Authors: Arshia Anand, Samuela Djienang, Davina Francis, Hanan Ibrahim, Madhalasa Iyer, Sandi Kelada, Martalinda Leiva, Lois Onuoma, Liliah Seluk, Briana Young, Amy Zheng, Olivia Zheng
Abstract– The outbreak of the Coronavirus (COVID-19) pandemic has changed the world—albeit not in a positive way. Globally 430 million enterprises are facing disruption, leading to unemployment rates soaring to a level not seen since the Great Depression. Job loss has been one of the worst financial shocks families have faced, making it extremely difficult to make ends meet and causing devastating downstream effects like foreclosures, evictions, and above all putting food on the table. To understand food accessibility during the pandemic, this paper explores different scenarios of affordability, accessibility, and transportation. We started with the premise that the lockdown, untenable living costs, and disruptions caused by COVID -19 would expose the fragility of people’s access to food especially, in lower socio-economic groups.
A cross-sectional survey in english and spanish was conducted using the PhenX Toolkit for 18 days. The modes of data collection included many virtual community portals like Facebook, Instagram, and YouTube. In the end, 103 valid responses from a highly diverse population of American Indian, White American, African-American, Hispanic and Latino American, Asian American, Multiracial, and Afghan American were collected. We used Excel which is a feature-rich environment that enabled us to organize our data using pivot tables. We tested our hypothesis with the Chi-square test and used functions to compute the depression scores from the PHQ-9 questionnaire.
Our results show that COVID-19 negatively impacted the affordability of food and access to food from food retailers. It, however, had no significant impact on the availability of healthy food in stores, qualification for food programs, distance to the nearest food retailer, and mode of transportation used for grocery shopping.
In conclusion, our study validated our hypothesis and exposed the vulnerability of the food system. It was not only the accessibility but also the affordability that was negatively impacted during the pandemic. It also offered a glimpse of a resilient food system, as communities came together to plug gaps in the provision of food causing a negligent impact on food programs.
We, at Scientia Lab, believe that this is just a starting point for a food system transformation that builds resilience at all levels, especially in affordability and accessibility during future pandemics.
Keywords– outbreak, COVID-19, unemployment, pandemic, food accessibility
INTRODUCTION
It is expected that due to the novel Coronavirus (COVID-19) pandemic the number of food insecure individuals could rise by 17.1 million (The Impact of the Coronavirus on Food Insecurity, 2020). Such a staggering number as result of the effects of this new disease which initially appeared in December of 2019 in Wuhan City, China. After spreading to various countries around the world, COVID-19 was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Two days later on March 13, 2020, the President of the United States declared a national emergency due to this disease, which is characterized by a severe respiratory illness. This pandemic has caused many disruptions nationwide such as school closures, unemployment, and financial instability. As mentioned earlier, the already existing problem of food inaccessibility, which has been ongoing since the 1960s, has been worsened as a result (National Research Council, 2006, Chapter 4).
The United States Department of Agriculture reports that in 2018 approximately 4.3% (5.6 million) of households have been impacted by severe food insecurity (Coleman-Jensen, Gregory, Rabbitt, 2019). Additionally, the National Institute of Health (NIH) speculates that approximately 14% of families were food insecure prior to the pandemic (Kinsey, Kinsey, & Rundle, 2020). Due to the pandemic, NIH researchers propose that this percentage may have increased.One reason for this is that states cannot issue nutrition benefits beyond the maximum limits to families that are already receiving them. Even though many of these people receive the maximum, it is now no longer enough. Moreover, many of these nutritional benefits are restricted to specific stores that accept them, making it harder for families to find what they need. In fact, many people are required to put themselves at risk since many of the benefits cannot be used to shop for food online (Kinsey, Kinsey, & Rundle, 2020). Relying on food pantries and soup kitchens is also no longer an option as a result of social distancing guidelines, leading families to have more difficulty in acquiring food (Kinsey, Kinsey, & Rundle, 2020).
