Racial/Ethnic Disparities in Household Food Insecurity During the COVID-19 Pandemic: a Nationally Representative Study

Health Behavior Changes during the COVID-19 Pandemic: A Longitudinal Analysis among Children

This longitudinal study compared children’s health behaviors before the COVID-19 pandemic versus during the pandemic. This analysis examined the association between individual-level characteristics and health behavior change. Four prospective cohort studies in the Environmental influences on Child Health Outcomes (ECHO) Program contributed data. Children aged 4−12 years and their caregivers were recruited in California, Colorado, North Dakota, and New Hampshire. Dietary intake, physical activity, screen time, and sleep duration were assessed with questionnaires pre-pandemic and during the pandemic. The final sample included 347 children: 47% female and 62% non-Hispanic White. Compared with pre-pandemic, weekday screen time duration was higher during the pandemic (3.0 vs. 4.5 h, p < 0.001). Unadjusted increases in screen time duration differed by race and ethnicity: 1.3 h/day for non-Hispanic White children, 2.3 h/day for Hispanic children, and 5.3 h/day for non-Hispanic Black children. Overall, no changes occurred in sugar-sweetened beverage (SSB) intake (p = 0.26), discretionary food intake (p = 0.93), and physical activity (p = 0.15). Sleep duration increased by 30 min among children who did not meet sleep recommendations pre-pandemic. Child sex and maternal education level were not associated with health behavior change. The pandemic may have exacerbated disparities in some health behaviors. Families may need support to re-establish healthy routines.

Redlining, racism and food access in US urban cores

In the 1930s, the Home Owners' Loan Corporation (HOLC) graded the mortgage security of urban US neighborhoods. In doing so, the HOLC engaged in the practice, imbued with racism and xenophobia, of "redlining" neighborhoods deemed "hazardous" for lenders. Redlining has caused persistent social, political and economic problems for communities of color. Linkages between redlining and contemporary food access remain unexamined, even though food access is essential to well-being. To investigate this, we used a census tract-level measure of low-income and low grocery store food access from the US Department of Agriculture Food Access Research Atlas, redlining data from Mapping Inequality Project, and demographic data from the American Community Survey. We employed generalized estimating equations with robust covariance estimates to analyze data pertaining to 10,459 census tracts in 202 US cities. Tracts that the HOLC graded as "C" ("decline in desirability") and "D" ("hazardous") had reduced contemporary food access compared to those graded "A" ("best"). Increases in contemporary census tract proportions of Black, Hispanic, or other racial/ethnic minority residents, as well as disabled residents, were associated with reduced food access. Increases in contemporary proportions of residents age 75 years and older or those without a car were associated with better food access. Tracts that underwent housing redevelopment since being graded had better food access, while those undergoing gentrification had reduced food access. Results suggest that issues of redlining, housing discrimination, racism, ableism, displacement, and food inaccessibility are deeply intertwined.

"I Think That's the Most Beneficial Change That WIC Has Made in a Really Long Time": Perceptions and Awareness of an Increase in the WIC Cash Value Benefit

During the COVID-19 pandemic, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Cash Value Benefit (CVB) for fruits and vegetables increased by roughly USD 25/month/person. We sought to understand WIC participant perceptions of this change and barriers and facilitators to using the CVB. We conducted 10 virtual focus groups (5 rural, 5 urban/suburban) with WIC participants (n = 55) in North Carolina in March 2022. Focus groups were recorded and transcribed. We open-coded the content and used thematic analysis to uncover consistencies within and between sampled groups. Participants expressed favorable perceptions of the CVB increase and stated the pre-pandemic CVB amount was insufficient. Barriers to using the increased CVB were identifying WIC-approved fruits and vegetables in stores and insufficient supply of fruits and vegetables. Barriers were more pronounced in rural groups. Facilitators of CVB use were existing household preferences for fruits and vegetables and the variety of products that can be purchased with CVB relative to other components of the WIC food package. Participants felt the CVB increase allowed their families to eat a wider variety of fruits and vegetables. The CVB increase may improve fruit and vegetable intake, particularly if made permanent, but barriers to CVB and WIC benefit use may limit the potential impact.

Food insecurity during COVID-19 in children with end-stage kidney disease: a pilot study

BACKGROUND

Food insecurity, an important social determinant of health among children, has become more common during the COVID-19 pandemic. Children with chronic diseases including end-stage kidney disease (ESKD) are at higher risk of food insecurity due to their complex care needs, medication burden, and dietary restrictions. No data exists describing food insecurity prevalence in pediatric ESKD patients during the COVID-19 pandemic.

METHODS

Food insecurity was assessed among families of children (age 0-18 years) with ESKD on chronic dialysis at two pediatric academic medical centers. Families were screened in April 2020 using the Hunger Vital Sign, a validated 2-question screening tool. We assessed impact of COVID-19 on food insecurity. We compared serum phosphorus "pre-COVID" (January/February 2020) to "during COVID" (April/May 2020).

RESULTS

A total of 29 families enrolled in this study. 62% (18/29) of children with ESKD lived in food insecure households, and of those, 72% (13/18) reported that COVID-19 had worsened their food insecurity status. During the COVID-19 pandemic, food insecure patients experienced greater rise in their serum phosphorus levels (1.1 mg/dL vs. 0 mg/dL, p = 0.03) and decreased likelihood of having adequate phosphorus control (50% vs. 11%, p = 0.03).

CONCLUSION

Food insecurity was common among children with ESKD on chronic dialysis during the COVID-19 pandemic. Children with food insecurity had a greater increase in their phosphorus levels during the pandemic than did food secure children. Further exploration into how food resources such as an onsite food pantry impacts food insecurity and phosphorus control in children with ESKD is essential.

Who should feed hungry families during crisis? Moral claims about hunger on Twitter during the COVID-19 pandemic

How do crisis conditions affect longstanding societal narratives about hunger? This paper examines how hunger was framed in public discourse during an early period in the COVID-19 crisis to mobilize attention and make moral claims on others to alleviate it. It does so through a discourse analysis of 1023 U.S.-based English-language posts dedicated to hunger on Twitter during four months of the COVID-19 pandemic. This analysis finds that Twitter users chiefly adopted hunger as a political tool to make moral claims on the state rather than individuals, civil society organizations, or corporations; however, hunger was deployed to defend widely diverse political agendas ranging from progressive support for SNAP entitlements to conservative claims reinforcing anti-lockdown and racist "America First" sentiments. Theoretically, the paper contributes to understanding how culture and morality operate in times of crisis. It demonstrates how culture can be deployed in crisis to reinforce longstanding ideological commitments at the same time that it organizes political imaginations in new ways. The result, in this case, is that longstanding cultural narratives about hunger were used to defend dissimilar, and in some ways contradictory, political ends. Practically, the paper demonstrates how moralized calls to alleviate hunger are vulnerable to political manipulation and used to further conflicting political goals, yet may also offer opportunities to leverage support for bolstered state investments in food assistance during times of crisis.

Food Insecurity, Financial Hardship, and Mental Health Among Multiple Asian American Ethnic Groups: Findings from the 2020 COVID-19 Household Impact Survey

Background

The COVID-19 pandemic has adversely impacted the financial and mental well-being of U.S. adults, however, Asian American (AA)-specific data are lacking, particularly disaggregated by AA ethnicity. Our objective was to evaluate food insecurity (FI), financial hardship, and mental health among disaggregated AA ethnic groups during the COVID-19 pandemic.

Methods

We used data from the COVID-19 Household Impact Survey, a sample of 10,760 U.S. adults weighted to reflect the U.S. population (weighted n: 418,209,893). AA ethnic categories were based on self-report (n=312, 5.1%; weighted n: 21,143,079) and provided as follows: Chinese American, South Asian, Filipino+Vietnamese, and Japanese+Korean. We estimated the prevalence of FI and financial hardship across AA ethnic categories. We estimated the demographic determinants of FI, including financial hardship, among AA adults using multivariable Poisson regression. We calculated the prevalence of mental health symptoms among food-insecure AA adults, as well as among AA adults experiencing both FI and financial hardship.

Results

Overall, the prevalence of FI and financial hardship among AA adults was highest among Filipino+Vietnamese adults (52.9-24.5%) and lowest among Japanese+Korean adults (13.9-8.6%). Determinants of FI among AA adults included Filipino+Vietnamese ethnicity (adjusted prevalence ratios [aPR]: 2.81, 95% confidence interval [CI]: 1.49-5.29), being widowed/divorced/separated (aPR: 3.14, 95% CI: 1.37-7.23), high school graduate only (aPR: 3.46, 95% CI: 1.96-6.11), having low income <$30,000 (aPR: 2.54, 95% CI: 1.27-5.06), and living in rural areas (aPR: 7.65, 95% CI: 1.17-50.14). Eighty-one percent and 63% of AA adults with anxiety and hopelessness at least 3-7 days/week, respectively, were food insecure and experiencing financial hardship.

