High Food Insecurity in Latinx Families and COVID-19 Associated Infection in the Greater Bay Area, California | BMC Nutrition
Racial and ethnic minorities have historically performed worse during and after disasters, as they already face a range of economic, political and social obstacles. [23, 24]. These include, but are not limited to, racial discrimination, exploitation, limited fluency in English, and lack of legal status. .
The overall prevalence of food insecurity in California between 2017 and 2019 was 9.9% with low food security and 3.6% with very low food security . Overall national levels of food insecurity were higher during this period for Hispanic households (15.6%).
Food insecurity has increased for American children and adults since the start of the COVID-19 pandemic with elevations in every state . Data from the Census Pulse Household Survey suggests that overall food insecurity tripled from 9.4% to 29.5% for households with children during COVID-19. Likewise, we report a dramatic increase in food insecurity among our low-income Latinx cohorts in the San Francisco Bay Area. These population groups already had low rates of food security. Before COVID-19, 76.9% of LEAD families reported having food security, but during COVID-19, only 38.1% reported having food security. Likewise, HEN’s food security increased from 79.6% of adults with food security to 34.2%. Decreases in child food security were also significant with 87.9% pre-COVID safety, decreasing from 56.9% in LEAD and from 89.2 to 54.1% in HEN. Our results in HEN and LEAD correspond to the high food insecurity rates (only 36% with food secure) reported by American adults living
Our results of high food insecurity among three Latinx cohorts in the San Francisco Bay Area suggest rapid growth in food insecurity in urban areas affected by COVID-19 closures. Latinxes among most likely to be plunged into poverty due to unemployment linked to pandemic [6, 27]. A significant percentage of our participants had no adult household members in employment at the time of the interview (over a third of HEN and LEAD households and a quarter of TAB households), and unemployment is strongly associated with unemployment. food insecurity. [6, 28]. Additionally, Latinx individuals, such as cohort individuals, who faced food insecurity before COVID-19 are likely to be more food insecure during the pandemic and are particularly at risk of negative outcomes. .
Common food insecurity coping strategies before COVID-19 include using pantries, borrowing money, visiting friends or family for meals, or sending from children to parents . Some, if not all of these tactics to protect families from food insecurity are more limited given the recommended physical distancing measures taken to prevent the transmission of COVID-19. . Even when pantry resources are available, Latinx families relative to other groups may face language barriers or legal status concerns that limit use. . Shame can also cause people to hide their hunger rather than going to pantries and further increase food vulnerability. .
Differences between Latinx cohorts
There were large differences between our Latinx cohorts in levels of food insecurity. This is partly explained by the socio-demographic differences depending on the cohort. HEN and LEAD were recruited primarily from Zuckerberg General Hospital in San Francisco, the local safety net county hospital, while TAB was recruited primarily from UCSF Benioff, a tertiary care teaching hospital. Women recruited for the HEN and LEAD cohorts had lower education levels at recruitment (a small percentage reported education beyond high school at recruitment (20.6% for LEAD and 26.1% for HEN) versus one much higher percentage of 65.7% for TAB). A low level of education is the best indicator of unemployment  and since the emergence of COVID-19, job losses have been associated with low levels of education . Higher rates of household and child food insecurity in HEN and LEAD compared to a much lower level in TAB (60% with high food security) alongside lower education levels and potential earning power in these cohorts [6, 28].
Additionally, over 90% of mothers in HEN and LEAD were preferred / dominant Spanish speakers, while 65% of mothers in TAB were predominantly English speakers. Speaking fluent English leads to greater employment opportunities  also potentially contribute to food insecurity [6, 28]. Our previous studies with HEN and LEAD also found that the majority of adults in these households are recent immigrants and foreign-born people. [17,18,19], potentially placing these families at a more disadvantage in terms of access to food and other government resources .
There was little difference in the reported indices of overcrowding (the number of people sharing bedrooms and bathrooms) between these three cohorts and although there were only associations between these measures and insecurity. food in TAB and HEN, possibly based on sample size differences (smaller sample size and less power in LEAD). Additionally, we observed no difference in food insecurity and education level or employment status for LEAD and HEN, possibly because there was little variation in education level. , the majority not having completed higher education beyond secondary school. We did not assess common underemployment among Latinx adults, but HEN and LEAD may have higher levels of underemployment. . Meanwhile, for the TAB, the association between education level and employment status and food insecurity was very significant. People with less education had greater food insecurity, possibly due to the heterogeneity of education levels for this cohort.
Interventions Needed for Latinx Families
Our data suggests the urgent need for interventions for Latinx families with children, especially those who are Spanish speaking and with low levels of education and employment in the context of the COVID-19 crisis. Data from our TAB cohort highlights the heterogeneity of Latinx families in the Bay Area and the potential need for targeted interventions in specific communities. Due to an urgent need, some safety net clinics in California have had creative responses in terms of providing food for families. More funding and development of these efforts should be prioritized by state and county lawmakers [38, 39]. In addition, individuals from under-represented groups tend not to have enough accessible information in their preferred language and mode of communication. . For example, 29% of Latinxes in the United States are not proficient in English . There may also be mistrust of government and health agencies due to poor history and lack of cultural competence [36, 40]. The best implementations for COVID-19 relief will be achieved through the inclusiveness of cultural richness, such as the availability of information in multiple languages, modes of communication and a diverse workforce to implement these interventions and work with diverse communities.
Risk of COVID-19 infection with household food insecurity
Previous researchers have noted an increased risk of COVID-19 morbidity and mortality due to poor nutrition, obesity and associated metabolic diseases . While factors of overcrowding and poverty are associated with the risk of COVID-19 infection and food insecurity, food insecurity may be independently associated with an increased risk of COVID-19 infection due to poorer immune health and increased susceptibility to disease. Previous studies, particularly related to the risk of HIV infection in the context of HIV exposure, suggest that food insecurity may be an independent risk factor for infectious disease . For example, other studies suggest that household food insecurity places children in a more vulnerable position to TB infection. . In multivariate analyzes adjusted for overcrowding, unemployment, and use of the Spanish language in the TAB cohort, the food insecurity score tended towards an association with household COVID infection (OR 1.25 , 95% CI 0.97-1.61). Further studies are needed with larger cohorts to assess the role between food insecurity, poor nutritional status and the risk of infectious disease, including COVID-19.