1
|
Alvis CE, Mosha M, Amankwah EK, Hernandez RG, Morrison JM. Comparison of Caregiver and Provider Food Insecurity Screening Preferences Within a Health System. Clin Pediatr (Phila) 2024; 63:650-658. [PMID: 37559340 DOI: 10.1177/00099228231191926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Food insecurity is a public health concern associated with poor health. Evidence guiding how to best implement screening for food insecurity across a pediatric health care system is lacking. We performed a single-center, multi-department, cross-sectional study of caregivers and health care providers in outpatient and inpatient settings to describe the beliefs, barriers, preferences, and preferred food insecurity screening location. Most providers and caregivers underestimated the pervasiveness of food insecurity while acknowledging the benefit of screening. Caregivers are overall receptive to food insecurity screening and disagree with feelings of discomfort or shame when disclosing food insecurity status. Providers acknowledged perceived caregiver discomfort, lack of community food resources, and lack of a validated screening tool as barriers to screening. Both caregivers and providers identified the primary care setting as the preferred screening setting.
Collapse
Affiliation(s)
- Courtney E Alvis
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | - Maua Mosha
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | - Ernest K Amankwah
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raquel G Hernandez
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John M Morrison
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
2
|
Suarez L, Armstrong S, Fleming R, Howard J, Cholera R. Families Benefit After Utilization of a Clinic-Based Food Pantry Irrespective of Food Insecurity Experiences in a Pediatric Obesity Treatment Program. Am J Health Promot 2024; 38:661-671. [PMID: 38321414 DOI: 10.1177/08901171241229828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
PURPOSE To evaluate the congruence between food insecurity screening outcome and clinic-based food pantry utilization and to examine caregiver reported comfort, motivation, and benefits of utilization. DESIGN Mixed-methods study. SETTING Academic pediatric obesity treatment clinic. SUBJECTS Convenience sample of caregivers. INTERVENTION Clinic-based food pantry offered irrespective of food insecurity screening outcome. MEASURES Food insecurity screening (Hunger Vital Sign) and severity, self-rated caregiver health, willingness to disclose food insecurity and receive food, and food-related stress. ANALYSIS Chi-square and t-tests were utilized to examine associations and descriptive analysis explored benefits. Rapid qualitative analysis was utilized to identify themes. RESULTS Caregivers of 120 children were included (child mean age 11.8; 56.7% female, 67.6% Non-Hispanic Black), with 47 of 59 eligible completing follow-up surveys and 14 completing in-depth interviews. Approximately half (N = 30/59, 50.8%) of families utilizing the food pantry screened negative for food insecurity. Families utilizing the food pantry were more likely to report severe food insecurity (N = 23/59; 38.9%) compared to those declining (N = 3/61; 4.9%, P < .001). Caregivers accepting food were able to meet a child health goal (N = 30/47, 63.8%). Caregivers reported feeling comfortable receiving food (N = 13/14) and felt utilizing the food pantry led to consumption of healthier foods (N = 7/14). CONCLUSIONS Families who screened both positive and negative for food insecurity utilized and benefited from a clinic-based food pantry. Clinics should consider strategies offering food resources to all families irrespective of screening outcome.
Collapse
Affiliation(s)
- Lilianna Suarez
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
- Department of Medicine, School of Medicine, Duke University, Durham, NC, USA
| | - Sarah Armstrong
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
- Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC, USA
- Duke Center for Childhood Obesity Research, Duke University, Durham, NC, USA
| | - Rachel Fleming
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
| | - Janna Howard
- Duke Center for Childhood Obesity Research, Duke University, Durham, NC, USA
| | - Rushina Cholera
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
- Duke Margolis Center for Health Policy, Duke University, NC, USA
| |
Collapse
|
3
|
Baker S, Gallegos D, Rebuli MA, Taylor AJ, Mahoney R. Food Insecurity Screening in High-Income Countries, Tool Validity, and Implementation: A Scoping Review. Nutrients 2024; 16:1684. [PMID: 38892619 PMCID: PMC11174716 DOI: 10.3390/nu16111684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/17/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
Household food insecurity has significant negative implications across the lifespan. While routine screening is recommended, particularly in healthcare, guidelines are lacking on selection of screening tools and best-practice implementation across different contexts in non-stigmatizing ways. The objective of this scoping review was to synthesize evidence on household food insecurity screening tools, including psychometrics, implementation in a range of settings, and experiences of carrying out screening or being screened. Four electronic databases were searched for studies in English published from 1990 until June 2023. A total of 58 papers were included, 21 of which focused on tool development and validation, and 37 papers described implementation and perceptions of screening. Most papers were from the USA and described screening in healthcare settings. There was a lack of evidence regarding screening in settings utilized by Indigenous people. The two-item Hunger Vital Sign emerged as the most used and most valid tool across settings. While there is minimal discomfort associated with screening, screening rates in practice are still low. Barriers and facilitators of screening were identified at the setting, system, provider, and recipient level and were mapped onto the COM-B model of behavior change. This review identifies practical strategies to optimize screening and disclosure.
Collapse
Affiliation(s)
- Sabine Baker
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, South Brisbane, QLD 4101, Australia; (D.G.); (A.J.T.)