Conclusion

Disparities exist in FI and financial hardship among AA adults, particularly Filipino+Vietnamese adults, and are associated with increased self-reporting of feelings of anxiety and hopelessness.

Racial/Ethnic Disparities in Food Pantry Use and Barriers in Massachusetts during the First Year of the COVID-19 Pandemic

This study sought to describe racial disparities in food insecurity, food pantry use, and barriers to and experiences with food pantries during the first year of the COVID-19 pandemic. We surveyed 2928 adults in Massachusetts regarding food access in the year before and during the first year of the pandemic. Weighted multivariable logistic regression models assessed racial differences in barriers to and experiences with pantry use during the pandemic. Black and Latino adults experienced the highest prevalence of food insecurity and pantry use. Additionally, Black and Latino adults reported more barriers to, but less stigma around, pantry use compared to White adults. Latino adults were less likely to know about pantry hours/locations and encounter staff who spoke their language. Black and Latino adults were also more likely to find pantry hours/locations inconvenient and have difficulty with transportation. The COVID-19 pandemic resulted in increased food insecurity, and food access inequities persisted. Programmatic policies to improve pantry access in communities of color could include increasing the hours/days that pantries are open, increasing bilingual staff, providing transportation or delivery, and creating multilingual public awareness campaigns on how to locate pantries.

Changes in health-related lifestyles and food insecurity and its association with quality of life during the COVID-19 lockdown in Malaysia

BACKGROUND

The pandemic of SARS CoV2 virus has severely impacted the entire world population. The lockdown imposed during the pandemic has created enormous challenges particularly on the health, economic and social life of most individuals. This study aimed to investigate the changes in health-related lifestyle and food security during the lockdown and how they influenced the quality of life (QoL) of Malaysian adults.

METHODS

An online survey using a structured questionnaire consisting of sociodemographic, body weight, diet quality, physical activity, sleep quality, food insecurity, and QoL was conducted among adult respondents across Malaysia. Multivariate linear regression analyses were conducted to assess the associations between the changes in each component and QoL based on the total score before and during the lockdown.

RESULTS

A total of 759 valid responses were included in the final analysis (75% female and 24.5% male). There was a significant improvement in diet quality during the lockdown while sleep quality and food insecurity worsened significantly. As for physical activity, metabolic equivalents (METs) in moderate activity increased significantly, whilst there was a significant decrease in the METs in walking and total minutes spent on physical activity during the lockdown. Overall, independent of age, gender, ethnicity, and religion, there were significant associations between QoL during lockdown and changes in BMI, METs of moderate activity, sleep quality, and food insecurity.

CONCLUSIONS

The unprecedented COVID-19 outbreak and the lockdown measure during the pandemic have caused significant negative changes in health-related lifestyles and affected the QoL of Malaysian adults. Despite the new norms and rules to prevent disease transmission, efforts to maintain a healthy lifestyle and food security among the population must be rolled out to improve the QoL and prevent further adverse mental and physical health outcomes.

Mission, Organization, and Future Direction of the Serological Sciences Network for COVID-19 (SeroNet) Epidemiologic Cohort Studies

Background

Global efforts are needed to elucidate the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the underlying cause of coronavirus disease 2019 (COVID-19), including seroprevalence, risk factors, and long-term sequelae, as well as immune responses after vaccination across populations and the social dimensions of prevention and treatment strategies.

Methods

In the United States, the National Cancer Institute in partnership with the National Institute of Allergy and Infectious Diseases, established the SARS-CoV-2 Serological Sciences Network (SeroNet) as the nation's largest coordinated effort to study coronavirus disease 2019. The network comprises multidisciplinary researchers bridging gaps and fostering collaborations among immunologists, epidemiologists, virologists, clinicians and clinical laboratories, social and behavioral scientists, policymakers, data scientists, and community members. In total, 49 institutions form the SeroNet consortium to study individuals with cancer, autoimmune disease, inflammatory bowel diseases, cardiovascular diseases, human immunodeficiency virus, transplant recipients, as well as otherwise healthy pregnant women, children, college students, and high-risk occupational workers (including healthcare workers and first responders).

Results

Several studies focus on underrepresented populations, including ethnic minorities and rural communities. To support integrative data analyses across SeroNet studies, efforts are underway to define common data elements for standardized serology measurements, cellular and molecular assays, self-reported data, treatment, and clinical outcomes.

Conclusions

In this paper, we discuss the overarching framework for SeroNet epidemiology studies, critical research questions under investigation, and data accessibility for the worldwide scientific community. Lessons learned will help inform preparedness and responsiveness to future emerging diseases.

Current dichotomous metrics obscure trends in severe and extreme child growth failure

Historically, the prevalence of child growth failure (CGF) has been tracked dichotomously as the proportion of children more than 2 SDs below the median of the World Health Organization growth standards. However, this conventional "thresholding" approach fails to recognize child growth as a spectrum and obscures trends in populations with the highest rates of CGF. Our analysis presents the first ever estimates of entire distributions of HAZ, WHZ, and WAZ for each of 204 countries and territories from 1990 to 2020 for children less than 5 years old by age group and sex. This approach reflects the continuous nature of CGF, allows us to more comprehensively assess shrinking or widening disparities over time, and reveals otherwise hidden trends that disproportionately affect the most vulnerable populations.

Food insecurity and mental health during the COVID-19 pandemic in cystic fibrosis households

BACKGROUND

The COVID-19 pandemic impacted many households due to shelter-in-place orders and economic hardship. People with cystic fibrosis (CF) experienced increased food insecurity compared to the general population before the pandemic, even though adequate food access is needed to maintain nutrition goals associated with improved health-related outcomes. Little is known about the impact the pandemic had on the food insecurity of people with CF and their families.

OBJECTIVE

To investigate how the COVID-19 pandemic impacted food insecurity, mental health, and self-care in people with CF.

METHODS

Adults with CF and parents/guardians of children with CF were recruited via social media to complete online questionnaires from May 2020 to February 2021. Questionnaires in English and Spanish included USDA 2-question food insecurity screening, Patient Health Questionnaire-4 for mental health screening, and directed questions on the impact of the pandemic.

RESULTS

Of 372 respondents, 21.8% of the households experienced food insecurity during the pandemic compared to 18.8% prepandemic (p < .001). More food insecure patients with CF reported weight loss (32.1% vs. 13.1%, p < .001), worse airway clearance adherence (13.6% vs. 5.8%, p < .01), and worse medication adherence (12.4% vs. 1.7%, p < .01) compared to food secure patients. Food insecure subjects were more likely to have an abnormal mental health screen compared to food secure subjects (53.1% vs. 16.2%, p < .001).

CONCLUSION

Food insecurity increased in the CF population during the COVID-19 pandemic. Food insecure subjects reported worse mental health and self-care during the pandemic compared to food secure subjects.

Change in Employment Status Due to the COVID-19 Pandemic, SNAP Participation, and Household Food Insecurity among Black and Latino Adults in Illinois

The onset of the COVID-19 pandemic resulted in record-high unemployment rates. Black and Latino adults experienced disproportionately higher rates of unemployment. We aimed to examine associations between pandemic-related employment status change and household food insecurity among an economically diverse sample of Black and Latino adults in Illinois during the early months of the COVID-19 pandemic. Furthermore, we evaluated the significance of Supplemental Nutrition Assistance Program (SNAP) participation to determine if it modified associations. We analyzed cross-sectional data collected from 1,809 Black and Latino adults in two waves: May 2020 and June/July 2020. Participants listed their change in employment status as “lost job entirely”, “employed, but paid hours reduced”, “employed, but anticipate job lost”, or “no change”. Participants self-reported their SNAP status and completed the USDA’s six item U.S. Food Security Module to report household food security status. We used logistic regression to assess the significance of associations after controlling for socio-demographics. Approximately 15.5% of participants lost their job entirely, 25.2% were SNAP participants, and 51.8% reported low food security (LFS). All changes in employment were significantly associated with increased odds of LFS after adjusting for socio-demographics. SNAP participants who lost their job had higher odds of LFS (OR: 4.69; 95% CI: 2.69–8.17) compared to non-participants who lost their job (OR: 2.97; 95%: 1.95–4.52). In summary, we observed strong associations between changes in employment and household food insecurity, particularly among SNAP participants, which underscores the pandemic’s impact on low-income and minority populations.

