Abstract
Introduction
The COVID-19 pandemic has amplified and exacerbated health disparities and social inequities that have plagued the United States (U.S.). Marginalized U.S. populations, such as racial/ethnic minority adults, have experienced the greatest burden of COVID-19-related outcomes. For example, COVID-19 related mortality experienced among racial/ethnic minority adults was 1.9–2.4 times greater than non-Hispanic adults (Badalov et al., 2022). Estimates also show a disproportionate burden of COVID-19 infection (Adhikari et al., 2020; Kimani et al., 2021) and hospitalizations (Karaca-Mandic et al., 2021; Roth et al., 2022) experienced by racial/ethnic adults. Even as the U.S. federal government has rescinded the COVID-19 national public health emergency, non-Hispanic Black and Latinx adults are still grappling with the consequences of elevated COVID-19 transmission/infection and mortality inequities at the height of the pandemic. Prior to the COVID-19 pandemic, Latinx adults experienced elevated rates of chronic conditions (Pebley et al., 2021; Ro et al., 2022), such as obesity (Isasi et al., 2022; Pirzada et al., 2023) and asthma-related outcomes (Han et al., 2020), with these chronic conditions increasing the risk of COVID-19 infection and mortality.
U.S. Latinx adults, compared to their non-Hispanic white (NHW) adult peers, are more likely to experience underlying health conditions (e.g., diabetes, hypertension, and obesity) linked with elevated risk of COVID-19 infection and mortality. In addition, the recategorization of “essential” occupations during initial U.S. pandemic response placed Latinx adults at higher risk of work-related COVID-19 infection. Furthermore, U.S. Latinx adults have experienced persistent occupational (Chantarat et al., 2022; Kearney & Imai, 2023; Mintz & Krymkowski, 2010; Queneau, 2009; Richey et al., 2022; Whitaker, 2022) and residential segregation (Galaskiewicz et al., 2021; Hess, 2021; White & Lawrence, 2019). These types of work environments, overrepresented by U.S. Latinx adults, include service-related work like grocery stores, transportation, agriculture, and meatpacking.
The confluence of occupational hazards, elevated COVID-19 infection, and mortality among U.S. Latinx adults have fueled social demographers to justifiably question the continued relevance of the Latino Health Paradox, a term used to describe the epidemiological finding that U.S. Latinos tend to have health outcomes that are comparable to or, in some cases, better than U.S. NHW counterparts (Sáenz & Garcia, 2021). Using 2020 provisional death data (February 1–August 22, 2020) from the Centers for Disease Control and Prevention, Sáenz and Garcia (2021) compute age-specific death rates (ASDRs) (deaths from COVID-19, residual deaths, and total deaths for four age groups [55–64, 65–74, 75–84, and 85 and older]) to assess the continued utility of the Latino health paradox. They find that U.S. Latinx adults experienced lower ASDRs for non-COVID-19 causes of death across all age groups compared to non-Latino white adults (“whites” hereafter) (Sáenz & Garcia, 2021); however, Latinx adults experienced significantly higher ASDRs for COVID-19 deaths than non-Latino white adults.
In addition, Sáenz and Garcia further show that Latino adult health advantages for total deaths have diminished significantly between 1999 and 2018 (Sáenz & Garcia, 2021). Subsequently, Garcia and Sáenz (2023) further assessed the resiliency of the Latino paradox, calculating Latinx-white ASDRs for 2020 and 2021 and expanding the age groups evaluated (45–54, 55–64, 65–74, 75–84, and 85+) in 13 states with Latino populations of at least 1 million. Garcia and Sáenz (2023) document three distinct patterns of COVID-19 mortality variations across 13 U.S. states. First, Latinx-white all-cause mortality disparities were significant, where disparities narrowed from younger adults to older ages in 2020 and 2021 (Garcia & Sáenz, 2023). Also, the Latinx-white COVID-19 mortality gaps diminished noticeably across all age groups between 2020 and 2021, although Latinx adults between 45 and 74 years of age continuing to exhibit heightened COVID-19 mortality rates, with doubled mortality rate compared to their white adult peers (Garcia & Sáenz, 2023). Pre-pandemic (1999–2018), Latinx adults aged 45 and older experienced a 30% mortality advantage compared to their white adult peers, with significant decreases in this mortality advantage in 2020 (10%) and 2021 (14%) (Garcia & Sáenz, 2023).
