Food insecurity and the role of food assistance programs in supporting diet quality during the COVID-19 pandemic in Massachusetts.

Background: Economic and supply chain shocks resulting from the COVID-19 pandemic in 2020 led to substantial increases in the numbers of individuals experiencing food-related hardship in the US, with programs aimed at addressing food insecurity like the Supplemental Nutrition Assistance Program (SNAP) and food pantries seeing significant upticks in utilization. While these programs have improved food access overall, the extent to which diet quality changed, and whether they helped mitigate diet quality disruptions, is not well understood. Objective: To evaluate food insecurity, food pantry and/or SNAP participation associations with both diet quality as well as perceived disruptions in diet during the COVID-19 pandemic among Massachusetts adults with lower incomes. Methods: We analyzed complete-case data from 1,256 individuals with complete data from a cross-sectional online survey of adults (ages 18 years and above) living in Massachusetts who responded to "The MA Statewide Food Access Survey" between October 2020 through January 2021. Study recruitment and survey administration were performed by The Greater Boston Food Bank. We excluded respondents who reported participation in assistance programs but were ineligible (n = 168), those who provided straightlined responses to the food frequency questionnaire component of the survey (n = 34), those with incomes above 300% of the federal poverty level (n = 1,427), those who completed the survey in 2021 (n = 8), and those who reported improved food insecurity (n = 55). Current dietary intake was assessed via food frequency questionnaire. Using Bayesian regression models, we examined associations between pandemic food insecurity, perceived disruption in diet, diet quality, and intakes of individual foods among those who completed a survey in 2020. We assessed interactions by pantry and SNAP participation to determine whether participation moderated these relationships. Results: Individuals experiencing food insecurity reported greater disruption in diet during the pandemic and reduced consumption of healthy/unhealthy foods. Pantry participation attenuated significant associations between food insecurity and lower consumption of unhealthy (b = -1.13 [95% CI -1.97 to -0.31]) and healthy foods (b = -1.07 [-1.82 to -0.34]) to null (unhealthy foods: -0.70 [-2.24 to 0.84]; healthy foods: 0.30 [-1.17 to 1.74]), whereas SNAP participation attenuated associations for healthy foods alone (from -1.07 [-1.82 to -0.34] to -0.75 [-1.83 to 0.32]). Results were robust to choice of prior as well as to alternative modeling specifications. Conclusion: Among adults with lower incomes, those experiencing food insecurity consumed less food, regardless of healthfulness, compared to individuals not experiencing food insecurity. Participation in safety-net programs, including SNAP and pantry participation, buffered this phenomenon. Continued support of SNAP and the food bank network and a focus on access to affordable healthy foods may simultaneously alleviate hunger while improving nutrition security.

Food insecurity and the role of food assistance programs in supporting diet quality during the COVID-19 pandemic in Massachusetts

Background Economic and supply chain shocks resulting from the COVID-19 pandemic in 2020 led to substantial increases in the numbers of individuals experiencing food-related hardship in the US, with programs aimed at addressing food insecurity like the Supplemental Nutrition Assistance Program (SNAP) and food pantries seeing significant upticks in utilization. While these programs have improved food access overall, the extent to which diet quality changed, and whether they helped mitigate diet quality disruptions, is not well understood. Objective To evaluate food insecurity, food pantry and/or SNAP participation associations with both diet quality as well as perceived disruptions in diet during the COVID-19 pandemic among Massachusetts adults with lower incomes. Methods We analyzed complete-case data from 1,256 individuals with complete data from a cross-sectional online survey of adults (ages 18 years and above) living in Massachusetts who responded to "The MA Statewide Food Access Survey” between October 2020 through January 2021. Study recruitment and survey administration were performed by The Greater Boston Food Bank. We excluded respondents who reported participation in assistance programs but were ineligible (n = 168), those who provided straightlined responses to the food frequency questionnaire component of the survey (n = 34), those with incomes above 300% of the federal poverty level (n = 1,427), those who completed the survey in 2021 (n = 8), and those who reported improved food insecurity (n = 55). Current dietary intake was assessed via food frequency questionnaire. Using Bayesian regression models, we examined associations between pandemic food insecurity, perceived disruption in diet, diet quality, and intakes of individual foods among those who completed a survey in 2020. We assessed interactions by pantry and SNAP participation to determine whether participation moderated these relationships. Results Individuals experiencing food insecurity reported greater disruption in diet during the pandemic and reduced consumption of healthy/unhealthy foods. Pantry participation attenuated significant associations between food insecurity and lower consumption of unhealthy (b = −1.13 [95% CI −1.97 to −0.31]) and healthy foods (b = −1.07 [−1.82 to −0.34]) to null (unhealthy foods: −0.70 [−2.24 to 0.84];healthy foods: 0.30 [−1.17 to 1.74]), whereas SNAP participation attenuated associations for healthy foods alone (from −1.07 [−1.82 to −0.34] to −0.75 [−1.83 to 0.32]). Results were robust to choice of prior as well as to alternative modeling specifications. Conclusion Among adults with lower incomes, those experiencing food insecurity consumed less food, regardless of healthfulness, compared to individuals not experiencing food insecurity. Participation in safety-net programs, including SNAP and pantry participation, buffered this phenomenon. Continued support of SNAP and the food bank network and a focus on access to affordable healthy foods may simultaneously alleviate hunger while improving nutrition security.

