Key Points Question Was the introduction of advance payments for the Child Tax Credit associated with food insufficiency in US households? Findings In this cross-sectional study using repeated surveys of a nationally representative sample of US households, the introduction of advance payments for the Child Tax Credit was associated with a significant reduction in household food insufficiency of approximately 26%. Meaning This study suggests that the Child Tax Credit advance payments acted as a buffer against food insufficiency among households with children.

Introduction People in low-income households face a disproportionate burden of health and economic consequences brought on by the COVID-19 pandemic, including COVID-19 and food insufficiency. State minimum wage and paid sick leave policies may affect whether people are vulnerable to employment and health shocks to income and affect food insufficiency. Methods We evaluated the relationship between state minimum wage policies and the outcome of household food insufficiency among participants younger than 65 during the COVID-19 pandemic. We used data from biweekly, state representative Census Pulse surveys conducted between August 19 and December 21, 2020. We conducted analyses in the full population under age 65 years, who are most likely to work, and in households with children. The primary exposure was state minimum wage policies in four categories: less than $8.00, $8.00 to $9.99, $10.00 to $11.99, and $12.00 or more. A secondary exposure was missing work due to COVID-19, interacted with whether participants reported not having paid sick leave. Food insufficiency was defined as sometimes or often not having enough to eat in the past seven days. Very low child food sufficiency was defined as children sometimes or often not eating enough in the past seven days because of inability to afford food. We conducted a multivariable modified Poisson regression analysis to estimate adjusted prevalence ratios and marginal effects. We clustered standard errors by state. To adjust for state health and social programs, we adjusted for health insurance and receipt of supplemental nutrition assistance program benefits, unemployment insurance, and stimulus payments. We conducted subgroup analyses among populations most likely to be affected by minimum wage policies: Participants who reported any work in the past seven days, who reported <$75,000 in 2019 household income, or who had a high school education or less. We conducted falsification tests among participants less likely to be directly affected by policies, ≥65 years or with >$75,000 in 2019 household income. Results In states with a minimum wage of less than $8.00, 14.3% of participants under age 65 and 16.6% of participants in households with children reported household food insufficiency, while 10.3% of participants reported very low child food sufficiency. A state minimum wage of $12 or more per hour was associated with a 1.83 percentage point reduction in the proportion of households reporting food insufficiency relative to a minimum wage of less than $8.00 per hour (95% CI: -2.67 to -0.99 percentage points). In households with children, a state minimum wage of $12 or more per hour was associated with a 2.13 percentage point reduction in household food insufficiency (95% CI: -3.25 to -1.00 percentage points) and in very low child food sufficiency (-1.16 percentage points, 95% CI: -1.69 to -0.63 percentage points) relative to a state minimum wage of less than $8.00 per hour. Minimum wages of $8.00 to $9.99 and $10.00 to $11.99 were not associated with changes in child food insufficiency or very low child food sufficiency relative to less than $8.00 per hour. Subgroup analyses and sensitivity analyses were consistent with the main results. Estimates were of a lesser magnitude (<0.6 percentage points) in populations that should be less directly affected by state minimum wage policies. Missing work due to COVID-19 without paid sick leave was associated with a 5.72 percentage point increase in the proportion of households reporting food insufficiency (95% CI: 3.59 to 7.85 percentage points). Discussion Food insufficiency is high in all households and even more so in households with children during the COVID-19 pandemic. Living in a state with at least a $12 minimum wage was associated with a decrease in the proportion of people reporting food insufficiency during the COVID-19 pandemic. Not having paid leave was associated with increases in food insufficiency among people who reported missing work due to COVID-19 illness. Policymakers may wish to consider raising the minimum wage and paid sick leave as an approach to reducing food insufficiency during and after the COVID-19 pandemic.