The disproportionate impact of COVID-19 is also evident in adults living with chronic respiratory diseases. In fact, multiple meta-analyses have demonstrated that respiratory comorbidities are associated with more severe COVID-19 symptoms and/or higher mortality (Lippi & Henry, 2020; Sanchez-Ramirez & Mackey, 2020). The evidence that those with pre-existing respiratory conditions may have worse COVID-19 prognoses is growing (Robinson et al., 2021). However, there is a lack of literature that is focused on the increased susceptibility to the mental and social burden that most adults with chronic pulmonary conditions, particularly Latinx adults are faced with. Wei et al. (2021) (Wei et al., 2021) found that adults with chronic respiratory conditions were more likely to report mental health symptoms during the COVID-19 pandemic. Studies have shown that racial/ethnic minority adult populations experiencing pulmonary chronic conditions (e.g., asthma) reported elevated mental health complications during the pandemic (Wei et al., 2021). However, less attention has been supplied to the interplay between asthma, mental health symptoms, and broader social inequities in food insecurity experienced by U.S. Latinx adults (Camacho-Rivera et al., 2022a, 2022b).
In addition, to the best of our knowledge, the social burden, particularly food insecurity, felt by adults living with chronic pulmonary conditions is under-studied. A cross-sectional study quantified differences in the social determinants of health (SDOH) and perceived changes in SDOH during the COVID-19 pandemic and the COVID psychosocial impacts across four groups: NHW parents of children with asthma; Black, Indigenous, or other People of Color (BIPOC) parents of healthy children; BIPOC parents of children with asthma; and NHW parents of healthy children (the referent group). This study determined that BIPOC families experienced greater food insecurity and discrimination, relative to NHW parents of healthy children. When compared with the NHW healthy group, COVID-19 resulted in greater parent-reported resource losses for both BIPOC groups and greater reductions in healthcare access for both asthma groups. Children with asthma and BIPOC children had greater distress surrounding COVID-19. BIPOC and NHW parents of children with asthma reported greater worries about resource losses due to COVID-19. Thus, it was concluded that the COVID-19 pandemic is widening the inequities for BIPOC families, especially families of children with asthma (Clawson et al., 2021). COVID-19 is exacerbating and fueling existing inequalities, due to the SDOH, but there is still room for more studies to be done on its impact on quality-of-life outcomes for minority adults (Hispanic Americans) living with chronic pulmonary conditions.
Our primary study objective was to evaluate the mental and social burden reported during the COVID-19 pandemic among a nationally representative sample of U.S. adults, focusing on adults of the Hispanic American community with chronic respiratory conditions, particularly asthma. Our secondary objective was to explore group heterogeneity within the Hispanic American ethnic groups, again focusing on adults with chronic pulmonary conditions (asthma). Understanding the mental and social burden among patients with chronic pulmonary conditions may improve patient self-management and help patients optimize their health, while minimizing the negative experiences with disease during the pandemic. To accomplish these objectives, we conducted a secondary data analysis of repeated cross-sectional data from the Understanding America Study (UAS).
Methods
Study Data
We use data from the UAS, a U.S. nationally representative probability-based online panel. The UAS panel consists of approximately 9,000 panel members and was generated through a multiphase (mail, web) recruitment of households through an address-based sampling frame. All materials, communications, and surveys are conducted in either English or Spanish. The UAS COVID-19 survey collected information on the attitudes and behaviors around the COVID-19 pandemic in the United States, as well as a diverse set of health measures. The project was launched with a standalone survey on March 10, 2020, as “Wave 1.” Of the UAS panel, 8,815 participants were invited, with 7,145 participating in the Wave 1 survey. The tracking survey included repeated cross-sectional surveys (Waves 2–29), which consisted of a national long-form questionnaire and a Los Angeles County short-form questionnaire. Waves 2–24 were administered bi-weekly (national) from April 1, 2020 to February 16, 2022. Survey waves 25–29 were administered monthly (national) from February 17 to July 20, 2021. Subsequent waves were conducted as standalone surveys. Reports, questionnaires, toplines, single data files, longitudinal data files, and documentation are provided after the end of each wave of the UAS COVID survey.
Measures
Food insecurity was based on participant's responses to the following three questions: “In the past seven days, were you worried you would run out of food because of a lack of money or other resources?”; “In the past seven days, did you eat less than you thought you should because of a lack of money or other resources?”; and “In the past seven days, did you go without eating for a whole day because of a lack of money or other resources?”. For each question, response options were “Yes,” “No,” or “Unsure.” Participants were categorized as reporting food insecurity if they responded “Yes” to any of the three questions.
