Perspectives on COVID-19-related relief measures and experience of food insecurity among low-wage worker families in two US cities

Abstract

To explore how 2020–2022 federal COVID-19 relief measures impacted food security, economic hardship and housing stability, we interviewed low-income workers in Minneapolis, MN and Raleigh, NC. Participants were a subset of 40 from a larger study with at least one child. We identified themes including mechanisms of potential impact: food assistance, increased household cash, promoting housing stability, and reducing household expenses. No single measure ameliorated hardship. Participants reported healthier food behaviors. Flexible relief measures allowed people to spend according to their needs. These effects were not durable because relief measures were temporary. Nonetheless, relief measures likely averted worse outcomes.

INTRODUCTION

The global coronavirus (COVID-19) pandemic significantly impacted the United States beginning in March 2020, resulting in the disruption of financial and social systems globally and within individual homes and communities. The immediate repercussions of the pandemic were an increased number of layoffs, business closures, and individuals unsuccessfully seeking work^1,2. We then saw an increase in food insecurity in the U.S., particularly among households with children, in early 2020³. Food insecurity is a household level economic and social condition of limited or uncertain access to food that occurs due to a lack of money or other resources⁴.

Pandemic disruptions were socially patterned and exacerbated existing disparities in risks for food insecurity⁵. Women, low-wage earners, and those with less education experienced the most significant impacts related to the pandemic closures and job loss⁶. Black and Hispanic workers were also at an increased risk of losing employment as compared to whites^6,7. Household Pulse Survey data, which measured not having enough food in the last 7 days in a snapshot measure throughout much of the pandemic, indicated that the proportion of Black households that reported that they sometimes or often did not have enough to eat approached 25% in late 2020, compared with about 10% among white households⁸.

In response to the pandemic, the US government implemented a number of temporary relief measures with the intention of providing economic support to individuals and families. These programs had the potential to mitigate increases in food insecurity through several mechanisms. First, two programs provided direct food assistance to those in need who met eligibility requirements. These two programs to increase benefit levels were: (1) increases to the Supplemental Nutrition Assistance Program (SNAP), a program targeting low-income individuals, which had been shown prior to the pandemic to reduce food insecurity, and (2) the creation of the Pandemic Electronic Benefit Transfer (P-EBT) program to provide nutrition assistance during periods of school closures for children eligible for free or reduced-price school meals^9,10. Households eligible for P-EBT were those with children who attended a school that was subsequently closed, beginning in the Spring of 2020, for at least five days and who would have received free or reduced-price meals at those schools¹¹.

Second, a set of flexible cash benefits were offered to increase the available cash in the household. The federal Child Tax Credit (CTC), available to nearly all low-and-medium income households with children, was expanded from $2,000 per child in 2018–2020 to a total annual amount of $3,600 per child in 2021¹². Three Economic Impact Payments (i.e., “stimulus checks”) and additional unemployment insurance also temporarily increased income and averted financial hardship for families¹³.

Third, relief measures such as the federal eviction moratorium and Emergency Rental Assistance programs administered by states supported housing stability. Food insecurity and housing instability are linked among low-income populations^14,15. Households make trade-offs in accessing necessities because of depleted resources^16,17. For example, an increase in housing costs can lead to inadequate resources for food. Moreover, for most U.S. households, housing is the largest household expense. In the economic disruption of the early COVID-19 pandemic, families with children were at the greatest risk of losing their homes¹⁸. Finally, other relief measures were meant to reduce expenses. These included measures such as a moratorium on student loan payments and Marketplace health insurance subsidies^19,20.

