ABSTRACT
Background: Food insecurity (FI), a lack of consistent access to food, is associated with more frequent fast food intake and poor dietary quality in children. This analysis explored whether FI is associated with children's restaurant behaviors more than 6 months into the COVID-19 pandemic, a time when FI has been particularly high in the United States (US). Methods: An online survey was administered to US parents of children (4-8 years;n = 1000) in October 2020 and included sociodemographics, perceived safety of restaurant use, local food retail regulations, FI, and children's frequency of restaurant meals over the past 2 months. Multivariate regression models examined associations between the aforementioned variables and children's restaurant behaviors. Post-hoc analyses were conducted to examine if parent's COVID-specific employment changes were associated with FI, to help us understand high rates of FI in this sample. Sampling weights were applied to analyses to assure results were nationally representative. Results: Parents' perceived safety of restaurant use, income, education and employment status were associated with children's restaurant use. FI had a small, but significant association with more frequent in-person restaurant dining and more frequent restaurant delivery, but was not associated with picking up takeout. Parents' COVID-related employment changes (e.g. job loss, reduced work hours) had stronger associations with FI than more stable sociodemographic variables (e.g. parental education). Conclusions: Consistent access to food has been a pressing issue for many families throughout the pandemic. These circumstances may be associated with family restaurant behaviors that can impact children's diet quality and health. Future research should explore the burden of COVID-19 on community food systems as well as interventions and resources that can help parents access healthy food.