Table 5.

Select quotations illustrating key themes identified across multiple Food Security Survey Module (FSSM)^a items and interview responses of Latino/a parents/caregivers in Mejorando la Esperanza en Seguridad Alimentaria (Improving Hope for Food Security) (n = 62)^b

Theme	Selected illustrative quotations
Food-secure responses despite reliance on food assistance	HHc1: “Is there not enough food because we couldn’t access it or is there not enough food because we couldn’t afford it?” [Clotilde, NY, Female, marginal FSd, Spe, “Enough but not always the kinds of food we want”]
	HH3: “[When I can’t afford enough food] that’s when I kind of look for alternatives, you know, like food drives or you know, just kind of like looking for free food or like the summer lunches, you know, that not always they [kids] like to eat either. So just at that point kind of looking for any alternative of food that I can get that’s not going to cost me.” [Ana, CA, Female, very low FS, Enf, “Sometimes true”]
	HH3: Interviewer: “Okay. So next statement. ‘The food that we bought just didn’t last and we didn’t have money to get more.’ Was that often, sometimes or never true for your household in the last 12 months?”
	Participant: That we didn’t have? No, never. No, definitely not.”
	Interviewer: “Thank you. Please tell me what you were thinking about when answering this question.”
	Participant: “The resources that I’ve been able to access you know. I’m very grateful for the food pantry and even my friend has helped me out some. So that’s what crossed my mind, like the fact that I’ve been able to run over to [town name] at least once a month and access food.” [Bea, TX, Female, low FS, En, “Never true”]
	ADg2: Interviewer: “The question says, ‘did you ever eat less than you thought you should because you didn’t have money for food?’ So that last part—yes, maybe there wasn’t enough money. But you didn’t stop eating because you had help from the food banks?”
	Participant: “Yes. I don’t know how it could be somewhere else, because when I don’t have any, I look for a food bank, right? So I don’t know what I would put down for that question.”
	Interviewer: “This part of the questionnaire is yes or no. But of course, you can tell me what best suits the situation. So—or, you’re not sure what answer you’ll be able to give? How would you answer it?”
	Participant: “Or then, well, put no.” [Rocio, NY, Female, low FS, Sp, “No”]
	CHh6: “Well, no, because it says that [...] the money was needed. But then, food [...] I receive— thank God, I receive [...] a lot of help from [food pantries]. And for food maybe they don’t give me a lot of meat. Sometimes they do give meat and chicken and all that and fish. Sometimes in other places they don’t give that, but there is always [a] little for [the kids] and canned fruits, vegetables, and seeds.” [Alma, CA, Female, low FS, Sp, “No”]
	CH7: Interviewer: “Okay. The first sentence is: ‘We had to feed the children or young people in the home with food of little variety and low cost because we ran out of money for food.’ In your household, did this happen often, sometimes, or never in the last 12 months?”
	Participant: “Because—that’s kind of different, because I work at a school and they provided lunch. So I brought food from school. So that’s why I never ran out of food, because I had food. And the children, when they left school, they gave them a bag with food. They gave them hot dogs, they gave them corn dogs, different things. Because that never really happened because they were in school. From school they bring food and I bring food from school. That was.”
	Interviewer: “Okay. So, for you this never happened?”
	Participant: “It never happened. Because the school helped me.” [Lupita, CA, Female, low FS, Sp, “Never true”]
Emotional sensitivity to discussion of food insecurity	CH1: “Same answer. Again, it’s easy. The question is very direct and should require a direct answer, but it’s just, again, you have to swallow your pride and be honest and say, hey, this is—this has happened or I have skipped meals because of this or my boyfriend skipped an entire meal because he’s more worried about the kids and myself, especially the fact that I’m pregnant.”[Lisa, CA, Female, very low FS, En, “Yes”]
	CH3: “Well, because I have always made an effort so that my daughter does not lack anything. I’d rather go hungry than my girl.” [Carmen, NY, Female, very low FS, Sp, “Never true”]
	CH4: “You know, many times you don’t look at yourself, but you look at your family—that happens to me. I do not know. But I noticed that, that it was reflected in my husband. That if my children said, I want more, I want more. My husband said, no, no more, I don’t have any more. So yes, it makes me sad. Because I couldn’t—I couldn’t fix that situation. I couldn’t help them from not having those needs.” [Leonela, NY, Female, low FS, Sp, “Yes”]
	CH4: “Am I starving my kids? Does that make me a bad parent? It sucks. Are they getting enough to eat? Is this going to be okay? Is this normal? Do other people do this? Am I the only one?” [Donna, TX, Female, very low FS, En, “Yes]
	CH4: “I kind of felt uncomfortable. Because sometimes, like sometimes kids think you don’t want them to eat. Like they think, maybe, that you don’t want to give them food or something. Or that they eat enough, but she doesn’t understand that there isn’t enough.” [Jessica, NY, Female, very low FS, Sp, “No”]
	CH5: [Interviewer prompted to think aloud] “How important it is to feed my kids and my children, even if I don’t have money to make sure that they have something. I always make sure they have something... my kid and... not being able to feed him. Like, that’s kind of scary.” [Mark, TX, Male, very low FS, En, “No”]