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Danielle Gallegos
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, South Brisbane, QLD 4101, Australia; (D.G.); (A.J.T.)
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | | | - Amanda J. Taylor
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, South Brisbane, QLD 4101, Australia; (D.G.); (A.J.T.)
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Ray Mahoney
- Australian e-Health Research Centre, CSIRO Health and Biosecurity, Herston, QLD 4029, Australia;
| |
Collapse
|
4
|
Craven CK, Highfield L, Basit M, Bernstam EV, Choi BY, Ferrer RL, Gelfond JA, Pruitt SL, Kannan V, Shireman PK, Spratt H, Morales KJT, Wang CP, Wang Z, Zozus MN, Sankary EC, Schmidt S. Toward standardization, harmonization, and integration of social determinants of health data: A Texas Clinical and Translational Science Award institutions collaboration. J Clin Transl Sci 2024; 8:e17. [PMID: 38384919 PMCID: PMC10880009 DOI: 10.1017/cts.2024.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/12/2023] [Accepted: 12/31/2023] [Indexed: 02/23/2024] Open
Abstract
Introduction The focus on social determinants of health (SDOH) and their impact on health outcomes is evident in U.S. federal actions by Centers for Medicare & Medicaid Services and Office of National Coordinator for Health Information Technology. The disproportionate impact of COVID-19 on minorities and communities of color heightened awareness of health inequities and the need for more robust SDOH data collection. Four Clinical and Translational Science Award (CTSA) hubs comprising the Texas Regional CTSA Consortium (TRCC) undertook an inventory to understand what contextual-level SDOH datasets are offered centrally and which individual-level SDOH are collected in structured fields in each electronic health record (EHR) system potentially for all patients. Methods Hub teams identified American Community Survey (ACS) datasets available via their enterprise data warehouses for research. Each hub's EHR analyst team identified structured fields available in their EHR for SDOH using a collection instrument based on a 2021 PCORnet survey and conducted an SDOH field completion rate analysis. Results One hub offered ACS datasets centrally. All hubs collected eleven SDOH elements in structured EHR fields. Two collected Homeless and Veteran statuses. Completeness at four hubs was 80%-98%: Ethnicity, Race; < 10%: Education, Financial Strain, Food Insecurity, Housing Security/Stability, Interpersonal Violence, Social Isolation, Stress, Transportation. Conclusion Completeness levels for SDOH data in EHR at TRCC hubs varied and were low for most measures. Multiple system-level discussions may be necessary to increase standardized SDOH EHR-based data collection and harmonization to drive effective value-based care, health disparities research, translational interventions, and evidence-based policy.
Collapse
Affiliation(s)
- Catherine K. Craven
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Division of Clinical Research Informatics, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Linda Highfield
- University of Texas Health Science Center at Houston, School of Public Health, San Antonio, TX, USA
| | - Mujeeb Basit
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Elmer V. Bernstam
- D. Bradley McWilliams School of Biomedical Informatics and Division of General Internal Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Byeong Yeob Choi
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Biostatistics Division, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Robert L. Ferrer
- Department of Community and Family Medicine, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Jonathan A. Gelfond
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Biostatistics Division, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Sandi L. Pruitt
- University of Texas Southwestern Medical Center, Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | | | - Paula K. Shireman
- Department of Surgery, Division of Vascular and Endovascular Surgery, Texas A&M University School of Medicine, Bryan, TX, USA
- Departments of Primary Care & Rural Medicine and Medical Physiology, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Heidi Spratt
- Department of Biostatistics and Data Science, University of Texas Medical Branch Galveston, Galveston, TX, USA
| | - Kayla J. Torres Morales
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Division of Clinical Research Informatics, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Chen-Pin Wang
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Biostatistics Division, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Zhan Wang
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Division of Clinical Research Informatics, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Meredith N. Zozus
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Division of Clinical Research Informatics, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Edward C. Sankary
- University of Texas Health Science Center San Antonio, UT Health Physicians, San Antonio, TX, USA
| | - Susanne Schmidt
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| |
Collapse
|
5
|
Wilkerson K, De Marchis E, Rudd N, Williams JC, Pantell M, Ackerman SL, Amerson EH, Chang AY. Patient Perspectives on Social Risk Screening and Documentation in a Dermatology Clinic. JAMA Dermatol 2023; 159:1346-1358. [PMID: 37878278 PMCID: PMC10600715 DOI: 10.1001/jamadermatol.2023.3887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/20/2023] [Indexed: 10/26/2023]
Abstract
Importance Providing person-centered dermatologic care includes consideration of social risk factors, such as housing instability and unreliable transportation, that may affect clinical management. Patients' perspectives on social risk screening and documentation in dermatology clinics have not yet been evaluated. Objective To understand patients' perspectives on social risk screening and documentation in a dermatology clinic. Design, Setting, and Participants This mixed-methods study used a survey and semistructured interviews and was conducted in a general dermatology clinic at a large urban public hospital. Patients at the clinic were eligible to complete the survey if they were 18 years or older; able to speak and read English, Spanish, or Cantonese; and comfortable using a computer tablet. Survey participants who preferred to use English were eligible for interviews. The survey included social risk screening questions, measures of acceptability, and questions on social risk factors associated with patient acceptability. Semistructured interviews were conducted to explore attitudes and beliefs about social risk screening and documentation. Survey and interview findings were integrated during data analysis through development of themes and joint display. Data were analyzed from December 2021 to April 2023. Main Outcomes and Measures There were 2 outcome measures of acceptability: appropriateness of screening in a dermatology clinic and comfort with documentation of social risk in the electronic health record (EHR). Results A total of 135 participants (including 73 males [54.1%]) answered both measures of acceptability in the survey. Of these participants, 116 (85.9%) reported that social risk screening in their dermatology clinic was very or somewhat appropriate and 85 (63.0%) reported being completely or somewhat comfortable with having their social risks documented in the EHR. Themes that were developed from surveys and interviews were the (1) role of interpersonal factors in willingness to disclose social risks, (2) implications of institutional trust for willingness to disclose and comfort with documentation, and (3) relevance of screening in a dermatology clinic. Conclusions and Relevance Results of this study showed that most participants found social risk screening to be appropriate in a dermatology clinic, although a smaller proportion of participants were comfortable with EHR documentation of their social risks. Optimizing patients' trust in their physicians and the medical system, while addressing privacy and discrimination concerns, may help facilitate disclosure of social risks.
