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

Racial and Ethnic Disparities in Food Insufficiency in Families with Children During the COVID-19 Pandemic: the Role of Risk and Protective Factors

BACKGROUND

Black and Hispanic households are at elevated risk of food insecurity and insufficiency-correlates of adverse outcomes in areas such as health and mental health-relative to White households in the USA. The COVID-19 pandemic and its economic shock threatened to further exacerbate these issues. Research has identified a number of risk and protective factors for food insecurity and insufficiency. These could relate to racial and ethnic disparities in two ways-through aggregate differences in the distribution of characteristics such as educational attainment and employment or through differences in the degree of risk or protection associated with a factor. We examined the relationship between four factors-household head age, educational attainment, single mother household composition, and employment-and disparities in food insufficiency between White, Black, and Hispanic households with children during the COVID-19 pandemic to consider these pathways.

METHODS

We analyzed data from the Census Bureau's Household Pulse Survey using bivariate statistics, multivariable regression, and decomposition methods to understand differences in the prevalence and consequences of underlying risk and protective factors for food insufficiency in households with children.

RESULTS

Consistent with prior literature, we documented higher rates of food insufficiency among Black and Hispanic households compared to White households. Differences in the distributions of education and employment accounted for a substantial fraction of the disparities in risk. Both the distribution and degree of risk associated with single mother household composition also related to disparities, but these differences were muted after accounting for economic resources. Much, though not all, of the relationship between the distributions of education and disparate risk of food insufficiency were also captured by differences in economic resources.

CONCLUSION

This study provides insight into the structure underlying racial and ethnic disparities in food insufficiency during the COVID-19 pandemic, highlighting the importance of human capital, income, and assets.

Does Race/Ethnicity Explain Regional Inequities in Child Food Insufficiency During the Second Year of the COVID-19 Pandemic?

Historically, food insecurity prevalence was higher in the U.S. Southern region than in other regions, particularly among children, but it is not known if the COVID-19 pandemic affected this situation. Our objectives were to (1) assess regional inequities in child food insufficiency during the second year of the pandemic between Deep South states (Alabama, Georgia, Louisiana, Mississippi, and South Carolina) and non-Deep South states, and (2) examine the role of race/ethnicity and other factors in the observed differences. Data from Household Pulse Survey phases 3.1-3.2 (4/15-10/11/2021) on households with children (n=267,106) were used. The outcome was child food insufficiency, and the predictor was living in a Deep South state. Weighted crude and adjusted logistic regressions were run, adjusting for participants' race/ethnicity, age, gender, marital status, and educational attainment; number of children in the household; and household income-to-poverty ratio. Child food insufficiency prevalence was higher in Deep South (15.0%) versus non-Deep South states (11.6%). In crude models, the odds of child food insufficiency were 35% higher in Deep South, compared to non-Deep South states. With a model that adjusted for race/ethnicity, this dropped to 24% higher in Deep South states, and down to 13% higher in the fully adjusted model. Regional inequities in child food insufficiency were present in the second year of the pandemic but were not fully explained by race/ethnicity nor by other household demographic and socioeconomic factors. Assessing the contribution of state-level contexts and social policies to observed inequities may assist in explaining them and identifying appropriate solutions.

US state-level containment policies not associated with food insecurity changes during the early COVID-19 pandemic: a multilevel analysis

OBJECTIVE

To investigate the relationship between US containment measures during the COVID-19 pandemic and household food insecurity.

DESIGN

To investigate these relationships, we developed a framework linking COVID-19-related containment policies with different domains of food security and then used multilevel random effects models to examine associations between state-level containment policies and household food security. Our framework depicts theorised linkages between stringency policies and five domains of food security (availability, physical access, economic access, acceptability in meeting preferences and agency, which includes both self-efficacy and infrastructure). We used US national data from a representative survey data from the National Food Access and COVID research Team that was fielded in July-August 2020 and April 2021. Containment policy measures came from the Oxford Stringency Index and included policies such as stay-at-home orders, closing of public transit and workplace closures.

SETTING

The USA.

PARTICIPANTS

3071 adult individuals from the National Food Access and COVID research Team survey.

RESULTS

We found no significant associations between state-level containment policies and overall food insecurity at the state level or any of the individual domains of food insecurity.

CONCLUSIONS

This research suggests that while food insecurity across all domains was a significant problem during the studied phases of the pandemic, it was not associated with these containment measures. Therefore, impacts may have been successfully mitigated, likely through a suite of policies aimed at maintaining food security, including the declaration of food workers as essential and the expansion of federal nutrition programmes.

Examining the moderation of the relationship between socio-economic status and consumption intentions by food information labels

Front-of-package-labelling needs to portray health and/or sustainability information effectively to all consumers in a way that is both effective and equitable. There is mixed evidence for the effectiveness of such labels based on socioeconomic status (SES). Framing health consequences in an intuitive manner could help to reduce disparities in label comprehension across SES. We examined whether the relationships of SES (objective and subjective) with perceived healthiness and environmental friendliness of foods is moderated by the presentation of food label information. We also examined intentions to change consumption as an outcome. Participants (N = 901, age: M = 46.62 years) from the USA completed the study online. Participants were randomly assigned to view either no information (control), standard nutrition facts (nutrition), HENI scores (health), carbon footprint scores (environment), or both HENI and carbon footprint scores (combined). Participants rated 24 foods on their perception of healthiness, environmental friendliness, and intentions to increase/decrease consumption. There was no consistent interaction effect between SES and food labels on perceived healthiness or environmental friendliness. There were also no consistent interactions of SES and food labels on intentions to change consumption. However, participants reporting higher subjective SES reported greater intentions to increase consumption of foods, regardless of their health or carbon footprint status. Overall, this preliminary research shows promise for HENI and environmental food labels as an intuitive method for portraying health and environmental information regardless of socioeconomic position.

Food Shopping Strategies Among a Diverse Sample of East Harlem Residents: A Qualitative Study

PURPOSE

To inform food retail interventions, this study explored food shopping strategies employed by people constrained by limited budgets but residing in an urban environment offering numerous retail options.

APPROACH

Qualitative study incorporating semi-structured interviews and shop-alongs.

SETTING

East Harlem, New York City.

PARTICIPANTS

37 East Harlem residents participated in interviews, of whom 15 participated in shop-alongs.

METHODS

Interviews and shop-alongs were conducted in English, Spanish, and Mandarin Chinese. Interview transcripts were analyzed using a grounded theory approach. Data from shop-alongs were used to supplement interview findings.

RESULTS

Participants shopped 1-2 times at an average of 4 retail locations per week. Two key themes emerged: (1) planning trips and choosing venues; and (2) shopping experiences and perceptions of stores. Price was the primary driver of store choice, followed by product quality and variety. Substantial time was invested in shopping. Most English- and Spanish-speaking participants shopped in East Harlem. Chinese American participants shopped in Chinatown due to language concordance, availability of culturally-preferred foods, and proximity to other services.

CONCLUSION

East Harlem residents invested substantial planning, time and effort in food shopping to acquire sufficient food for their households on limited budgets. These findings offer insight into how residents interact with food environments and key drivers of decision-making about food shopping that affect decisions about where to shop and what to purchase.

Gestational Weight Gain and Neonatal Biometry during the COVID-19 Pandemic: A Multicenter Observational Cohort

OBJECTIVE

 This study aimed to test the hypothesis that being pregnant and delivering during the coronavirus disease 2019 (COVID-19) pandemic was associated with changes in gestational weight gain (GWG) or frequency of small- (SGA) or large-for-gestational-age (LGA) neonates.

STUDY DESIGN

 Secondary analysis of a multicenter observational cohort comparing pregnant people who delivered during the COVID-19 pandemic (June-December 2020) to people who delivered prior to the pandemic (March-December 2019). Those with multiple gestations, fetuses with major congenital anomalies, implausible GWG values, unavailable body mass index (BMI), or who were severe acute respiratory syndrome coronavirus-2-positive were excluded. The primary outcome was frequency of optimal recommended GWG based on prepregnancy BMI. Neonatal outcomes included birth weight, ponderal index, and frequency of SGA, LGA, and small head circumference for live births. Multivariable regression analysis was used to assess associations between exposure to the pandemic and outcomes.

RESULTS

 A total of 10,717 pregnant people were included in our analysis. A total of 4,225 pregnant people were exposed to the pandemic and 6,492 pregnant people delivered prior to the COVID-19 pandemic. Pregnant people exposed to the pandemic were older and more likely to have gestational diabetes. The frequency of appropriate GWG was 28.0% during the pandemic and 27.6% before the pandemic (adjusted odds ratio [aOR]: 1.02, 95% confidence interval [CI]: 0.93-1.11). Excessive GWG was more likely (54.9 vs. 53.1%; aOR: 1.08, 95% CI: 1.001-1.17), and inadequate GWG was less likely during the pandemic (17.0 vs. 19.3%; aOR: 0.86, 95% CI: 0.77-0.95). The frequency of SGA was 5.4% during the pandemic and 6.1% before the pandemic (aOR: 0.90, 95% CI: 0.76-1.06), and the frequency of LGA was 16.0% during the pandemic versus 15.0% before the pandemic (aOR: 1.06, 95% CI: 0.95-1.18). Other neonatal outcomes including birth weight percentile (62.1 [35.8-83.2] vs. 60.2 [34.4-82.2]; adjusted mean difference (aMD) = 1.50, 95% CI: -0.28 to 3.29), ponderal index (2.6 g/cm3 [2.4-2.8] in both groups; aMD = 0.01, 95% CI: 0.00-0.02), and small head circumference for livebirths (<10th percentile [8.2 vs. 8.1%; aOR: 1.03, 95% CI: 0.89-1.19], <3rd percentile [3.5 vs. 3.1%; aOR: 1.16, 95% CI: 0.93-1.44]) were similar between groups as well.