Emerging evidence suggests that the combination of these economic relief measures was effective in curbing a rise in food insecurity during the pandemic. Studies from this period suggest a positive impact of specific programs as well. For example, one study estimated that SNAP expansions during the pandemic prevented 850,000 instances of household food insufficiency ²¹. Another study indicated a 3% increase in the likelihood of food sufficiency among children whose households received P-EBT benefits²². The Child Tax Credit significantly reduced child poverty for those who could access it, resulting in the child poverty rate decreasing from 9.7 percent in 2020 to 5.2 percent in 2021^23,24. Additionally, difference-in-difference analysis conducted after the receipt of the first Child Tax Credit payment demonstrated that it may have buffered against further food insuffiency²⁵. Still, many questions remain about the experiences of the intended beneficiaries of these relief measures. Should elements of these programs be considered for more permanent adoption, it will be essential to better understand these experiences. The purpose of this study was to explore how COVID-19 relief measures impacted families' experiences of food insecurity and other outcomes including economic hardship and housing stability among a sample of low-wage workers with children in two cities. We conducted and analyzed qualitative interviews with a subsample of 40 low-wage worker families participating in the Wage$ study in 2022²⁶ and having at least one child in the home of at least three years of age. These participants, drawn from an existing study, have known, complex financial needs and thus can provide key insights into the impact of these relief measures.

METHODS

Participants

Our participants were recruited from the parent Wage$ study, an NIH-funded natural experiment to assess the impact of a minimum wage ordinance on diet-related outcomes. The parent study enrolled 969 participants at baseline in 2018 and followed them annually through 2022 to compare changes in outcomes among low-wage workers in Minneapolis, Minnesota (which implemented a city ordinance incrementally increasing minimum wage to $15 an hour) and Raleigh, North Carolina (which has a state pre-emption preventing local minimum wage increases). The eligibility criteria for the NIH sample were that they were (1) 18 years old or older, (2) worked at least 10 hours a week at a wage of less than or equal to $11.50/hour in Minneapolis or Raleigh OR were employed at that wage within the last six months and are currently seeking work in Minneapolis or Raleigh, (3) planned to be in the workforce for at least five more years, (4) agreed to be contacted for follow-up data collection and (5) spoke Spanish or English.

At baseline, 67.3% of the sample reported food insecurity. An early-impact difference-in-difference analysis ²⁷ of changes in key outcomes from 2018–2020 suggested that there were no benefits or adverse effects of the minimum wage policy. However, trends across both cities demonstrated an overall decrease in food insecurity and non-linear trends in employment, hours worked, SNAP participation and dietary outcomes, which were likely a result of the COVID-19 pandemic and the federal response.

Semi-structured interviews were conducted with our 40 participants in 2022. We chose to include only participants with at least one child because we wanted to better understand the experiences of low-wage workers who were parenting and thus eligible to receive economic relief measures for households with children. Of the participants in the parent study at T5, 246 resided in households with children. From these, we invited participants to join the present study on a rolling basis, during their study visit for the 2022 wave of data collection for the parent study, if they had reported having at least one child of at least three years of age in their household during that survey (i.e., households that had, before the onset of the COVID-19 pandemic, at least one child), with a target of completing 40 interviews (20 Minneapolis, 20 Raleigh). Each participant who met the criteria was invited until we had interviewed 15 from each site. To ensure a diversity of experiences and perspectives, we then examined economic relief measure participation among those who we interviewed to determine whether the sample included representation from a variety of experiences. We did this, also, because we wanted to include at least five participants who did not benefit from the most frequently accessed support (Economic Impact Payments). Ultimately, fifty-three participants were invited to take part in this study. However, eight participants were unable to be reached for scheduling (three in Minneapolis, five in Raleigh) and five others invited declined to participate (three in Minneapolis, two in Raleigh). Human subjects approvals were obtained from the University of Minnesota Institutional Review Board for this study.

