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Kim RG, Ballantyne A, Conroy MB, Price JC, Inadomi JM. Screening for social determinants of health among populations at risk for MASLD: a scoping review. Front Public Health 2024; 12:1332870. [PMID: 38660357 PMCID: PMC11041393 DOI: 10.3389/fpubh.2024.1332870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Background Social determinants of health (SDoH) have been associated with disparate outcomes among those with metabolic dysfunction-associated steatotic liver disease (MASLD) and its risk factors. To address SDoH among this population, real-time SDoH screening in clinical settings is required, yet optimal screening methods are unclear. We performed a scoping review to describe the current literature on SDoH screening conducted in the clinical setting among individuals with MASLD and MASLD risk factors. Methods Through a systematic literature search of MEDLINE, Embase, and CINAHL Complete databases through 7/2023, we identified studies with clinic-based SDoH screening among individuals with or at risk for MASLD that reported pertinent clinical outcomes including change in MASLD risk factors like diabetes and hypertension. Results Ten studies (8 manuscripts, 2 abstracts) met inclusion criteria involving 148,151 patients: 89,408 with diabetes and 25,539 with hypertension. Screening was primarily completed in primary care clinics, and a variety of screening tools were used. The most commonly collected SDoH were financial stability, healthcare access, food insecurity and transportation. Associations between clinical outcomes and SDoH varied; overall, higher SDoH burden was associated with poorer outcomes including elevated blood pressure and hemoglobin A1c. Conclusion Despite numerous epidemiologic studies showing associations between clinical outcomes and SDoH, and guidelines recommending SDoH screening, few studies describe in-clinic SDoH screening among individuals with MASLD risk factors and none among patients with MASLD. Future research should prioritize real-time, comprehensive assessments of SDoH, particularly among patients at risk for and with MASLD, to mitigate disease progression and reduce MASLD health disparities.
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Affiliation(s)
- Rebecca G. Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - April Ballantyne
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Molly B. Conroy
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Jennifer C. Price
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - John M. Inadomi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, United States
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2
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Wright SM, Zaniletti I, Goodwin EJ, Gupta RC, Larson IA, Winterer C, Hall M, Colvin JD. Income and Household Material Hardship in Children With Medical Complexity. Hosp Pediatr 2024; 14:e195-e200. [PMID: 38487829 DOI: 10.1542/hpeds.2023-007563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND OBJECTIVES Household economic hardship negatively impacts child health but may not be adequately captured by income. We sought to determine the prevalence of household material hardship (HMH), a measure of household economic hardship, and to examine the relationship between household poverty and material hardship in a population of children with medical complexity. METHODS We conducted a cross-sectional survey study of parents of children with medical complexity receiving primary care at a tertiary children's hospital. Our main predictor was household income as a percentage of the federal poverty limit (FPL): <50% FPL, 51% to 100% FPL, and >100% FPL. Our outcome was HMH measured as food, housing, and energy insecurity. We performed logistic regression models to calculate adjusted odds ratios of having ≥1 HMH, adjusted for patient and clinical characteristics from surveys and the Pediatric Health Information System. RESULTS At least 1 material hardship was present in 40.9% of participants and 28.2% of the highest FPL group. Families with incomes <50% FPL and 51% to 100% FPL had ∼75% higher odds of having ≥1 material hardship compared with those with >100% FPL (<50% FPL: odds ratio 1.74 [95% confidence interval: 1.11-2.73], P = .02; 51% to 100% FPL: 1.73 [95% confidence interval: 1.09-2.73], P = .02). CONCLUSIONS Poverty underestimated household economic hardship. Although households with incomes <100% FPL had higher odds of having ≥1 material hardship, one-quarter of families in the highest FPL group also had ≥1 material hardship.
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Affiliation(s)
- S Margaret Wright
- Division of General Academic Pediatrics, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, University of Kansas School of Medicine, Kansas City, Missouri
| | | | - Emily J Goodwin
- Division of General Academic Pediatrics, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, University of Kansas School of Medicine, Kansas City, Missouri
| | | | | | | | - Matt Hall
- Division of General Academic Pediatrics, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, University of Kansas School of Medicine, Kansas City, Missouri
- Children's Hospital Association, Lenexa, Kansas
| | - Jeffrey D Colvin
- Division of General Academic Pediatrics, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, University of Kansas School of Medicine, Kansas City, Missouri
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3
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Brochier A, Torres A, Tyrrell H, Paz KB, Wexler MG, Griffith M, Joiner T, Magardino A, Messmer E, Rogers S, Scheindlin B, Serwint JR, Sharif I, Shone LP, Stockwell MS, Tripodis Y, Garg A, Drainoni ML. Addressing adverse social determinants of health in pediatric primary care: Study protocol for a hybrid type 2 effectiveness-implementation randomized controlled trial in two national pediatric practice-based research networks. Contemp Clin Trials 2024; 138:107436. [PMID: 38199577 PMCID: PMC10922627 DOI: 10.1016/j.cct.2024.107436] [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: 06/28/2023] [Revised: 12/06/2023] [Accepted: 01/07/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Growing evidence linking social determinants of health (SDOH) to child health outcomes has prompted widespread recommendations for pediatricians to screen and refer for adverse SDOH at primary care visits. Yet there is little evidence to date demonstrating the effectiveness of practice-based SDOH screening and referral interventions on increasing family engagement with resources. This hybrid type 2 effectiveness-implementation trial aims to demonstrate the non-inferiority of a low-touch implementation strategy in order to facilitate dissemination of an existing SDOH screening and referral system (WE CARE) and demonstrate its effectiveness and sustainability in various pediatric practices. METHODS We recruited eighteen pediatric practices in fourteen US states through two pediatric practice-based research networks. For this stepped wedge cluster RCT, practices serve as their own controls during the Usual Care phase and implement WE CARE during the intervention phase via one of two randomized implementation strategies: self-directed, pre-recorded webinar vs. study team-facilitated, live webinar. We collect data at practice, clinician/staff, and parent levels to assess outcomes grounded in the Proctor Conceptual Model of Implementation Research. We use generalized mixed effects models and differences in proportions to compare rates of resource referrals by implementation strategy, and intention-to-treat analysis to compare odds of engagement with new resources among families enrolled in the Usual Care vs. WE CARE phases. DISCUSSION Findings from this trial may inform decisions about broader dissemination of SDOH screening systems into a diverse spectrum of pediatric practices across the US and potentially minimize the impact of adverse SDOH on children and families.
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Affiliation(s)
- Annelise Brochier
- Department of Pediatrics, Boston Medical Center, Boston, MA, United States of America
| | - Alessandra Torres
- Primary Care Research, American Academy of Pediatrics, Itasca, IL, United States of America.
| | - Hollyce Tyrrell
- Academic Pediatric Association, McLean, VA, United States of America
| | - Katherine Barahona Paz
- Child Health Equity Center, Department of Pediatrics, UMass Chan Medical School, Worcester, MA, United States of America
| | | | - Miranda Griffith
- Primary Care Research, American Academy of Pediatrics, Itasca, IL, United States of America
| | - Terence Joiner
- Division of General Pediatrics, Department of Pediatrics, University of Michigan Medical School, and Ypsilanti Health Center, Ypsilanti, MI, United States of America
| | - Angela Magardino
- Department of Pediatrics, Boston Medical Center, Boston, MA, United States of America
| | - Emily Messmer
- Quality and Patient Experience, Mass General Brigham, Somerville, MA, United States of America
| | - Stephen Rogers
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | | | - Janet R Serwint
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Iman Sharif
- Harlem Hospital Center, New York, NY, United States of America; Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Laura P Shone
- Shone Sciences, DBA, Lowville, NY, United States of America
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Department of Population and Family Health, Mailman School of Public Health Columbia University, New York, NY, United States of America
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
| | - Arvin Garg
- Child Health Equity Center, Department of Pediatrics, UMass Chan Medical School, Worcester, MA, United States of America; UMass Memorial Children's Medical Center, Worcester, MA, United States of America
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine/Boston Medical Center, Boston, MA, United States of America; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, United States of America
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4
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Graff M. Addressing energy insecurity: Policy Considerations for enhancing energy assistance programs. Heliyon 2024; 10:e24178. [PMID: 38333786 PMCID: PMC10850901 DOI: 10.1016/j.heliyon.2024.e24178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 02/10/2024] Open
Abstract
Household energy consumption is crucial for a productive and safe life. Despite its importance, 33.7 million U.S. households experienced energy insecurity in 2020. This paper examines the prevalence, correlates, and effects of energy bill assistance programs, which aim to alleviate the hardship. This analysis relies on logistic regressions and the 2020 Residential Energy Consumption Survey, a nationally representative survey administered by the Energy Information Administration. Results reveal 16 percent of the energy insecure population received assistance to pay its energy bill in 2020. Several socioeconomic and housing characteristics are associated with receipt of assistance; however, logistic regression estimates suggest prior participation in energy assistance and receipt of a disconnection notice from a utility provider are indicators substantively and significantly associated with energy assistance participation that warrant attention from scholars and practitioners. Lastly, outcomes generally indicate previous participation in energy assistance does not impact the odds a household will experience energy insecurity. Based on findings, I offer three policy recommendations: 1) increase resources spent on energy assistance to align with demand; 2) enhance communication between utility providers and low-income households regarding available assistance opportunities; and 3) prioritize engagement with populations that never participated in energy assistance to facilitate successful application processes.
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Affiliation(s)
- Michelle Graff
- Maxine Goodman Levin School of Urban Affairs, Cleveland State University, 2121 Euclid Avenue, Cleveland, OH, 44115, USA
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5
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Resnick MP, Montella D, Brown SH, Elkin P. ACORN SDOH survey: Terminological representation for use with NLP and CDS. J Clin Transl Sci 2024; 8:e39. [PMID: 38476245 PMCID: PMC10928702 DOI: 10.1017/cts.2024.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/01/2024] [Accepted: 01/29/2024] [Indexed: 03/14/2024] Open
Abstract
Objective Social Determinants of Health (SDOH) greatly influence health outcomes. SDOH surveys, such as the Assessing Circumstances & Offering Resources for Needs (ACORN) survey, have been developed to screen for SDOH in Veterans. The purpose of this study is to determine the terminological representation of the ACORN survey, to aid in natural language processing (NLP). Methods Each ACORN survey question was read to determine its concepts. Next, Solor was searched for each of the concepts and for the appropriate attributes. If no attributes or concepts existed, they were proposed. Then, each question's concepts and attributes were arranged into subject-relation-object triples. Results Eleven unique attributes and 18 unique concepts were proposed. These results demonstrate a gap in representing SDOH with terminologies. We believe that using these new concepts and relations will improve NLP, and thus, the care provided to Veterans.
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Affiliation(s)
- Melissa P. Resnick
- Department of Biomedical Informatics, University at
Buffalo, Buffalo, NY, USA
- U.S. Department of Veteran Affairs, WNY VA,
Buffalo, NY, USA
| | - Diane Montella
- U.S. Department of Veteran Affairs, Office of Health
Informatics, Washington, DC,
USA
| | - Steven H. Brown
- U.S. Department of Veteran Affairs, Office of Health
Informatics, Washington, DC,
USA
| | - Peter Elkin
- Department of Biomedical Informatics, University at
Buffalo, Buffalo, NY, USA
- U.S. Department of Veteran Affairs, WNY VA,
Buffalo, NY, USA
- U.S. Department of Veteran Affairs, Office of Health
Informatics, Washington, DC,
USA
- Faculty of Engineering, University of Southern
Denmark, Odense, Denmark
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Siegel EL, Lane K, Yuan A, Smalls-Mantey LA, Laird J, Olson C, Hernández D. Energy Insecurity Indicators Associated With Increased Odds Of Respiratory, Mental Health, And Cardiovascular Conditions. Health Aff (Millwood) 2024; 43:260-268. [PMID: 38315917 DOI: 10.1377/hlthaff.2023.01052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Energy insecurity, defined as the inability to meet household energy needs, has multiple economic, physical, and coping dimensions that affect health. We conducted the first citywide representative survey of energy insecurity and health in a sample of 1,950 New York City residents in 2022. We compiled ten indicators that characterize energy insecurity as experienced in New York City housing settings and then examined associations between number and types of indicators and health conditions. Nearly 30 percent of residents experienced three or more indicators, with significantly higher levels among Black non-Latino/a and Latino/a residents compared with White non-Latino/a residents, renters compared with owners, recent immigrants compared with those living in the United States for longer, and those in households with children compared with those with no children. Residents with three or more indicators of energy insecurity had higher odds of respiratory, mental health, and cardiovascular conditions and electric medical device dependence than residents with no indicators. Our study demonstrates that broadening the understanding of energy insecurity with context-specific metrics can help guide interventions and policies that address disparities relevant to health and energy equity.