CONCLUSION

 Being pregnant and delivering during the COVID-19 pandemic was associated with a higher likelihood of excessive GWG and a lower likelihood of inadequate GWG.

KEY POINTS

· Delivering during the COVID-19 pandemic was associated with higher likelihood of excessive GWG.. · Delivering during the COVID-19 pandemic was associated with lower likelihood of inadequate GWG.. · COVID-19 pandemic was not associated with changes in frequency of SGA or LGA..

Recognising the heterogeneity of Indigenous Peoples during the COVID-19 pandemic: a scoping review across Canada, Australia, New Zealand and the USA

Objectives

The COVID-19 pandemic has had a disproportionate impact on the health of Indigenous Peoples in Canada, Australia, New Zealand and the USA, as reflected in the growing literature. However, Indigenous Peoples are often homogenised, with key differences often overlooked, failing to capture the complexity of issues and may lead to suboptimal public health policy-making. The objective of this review was to assess the extent to which the heterogeneity of the Indigenous Peoples in Canada, Australia, New Zealand and the USA has been reflected in COVID-19 research.

Design

This study took the form of a scoping review.

Data sources

Medline, Embase, CINAHL and Web of Science were searched for studies investigating COVID-19 pandemic outcomes among Indigenous Peoples in Canada, Australia, New Zealand and the USA. The search dates included January 2019 to January 2024.

Eligibility criteria

All citations yielded by this search were subjected to title and abstract screening, full-text review and data extraction. We included original, peer-reviewed research investigating COVID-19-related outcomes among Indigenous Peoples in Canada, Australia, New Zealand or the USA.

Data extraction and synthesis

Data extraction was conducted as an iterative process, reaching consensus between two of the study authors. All included studies were analysed through a combination of quantitative descriptive summary and qualitative thematic analysis.

Results

Of the 9795 citations found by the initial search, 428 citations were deemed eligible for inclusion. Of these citations: 72.9% compared Indigenous participants to non-Indigenous participants; 10.0% aggregated Indigenous and non-white participants; and 17.1% provided findings for Indigenous participants exclusively.

Conclusions

By overlooking the heterogeneity that exists among Indigenous Peoples in Canada, Australia, New Zealand and the USA, researchers and policy-makers run the risk of masking inequities and the unique needs of groups of Indigenous Peoples. This may lead to inefficient policy recommendations and unintentionally perpetuate health disparities during public health crises.

Predictors of Food Insecurity and Food Assistance Program Usage Among Puerto Ricans Before and During the COVID-19 Pandemic in Holyoke, Massachusetts

BACKGROUND/OBJECTIVES

Puerto Rican households often face elevated rates of food insecurity. Frequently, households experiencing food insecurity turn to federal and emergency nutrition assistance for urgent or prolonged aid. This study analyzes factors influencing food insecurity and food assistance program involvement among Puerto Ricans in Holyoke, Massachusetts, amidst the COVID-19 pandemic.

METHODS

Using a combination of community-based participatory recruitment, purposive sampling, and web-based tools, we collected 284 survey responses. Our paper employed Pearson's chi-square, logistic regression, and hierarchical linear models to assess relationships between demographic and household attributes and food access outcomes.

RESULTS

Variables such as having children in the household and age significantly influenced food relief participation and food insecurity outcomes. Puerto Rican heritage and low educational attainment were strong predictors of obtaining federal food aid. Low-income participants disproportionately faced food shortages and depended on emergency food initiatives. Our findings indicate that demographic and household factors significantly influence food insecurity and accessibility.

CONCLUSIONS

Our study demonstrates that the pandemic made it challenging for households to obtain consistent, safe, and affordable nourishment. The impacts were unequally spread; hence, Puerto Rican communities and low-income groups were most affected.

Mutual aid food sharing during the COVID-19 pandemic: case study of Tompkins County, NY

OBJECTIVE

The COVID-19 pandemic led to greater food insecurity across the world, and government and charitable organisations did not always respond quickly enough or adequately to meet food needs. Mutual aid (MA) - neighbours helping neighbours to meet survival needs - mobilised residents to share food, often through outdoor food cabinets and refrigerators. This study aims to understand how MA food sharing was implemented, including food availability, acceptability, accessibility and impact on food access.

DESIGN

This case study describes one MA food sharing system by triangulating data from flyers, notes from nineteen volunteer meetings, six cabinet host interviews, data extracted from 1387 social media posts and 356 photographs, and 111 resident surveys.

SETTING

Tompkins County, NY, USA (total population about 100 000).

RESULTS

We estimated high availability of food: approximately 250 000 food servings were shared monthly, mostly carbohydrates. Most residents obtaining food found it acceptable, including satisfaction with food safety and cleanliness, food quantity, and ease of travel to the cabinets but were less satisfied with food variety. MA food sharing was accessible to food-insecure, unemployed and disabled residents, but not other priority populations. About two-thirds of residents reported improved food access. Volunteers exhibited tenacity and ingenuity in meeting operational challenges which included trash and vandalism, winter weather and unusable food contributions while foregrounding residents' safety and privacy as shared values and navigating conflicting views about fairness.

CONCLUSIONS

In times of crisis, MA can improve food access through free food sharing cabinets, but barriers include unacceptable food contributions and outdoor conditions.

Impact of a school-based intervention and the COVID-19 pandemic on healthy eating in Navajo families: Results from the Yéego! Healthy eating and gardening intervention trial

Objectives

As part of a group randomized trial of a school-based intervention promoting gardening and healthy eating, health behaviors of adult family members were evaluated. The COVID-19 pandemic hit the Navajo Nation in March 2020 and the ongoing Yéego! collaborative study allowed description of adult response to COVID as an ancillary objective.

Methods

Six elementary schools on the Navajo Nation in Arizona or New Mexico had been randomized to intervention or comparison group. One adult family member for each 3rd and 4th grade student completed surveys at baseline, nine-month and 21-month follow-up. Adult outcomes were fruit and vegetable (F&V) intake, obesogenic dietary index and gardening frequency. COVID-related measures were collected at 21-month follow-up. Differential changes and interactions were examined using repeated measures linear mixed models.

Results

Adult F&V intake increased significantly more in the intervention group than in the comparison group at nine months by 2.26 servings/day (95% CI: 0.45, 4.06). No other changes were associated with the intervention at nine or 21 months. At 21 months, in the subgroup with COVID concerns, the differential change in F&V intake was 2.02 (95% CI: 0.21, 3.84) servings/day. In cross-sectional analyses, only healthy eating measures varied by levels of COVID concerns, stress and resilience.

Conclusions

The child focused school-based intervention had some impact on adult family members, particularly their F&V intake, suggesting the reach of the intervention extended to students' families. The impact on adult F&V intake persisted among those reporting COVID concerns. Findings have important implications for augmenting healthy eating interventions.

Perceived Discrimination Among Food Pantry Clients in Massachusetts

Introduction

Food insecurity is defined as inconsistent access to enough food to meet nutritional needs. Discrimination is associated with food insecurity and poor health, especially among racial and ethnic minoritized and sexual or gender minoritized groups. We examined the demographic associations of perceived everyday discrimination and food pantry discrimination in Massachusetts.

Methods

From December 2021 through February 2022, The Greater Boston Food Bank conducted a cross-sectional, statewide survey of Massachusetts adults. Of the 3,085 respondents, 702 were food pantry clients for whom complete data on food security were available; we analyzed data from this subset of respondents. We used the validated 10-item Everyday Discrimination Scale to measure perceived everyday discrimination and a 10-item modified version of the Everyday Discrimination Scale to measure perceived discrimination at food pantries. Logistic regression adjusted for race and ethnicity, age, gender identity, sexual orientation, having children in the household, annual household income, and household size assessed demographic associations of perceived everyday discrimination and discrimination at food pantries.

Results

Food pantry clients identifying as LGBTQ+ were more likely than those identifying as non-LGBTQ+ to report perceived everyday discrimination (adjusted odds ratio [AOR] = 2.44; 95% CI, 1.24-4.79). Clients identifying as Hispanic (AOR = 1.83, 95% CI, 1.13-2.96) were more likely than clients identifying as non-Hispanic White to report perceived discrimination at food pantries.

Conclusion

To equitably reach and serve households with food insecurity, food banks and pantries need to understand experiences of discrimination and unconscious bias to develop programs, policies, and practices to address discrimination and create more inclusive interventions for food assistance.