	CH5: “...you do understand, but the child does not know. And it’s more difficult for children: ‘I’m hungry and I can’t eat. They don’t feed me.’ It is difficult for me because I feel sick, but I understand, right? The children do not understand.” [Maria, CA, Female, very low FS, Sp, “No”]
	CH5: For myself, it was easy for me to, um, answer, um, but it could be difficult for other people [for their children]. Just going back to the, um, the feeling of someone being a bad parent, they—I mean, no one wants to be seen as a bad parent. So it might be difficult in that aspect for other people.” [Sam, TX, Female, low FS, En, “No”]
Interpretations and responses about reducing size of meals or skipping meals	AD1: Basically, I would make a bigger portion for dinner and maybe a little lunch after that. Or I would have to rotate it, or like I said, minimize the amount for maybe breakfast, lunch and dinner, or just do one big meal basically and have that through [the day].” [Wendy, CA, Female, very low FS, En, “No”]
	ADI: “Well, no, but when there wasn’t some items. I always had a lot of cereal that they give me, and milk. Well, there’s no lack of it, and we keep cereal or something there. We never run out of food. They give me a lot of apples, oranges, pears [...] You don’t eat a lot of food anymore, let’s say like that, now you fill up with any little thing and even more so if I make smoothies or fresh fruit water too, oat water too” [Alma, CA, Female, low FS, Sp, “No”]
	CH4: Interviewer. “Okay. The next one says: ‘in the last 12 months, did you ever reduce the food of the—the amount of food of a child or young person in the household because of lack of money to buy food?’ And you said ‘no.’ Can you tell me, how did you come to have that answer?”
	Participant: “Because I never stopped feeding my children.”
	Interviewer: “You didn’t have leftovers. But didn’t you reduce the food, the amount?”
	Participant: “I reduced it.”
	Interviewer: “Okay. You did reduce it, but they didn’t stop eating.”
	Participant: “No.” [Vanessa, NY, Female, low FS, Sp, “No”]
	CH4: Interviewer: “When thinking about feeding your children, what does the phrase cut the size of meals mean.”
	Participant: “Am I starving my kids? Does that make me a bad parent? It sucks.Are they getting enough to eat? Is this going to be okay? Is this normal? Do other people do this? Am I the only one?” [Donna, TX, Female, very low FS, En, “Yes”]
	CH4: “Just thinking about the last several months, and kind of just going off of if we had enough money for everyone to get a full meal every day. Them [children] not being able to get something that they wanted. If we, like, they were able to meet, eat like the main thing, but then if they wanted fruit or something like a dessert afterwards, then they wouldn’t be able to get that if we didn’t have enough to provide that. I think the children weren’t able to eat a full meal because we didn’t have enough, I guess.” [Sunflower, TX, Female, low FS, En, “No”]
Response options that do not fully represent experiences with managing food insecurity	AD1: “I’m going to be honest. it’s because I don’t understand it, and it’s like... Or I do sometimes, and it’s kind of more like they’re not being specific, so I’m taking it two ways and that’s where I find it difficult. Sometimes I find it so difficult to answer [the] question, so... I’m gonna leave it blank because I don’t understand it. I mean it’s, it’s words that you’re using that I’m just, my education didn’t get me there.” [Gizmo, TX, Female, very low FS, En, “Yes”]
	AD2: [Responding to FSSM] “Not really, no. Kind of, maybe, sometimes... [Interviewer prompted to select one response option.] I would just say sometimes... Just how I might not eat as much so that other people could eat ‘til they were full or satisfied.” [Sam, TX, Female, low FS, En, “Yes”]
	AD1: “It was a little difficult because it was strictly yes or no. And sometimes the answer is not clearly yes or no. Sometimes it could be sometimes.” [Jess, NY, Female, very low FS, En, “Yes”]
	AD1: Well, what do I think about the options that you said just now? Because it depends on how the situation is, right? [...] maybe 1 month you can go the whole month with what you have, maybe another month it’s not enough, because the other month you have absolutely nothing. It all depends on how the situation is going, how the situation is developing.” [Marina, CA, Female, very low FS, Sp, “Yes”]
	CH1: “For me it would be sometimes the second option (sometimes true), but most of the time no it is the third option (never true). [Rocio, NY, Female, marginal FS, Sp, “Sometimes true”]
	CH3: Interviewer: Okay. And would you change the phrase at all, ‘the not eating enough,’ so that it’s easier to understand?
	Partidpant: Yeah. I would probably put it in that description as ‘not eating enough.’
	Interviewer: Okay. Put it in a description for not eating enough?
	Participant: I would put it as in that, what you just said, as opposed to ‘often’ put ‘not eating enough.’
	Interviewer: Okay. You would put that as an answer option?
	Participant: Yeah. Basically. [Wendy, CA, Female, very low FS, En, “Often true”]

^aFSSM items are available at²⁶.

^bData are for Proyecto MESA participants from California (CA), New York (NY), and Texas TX) who completed cognitive interviews based on the FSSM. Each participant quote is followed by the participant-selected pseudonym, participant’s state, participant’s gender, participant’s household food security status, language of the interview, and participant’s response to the item being discussed.

^cHH: household-referenced items.

^dFS = food security.

^eSp = interviewed in Spanish.

^fEn = interviewed in English.

^gAD: adult-referenced items.

^hCH = child referenced items.