Understanding patterns of food insecurity and family well-being amid the COVID-19 pandemic using daily surveys

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.

Well-Being of Children and Families in COVID-19 Hotspots in Chicago

BACKGROUND

Families in high-risk communities for COVID-19 transmission experienced a disproportionate burden during the pandemic. This study assessed these families' needs, changes in children's well-being, and perceptions related to the pandemic.

METHODS

Four online surveys were administered January 2021 to September 2021 to parents of students, enrolled in parochial, kindergarten-eighth grade schools in Chicago neighborhoods with higher COVID-19 incidence rates by ZIP code, compared to the city average, and higher resource need.

RESULTS

The response rate was 69.1% (n = 186 of 269) in the baseline survey; and other surveys were at 1 (n = 151), 3 (n = 145), and 5 months (n = 154). Of the sample, 83% of parents identified as Hispanic/Latinx with a mean age of 38.3 years (SD: 8.5). Approximately a quarter of parents reported difficulty paying cable and internet bills (26%) and paying utilities (25%). Parents reported children as happy (94% and 95%, p = .59) and hopeful (96% and 95%, p = .74) at 1-month (February to May 2021) and 5-month surveys (June to September 2021). Parents also reported fewer children were irritable (29% vs 19%, p = .03), felt lonely (17% vs 10%, p = .03), and felt isolated (28% vs 9%, p < .001) between those survey waves. The majority (67%) of parents felt that their child had no difficulty wearing a mask in public.

CONCLUSIONS

In this longitudinal study, Chicago parents rated children's well-being highly and reported a decrease in negative emotions over time. The areas of need identified may be particularly relevant for outreach and providing resources to Hispanic/Latino families in future emergencies or global health threats.

Investigating the Poverty-Reducing Effects of SNAP on Non-nutritional Family Outcomes: A Scoping Review

INTRODUCTION/PURPOSE

Poverty-reduction efforts that seek to support households with children and enable healthy family functioning are vital to produce positive economic, health, developmental, and upward mobility outcomes. The Supplemental Nutrition Assistance Program (SNAP) is an effective poverty-reduction policy for individuals and families. This study investigated the non-nutritional effects that families experience when receiving SNAP benefits.

METHODS

We conducted a scoping review using the PRISMA Guidelines and strategic search terms across seven databases from 01 January 2008 to 01 February 2023 (n=2456). Data extraction involved two researchers performing title-abstract reviews. Full-text articles were assessed for eligibility (n=103). Forty articles were included for data retrieval.

RESULTS

SNAP positively impacts family health across the five categories of the Family Stress Model (Healthcare utilization for children and parents, Familial allocation of resources, Impact on child development and behavior, Mental health, and Abuse or neglect).

DISCUSSION/CONCLUSION

SNAP is a highly effective program with growing evidence that it positively impacts family health and alleviates poverty. Four priority policy actions are discussed to overcome the unintentional barriers for SNAP: distributing benefits more than once a month; increasing SNAP benefits for recipients; softening the abrupt end of benefits when wages increase; and coordinating SNAP eligibility and enrollment with other programs.

"I Used to Get WIC… But Then I Stopped": How WIC Participants Perceive the Value and Burdens of Maintaining Benefits

This study examines how individuals assess administrative burdens and how these views change over time within the context of the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC), which provides food to pregnant and breastfeeding women and children under age five. Using interview data from the Baby's First Years: Mothers' Voices study (n. = 80), we demonstrate how the circumstances of family life, shifiing food needs and preferences, and the receipt of other resources shape how mothers perceive the costs and benefits of program participation. We find that mothers' perceptions of WIC's costs and benefits vary over time and contribute to program participation trajectories, so many eligible people do not participate; need alone does not drive participation decisions.

Pilot Evaluation of the Elementary Social-Emotional Learning Program Sources of Strength

Schools and students have faced a variety of challenges during the 2020-2021 academic year as the COVID-19 pandemic continues. These issues have drawn attention to the increased need for robust social-emotional learning skills at the elementary level to address the deficits exacerbated by the pandemic. Sources of Strength is an evidence-based suicide prevention program for middle and high school students. In 2020, Sources of Strength launched an elementary school curriculum focused on promoting protective factors and resilience. Data were collected across 11 elementary schools (N = 1022; 3-5th graders) in the Great Plains region of the USA at two time points during the COVID-19 pandemic (T1: Fall of 2020, T2: Spring of 2021). We examine the effectiveness of the program using a pre- and post-test design measuring various student social-emotional outcomes including positive classroom climate, emotional problems, school belonging, help-seeking attitudes, bullying perpetration, peer victimization, student and teacher intervention, student well-being, and student resilience. The program was evaluated using multilevel regression models to examine the associations between self-reported student program exposure and student outcomes. Although comparisons between T1 and T2 indicated a worsening of several student outcomes, positive associations were found when accounting for the degree of student exposure to the program. Greater student exposure was associated with improved positive classroom climate, school belonging, help-seeking attitudes, student well-being, resiliency, and lower reports of emotional problems. Implications for research and practice are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12310-023-09567-0.