Collapse
Affiliation(s)
- Kamina Wilkerson
- University of California, San Francisco School of Medicine, San Francisco
| | - Emilia De Marchis
- Department of Family and Community Medicine, University of California, San Francisco School of Medicine, San Francisco
| | - Nora Rudd
- University of California, San Francisco School of Medicine, San Francisco
| | | | - Matt Pantell
- Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco
| | - Sara L. Ackerman
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco
| | - Erin H. Amerson
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco
- Department of Dermatology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Aileen Y. Chang
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco
- Department of Dermatology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| |
Collapse
|
6
|
Cacioppo AM, Winslow V, Abramsohn EM, Jagai JS, Makelarski JA, Waxman E, Wroblewski K, Tessler Lindau S. Food Insecurity and Experiences of Discrimination Among Caregivers of Hospitalized Children. Pediatrics 2023; 152:e2023061750. [PMID: 37986582 PMCID: PMC10657777 DOI: 10.1542/peds.2023-061750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Pediatric hospitals are adopting strategies to address food insecurity (FI), a stigmatizing condition, among families with children. We hypothesized that parents and other caregivers ("caregivers") from households with FI or marginal food security (MFS) are more likely to experience discrimination during their child's hospitalization. METHODS We analyzed data from 319 caregivers of children admitted to an urban, academic children's hospital and randomly assigned to the control arm of the double-blind randomized controlled CommunityRx-Hunger trial (November 2020 to June 2022, NCT R01MD012630). Household food security in the 30 days before admission and discrimination during hospitalization were measured with the US Household Food Security Survey and the Discrimination in Medical Settings Scale, respectively. We used logistic regression to model the relationship between food security status and discrimination, adjusting for gender, race, ethnicity, income, and partner status. RESULTS Most participants were African American or Black (81.5%), female (94.7%), and the parent of the hospitalized child (93.7%). FI and MFS were prevalent (25.1% and 15.1%, respectively). Experiences of discrimination during a child's hospitalization were prevalent (51.9%). Caregivers with FI had higher odds than caregivers with food security of experiencing discrimination (adjusted odds ratio = 2.0, 95% confidence interval 1.1-3.6, P = .03); MFS was not significantly associated with discrimination (P = .25). Compared with food secure caregivers, those with FI had higher odds of 5 of 7 experiences of discrimination assessed. CONCLUSIONS Among parents and other caregivers, household FI is associated with experiences of discrimination during a child's hospitalization.
Collapse
Affiliation(s)
| | | | | | | | | | - Elaine Waxman
- The Urban Institute, Washington, District of Columbia
| | | | | |
Collapse
|
7
|
Ujah OI, Olaore P, Ogbu CE, Okopi JA, Kirby RS. Prevalence and determinants of food insecurity among pregnant women in Nigeria: A multilevel mixed effects analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002363. [PMID: 37851664 PMCID: PMC10584166 DOI: 10.1371/journal.pgph.0002363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/21/2023] [Indexed: 10/20/2023]
Abstract
Food insecurity (FI) remains a key priority for sustainable development. Despite the well-known consequences of food insecurity on health and well-being, evidence regarding the burden and determinants of FI among pregnant women in Nigeria is limited. Framed by the social-ecological model, this study aimed to determine the prevalence of FI, and its associations with individual-/household-level and contextual-level factors among pregnant women in Nigeria. A cross-sectional study based on the Nigerian Multiple Indicator Cluster Survey (2021 Nigerian MICS6) was conducted among a sample of 3519 pregnant women aged 15-49 years. Several weighted multilevel multinomial logistic regression models were fitted to assess the association between individual-/household-s level and community-level characteristics with FI. We estimated and reported both fixed effects and random effects to measure the associations and variations, respectively. Results: The prevalence of FI among pregnant women in Nigeria was high, with nearly 75% of the participants reporting moderate to severe FI in the past 12 months (95% CI = 71.3%-75.8%) in 2021. There were also significant differences in all the experiences of food insecurity due to lack of money or resources, as measured by the Food Insecurity Experience Scale (FIES), except for feeling hungry but not eating because of lack of money or resources (p < 0.0001). Multivariate analysis revealed that higher parity, households with 5 or more members, household wealth index, urban residence, and community-level poverty were significantly associated with FI. Our study demonstrates a significantly high prevalence of FI among pregnant women in Nigeria in 2021. Given the negative consequences of FI on maternal and child health, implementing interventions to address FI during pregnancy remains critical to improving pregnancy outcomes.