As a result of these distressing findings, Scientia Research Team, powered by Mentoring in Medicine Inc, was prompted to use food inaccessibility as the research focus for our impact study. We have learned that proper nutrition is essential to a healthy immune system. The NIH’s article, ”COVID-19: The Inflammation Link and the Role of Nutrition in Potential Mitigation”, states that unhealthy diets have been associated with low-grade inflammation and oxidative stress; both of which can lead to chronic diseases that can increase the risk and severity of COVID-19 (Zabetakis, Lordan, Norton, & Tsoupras, 2020). These findings have prompted our research team to create an impact study with the goal of researching the effect of COVID-19 on food accessibility in the United States. Given the existing research on food insecurity and the disruptions caused by the COVID-19 pandemic, we predict that COVID-19 may have a negative effect on food accessibility, making it more challenging for food-insecure individuals in the United States to acquire proper nutrition. We believe this topic to be of great importance as a result of the significant link between nutrition and COVID-19 and through this topic, we hope to raise awareness for food insecurity with the goal of strengthening our food system for both the present and the future.
MATERIALS AND METHODS
Description of the Survey
To evaluate the impact of the COVID-19 outbreak on food accessibility in the United States using a cross-sectional population study, an English and Spanish survey was created using a Google form with 33 questions. The questions were used to assess socioeconomic status, demographics, and food accessibility prior to and during the COVID-19 pandemic were found on PhenX Toolkit under the recommendation of Mentoring in Medicine, Inc. The survey was made accessible to U.S residents from July 31, 2020, to August 18, 2020, through social media platforms including but not limited to Facebook, Instagram, and Youtube.
Study Population
Once all of the responses from the survey were collected, the first step to the data analysis was to generate the responses onto an Excel sheet. A grand total of 108 responses were received. Data cleaning was performed which resulted in 103 valid responses, as those including out of country zip codes or incomplete information were removed from the database. From the valid responses, 79.6% were female participants and 19.4% were male. Participant ages ranged from 18 to 55 years and above, with 67.9% of responses coming from ages 18-24. Participants were required to be at least 18 years of age or older to provide informed consent and accurate information. Responses were given by a diverse sample of participants including Asian, Black or African American, White, Middle Eastern, Multiracial, Hispanic, Afghan, and American Indian or Alaska Native. From these racial/ethnic groups, Asian participants had the highest response rate with a total of 33.0% of responses.
Statistical Analysis
Utilizing Excel functions, pivot tables (a tool that helped organize and summarize the collected data) were created from the 103 total responses. Bar graphs and pie charts were created in order to obtain visual images of the data. After further analysis of the 103 responses, four survey questions were disregarded due to the inconsistent responses of 17 participants. Then, sub-hypotheses were created for each question asked and then tested by running a Chi-square test comparing the results of each question prior to the pandemic and during the pandemic to see the significant changes between the two periods of time.
RESULTS
We examined the impacts of COVID-19 on food accessibility in the United States. All 103 of the participants whose responses were utilized, resided in the United States, with 66.01% of participants residing in New York, 17.48% in California, 4.85% in Texas, 2.91% in Mississippi, 2.91% in Pennsylvania, 1.94% in New Jersey, 0.97% in Colorado, 0.97% in Connecticut, 0.97% in Florida, and 0.97% in Michigan.
Figure 1: Number of participants counted by state. The range of red colors; a light red indicating a low number of participants from a state to dark red, a high number of participants from a state.
The COVID-19 pandemic negatively impacted access to food from food retailers.
The percentage of participants who had difficulties getting groceries they needed at the store significantly increased from before the pandemic (20.4%) to during the pandemic (65.0%) (P< 0.00001). Similarly, the percentage of participants who were afraid of going to the store to get groceries significantly increased from prior to the pandemic (14.6%) to during the pandemic (68.9%) (P=0.004765). There was no significant difference, however, between the percentage of participants who asked someone to go out and get groceries for them during the pandemic (28.2%) compared with prior to the pandemic (41.8%).
Figure 2: Percentage of participants who experienced difficulty getting groceries, fear of going to store, and asking others to get groceries prior to the pandemic vs. during the pandemic.
