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

Household Food Sourcing Patterns and Their Associations With Food Insecurity in Appalachian Ohio

BACKGROUND

Households experiencing food insecurity may use dynamic strategies to meet food needs. Yet, the relationship between household food sourcing behaviors and food security, particularly in rural settings, is understudied.

OBJECTIVE

To identify food sourcing patterns and their associations with food insecurity among households in rural Appalachian Ohio during the COVID-19 pandemic.

DESIGN

Survey data were collected from a cohort of households in Athens County, OH, in July 2020, October 2020, January 2021, and April 2021.

PARTICIPANTS/SETTING

The sample included 663 households with household food sourcing and food security information for ≥1 survey wave.

MAIN OUTCOME MEASURES

Household food sourcing patterns. Households reported the frequency with which they obtained food from various retailers and charitable sources, classified as supercenters, supermarkets, convenience stores, farmers markets, or charitable sources.

STATISTICAL ANALYSES

Principal component analysis was used to identify food sourcing patterns. Linear mixed models were used to assess changes in food sourcing behaviors over the study period and to determine whether food sourcing behaviors differed according to food security status.

RESULTS

Two patterns were identified: Convenience Stores and Charitable Food and Supermarkets and Farmers Markets, not Supercenters. Relative to July 2020, alignment of households' food sourcing behaviors with the Supermarkets and Farmers Markets, not Supercenters pattern was higher in October 2020 (β .07, 95% CI .02 to .12) and alignment with the Convenience Stores and Charitable Food pattern was lower in April 2021 (β -.06, 95% CI -.11 to -.02). Compared with food-secure households, food sourcing behaviors of food-insecure households were more closely aligned with the Convenience Stores and Charitable Food pattern (β .07, 95% CI .00 to .13); no statistically significant difference in scores was observed for the Supermarkets and Farmers Markets, not Supercenters pattern (β -.07, 95% CI -.15 to .02).

CONCLUSIONS

These findings support efforts to increase access to healthy, affordable options at venues where food-insecure households may be likely to obtain food, such as convenience stores and charitable sources.

Health and non-health benefits and equity impacts of individual-level economic relief programs during epidemics/pandemics in high income settings: a scoping review

BACKGROUND

Economic relief programs are strategies designed to sustain societal welfare and population health during a regional or global scale infectious disease outbreak. While economic relief programmes are considered essential during a regional or global health crisis, there is no clear consensus in the literature about their health and non-health benefits and their impact on promoting equity.

METHODS

We conducted a scoping review, searching eight electronic databases from January 01, 2001, to April 3, 2023, using text words and subject headings for recent pathogens (coronavirus (COVID-19), Ebola, Influenza, Middle East Respiratory Syndrome (MERS), severe acute respiratory syndrome (SARS), HIV, West Nile, and Zika), and economic relief programs; but restricted eligibility to high-income countries and selected diseases due to volume. Title and abstract screening were conducted by trained reviewers and Distiller AI software. Data were extracted in duplicates by two trained reviewers using a pretested form, and key findings were charted using a narrative approach.

RESULTS

We identified 27,263 de-duplicated records, of which 50 were eligible. Included studies were on COVID-19 and Influenza, published between 2014 and 2023. Zero eligible studies were on MERS, SARS, Zika, Ebola, or West Nile Virus. We identified seven program types of which cash transfer (n = 12) and vaccination or testing incentive (n = 9) were most common. Individual-level economic relief programs were reported to have varying degrees of impact on public health measures, and sometimes affected population health outcomes. Expanding paid sick leave programs had the highest number of studies reporting health-related outcomes and positively impacted public health measures (isolation, vaccination uptake) and health outcomes (case counts and the utilization of healthcare services). Equity impact was most often reported for cash transfer programs and incentive for vaccination programs. Positive effects on general well-being and non-health outcomes included improved mental well-being and quality of life, food security, financial resilience, and job security.

CONCLUSIONS

Our findings suggest that individual-level economic relief programs can have significant impacts on public health measures, population health outcomes and equity. As countries prepare for future pandemics, our findings provide evidence to stakeholders to recognize health equity as a fundamental public health goal when designing pandemic preparedness policies.

Enduring Effects of the COVID-19 Pandemic on Food Access, Nutrition, and Well-Being in Rural Appalachia

The COVID-19 pandemic produced acute effects on health inequities, yet more enduring impacts in vulnerable populations in rural Appalachia are understudied. This qualitative study included three focus groups with thirty-nine adults (74% female, mean age 52.7 years) to obtain perspectives on the impact of the COVID-19 pandemic on well-being in Martin County, Kentucky, in fall 2022. Grounded Theory was employed using an iterative inductive-deductive approach to capture the lasting effects of the COVID-19 pandemic on health practices and status. Three prominent themes emerged: (1) increased social isolation; (2) household cost of living strains caused by inflation; and (3) higher food prices and diminished food availability causing shifts in food purchasing and consumption. Participants noted that the rising cost of living resulted in residents having to "choose between medication, food and utilities". Increased food prices resulted in residents "stretching" their food, modifying how they grocery shopped, and limiting meat consumption. Persistent food shortages were exacerbated by there being few grocery stores in the county. Lastly, increased social isolation was profoundly articulated as widely impacting mental health, especially among youth. Our findings underscore the ongoing deleterious effects of inflation and food supply chain disruptions in this rural, geographically isolated community, which resulted in difficult spending choices for residents.