Collapse
Affiliation(s)
- Otobo I. Ujah
- Department of Obstetrics and Gynaecology, Federal University of Health Sciences, Otukpo, Nigeria
- College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Pelumi Olaore
- College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Chukwuemeka E. Ogbu
- College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Joseph-Anejo Okopi
- Department of Microbiology, Federal University of Health Sciences, Otukpo, Nigeria
| | - Russell S. Kirby
- College of Public Health, University of South Florida, Tampa, Florida, United States of America
| |
Collapse
|
8
|
Taylor AJ, Baker S, Gallegos D. Intersection of food insecurity and moral experiences of those involved in paediatric healthcare: A scoping review of child, caregiver and healthcare provider perspectives. J Child Health Care 2022:13674935221133476. [PMID: 36384283 DOI: 10.1177/13674935221133476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Food insecurity is a significant social and health issue for children in high-income countries and contributes to sub-optimal child outcomes. This scoping review examines how food insecurity intersects with the moral experiences of those involved in providing and receiving paediatric health care. Multiple databases were searched using a priori inclusion criteria, papers were screened by multiple reviewers. Searches yielded nine papers. Descriptive data was summarised and qualitative results extracted from included papers were analysed using inductive and deductive thematic analysis. Four main themes emerged: Food insecurity threatens caregiver and healthcare provider identity; is food insecurity the business of health? is screening for food insecurity surveillance or facilitating assistance? and the lived experience of navigating the tension of managing food insecurity and a child's health condition. The moral experiences lens has magnified the countless everyday encounters in which values and beliefs about what is 'right' or 'just' can be realised or thwarted in the context of the intersection between healthcare and food insecurity. Review findings have implications relating to the inclusion of children's voices in healthcare settings, healthcare practice and policy design, and the development and use of FI screening tools.
Collapse
Affiliation(s)
- Amanda J Taylor
- Woolworths Centre for Childhood Nutrition Research, Faculty of Health, 1969Queensland University of Technology, South Brisbane, QLD, Australia.,School of Exercise and Nutrition Science, Faculty of Health, 1969Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Sabine Baker
- Woolworths Centre for Childhood Nutrition Research, Faculty of Health, 1969Queensland University of Technology, South Brisbane, QLD, Australia.,School of Exercise and Nutrition Science, Faculty of Health, 1969Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Danielle Gallegos
- Woolworths Centre for Childhood Nutrition Research, Faculty of Health, 1969Queensland University of Technology, South Brisbane, QLD, Australia.,School of Exercise and Nutrition Science, Faculty of Health, 1969Queensland University of Technology, Kelvin Grove, QLD, Australia
| |
Collapse
|
9
|
Daundasekara SS, Schuler BR, Hernandez DC. A latent class analysis to identify socio-economic and health risk profiles among mothers of young children predicting longitudinal risk of food insecurity. PLoS One 2022; 17:e0272614. [PMID: 36001540 PMCID: PMC9401138 DOI: 10.1371/journal.pone.0272614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/22/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The purpose of the current study was to use a social determinants of health (SDOH) framework and latent class analysis (LCA) to identify risk classes among mothers with young children. The risk classes were then used to predict food insecurity severity and stability/change of food insecurity over time. METHOD The secondary data from the Fragile Families and Child Wellbeing Study (n = 2,368; oversampled for non-marital births) was used in this study. Household food insecurity was assessed using the 18-items USDA Food Security Survey. A seventeen-item inventory of educational, economic stability, incarceration (i.e. social context), neighborhood safety (i.e. neighborhood and built environment), health and health care, and substance use behaviors at baseline/Year-1 were included to identify SDOH risk indicators in the LCA. Covariate-adjusted multinomial logistic regression models were used to examine the relation between risk classes at Year-1 and the severity of food insecurity at Year-3 and stability/change of food insecurity between Year-3 and Year -5. RESULTS LCA identified five risk classes: High utility and medical hardship (Class 1), high housing and employment hardship, high substance use, and incarceration (Class 2), high housing and medical hardship, poor health, and health care (Class 3), high employment hardship and low-income (Class 4) and low-risk (Class 5). The Class 1, Class 2 and Class 3 had greater odds of low food security and very low food security at Year-3 compared to Class 4. In addition, compared to Class 4, Class 1, Class 2 and Class 3 had greater odds unstable food insecurity and persistent food insecurity over time. CONCLUSIONS LCA could be used to identify distinctive family system risk profiles predictive of food insecurity. The generated risk profiles could be used by health care providers as an additional tool to identify families in need for resources to ensure household food security.
