Disparities in food insecurity during the COVID-19 pandemic: A two-year analysis

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.

SNAP and/or WIC Participation and Diet Quality in Mother-Child Dyads living in Greater Boston after Pandemic: A Mixed-Method Study

INTRODUCTION/OBJECTIVES

Since the COVID-19 pandemic, few studies have examined how participation in Supplemental Nutrition Assistance Program (SNAP) and/or Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) impacts diet quality in families with young children. This study aims to explore the association between SNAP and/or WIC participation and diet quality in mother-child dyads in Greater Boston, MA.

METHODS

A mixed-method approach involving cross-sectional surveys and in-depth interviews were utilized. Participants included 69 mother-child dyads for quantitative and 18 mothers for qualitative data collection. Analysis of covariance using generalized linear models was employed to compare differences in Healthy Eating Index-2015 (HEI-2015) scores based on SNAP and/or WIC participation, and thematic analysis was used for coding themes.

RESULTS

Mothers who participated in SNAP and/or WIC were more from lower socioeconomic backgrounds. After adjusting for age, race/ethnicity, and education, no significant differences in diet quality were found for both mothers and their children. However, qualitative results showed that mothers prioritized their children's nutrition, used benefits to buy fruits and vegetables, and experienced stress that impacted their own diet quality.

CONCLUSIONS

Since the pandemic, SNAP and WIC appeared to support families experiencing socioeconomic disadvantage (e.g., lower income and educational attainment) to improve diet quality, particularly through increased access to fruits and vegetables. However, these programs have not fully eliminated persistent disparities in diet quality, which seems to continue even the pandemic's immediate effects have subsided.

Economic insecurity during the COVID-19 pandemic among healthcare workers by educational attainment

Prior to the COVID-19 pandemic, healthcare workers with less formal education (eg, nursing assistants and home care aides) vs more formal education (eg, physicians and nurses) were more likely to experience economic insecurity, the real and/or perceived risk of financial losses. Given the unprecedented impact of COVID-19 on healthcare workers, we sought to describe economic insecurity among these workers during the pandemic. Using data from the U.S. Census Bureau's Household Pulse Survey from July 2021 to July 2023, we examined economic insecurity among healthcare workers by educational attainment. Higher proportions of healthcare workers with an associate degree or below reported difficulty paying usual expenses, food insufficiency, and being behind on rent/mortgage payments compared to healthcare workers with a bachelor's degree or higher. Accounting for other sociodemographic characteristics, higher educational attainment was associated with significantly lower odds of economic insecurity. Since the public health emergency has ended and temporary policies to support low-wage workers during the pandemic have sunsetted, targeted policies to promote economic security among financially vulnerable low-wage workers are critical to enable recruitment and retention of these essential healthcare workers.

Heterogeneous Associations Between Pandemic-Induced Socioeconomic Hardships and COVID-19 Vaccine Uptake by Sexual Orientation and Gender Identity: A Nationally Representative Analysis in the United States

Background/Objectives: Socioeconomic hardship during the COVID-19 pandemic was associated with lower vaccine uptake. Since the pandemic has exacerbated socioeconomic challenges faced by sexual and gender minority populations, including employment income loss, housing instability, food insufficiency, and household expense difficulty, this study investigated the disparities in COVID-19 vaccine uptake among these populations. Methods: Using the U.S. Census Bureau Household Pulse Survey, a nationally representative sample of 1,767,966 individuals (6% gay or lesbian, 4.2% bisexual, 1.6% something else, and 90.6% heterosexual respondents), we quantified the COVID-19 vaccine uptakes among sexual and gender minorities, as well as the effect measure modifications by socioeconomic hardships. Results: Despite higher vaccine uptake rates among sexual and gender minorities compared to their heterosexual counterparts, socioeconomic hardships triggered by the pandemic among these populations were associated with decreased vaccine uptake. Importantly, the effect measure modifications by socioeconomic hardships were more pronounced among sexual and gender minority status compared to heterosexual individuals. Conclusions: These results highlight the critical need to address socioeconomic hardships among sexual and gender minorities to enhance vaccine uptake, along with the pre-existing and exacerbated social and economic disadvantages during the COVID-19 pandemic.

Nutritional quality of food purchases during the COVID-19 public health crisis: An analysis of geographic disparities in North Carolina

Objective

To examine geographic disparities in the nutritional quality of food purchases during the COVID-19 public health crisis in North Carolina (NC).

Methods

Using shopper-level longitudinal transaction records between October 2019- and December 2020 from NC's largest grocery retailer, we fit mixed-effect models to examine disparities in the nutritional quality of food purchases among shoppers in counties with different levels of socioeconomic development and how such disparities changed after March 2020, accounting for other observed and contextual factors.

Results

Shoppers in counties with lower development levels purchased a larger share of calories from least healthy foods and a smaller share from healthier foods compared to shoppers in counties with higher development levels. These disparities were slightly attenuated for the least healthy foods and did not change for healthier foods after the onset of the COVID crisis.