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Affiliation(s)
| | - Kathryn Lane
- Kathryn Lane, New York City Department of Health and Mental Hygiene, New York, New York
| | - Ariel Yuan
- Ariel Yuan, New York City Department of Health and Mental Hygiene
| | | | - Jennifer Laird
- Jennifer Laird, Lehman College-City University of New York, New York, New York
| | - Carolyn Olson
- Carolyn Olson, New York City Department of Health and Mental Hygiene
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Shapira S, Teschner N. No heat, no eat: (Dis)entangling insecurities and their implications for health and well-being. Soc Sci Med 2023; 336:116252. [PMID: 37769511 DOI: 10.1016/j.socscimed.2023.116252] [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] [Received: 02/28/2023] [Revised: 08/16/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Abstract
This study explores the associations between energy poverty, food insecurity, and a set of outcomes-including the self-reported burden of chronic illness, physical disabilities, and mental health-among social-aid recipients across Israel. We highlight the socio-demographic characteristics and housing conditions of energy-poor households and analyze the association between energy poverty and health and well-being using multivariate regression models. Of 1390 aid-recipient respondents, more than 85% met the criteria for living in an energy-poor household, and almost all of them also struggled with food insecurity and were raised in poor households as children. In addition, the severity of energy poverty was positively and significantly associated with the occurrence of diabetes, hypertension, and mental illness, and, as compared with energy-secure households, severely energy-poor households were more prone to forgo acquiring prescription medications, medical aid, or required health treatments due to financial hardships. These findings highlight the nuanced negotiation over necessities that aid-supported households make; despite being at greater risk of being sick, energy-poor households are more likely to forgo buying medicines and seeking healthcare so as to pay the electricity bills. Hidden energy poverty, coupled with what might be hidden morbidity, may have significant implications for healthcare systems, and a climate-sensitive health policy at both the municipal and national levels is required to strengthen resilience among low-income households.
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Affiliation(s)
- Stav Shapira
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheva, Israel.
| | - Naama Teschner
- Department of Environmental, Geoinformatic & Urban Planning Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheva, Israel.
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Russell LE, Cohen AJ, Chrzas S, Halladay CW, Kennedy MA, Mitchell K, Moy E, Lehmann LS. Implementing a Social Needs Screening and Referral Program Among Veterans: Assessing Circumstances & Offering Resources for Needs (ACORN). J Gen Intern Med 2023; 38:2906-2913. [PMID: 37165261 PMCID: PMC10171907 DOI: 10.1007/s11606-023-08181-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/17/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND The Department of Veterans Affairs (VA) healthcare system routinely screens Veterans for food insecurity, housing instability, and intimate partner violence, but does not systematically screen for other health-related social needs (HRSNs). OBJECTIVES To (1) develop a process for systematically identifying and addressing Veterans' HRSNs, (2) determine reported prevalence of HRSNs, and (3) assess the acceptability of HRSN screening among Veterans. DESIGN "Assessing Circumstances and Offering Resources for Needs" (ACORN) is a Veteran-tailored HRSN screening and referral quality improvement initiative. Veterans were screened via electronic tablet for nine HRSNs (food, housing, utilities, transportation, legal needs, social isolation, interpersonal violence, employment, and education) and provided geographically tailored resource guides for identified needs. Two-week follow-up interviews with a purposive sample of Veterans explored screening experiences. PARTICIPANTS Convenience sample of Veterans presenting for primary care at a VA urban women's health clinic and suburban community-based outpatient clinic (October 2019-May 2020). MAIN MEASURES Primary outcomes included prevalence of HRSNs, Veteran-reported acceptability of screening, and use of resources guides. Data were analyzed using descriptive statistics, chi-square tests, and rapid qualitative analysis. KEY RESULTS Of 268 Veterans screened, 50% reported one or more HRSNs. Social isolation was endorsed most frequently (29%), followed by educational needs (19%), interpersonal violence (12%), housing instability (9%), and utility concerns (7%). One in five Veterans reported at least one form of material hardship. In follow-up interviews (n = 15), Veterans found screening acceptable and felt VA should continue screening. No Veterans interviewed had contacted recommended resources at two-week follow-up, although several planned to use resource guides in the future. CONCLUSION In a VA HRSN screening and referral program, Veterans frequently reported HRSNs, felt screening was important, and thought VA should continue to screen for these needs. Screening for HRSNs is a critical step towards connecting patients with services, identifying gaps in service delivery, and informing future resource allocation.
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Affiliation(s)
- Lauren E Russell
- Office of Health Equity, Veterans Health Administration, Washington, DC, USA.
| | - Alicia J Cohen
- VA Health Services Research & Development (HSR&D) Center of Innovation in Long Term Services and Supports (LTSS-COIN), VA Providence Healthcare System, Providence, RI, USA
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Steven Chrzas
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Christopher W Halladay
- VA Health Services Research & Development (HSR&D) Center of Innovation in Long Term Services and Supports (LTSS-COIN), VA Providence Healthcare System, Providence, RI, USA
| | - Meaghan A Kennedy
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Kathleen Mitchell
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, Bedford, MA, USA
| | - Ernest Moy
- Office of Health Equity, Veterans Health Administration, Washington, DC, USA
| | - Lisa Soleymani Lehmann
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
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Brabo-Catala L, Cernic A, Collins E, Barton B. The heat goes on: Simplifying the identification of energy hardship. Heliyon 2023; 9:e19087. [PMID: 37636461 PMCID: PMC10450965 DOI: 10.1016/j.heliyon.2023.e19087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023] Open
Abstract
Energy hardship affects over 6% of households in New Zealand, defined as the inability to afford and obtain energy services. In late 2021, the Ministry of Business, Innovation and Employment proposed 26 indicators to identify energy hardship. However, this study aimed to explore the leading causes and consequences of energy hardship in the following year, including relevant variables not included in the proposed indicators. A survey of 1278 Kiwi respondents was conducted to understand their demographic and energy consumption patterns. Using 17 of the proposed indicators, the severity of energy hardship was measured and related to other important variables. Results showed that energy unaffordability, poor housing quality, and choosing between food expenses or energy bills were the main drivers of energy hardship. Consequences included feeling cold due to restricted energy consumption and accumulating energy debt. This study provides valuable insights to simplify the identification of households experiencing energy hardship and highlights the main areas of focus for policy development aimed at eradicating this problem.
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Affiliation(s)
| | | | - Eva Collins
- Waikato Management School, University of Waikato, Hamilton, New Zealand
| | - Barry Barton
- Te Piringa Faculty of Law, University of Waikato, Hamilton, New Zealand
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Drouin O, Perez T, Barnett TA, Ducharme FM, Fleegler E, Garg A, Lavoie K, Li P, Métras MÉ, Sultan S, Tse SM, Zhao J. Impact of Unmet Social Needs, Scarcity, and Future Discounting on Adherence to Treatment in Children With Asthma: Protocol for a Prospective Cohort Study. JMIR Res Protoc 2023; 12:e37318. [PMID: 36881458 PMCID: PMC10131837 DOI: 10.2196/37318] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/08/2022] [Accepted: 11/18/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Asthma is one of the most prevalent chronic diseases of childhood and disproportionately affects children with lower socioeconomic status. Controller medications such as inhaled corticosteroids significantly reduce asthma exacerbations and improve symptoms. However, a large proportion of children still have poor asthma control, in part owing to suboptimal adherence. Financial barriers contribute to hindering adherence, as do behavioral factors related to low income. For example, unmet social needs for food, lodging, and childcare may create stress and worry in parents, negatively influencing medication adherence. These needs are also cognitively taxing and force families to focus on immediate needs, leading to scarcity and heightening future discounting; thus, there is the tendency to attribute greater value to the present than to the future in making decisions. OBJECTIVE In this project, we will investigate the relationship between unmet social needs, scarcity, and future discounting as well as their predictive power over time on medication adherence in children with asthma. METHODS This 12-month prospective observational cohort study will recruit 200 families of children aged 2 to 17 years at the Asthma Clinic of the Centre Hospitalier Universitaire Sainte-Justine, a tertiary care pediatric hospital in Montreal, Canada. The primary outcome will be adherence to controller medication, measured using the proportion of prescribed days covered during follow-up. Exploratory outcomes will include health care use. The main independent variables will be unmet social needs, scarcity, and future discounting, measured using validated instruments. These variables will be measured at recruitment as well as at 6- and 12-month follow-ups. Covariates will include sociodemographics, disease and treatment characteristics, and parental stress. Primary analysis will compare adherence to controller medication, measured using the proportion of prescribed days covered, between families with versus those without unmet social needs during the study period using multivariate linear regression. RESULTS The research activities of this study began in December 2021. Participant enrollment and data collection began in August 2022 and are expected to continue until September 2024. CONCLUSIONS This project will allow the documentation of the impact of unmet social needs, scarcity, and future discounting on adherence in children with asthma using robust metrics of adherence and validated measures of scarcity and future discounting. If the relationship between unmet social needs, behavioral factors, and adherence is supported by our findings, this will suggest the potential for novel targets for integrated social care interventions to improve adherence to controller medication and reduce risk across the life course for vulnerable children with asthma. TRIAL REGISTRATION ClinicalTrials.gov NCT05278000; https://clinicaltrials.gov/ct2/show/NCT05278000. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/37318.
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Affiliation(s)
- Olivier Drouin
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Tamara Perez
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada
| | - Tracie A Barnett
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Francine M Ducharme
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Clinical Research and Knowledge Transfer Research Centre, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - Eric Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Medical School, Boston, MA, United States
- Division of General Academic Pediatrics, Department of Pediatrics, Boston Medical Center and School of Medicine, Boston University, Boston, MA, United States
| | - Kim Lavoie
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Ile-de-Montreal, Montreal, QC, Canada
- Department of Psychology, Université de Quebec à Montreal, Montreal, QC, Canada
| | - Patricia Li
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC, Canada
- Department of Pediatrics, McGill University, Montreal, QC, Canada
- Division of General Pediatrics, Montreal Children's Hospital, Montreal, QC, Canada
| | - Marie-Élaine Métras
- Pharmacy Department and Pharmacy Practice Research Unit, CHU Sainte-Justine, Montreal, QC, Canada
| | - Serge Sultan
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Psychology, Faculty of Arts and Sciences, Université de Montréal, Montreal, QC, Canada
| | - Sze Man Tse
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
- Division of Respiratory Medicine, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, QC, Canada
| | - Jiaying Zhao
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
- Institute for Resources, Environment and Sustainability, University of British Columbia, Vancouver, BC, Canada
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Roth SE, Gronowski B, Jones KG, Smith RA, Smith SK, Vartanian KB, Wright BJ. Evaluation of an Integrated Intervention to Address Clinical Care and Social Needs Among Patients with Type 2 Diabetes. J Gen Intern Med 2023; 38:38-44. [PMID: 36864267 PMCID: PMC9980858 DOI: 10.1007/s11606-022-07920-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 03/04/2023]
Abstract
BACKGROUND The Providence Diabetes Collective Impact Initiative (DCII) was designed to address the clinical challenges of type 2 diabetes and the social determinants of health (SDoH) challenges that exacerbate disease impact. OBJECTIVE We assessed the impact of the DCII, a multifaceted intervention approach to diabetes treatment that employed both clinical and SDoH strategies, on access to medical and social services. DESIGN The evaluation employed a cohort design and used an adjusted difference-in-difference model to compare treatment and control groups. PARTICIPANTS Our study population consisted of 1220 people (740 treatment, 480 control), aged 18-65 years old with a pre-existing type 2 diabetes diagnosis who visited one of the seven Providence clinics (three treatment and four control) in the tri-county area of Portland, Oregon, between August 2019 and November 2020. INTERVENTIONS The DCII threaded together clinical approaches such as outreach, standardized protocols, and diabetes self-management education and SDoH strategies including social needs screening, referral to a community resource desk, and social needs support (e.g., transportation) to create a comprehensive, multi-sector intervention. MAIN MEASURES Outcome measures included SDoH screens, diabetes education participation, HbA1c, blood pressure, and virtual and in-person primary care utilization, as well as inpatient and emergency department hospitalization. KEY RESULTS Compared to patients at the control clinics, patients at DCII clinics saw an increase in diabetes education (15.5%, p<0.001), were modestly more likely to receive SDoH screening (4.4%, p<0.087), and had an increase in the average number of virtual primary care visits of 0.35 per member, per year (p<0.001). No differences in HbA1c, blood pressure, or hospitalization were observed. CONCLUSIONS DCII participation was associated with improvements in diabetes education use, SDoH screening, and some measures of care utilization.
