A Multi-Site Analysis of the Prevalence of Food Insecurity in the United States, before and during the COVID-19 Pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic profoundly affected food systems including food security. Understanding how the COVID-19 pandemic impacted food security is important to provide support and identify long-term impacts and needs. OBJECTIVE: The National Food Access and COVID research Team (NFACT) was formed to assess food security over different US study sites throughout the pandemic, using common instruments and measurements. This study presents results from 18 study sites across 15 states and nationally over the first year of the COVID-19 pandemic. METHODS: A validated survey instrument was developed and implemented in whole or part through an online survey of adults across the sites throughout the first year of the pandemic, representing 22 separate surveys. Sampling methods for each study site were convenience, representative, or high-risk targeted. Food security was measured using the USDA 6-item module. Food security prevalence was analyzed using ANOVA by sampling method to assess statistically significant differences. RESULTS: Respondents (n = 27,168) indicate higher prevalence of food insecurity (low or very low food security) since the COVID-19 pandemic, compared with before the pandemic. In nearly all study sites, there is a higher prevalence of food insecurity among Black, Indigenous, and People of Color (BIPOC), households with children, and those with job disruptions. The findings demonstrate lingering food insecurity, with high prevalence over time in sites with repeat cross-sectional surveys. There are no statistically significant differences between convenience and representative surveys, but a statistically higher prevalence of food insecurity among high-risk compared with convenience surveys. CONCLUSIONS: This comprehensive study demonstrates a higher prevalence of food insecurity in the first year of the COVID-19 pandemic. These impacts were prevalent for certain demographic groups, and most pronounced for surveys targeting high-risk populations. Results especially document the continued high levels of food insecurity, as well as the variability in estimates due to the survey implementation method.

Delay discounting and obesity in food insecure and food secure women.

OBJECTIVES: The relation between food insecurity (FI) and delay discounting (DD) and probability discounting (PD) for food and money was tested in women. In addition, discounting was tested as a variable that mediates the relation between obesity and FI. METHOD: Women recruited from a community sample (N = 92) completed questionnaires. They completed the food choice questionnaire, the monetary choice questionnaire, measures for food and money probability discounting (which quantify sensitivity to risk aversion), and demographic measures. RESULTS: Women with FI had higher rates of obesity and higher food DD compared to food-secure women. However, DD for money or probability discounting for food or money did not significantly differ between FI and food secure groups when controlling for significant covariates. Neither DD or PD significantly mediated the relation between FI and obesity. CONCLUSIONS: These results suggest that FI is associated with greater impulsive food choice, but its association with other monetary discounting and probability discounting for food and money appears contingent upon other demographic factors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Self-efficacy is associated with increased food security in novel food pantry program.

We examined the effect of a novel food pantry intervention (Freshplace) that includes client-choice and motivational interviewing on self-efficacy and food security in food pantry clients. The study was designed as a randomized control trial. Participants were recruited over one year from traditional food pantries in Hartford, CT. Participants were randomized to Freshplace or traditional food pantries (controls) and data collection occurred at baseline with quarterly follow-ups for 18 months. Food security was measured using the USDA 18-item Food Security Module. A newly developed scale was utilized to measure self-efficacy. Scale reliability was measured using a Cronbach alpha test; validity was measured via correlating with a related variable. Analyses included chi-square tests for bivariate analyses and hierarchical linear modeling for longitudinal analyses. A total of 227 adults were randomized to the Freshplace intervention (n=112) or control group (n=115). The overall group was 60% female, 73% Black, mean age=51. The new self-efficacy scale showed good reliability and validity. Self-efficacy was significantly inversely associated with very low food security (p<.05). Being in the Freshplace intervention (p=.01) and higher self-efficacy (p=.04) were independently associated with decreased very low food security. The traditional food pantry model fails to recognize the influence of self-efficacy on a person's food security. A food pantry model with client-choice, motivational interviewing and targeted referral services can increase self-efficacy of clients. Prioritizing the self-efficacy of clients over the efficiency of pantry operations is required to increase food security among disadvantaged populations.

What role do local grocery stores play in urban food environments? A case study of Hartford-Connecticut.