A Preliminary Evaluation of Virginia Fresh Match: Impacts and Demographic Considerations for Future Fruit and Vegetable Incentive Programs

The purpose of this communication is to describe the preliminary evaluation of the Virginia Fresh Match (VFM) financial incentive program for fresh fruits and vegetables for Virginia Supplemental Nutrition Assistance Program shoppers and to determine if there were differences in incentive outcomes by race. In this cross-sectional study, a questionnaire was administered to shoppers using Virginia Fresh Match incentives at participating farmers markets and community-based food retail outlets. Repeated measures ANOVAs were used to detect differences in fruit and vegetable consumption between demographic groups over time. Chi-square tests were used to determine if there were associations between race and perceived impact of VFM incentives on making food last and the attribution of VFM incentives to changes in fruit and vegetable consumption frequency. Frequency of fruit and vegetable intake was significantly higher during VFM incentive use, with a difference of 1.17 ± 0.07 and 1.07 ± 0.07 on a Likert scale measure, respectively (p ≤ 0.001). There were racial differences in assertions that VFM incentives helped food to last. VFM incentives were effective at increasing fruit and vegetable consumption, but racial differences should be considered in the administration of VFM to avoid reinforcing systems or approaches that may contribute to disparities in food access and food security.

Education Racial and Gender Disparities in COVID-19 Worry, Stress, and Food Insecurities across Undergraduate Biology Students at a Southeastern University

The global spread of the novel coronavirus first reported in December 2019 led to drastic changes in the social and economic dynamics of everyday life. Nationwide, racial, gender, and geographic disparities in symptom severity, mortality, and access to health care evolved, which impacted stress and anxiety surrounding COVID-19. On university campuses, drastic shifts in learning environments occurred as universities shifted to remote instruction, which further impacted student mental health and anxiety. Our study aimed to understand how students from diverse backgrounds differ in their worry and stress surrounding COVID-19 upon return to hybrid or in-person classes during the Fall of 2020. Specifically, we addressed the differences in COVID-19 worry, stress response, and COVID-19-related food insecurity related to race/ethnicity (Indigenous American, Asian/Asian American, black/African American, Latinx/Hispanic, white, or multiple races), gender (male, female, and gender expressive), and geographic origin (ranging from rural to large metropolitan areas) of undergraduate students attending a regional-serving R2 university, in the southeastern U.S. Overall, we found significance in worry, food insecurity, and stress responses with females and gender expressive individuals, along with Hispanic/Latinx, Asian/Asian American, and black/African American students. Additionally, students from large urban areas were more worried about contracting the virus compared to students from rural locations. However, we found fewer differences in self-reported COVID-related stress responses within these students. Our findings can highlight the disparities among students' worry based on gender, racial differences, and geographic origins, with potential implications for mental health of university students from diverse backgrounds. Our results support the inclusion of diverse voices in university decisioning making around the transition through the COVID-19 pandemic.

Racial/Ethnic Differences in the Application and Receipt of Services to Address Social Needs: Impact of COVID-19

Black and Hispanic Americans are disproportionately affected by COVID-19, which impacts their social needs. The objective of this study was to examine differences in white, Black, and Hispanic adults' application and receipt of services to address their social needs during COVID-19. Utilizing weeks 1, 2, and 3 from the COVID Impact Survey, descriptive statistics analyzed covariates and the 12 social services by participants' race/ethnicity. Unweighted frequencies and weighted percentages were computed for the services score by race/ethnicity. Forward stepwise binary logistic regression analyses examined the relationship between services needed and race/ethnicity. All analyses were conducted using STATA MP 14. Among 20 533 participants, unemployment insurance was a common service participants reported applying for or trying to apply for. Compared with white participants, Hispanic participants had higher adjusted odds of needing unemployment insurance services (adjusted odds ratio [AOR] = 1.58; 95% confidence interval [CI], 1.18-2.11). Black (AOR = 3.25; 95% CI, 2.49-4.25) and Hispanic (AOR = 1.55; 95% CI, 1.14-2.10) participants had higher adjusted odds of needing Supplemental Nutrition Assistance Program services than white participants. It is important for Black and Hispanic Americans to have access to these social services. Research and evaluation studies are warranted to inform policies that sustain/modify social services for future use. These studies must include a representative sample of Black and Hispanic Americans.

A Scoping Review of the Health Impact of the COVID-19 Pandemic on Persons Experiencing Homelessness in North America and Europe

Persons experiencing homelessness (PEH) are at heightened risk for infection, morbidity, and mortality from COVID-19. However, health consequences of the pandemic extend far beyond those directly caused by the virus. This scoping review aimed to explore the impacts of the COVID-19 pandemic on the health and well-being of PEH in North America and Europe. A systematic search of academic and grey literature was conducted in September 2021. To be included, studies had to include primary data related to the impact of the pandemic on health or well-being of PEH and be written in English. All potentially relevant references were independently screened by two reviewers, and minor conflicts were settled with input of a third reviewer. A total of 96 articles met criteria for inclusion. Data extraction was completed for all included studies, and findings synthesised and presented thematically. Numerous health impacts of the pandemic on PEH were identified, including SARS-CoV-2 infection, morbidity, mortality, and hospitalisation, fear of infection, access to housing, hygiene, PPE, food, as well as mental health, substance use, other health-related outcomes and treatment services. Gaps in the literature relating to persons using alcohol, access to mental health support, and violence were also identified. Implications for future research are discussed.

Both sides of the screen: Predictors of parents' and teachers' depression and food insecurity during COVID-19-related distance learning

The COVID-19 pandemic has placed unprecedented strains on both parents and teachers, both of whose mental and financial hardships have serious implications for young children's wellbeing. We drew on an existing cohort study of families with low incomes in Tulsa, OK when children were in their Spring of first grade in 2020. We surveyed parents and teachers - children's caregivers on both sides of the screen during distance learning - before and after the COVID-19 pandemic hit and schools were closed. We first compared the proportion of parents and teachers who were depressed and food-insecure before and after the pandemic struck. We then used pre-pandemic characteristics of parents and teachers in separate models to predict their depression and food insecurity during the pandemic. Results showed that rates of depression among both parents and teachers spiked after COVID-19, and food insecurity rates also increased among parents. For both parents and teachers, the strongest predictor of depression during COVID-19 was having experienced depression before the pandemic. Similarly, the strongest predictor of food insecurity during COVID-19 was having experienced food insecurity beforehand. These results point intervention efforts towards identifying the caregivers of children in low-income contexts whose mental and financial wellbeing are likely to be most compromised during this and perhaps future disasters.

Racial Disparities in COVID-19 Impacts in Michigan, USA

Racial disparities have been observed in the impacts of COVID-19 in the USA. In the present paper, we used a representative sample of adults in Michigan to examine differences in COVID-19 impacts on Blacks and Whites in four domains: direct, perceived, political, and behavioral. We found that in the initial wave of the outbreak in May 2020, Blacks experienced more severe direct impacts: they were more likely to be diagnosed or know someone who was diagnosed, and more likely to lose their job compared to Whites. In addition, Blacks differed significantly from Whites in their assessment of COVID-19's threat to public health and the economy, the adequacy of government responses to COVID-19, and the appropriateness of behavioral changes to mitigate COVID-19's spread. Although in many cases these views of COVID-19 were also associated with political ideology, this association was significantly stronger for Whites than Blacks. Continued investigation of racial disparities in COVID-19's impact is necessary; however, these preliminary findings of a race-by-ideology interaction are important because they suggest some racial disparities are restricted to conservatives, while more liberal Whites and Blacks exhibit few differences.

Short-Term Impacts of COVID-19 Public Health Regulation on Consumer Food Purchases: A Case Study From a Grocery Store in Montana

The mitigation measures (e.g., lockdown policies) in response to the COVID-19 pandemic impacted food systems in unprecedented ways, in both scope and immediacy. Food retail, for example, changed fundamentally in the United States, as access to nutritious food became limited, supply chain shortages were common, and mandatory public health measures led to behavior changes among customers and employees. In the present case study, we hypothesized that these changes led to food purchasing shifts of grocery store consumers. Such shifts are seen as an outcome of both endogenous factors at the individual level and exogenous factors at the government/policy level. Our case study sought to better understand how the pandemic and associated regulations shaped consumer food choices during the “hard” lockdown period in Montana during 2020. We selected 112 food products based on the highest sales in a Gallatin County, Montana, grocery store. They were analyzed by predefined food groups aligned to the Dietary Guidelines for Americans 2020. All purchases were processed for each selected food item during March and April 2019 (before the pandemic) and March and April 2020 (during the lockdown in Montana). To further describe the pandemic experiences qualitatively, we conducted semi-structured interviews with managers and employees from two stores in Gallatin County. Overall, we found that consumers increased purchases in most food groups during the pandemic, including nutrient-dense and energy-dense products, most outstandingly for starchy vegetables, legumes, and convenience food. Products with long shelf-life and that required preparation at home were preferred. Endogenous causes, specifically panic and rushing, were likely stronger drivers of consumer behavior and food choices than regulations. Nonetheless, lockdown policies impacted consumer food purchases. We present a series of policy and practice recommendations based on our findings and the emerging literature on this topic.

