​Summary: The COVID-19 pandemic disproportionately affects low-income communities experiencing food insecurity because of 1) the increased risk for infection among people coping with conditions associated with food insecurity and 2) the effects of the pandemic on physical and financial access to sources of nutrition. The pandemic has increased rates of food insecurity by affecting the supply of food and the capacity of individuals to afford food. People experiencing poverty are at increased risk for COVID-19, and conditions typically associated with food insecurity, such as obesity, diabetes, and cardiovascular disease, are contributors to intensive care admission and in-hospital mortality among patients diagnosed with COVID-19.

The pandemic instigated an economic downturn that shuttered many businesses that provide food, closed schools where children ate, and left many without jobs. During the first month of the pandemic, approximately 30% of U.S. children, particularly those in low-income and racial and ethnic minority groups, experienced household food insecurity. In San Diego, the pandemic has had a similar impact: 44% of Black and Hispanic/Latine residents have experienced food insecurity, compared with 25% of the overall population (12). Nationwide, communities responded to these changes; 17% more families applied for SNAP to help mitigate food inaccessibility and unaffordability. EBT programs, like Pandemic-EBT, were created to help families purchase food, and evidence suggests that these programs reduced food hardship. However, the availability of stores that accept EBT and changes to these stores during the pandemic have not been described in detail.

Researchers expand existing research on food insecurity to explore changes in the availability of stores that accept EBT during the pandemic, including grocery stores and small food retailers like convenience stores and small markets. The researchers’ objective was to identify how the availability of stores that accept EBT payments, authorized by SNAP, changed in an area of San Diego County with long-standing patterns of food insecurity.

The study area included 159 low-income census block groups (CBGs) in 4 ZIP codes in the federally designated San Diego Promise Zone (92101, 92102, 92113, 92114) and 1 ZIP code from National City (91950), an adjacent neighborhood. Promise Zones are designated by the US Department of Housing and Urban Development as areas that receive special assistance for community revitalization. This study area comprised 15.5 square miles, approximately 279,511 people, and some of San Diego’s most food-insecure codes. Researchers overlaid 2021 land-use data from the San Diego Association of Governments in each CBG. Authors included CBGs that contain any amount of residential land use, including single family and multifamily.

Researchers downloaded the location of stores that accepted EBT payments from the USDA’s online SNAP Retailer Locator tool on July 23, 2019, and 2 years later, on July 23, 2021. Stores on the EBT list for San Diego County include large-scale supermarkets, small-scale local grocers, specialty markets (eg, bakery, butcher), convenience stores, gas station markets, and liquor stores. They coded each EBT store according to the presence of fresh produce reported previously and locations serviced by BrightSide Produce, an initiative designed to support the availability of fruits and vegetables at small markets, convenience stores, and liquor stores that accept EBTs.

Findings: The study area comprised 200 EBT stores on July 23, 2019; by July 23, 2021, twenty-three stores had been removed from San Diego County’s EBT list and 7 stores had been added, resulting in 184 stores (a net loss of 16 [−8.0%] stores). The 23 stores that either closed or stopped accepting EBT were 1 full-service supermarket, 3 bakeries, 3 produce outlets, 1 ice cream shop, 1 pharmacy, 11 convenience stores, 1 gas station, 1 fish market, and a food delivery service. Stores added to the EBT list included 6 convenience stores and 1 pharmacy; the full-service supermarket was not replaced. In 2019, 128 (64.0%) stores offered produce, and in 2021, 121 (65.7%) offered produce (including 2 of 7 new stores). Seven of the 23 closed stores had offered fruits and vegetables. Although fewer stores in 2021 accepted EBT, the percentage of stores that offered produce was similar.

Two-thirds of CBGs (105 of 159; 66.0%) lost access to 1 or more (range, 1–6) EBT stores within ½ mile, and 13 (8.2%) CBGs gained 1 EBT store. Over time, the average number of EBT stores accessible within half a mile declined by 1.2 stores on average across all CBGs. Mann–Whitney nonparametric tests suggested that the CBGs that lost EBT access, compared with CBGs that gained EBT access, had significantly lower median incomes, higher poverty rates, lower high school graduation rates, a higher proportion of households with no vehicle, larger Hispanic/Latine populations, and higher food insecurity rates. Although authors could not use statistical testing, they observed that CBGs that lost EBT stores that carried fresh produce were more varied in socioeconomic composition and experienced lower rates of food security than CBGs that gained fresh produce access.

The loss of EBT stores during the pandemic affected food access to a greater degree among residents in communities experiencing hardships (e.g., financial insecurity, lack of vehicle) than in communities experiencing these hardships to a lesser degree. Mapping and monitoring of food insecurity in neighborhoods of concern is crucial as the pandemic continues. Challenges not studied here may affect the number of EBT stores residents can access. As federal income assistance wanes, the demand for food outlets that accept EBT will likely increase. Research on local food landscapes should consider these changing contexts in neighborhoods of long-standing food insecurity. Measures of food retail choice should consider small food retailers, like the ones studied here, along with supermarkets and grocery stores.
 

Read the Publication:

• Journal Article: Mapping EBT Store Closures During the COVID-19 Pandemic in a Low-Income, Food-Insecure Community in San Diego