Addressing Food Insecurity in the United States: A Systematic Review of Interventions from Randomized Controlled...

Food insecurity remains a persistent public health challenge in the United States, affecting greater than 10% of households for the past 20 years. Although a variety of interventions have been implemented to address food insecurity, no prior review appears to have synthesized evidence exclusively from randomized controlled trials (RCTs).

The effectiveness of food insecurity interventions in the United States, focusing exclusively on evidence from RCTs, was examined in this systematic review. The strengths and limitations of the existing evidence were assessed, and recommendations are provided for future research, practice, and policy.

A comprehensive search was conducted across the PubMed, Embase, Web of Science, and ProQuest Central databases. Randomized controlled trials conducted in the United States that evaluated food security outcomes were included. Twenty-five studies met inclusion criteria.

Two reviewers independently screened abstracts and full texts. Data were extracted by a primary reviewer and verified by a second reviewer. Study quality was assessed using the Cochrane Risk of Bias tool.

The reviewed studies used a wide range of interventions across diverse settings. Findings were mixed, with 44% of included studies (n = 11) reporting significant improvements in food security compared with control groups.

The evidence does not support any single intervention as consistently effective and reveals significant gaps in geographic and population coverage. Key limitations across studies included short intervention and follow-up periods and limited assessment of intervention utilization. Future RCTs should prioritize long-term follow-up, inclusion of underserved regions and populations, and more rigorous evaluation of intervention uptake.

OSF registration no. 49jcs.