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.

Background: While food insecurity (FI) assesses household access to sufficient food, increasing attention is being paid to nutrition security (NS), the ability to obtain health-promoting foods. Aim: This cross-sectional analysis examined differences in sociodemographics, diet quality, and health status between food insecure families with low versus high NS and assessed if FI and NS severity was associated with food assistance program use. Methods: Data were obtained from the 2023 Massachusetts Statewide Food Access Survey of >3000 adults. FI was assessed using the United States Department of Agriculture 18-item Household Food Security Module, NS via a validated four-item scale, and diet quality via the Prime Diet Quality Score (PDQS). FI and NS were analyzed as binary and continuous variables. Inferential statistics assessed group differences. Logistic regression assessed associations between the severity of FI and NS and food assistance program use. Summary: Households with FI, ≥1 child (≤18 years), and annual income ≤$50,000 (n = 335) were included. Forty-three percent reported low NS. Low (vs. high) household NS was associated with a higher prevalence of child-level FI (79% vs. 43%, P < 0.001), SNAP use (83% vs. 70%, P = 0.009), food pantry use (69% vs. 44%, P < 0.001), adult overweight/obesity (39% vs. 17%, P < 0.001), and lower adult PDQS (43 ± 5.1 vs. 44 ± 4.3, P = 0.023), indicating lower diet quality. More severe household FI and lower NS were associated with higher odds of SNAP and food pantry use ( P < 0.001). These findings support expanding food assistance programs to increase nutritious food access for families with children before food and nutrition insecurity become severe.