Healthfulness of Online Grocery Shopping Behaviors: Analyzing Receipt Data From Low-Income Households With Children

OBJECTIVES: Online grocery services hold potential to reduce physical barriers to equitable healthy food procurement, particularly among low-income families who often live far from groceries stores. During COVID-19, the USDA authorized the use of the Supplemental Nutrition Assistance Program (SNAP) benefits online in some retailers across the US. We aimed to evaluate the nutritional quality of online grocery purchases among SNAP-eligible families. METHODS: Itemized receipt data was analyzed from a larger mixed methods study of online grocery shopping behaviors of SNAP-eligible families in Maryland. Of the 310 participants who completed the survey, 39 submitted grocery receipts. Of those, 19 participants submitted receipts with complete data for nutritional analysis on total amount spent, number of items purchased and units, weight (oz), and % of expenditure on fruits, vegetables, and sugar sweetened beverages (SSB). Nutritional analysis compared purchases of propensity score matched samples of SNAP (n = 14) versus SNAP-eligible non-participant families (n = 5) using a zero-inflated Poisson regression, controlling for sociodemographic factors. RESULTS: 43% of SNAP participants used SNAP benefits to purchase groceries online. Families spent, on average, 7.8% of their expenditure on SSBs, 5.3% on fruits and 4.5% on vegetables. SNAP participants purchased 61% less fruit by unit (p = 0.043) and 77% less fruit by weight (p = 0.004) compared to non-SNAP. Additionally, SNAP participants purchased 52% less vegetables by unit (p = 0.009), 65% less by weight (p = 0.006) and spent 69% less (p < 0.001) than non-SNAP. Lastly, SNAP participants purchased 247% more SSB by weight (p = 0.002) and spent 434% more on SSB (p = 0.001) than non-SNAP. CONCLUSIONS: SNAP participants may be purchasing more SSB and less fruits and vegetables online than SNAP-eligible non-participant. Findings call for future research using more rigorous receipt data sourced from larger, representative samples of SNAP-eligible families to evaluate the health behavior implications of equitable nutrition policies in the digital environment and direct future policy creation to promote equitable healthy food access. FUNDING SOURCES: Healthy Eating Research (Robert Wood Johnson Foundation).