Gender and Food insecurity in the COVID-19 pandemic in Brazil: hunger through women's voices. / Gênero e Insegurança alimentar na pandemia de COVID-19 no Brasil: a fome na voz das mulheres.

This paper presents the results of the research nested in the international project "Gender and COVID-19", which includes several topics related to the impact of the pandemic on the lives of women and their families, including food insecurity and hunger. Semi-structured interviews were conducted from December 2020 to November 2021 with 49 women living in two urban conglomerates, Cabana do Pai Tomás (Belo Horizonte, MG) and Sapopemba (São Paulo, SP), and two rural quilombola communities, Córrego do Rocha (Chapada do Norte, MG) and Córrego do Narciso (Araçuaí, MG). The analyses were based on the following categories: hunger-related feelings and terms; reduced food amount and quality; lack of food and nutrients; difficulties producing food, receiving emergency aid or food donations; governments evaluation and support networks. The respondents' reports show the challenges they experienced, their coping methods, and criticism of the government's lack of responses. Besides presenting a gender perspective, women, especially the leaders who worked in the construction of solidarity networks, are fundamental voices in planning actions to prevent and mitigate the impacts of emergencies in their communities.

Neste artigo apresentamos resultados de uma pesquisa que integra o projeto internacional "Gender and COVID-19", que contempla diversos temas relacionados aos impactos da pandemia na vida de mulheres e suas famílias, entre eles a insegurança alimentar e a fome. Foram feitas entrevistas semiestruturadas entre dezembro de 2020 e novembro de 2021 com 49 mulheres, moradoras de dois aglomerados urbanos, Cabana do Pai Tomás (Belo Horizonte, MG) e Sapopemba (São Paulo, SP), e de duas comunidades rurais quilombolas, Córrego do Rocha (Chapada do Norte, MG) e Córrego do Narciso (Araçuaí, MG). As análises foram baseadas nas seguintes categorias: sentimentos e termos relacionados à fome; redução na quantidade e qualidade de alimentos; ausência de alimento e nutrientes; dificuldades para produzir alimento, receber auxílio emergencial e/ou doação de alimentos; avaliação dos governos e redes de apoio. Os relatos das entrevistadas evidenciam os desafios vivenciados, suas formas de enfrentamento e críticas à falta de respostas dos governos. Além de apresentarem uma perspectiva de gênero, as mulheres, em especial as lideranças que atuaram na construção de redes de solidariedade, são vozes fundamentais no planejamento de ações de prevenção e mitigação dos impactos de situações emergenciais em suas comunidades.

The Prevalence and Determinants of Child Hunger and Its Associations with Early Childhood Nutritional Status among Urban Poverty Households during COVID-19 Pandemic in Petaling District, Malaysia: An Exploratory Cross-Sectional Survey.

Child hunger was prevalent during the COVID-19 pandemic, but the extent, determinants, and impact on pre-school children aged 6 months to 7 years old from Malaysian urban poor households are still unknown. This exploratory cross-sectional study was performed between July 2020 and January 2021 at the Lembah Subang People Housing Project, Petaling. The households' food security status was assessed using the previously validated Radimer/Cornell questionnaire, and the children's anthropometric measurements were taken. Food diversity score was assessed using the World Health Organization Infant and Young Children Feeding (under-2 children) or Food and Agriculture Organization Women's Dietary Diversity (2-year-old-and-above children) systems. Overall, 106 households were recruited. The prevalence of child hunger is 58.4% (95% CI: 50.0, 67.4). Significant differences were found in breastfeeding and sugar-sweetened beverage consumption between under-2 and ≥2-year-old children. There were no significant differences between child hunger and other food-insecure groups in weight-for-age, height-for-age, and weight-for-height z-scores. Only a higher dietary diversity score was significantly protective against child hunger after adjusting for maternal age, paternal employment status, and the number of household children (ORadjusted: 0.637 (95% CI: 0.443, 0.916), p = 0.015)). Proactive strategies are warranted to reduce child hunger during the COVID-19 pandemic by improving childhood dietary diversity.

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.

Food Insecurity, Food Assistance, and Psychological Distress among University Students: Cross-Sectional Survey Western Australia, 2020.

