The COVID-19 pandemic increased food insufficiency: a severe form of food insecurity. Drawing on an ecological framework, we aimed to understand factors that contributed to changes in food insufficiency from April to December 2020, in a large urban population hard hit by the pandemic.

We conducted internet surveys every 2 weeks in April–December 2020, including a subset of items from the Food Insecurity Experience Scale. Longitudinal analysis identified predictors of food insufficiency, using fixed effects models.

Los Angeles County, which has a diverse population of 10 million residents.

A representative sample of 1535 adults in Los Angeles County who are participants in the Understanding Coronavirus in America tracking survey.

Rates of food insufficiency spiked in the first year of the pandemic, especially among participants living in poverty, in middle adulthood and with larger households. Government food assistance from the Supplemental Nutrition Assistance Program was significantly associated with reduced food insufficiency over time, while other forms of assistance such as help from family and friends or stimulus funds were not.

The findings highlight that during a crisis, there is value in rapidly monitoring food insufficiency and investing in government food benefits.

Food pantries and the Supplemental Nutrition Assistance Program (SNAP) are widely available resources for individuals facing food insecurity, yet the dietary quality of individuals using both programmes is not well characterised. We describe the dietary intake of individuals in North Texas who use both food pantries and SNAP to identify nutritional gaps and opportunities to improve food assistance programmes.

We analysed baseline data from a randomised controlled trial examining food security and dietary intake. At baseline, we administered the validated, 26-item Dietary Screener Questionnaire (DSQ). We calculated descriptive statistics for dietary intake variables and compared with the 2020–2025 Dietary Guidelines for Americans recommended intake values.

Two large food pantries in Dallas County, TX.

Eligible participants were English or Spanish speaking adults receiving SNAP benefits who had used the food pantry within the last 4 months.

We analysed baseline DSQ data from 320 participants (mean age 47 years; 90% female; 45% Black or African American; 37% Hispanic or Latino). Despite receiving SNAP benefits and food pantry assistance, most participants did not meet the minimum recommended intake values for fruits (88.4%), vegetables (97.4%), fibre (90·7%), whole grains (99·7%), dairy products (98·4%) and Ca (83·4%). Furthermore, 73·2% of participants exceeded the maximum recommended intake for added sugar. Still, the gap between median daily intake and recommended daily intake could be partially bridged with food obtained through current food assistance programmes.

Multilevel, coordinated approaches within both SNAP and food pantry networks are needed to improve diet quality in individuals receiving food assistance.

To examine the variety of fruits and vegetables lower income households in the USA can buy while meeting Federal dietary recommendations at different levels of expenditure.

Simulation techniques were used to create 3000 market baskets of fruits and vegetables. All baskets contained enough food for a four-person household to meet dietary recommendations for fruits and vegetables over 1 week. Each basket’s retail value was estimated along with the ability of a representative household to afford each basket with different levels of expenditure.

We used data from the US Department of Agriculture’s (USDA) Fruit and Vegetable Prices data product which reports a US household’s costs to buy each of 157 different fruit and vegetable products per edible cup equivalent.

We consider the situation facing a lower income household that receives maximum benefits through the Supplemental Nutrition Assistance Program (SNAP). These benefits are enough for the household to obtain a nutritious and palatable diet without spending any of its own money on food if it approximately follows USDA’s Thrifty Food Plan.

Households receiving maximum SNAP benefits can buy a sufficient variety and quantity of fruits and vegetables if they allocate about 40 % of those benefits to these two food groups. However, if households spend less than that amount, the variety of products they can buy while still satisfying recommendations drops off quickly.

Households that move fruits and vegetables to the centre of their budgets can better afford to meet Federal dietary guidelines.

Supplemental Nutrition Assistance Program (SNAP) benefits are rapidly depleted after distribution. This phenomenon, known as the benefit cycle, is associated with poor nutrition and health outcomes. However, to date, no study has evaluated trends in food expenditures before and after households receive benefits using prospective data, and whether these trends vary by household characteristics.

Generalised estimating equations were used to model weekly household food expenditures during baseline (pre-benefit) and intervention months by vendor (restaurants and food retailers). Food retailer expenditures were further evaluated by food category (fruits and vegetables and foods high in added sugar). All expenditures were evaluated by household composition, demographics and economic means.

