LGBTQ+ Disparities in Food Insecurity, Food Assistance Use, and Barriers to Food Assistance.

Importance: Food insecurity disproportionately affects lesbian, gay, bisexual, transgender, and queer (LGBTQ+) adults, yet population-based data on disparities in food assistance use and barriers to accessing services remain limited. Objectives: To estimate the prevalence of food insecurity and food assistance program use among LGBTQ+ adults in Massachusetts from 2022 to 2024 and identify LGBTQ+-specific barriers to assistance. Design, Setting, and Participants: This repeated cross-sectional analysis used 2022 to 2024 data from the Massachusetts Statewide Food Access Survey, an annual online survey conducted by the Greater Boston Food Bank and Mass General Brigham. Exposure: LGBTQ+ identity, defined using a 2-step measure of sexual orientation and gender. Main Outcomes and Measures: Food insecurity, measured using the 10-item US Department of Agriculture Food Security Survey Module; food pantry and Supplemental Nutrition Assistance Program (SNAP) use; and barriers to food assistance access. Weighted prevalence estimates and adjusted prevalence ratios with 95% CIs were calculated by LGBTQ+ status. Results: The sample included 9174 Massachusetts adults (10.4%-12.8% LGBTQ+ across survey years). The prevalence of food insecurity increased significantly from 2022 to 2024 among both non-LGBTQ+ adults (29.8% [95% CI, 27.7%-32.0%] to 33.3% [95% CI, 31.3%-35.3%]) and LGBTQ+ adults (43.7% [95% CI, 37.7%-49.9%] to 54.9% [95% CI, 48.5%-61.1%]). Food pantry and SNAP use among LGBTQ+ adults remained stable over time. Among LGBTQ+ nonusers of food pantries in 2024, the most common barriers to use were wanting to be self-reliant (49.4% [95% CI, 41.6%-57.4%]), embarrassment (37.4% [95% CI, 30.1%-45.2%]), and fear of being identified as a pantry user (35.6% [95% CI, 28.6%-43.3%]); all barriers increased over time and were more commonly reported than among non-LGBTQ+ adults. Common barriers to SNAP use among LGBTQ+ adults in 2024 included wanting to be self-reliant (52.7% [95% CI, 43.4%-61.8%]), concern about taking benefits from someone with more need (44.6% [95% CI, 35.8%-53.7%]), and not knowing how to apply (26.0% [95% CI, 18.5%-35.1%]). In 2024, LGBTQ+ adults frequently endorsed grocery gift cards (42.5% [95% CI, 36.6%-48.7%]), home delivery (42.4% [95% CI, 36.4%-48.6%]), and online ordering (34.0% [95% CI, 28.5%-39.9%]) as strategies to increase pantry use. Conclusions and Relevance: In this cross-sectional study of food insecurity in Massachusetts, over half of LGBTQ+ adults experienced food insecurity in 2024, alongside barriers to food assistance use. Findings highlight the need for multilevel, community-co-created interventions to reduce disparities among LGBTQ+ individuals in food insecurity and improve equitable access to food assistance.