status, socioeconomic circumstances, or other contextual factors (Nayga & Reed, 1999). The purposes of the present research were to investigate the attitudes and beliefs toward supplement use among food stamp-eligible women to understand better the potential effects of policy changes in this population and to relate these findings to the earlier policy dialogue about this issue, including the discussion of policy goals, strategies, and criteria for selecting among them.