Trends in cannabis use among U.S. adults amid the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has had an impact on mental health and alcohol use in the US, however there is little research on its impacts on cannabis use. Considering the role of cannabis as a coping strategy or self-medicating behavior, there is a need to understand how individuals who use cannabis have adapted their use amid the pandemic. Therefore, this study examined changes in self-reported cannabis use among US adults in the context of COVID-19 pandemic by (1) describing trends of use during the first 8 months of the pandemic among adults who used cannabis in this period; and (2) characterizing trends of use within sociodemographic subgroups and by state cannabis policy status.

METHODS

The sample consisted of 1,761 US adults who used cannabis at least once during the 8-month study period from the nationally representative Understanding America Study. Linear mixed-effect models were used to model changes in the number of days of past-week cannabis use across 16 waves from March 10, 2020, to November 11, 2020.

RESULTS

Compared to early March, the number of days cannabis was used per week was significantly higher at the start of April (β=0.11, 95% CI=0.03, 0.18) and May (β=0.21,95% CI=0.05, 0.36). In subsequent months (June - November), the number of days of cannabis use attenuated to levels comparable to March. Trends of cannabis use across the study period generally did not differ across sociodemographic characteristics and state cannabis policy status.

CONCLUSION

Though increases in use were marginal among many groups, the evolving pandemic and the growing concern for the mental health of segments of the U.S. population warrant close monitoring of coping behaviors, including substance use.

Food-Seeking Behaviors and Food Insecurity Risk During the Coronavirus Disease 2019 Pandemic

OBJECTIVE

Food insecurity risk increases among disaster-struck individuals. The authors employed the social determinants of health framework to (1) describe the characteristics and food-seeking behaviors of individuals coping with the coronavirus disease 2019 pandemic and (2) evaluate the relationship between these factors and food insecurity risk.

DESIGN

A cross-sectional Qualtrics survey was administered May 14-June 8, 2020.

PARTICIPANTS

Adults living in New York were recruited online (n = 410).

MAIN OUTCOME MEASURE

Food insecurity risk.

ANALYSIS

Logistic regression analyses were conducted using a model-building approach.

RESULTS

A total of 38.5% of the sample was considered food insecure after the coronavirus disease 2019 outbreak. The final model revealed that not knowing where to find help to acquire food, reporting that more food assistance program benefits would be helpful, being an essential worker, having general anxiety, and being a college student were risk factors for food insecurity regardless of demographic characteristics.

CONCLUSIONS AND IMPLICATIONS

With more individuals experiencing food insecurity for the first time, there is a need for enhanced outreach and support. The findings complement emerging research on food insecurity risk during and after the pandemic and can help to inform food assistance programs and policies.

Household Spending Patterns and Hardships during COVID-19: A Comparative Study of the U.S. and Israel

The combined supply and demand shocks of the COVID-19 pandemic have created the largest consumer behavior shift in recent history, while exposing millions of households to material hardships like food insecurity and housing instability. In this study, we draw on national surveys conducted early in the pandemic to investigate the pandemic's effects on self-reported consumer spending behaviors and experiences of hardship for households in the US and Israel; two countries that are similar in terms of their development but have had divergent experiences with and responses to the pandemic. We also examine the extent to which racial/ethnic/religious minority status and pre-pandemic employment characteristics predict these outcomes. Using descriptive and logistic regression approaches, we find that housing expenditures were fairly stable in the U.S. and Israel, while food and credit card payment expenditures were relatively volatile. We also find that skipped utility bill payments were much higher in the US than Israel, while rates of skipping housing payments and food insecurity were similar between the two countries. Generally speaking, racial/ethnic/religious minorities in both countries were more likely to experience spending volatility, while Black and Hispanic (in the US) and Arab (in Israel) households were more likely to experience hardships. Employment and financial characteristics also appeared much more predictive of hardship in the US than in Israel.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10834-021-09814-z.

Evaluating the Full Plate Living lifestyle intervention in low-income monolingual Latinas with and without food insecurity

Introduction:

Food insecurity has long been associated with poor physical and mental health, especially among women from underrepresented minorities. Despite efforts to reduce food insecurity, rates continue to rise and remain disproportionately high among Latinx living in the United States, a group reporting worse mental health symptoms than any other ethnic group during the COVID-19 pandemic. The need to reduce the health burden associated with food insecurity among Latinas is urgent and requires a more targeted and innovative approach. Interventions using a popular education approach have proven effective among underserved populations, especially when these are delivered by community health workers. However, food insecurity status of the participants is often unreported and it is not clear whether or not results vary between those with and without food insecurity.

Objectives:

The aim of this quasi-experimental study was to examine physical and mental health changes among Latinas with, and without, food insecurity following a multicomponent health intervention led by community health workers using a popular education approach.

Methods:

Enrolled obese Latinas (N = 98) with and without food insecurity responded to demographic, health behaviors and mental health surveys and completed biometric measurements at baseline, immediately following the intervention and at 3 months.

Results:

At baseline, participants with food insecurity reported more anxiety and depression than those without, but average body mass index was comparable. Depression, anxiety and body mass index were lower at 3 months post and no statistically significant differences were seen between the groups. Participants with food insecurity benefited as much from the intervention as those without.

We found that, although community health workers are not licensed healthcare professionals, with proper training and support, they were able to successfully reduce the risk of chronic diseases and improve mental health symptoms among food-insecure Latinas.

Conclusion:

Given the promising results, similar interventions should be implemented on a larger scale in Latino communities among food insecure women. Long-term sustainability should also be explored.

Mutual aid organisations and their role in reducing food insecurity in Chicago's urban communities during COVID-19

The COVID-19 pandemic has disproportionately impacted food security and food access in urban communities of colour. Loss of income, often associated with food insecurity, has affected Hispanic, Black, low-wage workers, single mothers and women of colour more than other groups of individuals. Mutual aid organisations have proliferated in response to the COVID-19 pandemic, yet a description of the contributions of these organisations in addressing food insecurity has yet to be described in the literature to date. This article aims to describe the unique role and contributions of mutual aid organisations in addressing food insecurity and food access disparities in Chicago's communities of colour during the COVID-19 pandemic. Local mutual aid organisations can function as hubs to feed urban communities while reducing food waste and building community. During the pandemic, mutual aid organisations in Chicago have distributed thousands of pounds of food to families and individuals. Mutual aid organisations provide short-term food security while engaging with community members to create a more equitable and sustainable food system. The development of robust mutual aid hubs facilitated unique opportunities for collaboration and expansion of infrastructure that may allow mutual aid organisations to address food access in their communities well into the future.

Food Security, Access, and Challenges in New Mexico during COVID-19

BACKGROUND

The novel coronavirus disease 2019 (COVID-19) pandemic disrupted food systems and economies across the United States. Public health measures, including stay-at-home orders, led to employment disruptions and food system shocks that increased barriers to food access.

OBJECTIVES

We aimed to examine food insecurity and food access challenges in New Mexico (NM) during the COVID-19 pandemic.

METHODS

A cross-sectional study using a validated survey was conducted in NM in May and June 2020. Adults 18 y and older were recruited through convenience sampling via email, websites, and targeted social media ads from major universities, nongovernmental organizations, state agencies, and media outlets. Survey questions assessed food insecurity and food-related challenges and worry. Bivariate and multivariate logistic regression examined relations between food insecurity and demographic characteristics. z Tests were used to compare the proportions of individuals who responded affirmatively to food challenge and worry questions between food-secure and food-insecure respondents.

RESULTS

A total of 1487 residents participated in the study. Thirty percent of respondents reported experiencing food insecurity and 16% experienced very low food security since the pandemic started. Food insecurity was associated with each of 7 characteristics examined in bivariate logistic regression analyses. Multivariate logistic regression results showed that Hispanic (adjusted OR: 1.70; 95% CI: 1.18, 2.44) and female (adjusted OR: 1.78; 95% CI: 1.09, 2.90) respondents were more likely to experience food insecurity than non-Hispanic white and male respondents. Larger household sizes were associated with higher odds of food insecurity except for those in the lowest and highest income categories. z Tests showed that a higher proportion of food-insecure respondents experienced food-related challenges and worry than food-secure respondents.

CONCLUSIONS

Disparities in food insecurity persisted during the COVID-19 pandemic and food-insecure individuals were more likely to report experiencing food-related challenges and worry. Researchers and policy makers in NM may consider continuing efforts to mitigate food access issues as the pandemic continues.