Procedures

A semi-structured interview guide was developed, designed to take 45 minutes to complete. The study team worked with Community Advisory Boards in Minneapolis and Raleigh to ensure that questions were clear, non-invasive, and would yield relevant data. Interview questions prompted participants to describe the impact of COVID-19-related supports on food security and other outcomes including economic hardship and housing stability. Participants were asked about the support they received, with probes for the following measures: stimulus checks, P-EBT, SNAP benefit increases, emergency rental assistance, child tax credit, unemployment insurance, eviction moratorium, student loan deferment and healthcare subsidies. Opening questions were asked to query participants about their broader experiences with the pandemic. Participants were also asked about the process of receiving the supports during the pandemic. Those data are reported elsewhere²⁸.

All interviews were conducted via phone or video conferencing technology. Interviews were recorded, transcribed using transcription software and cleaned by the interviewers. Participants received $50 for their participation.

Data analysis

The qualitative analysis of the transcribed interviews was conducted using Lumivero NVivo (QSR International, 2023) by our research team members, using a constructivist approach to grounded theory ^29,30. This approach allows the data to be systematically coded for themes while considering literature or conceptual frameworks. This means that themes can emerge from the data, and the data can be closely examined for constructs such as the individual, household, and employment factors that have impacted the participants experience of policy mechanisms, as well as programmatic synergies and unanticipated consequences. Data saturation is less of a concern when following a constructivist approach to grounded theory. As a result, our analysis focused on exploring the experiences and perceptions participants held about how pandemic factors impacted their food security and housing stability and also how COVID-19-related supports impacted these outcomes.

Initially, two team members reviewed all transcripts to build a preliminary consensus-based codebook (a coding framework) using an iterative process to identify themes. Following this, an additional two members of the research team created a data summary document and organized it by theme. Next, using NVivo with the codes from the codebook incorporated, team members double coded all transcripts through a rigorous process of systematic review and consensus building, which led to identification of final themes. Any coding discrepancies were reviewed by the team to reach consensus, including discussion among the broader team for guidance where needed. Last, final themes were organized into two main themes: how the pandemic impacted food insecurity and housing stability and how COVID relief measures may have impacted these outcomes.

Positionality

Our research team has lived experience and social identities both similar to and different from our study participants. For example, the interviewers included two Black females; coders included one Black female, one Black male and two white females. The investigator team, which synthesized the codes and drafted the manuscript, were not recipients of any need-based relief during the COVID pandemic, however, some members of the team have experienced economic hardship and receipt of public assistance during their lives. These identities can influence how we developed our research aims, the interview questions asked, the conduct of the interviews and the analysis and interpretation of our results. As a result, we may have missed important questions to ask because of lack of personal experience with these policies. One way we worked to counteract these limitations was to engage community advisory boards in both Minneapolis and Raleigh throughout the study.

RESULTS

Participant Demographics

Of the 40 participants interviewed, 20 were in Minneapolis and 20 in Raleigh. Thirty-four identified as female and around half the sample were between 30–39 years of age. Twenty-eight identified as non-Hispanic Black. All participants came from a household with at least one child present over the age of three. See Table 1 for full participant demographics. Participants reported receipt of a variety of relief measures, including stimulus checks, P-EBT and SNAP increases (see Table 1).

Table 1.

Participant and household characteristics and participation in COVID-19 relief measures from 2020–2022 (n = 40).