INTRODUCTION: Research on urban food environments emphasizes limited access to healthy food, with fewer large supermarkets and higher food prices. Many residents of Hartford, Connecticut, which is often considered a food desert, buy most of their food from small and medium-sized grocery stores. We examined the food environment in greater Hartford, comparing stores in Hartford to those in the surrounding suburbs, and by store size (small, medium, and large). METHODS: We surveyed all small (over 1,000 ft2), medium, and large-sized supermarkets within a 2-mile radius of Hartford (36 total stores). We measured the distance to stores, availability, price and quality of a market basket of 25 items, and rated each store on internal and external appearance. Geographic Information System (GIS) was used for mapping distance to the stores and variation of food availability, quality, and appearance. RESULTS: Contrary to common literature, no significant differences were found in food availability and price between Hartford and suburban stores. However, produce quality, internal, and external store appearance were significantly lower in Hartford compared to suburban stores (all p<0.05). Medium-sized stores had significantly lower prices than small or large supermarkets (p<0.05). Large stores had better scores for internal (p<0.05), external, and produce quality (p<0.01). Most Hartford residents live within 0.5 to 1 mile distance to a grocery store. DISCUSSION: Classifying urban areas with few large supermarkets as 'food deserts' may overlook the availability of healthy foods and low prices that exist within small and medium-sized groceries common in inner cities. Improving produce quality and store appearance can potentially impact the food purchasing decisions of low-income residents in Hartford.

Formative research to examine collaboration between special supplemental nutrition program for woman, infants, and children and head start programs.

Both the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Head Start/Early Head Start (HS/EHS) Programs serve low-income women and children at high risk for health disparities, yet they do not have a formal state-level partnership in Connecticut. Both programs serve children up to age five, yet children's participation in the WIC Program declines sharply after 2 years of age, limiting the potential benefits of cross-program participation. The goal of this study is to examine current and prospective collaboration efforts among the WIC and HS/EHS Programs in Connecticut and identify barriers to collaboration. An online survey was administered to staff from both programs. Six focus groups were held in January, 2012 with staff and participants from both programs. Results showed areas of existing collaboration between local WIC and HS/EHS Programs, yet also identified many areas where relationships could be strengthened or established. Common themes that were identified included a need for more knowledge among staff about the other program, collaboration involving sharing of client information, and improving referral procedures. Staff from both programs strongly expressed interest in a cross-program collaboration (73 % of HS staff and 86 % of WIC staff). This research serves as a framework for how a state-level collaboration could be established in Connecticut, to enable these two programs to work together more efficiently and effectively for the benefit of mothers and children. Results can provide other State WIC Programs with a blueprint for collaborating with HS/EHS.

A novel food pantry program: food security, self-sufficiency, and diet-quality outcomes.

BACKGROUND: The number of food pantries in the U.S. has grown dramatically over 3 decades, yet food insecurity remains a persistent public health problem. PURPOSE: The goal of the study was to examine the impact of a food pantry intervention called Freshplace, designed to promote food security. DESIGN: Randomized parallel-group study with equal randomization. SETTING/PARTICIPANTS: Data were collected from June 2010 to June 2012; a total of 228 adults were recruited over 1 year from traditional food pantries and randomized to the Freshplace intervention (n=113) or control group (n=115), with quarterly follow-ups for 12 months. INTERVENTION: The Freshplace intervention included a client-choice pantry, monthly meetings with a project manager to receive motivational interviewing, and targeted referrals to community services. Control group participants went to traditional food pantries where they received bags of food. MAIN OUTCOME MEASURES: Data analyses were conducted from July 2012 to January 2013. Outcomes were food security, self-sufficiency, and fruit and vegetable consumption. Multivariate regression models were used to predict the three outcomes, controlling for gender, age, household size, income, and presence of children in the household. RESULTS: At baseline, half of the sample experienced very low food security. Over 1 year, Freshplace members were less than half as likely to experience very low food security, increased self-sufficiency by 4.1 points, and increased fruits and vegetables by one serving per day compared to the control group, all outcomes p<0.01. CONCLUSIONS: Freshplace may serve as a model for other food pantries to promote food security rather than short-term assistance by addressing the underlying causes of poverty.

