Social Determinants, Food Insecurity and Health Outcomes for South Bronx Residents during the COVID-19 Pandemic

Background. The COVID-19 pandemic intensified food insecurity, especially for low-income, ethnoracially minoritized populations. Pandemic-related job loss, social isolation, and weakened safety nets disproportionately harmed communities of color, a burden worsened in urban areas like NYC, where limited transportation often forces reliance on convenience stores and fast-food outlets. To address this gap, we applied the social determinants of health framework to understanding the associations between food insecurity and various health outcomes, namely anxiety, depression, COVID-19 diagnosis, and health care utilization.

In 2023, 13.5 percent of U.S. households (18 million) – experienced food insecurity at some point during the year. Food insecurity has isproportionately affected groups like children, single-parent households, ethnoracially minoritized groups, and individuals living at or below the federal poverty line. As of January 2024, 39% of adults in the Bronx experienced food insecurity, more than twice the state average of 24.9%. Given the elevated risk in the Bronx and the limited research on this issue locally, we selected the South Bronx as our intervention site.

Methods. Using purposive and convenience sampling,we recruited 218 food pantry recipients in the South Bronx to participate in a survey, applying the SDoH framework to examine health outcomes during the COVID-19 pandemic. The measure for SDoH was the Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE), which assessed health determinants across five domains: personal characteristics, family and home, finance and resources, social and emotional health; and personal safety.

Results. Multivariable linear regression revealed significant positive associations between SDoH domains and multiple health outcomes. In all models, we controlled for race/ethnicity, income and education. Greater food security was linked to lower anxiety, with each point increase corresponding to a 61% reduction in symptoms (β = -0.61, p = .039). Greater food security also corresponded to an 80% reduction in one standard deviation of depression symptoms (β = -0.80, p = .014). Both food security and financial resources significantly reduced the odds of a COVID-19 diagnosis. Individuals with stronger financial resources had 0.74 times lower odds of COVID-19 diagnosis (OR = 0.74, 95% CI: 0.56 – 0.99, p = .043), and those with high food security had similarly reduced odds (OR = 0.74, 95% CI: 0.56 – 0.99, p = .041). Food-secure individuals had 9% lower odds of a medical visit (OR = 0.91, p = .802). These findings are still preliminary and may be slightly adjusted in the final presentation.

Conclusions and Implications. These findings highlight the role ofSDoH in driving health disparities among those living with food insecurity and underscore the importance of community-based initiatives to improve access to healthy, affordable food. Single-parent households, renters, people of color, and individuals relying on government assistance are especially affected by food insecurity, and by extension, their physical and mental health outcomes are impacted as well. Greater recognition and address of social determinants of health will arguably have a positive impact not only on food insecurity, but also on anxiety, depression, COVID-diagnosis and health care utilization.