Differences in a Chain Supermarket's Sales to SNAP Shoppers Before and Since the COVID-19 Pandemic.

Objective: This study 1) compares grocery sales to Supplemental Nutrition Assistance Program (SNAP) shoppers in rural and urban grocery stores and 2) estimates changes in sales to SNAP shoppers in North Carolina (NC) since the pandemic.

Design: Weekly transaction data among loyalty shoppers at a large grocery chain across NC from October 2019 to December 2020 (n = 32; 182 store weeks) to assess nutritional outcomes.

Setting: North Carolina large chain grocery stores.

Participants: Large chain grocery store/SNAP shoppers.

Intervention: Rural/urban status of the stores and COVID-19 pandemic onset.

Main Outcome Measures: Share of total calories sold from fruits, vegetables, nuts, and legumes (FVNL) with and without additives, sugar-sweetened beverages (SSB), less healthful foods (LHF), and processed meats (PM).

Analysis: Multivariate random effects models with robust standard errors to examine the association of rural/urban status before and since coronavirus disease 2019 with the share of calories sold to SNAP shoppers from each food category. We controlled for county-level factors (eg, sociodemographic composition, food environment) and store-level factors.

Results: We did not find significant rural-urban differences in the composition of sales to SNAP shoppers in adjusted models. There was a significant decrease in the mean share of total calories from sugar-sweetened beverages (-0.43%) and less healthful food (-1.32%) and an increase in the share from processed meats (0.09%) compared with before the pandemic (P < 0.05).

Conclusions And Implications: Urban-rural definitions are insufficient to understand nuances in food environments, and more support is needed to ensure healthy food access.