Improving Maternal Health and Birth Outcomes Through FreshRx: A Food-Is-Medicine Intervention.

PURPOSE: Food insecurity has far-reaching consequences for health and well-being, especially during pregnancy and postpartum periods. This study examines a food-is-medicine approach that aimed to reduce food insecurity, maternal stress, depression, anxiety, preterm labor, and low birthweight. DESIGN: Pre-post interventional study of FreshRx: Nourishing Healthy Starts, a pregnancy focused food-is-medicine program led by a local hunger relief organization and obstetrics department. SETTING: St. Louis, Missouri, a Midwestern U.S. city with higher-than-average infant mortality, low birthweight, and preterm birth rates. SAMPLE: Participants (N = 125) recruited from a local obstetrics clinic had pregnancies earlier than 24 weeks gestation; spoke English; and were enrolled in Medicaid. At baseline, 67.0% reported very low food security and none reported high food security, while 34.7% indicated depressive symptoms. INTERVENTION: FreshRx included weekly deliveries of fresh food meal kits, nutrition counseling and education, care coordination, and supportive services. MEASURES: 18-Question U.S. Household Food Security Survey, Edinburgh Postnatal Depression Scale, birthweight, gestational age. ANALYSIS: Single arm pre-post analysis. RESULTS: Average gestational age of 38.2 weeks (n = 84) and birthweight of 6.7 pounds (n = 81) were higher than rates for the general population in the area. For study participants who completed a sixty-day post-partum assessment, 13% (n = 45) indicated maternal depression (P < .01). CONCLUSION: Food-is-medicine interventions may be an efficient, effective, and equitable tool for improving birth and maternal health outcomes.

Increased experiences of loneliness during the COVID-19 pandemic, emotional distress and changes in perceived physical and mental health: A structural equation model.

AIM: To explore how experiences of increased loneliness during the COVID-19 pandemic affected emotional distress and changes in perceptions of physical and mental health. DESIGN: Cross-sectional study. METHODS: Data from the Socio-Economic Impacts of Covid-19 Survey, a national survey administered to 5033 adults in August and September 2020 in the United States, was utilized in this study. Structural equation modelling was used to analyse the associations between increased experiences of loneliness during the pandemic, emotional distress and changes in perceptions of physical and mental health. RESULTS: Among the 47% of participants who reported increased experiences of loneliness during the pandemic, 31% reported a poorer perceived change in mental health and 12% reported a poorer perceived change in physical health. Increased experiences of loneliness during the pandemic were significantly associated with emotional distress and poorer perceived mental and physical health changes. Emotional distress significantly mediated the effect between increased experiences of loneliness during the pandemic and poorer perceived mental and physical health changes. These findings highlight the importance of producing preventative actions to combat increased loneliness and emotional distress during and after future pandemics in order to improve health perceptions, which can result in negative health outcomes over time.

Connecting the Dots between Barriers to W.I.C. Access and Adult and Child Food Insecurity: A Survey of Missouri Residents.

Background. Previous research has explored the impact of W.I.C. on recipients' health, but less is known about the connection between barriers to W.I.C. access and health outcomes. We fill in a gap in the literature by studying the relationship between barriers to Special Supplemental Nutrition Program for Women, Infants, and Children (W.I.C.) access and adult and child food insecurity. Methods. After survey administration, we analyzed a cross-sectional sample of 2244 residents in Missouri who have used W.I.C. or lived in a household with a W.I.C. recipient in the past three years. We ran logistic regression models to understand the relationships among barriers to W.I.C. utilization, adult food insecurity, and child food insecurity. Results. Having special dietary needs (for adults), lacking access to technology, encountering inconvenient clinic hours of operation, and experiencing difficulties taking off work were associated with increased adult food insecurity. Difficulties finding WIC-approved items in the store, technological barriers, inconvenient clinic hours, difficulties taking off work, and finding childcare were associated with increased child food insecurity. Conclusion. Barriers to accessing and utilizing W.I.C. are associated with adult and child food insecurity. However, current policies suggest promising approaches to curbing these barriers.

How Did Reskilling During the COVID-19 Pandemic Relate to Entrepreneurship and Optimism? Barriers, Opportunities, and Implications for Equity.