Food Insecurity across Age Groups in the United States during the COVID-19 Pandemic

Food insecurity increased during the COVID-19 pandemic, but the impact varied across different age groups during the prolonged public health emergency. This study sought to describe national food insecurity prevalence by adult age group at multiple stages of the pandemic and explore differences by demographic characteristics. Data were from the nationally representative US Census Bureau's Household Pulse Survey from April 2020 to May 2023 (N = 4,153,462). Locally weighted scatterplot smoothing (LOESS) regression analysis identified change points in food insecurity trends, segmenting the timeline into three periods: (1) April 2020-March 2021, (2) April 2021-May 2022, and (3) June 2022-May 2023. Logistic regression models examined associations between age, time period, and self-reported household food insecurity; covariates included demographics, socioeconomic status, household structure, and food support program usage. Overall, 9.3% of respondents experienced food insecurity, ranging from 3.5% among those aged ≥75 to 12.2% for ages 35-44 years. Significant interaction between age group and time period indicated inconsistency in the age-food insecurity association during the pandemic (p < 0.001). From Period 1 to 3, the proportion of food-insecure adults aged ≥65 rose from 9.2% to 13.9%. Across all age groups, higher odds of food insecurity were found among Black, Hispanic/Latino, or Other/Multiracial respondents; those with less than a Bachelor's degree; those with incomes below USD 35,000; those unemployed for reasons other than retirement; and non-homeowners (p < 0.001). The results show that trends and characteristics associated with food insecurity varied across age groups and time periods. Continuous monitoring of food insecurity during emergencies is critical to identify vulnerable populations and timely interventions.

The COVID-19 pandemic and food insecurity in households with children: A systematic review

BACKGROUND

Food insecurity is defined as not having safe and regular access to nutritious food to meet basic needs. This review aimed to systematically examine the evidence analysing the impacts of the COVID-19 pandemic on food insecurity and diet quality in households with children <18 years in high-income countries.

METHODS

EMBASE, Cochrane Library, International Bibliography of Social Science, and Web of Science; and relevant sites for grey literature were searched on 01/09/2023. Observational studies published from 01/01/2020 until 31/08/2023 in English were included. Systematic reviews and conference abstracts were excluded. Studies with population from countries in the Organisation for Economic Co-Operation and Development were included. Studies were excluded if their population did not include households with children under 18 years. The National Heart, Lung, and Blood institute (NIH) tool for observational cohort and cross-sectional studies was used for quality assessment. The results are presented as a narrative review.

RESULTS

5,626 records were identified and 19 studies were included. Thirteen were cross-sectional, and six cohorts. Twelve studies were based in the USA, three in Canada, one each in Italy and Australia and two in the UK. Twelve studies reported that the COVID-19 pandemic worsened food insecurity in households with children. One study reported that very low food security had improved likely due to increase in benefits as part of responsive actions to the pandemic by the government.

CONCLUSION

Although studies measured food insecurity using different tools, most showed that the pandemic worsened food security in households with children. Lack of diversity in recruited population groups and oversampling of high-risk groups leads to a non-representative sample limiting the generalisability. Food insecure families should be supported, and interventions targeting food insecurity should be developed to improve long-term health.

Position of the Society for Nutrition Education and Behavior: The Importance of Emergency-Related Food and Nutrition Education Before, During, and After a Disaster

It is the position of the Society for Nutrition Education and Behavior that for effective recovery from and resilience to disasters, it is essential that impacted individuals and communities have access to safe, nutritious, and culturally and contextually appropriate foods and beverages, and receive emergency-related food and nutrition education before, during, and after a disaster. Despite the increasing number, duration, and intensity of disasters worldwide, there is relatively limited guidance for research, policy, and practice about addressing the emergency-related food and nutrition needs of affected populations. Although nutrition emergencies tend to be understudied, emerging efforts are working to advance food and nutrition security during disaster response and recovery. To help elevate the importance of emergency-related food and nutrition education before, during, and after a disaster, Society for Nutrition Education and Behavior, which represents the unique professional interests of nutrition educators worldwide, summarizes the relevant literature and puts forth recommendations for all those who are engaged in this work in the following 4 key areas: (1) improving communication and outreach, (2) fostering community engagement and locally-driven preparedness, (3) building the evidence base and translating the evidence into action, and (4) training current professionals and the next generation of public health leaders. Altogether, before, during, and after a disaster, those who engage in this work, among other allies, can help elevate the importance of nutrition education and other strategies to promote healthy eating behaviors through research, policy, and practice.

Fruit and Vegetable Consumption, Food Acquisition Behavior, and Food Insecurity Before and After the COVID-19 Vaccine Rollout

OBJECTIVES

To assess changes in food acquisition behavior, food insecurity, and dietary behavior and identify factors associated with fruit and vegetable (FV) consumption during the transitional period (before and after the initial vaccine rollout for all adults) of the COVID-19 pandemic.

DESIGN

Successive independent samples design. Online surveys were conducted from October 2020 to February 2021 (time 1, before the vaccine rollout) and from October 2021 to December 2021 (time 2, after the vaccine rollout). Descriptive analysis examined changes in food sources, food security, and daily FV consumption in cup equivalents (CEs) from time 1 to time 2. A multivariable logistic regression analysis examined factors associated with FV consumption.

SETTING

The Capital Region of New York State.

PARTICIPANTS

1553 adults 18 years of age and older.

MAIN OUTCOME MEASURE

Meeting the 2020-2025 MyPlate daily FV consumption recommendations.

RESULTS

There were statistically significant (P < .05) increases in the use of supermarkets, eat-in restaurants, farmers' markets, and convenience stores from time 1 to time 2. Food insecurity (40.1% vs 39.4%) and FV consumption (2.6 CE vs 2.4 CE) slightly declined but not significantly. Home food procurement such as gardening and foraging (OR, 1.61; 95% CI, 1.08-2.37) and shopping at food co-op/health food stores (OR, 1.64; 95% CI, 1.07-2.49) were significantly associated with the FV outcome, and these relationships were not modified by food security status.

CONCLUSIONS

The present study highlights the importance of food sources in understanding adult dietary behavior during the transitional period of the pandemic. Continuing efforts to monitor access to food sources, food insecurity, and dietary behavior are warranted as various COVID-related emergency food assistance measures have expired.

Exploring Sociodemographic and Chronic Disease Factors Associated With Chronic, Seasonal, Intramonthly, and Intermittent Presentations of Food Security Instability

BACKGROUND

Food insecurity impacts 13.5 million US households yearly. Although food security instability (FS-I) can have many temporal presentations, these are not measured in the current US Household Food Security Survey Module.

OBJECTIVE

Explore sociodemographic and chronic disease correlates of 4 FS-I types (chronic, seasonal, intramonthly, and intermittent) using a 3-item US Household Food Security Survey Module instability supplement.

DESIGN

This study was a secondary analysis of cross-sectional survey pilot data collected to validate the US Household Food Security Survey Module instability supplement.

PARTICIPANTS AND SETTING

Adults at risk for food insecurity (n = 420) were recruited and answered the survey on their households' behalf from April to June 2021. The participants were recruited from 7 community organizations from 5 states (California, Florida, Maryland, North Carolina, and Washington).

MAIN OUTCOME MEASURES

The main outcomes were the odds of having a chronic, seasonal, intramonthly, or intermittent FS-I score ≥1 based on several sociodemographic factors and having ≥1 chronic disease.

STATISTICAL ANALYSES PERFORMED

Differences among the 4 FS-I types were analyzed using contingency tables and χ2 tests of independence. Then, mixed-effects logistic binary and conditional regressions were run for each FS-I type using clustering by state and odds ratios and 95% CI to interpret results.

RESULTS

The most common FS-I type experienced by the sample was intramonthly (n = 183 [43%]). Nonchronic food insecurity was most likely to happen during the winter, at the end of the month, or randomly with no certain time frame. FS-I in any form was associated with low income, chronic FS-I was associated with younger age and male sex, seasonal FS-I was associated with having no government-subsidized health insurance and females, intramonthly FS-I was associated with participation in nutrition assistance programs, and intermittent FS-I had lower odds among Hispanic/Latino households.

CONCLUSIONS

Further research is needed to explore other FS-I correlates and establish causative relationships; however, these results can be used with clinical judgment for targeted food insecurity screening and treatment.

Diaper need in the United States: A nationally representative study during the COVID-19 pandemic

Background

Diapers represent a unique financial burden for those with young children. Pre-pandemic, approximately one in three U.S. households with young children reported diaper need or an insufficient supply of diapers. To support this population, policymakers, clinicians, and service providers need a better understanding of the groups most commonly affected and the ways that families cope with deprivation.

Methods

An online survey was administered between February and July 2021 to a national sample of U.S. caregivers of at least one child aged 0-4 years in diapers (n = 881), investigating diaper need, diaper access, and how household expenses are balanced and prioritized vis-à-vis diapers. We use bivariate and multivariable models to assess factors associated with diaper need, and examine coping strategies, tradeoffs made to purchase diapers, and how caregivers would reallocate their money if diapers were accounted for.

Findings

The prevalence of diaper need (46 %) exceeded pre-pandemic estimates. Diaper need was more prevalent among Hispanic respondents, lower income respondents, cloth diaper users, those with more than one child in diapers, caretakers with depression, and those with a negative financial change in the past year. Caretakers with diaper need were more likely to utilize a range of resources to access diapers and to use diapers for longer than desired to extend their supply. Those with diaper need also made more economic tradeoffs to afford diapers and indicated that they would reallocate resources to cover other unmet basic needs if they did not have to buy diapers.

Interpretation

Our results indicate elevated levels of diaper need even after the U.S. economy had largely rebounded and raise concerns that inequities in diaper access may impact families' abilities to meet other basic needs. Diapers may be an important target for policies and interventions aimed at improving the well-being of families with young children.

