Community-based social assistance programs and household food insecurity among de novo food-aid seekers in Quebec, Canada

To examine the association between the use of community-based social assistance programs (CB-SAPs) and the reduction of household food insecurity among de novo food-aid seekers in Quebec, Canada. Prospective Cohort Study. A longitudinal observational study was conducted using a sample of 915 newly registered food-aid seekers in Quebec’s food banks from the (Blinded) cohort study (2018–2020). The outcome was any reduction in the severity of Household Food Insecurity. Exposures included three CB-SAPS:1) using food donations, 2) using food-management related CB-SAPs (other than food donations), and 3) using CB-SAPs unrelated to food. We used Longitudinal Targeted Maximum Likelihood Estimation (LTMLE) to estimate the Relative Risk (RR) and LTMLE for working Marginal Structural Models to estimate Average Additive Treatment Effects (ATE) of the relationship between the use of CB-SAPs and Household Food Insecurity. The use of CB-SAPs showed a trend towards reduction of Household Food Insecurity. Compared to households using exclusively food banks at baseline, households with multiple-food-acquisition (Multiple AFS) health-promoting practices were more likely to reduce (in the relative scale) Household Food Insecurity by using: food donations (RR: 1.30; 95%CI:1.01, 1.60); food-management related CB-SAPs (RR: 1.28; 95%CI:1.03, 1.58); and CB-SAPs unrelated to food (RR: 1.33; 95%CI:1.03, 1.62). Multiple AFS showed a reduction in the Household Food Insecurity (absolute) scale, especially among food-management related CB-SAPs users (ATE: -0.24; 95%CI:-0.43, -0.04). CB-SAPs use contributes to reducing Household Food Insecurity. This contribution varies depending on the food-acquisition health-promoting practices of food-aid seeker households. • Limited evidence exists on the effects of CB-SAPs usage on food insecurity. • CB-SAPs usage contribute to reducing food insecurity among new food-aid seekers. • CB-SAPs usage’ effects on food insecurity depend on household food-acquisition health-promoting practices.