Unemployment, SNAP Enrollment, and Food Insecurity Before and After California's COVID-19 Shutdown

OBJECTIVES

To examine whether the decrease in very low food security (VLFS) observed in California shortly after California's coronavirus disease (COVID-19) shutdown remained throughout Federal Fiscal Year (FFY) 2020. To investigate associations among unemployment, Supplemental Nutrition Assistance Program (SNAP) enrollment, and VLFS across FFY 2020.

METHODS

Telephone interview responses from mothers from randomly sampled households from low-income areas throughout California to the 6-item US Department of Agriculture Food Security Survey Module identified VLFS families. Logistic regression examined VLFS rates before vs after California's COVID-19 shutdown, with race/ethnicity, age, and education as covariates. Pearson correlations were calculated for unemployment, SNAP enrollment, and VLFS.

RESULTS

Most (66.4%) of the 2,682 mothers were Latina. VLFS declined from 19.3% before to 14.5% after California's COVID-19 shutdown (adjusted odds ratio, 0.705; P = 0.002). The correlation for unemployment and SNAP household participation was 0.854 (P = 0.007), and for SNAP participation and VLFS was -0.869 (P = 0.005).

CONCLUSIONS AND IMPLICATIONS

Publicly-funded assistance programs may lower food insecurity, even during a time of increased economic hardship. Examining the specific factors responsible for the observed decline in VLFS has merit. Whether VLFS remains below the rate observed before California's COVID-19 shutdown is worthy of ongoing study.

A Multi-Site Analysis of the Prevalence of Food Insecurity in the United States, before and during the COVID-19 Pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic profoundly affected food systems including food security. Understanding how the COVID-19 pandemic impacted food security is important to provide support and identify long-term impacts and needs.

OBJECTIVE

The National Food Access and COVID research Team (NFACT) was formed to assess food security over different US study sites throughout the pandemic, using common instruments and measurements. This study presents results from 18 study sites across 15 states and nationally over the first year of the COVID-19 pandemic.

METHODS

A validated survey instrument was developed and implemented in whole or part through an online survey of adults across the sites throughout the first year of the pandemic, representing 22 separate surveys. Sampling methods for each study site were convenience, representative, or high-risk targeted. Food security was measured using the USDA 6-item module. Food security prevalence was analyzed using ANOVA by sampling method to assess statistically significant differences.

RESULTS

Respondents (n = 27,168) indicate higher prevalence of food insecurity (low or very low food security) since the COVID-19 pandemic, compared with before the pandemic. In nearly all study sites, there is a higher prevalence of food insecurity among Black, Indigenous, and People of Color (BIPOC), households with children, and those with job disruptions. The findings demonstrate lingering food insecurity, with high prevalence over time in sites with repeat cross-sectional surveys. There are no statistically significant differences between convenience and representative surveys, but a statistically higher prevalence of food insecurity among high-risk compared with convenience surveys.

CONCLUSIONS

This comprehensive study demonstrates a higher prevalence of food insecurity in the first year of the COVID-19 pandemic. These impacts were prevalent for certain demographic groups, and most pronounced for surveys targeting high-risk populations. Results especially document the continued high levels of food insecurity, as well as the variability in estimates due to the survey implementation method.

Risk Factors for Veteran Food Insecurity: Findings from a National US Department of Veterans Affairs Food Insecurity Screener

Objective:

Food insecurity is associated with numerous adverse health outcomes. The US Veterans Health Administration (VHA) began universal food insecurity screening in 2017. This study examined prevalence and correlates of food insecurity among Veterans screened.

Design:

Retrospective cross-sectional study using VHA administrative data. Multivariable logistic regression models were estimated to identify sociodemographic and medical characteristics associated with a positive food insecurity screen.

Setting:

All US Veterans Administration (VA) medical centres (n 161). Participants: All Veterans were screened for food insecurity since screening initiation (July 2017–December 2018).

Results:

Of 3 304 702 Veterans screened for food insecurity, 44 298 were positive on their initial screen (1·3 % of men; 2·0 % of women). Food insecurity was associated with identifying as non-Hispanic Black or Hispanic. Veterans who were non-married/partnered, low-income Veterans without VA disability-related compensation and those with housing instability had higher odds of food insecurity, as did Veterans with a BMI < 18·5, diabetes, depression and post-traumatic stress disorder. Prior military sexual trauma (MST) was associated with food insecurity among both men and women. Women screening positive, however, were eight times more likely than men to have experienced MST (48·9 % v. 5·9 %).

Conclusions:

Food insecurity was associated with medical and trauma-related comorbidities as well as unmet social needs including housing instability. Additionally, Veterans of colour and women were at higher risk for food insecurity. Findings can inform development of tailored interventions to address food insecurity such as more frequent screening among high-risk populations, onsite support applying for federal food assistance programs and formal partnerships with community-based resources.

Nationwide Assessment of SNAP Online Purchasing Pilot State Communication Efforts During the COVID-19 Pandemic

OBJECTIVE

To conduct a nationwide assessment of communication by participating states and Washington DC about the Supplemental Nutrition Assistance Program (SNAP) Online Purchasing Pilot expansion.

DESIGN

Systematic coding of official communication from state and DC SNAP administrating agencies.

PARTICIPANTS

Forty-six states and DC approved to participate in the pilot as of October 2020 (n = 47). Data were collected from official SNAP administrating agency websites, state press releases, and state emergency coronavirus disease 2019 websites.

VARIABLES MEASURED

Four domains were collected from communication materials: (1) program information, (2) retailer information, (3) health and nutrition information, and (4) communication accessibility.

ANALYSIS

Qualitative content analysis, descriptive statistics.

RESULTS

Thirty-four (72%) states issued an official press release about the pilot that was easily accessible through online searches (15 available in multiple languages), 21 (45%) included information on their SNAP agency website, and 15 (32%) included information on their official coronavirus disease 2019 website. Most states identified authorized retailers (n = 37; 79%), provided information about pickup/delivery (n = 31; 66%), and stated the SNAP online start date (n = 29; 62%). About a quarter of states (n = 12; 26%) provided information about nutrition and health.

CONCLUSIONS AND IMPLICATIONS

State communication about the SNAP online pilot mostly focused on basic program and retailer information and included limited information about nutrition and health.

Food Access, Food Insecurity, and Gun Violence: Examining a Complex Relationship

PURPOSE OF REVIEW

Food insecurity and gun violence are timely and relevant public health issues impacting many regions within the USA with a potential association. Terminology surrounding food access and food security can be confusing, which is important to understand when examining the relationship between these issues and gun violence.

RECENT FINDINGS

Food insecurity is an individual level risk factor that appears to correlate with an increased rate of exposure and future involvement in violence. Food deserts represent geographic regions with limited access to food but do not necessarily represent regions with high prevalence of food insecurity. Although both food insecurity and food deserts in urban regions have been linked with increased incidence of gun violence, a high prevalence of food insecurity was found to be more predictive. A high prevalence of food insecurity in urban regions likely serves as a marker for socioeconomic disadvantage and intentional disinvestment. These regions are predictably associated with a higher incidence of interpersonal gun violence. Food deserts in rural areas have not, to date, been shown to correlate with interpersonal gun violence. Urban food insecurity and gun violence are both likely the byproduct of structural violence. Despite the significant overlap and similar contributors, the application of the public health framework in addressing these two issues has historically been quite different.

Prevalence and Risk Factors of Food Insecurity among Mexican University Students' Households

Household food insecurity (FI) remains a major public health challenge worldwide. Data about perceived FI and its risk factors in Mexican university students are lacking. We aimed to assess FI's prevalence and factors affecting it among university students' households in Mexico. This cross-sectional analysis involved 7671 university students' households using the 2018 Mexican National of Household Income and Expenditure Survey data. Variables analyzed included sociodemographic characteristics, and the 12-item validated Mexican Scale for Food Security (EMSA). Multivariable logistic regression modelling was performed to identify FI risk factors. The overall household FI prevalence was 30.8%. According to FI severity, prevalence rates were 16.3% for mild-FI, 8.8% for moderate-FI, and 5.7% for severe-FI. Low socioeconomic status (OR = 2.72; 95%CI: 2.09-3.54), low education level of household's head (OR = 2.36; 95%CI: 1.90-2.94), self-ascription to an indigenous group (OR = 1.59; 95%CI: 1.41-1.79), attending public university (OR = 1.27; 95%CI: 1.13-1.43), female-headed household (OR = 1.26; 95%CI: 1.13-1.40), having worked recently (OR = 1.19; 95%CI: 1.07-1.33), and being in second year of studies (OR = 1.17; 95%CI: 1.03-1.33), were significantly related to FI. Our results confirm that FI is highly prevalent among Mexican university students' households and that sociodemographic factors are essential in addressing this concern. Findings highlight the need for preventive programs and policies to alleviate FI.

