Ecological risk and protective factors for food insufficiency in Los Angeles County during the COVID-19 pandemic.

OBJECTIVE: 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. DESIGN: 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. SETTING: Los Angeles County, which has a diverse population of 10 million residents. PARTICIPANTS: A representative sample of 1535 adults in Los Angeles County who are participants in the Understanding Coronavirus in America tracking survey. RESULTS: 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. CONCLUSIONS: The findings highlight that during a crisis, there is value in rapidly monitoring food insufficiency and investing in government food benefits.

Food Insecurity Is Under-reported in Surveys That Ask About the Past Year.

INTRODUCTION: Food insecurity affects one in ten Americans in a typical year; recent U.S. Department of Agriculture data show that this food insecurity rate was stable from 2019 to 2021. However, data from Los Angeles County and other U.S. regions show that food insecurity spiked during the early months of the COVID-19 pandemic. One reason for this discrepancy may be that food insecurity measures assess experiences over different time frames. This study investigated the discrepancies in food insecurity rates by comparing past-week and past-year food insecurity measures and explored the role of recall bias. METHODS: Data were obtained from a representative survey panel of Los Angeles adults (N=1,135). Participants were surveyed about past-week food insecurity eleven times throughout 2021 and once about past-year food insecurity in December 2021. Data were analyzed in 2022. RESULTS: Of the participants who reported past-week food insecurity at any time in 2021, only two thirds also reported past-year food insecurity in December 2021, suggesting that one third of participants under-reported past-year food insecurity. Logistic regression models indicated that three characteristics were significantly associated with under-reporting of past-year food insecurity: having reported past-week food insecurity at fewer survey waves, not reporting recent past-week food insecurity, and having a relatively high household income. CONCLUSIONS: These results suggest substantial under-reporting of past-year food insecurity, related to recall bias and social factors. Measuring food insecurity at multiple points throughout the year may help to improve the accuracy of reporting and public health surveillance of this issue.

Self-reported dietary changes among Los Angeles County adults during the COVID-19 pandemic.

Poor diets are historically the leading cause of morbidity and mortality in the United States (U.S.), causing over 44,000 deaths each month. Dietary patterns have likely changed during the COVID-19 pandemic due to major shifts and crises in social, economic, and food systems. This study examines self-reported dietary changes in Los Angeles (L.A.) County during COVID-19, and identifies factors associated with making healthy and unhealthy changes. Data are from the Understanding Coronavirus in America Study, an internet panel of adults representative of L.A. County households (N = 1080). Multinomial logistic regression was used to test if self-reported change in diet healthiness assessed in July 2020 was associated with socio-ecological factors known to be associated with diet, assessed between April-July 2020. More than half of L.A. County residents reported making changes to their diet: 28.3% reported eating healthier food since the beginning of the pandemic, while 24.8% reported eating less healthy food. Individuals who were significantly more likely to report healthy changes were Non-Hispanic Black or Hispanic/Latino (vs. Non-Hispanic White), had received unemployment insurance, or had larger social networks. Individuals who were significantly more likely to report unhealthy changes were younger, of mixed race, had children in their household, had transportation barriers, or had obesity. Individuals who were significantly more likely to report both healthy and unhealthy changes were Asian, had experienced food insecurity, or had challenges getting food due to store closures. The pandemic may be exacerbating diet-related disease risk in some groups, such as communities of color, and among individuals with obesity and those facing transportation barriers.