key: cord-1011434-ds3nc7sr authors: Hingle, Melanie D; Shanks, Carmen Byker; Parks, Courtney; Prickitt, Joseph; Rhee, Kyung E; Wright, Jimmy; Hiller-Venegas, Sarah; Yaroch, Amy L title: Examining Equitable Online Federal Food Assistance During the SARS-CoV-2: A Case Study in Two Regions date: 2020-09-25 journal: Curr Dev Nutr DOI: 10.1093/cdn/nzaa154 sha: 9850a94f8ac2652ef4e02e0859a847ad98ec1711 doc_id: 1011434 cord_uid: ds3nc7sr The United States Department of Agriculture Supplemental Nutrition Assistance Program (SNAP) provides food and financial assistance to food insecure individuals and families. In the midst of the SARS-CoV-2 pandemic, SNAP benefits evolved. Policy changes and federal legislation expanded SNAP eligibility, raised benefit levels, and introduced program waivers that enabled online ordering to reduce participants’ exposure to community-acquired SARS-CoV-2. Although rapid expansion of SNAP benefits in the online space represents significant progress for federal food assistance, changes also introduced unforeseen partiality in how benefits and services were accessed and utilized, as illustrated by two populations and regions in the early months of the SARS-CoV-2 pandemic: low-income older adults in rural Alabama, and low-income Hispanic adults in urban California. Opportunities exist to build on the recent progress in SNAP, while also ensuring continued inclusiveness of eligible persons. Efforts should be informed by evidence that supports equitable access to federal food assistance. legislation expanded SNAP eligibility, raised benefit levels, and introduced program waivers that enabled online ordering to reduce participants' exposure to community-acquired SARS-CoV-2. Although rapid expansion of SNAP benefits in the online space represents significant progress for federal food assistance, changes also introduced unforeseen partiality in how benefits and services were accessed and utilized, as illustrated by two populations and regions in the early months of the SARS-CoV-2 pandemic: low-income older adults in rural Alabama, and lowincome Hispanic adults in urban California. Opportunities exist to build on the recent progress in SNAP, while also ensuring continued inclusiveness of eligible persons. Efforts should be informed by evidence that supports equitable access to federal food assistance. The SARS-Cov-2 pandemic influenced how federal food assistance resources are delivered and accessed. Data from two regions demonstrate it is essential to understand who benefits and how to reach them. The purpose of this case study report is to describe how two former and current grantees of FINI (Wright's Market, ¡Más Fresco!) and GusNIP (¡Más Fresco!) piloted online enrollment within their nutrition incentive programs, which enabled EBT-supported food ordering and purchasing during the early months of the SARS-CoV-2 pandemic in rural Alabama, and urban California, respectively. We also discuss challenges and opportunities associated with access and utilization of online resources in these regions. Data were collected by NTAE-affiliated scientists using stakeholder interviews and document review. This study was approved by [blinded] Institutional Review Board. Wright's Market 9 SNAP Online launched in March 2020 as the culmination of several years of preparatory work to ensure their e-commerce system seamlessly linked with customers' SNAP EBT benefits. Eligible SNAP participants established accounts, selected and paid for groceries using their EBT card, and received groceries curbside or delivered to their home address. Wright's e-commerce website, configured to help SNAP customers identify eligible products, English and Spanish language broadcast media. More than 350 SNAP participants enrolled online between April 1 and June 30, 2020. Demographic data suggested an emerging divide of language and access among participants. Prior to stay-at-home orders in California, 80-90% of SNAP participants at ¡Más Fresco! in-store enrollment events were primarily Spanish-speaking. After March 13, 2020, this proportion dropped to 35%. Furthermore, 21% of online enrollees compared to 2% of in-store enrollees indicated they wished to receive program reminders via email, while text message reminders remained more popular among in-store enrollees (84%) compared to online enrollees (53%). These differences indicate that additional work is warranted to understand potential barriers to digital enrollment and ensure that program participants continue to have the same opportunities post-SARS-CoV-2. Consequently, ¡Más Fresco! is in the process of conducting a study to determine the most effective digital outreach methods among participants with limited English proficiency. These data will inform future efforts to enable online incentive redemption for all 41 Northgate Gonzalez Market locations. Despite concerns that online enrollment and utilization of SNAP and nutrition incentive programs are problematic for some, the ability for SNAP participants to make online purchases and redeem nutrition incentives remains welcome progress for federal food assistance programs. It is important to understand whether lack of access to wireless and connected devices or the inability to pay a grocery delivery fee (a disallowed expense under SNAP), or some other phenomenon is responsible for the early data emerging from these two very different regions of the United States. As a nation, we have an opportunity to leverage progress to date into continued momentum and innovation. Future efforts to improve SNAP should be informed by access, utilization, and need, with the long-term goal of strengthening food security for vulnerable populations. (Table 1  Ensure SNAP Online is adequately supported with policy to continue into the future and expand to other federal food assistance programs.  Build policy, systems, and environment strategies for federal food assistance that simultaneously include and require nutrition education opportunities that leverage SNAP Ed.  Continue to promote fruit and vegetable purchases and consumption with nutrition incentive programs.  Establish culturally sensitive, user-friendly outreach resources to promote access and engagement to federal food assistance programs among individuals and families from underserved regions and populations.  Develop and sustain community partnerships to leverage expertise and promote outreach within diverse communities.  Conduct rigorous evaluation of novel strategies and disseminate results rapidly to inform continued efforts to reach vulnerable populations.  Allow local control over policies and implementation to ensure that strategies are appropriately tailored to communities. Addressing food insecurity in the United States: the role of policy, systems changes, and environmental supports Senate and House of Representatives of the United States of America in Congress Senate and House of Representatives of the United States of America in Congress Families First Coronavirus Response Act Senate and House of Representatives of the United States of America in Congress Date enacted State Guidance on Coronavirus Pandemic EBT (P-EBT) Effectiveness of subsidies in promoting healthy food purchases and consumption: a review of field experiments Senate and House of Representatives of the United States of America in Congress Date enacted