Racial and Ethnic Disparities in Health-Related Socioeconomic Risks During the Early COVID-19 Pandemic: A National Survey of U.S. Women

Background: Nearly half of U.S. women experienced new or worsening health-related socioeconomic risks (HRSRs) (food, housing, utilities and transportation difficulties, and interpersonal violence) early in the COVID-19 pandemic. We sought to examine racial/ethnic disparities in pandemic-related changes in HRSRs among women. Materials and Methods: We conducted a cross-sectional survey (04/2020) of 3200 women. Pre- and early pandemic HRSRs were described by race/ethnicity. Weighted, multivariable logistic regression models generated odds of incident and worsening HRSRs by race/ethnicity. Results: The majority of Black, East or Southeast (E/SE) Asian, and Hispanic women reported ≥1 prepandemic HRSR (51%-56% vs. 38% of White women, p < 0.001). By April 2020, 68% of Black, E/SE Asian, and Hispanic women and 55% of White women had ≥1 HRSR (p < 0.001). For most HRSRs, the odds of an incident or worsening condition were similar across racial/ethnic groups, except Black, E/SE Asian and Hispanic women had 2-3.6 times the odds of incident transportation difficulties compared with White women. E/SE Asian women also had higher odds of worsening transportation difficulties compared with White women (adjusted odds ratios = 2.5, 95% confidence interval 1.1-5.6). In the early pandemic, 1/19 Hispanic, 1/28 E/SE Asian, 1/36 Black and 1/100 White women had all 5 HRSRs (extreme health-related socioeconomic vulnerability). Conclusions: Prepandemic racial/ethnic disparities in HRSRs persisted and prevalence rates increased for all groups early in the pandemic. Disparities in transportation difficulties widened. White women were much less likely than others to experience extreme health-related socioeconomic vulnerability. An equitable COVID-19 response requires attention to persistent and widening racial/ethnic disparities in HRSRs among women.

Food Access Worries, Food Assistance Use, Purchasing Behavior, and Food Insecurity Among New Yorkers During COVID-19

The coronavirus disease of 2019 (COVID-19) disrupted health, economy, and food systems across the United States. This cross-sectional study examined the relationship between food access worries, food assistance use, and purchasing behaviors and food insecurity during COVID-19 among residents of New York State. New Yorkers were recruited to complete a web-based survey through Qualtrics. The survey took place in the summer and fall of 2020 and asked respondents about food access worries, food assistance use, food insecurity, and food purchasing behaviors. Chi-square analysis examined the relationships between food concerns, food assistance use, purchasing behaviors, and demographic characteristics by reported food insecurity, and significant results were analyzed in a series of logistic regression models. Results showed that higher food worries, Supplemental Nutrition Assistance Program (SNAP) use, reported food assistance and delivery as food sources, and self-reported Hispanic ethnicity were associated with a higher likelihood of experiencing food insecurity. Future research is needed to assess the ongoing impacts of the pandemic on food access and food insecurity, particularly among underserved groups. Measures that provide additional money for food and improved food access can alleviate barriers to accessing enough healthy food at this time.

Virtual Physical Education During COVID-19: Exploring Future Directions for Equitable Online Learning Tools

Introduction: School closures prompted by the COVID-19 pandemic reduced opportunities for US youth to be physically active and disproportionately impacted health disparities in this population. Physical education provides the largest intervention to support the physical activity of school-aged youth, but teachers' opinions about how to maintain quality programming during virtual learning periods remain unexplored. Applying a diversity, equity and inclusion framework, this study explored physical education teachers' perceived significance of different design features for an online teaching tool to promote physical activity equity during school closures. Methods: Previous literature and focus groups informed the development of a survey administered in summer/fall 2020. Survey participants (n = 60) were physical education teachers from 400 randomly selected US preschool-12th grade schools drawing from a national database. Participants rated the significance of four design features in relation to five key attributes of an online supplement to in-person physical education programs. One-way ANOVAs were used to assess differences in teachers' ratings by demographic characteristics. Results: Between-group differences were found in teacher ratings of design features related to the usability, accessibility, equitability, and formal assessment capabilities of an online physical education tool. Differences were based on teacher gender, school level, and geographic location. Conclusions: Future research to promote physical activity equity among preschool-12th grade youth should examine tailored virtual physical education learning tools that address what teachers perceive to be the most significant design features to support equitable physical education among diverse student groups.

COVID-19 Reveals Vulnerabilities of the Food-Energy-Water Nexus to Viral Pandemics

Food, energy, and water (FEW) sectors are inextricably linked, making one sector vulnerable to disruptions in another. Interactions between FEW systems, viral pandemics, and human health have not been widely studied. We mined scientific and news/media articles for causal relations among FEW and COVID-19 variables and qualitatively characterized system dynamics. Food systems promoted the emergence and spread of COVID-19, leading to illness and death. Major supply-side breakdowns were avoided (likely due to low morbidity/mortality among working-age people). However, COVID-19 and physical distancing disrupted labor and capital inputs and stressed supply chains, while creating economic insecurity among the already vulnerable poor. This led to demand-side FEW insecurities, in turn increasing susceptibility to COVID-19 among people with many comorbidities. COVID-19 revealed trade-offs such as allocation of water to hygiene versus to food production and disease burden avoided by physical distancing versus disease burden from increased FEW insecurities. News/media articles suggest great public interest in FEW insecurities triggered by COVID-19 interventions among individuals with low COVID-19 case-fatality rates. There is virtually no quantitative analysis of any of these trade-offs or feedbacks. Enhanced quantitative FEW and health models are urgently needed as future pandemics are likely and may have greater morbidity and mortality than COVID-19.

Current and Future Food Insufficiency During Covid-19: Examining Disparities by Race/Ethnicity and Recent Work Loss

The Covid-19 pandemic, which began in early 2020, has eroded the previous decade’s reductions in food insecurity. Pandemic-related food insufficiency has been concentrated among Black and Hispanic households and those who have experienced a recent work loss. Households with children are particularly vulnerable. Using the first twenty-one weeks of the US Census Bureau’s Household Pulse Survey data from April 2020 through December of 2020, we examine the association between recent work losses and food insufficiency and document the extent to which the impact varies by race/ethnicity. Work loss is predictive of current and future food insufficiency, with the association most acutely experienced by Blacks and Hispanics and households with children. There is evidence of racial/ethnic disparities in current and future food insufficiency. The results provide insight into how the pandemic has widened racial/ethnic gaps in the experience of food insufficiency despite recent policy interventions.

Socioeconomic variation in characteristics, outcomes, and healthcare utilization of COVID-19 patients in New York City

OBJECTIVES

There is limited evidence on how clinical outcomes differ by socioeconomic conditions among patients with coronavirus disease 2019 (COVID-19). Most studies focused on COVID-19 patients from a single hospital. Results based on patients from multiple health systems have not been reported. The objective of this study is to examine variation in patient characteristics, outcomes, and healthcare utilization by neighborhood social conditions among COVID-19 patients.

METHODS

We extracted electronic health record data for 23,300 community dwelling COVID-19 patients in New York City between March 1st and June 11th, 2020 from all care settings, including hospitalized patients, patients who presented to the emergency department without hospitalization, and patients with ambulatory visits only. Zip Code Tabulation Area-level social conditions were measured by the Social Deprivation Index (SDI). Using logistic regressions and Cox proportional-hazards models, we examined the association between SDI quintiles and hospitalization and death, controlling for race, ethnicity, and other patient characteristics.

RESULTS

Among 23,300 community dwelling COVID-19 patients, 60.7% were from neighborhoods with disadvantaged social conditions (top SDI quintile), although these neighborhoods only account for 34% of overall population. Compared to socially advantaged patients (bottom SDI quintile), socially disadvantaged patients (top SDI quintile) were older (median age 55 vs. 53, P<0.001), more likely to be black (23.1% vs. 6.4%, P<0.001) or Hispanic (25.4% vs. 8.5%, P<0.001), and more likely to have chronic conditions (e.g., diabetes: 21.9% vs. 10.5%, P<0.001). Logistic and Cox regressions showed that patients with disadvantaged social conditions had higher risk for hospitalization (odds ratio: 1.68; 95% confidence interval [CI]: [1.46, 1.94]; P<0.001) and mortality (hazard ratio: 1.91; 95% CI: [1.35, 2.70]; P<0.001), adjusting for other patient characteristics.

CONCLUSION

Substantial socioeconomic disparities in health outcomes exist among COVID-19 patients in NYC. Disadvantaged neighborhood social conditions were associated with higher risk for hospitalization, severity of disease, and death.