Minneapolis-St. Paul, Minnesota, metropolitan area.

Low-income households (n 249) enrolled May 2013–August 2015.

Weekly food retailer expenditures did not vary during baseline (pre-benefit), but demonstrated a cyclical pattern after households received benefits across all household characteristics and for both food categories, particularly for fruits and vegetables. Households with greater economic resources spent more throughout the month compared with those with fewer resources. Households with lower food security status experienced more severe fluctuations in spending compared with more food secure households.

Cyclical food purchasing was observed broadly across different household characteristics and food categories, with notable differences by household economic means and food security status. Proposed SNAP policy changes designed to smooth food expenditures across the benefit month, such as increased frequency of benefit distribution, should include a focus on households with fewest resources.

National concerns over food insecurity and obesity have prompted legislation seeking to further restrict Supplemental Nutrition Assistance Program (SNAP) purchases. The objective of this study is to provide insight on the potential impact of proposed purchase restrictions by comparing SNAP participant and income-eligible non-participants’ expenditures on current SNAP-restricted foods, that is, hot foods, prepared foods, alcohol, vitamins and meal supplements.

Cross-sectional study. Bivariate analysis and multivariable regression analysis with an instrumental variables approach were employed to compare the probability of purchasing and expenditures on current SNAP-restricted foods among SNAP participants and income-eligible non-participants.

National Household Food Acquisition and Purchase Survey, 2012–2013.

2513 households, of which 1316 were SNAP participants and 1197 were income-eligible non-participants.

Both the share of households purchasing and household expenditures on current SNAP-restricted foods were similar among SNAP participants and income-eligible non-participants.

Results provide further empirical evidence that proposed SNAP purchase restrictions on sugar-sweetened beverages, snack foods and luxury foods are unlikely to have a meaningful effect on SNAP household food purchases.

Electronic Benefit Transfer (EBT) placement at farmers’ markets can reduce access disparities for low-income consumers. However, resources needed to operate EBT programs may challenge markets’ business models. A conceptual model of factors impacting EBT program success was developed from literature, and an exploratory study conducted to assess the impact of model variables on market EBT sales.

Annual EBT sales data were obtained for all Hawai‘i farmers’ markets with EBT programs (n 22). Key informant interviews (n 19), along with records review, were performed to gather data on model variables. Exploratory analysis was conducted to estimate the impact of individual model variables on EBT sales.

Farmers’ markets accepting EBT in the state of Hawai‘i.

Market managers and EBT program partners (n 19).

Markets engaging in community partnerships $\left( {{\mkern 1mu} {\mkern 1mu} \Delta \overline x = \$ 852} \right)$, consumer education $\left( {{\mkern 1mu} {\mkern 1mu} \Delta \overline x = \$ {\rm{598}}} \right)$, social media promotion $\left( {{\mkern 1mu} {\mkern 1mu} \Delta \overline x = \$ {\rm{732}}} \right)$ or EBT incentives $\left( {{\mkern 1mu} {\mkern 1mu} \Delta \overline x = \$ {\rm{5}}0{\rm{9}}} \right)$ averaged higher sales than markets not reporting these practices. Sales increased by $3 for every ten additional SNAP-participating households and decreased by $35 for each competing EBT-accepting supermarket, grocery or farmers’ market within the market’s access area. Sales increased by $137/vendor for each additional hour/week the market was open.

Factors suggested by the model, particularly community engagement and partnership, marketing methods, consumer base and competition for EBT sales in the market area substantively affected EBT sales. Assessing these factors may identify markets with the greatest chance of EBT success and suggest ways to strengthen struggling EBT programs.

The 2009 American Recovery and Reinvestment Act (ARRA) increased monthly Supplemental Nutrition Assistance Program (SNAP) benefits and expanded SNAP eligibility, yet limited evidence exists on the potential impact of ARRA on dietary intake among at-risk individuals. We aimed to examine pre-/post-ARRA differences in food insecurity (FI) and dietary intake by SNAP participation status.

Pre/post analysis.

Boston, MA, USA.

