Table 1.

Description of Measures

Measure	Description
Food insufficiency	Participants were asked, “In the last 7 days, which of these statements best describes the food eaten in your household?” Potential response options included: “Enough of the kinds of food (I/we) wanted to eat”, “Enough, but not always the kinds of food (I/we) wanted to eat”, “Sometimes not enough to eat”, and “Often not enough to eat”. The response options “Enough of the kinds of food (I/we) wanted to eat” and “Enough, but not always the kinds of food (I/we) wanted to eat” were categorized as food sufficient, while the response options “Sometimes not enough to eat” and “Often not enough to eat” were categorized as food insufficient as reported by the U.S. Census.36 The questions regarding food sufficiency were consistent with the U.S. Household Food Security Survey Module.64 Food insufficiency generally describes whether households have enough food for their families to eat and is often the most extreme form of food insecurity.3 In other surveys, such as the Current Population Survey’s Food Security Supplement, 86%‒89% of people reporting food insufficiency were deemed food insecure.4
Received free food or groceries	“During the last 7 days, did you or anyone in your household get free groceries or a free meal?” Response options included “yes” or “no”. This item was included in order to determine the extent of receipt of food aid and to determine sources of food aid as below to inform policy and resource allocation during the COVID-19 pandemic.
Where did you get free groceries or food?	This item was asked of participants who responded “yes” to receiving free food or groceries and was measured using the question “Where did you get free groceries or free meals?” Potential response options included “Free meals through the school or other programs aimed at children”, “Food pantry or food bank”, “Home-delivered meal service like Meals on Wheels, Church, synagogue, temple, mosque or other religious organization”, “Shelter or soup kitchen”, “Other community program”, and “Family, friends, or neighbors”. These factors were chosen as part of the U.S. public-use household-level Current Population Survey Food Security Supplement (CPS-FSS), which was designed to understand where Americans receive food aid in relation to food insecurity.65 In addition, from a policy level, it is important to determine what proportion of Americans are receiving free food during the pandemic and where they are getting the food aid from. This can inform resource allocation for federal and state policies as part of the Coronavirus relief legislation.
Mental health symptoms	Mental health symptoms were measured using questions adapted from the 7-item Generalized Anxiety Disorder scale (GAD-7)66 and the 9-item Patient Health Questionnaire (PHQ-9),67 which are used to screen for generalized anxiety disorder and major depressive disorder, respectively. Participants were asked how often they had symptoms of anxiety, worry, anhedonia (lack of interest), and depression over the last 7 days. Potential response options for each question included “Not at all”, “Several days”, “More than half the days”, and “Nearly every day”. Each variable was dichotomized such that “Not at all” indicated the absence of the symptom and “Several days”, “More than half the days”, and “Nearly every day” indicated the presence of the symptom (i.e., any days).
Demographic variables	Demographic variables that may be associated with food insufficiency and potential confounders in the association between food insufficiency and poor mental health include age, sex, race/ethnicity, marital status, number of children in the household, and number of adults in the household.22,27,54,68
SES	Socioeconomic variables that may be associated with food insufficiency and potential confounders in the association between food insufficiency and poor mental health include employment loss in the past 7 days, federal poverty level, and education.17,22,68

CPS-FSS, Current Population Survey Food Security Supplement; GAD-7, Generalized Anxiety Disorder scale 7; PHQ, Patient Health Questionnaire-9.