Background: Food security, defined as consistent access to sufficient food to support an active life, is a crucial social determinant of health. A key dimension affecting food security is position along the rural-urban continuum, as there are important socio-economic and environmental differences between communities related to urbanicity or rurality that impact food access. The COVID-19 pandemic created social and economic shocks that altered financial and food security, which may have had differential effects by rurality and urbanicity. However, there has been limited research on how food security differs across the shades of the rural-urban community spectrum, as most often researchers have characterized communities as either urban or rural.
Methods: In this study, which linked restricted use Current Population Survey Food Security Supplement data to census-tract level United States Department of Agriculture Rural-Urban Commuting Area codes, we estimated the prevalence of household food security across temporal (2015-2019 versus 2020-2021) and socio-spatial (urban, large rural city/town, small rural town, or isolated rural town/area) dimensions in order to characterize variations before and during the COVID-19 pandemic by urbanicity/rurality. We report prevalences as point estimates with 95% confidence intervals.
Results: The prevalence of food security was 87.7% (87.5-88.0%) in 2015-2019 and 88.8% (88.4-89.3%) in 2020-2021 for urban areas, 85.5% (84.7-86.2%) in 2015-2019 and 87.1% (85.7-88.3%) in 2020-2021 for large rural towns/cities, 82.8% (81.5-84.1%) in 2015-2019 and 87.3% (85.7-89.2%) in 2020-2021 for small rural towns, and 87.6% (86.3-88.8%) in 2015-2019 and 90.9% (88.7-92.7%) in 2020-2021 for isolated rural towns/areas.
Conclusion: These findings show that rural communities experiences of food security vary and aggregating households in these environments may mask areas of concern and concentrated need.