Collapse
Affiliation(s)
- Sajeevika Saumali Daundasekara
- Department of Research, Cizik School of Nursing, University of Texas Health Science Center, Houston, Texas, United States of America
| | - Brittany R. Schuler
- School of Social Work, Temple University, Philadelphia, Pennsylvania, United States of America
| | - Daphne C. Hernandez
- Department of Research, Cizik School of Nursing, University of Texas Health Science Center, Houston, Texas, United States of America
| |
Collapse
|
10
|
Perspectives of Caregivers Experiencing Persistent Food Insecurity at an Academic Primary Care Clinic. Acad Pediatr 2022; 22:892-899. [PMID: 34365031 PMCID: PMC8818048 DOI: 10.1016/j.acap.2021.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Food insecurity (FI) is often transitory and instigated by changes in family circumstances or environmental events. Clinics have developed interventions to address FI, yet families may face persistent FI. Little is known about persistently food insecure families' experiences with clinic-based interventions. The objective of this study was to evaluate the perspectives of caregivers experiencing persistent FI in a clinical setting. METHODS We conducted 40 semistructured interviews at one academic primary care clinic between July 2019 and December 2019. The clinic routinely screened families for FI at every visit; families screening positive could meet with a care navigator and receive bags of nonperishable foods. Caregivers who received food bags at ≥3 visits, spoke English or Spanish, and were ≥18 years old were eligible to participate. Interviews were recorded, de-identified, transcribed, and systematically coded using inductive content analysis. A modified constant comparative method was used to iteratively review codes, identify emerging themes, and resolve differences through consensus. RESULTS Forty caregivers were interviewed; all were women; 45% were Hispanic/Latinx and 37.5% African American/Black. Three major themes emerged: 1) unmet social and medical needs and the challenges of caregiving complicate FI; 2) social supports help address FI and other social challenges that present barriers to accessing resources; and 3) caregivers provide practical recommendations for addressing persistent FI. CONCLUSION Families experiencing persistent FI described important social supports that help address FI and other social challenges that present barriers to accessing resources. Clinic-based resources were welcomed interventions, but their impact may be limited; practical recommendations were made.
Collapse
|
11
|
Berkowitz RL, Bui L, Shen Z, Pressman A, Moreno M, Brown S, Nilon A, Miller-Rosales C, Azar KMJ. Evaluation of a social determinants of health screening questionnaire and workflow pilot within an adult ambulatory clinic. BMC FAMILY PRACTICE 2021; 22:256. [PMID: 34952582 PMCID: PMC8708511 DOI: 10.1186/s12875-021-01598-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 11/29/2021] [Indexed: 12/05/2022]
Abstract
BACKGROUND There is increased recognition in clinical settings of the importance of documenting, understanding, and addressing patients' social determinants of health (SDOH) to improve health and address health inequities. This study evaluated a pilot of a standardized SDOH screening questionnaire and workflow in an ambulatory clinic within a large integrated health network in Northern California. METHODS The pilot screened for SDOH needs using an 11-question Epic-compatible paper questionnaire assessing eight SDOH and health behavior domains: financial resource, transportation, stress, depression, intimate partner violence, social connections, physical activity, and alcohol consumption. Eligible patients for the pilot receiving a Medicare wellness, adult annual, or new patient visits during a five-week period (February-March, 2020), and a comparison group from the same time period in 2019 were identified. Sociodemographic data (age, sex, race/ethnicity, and payment type), visit type, length of visit, and responses to SDOH questions were extracted from electronic health records, and a staff experience survey was administered. The evaluation was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. RESULTS Two-hundred eighty-nine patients were eligible for SDOH screening. Responsiveness by domain ranged from 55 to 67%, except for depression. Half of patients had at least one identified social need, the most common being stress (33%), physical activity (22%), alcohol (12%), and social connections (6%). Physical activity needs were identified more in females (81% vs. 19% in males, p < .01) and at new patient/transfer visits (48% vs. 13% at Medicare wellness and 38% at adult wellness visits, p < .05). Average length of visit was 39.8 min, which was 1.7 min longer than that in 2019. Visit lengths were longer among patients 65+ (43.4 min) and patients having public insurance (43.6 min). Most staff agreed that collecting SDOH data was relevant and accepted the SDOH questionnaire and workflow but highlighted opportunities for improvement in training and connecting patients to resources. CONCLUSION Use of evidence-based SDOH screening questions and associated workflow was effective in gathering patient SDOH information and identifying social needs in an ambulatory setting. Future studies should use qualitative data to understand patient and staff experiences with collecting SDOH information in healthcare settings.
