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To determine the prevalence of food insecurity and the coping strategies and to investigate the role of safety nets among low-income households in urban and rural west Texas.The Core Food Security Module, an 18-item scale, was used in a cross-sectional purposeful convenience sample comparing rural and urban households, whereas the demographic survey assessed participation in food assistance/safety net programs.Rural and urban neighborhoods in west Texas.Sample size of 191 participants from low-income households, predominantly African American and Hispanic people.Levels of food insecurity and use of safety nets.Comparisons between rural and urban households and between food-secure and food-insecure households were analyzed using the chi-square test of independence for categorical variables. Fisher's exact test was used whenever the number in each cell was < 5 in 2 × 2 contingency tables.Prevalence of household and child food insecurity in west Texas was 63% and 43%, respectively. Forgoing balanced meals was a common coping strategy. There was high intake of affordable energy-intense foods.The high prevalence of food insecurity in low-income households in west Texas led to high intake of energy-intense food with low nutrients, resulting in higher prevalence of anemia, obesity, and other chronic diseases. There was low participation in safety net programs. Educational interventions on food choices are recommended.