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SOCIAL DETERMINANTS SOCIAL DETERMINANTS
OF HEALTH OF HEALTH

Food insecurity, defined by the USDA as “the limited or uncertain ulations they one day hope to serve. They are working together to un- 3. Gundersen C, Waxman E, Crumbaugh AS. An Examination of
availability of nutritionally adequate and safe foods or limited/un- cover the details surrounding our food insecurity spike and are creating the Adequacy of Supplemental Nutrition Assistance Program
certain ability to acquire acceptable foods in socially acceptable ways”, new solutions to this issue. This project has received funding from the (SNAP) Benefit Levels: Impacts on Food Insecurity. Agricultural
has demonstrated consistent associations with the development of UT Health Community Service and Learning MIDI Grant. and Resource Economics Review. 2019;48(3):433-447.
chronic diseases like diabetes, hypertension and obesity in numerous These are unprecedented times that require careful analysis and doi:10.1017/age.2019.30
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studies. According to Feeding America, the food insecurity rate of novel reactions to a constantly evolving, novel situation. With a well- 4. Coleman-Jensen, Alisha, Matthew P. Rabbitt, Christian A. Gre-
Bexar County was 14.1% in 2018, 2.6% percent greater than the na- crafted, mixed-method approach, which consists of both a quantitative gory, and Anita Singh. 2019. Household Food Security in the
tional average. Furthermore, although Bexar County is among the survey distributed to SAFB clients living in Bexar County and quali- United States in 2018, ERR-270, U.S. Department of Agriculture,
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top 15 US counties with the highest number of Supplemental Nutri- tative focus group interviews for select survey participants, this team Economic Research Service.
tion Assistance Program (SNAP) recipients, a significant proportion hopes to bring to light occult issues that are contributing to the larger 5. https://www.twc.texas.gov/news/texas-unemployment-rate-130-
remain food insecure. Keep in mind, these statistics were collected trends we are seeing in a post-COVID Bexar County. percent
2,3
prior to the COVID-19 pandemic. 6. https://www.twc.texas.gov/news/texas-unemployment-rate-128-
Many families in our community are sitting down for dinner with- Olivia Chen and Dirk Wristers are students at the percent
out adequate meals to share. Other families are forced to skip meals UT Health San Antonio Long School of Medicine 7. https://www.twc.texas.gov/unemployment-rate-83-percent-sep-
completely. Food insecure patients may be hard to detect due to tember
stigma surrounding food assistance. Questions such as “Have you had References 8. Talbot, S., 2020. SA Food Bank Officials Concerned Demand
to cut the size of your meals or skip meals because there wasn’t enough 1 . Jo Weaver, L. and B. Fasel, C. (2018) A Systematic Review of the May Spike After Several Assistance Programs End This Week. [on-
money or food to go around?”. Additionally, the USDA offers a reli- Literature on the Relationships between Chronic Diseases and line] KSAT. Available at: <https://www.ksat.com/news/local/
able, six-question screening tool that can be used to assess food inse- Food Insecurity. Food and Nutrition Sciences, 9, 519-541. 2020/07/27/sa-food-bank-officials-concerned-demand-may-
curity in patients. Since the virus affected Texas early in March 2020, doi: 10.4236/fns.2018.95040. spike after-several-assistance-pr ograms-end-this-week/> [Ac-
Bexar County residents have seen their unemployment rates sky- 2. Feeding America. 2020. Map The Meal Gap. [online] Available cessed 8 September 2020].
Food Commission (TWC). For comparison, the unemployment rate in 2020].
at: <https://map.feedingamerica.org/> [Accessed 28 August
rocket up to 13.5% in April 2020, according to the Texas Workforce
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Bexar County was 3.0% in April 2019. As of September 2020, the
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unemployment rate in Bexar County remains quite high at 8.3%.
Months of record-high rates of unemployment have caused com-
Insecurity munity organizations like the San Antonio Food Bank (SAFB) to ex-
perience unprecedented surges in the number of clients they serve;
between March 2020 and July 2020, SAFB saw their original client
base double from 60,000 to 120,000. This massive increase in de-
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mand for services provided by local community organizations, in
in a Post-COVID combination with a lack of current research regarding the impact of
Bexar County COVID-19 on food access, has highlighted the crucial need for re-
search investigating the state of food security in Bexar County since
the COVID-19 pandemic.
By Olivia Chen and Dirk Wristers In response to this major gap in public health research and in part-
nership with SAFB, an interprofessional team of students developed
a community service and learning research project that will evaluate
how food insecurity, food access barriers and purchasing behaviors
have shifted in Bexar County since the COVID-19 pandemic began.
This team is led by Dirk Wristers, a 4th year MD/MPH student at
UT Health San Antonio, and consists of students from the UT
Health San Antonio medical, dental, and nursing schools as well as a
UTSA dietetics intern.
COVID-19 has had a profound impact on the education of these
medical students. Many were pulled out of the clinical learning envi-
ronment and are being asked to learn in unconventional ways amidst
an era that needs health care providers now more than ever. This team
of students resolved to continue to make a positive impact on their
communities despite their newfound distance from the patient pop-

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