Society of Behavioral Medicine (SBM) position statement: SBM urges Congress to preserve and increase the financing of federally funded nutrition assistance programs and services

Society of Behavioral Medicine (SBM) position statement: SBM urges Congress to preserve and... Abstract Deep cuts have been proposed to federally funded nutrition assistance programs, including the Supplemental Nutrition Assistance Program (SNAP); the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and federally subsidized school breakfast and lunch programs. Yet, these programs help parents afford healthy meals for their families, pregnant and postpartum mothers access supplemental foods and health services for themselves and their infants and young children, and children obtain the nutrition necessary for optimal school performance. Participation in these programs is linked with reductions in perinatal morbidity and mortality, improved childhood growth trajectories, enhanced school performance, and reductions in food insecurity and poverty. Given these compelling health and economic benefits, the Society of Behavioral Medicine urges Congress to protect and increase funding for federally funded nutrition assistance programs, specifically SNAP, WIC, and school breakfast and lunch programs. Per the recent (2017) recommendations of the School Nutrition Association, Congress should also resist any attempts to “block-grant” subsidized school breakfast and lunch programs, which could reduce access to these programs. It is further recommended that Congress improve the scope of implementation- and outcomes-based assessments of these programs. Finally, we recommend efforts to increase awareness of and participation in SNAP, WIC, and federally funded school meal programs for eligible individuals, children, and families. Implications Practice: Federally funded nutrition assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP); the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and school meal programs, help parents afford healthy meals for their families, pregnant and postpartum mothers access supplemental foods and health services for themselves and their infants and young children, and children obtain the nutrition necessary for optimal school performance. Research: To establish a more rigorous evidence base pertaining to best practices, costs, and impacts and inform future debates regarding funding, it is recommended that Congress increase and improve the scope and quality of implementation- and outcomes-based evaluations of federally funded nutrition assistance programs. Policy: Given the documented health benefits associated with nutrition assistance program participation, the Society of Behavioral Medicine recommends that Congress continue to fund federal nutrition assistance programs such as WIC, SNAP, and school breakfast and lunch programs and resist any attempts to “block-grant” these programs [1]. INTRODUCTION The Society of Behavioral Medicine urges Congress to protect and increase the funding of the Supplemental Nutrition Assistance Program (SNAP); the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and federally subsidized school breakfast programs (SBPs) and school lunch programs (SLPs). Recently, deep cuts have been proposed to these federally funded nutrition assistance programs [2]. Yet, these programs help parents afford healthy meals for their families, pregnant and postpartum mothers access supplemental foods and health services for themselves and their infants and young children, and children obtain the nutrition necessary for optimal school performance. It is argued that the economic and health-related consequences of the proposed cuts will perpetuate, rather than stem, poverty in America, and will result in serious public health problems. BACKGROUND In the USA, a country known for its wealth, economic distress and food insecurity are widespread [3, 4]. 12.7% (43.1 million people) live in poverty. Almost 20% of those living below the poverty line are children [5]. The Department of Health and Human Services defines the poverty line as earnings of ≤$12,060 per year for individuals, and ≤$24,600 per year for a family of four [6]. 6.4 million (one in six) American children suffer from “food insecurity” [5, 7], meaning they have “limited or uncertain access to adequate food.” [5, 8]. In households with “child food insecurity,” families run out of food by the end of the month [3, 4], and parents forgo buying food for themselves so their children can eat [3, 4]. Food insecure children are never sure there is going to be enough food [3, 4]. “Child food insecurity” is the most severe form of food insecurity [3, 4]. “Child food insecurity” exerts serious, and potentially permanent, effects on children’s neurological development [9, 10], cognitive development [10, 11], educational functioning [10], and overall health [10, 12]. The inadequate intake of important nutrients can lead to behavior problems, poor health [10, 12], and, counterintuitively, to obesity [13]. Apart from food insecurity, poverty and financial strain are associated with serious health problems in adults and children. In adults, poverty is related to illnesses such as obesity, asthma, hypertension, chronic