To assess mental health symptoms, the participants were asked how frequently they reported the following feelings within the 14-day period prior to the survey: “Over the past fourteen days, how often have you been bothered by any of the following problems?: Feeling nervous, anxious, or on edge; Not being able to stop or control worrying; Feeling down, depressed, or hopeless; Little interest or pleasure in doing things.” Response options for these questions were “Not at all,” “Several days,” “More than half the days,” or “Nearly every day.” Additional questions include: “Over the past fourteen days, how often have you been bothered by any of the following problems?: That you were unable to control the important things in your life; Confident about your ability to handle personal problems; That things were going your way; Difficulties were piling up so high that you could not overcome them?” For these questions, response options were: “Never,” “Almost Never,” “Sometimes,” “Fairly Often,” or “Very Often.”
Primary demographic predictors of interest include self-reported race and Latino ethnicity and Latino ethnic subgroup. This measurement approach for race and ethnicity derives from the U.S. Census’ two-part race and ethnicity question. The participant's self-report of race can be considered as singular (e.g., “1 White” or “2 Black”) or as mixed (in case the respondent identifies with two or more races). The value “6 Mixed” that the respondent answered “Yes” to at least two of the single race categories. This variable is generated based on the values of the different race variables (NHW, non-Hispanic Black, Native American, AAPI). This composite measure is not conditional on Hispanic or Latino ethnicity, so an individual may identify as Hispanic or Latino, and also as a member of one or more racial groups. Thus, our combined measure capturing race, Latinx ethnicity, and Latinx ethnic subgroup included the following six categories: NHW, non-Hispanic Black.
Covariates included in the analyses were based on review of the scientific literature, which particularly included metrics that have been shown to be associated with either mental health symptoms and/or food insecurity, minimizing potential confounding bias. These metrics include gender identity, age, immigration status (non-immigrant, first generation immigrant, second generation immigrant, or more), education, insurance status, and smoking status.
Analytic Strategy
Our analytic strategy included two phases. First, we computed chi-square tests to compare the prevalence of depression and food insecurity across key demographic covariates. Second, we computed multivariable generalized linear regression models, with a logit link function, to model food insecurity, stratified by gender, to examine associations between food insecurity, demographic characteristics, and mental health symptoms. We report adjusted odds ratios (aOR) and corresponding 95% confidence intervals (CIs) for gender-stratified multivariate regression models, where we present two models, one for men and women, respectively (gender-stratified estimates). All statistical analyses were conducted using Stata IC 15 (StataCorp LLC, College Station, TX). Sampling weights were applied to provide results that were nationally representative of the U.S. adult population.
Results
As shown in Table 1, self-report of depressive symptoms varied by history of food insecurity and across demographic characteristics. The participants with a history of food insecurity had a higher prevalence of depressive symptoms compared to those without a history of food insecurity (21.1% compared to 5.23%, p < .0001). Prevalence of depressive symptoms also varied across race and Latino ethnicity, with Latino participants of Mexican ethnicity reporting a significantly higher prevalence of depression compared to Latino participants of Puerto Rican origin, Central American origin, or another Latino ethnicity (8.94% compared to 2.84%, 1.76%, and 2.91%, respectively, p < .0001). The participants who were foreign born reported a significantly lower prevalence of depressive symptoms (10.0%) compared to those who were U.S. born, second generation (14.1%), or third generation (14.8%). Additional differences in self-reported depressive symptoms emerged by gender, educational attainment, marital status, health insurance status, and household income.
Prevalence of Depression Across Food Insecurity and Demographic Characteristics of UAS Participants (n = 182,855).
As shown in Table 2, associations of self-report of food insecurity among men varied by asthma status. Among men without a history of asthma, men of Mexican or Mexican American origin were significantly more likely to report being food insecure compared to NHW men (aOR = 1.30, 95% CI 1.08–1.57, p-value = .005). Similarly, men of Puerto Rican origin were more than twice as likely to report being food insecure compared to NHW men (aOR = 2.16, 95% CI 1.50–3.12, p-value < .0001). Conversely, men of other Latinx backgrounds were significantly less likely to report being food insecure compared to NHW men (aOR = 0.43, 95% CI 0.28–0.66, p-value < .0001). Upon examining differences in food insecurity by generational status, men who were first generation immigrants were significantly more likely to report being food insecure compared to men of non-immigrant backgrounds (aOR = 1.57, 95% CI 1.29–1.92, p-value < .0001). Compared to men aged 18–29 years old, men who were 30–44 years old were significantly more likely to report being food insecure (aOR = 1.32, 95% CI 1.09–1.60, p-value = .005). Conversely, men ages 65 years or above were significantly less likely to report being food insecure compared to men aged 18–29 years old (aOR = 0.37, 95% CI 0.29–0.47, p-value < .0001).