The association of food insecurity with mental health in preschool-aged children and their parents

BACKGROUND

Household food insecurity (HFI) is associated with poor general and mental health. Prior studies assessed parent and child mental health separately and did not assess other social risks.

OBJECTIVE

To assess the relationship between HFI and both parental and child mental health.

METHODS

Parents of 3-5-year-old children completed validated measures of food insecurity and mental health. Separate linear regression models were used for unadjusted analysis for each mental health outcome (parent depression, anxiety, and stress, and child mental health). Multivariable analysis was performed using hierarchical regression to adjust for relevant covariates.

RESULTS

Children (n = 335) were racially and socioeconomically diverse. HFI was reported in 10% of participants. HFI was associated with worse parent depression and stress in unadjusted analyses; however, after adjusting for covariates, the associations became insignificant. HFI was significantly associated with worse child mental health in unadjusted and multivariable analysis (aβ 2.24, 95% CI 0.59-3.88) compared to those without HFI.

CONCLUSION

HFI was not associated with parental mental health outcomes when other social risks were included in the analyses; however, HFI was significantly associated with worse childhood mental health in all analyses. Pediatric providers should screen for and develop interventions to target both HFI and mental health.

IMPACT

Household food insecurity was associated with worse parent depression and stress in unadjusted analyses; however, after adjusting for other social risks, the associations became insignificant. Household food insecurity was significantly associated with worse child mental health, even after adjusting for demographics, other social risks, and parent mental health. Social risks are differentially associated with parent and child mental health. Understanding the complexities of family stressors can help better support parents and children struggling with mental health problems and social risks.

The Determinants of Food Insecurity Among Hispanic/Latinx Households With Young Children: A Narrative Review

Food insecurity has disproportionately impacted Hispanic/Latinx households in the United States, specifically those with young children. Although the literature provides evidence of an association between food insecurity and adverse health outcomes in young children, minimal research has addressed the social determinants and related risk factors associated with food insecurity among Hispanic/Latinx households with children under three, a highly vulnerable population. Using the Socio-Ecological Model (SEM) as a framework, this narrative review identified factors associated with food insecurity among Hispanic/Latinx households with children under three. A literature search was conducted using PubMed and four additional search engines. Inclusion criteria consisted of articles published in English from November 1996 to May 2022 that examined food insecurity among Hispanic/Latinx households with children under three. Articles were excluded if conducted in settings other than the US and/or focused on refugees and temporary migrant workers. Data were extracted (i.e., objective, setting, population, study design, measures of food insecurity, results) from the final articles (n = 27). The strength of each article's evidence was also evaluated. Results identified individual factors (i.e., intergenerational poverty, education, acculturation, language, etc.), interpersonal factors (i.e., household composition, social support, cultural customs), organizational factors (i.e., interagency collaboration, organizational rules), community factors (i.e., food environment, stigma, etc.), and public policy/societal factors (i.e., nutrition assistance programs, benefit cliffs, etc.) associated with a food security status of this population. Overall, most articles were classified as "medium" or higher quality for the strength of evidence, and more frequently focused on individual or policy factors. Findings indicate the need for more research to include a focus on public policy/society factors, as well as on multiple levels of the SEM with considerations of how individual and policy levels intersect and to create or adapt nutrition-related and culturally appropriate interventions to improve food security of Hispanic/Latinx households with young children.

Design and rationale for evaluating the impact of salad bars on elementary school students' fruit, vegetable, and energy intake: a wait list control, cluster randomized controlled trial

BACKGROUND

Most children do not consume the recommended amount of fruit and vegetable (FV) servings. Changing the school food environment can be a cost-efficient, effective approach to improving children's dietary quality. There is great popular support for school salad bars as a means to increase children's FV intake within the National School Lunch Program (NSLP), yet empirical research is limited. Further, although FV consumption can facilitate healthy weight management if these foods replace high calorie items, there is a need to enhance understanding of salad bars' influence on children's diet quality and energy intake within the NSLP. This is particularly important to investigate in schools in communities characterized by high poverty, as students they serve are particularly likely to rely on school meals.