Collapse
Affiliation(s)
- Rachel L Berkowitz
- Department of Public Health and Recreation, College of Health and Human Sciences, San José State University, One Washington Square, San José, CA, 95192, USA
- Sutter Health Institute for Advancing Health Equity, 2121 N. California Blvd, Walnut Creek, CA, 94596, USA
| | - Linh Bui
- Sutter Health Institute for Advancing Health Equity, 2121 N. California Blvd, Walnut Creek, CA, 94596, USA
- Department of Nursing, School of Natural Sciences, Mathematics, and Engineering, California State University, Bakersfield, 9001 Stockdale Highway, Bakersfield, CA, 93311, USA
| | - Zijun Shen
- Sutter Health Institute for Advancing Health Equity, 2121 N. California Blvd, Walnut Creek, CA, 94596, USA
- Sutter Health Center for Health Systems Research, 2121 N. California Blvd, Walnut Creek, CA, 94596, USA
| | - Alice Pressman
- Sutter Health Institute for Advancing Health Equity, 2121 N. California Blvd, Walnut Creek, CA, 94596, USA
- Sutter Health Center for Health Systems Research, 2121 N. California Blvd, Walnut Creek, CA, 94596, USA
| | - Maria Moreno
- Sutter Health Institute for Advancing Health Equity, 2121 N. California Blvd, Walnut Creek, CA, 94596, USA
- Sutter Health Center for Health Systems Research, 2121 N. California Blvd, Walnut Creek, CA, 94596, USA
| | - Stephanie Brown
- Sutter Health Institute for Advancing Health Equity, 2121 N. California Blvd, Walnut Creek, CA, 94596, USA
- Alta Bates Summit Medical Center, Sutter Health, 350 Hawthorne Ave., Oakland, CA, 94609, USA
- Berkeley Emergency Medical Group, 2450 Ashby Ave., Berkeley, CA, 94705, USA
| | - Anne Nilon
- Sutter Health Population Health Services, 2121 N. California Blvd, Walnut Creek, CA, 94596, USA
| | - Chris Miller-Rosales
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Kristen M J Azar
- Sutter Health Institute for Advancing Health Equity, 2121 N. California Blvd, Walnut Creek, CA, 94596, USA.
- Sutter Health Center for Health Systems Research, 2121 N. California Blvd, Walnut Creek, CA, 94596, USA.
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St., Second Floor, San Francisco, CA, 94158, USA.
| |
Collapse
|
12
|
Morrison JM, Marsicek SM, Hopkins AM, Dudas RA, Collins KR. Using simulation to increase resident comfort discussing social determinants of health. BMC MEDICAL EDUCATION 2021; 21:601. [PMID: 34872529 PMCID: PMC8647375 DOI: 10.1186/s12909-021-03044-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 11/17/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND Social determinants of health (SDoH) play an important role in pediatric health outcomes. Trainees receive little to no training on how to identify, discuss and counsel families in a clinical setting. The aim of this study was to determine if a simulation-based SDoH training activity would improve pediatric resident comfort with these skills. METHODS We performed a prospective study of a curricular intervention involving simulation cases utilizing standardized patients focused on four social determinants (food insecurity, housing insecurity, barriers to accessing care, and adverse childhood experiences [ACEs]). Residents reported confidence levels with discussing each SDoH and satisfaction with the activity in a retrospective pre-post survey with five-point Likert style questions. Select residents were surveyed again 9-12 months after participation. RESULTS 85% (33/39) of residents expressed satisfaction with the simulation activity. More residents expressed comfort discussing each SDoH after the activity (Δ% 38-47%; all p < .05), with the greatest effect noted in post-graduate-year-1 (PGY-1) participants. Improvements in comfort were sustained longitudinally during the academic year. More PGY-1 participants reported engaging in ≥ 2 conversations in a clinical setting related to food insecurity (43% vs. 5%; p = .04) and ACEs (71% vs. 20%; p = .02). DISCUSSION Simulation led to an increased resident comfort with discussing SDoH in a clinical setting. The greatest benefit from such a curriculum is likely realized early in training. Future efforts should investigate if exposure to the simulations and increased comfort level with each topic correlate with increased likelihood to engage in these conversations in the clinical setting.
Collapse
Affiliation(s)
- John M Morrison
- Department of Pediatrics, Johns Hopkins University School of Medicine, MD Baltimore, USA
- Division of Pediatric Hospital Medicine, Department of Pediatric Medicine, Johns Hopkins All Children’s Hospital, FL St Petersburg, USA
| | - Sarah M. Marsicek
- Division of Pediatric Hospital Medicine, Department of Pediatric Medicine, AdventHealth for Children, FL Orlando, USA
| | - Akshata M Hopkins
- Department of Pediatrics, Johns Hopkins University School of Medicine, MD Baltimore, USA
- Division of Pediatric Hospital Medicine, Department of Pediatric Medicine, Johns Hopkins All Children’s Hospital, FL St Petersburg, USA
| | - Robert A Dudas
- Department of Pediatrics, Johns Hopkins University School of Medicine, MD Baltimore, USA
- Division of Pediatric Hospital Medicine, Department of Pediatric Medicine, Johns Hopkins All Children’s Hospital, FL St Petersburg, USA
| | - Kimberly R Collins
- Department of Pediatrics, Johns Hopkins University School of Medicine, MD Baltimore, USA
- Division of Pediatric Hospital Medicine, Department of Pediatric Medicine, Johns Hopkins All Children’s Hospital, FL St Petersburg, USA
| |
Collapse
|
13
|
Risk Factors for Veteran Food Insecurity: Findings from a National US Department of Veterans Affairs Food Insecurity Screener. Public Health Nutr 2021; 25:819-828. [PMID: 34743780 PMCID: PMC8957505 DOI: 10.1017/s1368980021004584] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: Food insecurity is associated with numerous adverse health outcomes. The US Veterans Health Administration (VHA) began universal food insecurity screening in 2017. This study examined prevalence and correlates of food insecurity among Veterans screened. Design: Retrospective cross-sectional study using VHA administrative data. Multivariable logistic regression models were estimated to identify sociodemographic and medical characteristics associated with a positive food insecurity screen. Setting: All US Veterans Administration (VA) medical centres (n 161). Participants: All Veterans were screened for food insecurity since screening initiation (July 2017–December 2018). Results: Of 3 304 702 Veterans screened for food insecurity, 44 298 were positive on their initial screen (1·3 % of men; 2·0 % of women). Food insecurity was associated with identifying as non-Hispanic Black or Hispanic. Veterans who were non-married/partnered, low-income Veterans without VA disability-related compensation and those with housing instability had higher odds of food insecurity, as did Veterans with a BMI < 18·5, diabetes, depression and post-traumatic stress disorder. Prior military sexual trauma (MST) was associated with food insecurity among both men and women. Women screening positive, however, were eight times more likely than men to have experienced MST (48·9 % v. 5·9 %). Conclusions: Food insecurity was associated with medical and trauma-related comorbidities as well as unmet social needs including housing instability. Additionally, Veterans of colour and women were at higher risk for food insecurity. Findings can inform development of tailored interventions to address food insecurity such as more frequent screening among high-risk populations, onsite support applying for federal food assistance programs and formal partnerships with community-based resources.
