Objective: To evaluate regional differences in factors associated with food insufficiency during the initial months of the COVID-19 pandemic among three major metropolitan regions in California, a state with historically low participation rates in the Supplementation Nutrition Assistance Program, the nation's largest food assistance programme.
Design: Analysis of cross-sectional data from phase 1 (23 April-21 July 2020) of the US Census Household Pulse Survey, a weekly national online survey.
Setting: California, and three Californian metropolitan statistical areas (MSA), including San Francisco-Oakland-Berkeley, Los Angeles-Long Beach-Anaheim and Riverside-San Bernardino-Ontario MSA.
Participants: Adults aged 18 years and older living in households.
Results: Among the three metropolitan areas, food insufficiency rates were lowest in the San Francisco-Oakland-Berkeley MSA. Measures of disadvantage (e.g., having low-income, being unemployed, recent loss of employment income and pre-pandemic food insufficiency) were widely associated with household food insufficiency. However, disadvantaged households in the San Francisco Bay Area, the area with the lowest poverty and unemployment rates, were more likely to be food insufficient compared with those in the Los Angeles-Long Beach-Anaheim and Riverside-San Bernardino-Ontario MSA.
Conclusions: Food insufficiency risk among disadvantaged households differed by region. To be effective, governmental response to food insufficiency must address the varied local circumstances that contribute to these disparities.
Keywords: COVID-19; Food insufficiency; Food policy; Health disparities.