The fall 2019 survey and April 2020 survey used similar questions for the 3 variables, except for the question on type of store. Figure.COVID-19-related changes in food insecurity, eating out, and food shopping behavior among low-income households with children (N = 1,048), Brighter Bites. Overall, the demographic characteristics of respondents did not vary substantially by site (Table 1). Overall, diagnosis of COVID-19 and prevalence of pre-existing conditions, such as diabetes, heart disease, and being immune compromised, were less than 5% among respondents at the time of survey completion. Pediatrics 2010;126(1):e26–32. Response was voluntary. Accessed April 20, 20182020. Kaiser Family Foundation. Medicaid benefi-ciaries are low-income by definition, and one-half of all Medicare beneficiaries had incomes below US$26,000 in 2016.6 Both groups are, therefore, key target populations for addressing social needs. Updated July 24, 2020. Starting in early and mid-March, many US states began implementing social distancing measures and lockdowns, which prompted retail outlets, restaurants, schools, universities, businesses, and other entities to close, and implemented a work-from-home policy where possible. October 18, 2016 4:19 PMCategory: Health Equity, by Matt Makara - MPH, Program Manager, Affiliate Affairs, American Public Health Association, Income can influence many aspects of a person’s life, including their health, where they live and the education that they receive. 5. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. b Number is the total number of survey responses received overall and by race/ethnicity. https://www.dol.gov/general/topic/statistics/employment. https://news.uark.edu/articles/52820/survey-shows-regions-of-elevated-food-insecurity-due-to-covid-19-pandemic. Program staff members distributed survey links through text messages. An overwhelming majority of our study families were food insecure, were experiencing financial instability, and had concerns about their employment status. Corresponding Author: Shreela Sharma, PhD, RDN, LD, Professor, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler St, Houston, TX 77030. Abbreviations: CHIP, Children’s Health Insurance Program; NA, not applicable; SNAP, Supplemental Nutrition Assistance Program; WIC, Special Supplemental Nutrition Program for Women, Infants, and Children. Centers for Disease Control and Prevention. This is a global phenomenon, seen in low, middle and high income countries. Qualitative data. J Nutr Educ Behav 2019;51(10):1202–1210.e1. I’m worried about my children’s safety. Survey completion was voluntary. Most (68.2%) respondents resided in Houston; 97.0% were female; 85.9% were Hispanic, 7.1% were African American, and 50.5% were mostly or only Spanish speaking; the mean age was 36.7 years. a Brighter Bites is a nonprofit organization whose mission is to improve access to fresh fruits and vegetables and nutrition education among underserved communities. Concern about increased prices of food in stores. RTI surveyed 1,000 Americans about awareness, perceptions of COVID-19. Health equity considerations and racial and ethnic minority groups. That we don’t have masks, gloves, or disinfectant wipes because you can’t find them at the stores. Accessed August 27, 2020. My biggest worry is going out and getting the coronavirus. Check out the following blogs to learn more about other social determinants of health: Tags:IncomeSDHsocial determinants of health. If a respondent answered “never true” to both questions, we considered the household food secure. We used the χ2 test or Fisher exact test and 1-way analysis of variance to compute differences in responses by city and race/ethnicity. A significantly greater proportion of Hispanic respondents (94.7%) than respondents in other racial/ethnic groups reported food insecurity (P < .001) (Table 2). That we don’t have work and can’t pay the rent and bills, and that this ends up with my kids having no place to live. [T]he fact that they can’t eat enough fruit or food that they like. Overall, 93.5% of respondents reported being food insecure in April 2020. Sharma SV, Markham C, Chow J, Ranjit N, Pomeroy M, Raber M. Evaluating a school-based fruit and vegetable co-op in low-income children: a quasi-experimental study. CDC twenty four seven. Updated August 16, 2017. The social determinants of health in poverty describe the factors that affect impoverished populations' health and health inequality. Income can influence many aspects of a person’s life, including their health, where they live and the education that they receive. National Cancer Institute, Division of Cancer Control and Population Sciences. To better understand the ongoing needs of families and provide critical services during the pandemic, Brighter Bites conducted a rapid-response survey in April 2020 in 4 locations (Houston, Dallas, Washington, DC, and Southwest Florida) among participating families. Concern about not having enough money to pay rent. Accessed August 27, 2020. Furthermore, school and childcare closures, which halt school meals for children, have further pushed families into stress and food insecurity. Accessed August 27, 2020. When we stratified results by race/ethnicity, a significantly greater proportion of African American (64.9%) and Non-Hispanic White (63.2%) respondents, compared with Hispanic respondents or in the “other” racial/ethnic group, was concerned about affordability of food (P = .009). c Significance set at P < .05 for all tests. That food is scarce, and when there is some the price is high, starting with our produce. Qual Res Psychol 2006;3(2):77–101. Social determinants of health. Percentages may not add to 100 because of rounding. Furthermore, thousands of people diagnosed and hospitalized with COVID-19 are experiencing employment challenges in conjunction with large medical bills (4–6). Seligman HK, Schillinger D. Hunger and socioeconomic disparities in chronic disease. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. The program, which uses a school co-op concept, is disseminated in Southwest Florida and 5 US cities: Houston, Austin, Dallas, New York City, and Washington, DC. With the continued threat of COVID-19, unemployment and financial instability may rise, pushing families into making trade-offs between basic needs such as food and shelter (ie, paying rent this week instead of buying food) (8). ICD-10-CM coding options include: Z59.5 extreme poverty; Z59.6 low income On average, 25.1% and 28.2% of families reported receiving WIC or SNAP, respectively. The survey asked families enrolled in a coordinated school-based nutrition program about their social needs, COVID-19–related concerns, food insecurity, and diet-related behaviors during the pandemic. However, as a result of COVID-19–related school closures, program implementation has paused. When asked about the effect of COVID-19 on fruit and vegetable consumption, 41.4% of families reported a decrease in intake of fruits and vegetables because of COVID-19; we found no significant differences by race/ethnicity in this response (Table 2). Social determinants of health may influence the burden of disease on global health in many ways. The concerns were due to various reasons, such as lack of personal protective equipment and working in frontline jobs. Accessed September 8, 2020. I’m worried about my husband getting sick and spreading it to me and my kids because he’s still working and his job doesn’t provide protection. Author Affiliations: 1Department of Epidemiology, Human Genetics and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas. Respondents could check all that applied. https://www.kff.org/coronavirus-covid-19/issue-brief/estimated-cost-of-treating-the-uninsured-hospitalized-with-covid-19. Overall, 76.3% of respondents reported concerns about financial stability, 42.5% were concerned about their employment, 69.4% about availability of food, 49.5% about affordability of food, 31.0% about housing stability, and 35.9% about access to a clinic or physician. The survey asked about financial stability, employment status, food security, housing security, transportation needs, access to child care, and access to health care. Brighter Bites collected all data and shared de-identified data with the University of Texas Health Science Center for analysis as part of a data-sharing agreement. Suggested citation for this article: Sharma SV, Chuang R, Rushing M, Naylor B, Ranjit N, Pomeroy M, et al. Little is known about the social needs of low-income households with children during the coronavirus-2019 (COVID-19) pandemic. Published April 23, 2020. Almost half (49.1%) reported in April 2020 shopping at least once per week, whereas 62.4% reported shopping at least once per week in fall 2019 (P < .001) (Figure). These results underscore how COVID-19 and the related economic crisis have not only caused physical harm but have further destabilized people who were already struggling. Most (97.1%) Brighter Bites families reported shopping at a large grocery store during the pandemic but at varying frequencies. ORIGINAL RESEARCH — Volume 17 — October 1, 2020. Addressing the social determinants of health has been highlighted by the U.S. government’s Healthy People 2020 initiative, National Partnership for Action to End Health Disparities, and National Prevention and Health Promotion Strategy as being integral to improving health for all. Planners4Health offers a... Good public health comes about through good planning, a lesson community members in Umatilla County, Oregon, have taken to heart with an initiative that combines both outlooks. Johns Hopkins University & Medicine, Coronavirus Media Center. They’re largely responsible for health disparities and can, therefore, impact cancer patients’ chances of survival. Because survey completion was voluntary, not all respondents answered all questions; thus, values for each variable may not sum to value in column head. We calculated descriptive statistics stratified by location and race/ethnicity. a Brighter Bites is a nonprofit organization whose mission is to improve access to fresh fruits and vegetables and nutrition education among underserved communities. Program options were the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Supplemental Nutrition Assistance Program (SNAP), Double Dollars, Medicaid/Texas Health Steps, Medicare, national school lunch and/or breakfast programs (free or reduced-price meals), and Children’s Health Insurance Program (CHIP). The U.S. spends less than other countries on non-health social services, but much more on health Click To Tweet. In addition, 83.5% of respondents reported decreasing the frequency of eating out because of COVID-19, with a greater proportion of Hispanic families (84.9%) than families in other racial/ethnic groups reporting decreased frequency (P = .003). These resources include information on where to get tested for COVID-19, how to register for government assistance programs, COVID-19 prevention practices, and maintaining healthy eating, physical activity, and mental health. Concern about not having enough food for family and/or children. The role of housing as a social determinant of health is well-established, but the causal pathways are poorly understood beyond the direct effects of physical housing defects. We distributed an electronic survey in April 2020 to 16,435 families in 4 geographic areas, and 1,048 responded. Texas Health & Human Services Commission. Our study has several limitations. It’s stressful, and the financial uncertainty. We’re just worried about having a better standard of living than right now. 2 Birthing parents † who do not breastfeed are at higher risk of negative health outcomes, including cancer, cardiovascular disease, … The survey also invited respondents to write in any other concerns by using this statement: “Please share your greatest concern at this time, or any other thoughts you would like to share with us.”. Understanding the social needs of our most vulnerable families with children is critical because of the health disparities associated with COVID-19 prevention and treatment (18). My worry is that this won’t end and we won’t be able to take care of our kids. Response was voluntary. Percentages may not add to 100 because of rounding. Lack of healthy food accessibility is a form of food insecurity As a result, and it may arise the hardship of low-income people. Our study demonstrated a significant increase in food insecurity during the pandemic and a decrease in intake of healthy food such as fruits and vegetables. All Rights Reserved. The survey asked respondents how much they had seen or heard about COVID-19. No copyrighted materials were used in this article. Fear of grocery shopping because of COVID-19. d Fisher exact test. Moreover, we conducted the qualitative analysis to help contextualize the quantitative findings, and these analyses indicated COVID-19–related shifts in food-related practices and behaviors among respondents. Dunn CG, Kenney E, Fleischhacker SE, Bleich SN. Brighter Bites is a nonprofit, evidence-based school health program that distributes fresh produce weekly to low-income families and provides nutrition education in school and for parents (10,11). That they close all the stores where you can find food. We should stay home. Most (81.8%) respondents reported knowing a great deal about COVID-19 and were concerned about being infected themselves (87.3%) or their children being infected (87.0%) (Table 2). The survey asked respondents about their frequency of eating out at restaurants in the previous 7 days and whether their frequency of eating out had changed because of the pandemic (15). Within countries, the evidence shows that in general the lower an individual’s socioeconomic position the worse their health. The 30-item self-report survey took approximately 10 minutes to complete. Response rates by location were 7.7%, Houston; 3.8%, Dallas; 6.4%, Washington, DC; and 6.9%, Southwest Florida. Accessed August 27, 2020. We conducted a rapid-response survey on social needs, COVID-19–related concerns, and diet-related behaviors during the shelter-in-place phase of the US pandemic among low-income households with children enrolled in a nutrition program. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health. Qualitative comments provided additional insight, with many respondents expressing a concern about a general scarcity of food. It’s been difficult to find fresh produce in the stores. Our qualitative assessment also demonstrated that although most respondents reported following safety guidelines, some expressed fear of becoming infected in public spaces. These questions were adapted from previously administered surveys (12). Accessed September 10, 2020. A plethora of research has shown that people with lower incomes tend to have poorer health in addition to being less likely to have health insurance. The survey used items adapted from the National Cancer Institute’s 2007 Food Attitudes and Behavior Survey (14). You will be subject to the destination website's privacy policy when you follow the link. They suggested that the combination of stress (resulting from unemployment and financial hardship) and poor nutrition can challenge disease prevention and management because these stressors strain the household budget, leaving little money for healthy foods and resulting in disordered eating (ie, consumption of unhealthy processed, nutrient-deficient foods), and increased medical care resulting in spending trade-offs (26). Employment and unemployment. Although varying models exist, consideration of social determinants of health generally includes: individual and community behaviors, … And I’m scared that we’re all going to get sick. MMWR Morb Mortal Wkly Rep 2020;69(15):458–64. Similarly, concerns about disruption of employment and financial hardship identified such acute problems as inability to pay rent or bills. A healthy diet is inextricably linked to overall health benefits , so improving eating habits should be crucial factor in improving health. Low income has been identified as a key social determinant of health.4 