Data were from the longitudinal Boston Puerto Rican Health Study (2007–2015). The US Department of Agriculture ten-item adult module assessed FI. A validated FFQ assessed dietary intake. Diet quality was assessed using the Alternate Healthy Eating Index-2010 (AHEI-2010). Self-reported pre-/post-ARRA household SNAP participation responses were categorized as: sustained (n 249), new (n 95) or discontinued (n 58). We estimated differences in odds of FI and in mean nutrient intakes and AHEI-2010 scores post-ARRA.

Compared with pre-ARRA, OR (95 % CI) of FI post-ARRA were lower for all participants (0·69 (0·51, 0·94)), and within sustained (0·63 (0·43, 0·92)) but not within new (0·94 (0·49, 1·80)) or discontinued (0·63 (0·25, 1·56)) participants. Post-ARRA, total carbohydrate intake was higher, and alcohol intake was lower, for sustained and new participants, and dietary fibre was higher for sustained participants, compared with discontinued participants. Scores for AHEI-2010 and its components did not differ post-ARRA, except for lower alcohol intake for sustained v. discontinued participants.

Post-ARRA, FI decreased for sustained participants and some nutrient intakes were healthier for sustained and new participants. Continuing and expanding SNAP benefits and eligibility likely protects against FI and may improve dietary intake.

The current study aimed to (i) describe racial/ethnic disparities in household food and beverage purchases among participants and non-participants in the Supplemental Nutrition Assistance Program (SNAP) and (ii) examine longitudinal associations between SNAP participation and purchases by race/ethnicity.

To describe disparities, we estimated sociodemographic-adjusted mean purchases of seven unhealthy food and beverage groups (e.g. junk food, sugar-sweetened beverages) and four nutrients (e.g. sugar, Na) among white, black and Hispanic SNAP-participating and non-participating households. To examine longitudinal associations, we used multivariable linear regression with household fixed effects.

USA, 2010–2014.

Food and beverage purchases among low-income (≤250 % federal poverty line) US households (n 30 403) participating in the Nielsen Homescan Panel.

Among non-participants, there were significant black–white disparities (i.e. differences favouring white households) in households’ adjusted mean purchases of processed meat, sweeteners, sugar-sweetened beverages, energy and Na. These disparities persisted among SNAP participants. In contrast, the only significant Hispanic–white disparity among non-participants was for Na purchases; this disparity was reduced in magnitude and no longer significant among SNAP-participating households. Additionally, Hispanic households purchased less energy from junk foods than white households, regardless of SNAP status. In longitudinal models accounting for household fixed effects, SNAP participation was associated with increased energy purchased among black households. No other significant longitudinal associations between SNAP and purchase outcomes were observed.

SNAP may not be meeting its potential to improve food and beverage purchases or reduce disparities. Research is needed to identify strategies for ensuring nutritious purchases across all racial/ethnic groups.

Farmers’ market interventions are a popular strategy for addressing chronic disease disparities in low-income neighbourhoods. With limited resources, strategic targeting of interventions is critical. The present study used spatial analysis to identify where market interventions have the greatest impact on healthy food access within a geographic region.

All farmers’ markets in a mixed urban/rural county were mapped and those that accepted Supplemental Nutrition Assistance Program (SNAP) electronic benefit transfer (EBT) cards identified. Households were grouped into small neighbourhoods and mapped. The area of ‘reasonable access’ around each market (walking distance (0·8 km; 0·5mile) in urban areas, driving distance (15 min) in rural areas) was calculated using spatial analysis. The percentage of county low-income households within a market’s access area, and the percentage of county SNAP-participating households within an EBT-accepting market’s access area, were calculated. The ten neighbourhoods with the most low-income households and with the most SNAP-participating households were then identified, their access areas calculated and mapped, and those lacking access identified. County-level gains resulting from improving market accessibility in these areas were calculated.

None.

Honolulu County, Hawaii, USA.

Only 44 % of SNAP-participating households had EBT-market access. Six of the ten highest SNAP-participant neighbourhoods lacked access. Improving access for these neighbourhoods increased county-level access by 23 %. Market access for low-income households was 74 %. Adding markets to these low-income neighbourhoods without market access increased county-level access by 4 %.

Geographic identification of market access demographics, and strategic targeting of EBT interventions, could improve regional access to healthy foods.