Multivariable Logistic Regression Results for Food Insecurity Among Men, Stratified by Asthma Status.
Educational attainment was significantly inversely associated with food insecurity, as men with a high school degree/GED (aOR = 0.65, 95% CI 0.57–0.76, p-value < .0001), men with some college (aOR = 0.57, 95% CI 0.48–0.66, p-value < .0001), and men with a bachelor's degree or more (aOR = 0.37, 95% CI 0.31–0.45, p-value < .0001) were significantly less likely to report being food insecure compared to men with less than a high school degree. Men who were widowed, divorced, or separated (aOR = 1.21, 95% CI 1.03–1.41, p-value = .19) or single/never married were significantly more likely to report being food insecure compared to men who were currently married (aOR = 1.60, 95% CI 1.41–1.82, p-value < .0001). Men without health insurance were significantly more likely to report being food insecure compared to men with health insurance (aOR = 1.65, 95% CI 1.45–1.88, p-value < .0001). Household income was significantly inversely associated with food insecurity, as men in all higher income categories were significantly less likely to report being food insecure compared to men with annual household incomes in the $0–$29,999 dollar category.
Among men with a history of asthma, men of Mexican or Mexican American origin were significantly more likely to report being food insecure compared to NHW men (aOR = 1.90, 95% CI 1.19–3.05, p-value = .007). Similarly, although CIs are wider due to the smaller sample size, men of Puerto Rican origin were more likely to report being food insecure compared to NHW men (aOR = 22.66, 95% CI 10.89–47.15, p-value < .0001). Conversely, men of other Latinx backgrounds were significantly less likely to report being food insecure compared to NHW men. Men with asthma who were of Asian background were three times as likely to report being food insecure compared to NHW men (aOR = 3.17, 95% CI 1.82–5.51). Upon examining differences in food insecurity by generational status, men who were first generation immigrants were significantly more likely to report being food insecure compared to men of non-immigrant backgrounds (aOR = 1.57, 95% CI 1.29–1.92, p-value < .0001).
Compared to men aged 18–29 years old, men who were 30–44 years old were significantly more likely to report being food insecure (aOR = 1.32, 95% CI 1.09–1.60, p-value = .005). Conversely, men ages 65 years or above were significantly less likely to report being food insecure compared to men aged 18–29 years old (aOR = 0.37, 95% CI 0.29–0.47, p-value < .0001). Educational attainment was significantly inversely associated with food insecurity, as men with a high school degree/GED (aOR = 0.65, 95% CI 0.57–0.76, p-value < .0001), men with some college (aOR = 0.57, 95% CI 0.48–0.66, p-value < .0001), and men with a bachelor’s degree or more (aOR = 0.37, 95% CI 0.31–0.45, p-value < .0001) were significantly less likely to report being food insecure compared to men with less than a high school degree. Men who were widowed, divorced, or separated (aOR = 1.21, 95% CI 1.03–1.41, p-value = .19) or single/never married were significantly more likely to report being food insecure compared to men who were currently married (aOR = 1.60, 95% CI 1.41–1.82, p-value < .0001). Men without health insurance were significantly more likely to report being food insecure compared to men with health insurance (aOR = 1.65, 95% CI 1.45–1.88, p-value < .0001). Household income was significantly inversely associated with food insecurity, as men in all higher income categories were significantly less likely to report being food insecure compared to men with annual household incomes in the $0–$29,999 dollar category.
As shown in Table 3, associations of self-report of food insecurity among women varied by asthma status. Among women without a history of asthma, women of Puerto Rican origin were significantly more likely to report being food insecure compared to NHW women (aOR = 3.01, 95% CI 2.42–3.75, p-value < .0001). Similarly, women of other Latina origin were almost twice as likely to report being food insecure compared to NHW women (aOR = 1.82, 95% CI 1.46–2.27, p-value < .0001). Asian women were significantly more likely to report being food insecure compared to NHW women ((aOR = 1.46, 95% CI 1.20–1.76, p-value < .0001). Upon examining differences in food insecurity by generational status, women who were first generation or second generation immigrants were significantly more likely to report being food insecure compared to women of non-immigrant backgrounds (aOR = 1.47, 95% CI 1.26–1.72, p-value < .0001; aOR = 1.43, 95% CI 1.25–1.63, p-value < .0001). Compared to women aged 18–29 years old, women who were 30–44 years old were significantly more likely to report being food insecure (aOR = 1.15, 95% CI 1.02–1.30, p-value = .020). Conversely, women ages 40–64 years and women 65 years or above were significantly less likely to report being food insecure compared to women aged 18–29 years old (aOR = 0.86, 95% CI 0.75–0.98, p-value = .026; aOR = 0.33, 95% CI 0.28–0.40, p-value < .0001).