Effect of Lockdown Period of COVID-19 Pandemic on Maternal Weight Gain, Gestational Diabetes, and Newborn Birth Weight

OBJECTIVE

This study aimed to determine whether the lockdown period of the initial novel coronavirus disease 2019 (COVID-19) surge in New York affected gestational weight gain (GWG), newborn birth weight (BW), and the frequency of gestational diabetes mellitus (GDM). Maternal and newborn outcomes during the first wave of the pandemic were compared with those during the same timeframe in the previous 2 years.

STUDY DESIGN

Retrospective cross-sectional study of all live singleton term deliveries from April 1 to July 31 between 2018 and 2020 at seven hospitals within a large academic health system in New York. Patients were excluded for missing data on: BW, GWG, prepregnancy body mass index, and gestational age at delivery. We compared GWG, GDM, and BW during the pandemic period (April-July 2020) with the same months in 2018 and 2019 (prepandemic) to account for seasonality. Linear regression was used to model the continuous outcomes of GWG and BW. Logistic regression was used to model the binary outcome of GDM.

RESULTS

A total of 20,548 patients were included in the study: 6,672 delivered during the pandemic period and 13,876 delivered during the prepandemic period. On regression analysis, after adjustment for study epoch and patient characteristics, the pandemic period was associated with lower GWG (β = -0.46, 95% confidence interval [CI]: -0.87 to -0.05), more GDM (adjusted odds ratio [aOR] = 1.24, 95% CI: 1.10-1.39), and no change in newborn BW (β = 0.03, 95% CI: -11.7 to 11.8) compared with the referent period. The largest increases in GDM between the two study epochs were noted in patients who identified as Hispanic (8.6 vs. 6.0%; p < 0.005) and multiracial/other (11.8 vs. 7.0%; p < 0.001).

CONCLUSION

The lockdown period of the pandemic was associated with a decrease in GWG and increase in GDM. Not all groups were affected equally. Hispanic and multiracial patients experienced a larger percentage change in GDM compared with non-Hispanic white patients.

KEY POINTS

· The COVID-19 lockdown was associated with decreased GWG and increased GDM.. · No change in newborn BW was seen during the lockdown.. · Overall, the lockdown did not have a large clinical effect on these pregnancy outcomes..

Emergency Free School Meal Distribution During the COVID-19 Pandemic in High-Poverty Urban Settings

BACKGROUND

The coronavirus disease 2019 pandemic triggered nationwide school closures in March 2020, putting millions of children in the United States who were reliant on subsidized school meals at risk of experiencing hunger. In response, the US Department of Agriculture mobilized the Summer Food Service Program and Seamless Summer Option program to provide emergency free school meals. There is a need to investigate the effectiveness of these programs in covering underresourced communities during the pandemic.

OBJECTIVE

This study assessed associations between meal distribution and census tract demographics (ie, poverty level, race/ethnicity, and deprivation level based on social deprivation index score).

DESIGN

An observational study using longitudinal meal distribution data collected over an 18-month period following school closures (March 2020 to August 2021).

PARTICIPANTS AND SETTING

Monthly meal distribution data were collected for community sites serving 142 census tracts within 4 urban New Jersey cities predominantly populated by people with low incomes and from racial and ethnic minority groups.

MAIN OUTCOME MEASURES

Main outcome measures were the number of meals served monthly by Summer Food Service Program and Seamless Summer Option meal sites.

STATISTICAL ANALYSES PERFORMED

A 2-part multivariable regression approach was used to analyze the data.

RESULTS

In the first step, logistic regression models showed that high-deprivation tracts were more likely to serve meals during the observed period (odds ratio 3.43, 95% CI 1.001 to 11.77; P = 0.0499). In the second step, among tracts that served any meals during the observed period, mixed effects negative binomial regression models showed that high-poverty and high-deprivation tracts served comparatively more meals (incidence rate ratio [IRR] 2.83, 95% CI 2.29 to 3.51; P < 0.001 and IRR 1.94, 95% CI 1.65 to 2.28; P < 0.001, respectively).

CONCLUSIONS

Findings show that meal distribution during the pandemic was higher within census tracts with higher poverty and deprivation levels, indicating that underresourced communities with higher need had more free meals available during this unprecedented public health emergency.

Healthy School Meals for All in Utah

BACKGROUND

The National School Lunch and School Breakfast programs reduce food insecurity and improve dietary intake. During the COVID-19 pandemic, school meals were provided to all children at no cost, regardless of income. This policy is known as Healthy School Meals For All (HSMFA). The purpose of the study was to examine the feasibility of a HSMFA policy in Utah.

METHODS

A mixed-methods approach was used, including qualitative interviews for policymakers, surveys for school foodservice directors, and financial modeling of Utah Child Nutrition Programs data. Analysis included a phenomenological analytic approach for qualitative data, descriptive statistics for surveys, and development of a cost model with 6 scenarios.

RESULTS

Qualitative data revealed themes of (1) awareness; (2) responsibility; (3) perspectives on school meals; and (4) new opportunities. Most (81%) foodservice directors believed HSMFA should continue post-pandemic. HSMFA would cost $51,341,436 to $82,358,375 per year.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

HSMFA would result in the equitable treatment of all children regarding access to healthy school meals.

CONCLUSIONS

Given the support of foodservice directors but the lack of political consensus, considering stepwise implementation and providing cost estimates may increase feasibility of a HSMFA policy in Utah.

Has food security in the EU countries worsened during the COVID-19 pandemic? Analysis of physical and economic access to food

The aim of the paper is to provide an ex-post assessment of the impact of the COVID-19 pandemic on food insecurity in the EU-27 countries expressed by physical and economic food access. We analysed trade and price effects, together with food insecurity and malnutrition indicators. Actual levels of the indicators were compared with their pre-pandemic magnitudes and/or with counterfactual levels derived from predictive models. We also aimed to compare the objective statistics with the subjective consumers' perception of their households' food security. Our research indicates that the EU food trade was more resilient to COVID-19 impacts than the trade in non-food products, while food trade decreases were of a temporary nature. This did not affect the trade balance significantly; however, the import reduction threatened the physical food access in most EU countries. Regarding economic food access, the results indicate that the increase in food prices was offset by the increase in disposable income. It may suggest that the COVID-19 pandemic did not significantly affect the deterioration of economic access to food in the EU countries. However, the prevalence of severe food insecurity in the total population or the proportion of households reporting inability to afford a meal with meat, chicken, fish, or a vegetarian equivalent increased in 2020-2021 compared to 2019. This means that the comparative analysis of the real data on prices and households' income, as well as consumer financial situation and food consumption affordability, does not offer a clear answer concerning the impact of the COVID-19 pandemic on the food security of EU households.

Systematic investigation of inadequate food access at a large southeastern land grant university

Over the past decade, the impact of low food security on student well-being and academic performance has become a growing concern at institutions of higher education across the U.S. This mixed methods study adds to the growing body of evidence on the association between student socio-demographic and economic characteristics and food security. An online survey covering food access, student well-being, and housing security was sent to 35,337 undergraduate and graduate students at a large southeastern land grant university. A total of 2,116 complete responses were received; a 6% response rate. The survey responses also included 176 written statements by students. The survey found that 16% of both undergraduate and graduate students had low or very low food security, as defined by a modified USDA food security measure. The socio-demographic and economic characteristics that were linked to a higher likelihood of low food security included: having a GPA of less than 3.0, having a disability, being an international student, being a first-generation student, being a transfer student, going into debt to pay for food, being a Black or African American student, having poor mental health, having uncertain living arrangements, and having no medical insurance. Recommendations for enhancing student access to food, housing, and mental health services are discussed.

"We Want to Eat and be Healthy just like Everybody Else:" How Social Infrastructures Affect Nutrition Equity in a Racialized Urban Community in the United States

Background

Food security and nutrition equity, 2 social determinants of health, are impacted by the coronavirus disease 2019 (COVID-19) pandemic and the racialization of urban communities. Few studies to date have examined how the use of social infrastructures in the United States during COVID-19 affected the ability to achieve food security and nutrition equity.

Objectives

To describe how the use of social infrastructures impacts food security and nutrition equity in a majority Black and urban community in the United States.

Methods

Semistructured in-depth interviews were conducted with 40 low-income, urban, and predominately Black people living in Buffalo, New York in May-July 2022.A thematic analysis using a phronetic iterative approach informed by the Social Ecological Model, Walsh's Family Resilience Framework, and a framework focused on the advancement of nutrition equity.

Results

We identified 9 themes mapped across 3 interrelated domains that impact nutrition equity, including 1) meeting food needs with dignity, 2) supply and demand for fresh and healthy foods, and 3) community empowerment and food sovereignty. We found that people used coping strategies, such as food budgeting and cooking skills, paired with different social infrastructures to meet food needs. People commonly used the Supplemental Nutrition Assistance Program and food pantries to meet food needs over receiving support from family members or friends outside of the household. Poverty, challenges accessing and affording healthy food, and the inability to reciprocate support to others undermined the advancement of nutrition equity despite social infrastructures being available for use. Historical and ongoing acts of disempowerment and disinvestment also hindered the advancement of nutrition equity.

Conclusions

Sustained, community-led investment is needed to address structural inequities preventing the advancement of nutrition equity. Social infrastructures should be expanded to inclusively support low-income populations, so wealth generation is possible to address the root cause of food insecurity.