METHODS

This report describes the design and rationale of a federally-funded investigation that uses validated methods to evaluate school salad bars. This district plans to install salad bars into 141 elementary schools over 5-years, facilitating the conduct of a waitlist control, cluster randomized controlled trial. Specifically, 12 pairs of matched schools will be randomly selected: half receiving a salad bar (Intervention) and half serving pre-portioned FVs only, standard under the NSLP (Control). Thus, groups will have different FV presentation methods; however, all schools will operate under a policy requiring students to take at least one FV serving. Schools will be matched on Title I status and percent of racial/ethnic minoritized students. Intake will be objectively assessed at lunch in each school pair, prior to (baseline), and 4-6 weeks after salad bars are installed (post), yielding ~ 14,160 lunch observations throughout the study duration. Cafeteria sales and NSLP participation data will be obtained to determine how salad bars impact revenues. Finally, implementation factors and cafeteria personnel's perspectives will be assessed, to identify barriers and facilitators to salad bars use and inform sustainability efforts. Proposed methods and current status of this investigation due to COVID-19 are described.

DISCUSSION

Results will have great potential to inform school nutrition policies and programs designed to improve dietary quality and reduce obesity.

TRIAL REGISTRATION

Retrospectively registered (10/28/22) in clinicaltrials.gov (NCT05605483).

School-Age Children's Wellbeing and School-Related Needs During the COVID-19 Pandemic

BACKGROUND AND OBJECTIVES

The COVID-19 pandemic and related school closures may have disrupted school-related supports and services important to children's wellbeing. However, we lack national data about US children's wellbeing and family priorities for school-related services. We sought to determine 1) children's social-emotional wellbeing and 2) needs and priorities for school-based services in the 2021-2022 school year among a US sample of parents of school-aged children.

METHODS

In June 2021, we surveyed 1504 parents of children enrolling in grades K-12 in the 2021-2022 school year participating in the Understanding America Study, a nationally representative probability-based Internet panel of families completing regular internet-based surveys (Response rate to this survey was 79.2%). Parents completed the Strengths and Difficulties Questionnaire and reported their needs for school-related services regarding "support getting healthcare", "mental wellness support", "food, housing, legal or transportation support", and "learning supports and enrichment." Weighted regressions examined associations among wellbeing, needs, and sociodemographic characteristics.

RESULTS

Approximately one-quarter of children had deficits in hyperactivity (26.1%), one-third in peer problems (32.6%), and 40% in prosocial areas. Most parents (83.5%) reported a school-related need, with 77% reporting learning supports and enrichment needs and 57% reporting mental wellness needs. The highest priority needs were for tutoring, socialization, increased instructional time, coping with stress, and physical activity.

CONCLUSIONS

US school children have high social-emotional and school-related needs. Investments in schools are urgently needed, particularly for learning supports and mental wellness, to meet the high demand for services and parents' priorities to support child health and wellbeing.

Assessing positive adaptation during a global crisis: The development and validation of the family positive adaptation during COVID-19 scale

The COVID-19 pandemic has negatively impacted the psychosocial functioning of children and families. It is important to consider adversity in relation to processes of positive adaptation. To date, there are no empirically validated multi-item scales measuring COVID-related positive adaptation within families. The aim of the current study was to develop and validate a new measure: the Family Positive Adaptation during COVID-19 Scale (Family PACS). The sample included 372 female and 158 male caregivers (73% White-European/North American; median 2019 income = $50,000 to $74,999 USD) of children ages 5–18 years old from the United Kingdom (76%), the United States (19%), Canada (4%), and Australia (1%), who completed measures in May 2020. Participants responded to a 14-item survey indexing a range of perceived coping and adaptation behaviors at the beginning of the pandemic. An exploratory factor analysis yielded an optimal one-factor solution comprised of seven items related to family cohesion, flexibility, routines, and meaning-making (loadings from 0.44 to 0.67). Multigroup confirmatory factor analysis demonstrated measurement invariance across female and male caregivers, demonstrating that the factor structure, loadings, and thresholds did not vary by caregiver sex. There was evidence for concurrent validity with significant bivariate correlations between the Family PACS scores and measures of caregiver positive coping, parenting practices, couple satisfaction, and family functioning (correlations from 0.10 to 0.23), but not negatively-valenced constructs. Findings inform our conceptualization of how families have adapted to adverse pandemic-related conditions. Further, we provide preliminary support for the Family PACS as a practical tool for evaluating positive family adaptation during this global crisis, with implications for future widespread crises.