We aimed to examine the food-seeking experiences of homeless emerging adults (age 18–24 years) in a US urban context.

The study used a qualitative descriptive design, combining semi-structured interviews with a standardized quantitative measure of food insecurity. Interview data were coded using constant comparative methods to identify patterns across and within interviews. Emerging themes were confirmed and refined through member checking.

Buffalo, a mid-sized city in the Northeastern USA.

A sample of thirty participants was recruited through community-based methods. Eligibility criteria specified that participants were aged 18–24 years and did not have a stable place to live. The sample was demographically diverse and included participants who were couch-surfing, staying on the streets and/or using shelters.

Participants’ food access strategies varied across their living circumstances. Common strategies included purchasing food with cash or benefits (reported by 77 %), using free meal programmes (70 %) and eating at friends’ or relatives’ homes (47 %). Although 70 % of participants received Supplemental Nutrition Assistance Program benefits, several reported access barriers, including initial denials of eligibility due to being listed on a parent’s application even when the participant no longer resided in the household. Participants described a stigma associated with using food pantries and free meal programmes and expressed preference for less institutionalized programmes such as Food Not Bombs.

Given endemic levels of food insecurity among homeless youth and young adults, policy modifications and service interventions are needed to improve food access for this population.

Previous research indicates that low-income individuals often struggle to consume the recommended amount of fruits and vegetables (F&V). LINK Up Illinois is a farmers’ market incentive programme that aims to increase F&V consumption among Supplemental Nutrition Assistance Program (SNAP) recipients by improving access to and affordability of locally grown foods. The present research aimed to identify barriers to F&V consumption that exist among users of the LINK Up Illinois programme.

Cross-sectional.

Farmers’ markets in Chicago, Springfield, Northbrook, Woodstock, Aurora and Urbana, IL.

In 2016, a volunteer sample of 140 LINK Up Illinois users (mean age 42·5 years; 81·7 % female; 28·7 % African American; 44·0 % obese) completed a survey at participating farmers’ markets across the state. Information on demographics, food shopping behaviours, programme satisfaction, barriers to F&V consumption and frequency of F&V consumption was collected and examined.

Approximately 23 % of survey participants reported consuming F&V ≥3 times/d. The barriers to F&V consumption most often reported by survey participants were the cost of F&V (29·5 %), spoilage (18·6 %), knowing how to cook F&V (8·7 %) and not thinking about F&V when hungry (8·6 %). Results from multivariable-adjusted logistic regression models suggested that reporting one or more barriers was associated with reduced odds of consuming vegetables ≥3 times/d, but not fruits.

Cost, spoilage and knowledge of cooking are key barriers to F&V consumption that exist among LINK Up Illinois users. Strategies are needed to mitigate these barriers and increase F&V consumption in this population.

Access to nutritious foods is key to achieving health promotion goals. While there is evidence that nutritious food access is complex, measures assessing multiple domains of access, including spatial-temporal, economic, social, service delivery and personal, are lacking. The current study evaluates psychometric properties of scales designed to measure perceptions of multiple domains of nutritious food access among low-income populations.

A cross-sectional survey was conducted in 2015. Eighty-one items were selected or developed to represent five domains of nutritious food access for food shopping overall and specific to shopping at farmers’ markets. Evaluation of the items included exploratory factor analysis within each domain and internal consistency reliability for each of the sub-scales.

Data were collected in seventeen urban neighbourhoods in Greater Cleveland, Ohio, USA that have high levels of poverty. All participants had access to at least one farmers’ market within 1·6 km (1 mile) of their home to standardize spatial access to nutritious foods.

Adults (n 304) receiving Supplemental Nutrition Assistance Program benefits.

Each domain included multiple sub-domains: spatial-temporal (four), service delivery (two), economic (two), social (three) and personal (three), for a total of fourteen subdomains. The internal consistency reliability for one of the sub-domains was outstanding (>0·90), seven were excellent (0·80–0·89), five were very good (0·70–0·79) and one scale had poor reliability (0·58).

Multiple sub-domains of nutritious food access can be assessed using short measures that have been tested for internal consistency. These measures are suitable for assessing the complex phenomena of nutritious food access among low-income populations.