Food insecurity, poor diet quality, and obesity among food pantry participants in Hartford, CT.

OBJECTIVE: Examine relationships between food security, diet quality, and body mass index (BMI) among food pantry users. METHODS: Convenience sample of 212 food pantry clients in Hartford, CT from June, 2010 to May, 2011. Main outcomes included food security (United States Department of Agriculture module), fruit and vegetable consumption (Block Screener), and BMI (stadiometer and digital medical scale). Chi-square tests, Spearman correlations, and logistic regression models were analyzed. RESULTS: Over half of the sample (50.5%) had very low food security. Mean BMI was 29.5 kg/m(2). Age was positively associated with food security (P < .01). Food-secure participants were twice as likely to eat fruit, vegetables, and fiber as food-insecure participants (P = .04). Women were 4 times as likely to be obese as men (P < .01), yet food insecurity was not associated with obesity in this sample. CONCLUSIONS AND IMPLICATIONS: Ensuring the nutritional adequacy of donated food is an important consideration for food donors and pantry staff.

Federal nutrition program changes and healthy food availability.

BACKGROUND: Literature on food environments is expanding rapidly, yet a gap exists regarding the role of the U.S. Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on healthy food availability. In October 2009, the U.S. Department of Agriculture revised the WIC food package, requiring certified stores to stock fresh produce, whole grains, and lower-fat milk. PURPOSE: The goal of this study is to compare availability of foods in stores that are versus those that are not WIC-certified before and after the policy change. METHODS: Store inventories were collected in 45 corner stores in Hartford CT with four inventories each (180 total inventories) from January 2009 to January 2010. Data on availability and variety of fresh fruits, fresh vegetables, whole grains, and lower-fat milk were recorded. Analyses were completed in 2012 using Fisher's exact test, chi-square, and t-tests for descriptive analyses and multilevel models to measure food availability longitudinally (significance at p<0.05). RESULTS: Controlling for covariates, WIC-certified vendors carried more varieties of fresh fruit (p<0.01); a greater proportion of lower-fat milk (p<0.01); and had greater availability of whole grain bread (p<0.01) and brown rice (p<0.05) than vendors without WIC authorization after the policy change. Conversely, for all outcomes, stores without WIC authorization did not significantly increase healthy food availability. CONCLUSIONS: The 2009 WIC revisions increased availability of healthy foods among WIC-certified vendors compared to those without WIC authorization in Hartford CT. For many residents without a car, these changes can create a convenient shopping location for healthy foods when a larger supermarket is not nearby.

If you stock it, will they buy it? Healthy food availability and customer purchasing behaviour within corner stores in Hartford, CT, USA.

OBJECTIVE: Literature on food environments has expanded rapidly, yet most research focuses on stores and community characteristics without integrating customer-level data. The present study combines customer shopping behaviour with store food inventory data. DESIGN: Face-to-face interviews were conducted with customers shopping in corner stores to measure food shopping behaviour, household food security and demographics. Store inventories were conducted to measure availability of healthy food in corner stores. Multilevel logistic regression models estimated the probability of customers purchasing a food item given the availability of that item in the store. SETTING: Nineteen corner stores in Hartford, CT, USA, average size 669 ft(2) (62.15 m(2)). SUBJECTS: Sample of 372 customers. RESULTS: The majority of customers were Black or Hispanic (54 % and 40 %, respectively) and 61 % experienced food insecurity. For each additional type of fruits or vegetables available in the store, the estimated odds of a customer purchasing fruits increased by 12 % (P = 0.03) and the odds for purchasing vegetables increased by 15 % (P = 0.01). Customers receiving the Supplemental Nutrition Assistance Program (SNAP) were 1.7 times as likely to purchase fruit as those not receiving SNAP (P = 0.04). Greater availability of reduced-fat milk was not associated with increased likelihood of customers purchasing reduced-fat milk. CONCLUSIONS: There is a positive association between fruit and vegetable variety and the probability that a customer purchases fruits and vegetables. Increasing the selection of produce in corner stores may increase their consumption by food-insecure and low-income residents at risk for health disparities. These findings have implications for future store interventions and food policies.