Effect of daily school and care disruptions during the COVID-19 pandemic on child behavior problems

The COVID-19 pandemic profoundly affected American families and children, including through the closure or change in the nature of their care and school settings. As the pandemic has persisted, many children remain in remote schooling and those attending in-person childcare or school have contended with unpredictable closures. This study investigated the frequency and consequences of disruptions to children's childcare and school arrangements during Fall 2020. The sample is parents who were hourly service-sector workers prior to the pandemic, had a young child between the ages of 3 and 8, and were at least partially responsible for their children's school and/or care in Fall 2020 (N = 676); half of the sample were non-Hispanic Black, 22% were Hispanic, and 18% are non-Hispanic White. Parents were asked to complete 30 days of daily surveys about whether their care and school arrangements went smoothly and as predicted that day, about their mood, parenting behaviors, and children's behavior. Results showed that daily disruptions to care and school were common, with families reporting a disruption on 24% of days. Families with children in exclusively remote schooling experienced more frequent disruption than families with children in in-person care or school. For all families, care or school disruptions were related to worse child behavior, more negative parental mood, and increased likelihood of losing temper and punishment. Within-family mediation suggests that parents' difficulties supporting children's learning, and to a lesser degree their mood and parenting behaviors, partially mediate effects of disruptions on child behavior. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Medium-term protective effects of quality early childhood education during the COVID-19 pandemic in Ghana

The COVID‐19 pandemic led to extended school closures globally. Access to remote learning opportunities during this time was vastly unequal within and across countries. Higher‐quality early childhood education (ECE) can improve later academic outcomes, but longer‐term effects during crises are unknown. This study provides the first experimental evidence of how previously attending a higher‐quality ECE program affected child engagement in remote learning and academic scores during pandemic‐related school closures in Ghana. Children (N = 1668; 50.1% male; M_age = 10.1 years; all Ghanaian nationals) who attended higher‐quality ECE at age 4 or 5 years had greater engagement in remote learning (d = .14) in October 2020, but not better language and literacy and math scores. Previous exposure to higher‐quality ECE may support educational engagement during crises.

The Impact of the COVID-19 Pandemic on Rural Food Security in High Income Countries: A Systematic Literature Review

Prior to the COVID-19 pandemic, rural-dwelling people in high-income countries were known to have greater challenges accessing healthy food than their urban counterparts. The COVID-19 pandemic has impacted food supplies across the world, and public health restrictions have changed the way people shop for food, potentially exacerbating food insecurity. This systematic literature review aimed to synthesize the available evidence on the impact of the COVID-19 pandemic on aspects of food insecurity in rural populations residing in high-income countries. Five electronic databases were searched, identifying 22 articles that assessed food insecurity prevalence or data on food availability, access, utilization and the stability of the food supply in rural populations during the COVID-19 pandemic. Ten studies examined the prevalence of food insecurity in rural populations, with the reported prevalence ranging from 15% to 95%. Where rural/urban comparisons were presented, most studies (n = 5; 71%) reported that food insecurity was significantly higher in rural regions. Five studies examined the availability of food and eight studies examined access to food, identifying that rural populations often had lower food availability and access to food during the pandemic. In contrast, two studies identified positive effects such as more gardening and increased online access to food. Rural populations experienced multiple changes to food utilization, such as reduced diet quality and food safety observed in eight studies, but this was not shown to be different from urban populations. Additionally, the food supply in rural regions was perceived to be affected in two studies. The results of this review may be used to inform region-specific mitigation strategies to decrease the impact of the current COVID-19 pandemic and future global events on food security. However, the lack of consistency in study outcomes in research on rural populations limits the identification of priority areas for intervention at a global-scale.

Patterns of Stress and Wellbeing Among Families Enrolled in Early Head Start/Head Start During COVID-19

The COVID-19 pandemic disproportionately affected low-income families in the U.S., particularly those with young children (Kalluri et al., 2021). This longitudinal study describes the resources, stress, and health and wellbeing of low-income families enrolled in an Early Head Start/Head Start program for two cumulative program years before and during the height of the COVID-19 pandemic. We found having more resources (higher income, higher education levels, full time employment) prior to the onset of COVID-19 was correlated with better wellbeing and lower stress throughout the pandemic. Implications and directions for future research include understanding the specific types of supports that programs like EHS/HS provided during COVID-19 and how families benefitted from them.