The COVID-19 pandemic had no significant impact on healthy foods in stores near neighborhoods
There was no statistically significant difference between the percentage of participants whose nearby grocery stores offered high-quality fresh fruits and vegetables during the pandemic (55.0%) compared with prior to the pandemic (53.4%). The percentage of participants whose grocery stores had a large selection of fresh fruits and vegetables prior to the pandemic (76.7%) decreased during the pandemic (63.1%), but this observed decrease was insignificant. The percentage of participants whose grocery stores offered a wide selection of low-fat products during the pandemic (68.0%) was the same as prior to the pandemic (68.0%).
The COVID-19 pandemic had a negative impact on the affordability of food
Significantly more participants ran out of food and weren’t able to afford more food during the pandemic (33.0%) compared with prior to the pandemic (11.7%) (P=0.000233). However, the percentage of participants who were hungry and unable to eat during the pandemic (5.8%) compared with pre-pandemic (3.9%) was not significantly different. The observed increase in the percentage of participants who were unable to afford balanced meals during the pandemic (24.3%) compared with prior to the pandemic (17.5%) was not significant.
Figure 3: Percentage of Participants who have experienced running out of food and being unable to afford more, feeling hungry and not affording enough food, and being unable to afford balanced meals prior to the pandemic vs. during the pandemic.
The COVID-19 pandemic had no impact on qualification for food programs. The percentage of participants who qualified for food assistance programs during the pandemic (16.5%) compared with prior to the pandemic (18.4%) was not significantly different.
The COVID-19 pandemic had no impact on modes of transportation taken to complete grocery shopping.
There was no statistically significant difference between the percentage of participants who used food delivery services to complete their grocery shopping during the pandemic (4.9%) compared prior to the pandemic (0.0%). The percentage of participants who walked to food retailers during the pandemic (26.2%) compared with prior to the pandemic (27.2%) was not significantly different. The decrease observed in the percentage of participants who took Ubers and/or Taxis to food retailers during the pandemic (0.0%) compared with prior to the pandemic (1.0%) was not significant. There was no significant difference between the percentage of participants who used public transportation to go to food retailers during the pandemic (1.0%) compared with prior to the pandemic (0.0%). The percentage of participants who drove to food retailers during the pandemic (68.0%) compared with prior to the pandemic (71.8%) was not significantly different.
The COVID-19 pandemic had no impact on the distance of the nearest food retailer from participants’ households.
There was no statistically significant difference between the percentage of participants who had a food retailer within fifteen minutes of their home within walking distance during the pandemic (83.5%) compared with prior to the pandemic (84.5%). The percentage of participants who had a food retailer within sixteen to thirty minutes of their home within walking distance during the pandemic (16.5%) compared with prior to the pandemic (14.6%) was not significantly different. The decrease observed in the percentage of participants who had a food retailer that is over an hour away from their home within walking distance during the pandemic (0.0%) compared with prior to the pandemic (1.0%) was not significant.
DISCUSSION
–Interpretation of the Results and Implications
At the beginning of this impact study, we hoped to find out how the COVID-19 pandemic has either facilitated or complicated access to food for underrepresented minorities and low-income communities in areas like NYC. Later on, this goal changed to focus on how the COVID-19 pandemic has facilitated or complicated access to food for the general population in the U.S. Our results do suggest that the COVID-19 pandemic has had a statistically significant negative impact on food accessibility throughout the country, but has not seemed to have a significant impact on the types of established food security programs, quality of food, or transportation methods accessible to people to allow them to purchase the groceries they need. However, due to a smaller sample size of 103 survey participants instead of a larger sample size of 150 participants or greater being analyzed, this may have had a significant impact on the results obtained from our survey data.
The National Institute of Health (NIH) recently uncovered a compelling result that approximately 14% of families were food insecure prior to the pandemic, and COVID-19 has only exacerbated their food inaccessibility concerns (Kinsey, Kinsey, & Rundle, 2020). However, according to our survey, there was no statistically significant difference between the percentage of participants who currently qualify for food assistance programs (16.5%) compared with prior to the pandemic (18.4%). Some of those food assistance programs asked about in the survey included Supplemental Nutrition Assistance Program (SNAP) outreach, child nutrition programs, food distribution programs, nutrition programs for seniors and Women, Infants, and Children (WIC).