Participant demographics	n	% or mean	SD
Sex	40
Male	6	15.0
Female	34	85.0
Non-binary	0	0.0
Age group	40
< 30 years-old	8	20.0
30 – 39 years-old	21	52.5
40 – 49 years-old	6	15.0
50 – 59 years-old	4	10.0
60 years or older	1	2.5
Race/Ethnicity	40
Hispanic	2	5.0
Non-Hispanic White	9	22.5
Non-Hispanic Black	28	70.0
Non-Hispanic Asian	0	0.0
Non-Hispanic Other	1	2.5
Birthplace	40
Born in the U.S. or U.S. territories	37	92.5
Foreign born (not of U.S. parent or parents)	0	0.0
Born abroad to U.S. citizen parent or Parents	3	7.5
Education	40
Less than high school	10	25.0
High School Diploma/GED	15	37.5
Some college	4	10.0
Associate's/Technical degree	9	22.5
Bachelor's degree or higher	2	5.0
Marital status	40
Married/Partnered	12	30.0
Single	28	70.0
Employment status	40
Employed	7	17.5
Not employed	33	82.5
Hourly wage	37	15.8	3.9
Bank account status	40
Has a bank account	18	45.0
Not having a bank account	22	55.0
Geographic location	40
Minneapolis	20	50.0
Raleigh	20	50.0
Household size	40	4.2	1.6
Number of children in the household	40	2.3	1.1
Household composition	40
Single adult w/ children	14	35.0
Multi-adult w/ children	26	65.0
Household income	40
<$20K Income	6	15.0
>$20K - $40K Income	8	20.0
>$40K Income	8	20.0
House instability status	40
Housing secure	25	62.5
Housing unstable	15	37.5
Food Security status	40
Food secure	16	40.0
Food insecure	24	60.0
Responded 'yes' to receiving or benefiting from the following in at least one year (2020–2022)	n	%
Stimulus check	37	92.5
P-EBT	34	85.0
SNAP benefit increases	33	82.5
Emergency Rental Assistance	30	75.0
Child Tax Credit	26	65.0
Unemployment insurance	22	55.0
Eviction moratorium	11	27.5
Student loan deferment	11	27.5
Healthcare subsidies	6	15.0

In the coming sections, we present the themes that highlight the perceptions and experiences our participants shared related to two main themes: how the pandemic impacted food insecurity and housing stability and how COVID relief measures may have impacted these outcomes. Within each of these themes, sub-themes and illustrative quotes are presented. The theme of pandemic impact on food insecurity and housing stability had two sub-themes: food insecurity and housing instability. The second theme, COVD-19 relief measure impact on outcomes had four sub-themes: direct food assistance, increased cash availability, increased housing stability and reduced household expenses.

COVID-19 pandemic factors impacting food security and housing stability

Participants described a broad range of pandemic disruptions that negatively and directly affected food and housing stability. Chronic financial hardship was also a common experience for participants. This hardship was often present prior to the pandemic, often due to employment challenges, and was frequently described as worsened by it. Participants shared their struggles with being laid off, having hours cut, or losing jobs when businesses were temporarily closed resulting in lost income.

“It impacted me because of the job I was working at, they cut my hours. I’ve been at that job for damn near 12 years.” Minneapolis participant #256

Participants also shared their experiences of the double burden of losing income while also experiencing the increased cost that came about because family members spent more of their time at home during the stay-at-home orders, including food and household utilities, such as heating and electricity. In households with children, these pandemic-related impacts were more burdensome due to lack of childcare, which jeopardized employment.

Food Insecurity.

Participants described that during periods where everyone was at home, food did not last as long as before the pandemic. Participants reported addressing this issue by re-allocating funds from other household needs to purchase additional food. In some cases, parents sacrificed their food needs to ensure the children had enough to eat. One participant shared that they resorted to selling their TVs for additional funds to buy food for their children. These challenges were further exacerbated for single parents.

“Your kids is hungry, and you canť feed them. You know they hungry. Iťs like Imma make sure y'all eat and I'll skip a meal.” Raleigh participant #133

As a result of challenges with food security, participants frequently shared that they had to rely on food pantries (called food shelves in Minnesota) or other charitable food sources. Dietary quality also suffered because of supply issues and increased food costs. Other participants reported frequenting fast food drive-thru restaurants because they felt that these were safer and more convenient compared to grocery stores or restaurants where they had to go inside.

“Yes. They had went from eating like a lot of healthy food to eating Takis and all types of junk food.” Minneapolis participant #425

Housing Instability.

The pandemic also contributed to housing instability for some participants. The inability to afford housing caused numerous participants to stay at a hotel, live with family members, or even live out of their car when they could no longer afford a hotel.