With shorter durations and fewer barriers to entry, reskilling programs may serve as vehicles for social mobility and equity, as well as tools for creating a more adaptive workforce and inclusive economy. Nevertheless, much of the limited large-scale research on these types of programs was conducted prior to the COVID-19 pandemic. Thus, given the social and economic disruptions spurred by the pandemic, our ability to understand the impact of these types of programs in recent labor market conditions is limited. We fill this gap by leveraging three waves of a longitudinal household financial survey collected across all 50 US states during the pandemic. Through descriptive and inferential methods, we explore the sociodemographic characteristics related to reskilling and associated motivations, facilitators, and barriers, as well as the relationships between reskilling and measures of social mobility. We find that reskilling is positively related to entrepreneurship and, for Black respondents, to optimism. Moreover, we find that reskilling is not merely a tool for upward social mobility, but also economic stability. However, our results demonstrate that reskilling opportunities are stratified across race/ethnicity, gender, and socioeconomic status through both formal and informal mechanisms. We close with a discussion of implications for policy and practice.

Racial and Ethnic Disparities in Housing Instability During the COVID-19 Pandemic: the Role of Assets and Income Shocks.

Stable and adequate housing is critical to sound public health responses in the midst of a pandemic. This study explores the disproportionate impact of the COVID-19 pandemic on housing-related hardships across racial/ethnic groups in the USA as well as the extent to which these disparities are mediated by households' broader economic circumstances, which we operationalized in terms of prepandemic liquid assets and pandemic-related income losses. Using a longitudinal national survey with more than 23,000 responses, we found that Black and Hispanic respondents were more vulnerable to housing-related hardships during the pandemic than white respondents. These impacts were particularly pronounced in low- and moderate-income households. We found that liquid assets acted as a strong mediator of the housing hardship disparities between white and Black/Hispanic households. Our findings imply that housing became less stable for minority groups as a result of the pandemic, particularly those households with limited liquid assets. Such housing-related disparities demonstrate the need for policies and practices that target support to economically marginalized groups and families of color in particular.

Predictors of and barriers to receipt of advance premium tax credits.

OBJECTIVES: The Advance Premium Tax Credit (APTC) is designed to remedy lack of health insurance due to cost; however, approximately 30 million Americans remain without health insurance and millions of households leave billions in tax credits unclaimed each year. A prerequisite of APTC is to file one's taxes; however, few studies have examined tax filing and APTC jointly. This study examined the relationship between tax filing and applying for APTC, as well as perceived barriers to and sociodemographic characteristics associated with applying for the APTC. STUDY DESIGN: Descriptive study. METHODS: Researchers surveyed 372 Marketplace-insured members who were eligible for APTC. RESULTS: Most of the sample filed personal taxes in 2019 and planned to file taxes in 2020, yet only 23% applied for the APTC in 2019, and 26.3% were planning to apply in 2020. Most commonly, respondents were not going to apply because they believed they were not eligible (53.5%), they did not know about the APTC (15.8%), and they did not know whether they were eligible (9.9%). Logistic regression modeling found that employment, income, and race were significantly associated with applying for the APTC. CONCLUSIONS: Barriers to applying for the APTC were unrelated to tax filing and were specific to a lack of knowledge about the APTC and eligibility. These results indicate the need to build knowledge and awareness of the APTC and eligibility and to target groups least likely to apply. Implications and future directions are discussed.

At Home and on the Brink: U.S. Parents' Mental Health during COVID-19.

Though the COVID-19 pandemic required significant changes and adaptations for most Americans, parents faced acute challenges as they had to navigate rapidly changing schooling and child care policies requiring their children to spend more time at home. This study examines the effects of COVID-19 school and workplace policies as well as environmental and economic characteristics on parental mental health, worry, hopelessness, and anxiety. Using data from four waves of the Socio-Economic Impacts of COVID-19 Survey and regression analysis, we explore associations between parents' mental health, worry, hopelessness, and anxiety and school learning environment, child grade and learning disability, employment characteristics, and sociodemographic factors. We find that having a child attend a private school or school with above average instructional quality was associated with better mental health of parents. Hybrid schooling options offering both in-person and online learning was associated with poor parental mental health, as was working from home. Being female or experiencing job or income loss were associated with worse mental health while having older children, a bachelor's degree, or high income were associated with better mental health. Results can help inform school and workplace family supports as well as opportunities to reduce mental health strains at home from various policy options.

Coping with COVID-19: Differences in hope, resilience, and mental well-being across U.S. racial groups.