Food Consumption Behavior of Pakistani Students Living in China: The Role of Food Safety and Health Consciousness in the Wake of Coronavirus Disease 2019 Pandemic

The emergence of coronavirus disease 2019 (COVID-19) has considerably changed global food production, processing, and consumption at different levels. Sojourners are among those who have experienced a higher level of food insecurity during the crisis of the COVID-19 outbreak. The current research aimed to investigate the immediate consumption behavioral intentions of the Pakistani international students in the People's Republic of China (PRC) during the wake of COVID-19 pandemic. This study applied the Theory of Planned Behavior (TPB) and background factors of food safety and health consciousness that influence the consumption behavioral intention of Pakistani students toward unfamiliar local food in China. A relational model was analyzed where food safety and health consciousness were hypothesized to serve as background variables associated with TPB components. Moreover, the indirect effects of food safety and health consciousness on behavioral intentions were assessed. The data were collected through convenience samples from 462 Pakistani international students and were analyzed through partial least square structural equation modeling (PLS-SEM). The results confirmed that food safety and health consciousness were positively associated with attitude (ATT), subjective norm (SN), and perceived behavioral control (PBC). However, food safety and health consciousness were indirectly associated with the behavioral intention only through ATT and SN. The results highlighted the role of food safety and health consciousness as important antecedents of classical TPB components that affect intentions and behaviors to avoid unfamiliar local food in a migrated context. The present study provides enlightenment to those who aim to investigate the consumption behavioral intentions of sojourners in the wake of the pandemic situation based on food safety and health consciousness. The findings of the current study are also applicable to general consumption patterns in the food sector.

Long-term effects of malnutrition on severity of COVID-19

The COVID-19 pandemic is a public health crisis that has the potential to exacerbate worldwide malnutrition. This study examines whether patients with a history of malnutrition are predisposed to severe COVID-19. To do so, data on 103,099 COVID-19 inpatient encounters from 56 hospitals in the United States between March 2020 and June 2020 were retrieved from the Cerner COVID-19 Dataset. Patients with a history of malnutrition between 2015 and 2019 were identified, and a random intercept logistic regression models for pediatric and adult patients were built controlling for patient demographics, socioeconomic status, admission vital signs, and related comorbidities. Statistical interactions between malnutrition and patient age were significant in both the pediatric [log-odds and 95% confidence interval: 0.094 (0.012, 0.175)] and adult [- 0.014 (- 0.021, - 0.006] models. These interactions, together with the main effect terms of malnutrition and age, imply higher odds for severe COVID-19 for children between 6 and 17 years with history of malnutrition. Even higher odds of severe COVID-19 exist for adults (with history of malnutrition) between 18 and 79 years. These results indicate that the long-term effect of malnutrition predisposes patients to severe COVID-19 in an age-dependent way.

Barriers to Accessing Healthy Food and Food Assistance During the COVID-19 Pandemic and Racial Justice Uprisings: A Mixed-Methods Investigation of Emerging Adults' Experiences

Background

A steep rise in food insecurity is among the most pressing US public health problems that has resulted from the COVID-19 pandemic.

Objective

This study aimed to (1) describe how food-insecure emerging adults are adapting their eating and child-feeding behaviors during COVID-19 and (2) identify barriers and opportunities to improve local food access and access to food assistance.

Design

The COVID-19 Eating and Activity Over Time study collected survey data from emerging adults during April to October 2020 and completed interviews with a diverse subset of food-insecure respondents.

Participants/setting

A total of 720 emerging adults (mean age: 24.7 ± 2.0 years; 62% female; 90% living in Minnesota) completed an online survey, and a predominately female subsample (n = 33) completed an interview by telephone or videoconference.

Main outcome measures

Survey measures included the short-form of the US Household Food Security Survey Module and 2 items to assess food insufficiency. Interviews assessed eating and feeding behaviors along with barriers to healthy food access.

Analyses performed

Descriptive statistics and a hybrid deductive and inductive content analysis.

Results

Nearly one-third of survey respondents had experienced food insecurity in the past year. Interviews with food-insecure participants identified 6 themes with regard to changes in eating and feeding behavior (eg, more processed food, sporadic eating), 5 themes regarding local food access barriers (eg, limited enforcement of COVID-19 safety practices, experiencing discrimination), and 4 themes regarding barriers to accessing food assistance (eg, lack of eligibility, difficulty in locating pantries). Identified recommendations include (1) expanding the distribution of information about food pantries and meal distribution sites, and (2) increasing fresh fruit and vegetable offerings at these sites.

Conclusions

Interventions of specific relevance to COVID-19 (eg, stronger implementation of safety practices) and expanded food assistance services are needed to improve the accessibility of healthy food for emerging adults.

Examining food insecurity and areas with unmet food needs during COVID-19: A geospatial, community-specific approach

Food insecurity is a public health issue that has increased in the U.S. since the 2020 COVID-19 pandemic. Understanding how this increase occurs locally is crucial in informing appropriate food insecurity-related responses. Analyzing 2-1-1 call data is one way to examine food insecurity-related needs at a zip code level. The purpose of this work was to: (1) examine overall call trend data to 2-1-1 from March through July 2019 and March through July 2020, (2) examine changes in food need call volume to 2-1-1 during COVID-19 by zip code, and (3) identify areas with unmet food needs during COVID-19 in central Texas. Data for 2-1-1 calls from Travis County zip codes for March through July 2020 were compared to calls for March through July 2019 and categorized by reason for calling. Descriptive statistics and paired t-tests were used to analyze food need calls by zip code and mapped using ArcGIS. Communities with high food call volume and no emergency food assets located within the zip code were categorized as areas with unmet food needs. Results indicated there were more overall calls to 2-1-1 in 2020 (N=37,572) than in 2019 (N=28,623), and significantly more food need calls in 2020 than in 2019 (p<0.01). Eastern Travis County, a racially and ethnically diverse and lower-income area, had the largest increase in food need calls. Two zip codes were identified as having unmet food needs, which informed the strategic placement of emergency food assets. This study illustrates how 2-1-1 data can result in rapid translation of research to policy and program implementation.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing for essential food production workers: evolving thinking, pilot testing, and lessons learned

An essential part of U.S. coronavirus disease 2019 (COVID-19) critical infrastructure is the country's food-production workforce. Keeping food-production workers safe during the COVID-19 pandemic has meant added workplace protections. Protection guidance came early from the Federal Government. Absent from such guidance were strategies to screen for the causative virus. Without viral screening, some food companies had outbreaks; some facilities had to close. Companies interested in viral screening had to devise their own strategies. One company devised a strategy having three main goals: (1) detecting asymptomatic infections, before opportunity for spread; (2) identifying workplace clusters, to indicate potential protection breakdowns; and (3) comparing company results to community infection rates. The company decided on pilot screenings at two U.S. production plants. Screenings involved mandatory viral testing (through reverse transcription polymerase chain reaction) and optional antibody testing (both immunoglobulins G and M). Pilot screenings showed benefits along with limitations: (1) detecting asymptomatic infections, but at questionably relevant time points; (2) identifying infection clusters, but with uncertain sites of transmission; (3) showing relatively low rates of infection, but absent details for meaningful community comparisons. Establishing a worker screening process was an enormous undertaking. Company employees had to stretch job roles and were distracted form usual responsibilities. Whether other companies would find sufficient benefits to justify similar screening is unclear. Moving forward, new Federal leadership could provide greater support for, and assistance with, worker screenings. In addition, new technologies could make future screenings more feasible and valuable. The worker screening experience from this pandemic offers learnings the next.

Changes in diet and food shopping behaviors among Asian-American adults due to COVID-19

Objective

COVID-19 has changed diet and food shopping behaviors, but a lack of disaggregated data by racial and ethnic subgroup makes it challenging to identify whether specific populations are experiencing greater challenges in safely securing an adequate food supply and engaging in healthy eating behaviors during the pandemic. Thus, the objective of this study was to measure such changes among Asian-American (AA) adults, overall and by ethnic subgroup.

Methods

Using a nationally derived nonprobability sample, 3084 AA adults were recruited, including 1737 East Asian, 570 South Asian, 587 Southeast Asian, and 124 multiethnic Asian adults. Participants completed an online survey with questions related to sociodemographics, health status, and diet and food shopping behaviors, including questions related to COVID-19. Logistic and linear regression were used to compare differences in survey responses by Asian ethnic subgroup.

Results

Compared to other AA subgroups, a higher percentage of Asian Indian (17%), Filipino (13%), Vietnamese (12%), and Korean (11%) adults reported no longer getting food resources they were receiving before COVID-19 (e.g., mobile meals, food pantry items). The percentage of Filipino (8%) and Vietnamese (7%) adults who reported not having enough money to buy food they need was also higher than other AA subgroups. And a higher percentage of Asian Indian adults (7%) reported not having a way to get to the food store since COVID-19 than other AA subgroups.

