Introduction
Household food insecurity (FI) has significant and enduring consequences for children’s health, academic performance, and behavior.1 The national prevalence of in FI in US households with children increased at the onset of the COVID-19 pandemic, decreased following pandemic economic support policies, and increased when policies expired amid the rising inflation.2 The transient nature of FI increases the risk that single point estimates may underestimate children’s FI exposure.3 Examining food security (FS) patterns through repeated measures among the same families can provide insight into the volatility of pandemic FS and its responsiveness to economic support policies.
We sought to describe patterns of household FS experienced by families before and throughout the COVID-19 pandemic and their relation to policies enacted to provide economic support, including COVID-19 economic impact payments (EIPs, commonly known as “stimulus” payments) and the expanded child tax credit (CTC). Given widening disparities in the prevalence of FI reported at the onset of the pandemic, we also examined economic and racial and ethnic differences associated with household FS patterns.
Methods
The COVID-19 Family Study observed a cohort of 697 racially, ethnically, and economically diverse families with children (median age at pandemic onset 9.7 years; range: 3.4–16.6 years) in Maryland.4 Families were recruited and enrolled from 2 wellness promotion cluster randomized controlled trials conducted in preschools and elementary/middle schools serving low- and middle-income communities (ended due to the pandemic).5,6 The study was approved by the Institutional Review Board and caregivers provided electronic informed consent for each survey wave. Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines were followed.
Caregivers completed electronic surveys over 4 waves: prepandemic (July 2017-February 2020; 98% response rate), early pandemic (May-August of 2020; 84% response rate), midpandemic (April-December of 2021; 87% response rate), and late pandemic (September 2022-May 2023; 64% response rate).4–6 Caregivers reported their household FI risk using the 2-item hunger vital sign7 at each wave, participation in EIPs in early and midpandemic, and participation in expanded CTC in late pandemic.
Our analytic sample included participants with prepandemic information on FS and at least 1 pandemic follow-up (N = 669). We defined 3 FS patterns: persistent FS, persistent FI, and transient (FS status change). Descriptive statistics and data visualizations were conducted in R version 4.3.1.
Results
Two-thirds of families were food secure throughout, 10% were persistently food insecure, and 24% experienced transient FS or were food insecure at some point during the study period. Compared with families with FS, transient and persistent families with FI tended to have lower incomes, be members of minoritized racial and ethnic groups, be single parent-led, and to reside in suburban and urban areas (Table 1). Most families (84%) received EIPs and expanded CTC payments with slightly higher participation among transient and persistent families with FI.
Sociodemographic Characteristics and COVID-19 Pandemic Economic Support Program Receipt by Household FS Patterna
| Sociodemographic Characteristics | Household FS Patterns | ||||
|---|---|---|---|---|---|
| Overall, n = 669, (%) | Persistent FS, n = 448, (%) | Transient, n = 157, (%) | Persistent FI, n = 64, (%) | P Valueb | |
| Household income, % FPLc | 331.5 (211.5) | 381.7 (97.3) | 222.7 (231.3) | 94.6 (114.4) | <.001 |
| Household income categories | <.001 | ||||
| ≤185 | 162 (25) | 47 (11) | 61 (39) | 54 (84) | |
| 186–300 | 113 (17) | 63 (14) | 42 (27) | 8 (12) | |
| >300 | 383 (58) | 329 (75) | 52 (34) | 2 (3) | |
| Locale | <.001 | ||||
| Rural | 167 (25) | 137 (31) | 24 (15) | 6 (9) | |
| Suburban | 372 (56) | 243 (54) | 99 (63) | 30 (47) | |
| Urban | 130 (19) | 68 (15) | 34 (22) | 28 (44) | |
| Caregiver race and ethnicity | <.001 | ||||
| Non-Hispanic white | 347 (52) | 292 (65) | 40 (25) | 15 (23) | |
| Minority race and ethnicityd | 322 (48) | 156 (35) | 117 (75) | 49 (77) | |
| Marital status | <.001 | ||||
| Married | 443 (66) | 348 (78) | 76 (48) | 19 (30) | |
| Singlee | 226 (34) | 100 (22) | 81 (52) | 45 (70) | |
| COVID-19 pandemic economic support program receipt | |||||
| EIPs | 564 (84) | 360 (81) | 145 (92) | 59 (92) | <.001 |
| Expanded CTC | 329 (84) | 210 (81) | 88 (88) | 31 (94) | .07 |
| Sociodemographic Characteristics | Household FS Patterns | ||||
|---|---|---|---|---|---|
| Overall, n = 669, (%) | Persistent FS, n = 448, (%) | Transient, n = 157, (%) | Persistent FI, n = 64, (%) | P Valueb | |
| Household income, % FPLc | 331.5 (211.5) | 381.7 (97.3) | 222.7 (231.3) | 94.6 (114.4) | <.001 |
| Household income categories | <.001 | ||||
| ≤185 | 162 (25) | 47 (11) | 61 (39) | 54 (84) | |
| 186–300 | 113 (17) | 63 (14) | 42 (27) | 8 (12) | |
| >300 | 383 (58) | 329 (75) | 52 (34) | 2 (3) | |
| Locale | <.001 | ||||
| Rural | 167 (25) | 137 (31) | 24 (15) | 6 (9) | |
| Suburban | 372 (56) | 243 (54) | 99 (63) | 30 (47) | |
| Urban | 130 (19) | 68 (15) | 34 (22) | 28 (44) | |
| Caregiver race and ethnicity | <.001 | ||||
| Non-Hispanic white | 347 (52) | 292 (65) | 40 (25) | 15 (23) | |
| Minority race and ethnicityd | 322 (48) | 156 (35) | 117 (75) | 49 (77) | |
| Marital status | <.001 | ||||
| Married | 443 (66) | 348 (78) | 76 (48) | 19 (30) | |
| Singlee | 226 (34) | 100 (22) | 81 (52) | 45 (70) | |
| COVID-19 pandemic economic support program receipt | |||||
| EIPs | 564 (84) | 360 (81) | 145 (92) | 59 (92) | <.001 |
| Expanded CTC | 329 (84) | 210 (81) | 88 (88) | 31 (94) | .07 |
Abbreviations: CTC, child tax credit; EIPs, economic impact payments; FPL, federal poverty level; FI, food insecurity; FS, food security.