To examine the association of both perceived and geographic neighbourhood food access with food security status among households with children.

This was a cross-sectional study in which participants’ perceptions of neighbourhood food access were assessed by a standard survey instrument, and geographic food access was evaluated by distance to the nearest supermarket. Multinomial logistic regression models were used to examine the associations.

The Midlands Family Study included 544 households with children in eight counties in South Carolina, USA. Food security status among participants was classified into three categories: food secure (FS), food insecure (FI) and very low food security among children (VLFS-C).

Compared with FS households, VLFS-C households had lower odds of reporting easy access to adequate food shopping. VLFS-C households also had lower odds of reporting neighbourhood access to affordable fruits and vegetables compared with FS households and reported worse selection of fruits and vegetables, quality of fruits and vegetables, and selection of low-fat products. FI households had lower odds of reporting fewer opportunities to purchase fast food. None of the geographic access measures was significantly associated with food security status.

Caregivers with children who experienced hunger perceived that they had less access to healthy affordable food in their community, even though grocery stores were present. Approaches to improve perceived access to healthy affordable food should be considered as part of the overall approach to improving food security and eliminating child hunger.

Because farmers’ markets include a variety of fruits and vegetables, shopping at farmers’ markets would likely improve diet quality among low-income consumers, as well as promote sustainable direct farm-to-consumer business models. However, not much is known about how to promote farmers’ market shopping among low-income consumers. Therefore, the purpose of the present paper was to examine barriers to and facilitators of shopping at farmers’ markets and associations between shopping at farmers’ markets and self-reported dietary behaviours (fruit and vegetable, sugar-sweetened beverage and fast-food consumption) and BMI.

Cross-sectional analyses of associations between farmers’ market shopping frequency, awareness of markets, access to markets, dietary behaviours and BMI.

Department of Social Services, Pitt County, eastern North Carolina, USA.

Between April and July 2013, Supplemental Nutrition Assistance Program (SNAP) participants (n 205) completed a quantitative survey.

Barriers to shopping at farmers’ markets included does not accept SNAP/electronic benefit transfer, out of the way and lack of transportation. Farmers’ market shopping was associated with awareness of farmers’ markets (estimate =0·18 (se 0·04), P<0·001). Fruit and vegetable consumption was positively associated with farmers’ market shopping (estimate =1·06 (se 0·32), P=0·001).

Our study is one of the first to examine SNAP participants’ farmers’ market shopping, distance to farmers’ markets and dietary behaviours. Barriers to shopping at farmers’ markets and increasing awareness of existing markets should be addressed in future interventions to increase SNAP participants’ use of farmers’ markets, ultimately improving diet quality in this high-risk group.

Public assistance programmes may increase risk of obesity among adults. The current study assessed whether participation in the Supplemental Nutrition Assistance Program (SNAP; formerly the Food Stamp Program), Supplemental Security Income (SSI) or California Work Opportunities and Responsibilities to Kids (CalWorks) was associated with obesity, independent of socio-economic status and food insecurity.

A cross-sectional analysis of the 2007 Adult California Health Interview Survey. Outcome measures included BMI and obesity. Distribution of BMI and prevalence of obesity were compared by participation in each programme, using weighted linear and binomial regression models in which BMI or obesity was the outcome, respectively, and programme participation was the predictor.

A population survey of various health measures.

Non-institutionalized adults (n 7741) whose household income was ≤130 % of the federal poverty level.

The prevalence of obesity was 27·4 %. After adjusting for sociodemographic characteristics, food insecurity and participation in other programmes, the prevalence of obesity was 30 % higher in SNAP participants (95 % CI 6 %, 59 %; P = 0·01) than in non-participants. This association was more pronounced among men than women. SSI participation was related to an adjusted 50 % higher prevalence of obesity (95 % CI 27 %, 77 %; P < 0·0001) compared with no participation. SNAP and SSI participants also reported higher soda consumption than non-participants of any programme. CalWorks participation was not associated with obesity after multivariable adjustment.

Participation in SNAP or SSI was associated with obesity independent of food insecurity or socio-economic status. The suggestion that these associations may be mediated by dietary quality warrants further investigation among low-income populations.