What was the association between participation in federal COVID-19 relief programs and mitigation of food and housing hardships and disparities among families with young children?

In a recent study published in JAMA Health Forum Journal, researchers evaluated the relationship between the coronavirus disease 2019 (COVID-19) relief programs and the mitigation of household food insecurities among families with young children and difficulty paying rent, and discrepancies in the receipt of the programs.

Study: Association Between Material Hardship in Families With Young Children and Federal Relief Program Participation by Race and Ethnicity and Maternal Nativity. Image Credit: TomasRagina/Shutterstock.com

Background

Even minor periods of adversity in childhood can have long-term ramifications. During the COVID-19 crisis, cross-sectional studies limited to individuals proficient in English and those having internet accessibility documented that families with children struggled to finance essentials like rent and food.

Data on the experiences of family members comprising young children, based on their ethnicity, race, and maternal birthplace, are limited.

About the study

In the present study, researchers investigated whether participating in the supplemental nutrition assistance program (SNAP) and/or EIP relief programs mediated ethnicity-, race-, and maternal birth-based discrepancies in food and housing insecurities during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.

Data from the cross-sectional and ongoing Children’s HealthWatch (CWH) study and CHW Follow-up Study (CHW-COVID), comprised of families surveyed before and during COVID-19, were analyzed.

The team administered baseline questionnaires between 1 January 2018 and 20 March 2020 in person to carers of ≤4.0-year-olds in Spanish or English at primary care centers or emergency departments across five cities in the United States (US), i.e., Boston, Baltimore, Minneapolis, Philadelphia, and Little Rock.

The participants were followed up using telephone-based questionnaires between 1 September 2020 and 30 June 2021. Questionnaires were distributed to obtain data on sociodemographic parameters (such as ethnicity and race), household material hardships, and participation in the EIP and SNAP public benefit programs.

The study exposure was participation in the SNAP program or ≥1.0 Economic Impact Payment (EIP, or stimulus checks) receipt during COVID-19. The study outcomes of interest were food-associated insecurity in the households [evaluated using the six item-United States Household Food Security Survey Module (HFSSM)] and delay in rent payments (indicating housing instability).

Log-binomial and multinomial logistic regression modeling analyses were performed to determine the adjusted odds ratio (aOR), adjusted prevalence ratio (aPR), and unadjusted prevalence ratio (uPR) values.

Covariates included the level of education of the carer, the number of pediatric individuals in the households, the age of the children, the type of health insurance for the children (as a proxy for income), and the employment status of the household members. An exploratory analysis was performed to determine whether relief program participation attenuated the discrepancies based on race, ethnicity, and nativity of mothers.

Results

Of 6,875 carers interviewed face-to-face before the COVID-19 crisis, 1,396 completed the follow-up questionnaires (20% response rate). Ethnicity and race information of  1,357 carers was available, among whom 38% (n=514) were non-Latino Blacks; 41% (n=558) were Latinos; 17% (n=230) were non-Latino Whites; and 4.0% (n=55) belonged to other types of non-Latino ethnicity or race.

Concerning relief program participation, 11% (n=148) carers did not participate in EIP or SNAP, 12% (n=161) participated in SNAP only, 38% (n=529) participated in EIP only, and 40% (n=558) caregivers participated in both programs during the pandemic.

Among 1,390 responses with non-missing data, 30% (n=417) of children had immigrant mothers, and among 1,388 responses, 34% had public insurance. In the COVID-19 crisis, 34% (n=467) of respondents documented food-related insecurities and 41% (n=567) documented delayed rent payments.

Family units with foreign mothers showed a lower probability of SNAP and EIP participation compared to those with mothers born in the US (aOR 0.1 for SNAPP and EIP versus neither), despite having a greater probability of reporting food- and housing-associated insecurities, with aPR values of 1.5 and 1.1, respectively.

In addition, families with Latino (uPR 1.5) or Black (uPR 1.4) carers or carers belonging to other races or ethnicities (uPR 1.7) showed a greater likelihood compared to families with non-Latino white carers of experiencing household insecurities associated with housing and food.

The uPR values for families with carers of Black, Latino, and other races or ethnicities were 2.0, 1.7, and 1.9, respectively. Covariate adjustment moderately attenuated the discrepancies, and additionally, adjusting for EIP and SNAP participation somewhat reduced the discrepancies for a few groups and study outcomes.

Conclusions

Overall, the study findings highlighted the exacerbation of pre-existing inequalities in food-associated insecurities and rent-paying difficulties during the COVID-19 pandemic by ethnicity, race, and maternal place of birth.

Despite federal programs for COVID-19 alleviation, the findings revealed significant disparities in suffering among families with young children. Equality-focused adjustments in health policies are required so that children and their families can satisfy fundamental demands for health optimization in the United States.

Families with immigrant mothers had a lower likelihood of participating in COVID-19-related relief programs than those with mothers born in the US, even though families with immigrant mothers, as well as those with Latino or Black carers, had a higher likelihood of experiencing food- or housing-associated insecurities, both of which were hardships addressed by the relief programs.

Differential rates of participating in the COVID-19 relief programs could not account for the disparities in household suffering altogether.