Collapse
|
14
|
Bayoumi I, Birken CS, Nurse KM, Parkin PC, Maguire JL, Macarthur C, Randall Simpson JA, Borkhoff CM. Screening for marginal food security in young children in primary care. BMC Pediatr 2021; 21:196. [PMID: 33892660 PMCID: PMC8063438 DOI: 10.1186/s12887-021-02674-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/16/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Household food insecurity (FI), even at marginal levels, is associated with poor child health outcomes. The Nutrition Screening Tool for Every Preschooler (NutriSTEP®) is a valid and reliable 17-item parent-completed measure of nutrition risk and includes a single item addressing FI which may be a useful child-specific screening tool. We evaluated the diagnostic test properties of the single NutriSTEP® FI question using the 2-item Hunger Vital Sign™ as the criterion measure in a primary care population of healthy children ages 18 months to 5 years. RESULTS The sample included 1174 families, 53 (4.5%) of which were marginally food secure. An affirmative response to the single NutriSTEP® question "I have difficulty buying food I want to feed my child because food is expensive" had a sensitivity of 85% and specificity of 91% and demonstrated good construct validity when compared with the Hunger Vital Sign™. CONCLUSION The single NutriSTEP® question may be an effective screening tool in clinical practice to identify marginal food security in families with young children and to link families with community-based services or financial assistance programs including tax benefits. TRIAL REGISTRATION TARGet Kids! practice-based research network (Registered June 5, 2013 at www.clinicaltrials.gov ; NCT01869530); www.targetkids.ca.
Collapse
Affiliation(s)
- Imaan Bayoumi
- Department of Family Medicine, Queen's University, 220 Bagot St., P.O. Bag 8888, Kingston, ON, K7L5E9, Canada.
- Centre for Studies in Primary Care, Queen's University, Kingston, ON, Canada.
| | - Catherine S Birken
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Sick Kids Research Institute, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kimberly M Nurse
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Patricia C Parkin
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Sick Kids Research Institute, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jonathon L Maguire
- Sick Kids Research Institute, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Paediatrics, St. Michael's Hospital, Toronto, ON, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Colin Macarthur
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Sick Kids Research Institute, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Janis A Randall Simpson
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, Canada
| | - Cornelia M Borkhoff
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Sick Kids Research Institute, Toronto, ON, Canada
| |
Collapse
|
15
|
Chau S, Oldman S, Smith SR, Lin CA, Ali S, Duffy VB. Online Behavioral Screener with Tailored Obesity Prevention Messages: Application to a Pediatric Clinical Setting. Nutrients 2021; 13:nu13010223. [PMID: 33466705 PMCID: PMC7828782 DOI: 10.3390/nu13010223] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/18/2022] Open
Abstract
Obesity prevention involves promoting healthy eating and physical activity across all children. Can we leverage technology to feasibly survey children’s health behaviors and deliver theory-based and user-tailored messages for brief clinical encounters? We assessed the acceptability and utility of an online pediatric-adapted liking survey (PALS) and tailored messages among children receiving non-urgent care in a pediatric emergency department (PED). Two hundred and forty-five children (average age = 10 years, racially/ethnically diverse, 34% overweight/obese from measured indices, 25% of families reporting food insecurity) and their parents/caregivers participated. Each reported the child’s activity and behaviors using the online PALS and received two to three messages tailored to the responses (aligned with elaboration likelihood and transtheoretical models) to motivate behavioral improvements or reinforce healthy behaviors. Most children and parents (>90%) agreed the PALS was easy to complete, encouraging thought about their own/child’s behaviors. The child’s PALS responses appeared reasonable (fair-to-good child–parent intraclass correlations). Most children and parents (≥75%) reported the tailored messages to be helpful and favorable for improving or maintaining the targeted behavior. Neither message type (motivating/reinforcing) nor favorability responses varied significantly by the child’s weight or family’s food security status. In summary, children and parents found the PALS with tailored messages acceptable and useful. The message types and responses could help focus brief clinical encounters.
