Introduction

Food insecurity can be generally understood as “the limited or uncertain availability of nutritionally adequate and safe foods” or “limited or uncertain ability to acquire acceptable foods in socially acceptable ways” [1]. More than 13.8 million households in the United States (U.S.) currently struggle with food insecurity [2], with “their access to adequate food for active, healthy living limited by lack of money and other resources” [3]. A 2021 report from the U.S. Department of Agriculture found that 20% of non-Hispanic Black households, 16% of Hispanic households, and 7% of non-Hispanic White households struggled with food insecurity (no separate data was provided for non-Hispanic Asian households) [4].

The prevalence of food insecurity in the U.S. is a serious cause for concern. Its many adverse health consequences include increased rates of diabetes, hypertension, and poor sleep [5]. Among Asian American women and children in particular, food insecurity has been found to be a predictor of obesity, anemia, and overall general worse health [6–8]. Food insecurity is also associated with increased behavioral and mental health complications, such as aggression and anxiety in children [9] and depression in adults [10, 11]. Furthermore, these outcomes have broader societal consequences. One such impact is higher healthcare utilization and cost. Households that experience food insecurity have significantly higher healthcare utilization such as emergency department visits and inpatient admissions [12, 13]. Similarly, food insecurity increases the cost of public education and emergency food distribution and lowers worker productivity, leading to a total associated cost of more than $167.5 billion in the U.S. annually [14]. Prevalence of food insecurity is influenced by a variety of factors, including individual- and group-level factors as well as broader environmental factors, which indicates that populations in certain areas are more vulnerable to food insecurity. Examples of broader environmental factors that increase vulnerability to food insecurity include climate change, disease epidemics and pandemics, and war; these factors are especially important to consider when developing, recommending, and implementing food insecurity coping strategies [15–17].

Coping strategies for food insecurity currently largely involve public and private food assistance programs. The Supplemental Nutrition Assistance Program (SNAP) is the largest public assistance program in the U.S. and assists 38 million people each year [18]. The eligibility for SNAP is determined by states and is based on resource and income levels. Eligible households receive monthly allotments that can be used to buy groceries at authorized food retailers [19]. Other nutrition assistance programs such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) aid especially vulnerable populations. WIC currently reaches around half of all infants born in the U.S. and provides checks or vouchers for food purchases as well as nutrition education and referrals to services [20]. Additionally, private food assistance also plays an important role. For example, food pantry networks, comprised of more than 60,000 pantries, reach up to 4.4% of the U.S. population and help alleviate the burden of food insecurity for many families [21, 22]. These assistance programs, however, are still often underutilized due to barriers to participation such as stigma, complex procedures, and lack of knowledge about eligibility [23–25]. As participation in these programs improves outcomes in dietary intake, various non-health outcomes, and the cost of health care services [26, 27], minimizing these barriers is essential to better leverage these critical tools in managing food insecurity.

Additional coping strategies vary on an individual and household level and play an important role in food insecurity management. Many food-insecure individuals report using social networks and financial strategies to alleviate the pressures of food insecurity [28]. Some of these strategies can contribute to the disruptive effect of food insecurity on health. For instance, food-insecure patients at an urban medical center report forgoing medical care to manage the financial stress of food insecurity [29].

Further, the usage of coping strategies has also been found to vary by ethnic and racial groups. A 2018 systematic review has examined strategies used by African American, American Indian, Hispanic, and Caucasian parents to cope with food insecurity. While the majority of ethnic and racial groups report using similar coping strategies (e.g., public or private assistance, nutrition-related strategies, financial-related strategies, and social networks), there are subtle differences in how these different groups employ these coping strategies [28]. For example, stigma has been noted as a barrier to the use of public assistance program among African American parents. Immigration has been noted as a barrier to the use of public assistance program among Hispanic parents. Therefore, differences in food insecurity management among racial or ethnic minoritized populations are of special interest in order to support the development and implementation of culturally relevant policies and community-based programs targeting food insecurity. Of note, this 2018 review did not include any study focusing on Asian Americans and food insecurity coping strategies [28].