“We was homeless for a whole year and a half. The six months we lived from in our vehicle … laying the seats down, kids sleeping in the backseat. I’m staying up during the night, making sure we don’t get killed or nothing like that. Living in the park, using the bathroom behind the tree at the park.” Raleigh participant #133

Trying to juggle the economic implications of employment changes, bills, and receipt of benefits from relief measures was challenging. Some participants were concerned with how many hours they worked because they could not make over a certain amount, or they’d lose their benefits. Some pieced together multiple part-time jobs to earn enough money. One participant, who lost their job, shared they were better off while unemployed and receiving unemployment benefits.

“The only time I was able to live freely was when we was getting that unemployment.” Minneapolis participant #178

All these experiences provide context for the introduction of policies meant to mitigate the social and economic disruptions of the COVID-19 pandemic. The participants in our study received a variety of these supports (see Table 1). The most mentioned relief measures were P-EBT, housing relief in various forms, and the Child Tax Credit.

Perception of impact of relief measures on food insecurity and other outcomes

Participants were asked to reflect on the pandemic-related relief measures they received and the impact of those supports on their behaviors. Many participants shared that their lives were economically complex, with hardship impacting many aspects of living. They largely considered their budgets as a whole, with multiple competing monthly expenses. As a result, even when prompted to discuss the impact of a single relief measure, participants tended to discuss household economic conditions more broadly, instead of drawing a connection between a single relief measure and a specific impact.

Participants were not always clear about which forms of relief they were receiving, further complicating their ability to separate out the distinct impact of any one support measure. Overall, participants felt that any extra income support did provide some help during the height of the pandemic. Participants reported using the extra assistance to catch up on various bills and to buy food.

“So when I got laid off - my bills were behind. My rent, everything was behind…Then unemployment came through and I was able to get caught up as much as possible.” Minneapolis participant #510

Still, for participants the complexity of their financial situation meant that while relief measures often did ease their economic situation, the impact was not enough to make a difference.

“So, these programs… they have for…COVID, all this stuff was just a crock. And they was like, well, I understand they gave the child tax credit. $250? What is $250 gonna do if you living in a hotel, and you got to pay $95 a night to stay there?” Raleigh participant #001

Despite this complexity in describing the experience of receiving support during the pandemic, the themes were conceptualized into four mechanisms: direct food assistance, increased cash availability, increased housing stability, or reducing household expenses. We describe each in turn.

Direct food assistance.

Participants tended not to make distinctions between benefits received for SNAP (via policies like SNAP COVID-19 Emergency Allotments) and for P-EBT but were aware of an increase in their nutrition benefit allowance. Participants felt that the direct food assistance benefits they received were enough, specifically the additional funds they received during the pandemic. Households discussed the positive impact of P-EBT benefits on their dietary behaviors, as this low-wage participant from Raleigh shared.

“Pandemic EBT was definitely a blessing because being home with the children at home schooling, of course, everybody is hungry every hour, for whatever reason. So it was a blessing to be able to have the food in the house…We were able to experiment with some extra things. As far as ways to make food stretch, try different meals.” Raleigh participant #029

This same Raleigh participant (#29) went on to share that receiving both SNAP and P-EBT afforded her the ability to pool those benefits to have more impact on her family’s diet:

“We were already receiving EBT. But the Pandemic-EBT gave us more…so whereas with the regular EBT, we may have been able to buy one pack of meat and have to figure out how to distribute that over a certain time period, we were able to buy two. So then we actually were able to implement…a taco night … with the extra because we could get enough meat to where we could not only have tacos that night, but also tacos for lunch the next day. So that extra made it easier for us to stretch a lot more.” Raleigh participant #029

Participants noted an increase in food prices, sharing that their increased nutrition benefits helped them to afford food during this period of inflation. They also appreciated the ability to afford healthy foods, such as fresh fruits and vegetables with this assistance. During the pandemic, with school-aged children at home, these increased benefits allowed recipients to improve their dietary behaviors.