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Affiliation(s)
- Sarah E Roth
- Center for Outcomes Research & Education (CORE), Providence St. Joseph Health, 5251 NE Glisan Street, Portland, OR, 97213, USA.
| | - Ben Gronowski
- Center for Outcomes Research & Education (CORE), Providence St. Joseph Health, 5251 NE Glisan Street, Portland, OR, 97213, USA
| | - Kyle G Jones
- Center for Outcomes Research & Education (CORE), Providence St. Joseph Health, 5251 NE Glisan Street, Portland, OR, 97213, USA
| | - Rachel A Smith
- Community Health Division, Providence Health and Services, Portland, OR, USA
| | | | - Keri B Vartanian
- Center for Outcomes Research & Education (CORE), Providence St. Joseph Health, 5251 NE Glisan Street, Portland, OR, 97213, USA
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12
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Parker MG, de Cuba SE, Rateau LJ, Shea M, Sandel MT, Frank DA, Cutts DB, Heeren T, Lê-Scherban F, Black MM, Ochoa ER, Rose-Jacobs R, Garg A. Associations of household unmet basic needs and health outcomes among very low birth weight children. J Perinatol 2023; 43:364-370. [PMID: 36750715 DOI: 10.1038/s41372-023-01626-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 09/15/2022] [Accepted: 01/24/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE We examined associations of past year household hardships (housing, energy, food, and healthcare hardships) with postnatal growth, developmental risk, health status, and hospitalization among children 0-36 months born with very low birth weight (VLBW) and the extent that these relationships differed by receipt of child supplemental security income (SSI). STUDY DESIGN We examined cross-sectional data from 695 families. Growth was measured as weight-for-age z-score change. Developmental risk was defined as ≥1 concerns on the "Parents' Evaluation of Developmental Status" screening tool. Child health status was categorized as excellent/good vs. fair/poor. Hospitalizations excluded birth hospitalizations. RESULTS Compared to children with no household hardships, odds of developmental risk were greater with 1 hardship (aOR 2.0 [1.26, 3.17]) and ≥2 hardships (aOR) 1.85 [1.18, 2.91], and odds of fair/poor child health (aOR) 1.59 [1.02, 2.49] and hospitalizations (aOR) 1.49 [1.00, 2.20] were greater among children with ≥2 hardships. In stratified analysis, associations of hardships and developmental risk were present for households with no child SSI and absent for households with child SSI. CONCLUSION Household hardships were associated with developmental risk, fair/poor health status, and hospitalizations among VLBW children. Child SSI may be protective against developmental risk among children living in households with hardships.
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Affiliation(s)
- Margaret G Parker
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
| | | | - Lindsey J Rateau
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Margaret Shea
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Megan T Sandel
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Deborah A Frank
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Diana B Cutts
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Félice Lê-Scherban
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.,RTI International, Research Triangel Park, NC, USA
| | - Eduardo R Ochoa
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ruth Rose-Jacobs
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
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13
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Nguyen HAT, Poblacion A, Ettinger de Cuba S, Bruce C, Cutts DB. Type of Child Care Setting Is Associated With Child Care Constraints and Food Insecurity Among Families With Low-Incomes. Acad Pediatr 2023; 23:387-395. [PMID: 35863736 PMCID: PMC10462405 DOI: 10.1016/j.acap.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/07/2022] [Accepted: 07/10/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE High quality child care positively affects long-term development in children and is a necessary support for parents who work or are in school. We assessed the association between child care setting and parents' report of difficulties with ability to work and/or further their education ("child care constraints") or material hardships among families with low incomes. METHODS Cross-sectional data were analyzed from families in Minneapolis, MN with children aged six weeks to 48 months in child care from 2004 to 2017. Associations between child care setting (formal, informal relative, informal non-relative) and child care constraints or material hardships (household/child food insecurity, housing instability, energy instability) were examined. RESULTS Among 1580 families, 73.8% used informal care. Child care subsidy and public assistance program participation were higher among families utilizing formal care. Compared to formal care, families using informal relative or non-relative care had 2.44 and 4.18 greater adjusted odds of child care constraints, respectively. Families with children in informal non-relative care had 1.51 greater adjusted odds of household food insecurity. There were no statistically significant associations between informal relative care and household or child food insecurity, and no associations between child care setting and housing instability or energy insecurity. CONCLUSIONS Informal care settings-relative and non-relative-were associated with child care constraints, and informal non-relative care with household food insecurity. Investment to expand equitable access to affordable, high-quality child care is necessary to enable parents to pursue desired employment and education and reduce food insecurity.
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Affiliation(s)
- Hong-An T Nguyen
- Department of Pediatrics (HAT Nguyen, A Poblacion, and C Bruce), Boston Medical Center, Boston, Mass.
| | - Ana Poblacion
- Department of Pediatrics (HAT Nguyen, A Poblacion, and C Bruce), Boston Medical Center, Boston, Mass
| | | | - Charlotte Bruce
- Department of Pediatrics (HAT Nguyen, A Poblacion, and C Bruce), Boston Medical Center, Boston, Mass
| | - Diana B Cutts
- Department of Pediatrics (DB Cutts), Hennepin County Medical Center, Minneapolis, Minn
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14
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Booth S, Deen C, Thompson K, Kleve S, Chan E, McCarthy L, Kraft E, Fredericks B, Brimblecombe J, Ferguson M. Conceptualisation, experiences and suggestions for improvement of food security amongst Aboriginal and Torres Strait Islander parents and carers in remote Australian communities. Soc Sci Med 2023; 320:115726. [PMID: 36753996 DOI: 10.1016/j.socscimed.2023.115726] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/14/2022] [Accepted: 01/24/2023] [Indexed: 01/26/2023]
Abstract
This study aimed to determine perceptions of the lived experience of food insecurity and suggestions to improve food security in four remote Aboriginal communities in the Northern Territory, and Queensland. Participants were Aboriginal and/or Torres Strait Islander pregnant and breastfeeding women, and parents/carers of children aged six months to five years. Semi-structured interviews (n=17) were conducted between June-July 2021 and the data thematically analysed using a four stage process. No specific term was used by participants to describe being either food secure or insecure. Descriptions of food security were centred in food sharing, food sufficiency, and family activities. Elements describing food insecurity were physical pain and emotional stress, adults going without food, seeking family help and managing without food until payday. Factors contributing to food insecurity were reported to be: (i) Low income and unemployment, (ii) Cost of living remotely, (iii) Resource sharing, and (iv) Impact of spending on harmful commodities and activities. Three themes were conceptualised: (1) Cultural practices buffer food insecurity, (2) Coping with food insecurity, (3) People accept a degree of food insecurity as normal. Findings suggest Aboriginal and Torres Strait Islander cultural practices such as sharing food buffer episodic food insecurity and constitute 'cultural food security'. Despite use of cultural practices (e.g., procuring traditional food) and generic coping strategies, regular episodes of food insecurity often aligned with the off week of social assistance payments. Household energy (electricity) security was coupled to food security. Suggestions for improving food security included better transport and food access, extending electricity rebates, increases in the regularity of social assistance payments, and computer access and training in budgeting. Policies to advance food security should embody deeper Aboriginal and Torres Strait Islander descriptions and experiences. Community-derived policy suggestions which aim to increase access to adequate, regular, stable household income are likely to succeed.
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Affiliation(s)
- Sue Booth
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, 4072, Australia; College of Medicine & Public Health, Flinders University, Australia.
| | - Caroline Deen
- Apunipima Cape York Health Council, Bungalow, Queensland, 870, Australia
| | - Kani Thompson
- Apunipima Cape York Health Council, Bungalow, Queensland, 870, Australia
| | - Sue Kleve
- Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, Victoria, 3168, Australia
| | - Ellie Chan
- Central Australian Aboriginal Congress, Alice Springs, Northern Territory, 0870, Australia
| | - Leisa McCarthy
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, 0810, Australia
| | - Emma Kraft
- Central Australian Aboriginal Congress, Alice Springs, Northern Territory, 0870, Australia
| | - Bronwyn Fredericks
- Office of the Pro-Vice Chancellor (Indigenous Engagement), The University of Queensland Brisbane, Queensland, 4072, Australia
| | - Julie Brimblecombe
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, 4072, Australia; Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, Victoria, 3168, Australia; Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, 0810, Australia
| | - Megan Ferguson
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, 4072, Australia; Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, Victoria, 3168, Australia; Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, 0810, Australia
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15
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Nix E, Betang E, Baame M, Abbott M, Saligari S, Shupler M, Čukić I, Puzzolo E, Pope D, Mbatchou B, Anderson de Cuevas R. Complex dynamics in sustaining clean cooking and food access through a pandemic: A COVID-19 impact study in peri-urban Cameroon. ENERGY FOR SUSTAINABLE DEVELOPMENT : THE JOURNAL OF THE INTERNATIONAL ENERGY INITIATIVE 2022; 71:167-175. [PMID: 36193045 PMCID: PMC9519385 DOI: 10.1016/j.esd.2022.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 09/15/2022] [Accepted: 09/17/2022] [Indexed: 05/22/2023]
Abstract
Access to clean energy for cooking is central to achieving Sustainable Development Goal 7. Latest predictions suggest that this goal will not be met by 2030, with further setbacks due to the COVID-19 pandemic. We investigated the impacts of COVID-19 restrictions on household cooking fuel, practices and dietary behaviours in a peri-urban community in Central Cameroon. Using surveys (n = 333) and qualitative semi-structured interviews (n = 12), we found negative financial impacts and high levels of food insecurity, with 83 % and 56 % of households reporting reduced income and insufficient food, respectively. Households reduced food intake and cooking frequency and relied more heavily on local sources (e.g., farmland) to feed their families. Changes in primary cooking fuel were less pronounced and fuel choice was inherently linked to cooking behaviours, with some households utilising LPG more often for simple tasks, such as reheating food. Local systems were key in sustaining food and fuel access and households demonstrated resilience by employing numerous mechanisms to overcome challenges. Our findings underline the vulnerability of households in maintaining sufficient food intake and sustaining clean cooking, highlighting how policy needs to take a nuanced approach considering food-energy dynamics and strengthening local systems to ensure access to clean energy is resistant to system shocks.
