US state-level containment policies not associated with food insecurity changes during the early COVID-19 pandemic: a multilevel analysis

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Abstract
Objective: To investigate the relationship between US containment measures during the COVID-19 pandemic and household food insecurity. Design: To investigate these relationships, we developed a framework linking COVID-19-related containment policies with different domains of food security and then used multilevel random effects models to examine associations between state-level containment policies and household food security. Our framework depicts theorised linkages between stringency policies and five domains of food security (availability, physical access, economic access, acceptability in meeting preferences and agency, which includes both self-efficacy and infrastructure). We used US national data from a representative survey data from the National Food Access and COVID research Team that was fielded in July–August 2020 and April 2021. Containment policy measures came from the Oxford Stringency Index and included policies such as stay-at-home orders, closing of public transit and workplace closures. Setting: The USA. Participants: 3071 adult individuals from the National Food Access and COVID research Team survey. Results: We found no significant associations between state-level containment policies and overall food insecurity at the state level or any of the individual domains of food insecurity. Conclusions: This research suggests that while food insecurity across all domains was a significant problem during the studied phases of the pandemic, it was not associated with these containment measures. Therefore, impacts may have been successfully mitigated, likely through a suite of policies aimed at maintaining food security, including the declaration of food workers as essential and the expansion of federal nutrition programmes.

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