**Background:** Economic hardships such as food insecurity and inability to pay rent are strongly associated with adverse health outcomes across the lifespan, with young children being particularly vulnerable. The COVID-19 pandemic exacerbated these hardships, with Black, Latino, and immigrant families disproportionately affected due to structural racism and xenophobia. The US Congress passed relief packages including expanded SNAP benefits and three rounds of Economic Impact Payments (stimulus checks) to mitigate economic distress. This study examined whether participation in these programs was associated with reduced food and housing hardships and whether disparities in participation existed by race/ethnicity and maternal nativity.
**Methods:** Data came from Children's HealthWatch (CHW), a repeat cross-sectional study, and the CHW-COVID follow-up study—a longitudinal sentinel cohort. Baseline in-person interviews were conducted between January 2018 and March 2020 in emergency departments or primary care clinics across 5 cities. Telephone follow-up occurred between September 2020 and June 2021. Of 6875 eligible caregivers, 1396 participated (20.3% response rate). Mean time between interviews was 24.0 months (SD 7.8). Household food insecurity was measured using the validated 6-item USDA Food Security Survey Module. Being behind on rent was self-reported. Program participation was categorized as: neither SNAP nor EIP, SNAP only, EIP only, or both. Covariates included caregiver education, number of children, child age, insurance type, and household employment. Multinomial logistic regression and log-binomial regression were used, with results reported as adjusted odds ratios (aORs) and adjusted prevalence ratios (aPRs), respectively.
**Key Results:** Among 1396 caregiver-child dyads, 37.9% were Black non-Latino, 41.1% Latino, 16.9% White non-Latino, and 4.1% other race/ethnicity; 30.0% had an immigrant mother. During the COVID-19 crisis, 33.5% reported household food insecurity (vs 20.9% at baseline) and 40.8% were behind on rent (vs 17.9% at baseline). For program participation: 10.6% received neither, 11.5% SNAP only, 37.9% EIP only, and 40.0% both. Compared with White non-Latino caregivers, Latino caregivers had significantly lower odds of EIP-only participation (aOR 0.16, 95% CI 0.08-0.31) and both programs (aOR 0.40, 95% CI 0.20-0.83). Families with immigrant mothers had dramatically lower odds of any program participation vs US-born mothers (SNAP only: aOR 0.30, 95% CI 0.18-0.49; EIP only: aOR 0.15, 95% CI 0.10-0.23; both: aOR 0.07, 95% CI 0.05-0.12). Regarding hardship outcomes, EIP only was associated with 27% lower prevalence of food insecurity (aPR 0.73, 95% CI 0.59-0.91) and both programs with 24% lower prevalence (aPR 0.76, 95% CI 0.60-0.96); SNAP only was not statistically significant (aPR 0.84, 95% CI 0.65-1.08). For being behind on rent, SNAP only (aPR 0.78, 95% CI 0.61-0.99) and EIP only (aPR 0.71, 95% CI 0.58-0.86) were associated with significantly lower prevalence, while both programs was not significant (aPR 0.86, 95% CI 0.72-1.03). Exploratory mediation analyses showed that disparities in hardships persisted even after adjusting for program participation, suggesting differential participation did not fully explain observed disparities.
**Clinical Implications:** This study demonstrates that federal relief programs were associated with reduced food and housing hardships among families with young children, but significant disparities in both program access and hardship outcomes persisted by race/ethnicity and maternal nativity. Immigrant families faced particularly stark barriers to accessing relief, likely due to immigration-related exclusions, administrative barriers, and chilling effects from anti-immigrant policies and rhetoric. The findings highlight that policy design matters: EIPs initially excluded families without Social Security numbers, and SNAP eligibility restrictions for recent immigrants remained in place. Clinicians and policymakers should recognize that young children in marginalized families remain at high risk for hardship-related health consequences. Equity-driven policy design—including removing immigration exclusions, reducing administrative barriers, and ensuring automatic enrollment—is critical to ensure relief reaches those most in need. The advance Child Tax Credit is noted as a potentially more inclusive policy model. Limitations include the non-nationally representative sample, self-reported data, and small sample sizes for some subgroups.