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Affiliation(s)
- Emily Nix
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | | | | | - Michael Abbott
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Serena Saligari
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Matthew Shupler
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Iva Čukić
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Elisa Puzzolo
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
- Global LPG Partnership (GLPGP), New York, United States
| | - Daniel Pope
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
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16
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Rajabzadeh-Dehkordi M, Mohammadi-Nasrabadi F, Nouri M, Ahmadi A, Faghih S. Determinants and consequences of food insecurity in families having children under the age of 2 years. Nutr Health 2022:2601060221135923. [PMID: 36412042 DOI: 10.1177/02601060221135923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background: Today, food insecurity is recognized as an important public health problem that can have detrimental effects on families. Aim: The aim of this study was to assess the determinants and consequences of food insecurity in families having children under the age of 2 years. Method: In this cross-sectional study, 307 mothers and their children under the age of 2 years were selected by stratified random sampling. Demographic and socioeconomic data were collected by completing questionnaires through face-to-face interview. Household food insecurity (HFI) status was determined using the United States Department of Agriculture (USDA) household food security questionnaire. Results: Based on the results, 67.4% of families were high food secure. Low and very low food security was 25.7% and 6.9%, respectively. House size (Beta = -0.019, 95% CI: -0.029, -0.009), father's job (Beta = -4.758, 95% CI:-6.777, -2.738), father education (Beta = -0.370, 95% CI: -0.717, -0.023), and economic status (Beta = -0.628, 95% CI: -0.809, -0.448) were significantly related to the USDA total food insecurity score (p < 0.05). Regression analysis showed that children birth weight, father's body mass index (BMI), and mother's waist circumference had a significant positive correlation with weight for age (Z-score) of children. Children's birth weight, father's BMI, and HFI status had significant and positive correlation with weight for length (Z-score). Moreover, the significant association between children's birth height, mother's BMI, and mother's waist circumference with length for age (Z-score) were observed (p < 0.05). Conclusion: We found the father's job was the most effective factor in food insecurity and economic status of the family was in the second place. Also, HFI had a relationship with weight status of children under the age of 2 years.
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Affiliation(s)
- Milad Rajabzadeh-Dehkordi
- Department of Community Nutrition, School of Nutrition and Food Sciences, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Mohammadi-Nasrabadi
- Food and Nutrition Policy and Planning Research Department, National Nutrition & Food Technology Research Institute (NNFTRI), Faculty of Nutrition Sciences and Food technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehran Nouri
- Department of Community Nutrition, School of Nutrition and Food Sciences, 48435Shiraz University of Medical Sciences, Shiraz, Iran
- Students' Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Ahmadi
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Shiva Faghih
- Department of Community Nutrition, School of Nutrition and Food Sciences, 48435Shiraz University of Medical Sciences, Shiraz, Iran
- Nutrition Research Center, 48435Shiraz University of Medical Sciences, Shiraz, Iran
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17
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Luo Y, Mobley C, Hossfeld L, Koob C, Hossfeld C, Baxter SLK, Griffin SF. The Association between Food Insecurity and Making Hunger-Coping Trade-Offs during the COVID-19 Pandemic: The Role of Sources of Food and Easiness in Food Access. Nutrients 2022; 14:nu14214616. [PMID: 36364877 PMCID: PMC9658505 DOI: 10.3390/nu14214616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Many individuals make financial, health and food related trade-offs to cope with the challenges of food insecurity and to meet their household needs for healthy, affordable food. A survey (n = 652) was conducted in nine rural counties in South Carolina, USA, during the COVID-19 pandemic from August 2020 to July 2021. We examine if level of food insecurity predicts hunger-coping trade-offs, and whether this relationship is moderated by easiness in food access and dependence on different food source types. Nearly one-third of the respondents experienced food insecurity. Making trade-offs between paying for food and other household expenses was common among the rural residents as on average they made nearly one type of trade-off in the past three months. The number of trade-offs was the highest among highly food insecure respondents (mean = 2.64), followed by moderately food insecure respondents (mean = 1.66); low food insecure respondents had the lowest number of trade-offs (mean = 0.39). The moderating effects of easiness in food access and dependence on food sources varied by level of food insecurity. The results show that individuals at different levels of food insecurity use different strategies to fulfill their food needs and social programs are more often utilized than personal food sources. We conclude with implications for addressing food insecurity in order to reduce the possibility of making trade-offs.
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Affiliation(s)
- Ye Luo
- Department of Sociology, Anthropology and Criminal Justice, Clemson University, Clemson, SC 29634, USA
- Correspondence: (Y.L.); (L.H.)
| | - Catherine Mobley
- Department of Sociology, Anthropology and Criminal Justice, Clemson University, Clemson, SC 29634, USA
| | - Leslie Hossfeld
- College of Social, Behavioral and Health Sciences, Clemson University, Clemson, SC 29634, USA
- Correspondence: (Y.L.); (L.H.)
| | - Caitlin Koob
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Cassius Hossfeld
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Samuel L. K. Baxter
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Sarah F. Griffin
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
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18
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Rosenberg J, Rosenthal A, Castillo S, Edwards E, Erickson C, Nogelo P, Fenick AM. Medical Certification for Utility Shut-Off Protection and Health-Related Social Needs. Pediatrics 2022; 150:e2022057571. [PMID: 36226533 PMCID: PMC9647589 DOI: 10.1542/peds.2022-057571] [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: 08/23/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children in families facing energy insecurity have greater odds of poor health and developmental problems. In this study of families who requested and received medical certification for utility shut-off protection and were contacted by our Medical Legal Partnership (MLP), we aimed to assess concurrent health-related social needs related to utilities, housing, finances, and nutrition. METHODS After medical certificates were completed at our academic pediatric center, our MLP office contacted families and assessed utility concerns as well as other health, social, and legal needs. In this observational study, we present descriptive analyses of patients who received certificates from September 2019 to May 2020 via data collected through the MLP survey during the coronavirus disease 2019 pandemic (June 2020-December 2021). RESULTS Of 167 families who received utility shut-off protection from September 2019 to May 2020, 84 (50.3%) parents and guardians were successfully contacted. Most (93%) found the medical certificate helpful. Additionally, 68% had applied for Energy Assistance, and 69% reported they were on utility company payment plans. Most (78%) owed arrearages, ranging from under $500 to over $20 000, for gas, electric, and/or water bills. Food, housing, and financial insecurity screening positivity rates were 65%, 85%, and 74%, respectively. CONCLUSIONS Patients who were contacted by an MLP after receiving medical certification for utility shutoff protection were found to have challenges paying for utilities and faced multiple food, housing, and financial stressors. Through consultation and completion of medical forms for utility shutoff protection, pediatricians and MLPs can provide resources and advocacy to support families' physical, emotional, and psychosocial needs.
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Affiliation(s)
| | - Alice Rosenthal
- Yale School of Medicine, New Haven, Connecticut
- Yale New Haven Hospital, New Haven, Connecticut
- Center for Children’s Advocacy, Hartford, Connecticut
| | | | - Emily Edwards
- Frank H. Netter School of Medicine, Quinnipiac University, Hamden, Connecticut
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19
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Furbacher J, Fockele C, Del Buono B, Janneck L, March C, Molina M, Duber H, Doran K, Lin M, Cooper R, Modi P. 2021 SAEM Consensus Conference Proceedings: Research Priorities for Developing Emergency Department Screening Tools for Social Risks and Needs. West J Emerg Med 2022; 23:817-822. [DOI: 10.5811/westjem.2022.8.57271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/17/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: The Emergency Department (ED) acts as a safety net for our healthcare system. While studies have shown increased prevalence of social risks and needs among ED patients, there are many outstanding questions about the validity and use of social risks and needs screening tools in the ED setting.
Methods: In this paper, we present research gaps and priorities pertaining to social risks and needs screening tools used in the ED, identified through a consensus approach informed by literature review and external expert feedback as part of the 2021 SAEM Consensus Conference -- From Bedside to Policy: Advancing Social Emergency Medicine and Population Health.
Results: Four overarching research gaps were identified: (1) Defining the purpose and ethical implications of ED-based screening; (2) Identifying domains of social risks and needs; (3) Developing and validating screening tools; and (4) Defining the patient population and type of screening performed. Furthermore, the following research questions were determined to be of highest priority: (1) What screening tools should be used to identify social risks and needs? (2) Should individual EDs use a national standard screening tools or customized screening tools? (3) What are the most prevalent social risks and needs in the ED? and (4) Which social risks and needs are most amenable to intervention in the ED setting?
Conclusion: Answering these research questions will facilitate the use of evidence-based social risks and needs screening tools that address knowledge gaps and improve the health of our communities by better understanding the underlying determinants contributing to their presentation and health outcomes.
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Affiliation(s)
- Jacqueline Furbacher
- University of Massachusetts Chan Medical School, Department of Emergency Medicine, Worcester, Massachusetts
| | - Callan Fockele
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Ben Del Buono
- Virginia Commonwealth University, Department of Emergency Medicine, Richmond, Virginia
| | - Laura Janneck
- University of Oklahoma School of Community Medicine, Department of Emergency Medicine, Tulsa, Oklahoma
| | - Cooper March
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Melanie Molina
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Herbet Duber
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Kelly Doran
- NYU School of Medicine, Departments of Emergency Medicine and Population Health, New York, New York
| | - Michelle Lin
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Richelle Cooper
- UCLA School of Medicine, Department of Emergency Medicine, Los Angeles, California
| | - Payal Modi
- University of Massachusetts Chan Medical School, Department of Emergency Medicine, Worcester, Massachusetts
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20
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Cutts DB, Ettinger de Cuba S, Bovell-Ammon A, Wellington C, Coleman SM, Frank DA, Black MM, Ochoa E, Chilton M, Lê-Scherban F, Heeren T, Rateau LJ, Sandel M. Eviction and Household Health and Hardships in Families With Very Young Children. Pediatrics 2022; 150:189509. [PMID: 36120757 DOI: 10.1542/peds.2022-056692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Families with versus without children are at greater eviction risk. Eviction is a perinatal, pediatric, and adult health concern. Most studies evaluate only formal evictions. METHODS Using cross-sectional surveys of 26 441 caregiver or young child (<48 months) dyads from 2011 to 2019 in emergency departments (EDs) and primary care clinics, we investigated relationships of 5 year history of formal (court-involved) and informal (not court-involved) evictions with caregiver and child health, history of hospitalizations, hospital admission from the ED on the day of the interview, and housing-related and other material hardships. RESULTS 3.9% of 26 441 caregivers reported 5 year eviction history (eviction), of which 57.0% were formal evictions. After controlling for covariates, we found associations were minimally different between formal versus informal evictions and were, therefore, combined. Compared to no evictions, evictions were associated with 1.43 (95% CI: 1.17-1.73), 1.55 (95% confidence interval [CI]: 1.32-1.82), and 1.24 (95% CI: 1.01-1.53) times greater odds of child fair or poor health, developmental risk, and hospital admission from the ED, respectively, as well as adverse caregiver and hardship outcomes. Adjusting separately for household income and for housing-related hardships in sensitivity analyses did not significantly alter results, although odds ratios were attenuated. Hospital admission from the ED was no longer significant. CONCLUSIONS Demonstrated associations between eviction and health and hardships support broad initiatives, such as housing-specific policies, income-focused benefits, and social determinants of health screening and community connections in health care settings. Such multifaceted efforts may decrease formal and informal eviction incidence and mitigate potential harmful associations for very young children and their families.
