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

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 center dot 27). Risk of early-pandemic FI was elevated for non-Hispanic Black (adjusted relative risk (aRR) = 2 center dot 1 (95 % CI 1 center dot 1, 4 center dot 0)) and Other families (aRR = 2 center dot 6 (1 center dot 3, 5 center dot 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 center dot 1 (1 center dot 2, 3 center dot 6) to 2 center dot 5 (1 center dot 5, 4 center dot 1)); CARES stimulus payment (aRR = 0 center dot 5 (0 center dot 3, 0 center dot 9)) and continued school meal participation (aRR = 0 center dot 2 (0 center dot 1, 0 center dot 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.