Associations between food insecurity and other social risk factors among U.S. adults.
COVID-19
disparities
food insecurity
health policy
poverty
public health
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
09 Aug 2023
09 Aug 2023
Historique:
received:
09
03
2023
accepted:
01
08
2023
medline:
10
8
2023
pubmed:
10
8
2023
entrez:
9
8
2023
Statut:
aheadofprint
Résumé
Food insecurity (FI) often co-exists with other social risk factors, which makes addressing it particularly challenging. The degree of association between FI and other social risk factors across different levels of income and before and during the COVID-19 pandemic is currently unknown, impeding the ability to design effective interventions for addressing these co-existing social risk factors. To determine the association between FI and other social risk factors overall and across different levels of income-poverty ratios and before (2019) and during (2020-2021) the pandemic. We used nationally representative data from the 2019-2021 National Health Interview Survey for our cross-sectional analysis. Social risk factors available in NHIS included difficulties paying for medical bills, difficulties paying for medications, receiving income assistance, receiving rental assistance, and "not working last week". 93,047 adults (≥18 years old). Individuals with other social risk factors (except receiving income assistance) were more likely to report FI, even after adjusting for income and education inequalities. While poverty leads to a higher prevalence of FI, associations between FI and other social risk factors were stronger among people with higher incomes, which may be related to their ineligibility for social safety net programs. Associations were similar before and during the pandemic, perhaps due to the extensive provision of social safety net programs during the pandemic. Future research should explore how access to a variety of social safety net programs may impact the association between social risk factors. With the expiration of most pandemic-related social supports, further research and monitoring are also needed to examine FI in the context of increasing food and housing costs. Our findings may also have implications for the expansion of income-based program eligibility criteria and screening for social risk factors across all patients and not only low-income people.
Sections du résumé
BACKGROUND
BACKGROUND
Food insecurity (FI) often co-exists with other social risk factors, which makes addressing it particularly challenging. The degree of association between FI and other social risk factors across different levels of income and before and during the COVID-19 pandemic is currently unknown, impeding the ability to design effective interventions for addressing these co-existing social risk factors.
OBJECTIVE
OBJECTIVE
To determine the association between FI and other social risk factors overall and across different levels of income-poverty ratios and before (2019) and during (2020-2021) the pandemic.
DESIGN
METHODS
We used nationally representative data from the 2019-2021 National Health Interview Survey for our cross-sectional analysis. Social risk factors available in NHIS included difficulties paying for medical bills, difficulties paying for medications, receiving income assistance, receiving rental assistance, and "not working last week".
SUBJECTS
METHODS
93,047 adults (≥18 years old).
KEY RESULTS
RESULTS
Individuals with other social risk factors (except receiving income assistance) were more likely to report FI, even after adjusting for income and education inequalities. While poverty leads to a higher prevalence of FI, associations between FI and other social risk factors were stronger among people with higher incomes, which may be related to their ineligibility for social safety net programs. Associations were similar before and during the pandemic, perhaps due to the extensive provision of social safety net programs during the pandemic.
CONCLUSIONS
CONCLUSIONS
Future research should explore how access to a variety of social safety net programs may impact the association between social risk factors. With the expiration of most pandemic-related social supports, further research and monitoring are also needed to examine FI in the context of increasing food and housing costs. Our findings may also have implications for the expansion of income-based program eligibility criteria and screening for social risk factors across all patients and not only low-income people.
Identifiants
pubmed: 37558857
doi: 10.1007/s11606-023-08360-8
pii: 10.1007/s11606-023-08360-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.
Références
Coleman-Jensen A, Rabbitt MP, Gregory CA, Singh A. Household Food Security in the United States in 2021. 2022. Available at: https://www.ers.usda.gov/webdocs/publications/104656/err-309.pdf?v=5262.1 , Accessed 2022.
Green K, Zook M. When talking about social determinants, precision matters. Health Affairs Blog. 2019;29.
Alderwick H, Gottlieb LM. Meanings and misunderstandings: a social determinants of health lexicon for health care systems. Milbank Q. 2019;97(2):407.
doi: 10.1111/1468-0009.12390
pubmed: 31069864
pmcid: 6554506
Fraze TK, Brewster AL, Lewis VA, Beidler LB, Murray GF, Colla CH. Prevalence of screening for food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence by US physician practices and hospitals. JAMA Netw Open. 2019;2(9):e1911514-e1911514.
doi: 10.1001/jamanetworkopen.2019.11514
pubmed: 31532515
pmcid: 6752088
Wallace AS, Luther B, Guo J-W, Wang C-Y, Sisler S, Wong B. Implementing a social determinants screening and referral infrastructure during routine emergency department visits, Utah, 2017–2018. Prev Chronic Dis. 2020;17:E45.
doi: 10.5888/pcd17.190339
pubmed: 32553071
pmcid: 7316417
Wallace AS, Luther BL, Sisler SM, Wong B, Guo J-W. Integrating social determinants of health screening and referral during routine emergency department care: Evaluation of reach and implementation challenges. Implement Sci Commun. 2021;2(1):1-12.
doi: 10.1186/s43058-021-00212-y
Social Interventions Research & Evaluation Network (SIREN). Social Needs Screening Tool Comparison Table. 2019. Available at: https://sirenetwork.ucsf.edu/tools-resources/resources/screening-tools-comparison , Accessed 2022.