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Affiliation(s)
- Diana B Cutts
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota
| | | | | | - Chevaughn Wellington
- Children's HealthWatch, Boston Medical Center, Boston, Massachusetts.,Frank H. Netter M.D. School of Medicine, Quinnipiac University, North Haven, Connecticut
| | - Sharon M Coleman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Deborah A Frank
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Maureen M Black
- Department of Pediatrics, Growth and Nutrition Division, University of Maryland School of Medicine, Baltimore, Maryland.,RTI International, Research Triangle Park, North Carolina
| | - Eduardo Ochoa
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Félice Lê-Scherban
- Epidemiology and Biostatistics.,Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Timothy Heeren
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Lindsey J Rateau
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Megan Sandel
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
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21
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Campbell C, O'Brien G, Tumin D. Timing and Persistence of Material Hardship Among Children in the United States. Matern Child Health J 2022; 26:1529-1539. [PMID: 35567701 PMCID: PMC9106985 DOI: 10.1007/s10995-022-03448-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 12/01/2022]
Abstract
Objective Screening for social determinants of health (SDH) has been widely adopted to identify child health risks associated with exposure to material hardship. Whereas SDH screening typically addresses a 12-month span, we sought to compare the prevalence of exposure to present (within the past year) as compared to recent (2–4 years ago) hardship among children in the United States. Methods We analyzed the 2014 Survey of Income and Program Participation, a nationally representative survey that interviewed participating households annually between 2014 and 2017. We included data from households with children in all waves. As of 2017, households were categorized as (1) experiencing present hardship (within the last year); (2) experiencing recent but not present hardship (any year between 2014 and 2016); and (3) experiencing no hardship over the 4-year period. Results Of 2422 households, 27% experienced present hardship and 29% experienced recent but not present hardship. Households presently experiencing hardship were more likely to have Medicaid insurance, less likely to be married, and had more children than families who had experienced recent hardship. However, these groups were similar on caregivers’ educational attainment, race/ethnicity, language spoken in the home, and age of the youngest child. Conclusions Our results suggest that clinical screening tools for SDH that use a 12-month time frame risk missing many children who have recently (within the past 4 years) experienced material hardship and may benefit from interventions to improve social support; a longer time frame could provide clinicians with valuable information for understanding social factors that impact child health and development.
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Affiliation(s)
- Colin Campbell
- Department of Sociology, East Carolina University, Greenville, NC, USA.
| | - Grant O'Brien
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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22
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Vasan A, Darko O, Fortin K, Scribano PV, Kenyon CC. Community Resource Connection for Pediatric Caregivers With Unmet Social Needs: A Qualitative Study. Acad Pediatr 2022; 22:461-469. [PMID: 34571255 PMCID: PMC8942862 DOI: 10.1016/j.acap.2021.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Pediatric health systems are increasingly screening caregivers for unmet social needs. However, it remains unclear how best to connect families with unmet needs to available and appropriate community resources. We aimed to explore caregivers' perceived barriers to and facilitators of community resource connection. METHODS We conducted semistructured interviews with caregivers of pediatric patients admitted to one inpatient unit of an academic quaternary care children's hospital. All caregivers who screened positive for one or more unmet social needs on a tablet-based screener were invited to participate in an interview. Interviews were recorded, transcribed, and coded by 2 independent coders using content analysis, resolving discrepancies by consensus. Interviews continued until thematic saturation was achieved. RESULTS We interviewed 28 of 31 eligible caregivers. Four primary themes emerged. First, caregivers of children with complex chronic conditions felt that competing priorities related to their children's medical care often made it more challenging to establish connection with resources. Second, caregivers cited burdensome application and enrollment processes as a barrier to resource connection. Third, caregivers expressed a preference for geographically tailored, web-based resources, rather than paper resources. Last, caregivers expressed a desire for ongoing longitudinal support in establishing and maintaining connections with community resources after their child's hospital discharge. CONCLUSION Pediatric caregivers with unmet social needs reported competing priorities and burdensome application processes as barriers to resource connection. Electronic resources can help caregivers identify locally available services, but longitudinal supports may also be needed to ensure caregivers can establish and maintain linkages with these services.
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Affiliation(s)
- Aditi Vasan
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia (A Vasan and CC Kenyon), Philadelphia, Pa; Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania (A Vasan and CC Kenyon), Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania (A Vasan, O Darko, K Fortin, PV Scribano, and CC Kenyon), Philadelphia, Pa.
| | - Olivia Darko
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Kristine Fortin
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Philip V. Scribano
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Chén C. Kenyon
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA,Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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23
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Housing Insecurity and Mental Health: the Effect of Housing Tenure and the Coexistence of Life Insecurities. J Urban Health 2022; 99:268-276. [PMID: 35303243 PMCID: PMC9033895 DOI: 10.1007/s11524-022-00619-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 10/18/2022]
Abstract
While the adverse effects of housing insecurity on mental health are known, much less is known about the modifiers underlying these effects. The aim of this study was to analyze the mental health of people with housing insecurity by housing tenure and considering the coexistence of other life insecurities (energy poverty and food insecurity). We conducted a cross-sectional study through a survey performed in all people attending the Platform for People Affected by Mortgages or the Alliance against Energy Poverty of Barcelona for the first time between June 2017 and December 2019 and who reported housing insecurity. The dependent variables were the risk of poor mental health, self-reported anxiety and/or depression, and the use of psychotropic drugs. We fitted age-adjusted robust Poisson regression models for each dependent variable and estimated adjusted prevalence ratios (aPR). The study included 256 women and 104 men. The prevalence of poor mental health was 89% in women and 85.3% in men, which was much higher than that in the general population of Barcelona (19.5% and 14.5%, respectively). Among women, mental health was worse in those living in a squat (aPR 1.16; 95% CI: 1.02-1.31) and in those with food insecurity (aPR 1.11; 95% CI: 1.01-1.21). The number of coexisting insecurities showed a gradient effect (3 insecurities: aPR 1.21; 95% CI: 1.01-1.45). Among men, the results showed no clear pattern. Poor mental health was highly prevalent in people with housing insecurity and was exacerbated by the coexistence of life insecurities. Public policymakers should consider the complexity of persons with housing insecurity.
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24
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Holcomb J, Oliveira LC, Highfield L, Hwang KO, Giancardo L, Bernstam EV. Predicting health-related social needs in Medicaid and Medicare populations using machine learning. Sci Rep 2022; 12:4554. [PMID: 35296719 PMCID: PMC8927567 DOI: 10.1038/s41598-022-08344-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/03/2022] [Indexed: 01/02/2023] Open
Abstract
Providers currently rely on universal screening to identify health-related social needs (HRSNs). Predicting HRSNs using EHR and community-level data could be more efficient and less resource intensive. Using machine learning models, we evaluated the predictive performance of HRSN status from EHR and community-level social determinants of health (SDOH) data for Medicare and Medicaid beneficiaries participating in the Accountable Health Communities Model. We hypothesized that Medicaid insurance coverage would predict HRSN status. All models significantly outperformed the baseline Medicaid hypothesis. AUCs ranged from 0.59 to 0.68. The top performance (AUC = 0.68 CI 0.66–0.70) was achieved by the “any HRSNs” outcome, which is the most useful for screening prioritization. Community-level SDOH features had lower predictive performance than EHR features. Machine learning models can be used to prioritize patients for screening. However, screening only patients identified by our current model(s) would miss many patients. Future studies are warranted to optimize prediction of HRSNs.
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Affiliation(s)
- Jennifer Holcomb
- Department of Management, Policy, and Community Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, 1200 Pressler St, Houston, TX, 77030, USA.,Sinai Urban Health Institute, 1500 South Fairfield Avenue, Chicago, IL, 60608, USA
| | - Luis C Oliveira
- The University of Texas Health Science Center at Houston (UTHealth) School of Biomedical Informatics, 7000 Fannin, Houston, TX, 77030, USA.,Houston Methodist Academic Institute, 6670 Bertner Ave, Houston, TX, 77030, USA
| | - Linda Highfield
- Departments of Management, Policy, and Community Health and Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, 1200 Pressler St, Houston, TX, 77030, USA.,Department of Internal Medicine, The University of Texas Health Science Center at Houston (UTHealth) John P and Katherine G McGovern Medical School, 6410 Fannin, Houston, TX, 77030, USA
| | - Kevin O Hwang
- Center for Healthcare Quality and Safety at UTHealth/Memorial Hermann, The University of Texas Health Science Center at Houston (UTHealth) John P and Katherine G McGovern Medical School, 6410 Fannin, Houston, TX, 77030, USA
| | - Luca Giancardo
- Center for Precision Health, The University of Texas Health Science Center at Houston (UTHealth) School of Biomedical Informatics, 7000 Fannin, Houston, TX, 77030, USA
| | - Elmer Victor Bernstam
- The University of Texas Health Science Center at Houston (UTHealth) School of Biomedical Informatics, 7000 Fannin, Houston, TX, 77030, USA. .,Department of Internal Medicine, The University of Texas Health Science Center at Houston (UTHealth) John P and Katherine G McGovern Medical School, 6410 Fannin, Houston, TX, 77030, USA.
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25
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Parker MG, de Cuba SE, Rateau LJ, Sandel MT, Frank DA, Cutts DB, Heeren TC, Lê-Scherban F, Black MM, Ochoa ER, Garg A. Household unmet basic needs in the first 1000 days and preterm birth status. J Perinatol 2022; 42:389-396. [PMID: 35102255 DOI: 10.1038/s41372-022-01325-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/13/2021] [Accepted: 01/19/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To examine the relationship of individual and composite number of unmet basic needs (housing, energy, food, and healthcare hardships) in the past year with preterm birth status among children aged 0-24 months. STUDY DESIGN We examined cross-sectional 2011-18 data of 17,926 families with children aged 0-24 months. We examined children born <31 weeks', 31-33 weeks', and 34-36 weeks' gestation versus term (≥37 weeks) using multivariable multinomial logistic regression. RESULTS At least 1 unmet basic need occurred among ≥60% of families with preterm children, compared to 56% of families with term children (p = 0.007). Compared to term, children born ≤30 weeks' had increased odds of healthcare hardships (aOR 1.28 [1.04, 1.56]) and children born 34-36 weeks' had increased odds of 1 (aOR 1.19 [1.05, 1.35]) and ≥2 unmet needs (aOR 1.15 [1.01, 1.31]). CONCLUSION Unmet basic needs were more common among families with preterm, compared to term children.
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Affiliation(s)
- Margaret G Parker
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
| | | | - Lindsey J Rateau
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Megan T Sandel
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Deborah A Frank
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Diana B Cutts
- Department of Pediatrics, Hennepin County Medical Center, Boston, MA, USA
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Félice Lê-Scherban
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.,RTI International, Research Triangle Park, NC, USA
| | - Eduardo R Ochoa
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
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26
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Nolen E, Cubbin C, Brewer M. The effect of maternal food insecurity transitions on housing insecurity in a population-based sample of mothers of young children. AIMS Public Health 2021; 9:1-16. [PMID: 35071664 PMCID: PMC8755969 DOI: 10.3934/publichealth.2022001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Studies have shown a link between food insecurity and housing problems, including trouble paying rent. Additional research is needed to test the longitudinal effect of food insecurity on housing insecurity in a socio-demographically diverse, population-based sample. We tested whether food insecurity transitions predicted housing insecurity using a housing insecurity index consisting of housing and neighborhood factors. We also tested whether social cohesion or social support mediated the food/housing insecurity relationship. METHOD Data were analyzed from a sample of 2868 mothers of young children residing in California at two time points: the baseline Maternal and Infant Health Assessment (2003-2007) and follow-up Geographic Research on Wellbeing survey (2012-2013). Women were categorized as food insecure both times; became food insecure; became food secure; and food secure both times. We constructed linear regression models for housing insecurity: models regressing each variable separately; a model regressing sociodemographic covariates and food insecurity status; mediation models adding social cohesion or social support; and mediation models for each racial/ethnic group. RESULTS Food insecurity transitions were associated with housing insecurity in a gradient pattern. Compared to women who were food secure both times, housing insecurity was highest among women who were food insecure both times, followed by those who became food insecure, and then those who transitioned out of food insecurity (became food secure). Food insecurity remained a significant risk factor for housing insecurity even after adjusting sociodemographic covariates. While social support and social cohesion were negatively associated with housing insecurity, there was limited evidence that social support/cohesion mediated the food insecurity/housing insecurity relationships. CONCLUSIONS The lack of substantial mediation suggests that factors beyond social ties may explain the food and housing insecurity relationship. Efforts to reduce material hardship should consist of streamlined policy efforts that offer tangible supports for women and their families.