Participants described preferring to receive more in SNAP benefits versus going to the food pantry, where they reported receipt of food that was expired or spoiled. During the pandemic, many food pantries pre-selected food instead of allowing participants to choose for themselves. As a result, participants did not know what food they were receiving.

“I utilize food, the food shelf a couple times. But then as I got more SNAP, I didnť have to go to the food shelf which was great because usually that most of the food is expired.” Minneapolis participant #184

Direct food assistance was generally appreciated. Still, on balance, for many it was simply not enough to improve their family’s diet. Some felt it was failing to keep pace with the rising cost of food. Others shared that assistance didn’t always come when needed.

“I would try to stretch the meals. So, I would maybe get like something to make spaghetti or something, you know, something that’s gonna last for a while, a couple of days for all of us, or say like, two days.” Raleigh participant #009

Increased cash availability.

Participants expressed a preference for flexible benefits, like Economic Impact Payments, unemployment insurance, and the Child Tax Credit, that allowed them to choose how to spend the funds where most needed, over more proscriptive benefits like those that could only be used to purchase food or stave off eviction.

“I mean, the increase was, okay, you know, like I said, we get extra food, but you can always get food, there's always resources for food. Thaťs not what I need help with. I need help with paying my bills, like actual cash hard money … and people donť understand that.” Minneapolis participant #178

“Um, the stimulus checks. They were a great help. It did help you catch up on bills. You know, it helped you stock up on supplies that you would need, because, you know, at one point in time we were shortaged on toilet paper. It was a shortage on pads for women…that money came in handy where we can stock up on things that we needed that, you know, we couldnť get with the SNAP/ EBT. So, it helped a lot.” Raleigh participant #079

There were frustrations as well. Participants reported the limitations of specific policies, such as the Child Tax Credit, which were described as not enough to cover daycare costs.

Increased housing stability.

The eviction moratorium and Emergency Rental Assistance programs were intended to temporarily assist with housing costs and ease the acute risk of eviction. In general, participants had complex experiences with these relief measures, as they were unfamiliar, specifically designed in response to the pandemic, and sometimes chaotically administered. Moreover, despite the official federal ban on eviction, receipt of eviction protection was not guaranteed. Uncooperative or uninformed landlords and court proceedings left participants in unstable housing situations. Participants shared negative experiences with their landlords when attempting to have an eviction moratorium invoked, causing negative impacts like stress and loss of employment.

“A lot of landlords is like, we're not going to take it because we want to increase this person's rent … And they have the option not to accept it. So that means…you have to go to court. When you go to court, the judge tell you, “Okay, you have 10 days to pay this money or you have to move,” and to me like okay, iťs the middle of COVID. I have 10 days to move. I have kids. Where am I gonna go? Raleigh participant #001

A participant in Raleigh shared how the rental assistance program felt like it wasn’t actually available as a source of assistance because of the long wait and uncertainty around distribution of the benefit or resolution of disputes with landlords and the courts.

“I think they were trying because I applied for it. I got approved, but …they never sent me or the apartment complex the money…And I actually have to go show up in court for because I got an eviction notice on my door. And I went to court. So, the program was there, people were getting approved, but they werenť sending out help.” Raleigh participant #071

Not all experiences with housing supports were negative, however. One participant found that the program did provide a safety net to prevent imminent eviction despite their landlord’s efforts. Even so, this support required eligible parties to make considerable efforts to understand the program's intricate workings.

Reducing household expenses.

This fourth mechanism for providing support during the pandemic, reducing expenses, included student loan deferment and healthcare subsidies. While a small number of study participants did report receipt of these types of supports, very little was shared as to the impact of those supports on household financial stability aside from sharing that they were received.

