Experiences of increased food insecurity, economic and psychological distress during the COVID-19 pandemic among Supplemental Nutrition Assistance Program-enrolled food pantry clients.

OBJECTIVE: The COVID-19 pandemic initially doubled the rates of food insecurity across the USA and tripled rates among households with children. Despite the association among food insecurity, chronic disease and psychological distress, narratives depicting the experiences of already food insecure populations are notably underrepresented in the literature. The current study assessed the impact of COVID-19 on clients of a food pantry who were also enrolled in the Supplemental Nutrition Assistance Program (SNAP). DESIGN: A qualitative study probing the effects of the pandemic on daily living, food needs, food buying and food insecurity. Interview transcripts were analysed using a combined deductive and inductive approach. SETTING: Interviews were conducted via telephone between May and June of 2020. PARTICIPANTS: Equal numbers of English- and Spanish-speaking clients (n 40 total). RESULTS: Three main findings emerged: (1) the pandemic increased economic distress, such as from job loss or increased utility bills due to sustained home occupancy and (2) the pandemic increased food needs, food prices and food shortages. In combination with economic stressors, this led to greater food insecurity; (3) increased economic stress and food insecurity contributed to increased psychological stress, such as from fear of infection, isolation and children being confined at home. CONCLUSIONS: Despite federal legislation and state and local programmes to alleviate food insecurity, COVID-19 exacerbated economic hardship, food insecurity and psychological distress among urban SNAP and food pantry clients. Additional research is needed to identify the most effective policies and programmes to ameliorate the short- and long-term health and economic inequities exacerbated by the pandemic.

Caregivers of youth in foster care in Texas and their role in contraception decision-making for adolescents in care.

OBJECTIVES: This study describes the perspectives of caregivers of youth in foster care in Texas about the caregiver's role in adolescent contraception decision-making for adolescents in their care, particularly for long-acting reversible contraception. The study also explores how providers and foster care agencies can better support pregnancy prevention for youth in care. STUDY DESIGN: Researchers recruited 18 caregivers of youth in care from an academic center in Texas to complete in-person, one-on-one, semistructured interviews from August to December 2019. Two independent coders identified the main concepts with thematic analysis; discrepancies were resolved by consensus. RESULTS: Most caregivers identified as female (88%), Black (59%), and ranged in age from 30 to 69 years old. Half (47%) reported previously caring for an adolescent who was pregnant or parenting. Themes from the interviews included the importance of building relationships before contraception conversations, the balance between adolescent autonomy and strict caregiver oversight in contraceptive decision-making, variation in beliefs about contraception for youth in care, and extreme reactions to long-acting reversible contraception in both directions. Providers and foster care agencies played an important role managing confidential expectations and providing resources or trainings about contraception. CONCLUSIONS: In a region of the country with high rates of adolescent pregnancy, strategies that empower adolescent autonomy allow delicate caregiver oversight, provide comprehensive information about all contraceptive options, and respond to extreme long-acting reversible contraception reactions and trainings that focus on the context of contraception that should inform communication-based interventions to address teen pregnancy prevention among youth in care. IMPLICATIONS: Few studies address the experiences of caregivers of adolescents in foster care. This study highlights a range of caregiver attitudes about contraception for adolescents in care. Provider training regarding contraception should include strategies to manage caregiver beliefs and extreme reactions to contraception use among youth in care.