OBJECTIVES: To explore if the COVID-19 pandemic revealed differences across racial groups in coping, resilience, and optimism, all of which have implications for health and mental well-being. METHODS: We collect data obtained from four rounds of a national sample of 5,000 US survey respondents in each round from April 2020 to February 2021. Using logistic regression and fixed effects models, we estimate the pandemic impacts on COVID-19 related concerns, social distancing behaviors, and mental health/life satisfaction and optimism for racial/income groups. RESULTS: Despite extreme income and health disparities before and during the COVID-19 outbreak, Blacks and Hispanics remain more resilient and optimistic than their White counterparts. Moreover, the greatest difference in resilience, optimism and better mental health-is found between poor Blacks and poor Whites, a difference that persists through all four rounds. CONCLUSIONS: These deep differences in resilience have implications for the long-term mental health of different population groups in the face of an unprecedented pandemic. Better understanding these dynamics may provide lessons on how to preserve mental health in the face of public health and other large-scale crises.

Household Spending Patterns and Hardships during COVID-19: A Comparative Study of the U.S. and Israel.

The combined supply and demand shocks of the COVID-19 pandemic have created the largest consumer behavior shift in recent history, while exposing millions of households to material hardships like food insecurity and housing instability. In this study, we draw on national surveys conducted early in the pandemic to investigate the pandemic's effects on self-reported consumer spending behaviors and experiences of hardship for households in the US and Israel; two countries that are similar in terms of their development but have had divergent experiences with and responses to the pandemic. We also examine the extent to which racial/ethnic/religious minority status and pre-pandemic employment characteristics predict these outcomes. Using descriptive and logistic regression approaches, we find that housing expenditures were fairly stable in the U.S. and Israel, while food and credit card payment expenditures were relatively volatile. We also find that skipped utility bill payments were much higher in the US than Israel, while rates of skipping housing payments and food insecurity were similar between the two countries. Generally speaking, racial/ethnic/religious minorities in both countries were more likely to experience spending volatility, while Black and Hispanic (in the US) and Arab (in Israel) households were more likely to experience hardships. Employment and financial characteristics also appeared much more predictive of hardship in the US than in Israel. Supplementary Information: The online version contains supplementary material available at 10.1007/s10834-021-09814-z.

Financial Shocks and Financial Well-Being: What Builds Resiliency in Lower-Income Households?

Households in the U.S. regularly experience unexpected negative income or expense shocks, and low- and moderate-income households experience these shocks at disproportionately high rates. Relatively little is known about the impact these shocks have on households' subjective sense of financial well-being, and how access to different types of liquidity (e.g., liquid assets, credit cards, social resources, and income flows) can mitigate the impact of these shocks on subjective financial well-being. To address these gaps in the literature, this paper uses data from a two-wave survey administered to 3,911 low- and moderate-income tax filers in 2018. Applying a difference-in-difference analysis, we find that the experience of an income shock between survey waves was associated with a large decline in subjective financial well-being, while the experience of an expense shock was associated with a more modest decline. Relatively liquidity-constrained households tended to be more negatively impacted by shocks than their counterparts, though not all sources of liquidity were equally as effective in buffering households against shocks. The findings of this paper point to the need for policymakers and program administrators to develop tools that can facilitate access to different types of liquidity to offset different financial risks for households.

How Did School Meal Access Change during the COVID-19 Pandemic? A Two-Step Floating Catchment Area Analysis of a Large Metropolitan Area.

SARS-CoV-2 (COVID-19) resulted in school closures and contingencies across the U.S. that limited access to school meals for students. While some schools attempted to provide alternative meal access points where students or parents could pick up meals, many students-especially those in low-income households-lacked adequate transportation to these access points. Thus, physical proximity to meal access points was particularly important during the pandemic. In this study, we explore how school meal access changed during the COVID-19 pandemic, especially as it relates to race/ethnicity and socio-economic status. Taking into account both the "supply" (meal access points) and the "demand" (low-income students) for free meals, we employed a two-step floating catchment area analysis to compare meal accessibility in St. Louis, Missouri before and during the pandemic in the spring and summer of 2019 and 2020. Overall, while school meal access decreased during the spring of 2020 during the early months of the pandemic, it increased during the summer of 2020. Moreover, increased access was greatest in low-income areas and areas with a higher proportion of Black residents. Thus, continuing new policies that expanded access to school meals-especially for summer meal programs-could lead to positive long-term impacts on children's health and well-being.