DISCUSSION

Our study offers a window into the experiences of low-wage worker households during the COVID-19 pandemic. Our participants shared that rising costs of goods, especially food, were made worse by the loss of employment. Family members being home more regularly stressed household budgets, resulting in increased expenditure on items like heat and electricity. Having school-aged children at home all day required food at meals they would normally have had at school, and parental supervision when those parents would normally be working. The loss of stable housing was not uncommon, often leading to higher expenses such as staying in hotels. These experiences led to the need for myriad COVID-19-related relief measures.

Our results did not uncover any variation in experiences among our participants in Minneapolis versus Raleigh. This may be because our two study sites were matched on demographic characteristics, and all our participants are in low-income worker households resulting in exposure to similar stressors due to the COVID-19 pandemic.

Much research has been done exploring these issues. We know from quantitative studies that these relief measures did positively impact outcomes like food security ^21,22,25,31. Our study contributes, uniquely, to the literature by exploring how receipt of these relief measures was experienced by an economically vulnerable population, and how they viewed the impact of those relief measures on their food security and housing stability. We conceptualized the relief measures made available during the pandemic into four categories based on their potential mechanism of impact: direct food assistance, increased cash availability, promoting housing stability, or reducing household expenses. On balance, our economically vulnerable participants described these relief measures as helpful in providing some temporary relief during a tumultuous time, but also as confusing and fleeting. The complexity of experience in our sample meant that there was no single pathway or combination of these temporary measures through which participants felt their economic and food insecurity issues were optimally addressed. However, participants generally shared having a preference for flexible relief measures that increased available household cash, including the Child Tax Credit, Economic Impact Payments and Unemployment Insurance. This was because participants shared that such benefits allowed them to prioritize their most acute need, as opposed to the benefits that were designed to address one specific need like direct food assistance or housing-related relief.

On the other hand, our study also reveals the often-overlooked aspect of psychological distress, the necessity of embracing tradeoffs, and resorting to various coping strategies, which compound the hardships experienced by lower-income populations during the COVID-19 pandemic, in comparison to other segments of the population. In this respect, our findings support existing literature that has elevated this added burden for further consideration ^32,33,34,35.

Most assistance offered a way to temporarily address pre-existing problems exacerbated by the pandemic. While temporary relief was needed and valued, participants felt that it often didn’t go far enough to address the changes they were experiencing during this period of upheaval. Further, once these supports were removed, participants experienced challenges adjusting to the loss of new benefits they had relied on. The experiences discussed by our participants were found in other settings such as a study by health care providers Balasuriya and colleagues, who, based on their experiences with patients, called for phasing out benefits more slowly as family financial dynamics change (an increase in earnings leading to immediate loss of benefits) or, as in the present case, a public health emergency is deemed to have ended³⁶.

Most of the temporary supports discussed, however, did tend to operate through expected mechanisms and have the intended policy impact, which supports the findings of previous studies. Direct food assistance such as P-EBT and SNAP Emergency Allotments assisted families in obtaining adequate, healthy food in the face of life disruptions and increased food costs ³⁷. Direct food assistance also allowed more freedom and choice, as participants could rely less on pre-selected and less desirable foods received from food pantries²¹. Measures offering flexible cash temporarily reduced financial pressures and allowed participants to spend according to their needs ^{13, 25, 38}.

Measures to support housing stability were the most challenging for participants to obtain, as they were often not enforced or respected by landlords seeking to evict tenants or the assistance was delayed, a finding documented in a previous study³⁹. In a study exploring housing instability during the pandemic through interviews with a similar population to our’s, Black women, their participants shared that people were still be evicted despite the moratoria⁴⁰. Still, consistent with what our participants shared, An and colleagues (2021) found that the eviction moratorium had a beneficial impact on those who were able to obtain help⁴¹. Those who were able to get help from the eviction moratorium saw their spending on food and groceries boosted and food insecurity decrease⁴¹.