The Intersectionality of Food Insecurity, Job Insecurity, Healthcare Insecurity, and Mental Health Challenges in NYC Households During Covid-19

Our intersectional research explored food insecurity and job insecurity as predictors of healthcare insecurity and mental health challenges among households living in economic instability since the COVID19 pandemic began. The New York City COVID19 Research Team adapted a validated, web based, anonymous survey questionnaire using a Social Determinants of Health Framework. The study oversampled underserved populations with a total of 2,099 participants. We report strong associations between food insecurity and job insecurity among healthcare insecure households, and significant mental health challenges among food insecure and healthcare insecure households. This underscores the need for integrated social policies to protect underserved urban populations.

Home and wild food procurement were associated with improved food security during the COVID-19 pandemic in two rural US states

Both food insecurity and home and wild food procurement (HWFP), including gardening, increased in many countries during the COVID-19 pandemic; yet little evidence has demonstrated what impact HWFP had on food security. Using data from a representative sample of nearly 1000 residents in the two most rural US states (Vermont and Maine) conducted via an online survey in Spring/Summer 2021, as well as matching techniques, we compare food security outcomes among households who did and did not participate in HWFP in the first year of the pandemic. Nearly 60% of respondents engaged in HWFP in some way during the first year of the pandemic, with food insecure households more likely to do HWFP. Furthermore, HWFP early in the COVID-19 pandemic is associated with improved food security in the 9-12 months later, though these improvements were primarily associated with newly, not chronically, food insecure households. Newly and chronically food insecure households were more likely to want to continue these activities in the future, but also exhibited greater barriers to land access and costs associated with these activities. These results suggest that HWFP may provide food security improvements for certain households that utilize them, especially during crisis situations. Future research about HWFP should continue to explore multiple HWFP strategies, their barriers, and their potentially myriad relationships to food security, diet, and health outcomes, especially with longitudinal data.

Thomas A, Ohri-Vachaspati P. Parent Perceptions and Opinions of Universal Free School Meals in Arizona

To support families during the COVID-19 pandemic, the USDA allowed all US schools to offer meals at no cost regardless of family income, a policy referred to as Universal Free Meals or Healthy School Meals for All (HSM4A). Despite the recognized benefits and popularity of HSM4A during the pandemic, the policy expired in June 2022. The goal of this study was to gather perceptions of parents in Arizona about school meals, the HSM4A program, and the discontinuation of HSM4A. In collaboration with a local anti-hunger group, using an online survey distributed in September and October 2022, we collected data from a diverse sample of over 2000 parents living in Arizona. Parents unequivocally supported HSM4A during the pandemic (97%) and expressed support for continuing to offer HSM4A (95%). High levels of support were seen across all groups in the study, including from individuals who identified as politically conservative. We also analyzed 750 responses to an open-ended question asking respondents to share their thoughts about offering meals to all Arizona students regardless of family income. The majority of emergent themes related to perceived benefits of HSM4A, including reducing financial burden and stress for families. Our findings will be useful for advocates and policy makers considering HSM4A legislation.

COVID-19 Pandemic Effects on Job Search and Employment of Graduates (2015-2020) of Canadian Dietetic Programmes

Purpose: Self-reported coronavirus 2019 (COVID-19) pandemic effects on dietetic job search, employment, and practice of recent graduates were explored within a national workforce survey.Methods: Graduates (2015-2020) who were registered/licensed dietitians or eligible to write the Canadian Dietetic Registration Exam were recruited through dietetic programmes, Dietitians of Canada's communication channels, and social media. The online survey, available in English and French from August through October 2020, included questions about pandemic experiences. Descriptive statistics and thematic analysis were applied to closed and open-ended responses, respectively.Results: Thirty-four percent of survey respondents (n = 524) indicated pandemic effects on job search and described delayed entry into dietetics, fewer job opportunities, and challenges including restricted work between sites. The pandemic affected employment for 44% of respondents; of these, 45% indicated working from home, 45% provided virtual counselling, 7% were redeployed within dietetics, 14% provided nondietetic COVID-19 support, and 6% were furloughed or laid off. Changed work hours, predominantly reduced, were identified by 29%. Changes in pay, identified by 12%, included loss (e.g., raises deferred) or gain (e.g., pandemic pay). Fear of infection and stress about careers and finances were expressed.Conclusion: The COVID-19 pandemic profoundly affected both acquiring positions and employment in 2020 for recent dietetic graduates.

A systematic review of the direct and indirect COVID-19's impact on food security and its dimensions: pre-and post-comparative analysis

BACKGROUND

Since its emergence, the COVID-19 pandemic has compromised the food security both directly by impacting food supply chain and indirectly by overwhelming the individual health and/or personal financial situation. The overarching aim of the current study is to assess aspects of the food security crisis that have arisen due to COVID-19 and to identify which, if any, food security dimensions were specifically compromised.

METHODS

Primary research articles were initially identified through four online databases (Scopus, PubMed, Google Scholar, and Web of Science), with the references of each paper then also reviewed for additional article. The food security status of individuals and the wider community, both before and after the emergence of COVID-19, were examined.

RESULTS

Of the 2,057 studies initially identified, a total of ten were included in the final review. The included studies confirmed that COVID-19 had substantially impacted food security, with individuals, households and the wider community experiencing food insecurity. Nine of the included studies aruged that the food accessibility dimension was the most compromised.

CONCLUSION

To address the identified direct and indirect food security issues associated with COVID-19, it is proposed that a combination of prevention practices and proactive food security activities is required. Integrating food security interventions, supporting and facilitating food security resilience, and conducting further studies on the food security of COVID-19 are also recommended.

A Mixed-Methods Approach to the Development of a Disaster Food Security Framework

BACKGROUND

Limited research on food systems and food insecurity (FI) following disasters finds contextual differences in post-disaster food systems that shape dimensions of FI. Measurement limitations make it difficult to address FI and develop effective practices for disaster-affected communities.

OBJECTIVE

To develop, validate, and test a Disaster Food Security Framework (DFSF).

DESIGN

Mixed-methods approach was used, including in-depth interviews to understand lived experiences during disasters; expert panel input to validate DFSF designed using responses from in-depth interviews; and quantitative testing of robustness of DFSF using the coronavirus disease 2019 pandemic as a disaster example.

PARTICIPANTS AND SETTING

The in-depth interviews included participants from Vermont (n = 5), North Carolina (n = 3), and Oklahoma (n = 2) who had been living in those states during Hurricane Irene (2011), Hurricane Florence (2018), the Moore tornadoes (2013), and coronavirus disease 2019 pandemic (2020). The expert panel consisted of researchers and practitioners from different US geographical regions and food-related disciplines (n = 18). For the quantitative testing survey, data from 4 US states (New York, New Mexico, Vermont, and Maryland; n = 3,228) from the National Food Access and COVID Research Team was used.

MAIN OUTCOME MEASURES

The outcomes from the in-depth interviews were dimensions of disaster FI, those from the expert panel was a content validity ratio, and those from the quantitative testing was the number of items and components to be included.

ANALYSES PERFORMED

Inductive and deductive reasoning were using when reporting on the in-depth interviews and expert panel results, including frequencies. The quantitative testing was conducted using multiple correspondence analysis.

RESULTS

The in-depth interviews revealed four dimensions of FI: availability (supply and donation), accessibility (economic, physical, and social), acceptability (preference and health), and agency (infrastructure and self-efficacy). The panel of experts reported high content validity for the DFSF and its dimensions (content validity ratio >0.42), thus giving higher credibility to the DFSF. Multiple correspondence analysis performed on 25 food-related variables identified one component with 13 indicators representing three of the four dimensions: availability, acceptability, and accessibility, but not agency.

Wild and backyard food use during COVID-19 in upstate New York, United States

Introduction

COVID-19 acutely shocked both socio-economic and food systems in 2020. We investigated the impact of COVID-19 on production and consumption of gardened produce, backyard poultry, wild game and fish, and foraged mushrooms, berries, and other plants in New York State, aiming to understand crisis influenced food choice and motivations, including food security.

Methods

We conducted an online, cross-sectional survey in October-December 2020 with a convenience sample of participants (n = 505) with an interest in gardening, poultry rearing, foraging, hunting, and/or fishing from six counties in upstate New York. We recruited through the New York Department of Environmental Conservation, Cornell Cooperative Extension, and other relevant email and social media pages.

Results

Across the wild and backyard food production strategies, 4.0-14.3% of respondents reported engaging for the first time and 39.6-45.7% reported increased production (a little or a lot more), and 31.6-42.7% of respondents' production was the same as the previous year. Consumption of foods produced was widespread, including fruit and vegetables (97.6% of producers also consumed), backyard eggs (92.7%), and foraged foods (93.8%). For meats, a majority consumed backyard poultry meat (51.2%), wild-caught fish (69.7%), and wild game they hunted (80.1%). The frequency of consumption of fruit and vegetables (average of 13.5 times/month) and eggs (16.4 times/month) was very high, while average consumption of poultry meat, foraged foods, fish, and wild game ranged from 3.1 to 5.8 times/month. The number of respondents who reported "have more control over food availability" as motivation to produce all wild and backyard foods increased from 2019 to 2020 (p < 0.05 - p < 0.001). There was also a significant relationship between experiences of COVID-19 related hardship (i.e., food insecurity, income loss) with gardening and poultry-rearing (p ≤ 0.05), but not with other production methods or with consumption of wild and backyard foods.

Discussion

Our findings help to locate wild and backyard foods within COVID-19 impacted food environments, and describe food security as a particularly relevant motivation, among others, reported by respondents in 2020. Given this, New York State service providers can use these findings to tailor current future support for households exerting control over their own food environments with wild and backyard foods, allowing the state to be better prepared for future crises.