Collapse
Affiliation(s)
- Sarah Chau
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (S.C.); (S.O.); (S.A.)
| | - Samantha Oldman
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (S.C.); (S.O.); (S.A.)
| | - Sharon R. Smith
- CT Children’s Medical Center, University of CT School of Medicine, Hartford, CT 06269-1101, USA;
| | - Carolyn A. Lin
- Communications Department, University of CT, Storrs, CT 06269-1101, USA;
| | - Saba Ali
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (S.C.); (S.O.); (S.A.)
| | - Valerie B. Duffy
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (S.C.); (S.O.); (S.A.)
- Correspondence: ; Tel.: +1-860-486-1997
| |
Collapse
|
16
|
Wirth SH, Palakshappa D, Brown CL. Association of household food insecurity and childhood weight status in a low-income population. Clin Obes 2020; 10:e12401. [PMID: 32915524 PMCID: PMC8405045 DOI: 10.1111/cob.12401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/15/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022]
Abstract
One in seven US households with children are food insecure. The health effects of household food insecurity (HFI) are well documented, but its association with childhood weight status remains unclear. We aimed to assess this association and to describe correlates of HFI in children. We conducted a cross-sectional study of 3019 low-income children aged 2 to 17 years. Data were extracted via chart review. HFI was assessed using the hunger vital sign screener. Body mass index (BMI) was calculated from documented clinical measurements. We used adjusted linear and logistic regression to assess the association of HFI with BMI z-score (BMIz) and weight status. We used logistic regression to examine correlates of HFI including age, race/ethnicity, tobacco exposure, number of parents and siblings living at home, weight status, and census-tract poverty rate and food access. Of participants whose HFI status was documented, 91% were food secure and 9% were food insecure. The mean (SD) BMIz was 0.81 (1.11). Fifty five percentage of children were healthy weight, 18% overweight, and 26% obese. In adjusted analyses, HFI was not associated with BMIz but was associated with decreased odds of obesity (OR 0.56; 95% CI 0.36-0.87). Tobacco exposure (1.63; 1.10-2.44), additional siblings (1.16; 1.04-1.30), and residence census tract with high poverty rate (1.02; 1.01-1.03) were all associated with HFI. We concluded that food-insecure children were less likely to have obesity and had differences in household makeup, exposures, and residential location compared to food-secure children. Clinicians should understand these relationships when counselling families about weight status and food insecurity.
Collapse
Affiliation(s)
- Scott H Wirth
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Deepak Palakshappa
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Callie L Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
17
|
Bayoumi I, Parkin PC, Birken CS, Maguire JL, Borkhoff CM. Association of Family Income and Risk of Food Insecurity With Iron Status in Young Children. JAMA Netw Open 2020; 3:e208603. [PMID: 32729920 DOI: 10.1001/jamanetworkopen.2020.8603] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Iron deficiency (ID) has the greatest prevalence in early childhood and has been associated with poor developmental outcomes. Previous research examining associations of income and food insecurity (FI) with ID is inconsistent. OBJECTIVE To examine the association of family income and family risk of FI with iron status in healthy young children attending primary care. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 1245 children aged 12 to 29 months who attended scheduled primary care supervision visits from 2008 to 2018 in Toronto, Canada, and the surrounding area. EXPOSURES Family income and risk of FI were collected from parent-reported questionnaires. Children whose parents provided an affirmative response to the 1-item FI screen on the Nutrition Screening Tool for Every Toddler or at least 1 item on the 2-item Hunger Vital Sign FI screening tool were categorized as having family risk of FI. MAIN OUTCOMES AND MEASURES Iron deficiency (serum ferritin level <12 ng/mL) and ID anemia (IDA; serum ferritin level <12 ng/mL and hemoglobin level <11.0 g/dL). All models were adjusted for age, sex, birth weight, body mass index z score, C-reactive protein level, maternal education, breastfeeding duration, bottle use, cow's milk intake, and formula feeding in the first year. RESULTS Of 1245 children (595 [47.8%] girls; median [interquartile range] age, 18.1 [13.3-24.0] months), 131 (10.5%) were from households with a family income of less than CAD $40 000 ($29 534), 77 (6.2%) were from families at risk of FI, 185 (14.9%) had ID, and 58 (5.3%) had IDA. The odds of children with a family income of less than CAD $40 000 having ID and IDA were 3 times higher than those of children in the highest family income group (ID: odds ratio [OR], 3.08; 95% CI, 1.66-5.72; P < .001; IDA: OR, 3.28; 95% CI, 1.22-8.87; P = .02). Being in a family at risk of FI, compared with all other children, was not associated with ID or IDA (ID: OR, 0.43; 95% CI, 0.18-1.02; P = .06; IDA: OR, 0.16; 95% CI, 0.02-1.23; P = .08). CONCLUSIONS AND RELEVANCE In this study, low family income was associated with increased risk of ID and IDA in young children. Risk of FI was not a risk factor for ID or IDA. These findings suggest that targeting income security may be more effective than targeting access to food to reduce health inequities in the prevention of iron deficiency.
Collapse
Affiliation(s)
- Imaan Bayoumi
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
- Centre for Studies in Primary Care, Queen's University, Kingston, Ontario, Canada
| | - Patricia C Parkin
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario, Canada
| | - Catherine S Birken
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The Applied Health Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- St Michael's Hospital, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario, Canada
| | | |
Collapse
|