The fourth mechanism, reducing expenses, was less salient in our population, at least in these particular interviews. These relief measures, student loan deferment and healthcare subsidies, were used by a small number of our interviewees. Student loan deferment measures were more likely to be used by those with higher educational attainment than possessed by those individuals we interviewed. Similarly, healthcare subsidies may have been less relevant in our study population because of the type of health insurance they had.

Though the temporary pandemic-related relief measures have ended, the increased cost of living expenses lingered, leading to a significant decline in real median household income⁴² especially for low-wage earners. In comparison, real median household income did not change statistically between 2020 and 2021⁴³. The poverty rate grew in 2022 compared to 2021, the first time that measure has seen an increase in over 10 years⁴⁴. Food insecurity also increased significantly, especially for households with children, between 2021 and 2022 ⁴⁵. This data indicates that, though the worst of health-related impacts of the pandemic may be behind us, economic challenges persist and may continue to grow. When we conducted our interviews some pandemic relief measures were still in effect. While we found the SNAP benefits to be adequate during the height of the pandemic, responses may have been different if participants had been queried following the end of Emergency Allotments in February 2023.

Strengths and Limitations

The strengths of this study were that it included a novel sample of low-wage workers with children, who were the target recipients of these relief measures. These participants had known, complex financial needs, which allowed them to share insights from their lived experiences with multiple relief measures as opposed to those with less need. The combination of these elements – the perspectives of our unique population queried across multiple benefits and safety net programs – provides an important contribution to the field of existing literature, much of which examines either one particular benefit and its impacts, or a different segment of the population^46,47,48. Further, we engaged community advisory boards in Minneapolis and Raleigh to provide insight into how relief measures were administered. In addition, we conducted our interviews during the time that participants were still receiving some of these COVID supports and, thus, experiences were fresh in their minds. In that regard this study is similar to others deemed strong in approach and analysis^46,48,49. Yet, in many cases, it was not possible to tease out the impact of individual relief measures. We saw this limitation because our sample was from a high needs population and participants received multiple benefits. As a result, we are restrained in interpreting the impact of any individual support. The fact that our participants did have experience with multiple relief measures, however, allowed us to provide insight into the panoply of policies where other studies may not have been able to. Finally, our sample size is relatively small and only represents the experiences of those living in Minneapolis and Raleigh. Thus, these data may not be generalizable to other populations or settings.

Conclusions

During the social and economic upheaval of the pandemic, participants relied on multiple relief measures to make ends meet. We found that direct nutrition assistance allowed for some increase in healthier food purchasing behavior, less reliance on food pantries and the pooling of resources from multiple benefits to ease meal planning. We also found that relief measures that offered flexibility allowed participants to spend according to their needs. Still, the findings from our study suggest that policy impacts were modest, and that the economic hardship experienced by low-wage workers and their families persisted in the long run. At the same time, without these COVID-related relief measures, evidence suggests that U.S. families like those in our study would have likely experienced further deterioration of economic stability and food insecurity. As these supports have waned, indicators of increased food insecurity are emerging.

The persistent economic hardship experienced by our participants, despite the presence of these pandemic-related relief measures, warrants policy analysis. Future relief measures should more realistically account for economic hardship in terms of level of support and phase out period. To have a greater impact during future public health emergencies, state and federal policymakers should implement benefit policies that allow flexibility in their use and are easier to access. Attention should also be given to the quality of the food provided through food pantries and food shelves. More resources given to these organizations during times of crisis will allow for the provision of food resources that are more acceptable to families. Further, policymakers and practitioners, alike, must continue to prioritize seeking feedback from those with experience using these benefit programs to be able to develop the most effective policies. Recently, the measurement of food security through the United States Census Annual Household Survey was halted⁵⁰. Ongoing nationwide surveillance of food insecurity, at a population-level, is essential to track the impact of policy responses to human needs and direct resources where needed most. The collection of this data must continue.