Supplemental Nutrition Assistance Program Education reductions during COVID-19 may have exacerbated health inequities

OBJECTIVE

Describe, and assess disparities in, the changes in Supplemental Nutrition Assistance Program Education (SNAP-Ed) that occurred the year before vs. the year when COVID-19 restrictions were implemented.

DESIGN

Observational study comparing reach, intensity, and dose of California Local Health Department (LHD) SNAP-Ed interventions in Federal Fiscal years 2019 and 2020 (FFY19, FFY20).

ANALYSIS

Student t-tests determined significance of differences in the number of Direct Education (DE) programs, Policy, Systems and Environmental change (PSE) sites, people reached, and intervention intensity and dose between FFY19 and FFY20 using data reported online by LHDs. Linear regression assessed associations between census tract-level characteristics (urbanicity; percentages of population with income <185% of federal poverty level, under 18 years of age, and belonging to various racial/ethnic groups; and California Healthy Places Index) and changes in number of DE programs, PSE sites, people reached, and intervention dose between FFY19 and FFY20.

RESULTS

From FFY19 to FFY20, the number of DE programs, PSE sites, people reached, and census tract-level intervention intensity and dose decreased. Higher census tract poverty, higher proportions of Black and Latino residents, and less healthy neighborhood conditions were associated with greater decreases in some intervention characteristics including PSE sites, PSE reach, DE programs, and DE dose.

CONCLUSIONS AND IMPLICATIONS

These reductions in LHD SNAP-Ed interventions indicate reduced access to education and environments that support healthy eating and obesity prevention during a time when this support was especially needed to reduce risk of COVID-19 infection and complications. Disproportionately reduced access, may have worsened health disparities in already-disadvantaged communities. Assuring maintenance of SNAP-Ed interventions, especially in disadvantaged communities, should be a priority during public health emergencies.

Disparities in Food Security and Glycemic Control Among People with Type 2 Diabetes During the COVID-19 Pandemic

Background

Little is known about the differing impacts of food insecurity on HbA1c by race in type 2 diabetes (T2D). Predictions around increased food insecurity from COVID-19 exacerbating racial disparities led us to estimate its prevalence and associations with HbA1c by race during the COVID-19 pandemic.

Methods

Data came from medical records and surveys among a clinic-based sample of T2D patients. Linear regression models estimated associations between food insecurity and HbA1c and between change in food insecurity and change in HbA1c. Likelihood ratio tests and examination of stratum-specific estimates assessed effect modification by race.

Results

Our sample was 59% White, 59% female, and mean age was 60.8 ± 12.6. During the pandemic, food insecurity prevalence and HbA1c were significantly (p < .05) higher among non-Whites (39%, 8.4% ± 2.1) compared to Whites (15%, 7.8% ±1.6). HbA1c among those who were very food insecure was 1.00% (95% CI: 0.222, 1.762, p = .01) higher than those who were food secure. Those with increased food insecurity had a 0.58% (95% CI: 0.024, 1.128, p = .04) higher HbA1c increase than among those experiencing no change. No effect modification was detected.

Limitations

Convenience sampling in an endocrinology clinic, recall bias, and inadequate power may underlie null effect modification results.

Conclusion

Although effect modification was not detected, racial disparities in HbA1c and food insecurity warrant further investigation. These disparities, combined with the significant impact of food insecurity on HbA1c, suggest that prioritization of resources to high-risk populations should be considered early during public emergencies to minimize short- and long-term health consequences.

A coalition-driven examination of organization capacity to address food insecurity in Greater Houston: a qualitative research study

Background

Economic and social hardships have worsened food insecurity, particularly among low income and racial-ethnic minority groups. Given the core goal of the 150+ member Houston Health Equity Collective (HEC) to reduce food insecurity by 5% in 2025, we explored member organizations' capacity and challenges faced in screening and responding to food insecurity through care coordination efforts.

Methods

A twice-administered Qualtrics XM survey (Provo, Utah) with 76 organizations, followed by five focus groups with 22 of these organizations, explored reach and response efforts to food insecurity. Qualitative assessments lasted between 0.5 to 1.5 h, were audio-recorded, cleaned, coded, and thematically analyzed using NVivo, version 11 (Burlington, Massachusetts). The qualitative study was guided by a general inductive approach. In total, over 6 h of audiovisual recording were extracted, and over 100 pages of text exported to NVivo for data analysis. The research team read and coded transcripts independently using the codebook, and met routinely to discuss and resolve codes -resulting in numerous revisions to the codebook. Coding structure was discussed at multiple meetings and differences were addressed through consensus. Predominant qualitative themes impacting food insecurity screening were "stigma and cultural-related barriers", "clinic capacity and attitudes", "need to focus on upstream influences of food insecurity and SDOH needs", "impact of COVID-19", and "need for HEC system responses". Main recommendations to enhance screening and reach included improving staff culture, enhancing cultural sensitivity across organizational practices, and using shared technology to coordinate care. Respondents stated that the HEC can drive these recommendations through networking opportunities, use of shared resource directory, and placing focus on upstream factors.

Conclusions

Recommendations to target food insecurity must focus on organizational staff responsiveness and sensitivity to patients' needs. Of equal importance is the need for increased attention to the upstream influencers and integration of systems-level interventions to holistically target the barriers impacting food insecurity.

A Tale of Two Cities During the COVID-19 Pandemic: Evaluating Food Insecurity in Chicago and New York City

BACKGROUND

COVID-19 revealed and broadened existing disparities in large cities. This article interprets the early impacts of COVID-19 on food insecurity (FI) in the Chicago and New York City (NYC) metropolitan areas for Black, Indigenous, and People of Color (BIPOC) and provides a study using a Social Determinants of Health (SDOH) framework.

METHODS

A cross-sectional survey adapted from the National Food Access and COVID Research Team (NFACT) was deployed in Chicago (N = 680) and in NYC (N = 525) during summer 2020 and oversampled for race, ethnicity, and socioeconomic status. Multivariate binary logistic regression generated adjusted odds ratios (aOR) and 95% CIs for FI and select SDOH variables, which was conducted on each dataset.

RESULTS

The prevalence of FI in NYC increased to 66.8% (from 57.8%) and in Chicago to 44.8% (from 41.0%). While higher income protected against FI before, protection was diminished or eliminated since COVID-19. FI declined for households with children in NYC while odds increased and became significant in Chicago. Respondents with chronic health conditions experienced increased odds of FI since COVID. In Chicago, this variable had the highest odds of FI. Respondents with depression or anxiety had increased odds of FI. In NYC, depression had the highest odds of FI. Females in NYC were protected against FI. Hispanics in NYC lost protection against FI from before to since COVID-19.

CONCLUSIONS

Results support the observed rise of FI for BIPOC and its association with health status. The analysis has multifaceted, structural policy implications for reducing FI in urban centers.

United States Department of Agriculture nutrition assistance programs during the COVID-19 pandemic: A scoping review protocol

OBJECTIVE

The goal of this scoping review is to examine the published research on federal nutrition assistance programs administered by the United States (U.S.) Department of Agriculture during the COVID-19 pandemic, in the U.S., U.S. territories, and tribal nations. The review will identify the scope of the available research and provide research and policy recommendations.

INTRODUCTION

The COVID-19 pandemic made individuals more vulnerable to experiencing food insecurity. Federal nutrition assistance programs help to address food insecurity and have been rapidly adapting to meet food and nutrition needs among affected communities during the COVID-19 pandemic. It is important to understand the scope of the current research on this topic to help inform future research, practice, and policy recommendations.

INCLUSION CRITERIA

This review will include studies focused on federal nutrition assistance programs administered by the U.S. Department of Agriculture during the COVID-19 pandemic. The scoping review will consider all primary research designs.

METHODS

Pubmed, CINHAL, Scopus, and Proquest's Health Management databases will be used for the literature search. Only articles published in English since March 1, 2020 will be considered. Titles/abstracts followed by full-text articles will be reviewed to determine which articles meet the inclusion criteria and should be included in the review. Data will be extracted from each included article using a data extraction template in Covidence that will be developed by the study team. Data extracted will include information on key findings related to the review questions. At each step, two independent reviewers will be assigned to each article. Data will be summarized and presented in tables, charts, and narrative summary.

Socio-economic outcomes of COVID-19 on the marginalised: Who have taken the hardest hit?

This article aims to examine the socioeconomic outcomes of COVID-19 for socially marginalised people who are clients of social care organisations (e.g. people experiencing homelessness), and the factors influencing these outcomes. We tested the role of individual and socio-structural variables in determining socioeconomic outcomes based on a cross-sectional survey with 273 participants from eight European countries and 32 interviews and five workshops with managers and staff of social care organisations in ten European countries. 39% of the respondents agreed that the pandemic has had a negative effect on their income and access to shelter and food. The most common negative socio-economic outcome of the pandemic was loss of work (65% of respondents). According to multivariate regression analysis, variables such as being of a young age, being an immigrant/asylum seeker or residing in the country without documentation, living in your own home, and having (in)formal paid work as the main source of income are related to negative socio-economic outcomes following the COVID-19 pandemic. Factors such as individual psychological resilience and receiving social benefits as the main source of income tend to "protect" respondents from negative impacts. Qualitative results indicate that care organisations have been an important source of economic and psycho-social support, particularly significant in times of a huge surge in demand for services during the long-term crises of pandemic.