While the effect of income on health has been the subject of debate and study, research appears to uphold the link between low income and health. Prevalence of single and multiple leading causes of death by race/ethnicity among US adults aged 60 to 70 years. Even in affluent countries such as Canada the social gradient exists but is often masked by the high levels of overall population health status (Mikkonen & Raphael, 2010). Worry/fear of future financial challenges. Beyond health care: the role of social determinants in promoting health and health equity. What are the implications for public health practice? University of Arkansas News. Pinker J. US Department of Labor. Hager ER, Quigg AM, Black MM, Coleman SM, Heeren T, Rose-Jacobs R, et al. Sociodemographic characteristics. Breastfeeding is an issue of health equity. The survey collected data on respondent’s sex, respondent’s relationship to the child, respondent’s and child’s race/ethnicity, respondent’s employment status, respondent’s education level, and enrollment in government assistance programs. Overall, 93.5% of respondents reported being food insecure, a 22-percentage-point increase since fall 2019. Levitt L, Schwartz K, Lopez E. Estimated cost of treating the uninsured hospitalized with COVID-19. Overall, 61.6% of respondents reported never eating food from a restaurant during the previous 7 days (including take-out), with a smaller proportion of non-Hispanic White families (34.2%) than other racial/ethnic groups never eating out (P < .001). Funding for the study was provided by Brighter Bites through Feeding Texas and the Texas Health and Human Services Commission. e χ2 test. Chambers has documented the connections between housing and neighborhood conditions and health disparities among low-income Latinos in the Bronx. Because survey completion was voluntary, not all respondents answered all questions; thus, values for each variable may not sum to value in column head. d Fisher exact test. Published April 10, 2020. Qualitative assessment identified 4 main themes: 1) fear of contracting COVID-19, 2) disruption of employment status, 3) financial hardship, and 4) exacerbated food insecurity. Currently he is working in the areas of health inequalities, marginalization, political advocacy, health policy, and the social determinants of health… Collectively, all themes stemmed from fear of contracting COVID-19. There is a social gradient across many of these determinants that contribute to health with poorer individuals experiencing worse health outcomes than people who are better off. My biggest concern is about my husband who is working picking tomatoes and he says that a lot of the workers aren’t being as careful as they should about coronavirus and that the bosses don’t care about them. Strategies that aim to increase the economic mobility of families (for example, job training programs and Early Head Start) may help to alleviate the negative effects of poverty. The broad social and economic circumstances that together influence health throughout the life course are known as the ‘social determinants of health’. In the U.S., there are significant differences in life expectancy between the wealthiest and poorest citizens and children from low-income households are more likely to suffer from chronic disease and poor health throughout their lives. We used thematic analysis and an inductive approach to examine the open-ended comments. I hope this is over fast. Economic instability, since unemployment comes from it. All values are number (percentage) unless otherwise indicated. Concern about not having enough money to pay bills/utilities. US Bureau of Labor Statistics. All changes were significant at P < .001, except for shopping at a farmers market/food co-op/farm stand ≥1 time per week (P= .31). c Significance set at P < .05 for all tests. Housing is one of the best-researched social determinants of health, and selected housing interventions for low-income people have been found to improve health outcomes and decrease health … DOI: http://dx.doi.org/10.5888/pcd17.200322external icon. Feeding America. Prev Chronic Dis 2017;14:E101. The survey was administered electronically in April 2020 to 16,436 Brighter Bites families who were enrolled in the program during the 2019–2020 school year. Chowkwanyun M, Reed AL Jr. The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. What’s happening is really hard because there’s no work but being healthy is the important thing. Webb Hooper M, Nápoles AM, Pérez-Stable EJ. If the respondent indicated “often true” or “sometimes true” to either of the 2 questions, we considered the household food insecure. I’m worried about how to feed my kids because there’s no work right now. The potential health care costs and resource use associated with COVID-19 in the United States. Coronavirus resource center COVID-19 map. However, this issue has many layers. The overall survey response rate was 6.4% (1,048 of 16,436). We’re just worried about how to pay the bills this month. Published May 10, 2018. Because demographic characteristics did not vary by site, our examination of COVID-19–related knowledge, risks, attitudes, and behaviors across racial/ethnic groups did not adjust for site differences. The other authors have no conflicts of interest relevant to this article to disclose.

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