metabolic disease, diabetes, depression, and cardiovascular death [14, 15]. In children, poverty is related to higher rates of infant mortality and chronic diseases such as asthma, growth problems from poor nutrition, and increased obesity [16]. Poverty-related psychosocial distress in families can lead to behavioral health problems such as parental drug abuse, child neglect, family violence, and homelessness [17, 18], all of which are identified as toxic childhood stressors and childhood adversities [17, 18]. Many food insecure children experience profound psychosocial distress, including suicidality [19]. In children, the health, psychological, and cognitive effects of poverty-related adversities can persist well into adulthood and can potentially reduce life expectancy by up to 20 years [17–19]. Assessment of nutrition safety nets: SNAP, WIC, and federally subsidized SBPs and SLPs SNAP—Food Stamps SNAP helps more than 40 million people pay for food [2]. SNAP services approximately 44% of America’s poor children [7] (20 million children per month [7]). The Center for Budget and Policy Priorities calls SNAP “the nation’s most important anti-hunger program” (p. 1)[20]. • 32% of all SNAP households and 55% of SNAP households with children have at least one employed member but do not earn enough to pay for adequate food along with housing and other nondiscretionary expenses [3, 4, 21]. • SNAP reduces poverty among families by 40% [22], a benefit that was found to be almost as effective as Earned Income Credits in reducing poverty rates among families [22, 23]. SNAP improves child health and cognition and is related to better school performance and achievement [7, 24]. Children receiving SNAP benefits are more likely to experience • better health [25–27], • normal development (i.e., less likely to experience developmental delays) [25–27], • healthier weight [25–27], • improved reading and math skills [12], • increased high school graduation rates [12], and • better health and economic self-sufficiency into adulthood [7, 12]. SNAP is particularly effective during times when school is not in session, when children cannot access free or reduced cost breakfast and lunch programs. WIC WIC provides supplemental foods, referrals for health care and social services, breastfeeding support, and nutrition education to more than 8 million low-income pregnant and postpartum women, along with their infants and young children [28–30]. About 53% of U.S. infants receive WIC benefits [31, 28]. WIC participation is associated with • reduced preterm births, low birthweight, and infant mortality [32, 33], • reduced childhood and household food insecurity [34], • increased childhood immunization rates [35, 36], • increased attendance at well-child visits [37, 38], • increased use of preventative care [37, 38], • reduced childhood anemia [39], and • improved early childhood cognitive development and scholastic achievement [40]. After revisions to food packages in 2009 and 2017 to meet new dietary guidelines and incentivize breastfeeding, there have been dramatic improvements among WIC participants in rates of breastfeeding initiation [41], childhood obesity [42], and household consumption of healthier foods including fruits, vegetables, whole grains, and low-fat milk [43, 44]. In fiscal year 2016, federal costs of WIC were approximately $5.95 billion [45]. This equates to the lowest WIC spending as a share of the economy since 1997. There has also been a drop of 23% in per-participant food costs over the last 26 years, with total per-participant costs growing more slowly than the rate of inflation [45]. Hence, WIC continues to be a cost-efficient investment of taxpayer dollars. Federally subsidized SBPs and SLPs Federally funded SBPs and SLPs provide free and low-cost meals to school children from low-income families. According to Children’s HealthWatch (2017), which monitors the impact of economic conditions and public policies on the health and well-being of young children, schools are on “the front lines of alleviating child hunger” (p. 3) [46]. In fact, federally subsidized SBPs and SLPs are among the most ubiquitous federally funded nutrition assistance programs in the USA. Approximately 92% of all American schools offer SBPs, which include both before-class programs and “Breakfast in Class” (i.e., BICs or “After the Bell”) breakfast programs [46–48, 19, 36]. Even more schools, 95%, offer subsidized SLPs [49]. The National School Lunch Program is the second largest food and nutrition safety net program behind SNAP [49]. During the 2015–2016 school year, 12.1 million children in America participated in free or low-cost SBPs [49]. “Breakfast in Class” programs increased school nutrition program participation even further [46, 47]. During the 2015–2016 school year, an average of 30 million children per day received subsidized, nutritionally balanced school lunches [1, 49]. Subsidized SBPs and SLPs are associated with multiple health and scholastic benefits for children, including • increased school attendance [50–53, 46, 47], including reduced absences and tardiness [51, 46–48]; • more focused task performance [54] and better psychosocial functioning, including fewer behavior problems, and less