Food Insecurity During the First Year of COVID-19: Employment and Sociodemographic Factors Among Participants in the CHASING COVID Cohort Study

OBJECTIVE

While much has been reported about the impact of the COVID-19 pandemic on food insecurity, longitudinal data and the variability experienced by people working in various industries are limited. This study aims to further characterize people experiencing food insecurity during the pandemic in terms of employment, sociodemographic characteristics, and degree of food insecurity.

METHODS

The study sample consisted of people enrolled in the Communities, Households and SARS-CoV-2 Epidemiology (CHASING) COVID Cohort Study from visit 1 (April-July 2020) through visit 7 (May-June 2021). We created weights to account for participants with incomplete or missing data. We used descriptive statistics and logistic regression models to determine employment and sociodemographic correlates of food insecurity. We also examined patterns of food insecurity and use of food support programs.

RESULTS

Of 6740 participants, 39.6% (n = 2670) were food insecure. Non-Hispanic Black and Hispanic (vs non-Hispanic White) participants, participants in households with children (vs no children), and participants with lower (vs higher) income and education levels had higher odds of food insecurity. By industry, people employed in construction, leisure and hospitality, and trade, transportation, and utilities industries had the highest prevalence of both food insecurity and income loss. Among participants reporting food insecurity, 42.0% (1122 of 2670) were persistently food insecure (≥4 consecutive visits) and 43.9% (1172 of 2670) did not use any food support programs.

CONCLUSIONS

The pandemic resulted in widespread food insecurity in our cohort, much of which was persistent. In addition to addressing sociodemographic disparities, future policies should focus on the needs of those working in industries vulnerable to economic disruption and ensure those experiencing food insecurity can access food support programs for which they are eligible.

Predictors of food insecurity among older adults before and during COVID-19 in the United States

Background

The COVID-19 pandemic has strained the health and wellbeing of older adult populations through increased morbidity, mortality, and social exclusion. However, the impact of COVID-19 on the health of older adults through food security has received relatively little attention, despite the strong impact of diet quality on the health and longevity of older adults.

Objective

The objective of this study was to identify sociodemographic and socioeconomic predictors of self-reported food insecurity before and early in the COVID-19 pandemic among community-dwelling older adults in the United States.

Methods

Using longitudinal data from the Health and Retirement Study, a nationally representative sample of middle-aged and older adults in the United States, we examined the associations between sociodemographic and socioeconomic predictors of self-reported food insecurity between 2018 (N = 2,413) and June 2020 (N = 2,216) using population-weighted multivariate logistic regression models.

Results

The prevalence of food insecurity doubled among participants from 2018 (4.83%) to June 2020 (9.54%). In 2018, non-Hispanic Black and rural residents were more likely to report food insecurity, while individuals with higher education and greater wealth were less likely to report food insecurity in adjusted models. In June 2020, those who were relatively younger, not working due to a disability, and renting were more likely to report food insecurity. Those with an increased number of functional limitations, a recent onset of a work-limiting disability, and those who were no longer homeowners experienced an elevated longitudinal risk for food insecurity.

Conclusion

Future research should examine effective policies and interventions to address the disproportionate impacts of COVID-19 on populations at a heightened risk of experiencing food insecurity.

Understanding the Role of CalFresh Participation and Food Insecurity on Academic Outcomes among College Students during the COVID-19 Pandemic

Food insecurity (FI) is associated with many adverse outcomes in college students. The Supplemental Nutrition Assistance Program (SNAP, known as CalFresh in California) has been observed to alleviate FI; however, on college campuses, the benefits of food assistance programs are not well understood. This study investigated whether college students benefit from CalFresh participation. It was hypothesized that students would experience increased FI over time and that CalFresh participation would moderate the effect of FI on grade point average (GPA). A comprehensive FI and CalFresh questionnaires were distributed during the 2020-2021 academic year to 849 students. The chi-square test of independence assessed differences between FI and student factors. A Friedman test assessed differences in FI during the three quarters. Moderation analysis assessed whether CalFresh participation moderated FI's effect on GPA. Differences were observed among food security scores in Winter 2021 (median = 1.69) and Fall 2020 (median = 2.14; p = 0.013) and Spring 2020 (median = 2.17; p = 0.009). In the moderation model, the interaction of FI score and CalFresh participation was positively correlated with GPA (B = 0.11; p = 0.002). These results indicate that SNAP/CalFresh participation was particularly beneficial for mitigating the negative effects of FI on GPA. Given these benefits, encouraging SNAP/CalFresh enrollment should be a priority for university administrators.

The association between chronic conditions, COVID-19 infection, and food insecurity among the older US adults: findings from the 2020-2021 National Health Interview Survey

BACKGROUND

This study aims to examine how the presence of chronic conditions or positive COVID-19 infection (as exposures) is related to food insecurity (as an outcome) in the older population and whether there is a dose-response relationship between the number of chronic conditions and the severity of food insecurity.

METHODS

Cross-sectional data of 17,977 older adults (≥ 65 years) from the 2020-2021 National Health Interview Survey were analyzed. Chronic conditions included physical health conditions (i.e., arthritis, coronary heart diseases, hypertension, stroke, prediabetes, diabetes, asthma, chronic obstructive pulmonary disease, and disability) and mental health conditions (i.e., anxiety and depression disorder). COVID-19 infection status was determined by a self-reported diagnosis of COVID-19. Household food insecurity was measured using the 10-item US Department of Agriculture (USDA) Food Security Survey Module with a 30-day look-back window. Multinomial logistic regression models were used to examine the association between health conditions and food insecurity controlling for socio-demographic factors.

RESULTS

Our results indicated that 4.0% of the older adults lived in food-insecure households. The presence of chronic conditions was significantly associated with higher odds of being food insecure independent of socio-demographic factors (AOR ranged from 1.17 to 3.58, all p < 0.0001). Compared with participants with 0-1 chronic condition, the odds of being (low or very low) food insecure was 1.09 to 4.07 times higher for those with 2, or ≥ 3 chronic conditions (all p < 0.0001). The severity of food insecurity significantly increased as the number of chronic conditions increased (p for trend < 0.0001). Besides, COVID-infected participants were 82% more likely to be very low food secure than the non-infected participants (AOR = 1.82, 95% CI: 1.80, 1.84).

CONCLUSIONS

The presence of chronic conditions or positive COVID-infection is independently associated with household food insecurity. Clinical health professionals may help identify and assist individuals at risk of food insecurity. Management and improvement of health conditions may help reduce the prevalence and severity of food insecurity in the older population.

Food Insecurity Trajectories in the US During the First Year of the COVID-19 Pandemic

INTRODUCTION

The objective of this study was to characterize population-level trajectories in the probability of food insecurity in the US during the first year of the COVID-19 pandemic and to examine sociodemographic correlates associated with identified trajectories.

METHODS

We analyzed data from the Understanding America Study survey, a nationally representative panel (N = 7,944) that assessed food insecurity every 2 weeks from April 1, 2020, through March 16, 2021. We used latent class growth analysis to determine patterns (or classes) of pandemic-related food insecurity during a 1-year period.

RESULTS

We found 10 classes of trajectories of food insecurity, including 1 class of consistent food security (64.7%), 1 class of consistent food insecurity (3.4%), 5 classes of decreasing food insecurity (15.8%), 2 classes of increasing food insecurity (4.6%), and 1 class of stable but elevated food insecurity (11.6%). Relative to the class that remained food secure, other classes were younger, had a greater proportion of women, and tended to identify with a racial or ethnic minority group.

CONCLUSION

We found heterogeneous longitudinal patterns in the development, resolution, or persistence of food insecurity during the first year of the COVID-19 pandemic. Experiences of food insecurity were highly variable across the US population, with one-third experiencing some form of food insecurity risk. Findings have implications for identifying population groups who are at increased risk of food insecurity and related health disparities beyond the first year of the pandemic.

Racial Disparity and Trend of Food Scarcity Amid COVID-19 Pandemic in the United States

An increase in households with food insecurity has been reported during the COVID-19 pandemic, but the trend of food insecurity during the pandemic remains unclear. Using Household Pulse Survey (HPS) data over 34 weeks from June 2020 to September 2021 (nationally representative samples of US adults in the households from the US Census Bureau), we examined racial disparity and trends of food scarcity amid the COVID-19 pandemic. The time series plots illustrated that the food scarcity rate was incremental until December 2020 and began improving thereafter across all racial groups. Such improvements in food scarcity were accompanied by the rise in regular income rates while the use of food assistance programs, unemployment insurance, and stimulus payments remained unchanged or reduced. As the US economy recovered, the gaps in food scarcity rates also narrowed between Black/Hispanic and White households.

Changes in Depressive Symptoms, Perceived Stress, and Food Security Among Study Participants With Metabolic Syndrome During a COVID-19-Mandated Research Pause

INTRODUCTION

We explored how depressive symptoms, perceived stress, and food security of people with metabolic syndrome (MetS) changed during the COVID-19 pandemic.

METHODS

An online survey was administered from October 2019 through March 2020, to participants in a 2-year lifestyle intervention trial to reverse MetS; the survey was repeated during the COVID-19 pandemic. Outcomes were a change in depressive symptoms, perceived stress, and food security as measured by the Patient Health Questionnaire-8 (PHQ-8), Perceived Stress Scale, and US Department of Agriculture's 10-item Adult Food Security Module. We analyzed changes in outcomes with measures of association, paired t tests, repeated measures, and independent t tests.