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Affiliation(s)
- Erin Nolen
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Catherine Cubbin
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
- Dell Medical School, Department of Population Health, University of Texas at Austin, Austin, TX, USA
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27
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Green KA, Bovell-Ammon A, Sandel M. Housing and Neighborhoods as Root Causes of Child Poverty. Acad Pediatr 2021; 21:S194-S199. [PMID: 34740428 DOI: 10.1016/j.acap.2021.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/16/2021] [Accepted: 08/25/2021] [Indexed: 10/19/2022]
Abstract
Understanding how housing inequities among families with children are rooted in structural racism is important for identifying opportunities to engage in ongoing and collective work as pediatricians to lift children out of poverty. This article discusses the complex mechanisms between housing and child and family health outcomes, and offers potential solutions linking housing, health programs, and policy solutions. Beginning with a review of historical antecedents of housing policy and their impact on health inequities, the authors outlines policies and structures directly linked to disproportionate housing instability and inequities in health outcomes among children. This article examines four key domains of housing - affordability, stability, quality, and neighborhood - and their relationship to child and family health. Finally, the authors present multidimensional solutions for advancing health equity.
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Affiliation(s)
| | | | - Megan Sandel
- Department of Pediatrics, Boston Medical Center (M Sandel), Boston, Mass.
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28
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Arbour MC, Floyd B, Morton S, Hampton P, Sims JM, Doyle S, Atwood S, Sege R. Cross-Sector Approach Expands Screening and Addresses Health-Related Social Needs in Primary Care. Pediatrics 2021; 148:peds.2021-050152. [PMID: 34706903 DOI: 10.1542/peds.2021-050152] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES During infancy, the American Academy of Pediatrics Bright Futures fourth edition health supervision guidelines recommend frequent well-child visits (WCVs) in which providers are expected to screen for and address maternal depression, intimate partner violence (IPV), and health-related social needs (HRSN). We spread an evidence-based approach that implements these recommendations (Developmental Understanding and Legal Collaboration for Everyone; DULCE) with 3 aims for 6-month-old infants and their families: 75% receive all WCVs on time, 95% are screened for 7 HRSNs, and 90% of families with concrete supports needs and 75% of families with maternal depression or IPV receive support. METHODS Between January 2017 and July 2018, five DULCE teams (including a community health worker, early childhood system representative, legal partner, clinic administrator, pediatric and behavioral health clinicians) from 3 communities in 2 states participated in a learning collaborative. Teams adapted DULCE using Plan-Do-Study-Act cycles, reported data, and shared learning monthly. Run charts were used to study measures. The main outcome was the percent of infants that received all WCVs on time. RESULTS The percentage of families who completed all WCVs on time increased from 46% to 65%. More than 95% of families were screened for HRSNs, 70% had ≥1 positive screen, and 86% and 71% of those received resource information for concrete supports and maternal depression and IPV, respectively. CONCLUSIONS Quality improvement-supported DULCE expansion increased by 50% the proportion of infants receiving all WCVs on time and reliably identified and addressed families' HRSNs, via integration of existing resources.
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Affiliation(s)
| | - Baraka Floyd
- Stanford School of Medicine, Stanford, California
| | | | - Patsy Hampton
- Center for the Study of Social Policy, Washington, DC
| | | | | | | | - Robert Sege
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
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29
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Gonzalez JV, Hartford EA, Moore J, Brown JC. Food Insecurity in a Pediatric Emergency Department and the Feasibility of Universal Screening. West J Emerg Med 2021; 22:1295-1300. [PMID: 34787554 PMCID: PMC8597682 DOI: 10.5811/westjem.2021.7.52519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/17/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction Children with food insecurity (FI) experience adverse health outcomes due to inadequate quantity or quality of food. Food insecurity may be high among families seeking emergency care. The Hunger Vital Sign (HVS) is a two-question validated tool used to screen families for FI. Our goal in this study was to assess prevalence of FI among emergency department (ED) patients, patient-level risk factors for FI, and the feasibility of screening. Methods This was a cross-sectional analysis of FI in the ED. Parents or guardians of ED patients and adult patients (18 years or older) were approached for screening using the HVS during screening periods spanning weekdays/weekends and days/evenings. All ED patients were eligible, excluding siblings, repeat visits, critically ill patients, minors without a guardian, and families that healthcare staff asked us not to disturb. Families answered the HVS questions verbally or in writing, based on preference. Families with positive screens received information about food resources. We summarized patient and visit characteristics and defined medical complexity using a published algorithm. Multivariable logistic regression was used to assess FI risk factors. Results In July–August 2019, 527 patients presented during screening periods: 439 agreed to screening, 18 declined, 19 met exclusions, and 51 were missed. On average the screening tool required five minutes (range 3–10 minutes) to complete. Most families (328; 75%) preferred to answer in writing rather than verbally. Overall, 77 participants (17.5%) screened positive for FI. In regression analyses, FI was associated with self-reported race/ethnicity (combined variable) of African American or Black (odds ratio [OR] 5.21, 95% confidence interval [CI], 2.13–12.77), Hispanic (OR 3.47, 95% CI, 1.48–8.15), or mixed/other (OR 3.81, 95% CI, 1.54–9.39), compared to non-Hispanic white. FI was also associated with public insurance type (OR 5.74, 95% CI, 2.52–13.07, reference: private insurance), and each year of increasing patient age (OR 1.05, 95% CI, 1.01–1.09). There were no associations between FI and medical complexity or preferred language. Conclusion Food insecurity was common among our ED patients. Race and ethnicity, insurance status, and increasing patient age were associated with increased odds of FI. Efforts to include universal FI screening for ED patients with immediate connection to resources will enhance overall care quality and address important health needs.
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Affiliation(s)
| | - Emily A Hartford
- University of Washington, Department of Pediatrics, Division of Emergency Medicine, Seattle, Washington
| | - Jennifer Moore
- University of Washington, Department of Pediatrics, Seattle, Washington
| | - Julie C Brown
- University of Washington, Department of Pediatrics, Division of Emergency Medicine, Seattle, Washington
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30
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The Association of Energy Poverty with Health and Wellbeing in Children in a Mediterranean City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115961. [PMID: 34199387 PMCID: PMC8199602 DOI: 10.3390/ijerph18115961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/27/2021] [Accepted: 05/30/2021] [Indexed: 11/29/2022]
Abstract
Children have been identified as being particularly vulnerable to energy poverty (EP), but little empirical research has addressed the effect of EP on children’s health and wellbeing, especially in southern Europe. In this work we aimed to provide an in-depth description of the distribution of EP by sociodemographic, socioeconomic and housing characteristics, as well as to analyse the association between EP and health and wellbeing in children in Barcelona. We performed a cross-sectional study using data from the Barcelona Health Survey for 2016 (n = 481 children under 15 years). We analysed the association between EP and health outcomes through prevalence differences and prevalence ratios (PR) and their 95% confidence interval (CI), using Poisson regression models with robust variance. In Barcelona, 10.6% of children were living in EP and large inequalities were found by sociodemographic, socioeconomic and housing characteristics. EP was strongly associated with poor health in children (PR (95% CI): 7.70 (2.86, 20.72)). Living in EP was also associated with poor mental health (PR (95% CI): 2.46 (1.21, 4.99)) and with more cases of asthma (PR (95% CI): 4.19 (1.47, 11.90)) and overweight (PR (95% CI): 1.50 (1.05, 2.15)) in children. It is urgent to develop specific measures to avoid such serious and unfair health effects on children.
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31
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Tsui J, Yang A, Anuforo B, Chou J, Brogden R, Xu B, Cantor JC, Wang S. Health Related Social Needs Among Chinese American Primary Care Patients During the COVID-19 Pandemic: Implications for Cancer Screening and Primary Care. Front Public Health 2021; 9:674035. [PMID: 34123992 PMCID: PMC8192797 DOI: 10.3389/fpubh.2021.674035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/23/2021] [Indexed: 12/28/2022] Open
Abstract
Research Objective: Initiatives to address social determinants of health (SDOH) and measure health-related social needs (HRSN) within clinic settings are increasing. However, few have focused on the specific needs of Asian Americans (AA). We examine the prevalence of HRSN during a period spanning the COVID-19 pandemic to inform strategies to improve cancer screening and primary care among AA patients. Methods: We implemented a self-administered HRSN screening tool in English and Chinese, traditional (T) or simplified (S) text, within a hospital-affiliated, outpatient primary care practice predominantly serving AA in New Jersey. HRSN items included food insecurity, transportation barriers, utility needs, interpersonal violence, housing instability, immigration history, and neighborhood perceptions on cohesion and trust. We conducted medical chart reviews for a subset of participants to explore the relationship between HRSN and history of cancer screening. Results: Among 236 participants, most were Asian (74%), non-US born (79%), and privately insured (57%). One-third responded in Chinese (37%). Half reported having ≥1 HRSN. Interpersonal violence was high across all participants. Transportation needs were highest among Chinese-T participants, while food insecurity and housing instability were higher among Chinese-S participants. Lower-income patients had higher odds of having ≥2 HRSN (OR:2.53, 95% CI: 1.12, 5.98). Older age and public insurance/uninsured were significantly associated with low neighborhood perceptions. Conclusions: We observed higher than anticipated reports of HRSN among primary care patients in a suburban, hospital-affiliated practice serving AA. Low neighborhood perceptions, particularly among Chinese-S participants, highlight the importance of addressing broader SDOH among insured, suburban AA patients. These study findings inform the need to augment HRSN identification to adequately address social needs that impact health outcomes and life course experiences for Asian patients. As HRSN measuring efforts continue, and COVID-19's impact on the health of minority communities emerge, it will be critical to develop community-specific referral pathways to connect AA to resources for HRSN and continue to address more upstream social determinants of health for those who are disproportionately impacted.
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Affiliation(s)
- Jennifer Tsui
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Annie Yang
- Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Bianca Anuforo
- Section of Behavioral Sciences, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Jolene Chou
- Rutgers Center for State Health Policy, Institute for Health, Health Care Policy, and Aging Research, New Brunswick, NJ, United States
| | - Ruth Brogden
- RWJBarnabas Health Medical Group, Center for Asian Health, Saint Barnabas Medical Center, Florham Park, NJ, United States
| | - Binghong Xu
- RWJBarnabas Health Medical Group, Center for Asian Health, Saint Barnabas Medical Center, Florham Park, NJ, United States
| | - Joel C. Cantor
- Rutgers Center for State Health Policy, Institute for Health, Health Care Policy, and Aging Research, New Brunswick, NJ, United States
- Rutgers Edward J. Bloustein School of Planning and Public Policy, New Brunswick, NJ, United States
| | - Su Wang
- RWJBarnabas Health Medical Group, Center for Asian Health, Saint Barnabas Medical Center, Florham Park, NJ, United States
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32
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Abstract
Latino children face barriers to high-quality healthcare. Because children with medical complexity (CMC) have higher healthcare needs, Latino CMC are likely to experience greater effects of these barriers. These vulnerabilities are exacerbated when Latino CMC endure adverse social conditions, such as food insecurity and housing instability. The study objective was to describe the challenges faced by caregivers of Latino CMC in meeting the practical needs of their children when caring for them at home. In this qualitative study, 70 Latino CMC enrolled in a complex care program of a tertiary care children's hospital were followed for a median duration of 45 months. We collected care coordination notes from encounter logs and interviewed bilingual care coordinators regarding their experiences with each child. Using thematic content analysis and an iterative process, we identified recurrent themes related to practical needs. Four themes emerged. Caregivers: 1) faced financial challenges due to many reasons that were exacerbated by children's medical conditions; 2) had challenges meeting basic needs of their families, including food and shelter; 3) experienced difficulties obtaining necessary medical supplies for their children; and 4) relied on care coordinators to navigate the system. We conclude that Latino caregivers of CMC experience many challenges meeting their families' basic needs and obtaining necessary medical supplies to care for their CMC at home. Care coordinators play a major role in addressing the practical needs of Latino CMC. Future studies should determine whether addressing the practical needs of Latino CMC would improve their health outcomes.