Examining Mental Health, Academic, and Economic Stressors During the COVID-19 Pandemic Among Community College and 4-Year University Students

Objective: The COVID-19 global pandemic has created severe, long-lasting challenges to college students in the United States (US). In the present study, we assessed mental health symptomatology (depression, anxiety, life stress), academic challenges, and economic stress during the first wave of the Coronavirus pandemic. Method: A total sample of 361 college students (Mage = 22.26, SD = 5.56) was gathered from a community college (N = 134) and mid-size public university (N = 227) in Southwest US, both designated as Hispanic Serving Institutions. Results: Pearson and point biserial correlations indicated associations between mental health symptomatology, academic challenges, and economic stress, including expected delays in graduation. Multivariate analysis revealed that community college students had statistically significantly higher scores on anxiety F(1, 312) = 5.27, p = .02, η p 2  = .01 than 4-year university students, as well as key differences with respect to academic challenges. Chi Square analyses revealed that Latinx families experienced greater economic hardships, including job loss or reduced work hours (χ2 (1, N = 361) = 28.56, p = .00) than other ethnic/racial groups. Conclusions/Contributions: Findings revealed that community college students faced disparately negative mental health symptomatology, academic challenges, and economic stress during the first wave of the Coronavirus pandemic. Further, Latinx students' families experienced significant economic hardship that may have impacted students' academic progress and future planning.

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.

Comparison of Current Attitudes Toward COVID-19 Vaccination in New York City and the US Nationally

COVID-19 vaccination has resulted in decreased hospitalization and mortality, particularly among those who have received a booster. As new effective pharmaceutical treatments are now available and requirements for non-pharmaceutical interventions (e.g. masking) are relaxed, perceptions of the risk and health consequences of SARS-CoV-2 infection have decreased, risking potential resurgence. This June 2022 cross-sectional comparative study of representative samples in New York City (NYC, n = 2500) and the United States (US, n = 1000) aimed to assess differences in reported vaccine acceptance as well as attitudes toward vaccination mandates and new COVID-19 information and treatments. NYC respondents reported higher COVID-19 vaccine acceptance and support for vaccine mandate than U.S. respondents, yet lower acceptance for the booster dose. Nearly one-third of both NYC and U.S. respondents reported paying less attention to COVID-19 vaccine information than a year earlier, suggesting health communicators may need innovation and creativity to reach those with waning attention to COVID-19-related information.

Impacts of community-level grassroots organizations on household food security during the COVID-19 epidemic period in China

Purchasing food via community-level grassroots organizations was a new pattern of food patronage for Wuhan residents during the COVID-19 lockdown in 2020, but little attention was paid to it. The study examined the relationship between community-level grassroots organizations and household food insecurity based on an online survey of household food insecurity in Wuhan in March 2020. The study found that problems in all three domains of food insecurity including food anxiety, insufficient quality and inadequate quantity existed but were uneven. Community-level grassroots organizations played an important role in promoting food security including reducing worries about food supply and providing enough food intake, but did not ensure households had adequate food quality due to increasing food prices, fewer varieties of food and decreased food freshness. Compared to other grassroots organizations, the community committee had actually become an extension of the government to run administrative grassroots affairs before the epidemic, so its tight relationship with local government made it become the major grassroots power in ensuring household food security at the residential community level.

Prevalence and determinants of food insecurity during the 2022 COVID-19 related lockdown in Shanghai

The SARS-CoV-2 coronavirus pandemic has led to increased food insecurity levels. This cross-sectional study examines the prevalence and determinants of food insecurity during the two-month (1 April to 1 June 2022) city-wide lockdown in Shanghai. The data was collected via an online questionnaire from 3230 adult Shanghai residents during the lockdown. Food insecurity was measured using an adapted version of the Household Food Insecurity Access Scale. Nearly 70% of participants reported being exposed to food insecurity. Using multivariable logistic regressions, we examined the associations between key correlates (i.e. age, income, lockdown-related income loss, migration, employment status, social capital, preparedness, and received social support) and overall food insecurity while adjusting for ethnicity, gender, education, household size, and marital status. Results showed that compared to local Shanghai residents, migrants (i.e, permanent migrants with Hukou (OR = 2.16), permanent migrants without Hukou (OR = 2.06), temporary migrants (OR = 2.74)), and participants with less than or greather than 50% lockdown-related income loss (OR = 2.60, OR = 3.09), were associated with higher odds of overall food insecurity. Participants with greater preparedness (OR = 0.66), greater bonding social capital (OR = 0.93), and greater bridging social capital (OR = 0.94), had lower odds of overall food insecurity. Targeted interventions are needed to enhance food resilience and health equity among vulnerable populations.