RESULTS

Survey respondents (N = 132) were mostly female (67%), White (70%), and middle-aged, with a median income of $86,000. Frequency of depressive symptoms increased from baseline to follow-up and the increase was related to lower mean (SD) baseline vitality (44.4 [20.7] vs 60.3 [18.9]; P = .01) and mental health decline (71.0 [14.3] vs 82.0 [10.4]; P = .002). Mean (SD) perceived stress was significantly higher at baseline than follow-up (18.5 [6.4] vs 14.9 [7.2]; P < .001). Food security increased from 83% at baseline to 90% at follow-up (P < .001). Movement to or continued food insecurity (n = 13) tended to be associated with a racial or ethnic minority group (P = .05).

CONCLUSION

A sample at high risk for COVID-19 did not experience increased stress or food insecurity, but demonstrated increased depressive symptoms after the onset of the COVID-19 pandemic, with some baseline susceptibility.

Food security and food access during the COVID-19 pandemic: Impacts, adaptations, and looking ahead

The coronavirus disease 2019 (COVID-19) pandemic continues to alter US household food consumption and food spending. Although terminology used to describe food insecurity has varied during the COVID-19 pandemic, many reliable estimates illustrate a dramatic increase in food insecurity from approximately 10% of US households before the pandemic to 25%-30% of households during the pandemic, with an even higher prevalence reported by more vulnerable and socially disadvantaged populations. To address the increase in food and economic insecurity, food and nutrition assistance policies and programs made innovative and temporary changes, and enrollment in these programs generally increased. However, some changes to food, nutrition, and income assistance programs are now expiring or contracting even as food insecurity prevalence is again on the rise and elevated food and nutrition assistance needs are expected to persist based on historical patterns. American Society for Parenteral and Enteral Nutrition (ASPEN) practitioners can play an important role in identifying clients at elevated risk of food insecurity-related acute and chronic conditions and connecting high-risk clients to resources. ASPEN practitioners can contribute to the evidence base linking food insecurity and nutrition outcomes. ASPEN practitioners can also advocate for addressing the root social and structural determinants of food insecurity and for the continuation of effective food and nutrition policy changes and innovations.

Schools' Participation in the Community Eligibility Provision Affects Students' Receipt of Emergency Benefits during the COVID-19 Pandemic

Pandemic Electronic Benefits Transfer (P-EBT) benefits were intended for families of school children who lost access to free or reduced-price school meals (FRPMs) during the COVID-19 pandemic-related school closures. In high-poverty communities, all students from schools participating in the Community Eligibility Provision (CEP) were automatically eligible for P-EBT benefits; in non-CEP schools, only students already participating in FRPMs-for which their parents submitted an individual application-were eligible for P-EBT benefits. Using publicly available data from 105 K-12 public schools located in 4 sizeable low-income New Jersey (NJ) cities, this study investigated the association between school CEP participation status and the reach of P-EBT benefits for eligible students. A generalized linear model with a logit link, a binomial family, and robust standard errors was used. Across all levels of FRPM eligibility based on students' household income, as expected, almost all students from CEP schools received P-EBT benefits; significantly fewer received P-EBT benefits if they attended non-CEP schools, even when they were eligible for FRPMs. Our findings show that without changes to the qualification process for CEP, large numbers of eligible children will not receive the intended health benefits of federal meals programs or similar emergency relief initiatives. Expanding CEP eligibility and simplifying the process through which schools qualify would likely improve the uptake of federal meals programs and emergency interventions, and more effectively achieve their intent.

Prevalence of household food insecurity among a healthy Iranian population: A systematic review and meta-analysis

Background

Food security is a fundamental human right that must be upheld to preserve excellent general welfare, and mental, physical, and social health. However, according to the United Nations Food and Agriculture Organization (FAO) report in 2020, the level of food insecurity in the world is increasing.

Objective

Determining the prevalence of food insecurity in Iran will be beneficial for Iran and other low-middle-income countries.

Methods

We searched both English and Persian (Iranian) databases including PubMed, Scopus, Web of Science, Google Scholar, SID, Irandoc, Magiran, Civilica, and Iranian Medical Sciences Theses System from 01 January 1990 to 01 February 2022. Observational studies that reported the prevalence of household food insecurity among a healthy Iranian population and assessed food insecurity at the individual or household level using validated questionnaires were included.

Results

One hundred six studies and/or theses with a total of 152, 300 participants met the review criteria. Our analyses demonstrated that the prevalence of food insecurity among the healthy Iranian population was 55.9% (95% CI: 52.6-59.2%) and the highest prevalence of food insecurity was in the western regions with 64.8% (95% CI: 57.7-72.0%). Subgroup analyses showed that food insecurity among women at 51.3% (95% CI: 45.1-57.6%) and rural inhabitants at 66.1% (95% CI: 58.8-73.4%) was significantly higher than men at 47.8% (95% CI: 41.8-53.8%) and urban residents at 47.1% (95% CI: 44.1-50.0%), respectively. Among the age groups, the highest prevalence of food insecurity was in adults at 56.5% (95% CI: 51.7-61.2%).

Conclusion

The prevalence of food insecurity in a healthy Iranian population was higher than the global average. Women, rural residents, and residents of the western regions of Iran had a higher prevalence of food insecurity. These groups should be prioritized in programs to reduce the prevalence of food insecurity in Iran.

Systematic review registration

www.crd.york.ac.uk/PROSPERO, identifier: CRD42022328473.

Federal Food Assistance Program Participation during the COVID-19 Pandemic: Participant Perspectives and Reasons for Discontinuing

This study aims to describe reasons for discontinuing participation and experiences participating in the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) during the COVID-19 pandemic. We analyzed data from a cross-sectional online survey distributed to a national sample, restricted to (1) households that discontinued participating in SNAP (n = 146) or WIC (n = 149) during the pandemic and (2) households that participated in SNAP (n = 501) or WIC (n = 141) during spring 2021—approximately one year into the pandemic. We conducted thematic analyses of open-ended survey questions and descriptive statistics for Likert-scale items. Themes raised by respondents who discontinued participating in SNAP or WIC included difficulty recertifying and virus exposure concerns. Former WIC participants reported the program was not worth the effort and former SNAP participants reported failing to requalify. Respondents participating in WIC or SNAP during the pandemic mentioned transportation barriers and insufficient benefit value. WIC participants had trouble redeeming benefits in stores and SNAP participants desired improved online grocery purchasing experiences. These results suggest that enhancements to WIC and SNAP, such as expanded online purchasing options, program flexibilities, and benefit increases, can improve program participation to ensure access to critical nutrition supports, especially during emergencies.

Food security and well-being among older, rural Americans before and during the COVID-19 pandemic

The COVID-19 pandemic has impacted many aspects of our lives. Older adults, those with less income or fewer resources, and those living in rural parts of the United States are potentially more vulnerable. To understand the negative impact of COVID-19 on perceived food security, physical and mental health, and loneliness in a sample of older, rural, low-income adults in the United States, we use results from a mailed survey in which residents of four Indiana counties contrasted their status during the early period of the pandemic to their typical pre-pandemic status. We test for significant changes in status and what predicts negative impacts to food security, health, and loneliness. We asked respondents to report on both pre-pandemic and since-pandemic experiences in the instrument, which was administered after the pandemic had begun, in May 2020. We measure food security using the U.S. Household Food Security Survey Module (six-item short form; HFSSM), physical and mental health using the Centers for Disease Control’s Healthy Days Measures (HRQOL-4), and loneliness using the UCLA Revised Loneliness Scale. A binomial test identified significant declines in status for all three measures. Logistic regressions identified factors associated with each of the measures worsening. Fear of going to the store or food pantry was associated with all three measures. Decreased store hours and closed food pantries were associated with lower food security. More education, fewer years of age, being female, decreased income, and stockpiling were associated with more reported days of poor physical or mental health. Fewer years of age, lack of transportation, and eating less often with others were associated with perceived increased loneliness. The pandemic had a negative impact on respondents’ food security, unhealthy days, and loneliness, but different factors were associated with each measure for this population. Our findings provide insight for targeted recovery efforts.

Implementing a Process for Screening Hospitalized Adults for Food Insecurity at a Tertiary Care Center

ABSTRACT

Food insecurity has been linked to numerous chronic conditions and higher healthcare costs; however, screening for food insecurity lags behind screening for other social determinants of health, particularly in the hospital setting. Although our hospital serves a population with a high prevalence of food insecurity, no process previously existed to universally screen patients. Our multidisciplinary team developed and implemented a process to screen hospitalized adults for food insecurity and connect them with food resources, which we piloted on a 26-bed hospital medicine unit. We integrated a validated 2-item screen into the electronic health record (EHR) nursing admission workflow, and provided 2 weeks of nursing education before process implementation. Adherence to screening was monitored weekly and adjustments were made using plan-do-study-act cycles. After 28 weeks, 361/587 (61.5%; weekly average 61.1%) encounters were screened (compared with a baseline of 2.2%), with 21/361 (5.8%) identified as food insecure. The implementation of an EHR-based food insecurity screening process in the hospital setting increased screening and identification of food insecure patients. Through improved integration of screening questions into the existing nursing workflow and continued education, success was sustained despite challenges with nursing staff turnover and staff shortages during the COVID-19 pandemic.