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McMonagle R, Castellanos I, Sutaria Patel S. Advancing Energy Justice as a Climate and Public Health Solution. WORLD MEDICAL & HEALTH POLICY 2021. [DOI: 10.1002/wmh3.420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Coronavirus disease 2019, food security and maternal mental health in Ceará, Brazil: a repeated cross-sectional survey. Public Health Nutr 2021; 24:1836-1840. [PMID: 33563355 PMCID: PMC7948104 DOI: 10.1017/s1368980021000628] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: To quantify the change in the risk of food insecurity and maternal mental disorder (MMD) before and during the coronavirus disease 2019 (COVID-19) pandemic. Design: Repeated cross-sectional survey. Between 17 July and 10 September 2020, mother–child pairs who were enrolled in a population-based survey in 2017 were re-contacted by telephone for consent and to complete a telephonic COVID-19 survey. We used the Brazilian Food Insecurity Scale to assess food security and the Self Reporting Questionnaire-20 to assess MMD. McNemar’s test for paired data that also accounted for clustering was used. Logistic regression was used to assess the relationship of unemployment and receipt of government assistance with food insecurity and MMD in 2020. Setting: Ceará, Brazil. Participants: Five hundred and seventy-seven mother–child pairs completed the 2017 and 2020 surveys. At the time of the 2020 interview, the child cohort was 36–108 months of age. Results: The proportion of mothers reporting food insecurity was 15·5 % higher (95 % CI 5·9, 25·1, P value < 0·001) during the pandemic in July–August 2020 as compared with November 2017, while the prevalence of MMD was 40·2 % higher during the pandemic (95 % CI 32·6, 47·8, P value < 0·001). Loss of formal employment was associated with increased risk of food insecurity, but not with the risk of MMD. Conclusions: The risk of food insecurity and MMD in Ceará increased during the COVID-19 pandemic. These findings highlight the need for policies and interventions to reduce the impact of the COVID-19 pandemic on maternal and child health, nutrition and well-being in Brazil.
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Bona K, Brazauskas R, He N, Lehmann L, Abdel-Azim H, Ahmed IA, Al-Homsi AS, Aljurf M, Arnold SD, Badawy SM, Battiwalla M, Beattie S, Bhatt NS, Dalal J, Dandoy CE, Diaz MA, Frangoul HA, Freytes CO, Ganguly S, George B, Gomez-Almaguer D, Hahn T, Kamble RT, Knight JM, LeMaistre CF, Law J, Lazarus HM, Majhail NS, Olsson RF, Preussler J, Savani BN, Schears R, Seo S, Sharma A, Srivastava A, Steinberg A, Szwajcer D, Wirk B, Yoshimi A, Khera N, Wood WA, Hashmi S, Duncan CN, Saber W. Neighborhood poverty and pediatric allogeneic hematopoietic cell transplantation outcomes: a CIBMTR analysis. Blood 2021; 137:556-568. [PMID: 33104215 PMCID: PMC7845011 DOI: 10.1182/blood.2020006252] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/25/2020] [Indexed: 12/18/2022] Open
Abstract
Social determinants of health, including poverty, contribute significantly to health outcomes in the United States; however, their impact on pediatric hematopoietic cell transplantation (HCT) outcomes is poorly understood. We aimed to identify the association between neighborhood poverty and HCT outcomes for pediatric allogeneic HCT recipients in the Center for International Blood and Marrow Transplant Research database. We assembled 2 pediatric cohorts undergoing first allogeneic HCT from 2006 to 2015 at age ≤18 years, including 2053 children with malignant disease and 1696 children with nonmalignant disease. Neighborhood poverty exposure was defined a priori per the US Census definition as living in a high-poverty ZIP code (≥20% of persons below 100% federal poverty level) and used as the primary predictor in all analyses. Our primary outcome was overall survival (OS), defined as the time from HCT until death resulting from any cause. Secondary outcomes included relapse and transplantation-related mortality (TRM) in malignant disease, acute and chronic graft-versus-host disease, and infection in the first 100 days post-HCT. Among children undergoing transplantation for nonmalignant disease, neighborhood poverty was not associated with any HCT outcome. Among children undergoing transplantation for malignant disease, neighborhood poverty conferred an increased risk of TRM but was not associated with inferior OS or any other transplantation outcome. Among children with malignant disease, a key secondary finding was that children with Medicaid insurance experienced inferior OS and increased TRM compared with those with private insurance. These data suggest opportunities for future investigation of the effects of household-level poverty exposure on HCT outcomes in pediatric malignant disease to inform care delivery interventions.
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Affiliation(s)
- Kira Bona
- Division of Population Sciences, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Ruta Brazauskas
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, and
- Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Naya He
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, and
| | - Leslie Lehmann
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Ibrahim A Ahmed
- Department of Hematology Oncology and Bone Marrow Transplantation, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | | | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Staci D Arnold
- Aflac Cancer and Blood Disorder Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Sara Beattie
- Department of Psychosocial Oncology and Rehabilitation, Tom Baker Cancer Centre, Calgary, AB, Canada
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Neel S Bhatt
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jignesh Dalal
- Rainbow Babies and Children's Hospital, Cleveland Case Western Reserve School of Medicine, Cleveland, OH
| | - Christopher E Dandoy
- Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Haydar A Frangoul
- Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN
| | | | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS
| | - Biju George
- Department of Haematology, Christian Medical College, Vellore, India
| | - David Gomez-Almaguer
- Hospital Universitario Dr. José E. González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Theresa Hahn
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX
| | - Jennifer M Knight
- Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI
| | | | - Jason Law
- Division of Pediatric Hematology/Oncology, Floating Hospital for Children at Tufts Medical Center, Boston, MA
| | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Navneet S Majhail
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Richard F Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Jaime Preussler
- CIBMTR, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Raquel Schears
- Department of Emergency Medicine, University of Central Florida, Orlando, FL
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN
| | - Alok Srivastava
- Centre for Stem Cell Research, Christian Medical College, Vellore, India
| | - Amir Steinberg
- Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY
| | - David Szwajcer
- CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Baldeep Wirk
- Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, PA
| | - Ayami Yoshimi
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University of Freiburg Medical Center, Freiburg, Germany
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ
| | - William A Wood
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, MN; and
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Christine N Duncan
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, and
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Bovell-Ammon A, Yentel D, Koprowski M, Wilkinson C, Sandel M. Housing Is Health: A Renewed Call for Federal Housing Investments in Affordable Housing for Families With Children. Acad Pediatr 2021; 21:19-23. [PMID: 32619545 DOI: 10.1016/j.acap.2020.06.141] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/17/2020] [Accepted: 06/27/2020] [Indexed: 11/17/2022]
Affiliation(s)
| | - Diane Yentel
- National Low Income Housing Coalition (D Yentel, M Koprowski, and C Wilkinson), Washington, DC
| | - Mike Koprowski
- National Low Income Housing Coalition (D Yentel, M Koprowski, and C Wilkinson), Washington, DC
| | - Chantelle Wilkinson
- National Low Income Housing Coalition (D Yentel, M Koprowski, and C Wilkinson), Washington, DC
| | - Megan Sandel
- Boston Medical Center (A Bovell-Ammon and M Sandel), Boston, Mass
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Byhoff E, De Marchis EH, Gottlieb L, Halperin-Goldstein S, Nokes K, LeClair AM. Screening for Immigration-Related Health Concerns in a Federally Qualified Health Center Serving a Diverse Latinx Community: A Mixed Methods Study. J Immigr Minor Health 2020; 22:988-995. [PMID: 32277341 PMCID: PMC7442677 DOI: 10.1007/s10903-020-01005-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Immigration-related concerns can impact health and are an important consideration while caring for a multinational Latinx immigrant community. Patients and caregivers waiting for a non-urgent clinic appointment were randomly screened with one of two social risk screening tools. One tool included a question about "any health or stability concerns related to immigration status." The other tool did not include an immigration health question. Immediately following, respondents were invited to participate in a semi-structured interview regarding their social risk screening experience. 201 screens were completed, and 20 patients agreed to an interview. There were no significant sociodemographic differences between groups. Of those screened for immigration, 11% reported a concern. In both arms, interviewees felt that social risk screening was acceptable in a clinic setting. Questions about immigration are timely, important, and relevant, and can be considered when implementing social assessments in communities where there are high levels of trust in providers.
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Affiliation(s)
- Elena Byhoff
- Department of Medicine, Tufts Medical Center, 800 Washington St, Box #63, Boston, USA.
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, 02111, USA.
| | - Emilia H De Marchis
- Department of Family Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Laura Gottlieb
- Department of Family Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Keith Nokes
- Tufts University School of Medicine, Boston, MA, USA
- Department of Family Medicine, Greater Lawrence Family Health Center, Boston, MA, USA
| | - Amy M LeClair
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, 02111, USA
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Pourmotabbed A, Moosavian SP, Hadi A, Mohammadi H, Dadfarma A, Rezaei S, Babaei A, Moradi S, Mirzaei K. The Relationship between Food Insecurity and Risk of Overweight or Obesity in under 18 Years Individuals: A Systematic Review and Meta-Analysis. Int J Prev Med 2020; 11:158. [PMID: 33312467 PMCID: PMC7716614 DOI: 10.4103/ijpvm.ijpvm_463_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/23/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Food insecurit (FI) has been considered as reason for childhood and adolescent overweight/obesity (OW/OB). Hence, this study was undertaken to assess these relationships. DESIGN Related articles were found by searching the Web of Science, Scopus, PubMed and Embase databases until October 2019. Odds ratio (OR) was analized by a random-effects model. Standard methods were used for assessment of heterogeneity and publication bias. Data were available from 32 studies. The risk ratios of 139,762 participants were pooled from these articles for the meta-analysis. RESULTS This study domenstrated that children and adolescents in food-insecure condition are not at risk of OW/OB (OR = 1.02 95% CI: 0.99, 1.05). However, subgroup analysis indicated that FI related with inhanced risk of OW/OB in adolescents living in developed countries (OR = 1.14; 95% CI: 1.02, 1.27). Other subgroup analysis indicated that severe FI increased the risk of OW/OB among adolescents (OR = 1.24 95% CI: 1.03-1.49). In addition, we found that lower economic development significantly decreased risk of OW/OB among under 6 year children (OR = 0.88; 95% CI: 0.84, 0.93). CONCLUSIONS Our results showed that higher FI degrees were related with more risks of OW/OB among adolescents (12-18 years). Moreover, the country economic levels had effect on the association between FI and risk of OW/OB.
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Affiliation(s)
- Ali Pourmotabbed
- Department of Physiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyedeh Parisa Moosavian
- Department of Clinical Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Hadi
- Halal Research Center of IRI, FDA, Tehran, Iran
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Dadfarma
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahabeddin Rezaei
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Babaei
- Department of Physiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sajjad Moradi
- Halal Research Center of IRI, FDA, Tehran, Iran
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Khadijah Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Ettinger de Cuba S, Chilton M, Bovell-Ammon A, Knowles M, Coleman SM, Black MM, Cook JT, Cutts DB, Casey PH, Heeren TC, Frank DA. Loss Of SNAP Is Associated With Food Insecurity And Poor Health In Working Families With Young Children. Health Aff (Millwood) 2020; 38:765-773. [PMID: 31059367 DOI: 10.1377/hlthaff.2018.05265] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Supplemental Nutrition Assistance Program (SNAP) helps working families meet their nutritional needs. Families whose earned income increases in a given month may have their SNAP benefits abruptly reduced or cut off in the following month. Using sentinel sample data from 2007-15 for families with children younger than age four, we investigated how SNAP benefit reductions or cutoffs resulting from increased income were related to economic hardships (food and energy insecurity, unstable housing, forgone health and/or dental care, and health cost sacrifices) and to caregiver and child health. After we controlled for covariates, we found that the groups whose SNAP benefits were reduced or cut off had significantly increased odds of household and child food insecurity, compared to a group with consistent participation in SNAP. Reduced benefits were associated with 1.43 and 1.22 times greater odds of fair or poor caregiver and child health, respectively. Policy modifications to smooth changes in benefit levels as work incomes improve may protect working families with young children from increased food insecurity, poor health, and forgone care.