To address food inaccessibility faced in the United States, our study aimed to include greater than 100 participants aged 18 to 55+, of all ethnicities and sexual identities, to reduce bias and allow for diversity in the responses. Expanding the acceptable range of study participants did not, however, prevent discrepancies in our results, especially since we chose solely to focus on U.S. citizens and how a global pandemic has impacted their means of obtaining food for their households. First and foremost, more females than males participated in taking the survey (79.6% females compared to 19.4% males), which may have led to biased results. The percentage of participants who have difficulties getting groceries they need at the store significantly increased from prior to the pandemic value of 20.4% to 65.0% during the pandemic (P< 0.00001). Since more women participated in the impact study than males, this may imply that women have struggled to make ends meet during the pandemic compared to men, especially single mothers, who tend to bear a disproportionate burden of poverty (“Pandemic Influenza Preparedness and Response Among Public-Housing Residents, Single-Parent Families, and Low-Income Populations”, 2009). Similarly, while there has not been a significant change in modes of transportation used by participants to go grocery shopping (walking, driving, uber/taxi, biking, or public transportation systems) as a result of the pandemic, the percentage of participants who are afraid of going to the store to get groceries has significantly increased from prior to the pandemic value of 14.6% to 68.9% during the pandemic (P=0.004765). In the case of single parents, these significant results might be due to their fear of infecting their children by going to the store to buy groceries, or their concern of not having anyone else tutor their younger children while they go shopping. It is evident that, although certain modes of transportation (such as intra-city public transportation systems) are more likely to put individuals at risk of contracting COVID-19, these transportation systems are not the main source of concern for the participants of this impact study (Tian et al., 2020).
Furthermore, the population specification for what constituted a minority group in the United States was not fully defined at the time the survey responses were collected and analyzed for the impact study. There was an indecision regarding whether gender and sexual minorities should be considered in addition to ethnic and racial minorities. Multiple sources were referred to which defined and categorized minorities differently. Some participants identified themselves as multiracial in the survey, but we were unable to find literature to support whether or not they would be considered a minority. Ultimately, we decided to shift our focus on working towards identifying low-income households and separating them from the average or above average income households, for further analysis . It was later realized that the ratio of the participants who fell in either of the two categories was not equivalent; with 16 out of the 103 participants reporting “Don’t know” for the survey question inquiring about their household income for 2019 (before taxes). Therefore, it was decided that the target population should just be the general population of the United States.
–Limitations of Study
Since social media platforms were used to promote the survey, this may have proven disadvantageous to not only achieving a proper sample size with diverse populations represented, but also could have led to other sample frame errors within our impact study. Upon collecting the data, 108 responses were originally obtained, but five of those responses had to be removed, either because of invalid zip codes or incomplete information provided in the survey. Errors such as this were potentially made by participants due to misunderstandings surrounding the demographic survey questions due to the wording. For instance, a two part question was asked of participants about their situation before and during the pandemic. The first part implored “did you or other adults in your household ever cut/skip meals because there was not enough food?” and the second part inquired exactly how often this situation occurred, using a rating scale (almost every day, 1-2 times a week, once a week, rarely, not at all). Some respondents first stated that they did not ever have to cut/skip meals due to lack of monetary funding, even though they indicated a rating which suggested otherwise. For those two questions, 17 out of 103 of the participants’ responses did not align with the prompt and the questions had to be removed from the survey results.
Although our research team did not uncover a statistically significant link between the quality of food offered to U.S. citizens before versus during the pandemic, results do suggest that COVID-19 has had a negative impact on the affordability of food, with significantly more participants saying that they are running out of food and are not able to afford more (33.0%) compared with prior to the pandemic (11.7%) (P=0.000233). This implies that the COVID-19 pandemic has negatively impacted participants’ access to food from food retailers, even though it has not had a significant impact on how far participants must travel to reach their nearest food retailer from their households. Furthermore, despite the COVID-19 pandemic not having a significant impact on the percentage of nearby grocery stores offering high quality fresh fruits and vegetables to participants, the results mentioned above indicating COVID-19’s negative impact on the affordability of food demonstrate that just because higher quality groceries are available for purchase near an individual’s household does not necessarily mean they can afford it . It also informs that simply having convenient locations to buy groceries from does not automatically equate to having accessibility to higher quality food sources. This is concerning since food should be more accessible during a worldwide pandemic, especially since nutrition is essential to overall health and helps to combat illnesses.