A new face of food security: A global perspective of the COVID-19 pandemic

COVID-19 has impacted the world economy and food system in many aspects. We conducted a comprehensive examination of global food security during the COVID-19 pandemic by considering the food security index and its four key pillars (affordability, availability, quality and safety, and natural resources and resilience) for 102 countries. In addition to the fixed effect panel data estimator, the Method of Moments Quantile regression is useful for disaggregating the impact of the COVID-19 pandemic in relation to inflation, economic growth, urbanization, and agricultural land on global food security among countries with different levels of food security. We found that COVID-19 has negatively affected food security globally, especially in countries with a low food security level. The effect of income per capita and urbanization rate on the food security index is positive and statistically significant across all quantiles. Inflation rate and agricultural land, however, adversely affect food security, and this effect is stronger for countries with lower levels of food security. The results of affordability, availability, quality, and safety, and natural resources and resilience models provide meaningful implications for governments and policymakers to build resilience in food systems and to be better prepared for future crises and disruptions in the food supply.

Food availability and shopping channels during the disasters: Has the COVID-19 pandemic changed peoples' online food purchasing behavior?

COVID-19 caused online buying channels to flourish across the globe. However, the extent to which online channels in Pakistan assisted peoples in coping with the pandemic remains unknown. This study aims to examine peoples behavior and perceptions regarding online food purchasing and its impact on different aspects of food security. The data were collected through online surveys of 1067 respondents in Punjab and Sindh provinces during the COVID-19 pandemic. We find that peoples access to food was adversely affected by the pandemic. However, people are increasingly purchasing food online, which has improved their accessibility to food. According to the findings, 62.51% of respondents reported to have changed their perception and behavior regarding online food purchasing. In addition, almost 46.40% of peoples reported that online shopping increased their access to food during the pandemic. Using logit regression, economic analysis shows that education, monthly income, and access to basic necessities such as clean drinking water, better sanitation, and better employment are positively related to online buying behavior. For future disaster situations in Pakistan to mitigate the adverse effects on food security, strengthening and promoting the use of online purchasing channels could be an important policy instrument.

Grocery Purchase Changes Were Associated With A North Carolina COVID-19 Food Assistance Incentive Program

Many low-income Americans experience food insecurity, which may have been exacerbated by economic instability during the early stages of the COVID-19 pandemic in 2020. In this study we assessed the impact of Healthy Helping, a short-term fruit and vegetable incentive program aimed at alleviating food insecurity and improving diet quality for Supplemental Nutrition Assistance Program participants, on grocery purchases, using transaction data from a large supermarket chain in North Carolina. We compared Healthy Helping participants' purchases of key food groups before and during the program with purchases by control shoppers participating in federal food assistance programs during the same period. Healthy Helping enrollment was associated with a $26.95 increase in monthly spending on fruit, vegetables, nuts, and legumes-an increase of 2.5 grams of fiber per 1,000 kilocalories purchased-and other shifts in the composition of food purchases, relative to control shoppers. These findings suggest that the program increased healthy food purchases while also increasing dollar sales at participating retailers. On average, participants did not use the full benefit; future research should explore factors associated with non- or underuse of benefits, to inform program design and outreach.

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.

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

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

Cooking at Home, Fast Food, Meat Consumption, and Dietary Carbon Footprint among US Adults

Shifting consumer behavior towards more sustainable diets can benefit environmental sustainability and human health. Although more frequent home cooking is associated with a better diet quality and fast-food consumption with worse diet quality, the environmental impact of diets based on frequency of cooking or eating fast food is not well understood. The objective of this study was to investigate whether the frequency of cooking dinner at home or eating fast food is associated with dietary greenhouse gas emissions (GHGE). We linked 24-h dietary recall data from adult respondents in the 2007-2010 National Health and Nutrition Examination Survey (NHANES) (N = 11,469) to a database of GHGE factors to obtain a measure of dietary GHGE (kgCO2-eq/2000 kcal) (the sum of emissions released in the production of food for an individual's diet), adjusted by energy intake (kgCO2-eq/2000 kcal). We examined associations between frequency of cooking dinner (the only meal for which cooking frequency was measured), frequency of eating fast food, and dietary GHGE and protein sources (beef, pork, poultry, other meat, and fish and seafood (g/2000 kcal)) using generalized linearized regression models that controlled for age, sex, and other socio-economic characteristics. Greater cooking frequency was associated with higher dietary GHGE. In fully adjusted models, cooking 5-6 times/week was associated with an additional 0.058 kgCO2-eq/2000 kcal (SE 0.033) and cooking 7 times/week was associated with an additional 0.057 kgCO2-eq/2000 kcal (SE 0.027) when compared to cooking 0-2 times/week. Individuals in households who cooked dinner more frequently consumed significantly more meat, poultry, and fish (cooking 7 times/week: 148.7 g/2000 kcal vs. cooking 0-2 times/week: 135.4 g/2000 kcal, p-trend = 0.005), which could explain the association with a higher carbon footprint diet. There were few associations of note between fast-food frequency and GHGE. Policies and interventions that reduce consumption of meat and increase consumption of plants when both cooking meals at home and eating meals out are needed to shift toward diets that will be beneficial for both human health and the health of the planet.