Multivariable Logistic Regression Results for Food Insecurity Among Women, Stratified by Asthma Status.
Educational attainment was significantly inversely associated with food insecurity, as women with a high school degree/GED (aOR = 0.57, 95% CI 0.51–0.64, p-value < .0001), women with some college (aOR = 0.63, 95% CI 0.56–0.71, p-value < .0001), and women with a bachelor's degree or more (aOR = 0.32, 95% CI 0.28–0.38, p-value < .0001) were significantly less likely to report being food insecure compared to women with less than a high school degree. Women who were widowed, divorced, or separated (aOR = 1.16, 95% CI 1.04–1.28, p-value = .006) or single/never married were significantly more likely to report being food insecure compared to women who were currently married (aOR = 1.14, 95% CI 1.03–1.27, p-value = .011). Interestingly, women without health insurance were significantly less likely to report being food insecure compared to women with health insurance (aOR = 0.73, 95% CI 0.65–0.83, p-value < .0001). Household income was significantly inversely associated with food insecurity, as women in all higher income categories were significantly less likely to report being food insecure compared to women with annual household incomes in the $0–$29,999 dollar category.
Among women with a history of asthma, women of Puerto Rican origin were significantly more likely to report being food insecure compared to NHW women (aOR = 2.44, 95% CI 1.30–4.56, p-value = .005). Similarly, asthmatic women of Central or South American origin were more than twice as likely to report being food insecure compared to asthmatic NHW women (aOR = 2.05, 95% CI 1.38–3.03, p-value < .0001). Similarly, asthmatic women of other Latina origin were more than three times as likely to report being food insecure compared to non-Hispanic asthmatic white women (aOR = 3.24, 95% CI 2.07–5.08, p-value < .0001). Asian women with asthma were more than twice as likely to report being food insecure compared to NHW women with asthma (aOR = 2.13, 95% CI 1.37–3.31, p-value < .0001). Upon examining differences in food insecurity among asthmatic women by generational status, women who were first generation were nearly three times as likely to report being food insecure compared to asthmatic women of non-immigrant backgrounds (aOR = 2.84, 95% CI 2.27–3.55, p-value < .0001). Compared to women aged 18–29 years old, asthmatic women who were 30–44 years old were significantly more likely to report being food insecure (aOR = 1.45, 95% CI 1.15–1.85, p-value = .002). Conversely, women ages 65 years or above were significantly less likely to report being food insecure compared to women aged 18–29 years old (aOR = 0.21, 95% CI 0.14–0.30, p-value < .0001).
Educational attainment was significantly inversely associated with food insecurity, as women with a high school degree/GED (aOR = 0.63, 95% CI 0.50–0.78, p-value < .0001) and women with some college degree (aOR = 0.52, 95% CI 0.42–0.65, p-value < .0001) were significantly less likely to report being food insecure compared to women with less than a high school degree. Asthmatic women without health insurance were significantly more likely to report being food insecure compared to asthmatic women with health insurance (aOR = 1.68, 95% CI 1.37–2.04, p < .0001). Household income was significantly inversely associated with food insecurity, as women in all higher income categories were significantly less likely to report being food insecure compared to women with annual household incomes in the $0–$29,999 dollar category.
Discussion
This study found that there is a higher prevalence of food insecurity among those with asthma who are first generation, have a lower level of educational attainment, have a lower household income, have no insurance, and are of Mexican or Puerto Rican backgrounds. This trend was seen in both men and women during the COVID-19 pandemic. Although food insecurity among individuals with chronic respiratory conditions is under-studied, this study's results demonstrate a similar socioeconomical burden experienced by individuals with other chronic health conditions. For example, it was found that the determinants of food insecurity among individuals with cardiometabolic conditions, during the pandemic, included Hispanic race/ethnicity, an educational degree lower than a baccalaureate, a household of less than $100,000, and having Medicaid or no insurance (Camacho-Rivera et al., 2022a). Similar factors associated with an increased risk of food insecurity were seen among cancer survivors, including lower levels of education, household income of less than $30,000 per year, and having Medicaid or no insurance coverage (Camacho-Rivera et al., 2022b).