University students have been identified as a population sub-group vulnerable to food insecurity. This vulnerability increased in 2020 due to the COVID-19 pandemic. This study aimed to assess factors associated with food insecurity among university students and the differences between students with and without children. A cross-sectional survey of (n = 213) students attending one university in Western Australia measured food insecurity, psychological distress, and socio-demographic characteristics. Logistic regression analyses were conducted to identify factors associated with food insecurity. Forty-eight percent of students who responded to the survey had experienced food insecurity in 2020. International students who were studying in Australia were nine times more likely to experience food insecurity than domestic students (AOR = 9.13; 95% CI = 2.32-35.97). International students with children were more likely to experience food insecurity than international students without children (p < 0.001) and domestic students with (p < 0.001) or without children (p < 0.001). For each unit increase in depression level, the likelihood of experiencing food insecurity increased (AOR = 1.62; 95% CI = 1.12-2.33). Findings show a higher prevalence of food insecurity among international university students and students with children during the COVID-19 pandemic and that food insecurity was associated with higher levels of psychological distress. These findings highlight the need for targeted interventions to mitigate the risk of food insecurity among Australian university students, particularly among international students, students with children, and those experiencing psychological distress.

Household food insecurity during the COVID-19 pandemic is associated with anxiety and depression among US- and foreign-born adults: Findings from a nationwide survey.

The COVID-19 pandemic led to significant disruptions to household food security with as many as 10.5 % of US households experiencing food insecurity during 2020. Food insecurity is associated with psychological distress including depression and anxiety. However, to the best of our knowledge, no study has analyzed the association between COVID-19 food insecurity and poor mental health outcomes by place of birth. The Understanding the Impact of the Novel Coronavirus (COVID-19) and Social Distancing on Physical and Psychosocial (Mental) Health and Chronic Diseases national survey assessed the physical and psychosocial effects of social and physical distancing during the COVID-19 pandemic among a diverse population of US- and foreign-born adults. Multivariable logistic regression was used to assess the relationship between place of birth and food security status and anxiety (N = 4817) and depression (N = 4848) among US- and foreign-born individuals. Stratified models subsequently analyzed the associations between food security and poor mental health among US- and foreign-born populations separately. Model controls included sociodemographic and socioeconomic factors. Low and very low household food security were associated with greater odds of both anxiety (low: odds ratio (OR) [95 % confidence interval (CI)] = 2.07 [1.42-3.03]; very low: OR [95 % CI] = 3.35 [2.15-5.21]) and depression (low: OR [95 % CI] = 1.92 [1.33-2.78]; very low: OR [95 % CI] = 2.36 [1.52-3.65]). However, this relationship was attenuated among foreign-born individuals compared to US-born individuals in the stratified models. All models found a dose-response relationship between increasing levels of food insecurity and anxiety and depressive symptoms. Further research is needed to explore the factors that attenuated the relationship between food insecurity and poor mental health among foreign-born individuals.

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.

[Assessment of food insecurity in the context of COVID-19: association with emergency aid and collecting food donations among the socially vulnerable population of a capital in Northeastern Brazil]. / Avaliação da insegurança alimentar no contexto da COVID-19: associação com o auxílio emergencial e recebimento de doação de alimentos na população em vulnerabilidade social de uma capital do Nordeste do Brasil.

The scope of this study was to investigate the prevalence of food insecurity in the context of COVID-19 and its association with the emergency aid income-transfer program and the collecting of food donations by the population in a situation of social vulnerability. A cross-sectional study was carried out with socially vulnerable families eight months after confirming the first case of COVID-19 in Brazil. A total of 903 families, living in 22 underprivileged communities of Maceió, in the state of Alagoas, were included. Sociodemographic characteristics were evaluated, and the Brazilian Food Insecurity Scale was applied. The association of food insecurity with the variables studied was performed using Poisson regression with robust variance estimation, considering α = 5%. Of the total sample, 71.1% were food insecure, a situation associated with receiving food donations (PR = 1.14; 95%CI: 1.02; 1.27) and being a beneficiary of emergency aid (PR =1.23; 95%CI: 1.01; 1.49). The results show that the population in a situation of social vulnerability was strongly affected by food insecurity. On the other hand, the population group in question benefited from actions implemented at the outset of the pandemic.