Berkowitz SA, Seligman HK, Choudhry NK. Treat or eat: food insecurity, cost-related medication underuse, and unmet needs. Am J Med. 2014;127(4):303-310. e303.
doi: 10.1016/j.amjmed.2014.01.002
pubmed: 24440543
Sharareh N, Wallace AS. Applying a Health Access Framework to Understand and Address Food Insecurity. Paper presented at: Healthcare 2022.
Charkhchi P, Fazeli Dehkordy S, Carlos RC. Housing and food insecurity, care access, and health status among the chronically ill: an analysis of the behavioral risk factor surveillance system. J Gen Intern Med. 2018;33(5):644-650.
doi: 10.1007/s11606-017-4255-z
pubmed: 29299816
pmcid: 5910337
Kushel MB, Gupta R, Gee L, Haas JS. Housing instability and food insecurity as barriers to health care among low-income Americans. J Gen Intern Med. 2006;21(1):71-77.
doi: 10.1111/j.1525-1497.2005.00278.x
pubmed: 16423128
pmcid: 1484604
Sharareh N, Wallace AS, Brintz BJ, Wan N, Guo J-W, Wong B. Associated factors with patient-reported unmet food needs among emergency department adult patients–A social need perspective. Prev Med Rep. 2022;29:101974.
doi: 10.1016/j.pmedr.2022.101974
pubmed: 36161133
pmcid: 9502286
Wight V, Kaushal N, Waldfogel J, Garfinkel I. Understanding the link between poverty and food insecurity among children: does the definition of poverty matter? J Child Poverty. 2014;20(1):1-20.
doi: 10.1080/10796126.2014.891973
pubmed: 25045244
pmcid: 4096937
Nazmi A, Condron K, Tseng M, et al. SNAP Participation Decreases Food Insecurity among California Public University Students: A quasi-experimental Study. J Hunger Environ Nutr. 2022:1-16.
Carlson S, Keith-Jennings B. SNAP is linked with improved nutritional outcomes and lower health care costs. Washington, DC: Center on Budget and Policy Priorities. 2018:1-19.
Ratcliffe C, McKernan S-M. How much does SNAP reduce food insecurity? 2010.
Census. Who Is Receiving Social Safety Net Benefits? 2022. Available at: https://www.census.gov/library/stories/2022/05/who-is-receiving-social-safety-net-benefits.html , Accessed 2022.
Schanzenbach DW, Bauer L, Nantz G. Twelve facts about food insecurity and SNAP. Brookings Institution Washington, DC, USA; 2016.
Sharareh N, Seligman H, Adesoba TP, Wallace AS, Hess R, Wilson FA. Food Insecurity Disparities Among Immigrants in the United States. AJPM Focus. 2023:100113.
Caspi C, Seligman H, Berge J, Ng S, Krieger J. COVID-19 Pandemic-Era Nutrition Assistance: Impact and Sustainability. Health Aff. 2022.
Suarez L, Cholera R. Reducing Child Food Insecurity After COVID-19: Policy Innovations And Cross-Sector Partnerships. Health Affairs Forefront. 2022.
Wolfson JA, Leung CW. Food insecurity during COVID-19: an acute crisis with long-term health implications. In. Vol 110: American Public Health Association; 2020:1763-1765.
Food and Nutrition Service. Getting Food on the Table. 2022. Available at: https://www.fns.usda.gov/coronavirus , Accessed 2022.
USA Government. Financial Assistance for Food, Housing, and Bills. 2022. Available at: https://www.usa.gov/covid-financial-help-from-the-government , Accessed 2022.
CDC. National Health Interview Survey (NHIS). 2022. Available at: https://www.cdc.gov/nchs/nhis/index.htm , Accessed 2022.
CDC. 2019 Questionnaire Redesign. 2023. Available at: https://www.cdc.gov/nchs/nhis/2019_quest_redesign.htm , Accessed 2023.
Healthy People 2030. Social Determinants of Health. 2030. Available at: https://health.gov/healthypeople/priority-areas/social-determinants-health , Accessed 2023.
Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995:1-10.
Patterson JG, Russomanno J, Teferra AA, Tree JMJ. Disparities in food insecurity at the intersection of race and sexual orientation: A population-based study of adult women in the United States. SSM-Population Health. 2020;12:100655.
doi: 10.1016/j.ssmph.2020.100655
pubmed: 32864410
pmcid: 7442904
Walsemann KM, Ro A, Gee GC. Trends in food insecurity among California residents from 2001 to 2011: Inequities at the intersection of immigration status and ethnicity. Prev Med. 2017;105:142-148.
doi: 10.1016/j.ypmed.2017.09.007
pubmed: 28911952
R Core Team.R: A language and environment for statistical computing [computer program]. 2022.
StataCorp.Stata Statistical Software: Release 17. College Station, TX: StataCorp LLC [computer program]. 2022.
Siegel Bernard T, Lieber R. The Pandemic Safety Net Is Coming Apart. Now What? 2021. Available at: https://www.nytimes.com/2021/07/18/your-money/coronavirus-relief-expiration.html , Accessed 2022.
Williams N. Unemployment Benefits under the Federal COVID-19 Relief Package. 2020. Available at: https://crowe.wisc.edu/wp-content/uploads/sites/313/2020/03/UI-benefits3.pdf , Accessed 2022.
Bennett DA. How can I deal with missing data in my study? Aust N Z J Public Health. 2001;25(5):464-469.
doi: 10.1111/j.1467-842X.2001.tb00294.x
pubmed: 11688629