Food Insecurity and Chronic Disease Among Native Hawaiians and Pacific Islanders on the Continent During COVID-19

Financial precarity and food insecurity are strongly associated with poor health outcomes. Recently, the COVID-19 pandemic caused major disruptions to people's livelihoods as well as interrupting supply chains, furthering economic hardship and exacerbating existing inequities. Native Hawaiian and Pacific Islander individuals, particularly those living on the continent, were especially impacted by the pandemic. This analysis used data from the Moana: Alternative Surveillance of COVID-19 in a Unique Population study to assess the economic and health correlates of food insecurity. We used the baseline survey data from 295 adult respondents and applied logistic regression to calculate adjusted Odds Ratios (aORs) and 95% Confidence Intervals (CIs). We used three definitions of food insecurity, including two definitions from the US Department of Agriculture and a third question that queried about food insecurity since the onset of the pandemic. Over half of participants expressed concerns around food security (56.0% worried about food, 52.5% reported food didn't last). Experiencing a reduction in hours due to COVID-19 was positively associated with all measures of food insecurity, while being an essential worker was protective. We also found that people with diagnosed diabetes had higher odds of reporting that food did not last (aOR: 2.12; 95% CI: 1.05-4.41) or experiencing food insecurity since the beginning of the COVID-19 pandemic (aOR: 2.36; 95% CI: 1.19-4.72). Our findings support the growing body of literature indicating a relationship between food insecurity and cardiometabolic diseases. It also suggests that NH/PI on the continent may benefit from additional, culturally tailored interventions.