Values presented as n (%) or median (IQR), as appropriate.
P value from nonparametric analysis of variance or χ2 test, as appropriate.
Median (IQR).
Minority race and ethnicity includes Non-Hispanic Black (n = 253), Hispanic of any race (n = 38), Non-Hispanic multiracial (n = 24), other race and ethnicity (n = 19), and unknown race and ethnicity (n = 11).
Single includes widowed, divorced, and separated.
Figure 1 shows FS patterns aligned with economic support policies. Among transient families, FI increased in 2020, decreased in 2021 following EIPs and expanded CTC payments, and increased in 2023 after these policies expired.
Household FS patterns before, during, and following the expiration of COVID-19 pandemic economic support programs. The line graph displays the prevalence of FI at each survey wave by household FS pattern. FI prevalence is plotted at the midresponse date for each survey wave. The horizontal bars represent the periods that federal COVID-19 economic support programs were active.
Household FS patterns before, during, and following the expiration of COVID-19 pandemic economic support programs. The line graph displays the prevalence of FI at each survey wave by household FS pattern. FI prevalence is plotted at the midresponse date for each survey wave. The horizontal bars represent the periods that federal COVID-19 economic support programs were active.
Discussion
This investigation examined patterns in FI across the COVID-19 pandemic in conjunction with economic support policies implemented at the time. Despite a major expansion of the social safety net and wide uptake of pandemic-era economic supports, one-third of families experienced FI.
The transient group was highly sensitive to economic volatility (ie, inflation) and economic support policies. A quarter of families experienced transient FI, which coincided with the introduction and withdrawal of economic supports like the EIPs and CTC and is consistent with repeated cross-sectional research.8 Among the persistent FI group, the EIPs and CTC did not appear to alleviate FI. A limitation, however, is that the hunger vital sign could not detect decreases in FI severity that may have occurred.
The prevalence of FI for the transient group was higher at follow-up than at prepandemic, suggesting that a permanent policy change that offers direct financial support to families and extends policies, such as the EIPs and CTC, may be necessary to prevent FI among this vulnerable group of families. Furthermore, families experiencing persistent FI may need more substantial support from economic support policies. Such policies have important implications for reducing longstanding economic and racial and ethnic disparities in the burden of FI and its detrimental effects for children.
Dr Kowalski conceptualized and designed the study, carried out the initial analyses, drafted the initial manuscript, and critically reviewed and revised the manuscript; Drs Hatton, Qureshi, and Dou critically reviewed and revised the manuscript for important intellectual content; Ms Deitch coordinated and supervised data collection and critically reviewed and revised the manuscript for important intellectual content; and Drs Black and Hager conceptualized and designed the study, designed the data collection instruments, coordinated and supervised data collection, drafted the initial manuscript, and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
CONFLICT OF INTEREST DISCLOSURES: The authors have no conflicts of interest relevant to this article to disclose.
FUNDING: This work was supported by the National Institutes of Health (R01 HD105356, 2021–2025; R01 DK107761, 2016–2020; Mid-Atlantic Nutrition Obesity Research Center 5P30DK072488, 2020; University of Maryland, Baltimore, Institute for Clinical and Translational Research and the National Center for Advancing Translational Sciences Clinical Translational Science Award 1UL1TR003098, 2020), the US Department of Agriculture (USDA AFRI/NIFA Childhood Obesity Grant 2016-68001-24927, 2016–2021), the Bloomberg American Health Initiative (2022–2023), and the Health Resources and Services Administration (T76MC00003).
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