COVID-19 Economic Supports and Household Food Security Patterns

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.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.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.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.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.