O estudo objetivou investigar a prevalência de insegurança alimentar no contexto da COVID-19 e sua associação com o programa de transferência de renda Auxílio Emergencial e o recebimento de doação de alimentos na população em vulnerabilidade social. Estudo transversal, realizado com famílias em vulnerabilidade social, oito meses após a confirmação do primeiro caso de COVID-19 no Brasil. Foram incluídas 903 famílias, residentes em 22 aglomerados subnormais de Maceió, em Alagoas. Avaliaram-se características sociodemográficas e foi aplicada a Escala Brasileira de Insegurança Alimentar. A associação da insegurança alimentar com as variáveis estudadas foi realizada por meio de regressão de Poisson com estimativa robusta das variâncias, considerando α = 5%. Do total da amostra, 71,1% estavma em insegurança alimentar, situação que se associou com o recebimento de doação de alimentos (RP = 1,14, IC95%: 1,02; 1,27) e ser beneficiário do Auxílio Emergencial (RP = 1,23, IC95%: 1,01; 1,49). Os resultados mostram que a população em vulnerabilidade social foi fortemente afetada pela insegurança alimentar. Em contrapartida, essa população foi beneficiada por ações que foram implementadas no início da pandemia.

Dietary behaviours during COVID-19 among households at risk for food insecurity.

The objective of the present study was to examine associations between variables of COVID-19-related concerns and changes in fruit and vegetable (FV) consumption among a sample of participants from the Brighter Bites program at risk for food insecurity. Cross-sectional data were collected during April-June 2020 using a rapid-response survey to understand social needs, COVID-19-related concerns and diet-related behaviours among families with children participating in Brighter Bites (n 1777) in the 2019-2020 school year at risk for food insecurity, within the surrounding Houston, Dallas, Austin, Texas area; Southwest Florida; Washington, D.C., United States. Of the 1777 respondents, 92 % of households reported being at risk for food insecurity. Among those from food insecure households, the majority were of Hispanic/Mexican-American/Latino (84⋅1 %) ethnic background, predominantly from Houston, Texas (71⋅4 %). During the pandemic, among individuals from food insecure households, 41 % (n 672) reported a decrease in FV intake, 32 % (n 527) reported an increase in FV intake, and 27 % (n 439) reported no change in FV intake. Those who reported concerns about financial stability had a 40 % greater risk of decreased FV intake compared to those not concerned about financial stability (RR 1⋅4; 95 % CI 1⋅0, 2⋅0; P = 0⋅03). The present study adds to this current body of sparse literature on how the initial phase of the pandemic impacted FV consumption behaviours among food insecure households with children. Effective interventions are needed to diminish the negative impact of COVID-19 on the population's health.

Food insecurity in a Brazilian transgender sample during the COVID-19 pandemic.

Transgender people often live with social vulnerability, largely promoted by gender-based prejudice. Our aim in this article was to raise preliminary data on how the COVID-19 pandemic and perceived prejudice have contributed to the problem of food and food insecurity in the transgender communities in Brazil. We conducted a web-based cross-sectional study, in which 109 transgender people from all regions of Brazil participated. We used the Chi-Square test and Poisson regression modeling with robust variance to estimate the association between food insecurity and the investigated factors. In our sample, 68.8% of transgender people experienced food insecurity, of these, 20.2% experienced severe food insecurity. Our results showed that the difficulties in purchasing food in the transgender community predate the COVID-19 pandemic, yet that the restrictive measures adopted have also impacted overall access to quality food. However, the main explanations for food insecurity were income and employment. In predicting food insecurity, the experiences of prejudice must be considered, and give rise to the hypothesis that specific conditions to which transgender people are exposed explain, to some degree, their vulnerability to food insecurity.

Supplemental Nutrition Assistance Program Participation is Associated with Lower Health Care Spending among Working Age Adults without Dependents.

Prior evidence suggests an association among food insecurity, poor health, and increased health care spending. In this study, we are using a natural experiment to confirm if longer participation in the Supplemental Nutrition Assistance Program (SNAP) is associated with reduced Medicaid spending among a highly impoverished group of adults. In 2013, the mandatory work requirements associated with SNAP benefits were lifted for able-bodied adults without dependents (ABAWDs). Using 2013 to 2015 Medicaid and SNAP data of 24,181 Minnesotans aged 18-49, we examined if changes in SNAP enrollment duration affect health care expenditures. In fully adjusted within-participant regression models, for each additional month of SNAP, average annual health care spending was $98.8 lower (95% CI: -131.7, -66.0; p<.001) per person. Our data suggests that allowing ABAWDs to receive SNAP even in months they are not working may be critical to their health as well as cost-effective.