Caregivers' Perceived Impact of WIC's Temporary Cash-Value Benefit (CVB) Increases on Fruit and Vegetable Purchasing, Consumption, and Access in Massachusetts.

Responding to the COVID-19 pandemic, the American Rescue Plan (2021) allowed state agencies of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) the option of temporarily increasing the Cash-Value Benefit (CVB) for fruit and vegetable (FV) purchases. To examine the impact of this enhancement on WIC caregiver experience, the MA WIC State Office invited 4600 randomly selected MA WIC caregivers to complete an online survey (February-March 2022). Eligible adults had at least one child, had been enrolled at least a year, and were aware of the increase. Of those who opened the screener (n = 545), 58.9% completed it (n = 321). We calculated the frequencies of reporting increased FV outcomes and tested whether responses differed by race/ethnicity, market access, and food security. Most caregivers perceived the CVB increase to benefit FV purchasing (amount and quality, 71.0% and 55.5%), FV consumption (offered to children and personally consumed, 70.1% and 63.2%), and satisfaction with the WIC food package (37.1% reported improved satisfaction, pre- vs. post-increase). Probability of reporting improved outcomes was not found to differ by race/ethnicity, market access, or food security. CVB increases may pose important implications for dietary behaviors and satisfaction with WIC. Policymakers should consider making this increase permanent.

Trauma, Posttraumatic Stress Disorder, and Treatment Among Middle-Aged And Older Women

Posttraumatic stress disorder (PTSD) is twice as prevalent in women as in men, and is an established risk factor for chronic disease, but few studies have comprehensively assessed lifetime PTSD in middle-aged and older civilian women. We surveyed 33,328 women aged 54-74 from the Nurses’ Health Study II from August 2018 to January 2020 to understand trauma exposure, PTSD based on the Diagnostic and Statistical Manual of Mental Disorders Version 5, and trauma-related treatment use. The majority (82.2%) of women reported one or more lifetime traumas. 10.5% of those with trauma had lifetime PTSD and 1.5% had past-month PTSD. The most common trauma types were sudden or unexpected death of a loved one (44.9%) and interpersonal or sexual violence (43.5%). Almost 30% experienced occupational (nursing-related) trauma. Interpersonal or sexual violence event types explained the largest proportion of PTSD cases (33.6%) out of seven categories of events assessed. Only 25% of women with trauma ever accessed trauma-related treatment, but this proportion was higher (66.4%) among those with diagnosable PTSD, and among those with current depression (35.9%). Treatment was most common among women who experienced interpersonal/sexual violence and lowest among those with occupational trauma, but treatment satisfaction did not vary by worst trauma type. Psychotherapy was the most common type of treatment. These results demonstrate that trauma is nearly universal in middle-aged to older women, which has important implications for their long-term health and well-being—particularly in the era of COVID-19 which is likely to produce additional trauma in this population.

Barriers and facilitators to achieving food security during the COVID-19 pandemic.

The COVID-19 pandemic has considerably increased food insecurity. To identify where intervention and policy solutions are most needed, we explored barriers to obtaining food and predictors of experiencing food insecurity due to the COVID-19 pandemic. Between May and July 2020, we conducted cross-sectional online surveys with two convenience samples of U.S. adults (Study 1: n = 2,219, Study 2: n = 810). Roughly one-third of participants reported experiencing food insecurity due to the COVID-19 pandemic (Study 1: 32%, Study 2: 35%). Between one-third and half reported using the charitable food system (Study 1: 36%, Study 2: 46%). The majority of participants experienced barriers to getting food (Study 1: 84%, Study 2: 88%), of which the most commonly reported were not having enough money to buy food (Study 1: 48%; Study 2: 53%) and worrying about getting COVID-19 at the store (Study 1: 50%; Study 2: 43%). Higher education was associated with greater risk of food insecurity in both studies (all p < 0.05). Receipt of aid from SNAP buffered against the association between financial struggles and food insecurity in Study 1 (p = 0.03); there was also some evidence of this effect in Study 2 (p = 0.05). Our findings suggest that food insecurity might be reduced by mitigating financial struggles (e.g., by increasing access to SNAP) and by addressing barriers to obtaining food (e.g., by expanding accessibility of food delivery programs).