Food Insecurity and COVID-19 Infection: Findings From the 2020-2021 National Health Interview Survey

Food insecurity in urban American Indian and Alaska Native populations during the COVID-19 pandemic

BACKGROUND

Food insecurity is an important social determinant of health that was exacerbated by the COVID-19 pandemic. Both food insecurity and COVID-19 infection disproportionately affect racial and ethnic minority groups, particularly American Indian and Alaska Native communities; however, there is little evidence as to whether food insecurity is associated with COVID-19 infection or COVID-19 preventive behaviors such as vaccination uptake. The purpose of this study was to evaluate associations between food insecurity, COVID-19 infection, and vaccination status among urban American Indian and Alaska Native adults seen at 5 clinics serving urban Native people.

METHODS

In partnership with health organizations in Alaska, Colorado, Kansas, Minnesota, and New Mexico, the study team conducted a cross-sectional survey in 2021 to assess food security status and attitudes, barriers, and facilitators for COVID-19 testing and vaccination. Logistic regression was used to examine the association of food security status with sociodemographic factors and COVID-19 infection and vaccination status. Marginal standardization was applied to present results as prevalence differences.

RESULTS

Among 730 American Indian and Alaska Native adults, the prevalence of food insecurity measured during the pandemic was 38%. For participants who reported persistent food security status before and during the pandemic (n = 588), the prevalence of food insecurity was 25%. Prevalence of COVID-19 infection and vaccination did not vary by food security status after adjustment for confounders.

CONCLUSIONS

High rates of food insecurity among American Indian and Alaska Native communities likely increased during the COVID-19 pandemic. However, despite the high prevalence of food insecurity, community-led efforts to reduce COVID-19 infection and increase vaccination uptake across Indian Health Service and Tribal healthcare facilities may have mitigated the negative impacts of the pandemic for families experiencing food insecurity. These successful approaches serve as an important reference for future public health efforts that require innovative strategies to improve overall health in American Indian and Alaska Native communities.

Food Insecurity in Urban American Indian and Alaska Native Populations During the COVID-19 Pandemic

Background

Food insecurity is an important social determinant of health that was exacerbated by the COVID-19 pandemic. Both food insecurity and COVID-19 infection disproportionately affect racial and ethnic minority groups, particularly American Indian and Alaska Native communities; however, there is little evidence as to whether food insecurity is associated with COVID-19 infection or COVID-19 preventive behaviors such as vaccination uptake. The purpose of this study was to evaluate associations between food insecurity, COVID-19 infection, and vaccination status among urban American Indian and Alaska Native adults seen at 5 clinics serving urban Native people.

Methods

In partnership with health organizations in Alaska, Colorado, Kansas, Minnesota, and New Mexico, the study team conducted a cross-sectional survey in 2021 to assess food security status and attitudes, barriers, and facilitators for COVID-19 testing and vaccination. Logistic regression was used to examine the association of food security status with sociodemographic factors and COVID-19 infection and vaccination status. Marginal standardization was applied to present results as prevalence differences.

Results

Among 730 American Indian and Alaska Native adults, the prevalence of food insecurity measured during the pandemic was 38%. For participants who reported persistent food security status before and during the pandemic (n=588), the prevalence of food insecurity was 25%. Prevalence of COVID-19 infection and vaccination did not vary by food security status after adjustment for confounders.

Conclusions

High rates of food insecurity among American Indian and Alaska Native communities likely increased during the COVID-19 pandemic. However, despite the high prevalence of food insecurity, community-led efforts to reduce COVID-19 infection and increase vaccination uptake across Indian Health Service and Tribal healthcare facilities may have mitigated the negative impacts of the pandemic for families experiencing food insecurity. These successful approaches serve as an important reference for future public health efforts that require innovative strategies to improve overall health in AIAN communities.

Trends, Prevalence, and Risk Factors of Food Insecurity Among Pregnant and Postpartum Women in the United States: Findings from the 2019-2021 National Health Interview Survey

Background: Despite the widespread food insecurity in the United States, there is limited research investigating its prevalence among pregnant women and the potential impact it has on maternal and child health outcomes. This study examined trends in the prevalence of, and investigated risk factors for, food insecurity among peripartum women, using a nationally representative sample in the United States. Materials and Methods: This cross-sectional study included pregnant and postpartum women aged 18-49 years who reported being currently pregnant or pregnant in the past 12 months and who participated in the National Health Interview Survey from 2019 to 2021. Weighted multivariable logistic regression analysis was used to estimate associations with food insecurity. Results: A total of 1,527 pregnant women, weighted to represent 5,588,192 women in the United States, were included in the analysis. Overall, from 2019 to 2021, 10.8% of peripartum women were food insecure. The prevalence of food insecurity changed substantially between 2019 and 2021 (2019: 10.6% confidence interval [95% CI: 8.7-13.5], 2020: 16.0% [95% CI: 10.9-22.8], 2021: 6.2% [95% CI: 4.2-9.1]). The adjusted odds of food insecurity were significantly higher among pregnant and postpartum women in 2020 (aOR 2.15), who had a health insurance coverage (aOR 2.98) and who had an unmet health care need in the preceding 12 months (aOR 6.52). Conclusion: We found that food insecurity was common among peripartum women between 2019 and 2021 and was exacerbated by the COVID-19 pandemic. Identifying the factors that predispose peripartum women to the risk of food insecurity can guide the development and implementation of targeted interventions aimed at reducing the adverse impact of food insecurity on perinatal and infant health.