Geographical variations of food insecurity and its associated factors in Bangladesh: Evidence from pooled data of seven cross-sectional surveys.

Food insecurity has multiple negative effects on maternal and child health and nutritional outcomes. There is a dearth of up-to-date evidence on the prevalence of food insecurity in Bangladesh based on geographical variations. We investigated the prevalence of food insecurity based on geographical variations and its associated factors. We pooled data from seven cross-sectional surveys conducted in 15,009 households from March 2015 to May 2018. This study was a part of the evaluation of the Maternal Infant Young Child Nutrition Phase 2 programme implemented by BRAC, one of the largest international non-governmental organizations located in Bangladesh that covered rural areas in 26 districts and two urban slums in Dhaka, Bangladesh. We used Household Food Insecurity Access Scale (a widely used scale to measure household food insecurity) to estimate the food insecurity status from the data collected through a face-to-face interview using a structured questionnaire. Hot spot analysis was conducted using the Getis-Ord Gi* statistic. The multiple logistic regression model was applied to explore the associated factors of food insecurity. The food insecurity hotspots were in the northwestern, central-southwestern, and coastal districts of Bangladesh. The overall prevalence of mild, moderate, and severe food insecurity were 12.7%, 13.8%, and 3.5%, respectively. In the adjusted model, household heads and caregivers of children with five or more years of schooling had respectively 42% (adjusted odds ratio (AOR): 0.58, 95% confidence interval (CI): 0.52, 0.64) and 46% (AOR: 0.54; 95% CI: 0.49, 0.61) less likelihood to suffer from food insecurity. Households in the middle (AOR: 0.58, 95% CI: 0.52, 0.65) and rich (AOR: 0.32, 95% CI: 0.28, 0.36) wealth status had lower odds of food insecurity. Food insecurity is widely spread in rural districts of Bangladesh and the degree of vulnerability is higher among the households of the northwestern, central-southwestern, and coastal areas of Bangladesh. Comprehensive interventions including strategies for poverty reduction and education for all might be effective to reduce food insecurity at rural households in Bangladesh.

Food insecurity in the Eastern Indo-Gangetic plain: Taking a closer look.

OBJECTIVE: Food security is an important policy issue in India. As India recently ranked 107th out of 121 countries in the 2022 Global Hunger Index, there is an urgent need to dissect, and gain insights into, such a major decline at the national level. However, the existing surveys, due to small sample sizes, cannot be used directly to produce reliable estimates at local administrative levels such as districts. DESIGN: The latest round of available data from the Household Consumer Expenditure Survey (HCES 2011-12) done by the National Sample Survey Office of India used stratified multi-stage random sampling with districts as strata, villages as first stage and households as second stage units. SETTING: Our Small Area Estimation approach estimated food insecurity prevalence, gap, and severity of each rural district of the Eastern Indo-Gangetic Plain (EIGP) region by modeling the HCES data, guided by local covariates from the 2011 Indian Population Census. PARTICIPANTS: In HCES, 5915 (34429), 3310 (17534) and 3566 (15223) households (persons) were surveyed from the 71, 38 and 18 districts of the EIGP states of Uttar Pradesh, Bihar and West Bengal respectively. RESULTS: We estimated the district-specific food insecurity indicators, and mapped their local disparities over the EIGP region. By comparing food insecurity with indicators of climate vulnerability, poverty and crop diversity, we shortlisted the vulnerable districts in EIGP. CONCLUSIONS: Our district-level estimates and maps can be effective for informed policy-making to build local resiliency and address systemic vulnerabilities where they matter most in the post-pandemic era. ADVANCES: Our study computed, for the Indian states in the EIGP region, the first area-level small area estimates of food insecurity as well as poverty over the past decade, and generated a ranked list of districts upon combining these data with measures of crop diversity and climatic vulnerability.

The Association of Food Insecurity With Asthma Control in Adults During COVID-19.