Additionally, our study demonstrated that the participants with a history of food insecurity had a higher prevalence of depressive symptoms compared to those without a history of food insecurity. This burden of mental health symptoms was also comparable in other populations with other chronic health conditions, as it was found that among individuals with cardiometabolic conditions without an existing mental health condition, the odds of having mental health symptoms were greater in those experiencing food insecurity compared to those not experiencing food insecurity (Camacho-Rivera et al., 2022a)). Cancer survivors also facing food insecurity were nine times more likely to feel nervous or anxious 3–7 days per week than those who were food insecure. They were more likely to feel depressed, lonely, or hopeless than those who are food secure (Camacho-Rivera et al., 2022b).
Additional studies conducted among asthmatics during the COVID-19 pandemic have documented associations between food insecurity and asthma control, finding that the participants reporting high food insecurity were more likely to have uncontrolled asthma compared to those with lower food insecurity (Ni et al., 2023). A 2021 study of asthmatic participants in the California Health Interview Survey observed that food insecure adults were 148% more likely to report delay in asthma prescription, as compared to those who were food secure (adjusted odds ratio =2.48; 95% CI: 1.58, 3.89) (Grande et al., 2023). A repeated cross-sectional analysis of the 2003–2018 National Health and Nutrition Examination Survey (NHANES) observed that food insecurity among U.S. adults was associated with asthma, asthma attacks, and asthma-related ER visits (Becerra et al., 2021). Taken together, these studies confirm that food insecurity exists in adults with asthma and is associated with uncontrolled asthma and associated asthma morbidity. Providers should consider screening their patients for food insecurity when treating individuals with uncontrolled asthma.
Surveillance data indicate that food security rates increased among Supplemental Nutrition Assistance Program (SNAP) participants during the COVID-19 pandemic (2020 and 2021) compared with pre-pandemic (2019), and was not attributable to changes in the sociodemographic characteristics of the participants during this period (Brady et al., 2023).
The study's strengths and limitations should also be acknowledged. The strengths of the study include the use of a nationally representative sample, which allows findings to be generalized to non-institutionalized adults living in the U.S. during the COVID-19 pandemic. Further, we were able to include more nuanced information about potential subpopulations experiencing food insecurity or mental health symptoms during the COVID-19 pandemic. The limitations of the study include the cross-sectional design, which prohibits the ability to establish temporal associations between reports of food insecurity and mental health symptoms. In addition, the report of participant's medical histories, including asthma status, is based on self-report. Lastly, while self-report of mental health symptoms was based on validated measures, clinical diagnoses of depression or anxiety were not available.
Conclusion
To the best of our knowledge, this is the first study to identify the prevalence of food insecurity among adults with and without asthma, particularly those of Hispanic background, as well as determine associations between food insecurity and mental health symptoms among individuals with asthma during the COVID-19 pandemic. Given the associations that were found between food insecurity, chronic respiratory conditions (e.g., asthma), and mental health during the COVID-19 pandemic, our study suggests a need for interventions and improved access to these interventions for the most vulnerable populations. Screening for food insecurity is essential at health visits so healthcare providers can refer patients to the appropriate social services, such as SNAP, and potentially expand these programs to individuals with chronic respiratory conditions, like asthma.
For Latinx adults, access to programs such as SNAP may be improved by initiatives that focus on modifying eligibility restrictions, increasing the number of bilingual staff interacting with individuals during the application process, and enhancing understanding about available programs through trusted community partners (Rodriguez et al., 2021). And finally, mental health screenings, especially among asthmatics with unmet social needs like food insecurity, are also beneficial, as increased linkages to counseling or psychiatric services, as well as food assistance services, would lessen asthma disparities among U.S. Latinx adults. Increasing screening efforts in clinical settings, and initiation of appropriate referrals to community service, should be considered as an ongoing approach, due to the magnitude of food insecurity in the Latinx population, particularly during the COVID-19 pandemic. Despite variability among policymakers to expand or enhance social safety net programs, permanently incorporating COVID-19-related policy interventions could lessen food insecurity and its associated health consequences in years to come.
Footnotes
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Stony Wold-Herbert Fund.