Moreover, effective food insecurity management requires addressing the differences in the experience of food insecurity among racial and ethnic minority groups. Racial and ethnic disparities in food insecurity have been well-established for over 20 years [30–33]. For instance, national data on food insecurity trends shows that food insecurity among non-Hispanic Black and Hispanic households is more than twice that of non-Hispanic White households [2]. Various socioecological factors influence these racial and ethnic disparities in food insecurity. Social and economic disadvantages faced by minority groups play a critical role, as White households in the United States consistently have significantly higher median income, median wealth, and education than Black and Hispanic households [34]. However, racial and ethnic disparities in food insecurity persist even after these socioeconomic determinants are accounted for [35], and structural racism in the U.S. is increasingly being recognized as an important contributor to such disparities. Defined as the macro level systems, social forces, institutions, ideologies, and processes that interact with one another to generate and reinforce inequities among racial and ethnic minority groups [36], structural racism leads to increased food insecurity through both socioeconomic inequalities and other factors such as racial discrimination [37]. Additionally, upstream-level policies and practices create conditions that are not conducive to food security for these groups. For example, states with a higher concentration of minority groups are more likely to have stricter regulations and more severe punishments associated with food assistance programs [37], reducing enrollment and participation. Food deserts are also more common in neighborhoods with high concentrations of minority groups, which is often a result of segregation practices [38–40]. These disparities in food insecurity have been exacerbated by the COVID-19 pandemic, further necessitating the examination of food insecurity faced by different racial groups [41].

While a body of literature has focused on experiences of food insecurity in several racial and ethnic minority populations, this topic has been understudied among Asian Americans though they are one of the fastest growing demographic groups in the U.S. with an estimated population of 18.9 million [42]. In a literature review conducted by Maynard and colleagues that includes 33 studies on food insecurity among immigrants in the U.S., only two studies with food insecurity data of Asians were identified [43]. Similarly, a review of food insecurity coping strategies by racial and ethnic minority groups in the U.S. could not identify any studies that pertained to the Asian American population [28]. To date, while there are multiple literature reviews of experiences of food insecurity among other minority groups [44–46], no such review exists for food insecurity among Asian Americans.

Furthermore, there is a lack of disaggregated data among Asian Americans in many studies, and little is known about the heterogeneous experiences of food insecurity among different origin groups [47]. There are multiple possible reasons behind this discrepancy. The “model minority myth” that suggests that all Asian Americans achieve educational and occupational success may hinder the study of socioeconomic disadvantages among Asian Americans [48]. Additionally, the method and administration of national surveys may contribute to this lack of research. National surveys often aggregate Asian Americans into one category, which can hide any disparity that may exist among origin groups [47]. Many surveys are available in only English and Spanish, systematically excluding Asian individuals with limited English proficiency who may also experience higher food insecurity levels [49, 50].

Given these gaps in the literature, this review aims to establish what is known about the experiences of food insecurity and nutrition program participation in the Asian American population and among Asian origin groups and to suggest further research and policy action to better address food insecurity in this population. Because our goals are to broadly understand what has been written about the experiences of food insecurity among Asians living in the U.S and identifying literature gaps, a scoping review was deemed more appropriate for this purpose than a systematic review [51]. Our review is guided by the methodological framework proposed by Arksey and O’Malley [52] and refined and outlined by Levac and colleagues [53] and the Joanna Briggs Institute [54]. The protocol is reported based on the guidance provided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) [55] (S1 Table).

Materials and methods

Discussion

Food insecurity is an important social determinant of health linked to multiple individual and societal outcomes. The COVID-19 pandemic has exacerbated food insecurity in the United States [60, 61], warranting further examination to inform policy and practices that can better address food insecurity in general and close the gap in racial and ethnic disparities in food insecurity in particular. The aim of this review is to explore and synthesize existing evidence on food insecurity and the use of nutrition assistance programs among Asian Americans. We expect to identify possible disparities in food insecurity, important health-correlates of food insecurity, and different patterns of nutrition assistance program participation that can have broad implications for how food insecurity is addressed moving forward. The identification of disparities in food insecurity levels among Asian origin groups can play a crucial role in informing policy decisions aimed at extending and removing barriers to food assistance programs. Understanding the health-related impacts of food insecurity among Asian Americans can also reveal important implications and create policy opportunities to address disparities in these communities. By analyzing patterns of participation in nutrition assistance programs, we can identify specific obstacles to access and recommend changes to outreach as well as the administration and structure of these programs to promote equity in program uptake. Moreover, this review aims to evaluate the robustness of the current literature on food insecurity among Asian Americans, to identify gaps in knowledge and provide insights for future research in this area. Findings of this review will be invaluable in informing evidence-based policy decisions and practices that can address food insecurity in Asian American communities. This review will provide an overview of the evidence relevant to food insecurity in the Asian American population that will be of interest to researchers and practitioners concerned with food insecurity. We plan to disseminate the results through a peer-reviewed manuscript and conference presentations.

Supporting information