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Many individuals make financial, health and food related trade-offs to cope with the challenges of food insecurity and to meet their household needs for healthy, affordable food. A survey (n = 652) was conducted in nine rural counties in South Carolina, USA, during the COVID-19 pandemic from August 2020 to July 2021. We examine if level of food insecurity predicts hunger-coping trade-offs, and whether this relationship is moderated by easiness in food access and dependence on different food source types. Nearly one-third of the respondents experienced food insecurity. Making trade-offs between paying for food and other household expenses was common among the rural residents as on average they made nearly one type of trade-off in the past three months. The number of trade-offs was the highest among highly food insecure respondents (mean = 2.64), followed by moderately food insecure respondents (mean = 1.66); low food insecure respondents had the lowest number of trade-offs (mean = 0.39). The moderating effects of easiness in food access and dependence on food sources varied by level of food insecurity. The results show that individuals at different levels of food insecurity use different strategies to fulfill their food needs and social programs are more often utilized than personal food sources. We conclude with implications for addressing food insecurity in order to reduce the possibility of making trade-offs.

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Pickens County, SC residents experienced disruptions to the state of their household food security status during the COVID-19 pandemic. Through job losses, work hour reductions, and the increased responsibilities of childcare due to school closures, low-income households were forced to adjust their food provisioning habits and food budgets in order to maintain food security. As national and regional food insecurity rates rose from pre-COVID-19 pandemic rates, a need arose to research how households managed their food security status. In order to address this research, the National Science Foundation (NSF) provided funding for qualitative research. As a result, thirty-nine semi-structured interviews were conducted with sixteen low-income Pickens County, SC residents. Through these interviews, and subsequent coding procedures, several themes emerged suggesting how these households attempted to maintain food security during the COVID-19 pandemic. These themes include the use of supplemental government support payments such as P-EBT, the expanded Child Tax Credit, and Economic Impact Payments. These themes also include the use of an improved emergency food system, such as school meal deliveries and drive through food pantry services. Through these mechanisms, it is believed that the Pickens County, SC food insecurity rate was able to remain stable during the COVID-19 pandemic.

In this study, we explored the relationship between the food environment and food security among rural adults during the COVID-19 pandemic. Researchers, with assistance from community partners, conducted a cross-sectional survey assessing the impact of COVID-19 on food access, food security, and physical activity in 9 rural South Carolina (SC) counties. This survey was administered to a purposive sample (N = 587) from August 2020 to March 2021. The dependent variable was a binary indicator of food insecurity (past 3 months), in accordance with the USDA Household Food Security Survey Module. Independent variables were sociodemographic characteristics, food environment factors (eg, shopping at grocery stores, partial markets, and farmers' markets), and shopping behaviors during the pandemic. Overall, 31% of respondents were food insecure. Food security status differed by income and household composition. Results indicate that the odds of food insecurity were higher for respondents who shopped frequently at partial markets (adjusted odds ratio [AOR] = 1.61, 95% confidence interval [CI]: 1.01-2.56) and shopped more for food before the pandemic than during the pandemic (AOR = 1.68, 95% CI: 1.07-2.64). Findings underscore the importance of examining the relationship between the food environment and food insecurity during COVID-19 in rural settings.