BACKGROUND: Food insecurity has been associated with poorer asthma control in children, but research lacks in adults. OBJECTIVE: To assess the frequency of food insecurity and its association with asthma control in adults during the coronavirus disease 2019 pandemic. METHODS: An online cross-sectional survey study was conducted in US adults with asthma. Survey questions included how worried or concerned participants were about food security since the pandemic. Asthma control was assessed using the Asthma Control Test, with uncontrolled asthma defined as Asthma Control Test score less than or equal to 19. Self-report of food insecurity since the pandemic was assessed. Food insecurity variables were dichotomized into high insecurity (≥3) or low insecurity (<3). Descriptive statistics and bivariate analyses were performed. RESULTS: Of the total participants (N = 866), 82.79% were female; mean age of participants was 44 ± 15.05 years, their mean Asthma Control Test score was 19.25 ± 4.54, and 18.48% had high food insecurity. Participants with high food insecurity were more likely to have uncontrolled asthma (74.38%) compared with those with lower food insecurity (34.99%; P < .01). The relationship between asthma control and food insecurity remained significant after adjusting for age, education, sex, race, anxiety, and living stability concerns due to the pandemic. CONCLUSIONS: Food insecurity exists in adults with asthma and is associated with uncontrolled asthma. Providers should consider screening their patients for food insecurity when treating individuals with uncontrolled asthma.

Food insecurity, dietary diversity and the right to adequate food among households in landslide-prone communities in Eastern Uganda: A cohort study.

We assessed food insecurity, dietary diversity and the right to adequate food among households in communities in Eastern Uganda that were affected by major landslides in 2010 and 2018. A prospective cohort study was applied to select 422 households during May-August (the food-plenty season) of 2019. In January-March (the food-poor season) of 2020, 388 households were re-assessed. Socio-demographic, food security, dietary diversity and right to adequate food data were collected using structured questionnaires. Four focus groups discussions and key informant interviews with 10 purposively sampled duty-bearers explored issues of food insecurity, dietary and the right to adequate food. The affected households had significantly higher mean (SE) food insecurity scores than controls, both during the food plenty season: 15.3 (0.5) vs. 10.8 (0.5), and during food-poor season: 15.9 (0.4) vs. 12.5 (0.0). The affected households had significantly lower mean (SE) dietary diversity scores than controls during the food plenty season: 5.4 (0.2) vs. 7.5 (0.2) and during the food poor season: 5.2 (0.2) vs. 7.3 (0.1). Multivariate analyses showed that the disaster event, education and main source of livelihood, were significantly associated with household food security and dietary diversity during the food-plenty season whereas during the food-poor season, the disaster event and education were associated with household food security and dietary diversity. During both food seasons, the majority of affected and control households reported to have consumed unsafe food. Cash-handout was the most preferred for ensuring the right to adequate food. Comprehension and awareness of human rights principles and state obligations were low. The severity of food-insecurity and dietary diversity differed significantly between the affected and control households during both food seasons. Moreover, the right to adequate food of landslide victims faced challenges to its realization. There is need for policy and planning frameworks that cater for seasonal variations, disaster effects and right to adequate food in order to reduce landslide victims' vulnerability to food insecurity and poor dietary diversity. In the long-term, education and income diversification program interventions need to be integrated into disaster recovery programs since they are central in enhancing the resilience of rural livelihoods to shocks and stressors on the food system.

Roadside sales activities in a South Pacific Island (Bora-Bora) reveal sustainable strategies for local food supply during a pandemic.

During the COVID-19 pandemic, the reduced exports and imports as well as the lack of activity due to the interruption in the international tourism economy seriously impacted food security in many Pacific Islands. People often returned to natural resources to provide for themselves, their families, or to generate income. On Bora-Bora Island, the major tourist destination in French Polynesia, roadside sales are widespread. Our study analyses the impact of the COVID-19 pandemic on roadside sales activities through a census of roadside stalls on the five Bora-Bora districts conducted before (January and February 2020), during (from March 2020 to October 2021) and after (from November to December 2021) health-related activity and travel restrictions. Our results showed that the marketing system for local products (fruits, vegetables, cooked meals, and fish) increased in the form of roadside sales during the COVID-19 in two of the five districts of Bora-Bora. Roadside selling would be an alternative system for providing food to the population at Bora-Bora during a global crisis and that could reveal itself sustainable after this pandemic.

The Impact of the COVID-19 Pandemic on the Experiences and Operations of Sponsors of the Summer Food Service Program in Maryland, USA: A Multiphase Mixed Methods Study.