Research previously conducted by the NIH has shown that there is a strong relationship between a person’s diet and the COVID-19 pandemic (Zabetakis, Lordan, Norton, & Tsoupras, 2020). Consuming a diet high in saturated fats, sugars, and refined carbohydrates is the cause of several diseases including type II diabetes and cardiovascular disease. These diets activate the innate immune system and impair adaptive immunity, leading to chronic inflammation and the inability of the immune system to fight off the COVID-19 virus during its 14-day incubation period in the human body. This inflammation can cause long-term medical conditions, which is why the consumption of higher quality, healthy food like fruits and vegetables is beneficial. The difference in food accessibility shown by the survey data before versus during the COVID-19 pandemic across the U.S. demonstrates how there are severe implications associated with not consuming a proper diet, such as pre-existing conditions and a weaker immune system, which make an individual more likely to contract COVID-19 and experience more severe symptoms. Ultimately, bringing awareness to how COVID-19 impacted participants’ food accessibility is essential to understanding how nutrition and COVID-19 immunity may intersect.
CONCLUSION
The COVID-19 pandemic has been and continues to be a major disruption all over the world. In the United States, specifically, there was a sudden halt in academics, employment, and government programs. The Scientia research team sought to create an impact study with the goal of discovering the negative effect of COVID-19 on food accessibility in the United States. The team was able to do so by conducting a survey and collecting data from numerous participants. Out of 103 participants, we found that around 66% were New York residents, while the remaining were scattered throughout other states, including California, Colorado, Connecticut, Mississippi, New Jersey, Pennsylvania, and Texas.
Our findings indicate that COVID-19 has negatively impacted both people’s access to food and their purchasing power . Limited access to quality food can affect one’s mental health. There was a significant difference in the percentage of participants who experienced difficulty getting groceries and feared going to the grocery store during COVID-19 compared to before the COVID-19 pandemic. Thirty-three percent of people are running out of food, experiencing hunger, and unable to afford a well-balanced meal during the COVID-19 pandemic than before.
In our study, we had some limitations that could be improved. We hope to improve in the future by creating the survey ahead of time, in order to allow an ample amount of time to strengthen the survey before sending it out to people. This impacted our small sample size as a result. Another limitation was that our team should have utilized a more direct means of promoting the survey such as using the telephone rather than limiting the promotion to social media. We should have sent reminders to participants and followed up with them regarding their experience taking the survey as well as their suggestions for future improvement. Although we aim to study the impact of the COVID-19 pandemic in the US, we didn’t have a sufficient sample size because the statistics we found are only limited to the participants who took our survey. One survey may not be good enough to analyze food accessibility in the United States. However, the responses by people from the different states showed that food insecurity is a large-scale problem. However, we can have an impact on food accessibility in the United States using our research findings.
This survey was only the first step to learn more about COVID-19 and its impact on food accessibility in the United States. In the near future, our team plans to continue our research to discover ways that we as a team can help our communities and society as a whole. There is enough data to give us a lead to how big this problem is on a larger scale. We will continue to spread awareness and share information through our social media platforms so that we can educate a larger audience and continue the ever-expanding conversation around food insecurity.
Acknowledgments
This paper and the research behind it would not have been possible without the exceptional support of our program facilitator, Mr. Morrison. His knowledge, direction, and professional guidance during meetings and office hours have been an inspiration. It helped our team stay on track from the very beginning.
We also like to offer special thanks to Dr. Natasha Gutierrez for playing an important role in helping us with creating standard survey questions all the way to offering guidance on what to expect in a research paper. We would also like to thank Dr. Gail Rosenbaum for assistance in data analysis.
We would like to express our gratitude to the Mentoring in Medicine (MIM), Inc. platform, for giving our team this opportunity to develop our research experience this summer.
A special thank you to all members of our team for working diligently to make this research successful.
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