Pre-pandemic to early-pandemic changes in risk of household food insecurity among Maryland families with children

Alysse J. Kowalski, Ann Pulling Kuhn, Hannah G. Lane, Angela C.B. Trude, Helina Selam, Erin R. Hager, Maureen M. Black

Research output: Contribution to journalArticlepeer-review


Objective: The objective was to examine risk and protective factors associated with pre- to early-pandemic changes in risk of household food insecurity (FI). Design: We re-enrolled families from two statewide studies (2017-2020) in an observational cohort (May-August 2020). Caregivers reported on risk of household FI, demographics, pandemic-related hardships, and participation in safety net programmes (e.g. Coronavirus Aid, Relief, and Economic Security (CARES) stimulus payment, school meals). Setting: Maryland, USA. Participants: Economically, geographically and racially/ethnically diverse families with preschool to adolescent-age children. Eligibility included reported receipt or expected receipt of the CARES stimulus payment or a pandemic-related economic hardship (n 496). Results: Prevalence of risk of FI was unchanged (pre-pandemic: 22 %, early-pandemic: 25 %, p = 0·27). Risk of early-pandemic FI was elevated for non-Hispanic Black (adjusted relative risk (aRR) = 2·1 (95 % CI 1·1, 4·0)) and Other families (aRR = 2·6 (1·3, 5·4)) and families earning ≤ 300 % federal poverty level. Among pre-pandemic food secure families, decreased income, job loss and reduced hours were associated with increased early-pandemic FI risk (aRR = 2·1 (1·2, 3·6) to 2·5 (1·5, 4·1)); CARES stimulus payment (aRR = 0·5 (0·3, 0·9)) and continued school meal participation (aRR = 0·2 (0·1, 0·9)) were associated with decreased risk. Among families at risk of FI pre-pandemic, safety net programme participation was not associated with early-pandemic FI risk. Conclusions: The CARES stimulus payment and continued school meal participation protected pre-pandemic food secure families from early-pandemic FI risk but did not protect families who were at risk of FI pre-pandemic. Mitigating pre-pandemic FI risk and providing stimulus payments and school meals may support children's health and reduce disparities in response to pandemics.

Original languageEnglish (US)
Pages (from-to)1701-1710
Number of pages10
JournalPublic Health Nutrition
Issue number6
StatePublished - Jun 10 2022


  • CARES stimulus payment
  • COVID-19
  • Food insecurity
  • Health disparities
  • Pandemic
  • School meals

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics
  • Public Health, Environmental and Occupational Health


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