Hunger Tradeoffs and Coping Strategies Among Families with Food Insecurity in Massachusetts.

Background/Objectives: Many individuals facing food insecurity make tradeoff decisions between spending money on food or other basic needs. In addition, many engage in coping strategies to stretch food budgets or make food last longer. There is limited data on how participation in food assistance programs is associated with use of tradeoffs or coping strategies among households experiencing food insecurity. Methods: A secondary analysis of 2021, 2022 and 2023 cross-sectional state-wide survey on food access, including questions on use of tradeoffs and coping mechanisms, and participation in food assistance programs (Special Supplemental Nutrition Program for Women, Infants, and Children, Supplemental Nutrition Assistance Program, school meals or food pantries). Prevalences of tradeoffs and coping strategies by food assistance use were determined. Multivariable logistic regression models determined odds of tradeoffs and coping strategies reported by food-insecure households. Results: Overall, 85% of respondents reported making any tradeoffs and 90% reported any coping strategy use in the prior year. Any food assistance program participation was associated with higher prevalences of making any tradeoff compared to not participating in food assistance programs (89% vs. 78%, p < 0.001) and a higher prevalence of engaging in any coping strategy (92% vs. 84%, p < 0.001). Food assistance participation was associated with increased odds of making any tradeoff (OR 1.82 95% CI 1.39, 2.39) or any coping strategy (1.85, 95% CI 1.22, 2.80). Conclusions: Meeting food assistance program income eligibility requirements is likely a marker of poverty that extends beyond food insecurity. Food assistance is necessary but insufficient to meet family needs.