anxiety, depression, and hyperactivity [46, 48]; • better dietary intake [46, 48], including increased consumption of a variety of foods, including fruit and milk, vitamin C, vitamin A, and calcium [48]; • improved health outcomes, including lowered body mass index [46], and fewer visits to the school nurse, especially for stomachaches and headaches [46]; • improved test performance [50, 53, 48]; and • increased high school graduation rates [55]. SBPs and SLPs were also found to mitigate the effects of poverty [50, 52, 56] and reduce overall poverty levels in the USA [57]. IMPLICATIONS OF CURRENT POLICIES Substantial reductions in federal funding for SNAP, WIC, and school meal programs have been proposed. The Trump administration’s fiscal year 2018 budget proposes $192 billion in cuts to SNAP [58] and $11.1 billion (15.1%) in cuts to WIC [59]. School meal programs would be funded through fixed block grants instead of more flexible federal entitlements. This change stands to ultimately reduce subsidized school meal funding by 12%[60]. (Note: In lieu of more flexible federal entitlements, fixed “block-funded” grants are proposed to finance federally subsidized SBPs and SLPs [1, 60]. In this plan, schools would lose all paid-meal reimbursements, plus six-cents per meal in programs certified as meeting federal nutrition standards [60]. In addition, safeguards would be removed regarding federal rules for food safety, quantity, and nutritional value [60]. Furthermore, eligibility for free meals would narrow to potentially exclude some children at or near the poverty line [60]. According to recent analyses [1, 60], the grant funding to the states would be set below the funding level for FY 2016 and then be frozen for 3 years with no adjustment for inflation, resulting in 12% funding cuts by the third year. States could then extend the block funding for another 3 years. However, if the grant funding ran out during the school year [which could happen in times of economic hardship such as recession or natural disaster], poor or indigent children could lose their access to free or low-cost school meals [1, 60].) The proposed reductions to these critical programs not only stand to exact an overwhelming toll on individuals, families, and children, but also would create crippling financial costs for communities, cities, and states, which would need to support those suffering from severe financial crises and food deprivation. POLICY RECOMMENDATIONS The Society of Behavioral Medicine recommends that Congress should: • Continue to fund federal nutrition assistance programs including SNAP, WIC, and SBPs and SLPs. • Resist any attempts to “block-grant” subsidized SBPs and SLPs, per the recent (2017) recommendations of the School Nutrition Association [1]. • Improve the scope of implementation- and outcomes-based evaluations of federally funded nutrition programs. This would establish a more rigorous evidence base pertaining to best practices, costs, and impacts and inform future debates regarding funding. • Increase efforts to raise awareness of and participation in nutrition assistance programs for eligible individuals, families, and children. Compliance With Ethical Standards Primary Data: On October 24, 2017, a shorter version of this manuscript was posted, in policy brief format, on the Society of Behavioral Medicine’s Twitter and Facebook pages. The authors have full control of the entire content of this manuscript and allow the journal to review its information and sources. Conflict of Interest: Pamela Behrman, Jill Demirci, Betina Yanez, Nisha Beharie, and Helena Laroche declare they have no conflicts of interest. Ethical Approval: This manuscript is not being simultaneously submitted elsewhere. All procedures were conducted in accordance with ethical standards. This article does not contain studies with human participants performed by any of the authors. This article does not contain any studies with animals performed by any of the authors. Acknowledgments The authors of the Nutrition Safety Net policy brief gratefully acknowledge the Health Policy Committee and the Health Policy Council for their constructive guidance and feedback. The authors also acknowledge the contributions and support of the Ethnic Minority and Multicultural Health (EMMH) Special Interest Group. The authors also thank the Advisory Board of the Child and Family Health Special Interest Group for their interest and support. This project was not funded. References 1. School Nutrition Association . School meal block grants compromise children’s nutrition . 2017 Position Paper . 2017 ; https://schoolnutrition.org/ uploadedFiles/2_ Meetings_and_Events/LAC_2017/ Pages/LAC2017-Infographic.pdf. Accessibility verified September 03, 2017 . 2. Lu D , Soffen K . Politics: What Trump’s budget cuts from the social safety net . The Washington Post . 2017 ; https://www.washingtonpost.com/graphics/politics/trump-budget-benefits-cuts/?utm_term= .6d20022e42fe. Accessibility verified May 29, 2017 . 3. McMillan T. The new face of hunger: Why are people malnourished in the richest country on earth ? National Geographic Magazine . 2014 ; http://www.nationalgeographic.com/foodfeatures/hunger/. Accessibility verified September 11, 2017 . 4. McMillan T. 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Center for Budget and Policy Priorities . 2016 ; https://www.cbpp.org/research/food-assistance/house-proposal-to-block-grant-school-meal-programs-would-put-childrens. Accessibility verified September 03, 2017 . 60. Pratt-Heavner D. Block grants would slash millions from school meal budgets and compromise meal service for students . School Nutrition Association Press Release . 2016 ; https://schoolnutrition.org/NewsPublications/ PressReleases/ BlockGrants WouldSlashMillions FromSchoolMealBudgets/. Accessibility verified September 03, 2017 . © Society of Behavioral Medicine 2018. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Translational Behavioral Medicine Oxford University Press