Conclusions

Previous work has not included disaggregated data, which may mask important disparities in food access and food insecurity among people hit hardest by COVID-19, such as Filipino, Vietnamese, and Asian Indian households.

Associations of Race/Ethnicity and Food Insecurity With COVID-19 Infection Rates Across US Counties

IMPORTANCE

Food insecurity is prevalent among racial/ethnic minority populations in the US. To date, few studies have examined the association between pre-COVID-19 experiences of food insecurity and COVID-19 infection rates through a race/ethnicity lens.

OBJECTIVE

To examine the associations of race/ethnicity and past experiences of food insecurity with COVID-19 infection rates and the interactions of race/ethnicity and food insecurity, while controlling for demographic, socioeconomic, risk exposure, and geographic confounders.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study examined the associations of race/ethnicity and food insecurity with cumulative COVID-19 infection rates in 3133 US counties, as of July 21 and December 14, 2020. Data were analyzed from November 2020 through March 2021.

EXPOSURES

Racial/ethnic minority groups who experienced food insecurity.

MAIN OUTCOMES AND MEASURES

The dependent variable was COVID-19 infections per 1000 residents. The independent variables of interest were race/ethnicity, food insecurity, and their interactions.

RESULTS

Among 3133 US counties, the mean (SD) racial/ethnic composition was 9.0% (14.3%) Black residents, 9.6% (13.8%) Hispanic residents, 2.3% (7.3%) American Indian or Alaska Native residents, 1.7% (3.2%) Asian American or Pacific Islander residents, and 76.1% (20.1%) White residents. The mean (SD) proportion of women was 49.9% (2.3%), and the mean (SD) proportion of individuals aged 65 years or older was 19.3% (4.7%). In these counties, large Black and Hispanic populations were associated with increased COVID-19 infection rates in July 2020. An increase of 1 SD in the percentage of Black and Hispanic residents in a county was associated with an increase in infection rates per 1000 residents of 2.99 (95% CI, 2.04 to 3.94; P < .001) and 2.91 (95% CI, 0.39 to 5.43; P = .02), respectively. By December, a large Black population was no longer associated with increased COVID-19 infection rates. However, a 1-SD increase in the percentage of Black residents in counties with high prevalence of food insecurity was associated with an increase in infections per 1000 residents of 0.90 (95% CI, 0.33 to 1.47; P = .003). Similarly, a 1-SD increase in the percentage of American Indian or Alaska Native residents in counties with high levels of food insecurity was associated with an increase in COVID-19 infections per 1000 residents of 0.57 (95% CI, 0.06 to 1.08; P = .03). By contrast, a 1-SD increase in Hispanic populations in a county remained independently associated with a 5.64 (95% CI, 3.54 to 7.75; P < .001) increase in infection rates per 1000 residents in December 2020 vs 2.91 in July 2020. Furthermore, while a 1-SD increase in the proportion of Asian American or Pacific Islander residents was associated with a decrease in infection rates per 1000 residents of -1.39 (95% CI, -2.29 to 0.49; P = .003), the interaction with food insecurity revealed a similar association (interaction coefficient, -1.48; 95% CI, -2.26 to -0.70; P < .001).

CONCLUSIONS AND RELEVANCE

This study sheds light on the association of race/ethnicity and past experiences of food insecurity with COVID-19 infection rates in the United States. These findings suggest that the channels through which various racial/ethnic minority population concentrations were associated with COVID-19 infection rates were markedly different during the pandemic.

Anxiety is associated with appetitive traits in university students during the COVID-19 pandemic

BACKGROUND

COVID-19 has impacted mental health globally, however, associations between anxiety and appetitive traits during the pandemic are unreported. This study evaluated anxiety symptom severity and associations with appetitive traits in students at a large public University in the U.S. during the pandemic.

METHODS

Current undergraduate and graduate/professional students completed a cross-sectional survey in fall 2020. Demographic information, anxiety symptoms in the past 2 weeks assessed by the Generalized Anxiety Disorder Scale (GAD-7), and appetitive traits assessed by the Adult Eating Behavior Questionnaire (AEBQ) were evaluated. Mean scores for eight AEBQ scales (four food approach and four food avoidance traits) were calculated. Differences in mean scores were examined between participants with moderate to severe anxiety symptoms (GAD-7 score ≥ 10) and those with mild to no anxiety symptoms (GAD-7 score < 10) via independent samples t-tests and effect sizes. Associations between GAD-7 score and individual appetitive traits were also examined, adjusting for age and gender.

RESULTS

Of the 1243 students who completed the survey (57% undergraduates; mean age = 26.5 years), 51.9% reported moderate to severe anxiety symptoms. Groups experiencing the highest degree of moderate to severe anxiety symptoms included transgender, gender fluid, and other-gendered participants (73.6%); the youngest age group [18-20 years (62%)]; undergraduate students (60.7%); and Hispanic/Latinx participants (57.7%). Participants with moderate to severe anxiety symptoms had higher scores for most food approach and avoidance traits but lower scores for enjoyment of food than those with mild to no anxiety symptoms. Effect sizes were largest for hunger and emotional over-eating (Cohen's d = 0.31 and 0.30, respectively). Adjusting for age and gender, GAD-7 score was significantly and positively associated with hunger, emotional over-eating, food and satiety responsiveness, and food fussiness and negatively associated with enjoyment of food.

CONCLUSIONS

Over half of students at a U.S. University reported moderate to severe anxiety symptoms during COVID-19. More severe anxiety symptoms were associated with increased hunger, emotional over-eating, and food and satiety responsiveness and decreased enjoyment of food. Universities must consider strategies to address anxiety, particularly in younger students; transgender, gender fluid, and students of other genders; and across race/ethnicities keeping in mind associations with appetitive traits.

The Sequential Mediating Effects of Dietary Behavior and Perceived Stress on the Relationship between Subjective Socioeconomic Status and Multicultural Adolescent Health

Studies have examined the impact of social determinants of health on the health behaviors and health statuses of ethnic minority adolescents. This study examines the subjective health of this population by examining the direct effects of multicultural adolescents’ subjective socioeconomic status (SES) and the sequential mediating effects of their dietary behaviors and perceived stress. We utilized secondary data of 500 middle school students from multicultural families who participated in the 15th Korean Youth Health Behavior Survey, 2019. Information about SES, perceived stress, subjective health status, and dietary behavior (measured by the breakfast intake frequency during the prior week) were utilized. For the relationship between the SES and the subjective health status, we confirmed the sequential mediating effects of breakfast frequency and perceived stress using SPSS 25.0 and PROCESS macro with bootstrapping. The results showed that SES had a direct effect on subjective health status and indirectly influenced subjective health status through the sequential mediating effect of breakfast frequency and perceived stress. However, SES had no direct effects on perceived stress. These findings emphasize that broadening the community-health lens to consider the upstream factor of SES when preparing health promotion interventions is essential to achieving health equity for vulnerable populations.

Rural-urban differences in the labor-force impacts of COVID-19 in the United States

COVID-19 has had dramatic impacts on economic outcomes across the United States, yet most research on the pandemic's labor-market impacts has had a national or urban focus. We overcome this limitation using data from the U.S. Current Population Survey's COVID-19 supplement to study pandemic-related labor-force outcomes in rural and urban areas from May 2020 through February 2021. We find the pandemic has generally had more severe labor-force impacts on urban adults than their rural counterparts. Urban adults were more often unable to work, go unpaid for missed hours, and be unable to look for work due to COVID-19. However, rural workers were less likely to work remotely than urban workers. These differences persist even when adjusting for adults' socioeconomic characteristics and state-level factors. Our results suggest rural-urban differences in the nature of work during the pandemic cannot be explained by well-known demographic and political differences between rural and urban America.

Parents' Perception of Food Insecurity and of Its Effects on Their Children in Italy Six Months after the COVID-19 Pandemic Outbreak

The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic and subsequent containment measures are causing an increase in food insecurity (FI) worldwide, with direct consequences on children’s nutrition. We aimed to investigate the effects of the lockdown imposed in Italy on FI and changes in eating habits and body weight in the pediatric population 6 months after the beginning of the pandemic through a cross-sectional online survey proposed to parents of children <18 and living in Italy. Among 5811 respondents, most of whom were Italian, living in Northern Italy, and with a wealthy household economy, 8.3% reported that their families were at risk of FI before the appearance of SARS-CoV-2 and, alarmingly, this percentage increased to 16.2% after the pandemic began, with households from Southern Italy being more at risk. Moreover, 27.3% of the parents reported that their children were eating more; an increase in “junk food” consumption was also found; 31.8% of the respondents declared an increase in children’s weight; weight loss prevailed among adolescents. Since the SARS-CoV-2 pandemic is again requiring restrictions, our findings might serve as a warning to politicians to promote healthy lifestyles and provide assistance to the groups in need.