During the COVID-19 pandemic, the Summer Food Service Program (SFSP) was allowed to operate in untraditional non-summer months to ensure children did not lose access to free and reduced-priced nutritious meals when schools were mandated to close in the United States. This study assessed the impact of the pandemic on the operations and experiences of Summer Food Service Program (SFSP) sponsors in the state of Maryland during the COVID-19 pandemic in 2020 (Phase I) and 2021 (Phase II). This study used a multiphase explanatory sequential mixed methods design with qualitative prioritization. Maryland SFSP sponsors completed an online survey (Phase I: n = 27, Phase II: n = 30), and semi-structured in-depth interviews were conducted with a subset of sponsors who completed the survey (Phase I: n = 12, Phase II: n = 7). Inductive and deductive analyses were used for qualitative data, and descriptive statistics were used for quantitative data. The COVID-19 pandemic caused SFSP sponsors to change their operations. Sponsors were primarily concerned about staff safety/burnout and decreased participation. Sponsors perceived waivers implemented by the United States Department of Agriculture to be crucial in enabling them to serve meals to children during the pandemic. The findings from our study support advocacy efforts to permanently implement waivers and provide free school meals for all children.

Differences in a Chain Supermarket's Sales to SNAP Shoppers Before and Since the COVID-19 Pandemic.

OBJECTIVE: This study 1) compares grocery sales to Supplemental Nutrition Assistance Program (SNAP) shoppers in rural and urban grocery stores and 2) estimates changes in sales to SNAP shoppers in North Carolina (NC) since the pandemic. DESIGN: Weekly transaction data among loyalty shoppers at a large grocery chain across NC from October 2019 to December 2020 (n = 32; 182 store weeks) to assess nutritional outcomes. SETTING: North Carolina large chain grocery stores. PARTICIPANTS: Large chain grocery store/SNAP shoppers. INTERVENTION: Rural/urban status of the stores and COVID-19 pandemic onset. MAIN OUTCOME MEASURES: Share of total calories sold from fruits, vegetables, nuts, and legumes (FVNL) with and without additives, sugar-sweetened beverages (SSB), less healthful foods (LHF), and processed meats (PM). ANALYSIS: Multivariate random effects models with robust standard errors to examine the association of rural/urban status before and since coronavirus disease 2019 with the share of calories sold to SNAP shoppers from each food category. We controlled for county-level factors (eg, sociodemographic composition, food environment) and store-level factors. RESULTS: We did not find significant rural-urban differences in the composition of sales to SNAP shoppers in adjusted models. There was a significant decrease in the mean share of total calories from sugar-sweetened beverages (-0.43%) and less healthful food (-1.32%) and an increase in the share from processed meats (0.09%) compared with before the pandemic (P < 0.05). CONCLUSIONS AND IMPLICATIONS: Urban-rural definitions are insufficient to understand nuances in food environments, and more support is needed to ensure healthy food access.

Food insecurity and health outcome nexus: empirical evidence from the informal sector enterprises in Bangladesh.

BACKGROUND: Food insecurity indicates the difficulty of constantly obtaining adequate food because of limited economic resources. Food insecurity challenges the desired health outcomes. Although extensive literature has examined the associations between food security and health, low-wage informal sector workers have been less frequently addressed in this topic. The present study has focused on food insecurity among the workers working in the informal sector enterprises who experienced entrenched disadvantage during COVID-19 and examines the relationship between food insecurity and health status as measured by self-reported physical and mental health conditions. METHODS: This study has utilized cross-sectional data collected from workers working in informal manufacturing and business enterprises in Dhaka city of Bangladesh. The Food Insecurity Experience Scale (FIES) with eight items is used to screen for food insecurity, and the Short Form 12v2 (SF12v2) scale with 12 questions, and validated for use with Bengali respondents, is used to measure the health status of the informal workers. A health production function has been constructed where the health status (both physical and mental) of workers is associated with food insecurity and other socio-economic and health care factors. Empirical analyses of the study have included descriptive statistics, mean score comparisons, and multivariate regression analyses to identify the predictive factors of the physical and mental health status of the workers. RESULTS: A moderate to severe food insecurity is found to be responsible for the poor health status (both physical and mental) of the selected working group population. Moreover, age over 40 years, having a large family, dissatisfaction with the work place, and the prevalence of occupational health risks are linked to lower physical health, while dissatisfaction with the work place and the incidence of severe diseases contribute to poor mental health status along with food insecurity. CONCLUSIONS: Extending social and economic protection towards health coverage and basic consumption is suggested as an immediate action to save lives and ensure productivity of the informal workers. Besides, an increase in income and ensuring decent working conditions are also recommended for the health, safety and satisfaction of workers working in informal sector enterprises.