Conclusion

Despite existing nutritional disparities among shoppers in counties with different levels of socioeconomic development, we did not observe a large-scale accentuation of inequities in dietary quality during the COVID-19 crisis. This pattern may have resulted from programmatic responses to mitigate the adverse effects of the COVID crisis on vulnerable populations. Future work should further explore the role of such responses.

Factors and Perceptions Associated with Post-Pandemic Food Sourcing and Dietary Patterns among Urban Corner Store Customers in Baltimore, Maryland

OBJECTIVE

Diet-related disease is rising, disproportionately affecting minority communities in which small food retail stores swamp supermarkets. Barriers to healthy food access were exacerbated by the pandemic. We examined the following: (1) individual- and household-level factors in a sample of Baltimore community members who regularly shop at corner stores and (2) how these factors are associated with indicators of dietary quality.

DESIGN

Cross-sectional data were collected using an online survey to capture sociodemographics, anthropometrics, and food sourcing, spending, and consumption patterns. Concurrent quantitative and qualitative analyses were conducted in Stata 18 and ATLAS.ti.

SETTING

This study was set in Baltimore, Maryland, USA.

PARTICIPANTS

The participants included adults (n = 127) living or working in Baltimore who identified as regular customers of their neighborhood corner store.

RESULTS

The respondents were majority Black and low-income, with a high prevalence of food insecurity (62.2%) and overweight/obesity (66.9%). Most (82.76%) shopped in their neighborhood corner store weekly. One-third (33.4%) of beverage calories were attributed to sugar-sweetened beverages, and few met the recommended servings for fruits and vegetables or fiber (27.2% and 10.4%, respectively). Being Black and not owning a home were associated with lower beverage and fiber intake, and not owning a home was also associated with lower fruit and vegetable intake. Food insecurity was associated with higher beverage intake, while WIC enrollment was associated with higher fruit and vegetable and fiber intakes. Open-ended responses contextualized post-pandemic food sourcing and consumption in this setting.

CONCLUSIONS

This paper helps characterize the consumers of a complex urban food system. The findings will inform future strategies for consumer-engaged improvement of local food environments.

Food Insecurity in the Rural South in the Wake of the COVID-19 Pandemic

Food insecurity in rural communities in the Southern US continues to grow, especially in the wake of the COVID-19 pandemic. Understanding the characteristics of food-insecure individuals and families in this region is critical for developing creative strategies for eliminating this health disparity issue. A food insecurity survey was given to attendees at food-security events held in several counties in one Southern US state. A descriptive analysis of food insecurity in this region is presented, and recommendations for addressing food insecurity among underserved and disadvantaged populations are suggested.

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.

What Is Associated with Changes in Food Security among Low-Income Residents of a Former Food Desert?

Lack of geographic access to foods has been postulated as a cause for food insecurity, which has been linked to poor nutrition, obesity, and chronic disease. Building on an established cohort of randomly selected households from a low-income, predominantly Black neighborhood, we examined household food security, distance to where study participants reported doing their major food shopping, and prices at stores where they shopped. Data from the Pittsburgh Hill/Homewood Research on Eating, Shopping, and Health study for years 2011, 2014 and 2018 was limited to residents of the neighborhood that began as a food desert (i.e., low access to healthy foods), but acquired a full-service supermarket in 2013. We calculated descriptive statistics and compared study participants in the former food desert neighborhood whose food security improved to those whose food security did not improve across survey waves. We estimated cross sectional linear regressions using all waves of data to assess food security level among study participants. Distance to major food shopping store was positively associated with food security (p < 0.05) while food-store prices were not significantly associated with food security. Findings suggest that for predominantly low-income residents, food secure individuals traveled further for their major food shopping.

Regional Disparities in COVID-19 Vaccine Hesitancy: The Moderating Role of Social Distancing and Vaccine Rollout in the U.S

This study examines the relationship between statewide contexts and individuals’ COVID-19 vaccine hesitancy by using the Household Pulse Survey, a national and near real-time data timely deployed by the U.S. Census Bureau. Controlling for the individual- and state-level variables in addition to temporal effect, this study finds that racial and ethnic minorities and COVID-19-infected people are more hesitant than their counterparts to receive a vaccine. Individuals who reside in a state where more stringent social distancing measures – particularly mask mandate – are implemented and vaccine rollout conditions are better appear to be less hesitant to receive a COVID-19 vaccine. Vulnerable subpopulation groups such as people of color and COVID-19-infected individuals are more hesitant to vaccine uptake even if regional circumstances are equal. These findings suggest that the continuation and extension of vaccine campaigns at the regional as well as individual levels are all important for expediting COVID-19 vaccination and reducing vaccine hesitancy as the world is in the middle of the third year of the pandemic.