Society of Behavioral Medicine (SBM) position statement: SBM urges Congress to preserve and increase the financing of federally funded nutrition assistance programs and services

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Abstract

Abstract Deep cuts have been proposed to federally funded nutrition assistance programs, including the Supplemental Nutrition Assistance Program (SNAP); the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and federally subsidized school breakfast and lunch programs. Yet, these programs help parents afford healthy meals for their families, pregnant and postpartum mothers access supplemental foods and health services for themselves and their infants and young children, and children obtain the nutrition necessary for optimal school performance. Participation in these programs is linked with reductions in perinatal morbidity and mortality, improved childhood growth trajectories, enhanced school performance, and reductions in food insecurity and poverty. Given these compelling health and economic benefits, the Society of Behavioral Medicine urges Congress to protect and increase funding for federally funded nutrition assistance programs, specifically SNAP, WIC, and school breakfast and lunch programs. Per the recent (2017) recommendations of the School Nutrition Association, Congress should also resist any attempts to “block-grant” subsidized school breakfast and lunch programs, which could reduce access to these programs. It is further recommended that Congress improve the scope of implementation- and outcomes-based assessments of these programs. Finally, we recommend efforts to increase awareness of and participation in SNAP, WIC, and federally funded school meal programs for eligible individuals, children, and families. Implications Practice: Federally funded nutrition assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP); the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and school meal programs, help parents afford healthy meals for their families, pregnant and postpartum mothers access supplemental foods and health services for themselves and their infants and young children, and children obtain the nutrition necessary for optimal school performance. Research: To establish a more rigorous evidence base pertaining to best practices, costs, and impacts and inform future debates regarding funding, it is recommended that Congress increase and improve the scope and quality of implementation- and outcomes-based evaluations of federally funded nutrition assistance programs. Policy: Given the documented health benefits associated with nutrition assistance program participation, the Society of Behavioral Medicine recommends that Congress continue to fund federal nutrition assistance programs such as WIC, SNAP, and school breakfast and lunch programs and resist any attempts to “block-grant” these programs [1]. INTRODUCTION The Society of Behavioral Medicine urges Congress to protect and increase the funding of the Supplemental Nutrition Assistance Program (SNAP); the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and federally subsidized school breakfast programs (SBPs) and school lunch programs (SLPs). Recently, deep cuts have been proposed to these federally funded nutrition assistance programs [2]. Yet, these programs help parents afford healthy meals for their families, pregnant and postpartum mothers access supplemental foods and health services for themselves and their infants and young children, and children obtain the nutrition necessary for optimal school performance. It is argued that the economic and health-related consequences of the proposed cuts will perpetuate, rather than stem, poverty in America, and will result in serious public health problems. BACKGROUND In the USA, a country known for its wealth, economic distress and food insecurity are widespread [3, 4]. 12.7% (43.1 million people) live in poverty. Almost 20% of those living below the poverty line are children [5]. The Department of Health and Human Services defines the poverty line as earnings of ≤$12,060 per year for individuals, and ≤$24,600 per year for a family of four [6]. 