Food insecurity and gender are risk factors for obesity.

OBJECTIVE: Examine relationships between adult obesity, childhood overweight, and food insecurity. DESIGN: Cross-sectional retrospective study. SETTING: Community settings in Hartford, Connecticut. PARTICIPANTS: Convenience sample of 200 parents and their 212 children, aged 2-12. MAIN OUTCOME MEASURES: Adult obesity (Body Mass Index [BMI] > 30), childhood overweight (BMI-for-age > 95(th) percentile), and household food security (U.S. Department of Agriculture module). ANALYSIS: Chi-square tests between weight status and socioeconomic characteristics. Multinomial regression analyses to determine risk factors for adult obesity and childhood overweight. RESULTS: Over half of parents (51%) were obese, and almost one-third of children (31.6%) were overweight. Over half of households were food insecure. Food insecure adults were significantly more likely to be obese as those who were food secure (Odds Ratio [OR]=2.45, p = .02). Being a girl and having an obese parent doubled the likelihood of children being overweight (OR=2.56, P = .01; OR=2.32, P = .03). Children with family incomes below 100% of poverty were half as likely to be overweight as those with higher incomes (OR=.47, P = .05). Food insecurity did not increase odds of childhood overweight. CONCLUSIONS AND IMPLICATIONS: Obesity prevention programs and policies need to address food insecurity and gender as key risk factors.

Social capital is associated with decreased risk of hunger.

This article explores whether social capital-a measure of trust, reciprocity and social networks-is positively associated with household food security, independent of household-level socioeconomic factors. Interviews were conducted in 330 low-income households from Hartford, Connecticut. Social capital was measured using a 7-item Likert scale and was analyzed using household- and community-level scores. Household food security and hunger were measured using the US Household Food Security Module. chi2 tests were used to examine associations between social capital, food security and household demographic characteristics. Logistic regression was used to examine whether household- and community-level social capital decreases the odds of household hunger, and to estimate which household characteristics increase the likelihood of having social capital. Consistent with our hypotheses, social capital, at both the household and community levels, is significantly associated with household food security in these data. Community-level social capital is significantly associated with decreased odds of experiencing hunger (adjusted odds ratio (AOR)=0.47 [95% CI 0.28, 0.81], P<0.01), while controlling for household socioeconomic status. Results show that households with an elderly member are over two and a half times as likely to have high social capital (AOR=2.68 [1.22, 5.87], P<0.01) than are non-elderly households, after controlling for socioeconomic status. Having a household member who participates in a social or civic organization is also significantly associated with having higher levels of social capital. Social capital, particularly in terms of reciprocity among neighbors, contributes to household food security. Households may have similarly limited financial or food resources, but households with higher levels of social capital are less likely to experience hunger.

Public versus private food assistance: barriers to participation differ by age and ethnicity.

OBJECTIVE: To examine participation in the Food Stamp Program, food pantries, and soup kitchens and to identify reasons food-insecure households choose not to participate. DESIGN: Cross-sectional retrospective cohort study. SETTING: In respondents' homes. PARTICIPANTS: 330 randomly selected low-income households (below 185% of poverty). MAIN OUTCOME MEASURES: Participation in any of 3 public or private food assistance programs and barriers to participation in each program. ANALYSIS: Chi-square tests of association between program participation and sociodemographic characteristics. Logistic regression tested for associations between program participation and ethnicity and between food security status and household composition while controlling for potential confounding factors. RESULTS: Controlling for socioeconomic status, Black households are less than half as likely to receive food stamps (odds ratio [OR] = 0.49; P <.02) as Hispanic households. Hispanic households are more likely than non-Hispanic households to say that they feel uncomfortable using food pantries (P <.01). Elderly households are less than half as likely to receive food stamps (OR = 0.44; P =.04) as nonelderly households and are more likely to say that they feel uncomfortable receiving food stamps (P =.05). CONCLUSIONS AND IMPLICATIONS: Low-income households' perceptions of which programs are socially acceptable differ by race and age. Outreach for food stamps and private food assistance should accommodate these differences so that food-insecure households can benefit from all available food assistance.