6.4 million (one in six) American children suffer from “food insecurity” [5, 7], meaning they have “limited or uncertain access to adequate food.” [5, 8]. In households with “child food insecurity,” families run out of food by the end of the month [3, 4], and parents forgo buying food for themselves so their children can eat [3, 4]. Food insecure children are never sure there is going to be enough food [3, 4]. “Child food insecurity” is the most severe form of food insecurity [3, 4]. “Child food insecurity” exerts serious, and potentially permanent, effects on children’s neurological development [9, 10], cognitive development [10, 11], educational functioning [10], and overall health [10, 12]. The inadequate intake of important nutrients can lead to behavior problems, poor health [10, 12], and, counterintuitively, to obesity [13]. Apart from food insecurity, poverty and financial strain are associated with serious health problems in adults and children. In adults, poverty is related to illnesses such as obesity, asthma, hypertension, chronic metabolic disease, diabetes, depression, and cardiovascular death [14, 15]. In children, poverty is related to higher rates of infant mortality and chronic diseases such as asthma, growth problems from poor nutrition, and increased obesity [16]. Poverty-related psychosocial distress in families can lead to behavioral health problems such as parental drug abuse, child neglect, family violence, and homelessness [17, 18], all of which are identified as toxic childhood stressors and childhood adversities [17, 18]. Many food insecure children experience profound psychosocial distress, including suicidality [19]. In children, the health, psychological, and cognitive effects of poverty-related adversities can persist well into adulthood and can potentially reduce life expectancy by up to 20 years [17–19]. Assessment of nutrition safety nets: SNAP, WIC, and federally subsidized SBPs and SLPs SNAP—Food Stamps SNAP helps more than 40 million people pay for food [2]. SNAP services approximately 44% of America’s poor children [7] (20 million children per month [7]). The Center for Budget and Policy Priorities calls SNAP “the nation’s most important anti-hunger program” (p. 1)[20]. • 32% of all SNAP households and 55% of SNAP households with children have at least one employed member but do not earn enough to pay for adequate food along with housing and other nondiscretionary expenses [3, 4, 21]. • SNAP reduces poverty among families by 40% [22], a benefit that was found to be almost as effective as Earned Income Credits in reducing poverty rates among families [22, 23]. SNAP improves child health and cognition and is related to better school performance and achievement [7, 24]. Children receiving SNAP benefits are more likely to experience • better health [25–27], • normal development (i.e., less likely to experience developmental delays) [25–27], • healthier weight [25–27], • improved reading and math skills [12], • increased high school graduation rates [12], and • better health and economic self-sufficiency into adulthood [7, 12]. SNAP is particularly effective during times when school is not in session, when children cannot access free or reduced cost breakfast and lunch programs. WIC WIC provides supplemental foods, referrals for health care and social services, breastfeeding support, and nutrition education to more than 8 million low-income pregnant and postpartum women, along with their infants and young children [28–30]. About 53% of U.S. infants receive WIC benefits [31, 28]. WIC participation is associated with • reduced preterm births, low birthweight, and infant mortality [32, 33], • reduced childhood and household food insecurity [34], • increased childhood immunization rates [35, 36], • increased attendance at well-child visits [37, 38], • increased use of preventative care [37, 38], • reduced childhood anemia [39], and • improved early childhood cognitive development and scholastic achievement [40]. After revisions to food packages in 2009 and 2017 to meet new dietary guidelines and incentivize breastfeeding, there have been dramatic improvements among WIC participants in rates of breastfeeding initiation [41], childhood obesity [42], and household consumption of healthier foods including fruits, vegetables, whole grains, and low-fat milk [43, 44]. In fiscal year 2016, federal costs of WIC were approximately $5.95 billion [45]. This equates to the lowest WIC spending as a share of the economy since 1997. There has also been a drop of 23% in per-participant food costs over the last 26 years, with total per-participant costs growing more slowly than the rate of inflation [45]. Hence, WIC continues to be a cost-efficient investment of taxpayer dollars. Federally subsidized SBPs and SLPs Federally funded SBPs and SLPs provide free and low-cost meals to school children from low-income families. According to Children’s HealthWatch (2017), which monitors the impact of economic conditions and public policies on the health and well-being of young children, schools are on “the front lines of alleviating child hunger” (p. 3) [46]. In fact, federally subsidized SBPs and SLPs are among the most ubiquitous federally funded nutrition assistance programs in the USA. Approximately 92% of all American schools offer SBPs, which include both before-class programs and “Breakfast in Class” (i.e., BICs or “After the Bell”) breakfast programs [46–48, 19, 36]. Even more schools, 95%, offer subsidized SLPs [49]. The National School Lunch Program is the second largest food and nutrition safety net program behind SNAP [49]. During the 2015–2016 school year, 12.1 million children in America participated in free or low-cost SBPs [49]. “Breakfast in Class” programs increased school nutrition program participation even further [46, 47]. During the 2015–2016 school year, an average of 30 million children per day received subsidized, nutritionally balanced school lunches [1, 49]. Subsidized SBPs and SLPs are associated with multiple health and scholastic benefits for children, including • increased school attendance [50–53, 46, 47], including reduced absences and tardiness [51, 46–48]; • more focused task performance [54] and better psychosocial functioning, including fewer behavior problems, and less anxiety, depression, and hyperactivity [46, 48]; • better dietary intake [46, 48], including increased consumption of a variety of foods, including fruit and milk, vitamin C, vitamin A, and calcium [48]; • improved health outcomes, including lowered body mass index [46], and fewer visits to the school nurse, especially for stomachaches and headaches [46]; • improved test performance [50, 53, 48]; and • increased high school graduation rates [55]. SBPs and SLPs were also found to mitigate the effects of poverty [50, 52, 56] and reduce overall poverty levels in the USA [57]. IMPLICATIONS OF CURRENT POLICIES Substantial reductions in federal funding for SNAP, WIC, and school meal programs have been proposed. The Trump administration’s fiscal year 2018 budget proposes $192 billion in cuts to SNAP [58] and $11.1 billion (15.1%) in cuts to WIC [59]. School meal programs would be funded through fixed block grants instead of more flexible federal entitlements. This change stands to ultimately reduce subsidized school meal funding by 12%[60]. (Note: In lieu of more flexible federal entitlements, fixed “block-funded” grants are proposed to finance federally subsidized SBPs and SLPs [1, 60]. In this plan, schools would lose all paid-meal reimbursements, plus six-cents per meal in programs certified as meeting federal nutrition standards [60]. In addition, safeguards would be removed regarding federal rules for food safety, quantity, and nutritional value [60]. Furthermore, eligibility for free meals would narrow to potentially exclude some children at or near the poverty line [60]. According to recent analyses [1, 60], the grant funding to the states would be set below the funding level for FY 2016 and then be frozen for 3 years with no adjustment for inflation, resulting in 12% funding cuts by the third year. States could then extend the block funding for another 3 years. However, if the grant funding ran out during the school year [which could happen in times of economic hardship such as recession or natural disaster], poor or indigent children could lose their access to free or low-cost school meals [1, 60].) The proposed reductions to these critical programs not only stand to exact an overwhelming toll on individuals, families, and children, but also would create crippling financial costs for communities, cities, and states, which would need to support those suffering from severe financial crises and food deprivation. POLICY RECOMMENDATIONS The Society of Behavioral Medicine recommends that Congress should: • Continue to fund federal nutrition assistance programs including SNAP, WIC, and SBPs and SLPs. • Resist any attempts to “block-grant” subsidized SBPs and SLPs, per the recent (2017) recommendations of the School Nutrition Association [1]. • Improve the scope of implementation- and outcomes-based evaluations of federally funded nutrition programs. This would establish a more rigorous evidence base pertaining to best practices, costs, and impacts and inform future debates regarding funding. • Increase efforts to raise awareness of and participation in nutrition assistance programs for eligible individuals, families, and children. Compliance With Ethical Standards Primary Data: On October 24, 2017, a shorter version of this manuscript was posted, in policy brief format, on the Society of Behavioral Medicine’s Twitter and Facebook pages. The authors have full control of the entire content of this manuscript and allow the journal to review its information and sources. Conflict of Interest: Pamela Behrman, Jill Demirci, Betina Yanez, Nisha Beharie, and Helena Laroche declare they have no conflicts of interest. Ethical Approval: This manuscript is not being simultaneously submitted elsewhere. All procedures were conducted in accordance with ethical standards. This article does not contain studies with human participants performed by any of the authors. This article does not contain any studies with animals performed by any of the authors. Acknowledgments The authors of the Nutrition Safety Net policy brief gratefully acknowledge the Health Policy Committee and the Health Policy Council for their constructive guidance and feedback. The authors also acknowledge the contributions and support of the Ethnic Minority and Multicultural Health (EMMH) Special Interest Group. 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Translational Behavioral MedicineOxford University Press

Published: May 3, 2018

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