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Affiliation(s)
- Stephanie Ettinger de Cuba
- Stephanie Ettinger de Cuba ( ) is executive director of Children's HealthWatch in the Department of Pediatrics, Boston University School of Medicine, in Massachusetts
| | - Mariana Chilton
- Mariana Chilton is a professor of health management and policy at the Dornsife School of Public Health, Drexel University, in Philadelphia, Pennsylvania
| | - Allison Bovell-Ammon
- Allison Bovell-Ammon is deputy director of policy strategy at Children's HealthWatch in the Department of Pediatrics, Boston Medical Center, in Massachusetts
| | - Molly Knowles
- Molly Knowles is a clinical research coordinator in the Division of General Internal Medicine, Penn Center for Community Health Workers, Perelman School of Medicine, University of Pennsylvania, in Philadelphia
| | - Sharon M Coleman
- Sharon M. Coleman is a statistical analyst at the Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health
| | - Maureen M Black
- Maureen M. Black is a professor of pediatrics at the University of Maryland School of Medicine, in Baltimore, and distinguished fellow with RTI International in Research Triangle Park, North Carolina
| | - John T Cook
- John T. Cook is an associate professor of pediatrics at the Boston University School of Medicine
| | - Diana Becker Cutts
- Diana Becker Cutts is an associate professor of pediatrics at the Hennepin County Medical Center, in Minneapolis, Minnesota
| | - Patrick H Casey
- Patrick H. Casey is a professor of pediatrics at the University of Arkansas School of Medicine, in Little Rock
| | - Timothy C Heeren
- Timothy C. Heeren is a professor of biostatistics at the Boston University School of Public Health
| | - Deborah A Frank
- Deborah A. Frank is a professor of child health and well-being at the Boston University School of Medicine
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Associations between parental stress, parent feeding practices, and child eating behaviors within the context of food insecurity. Prev Med Rep 2020; 19:101146. [PMID: 32642403 PMCID: PMC7334818 DOI: 10.1016/j.pmedr.2020.101146] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 05/23/2020] [Accepted: 06/10/2020] [Indexed: 10/27/2022] Open
Abstract
Food insecurity is becoming increasingly prevalent, especially for children from diverse households. Food insecurity presents a potentially different context in which parents engage in food-related parenting practices and children engage in eating behaviors. Parents may also experience higher levels of stress and depressed mood in the context of food insecurity. This study aims to examine associations between momentary parental stress and depressed mood, food-related parenting practices, and child eating behaviors within food secure and insecure households. Children ages 5-7 and their families (n = 150) from six racial/ethnic groups (n = 25 each African American, Hispanic, Hmong, Native American, Somali, White) were recruited for this mixed-methods study through primary care clinics in Minneapolis/St. Paul, MN in 2015-2016. High levels of parental stress and depressed mood experienced earlier in the day within food insecure households was associated with using restrictive feeding practices and serving more pre-prepared foods at the evening meal the same night. Parents from food secure households who experienced high levels of stress earlier in the day were more likely to engage in pressure-to-eat feeding practices, serve more fast food, and to have children who engaged in picky eating behaviors at the evening meal the same night. Health care clinicians may want to consider, or continue to, screen parents for food insecurity, stress, and depressed mood during well child visits and discuss the influence these factors may have on every day food-related parenting practices. Additionally, future research should consider using real-time interventions to reduce parental stress to promote healthy food-related parenting practices within food insecure and secure households.
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Sandel MT, Bovell-Ammon A. Associations Between Federal Rental Housing Assistance and Childhood Asthma-A Renewed Call for Investing in Housing for Health. JAMA Pediatr 2020; 174:525-526. [PMID: 32150225 DOI: 10.1001/jamapediatrics.2019.6272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Megan T Sandel
- Children's HealthWatch, Boston Medical Center, Boston, Massachusetts.,Department of General Academic Pediatrics, Boston Medical Center, Boston, Massachusetts
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Boateng GO, Balogun MR, Dada FO, Armah FA. Household energy insecurity: dimensions and consequences for women, infants and children in low- and middle-income countries. Soc Sci Med 2020; 258:113068. [PMID: 32534302 DOI: 10.1016/j.socscimed.2020.113068] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/14/2020] [Accepted: 05/15/2020] [Indexed: 11/26/2022]
Abstract
Energy insecurity, the lack of access to adequate, affordable, reliable, acceptable, and clean sources of energy for a healthy and sustainable livelihood, poses a challenge to several households. However, the conceptualization of its dimensions and role in the health outcomes of women, infants, and children in most sub-Saharan African countries have rarely been investigated systematically. We assessed the dimensions and adverse consequences of household energy insecurity (HEINS) in a sample of 347 Ghanaians and 420 Nigerians, with over 80% participation of women. The majority of respondents from Ghana (57%) and Nigeria (80%) had experienced of energy insecurity, at least once in the last four weeks. Following the energy insecurity framework, the experiences of participants were classified into physical, behavioral, and economic dimensions of energy insecurity. The consequences of energy insecurity grouped into psychosocial, nutritional, and disease domains. The development of a national as well as a cross-culturally validated scale that embodies these dimensions and domains will facilitate the assessment of the prevalence, causes, and consequences of HEINS. This will eventually enable the development of interventions and policies to mitigate energy insecurity and unearth modifiable factors that influence deleterious maternal, infant and child health outcomes in low-and middle-income countries.
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Affiliation(s)
- Godfred O Boateng
- Public Health Program, Department of Kinesiology, College of Nursing and Health Innovations, The University of Texas at Arlington, TX, USA.
| | - Mobolanle R Balogun
- Department of Community Health & Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Festus O Dada
- Department of Community Health & Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Frederick A Armah
- Department of Environmental Science, University of Cape Coast, Cape Coast, Ghana
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Weida EB, Phojanakong P, Patel F, Chilton M. Financial health as a measurable social determinant of health. PLoS One 2020; 15:e0233359. [PMID: 32421755 PMCID: PMC7233592 DOI: 10.1371/journal.pone.0233359] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/04/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Financial health, understood as one's ability to manage expenses, prepare for and recover from financial shocks, have minimal debt, and ability to build wealth, underlies all facets of daily living such as securing food and paying for housing, yet there is inconsistency in measurement and definition of this critical concept. Most social determinants research and interventions focus on siloed solutions (housing, food, utilities) rather than on a root solution such as financial health. In light of the paucity of public health research on financial health, particularly among low-income populations, this study seeks to: 1) introduce the construct of financial health into the domain of public health as a useful root term that underlies other individual measures of economic hardship and 2) demonstrate through outcomes on financial, physical and mental health among low-income caregivers of young children that the construct of financial health belongs in the canon of social determinants of health. MATERIALS AND METHODS In order to extract features of financial health relevant to overall well-being, principal components analysis were used to assess survey data on banking and personal finances among caregivers of young children who participate in public assistance. Then, a series of logistic regressions were utilized to examine the relationship between components of financial health, depression and self-rated health. RESULTS Components aligned with other measures of financial health in the literature, and there were strong associations between financial health and health outcomes. PRACTICE IMPLICATIONS Financial health can be conceived of and measured as a key social determinant of health.
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Affiliation(s)
- Emily Brown Weida
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Pam Phojanakong
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Falguni Patel
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Mariana Chilton
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
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Kahn PA, Daggula KR, Teng W, Hintz RC, Berland G. Medical Exemption From Disconnection of Utilities in Connecticut. JAMA 2020; 323:1189-1190. [PMID: 32207786 PMCID: PMC7093762 DOI: 10.1001/jama.2020.0542] [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] [Indexed: 11/14/2022]
Abstract
This study uses data from the Connecticut Public Utilities Regulatory Authority to describe trends in medical exemptions from utility disconnection and characteristics and health care use of adults applying for such exemptions at a Yale New Haven Hospital care practice between 2011 and 2017.
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Affiliation(s)
- Peter A. Kahn
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Krishna R. Daggula
- Joint Data Analytics Team, Yale New Haven Health System, New Haven, Connecticut
| | - Wei Teng
- Joint Data Analytics Team, Yale New Haven Health System, New Haven, Connecticut
| | - Richard C. Hintz
- Joint Data Analytics Team, Yale New Haven Health System, New Haven, Connecticut
| | - Gretchen Berland
- Department of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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de Oliveira KHD, de Almeida GM, Gubert MB, Moura AS, Spaniol AM, Hernandez DC, Pérez‐Escamilla R, Buccini G. Household food insecurity and early childhood development: Systematic review and meta-analysis. MATERNAL & CHILD NUTRITION 2020; 16:e12967. [PMID: 32052571 PMCID: PMC7296813 DOI: 10.1111/mcn.12967] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 12/22/2019] [Accepted: 01/21/2020] [Indexed: 01/25/2023]
Abstract
Household food insecurity (HFI) is a powerful stressor negatively associated with early childhood development (ECD). However, no comprehensive review has examined the association of HFI and ECD. Therefore, this systematic review and meta-analysis investigated the association between HFI and ECD domains and subdomains in children under 5 years old. Peer-reviewed and grey literature were systematically searched in electronic databases with no year or language restrictions. Studies were eligible if they assessed the association between HFI and one or more ECD domains. Data were extracted using a standard predefined protocol. Meta-analysis was performed, and the heterogeneity across studies was explored. Nineteen studies were included in the systematic review and 14 in the meta-analysis. Of the studies, 15 were from high income countries (HICs) and four from low-middle income countries (LMICs). For developmental risk and the cognitive/math and cognitive/school readiness and reading subdomains, the only studies available were conducted in HICs. The meta-analysis showed that HFI was associated with developmental risk (OR 1.28; 95% CI [1.14, 1.45]), cognitive/vocabulary (OR 0.94; 95% CI [0.90, 0.98]), and cognitive/math (OR 0.84; 95% CI [0.73, 0.96]). HFI was marginally associated with cognitive/school readiness and reading (OR 0.91; 95% CI [0.82, 1.00]) and motor development (OR; 0.91, 95% CI [0.80, 1.04]). HFI was associated with poor ECD in children under 5 years old. Specifically, HFI was associated with developmental risk and poor math skills in studies conducted in HICs and with poor vocabulary skills in studies conducted in both HICs and LMICs. Prospective studies examining HFI and ECD are needed in LMICs.
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Affiliation(s)
| | | | | | | | | | - Daphne C. Hernandez
- Department of Research, Cizik School of NursingUniversity of Texas Health Science CenterHoustonTexas
| | - Rafael Pérez‐Escamilla
- Department of Social and Behavioral SciencesYale School Public HealthNew HavenConnecticut
| | - Gabriela Buccini
- Department of Social and Behavioral SciencesYale School Public HealthNew HavenConnecticut
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Jessel S, Sawyer S, Hernández D. Energy, Poverty, and Health in Climate Change: A Comprehensive Review of an Emerging Literature. Front Public Health 2019; 7:357. [PMID: 31921733 PMCID: PMC6920209 DOI: 10.3389/fpubh.2019.00357] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 11/11/2019] [Indexed: 11/25/2022] Open
Abstract
Household energy is increasingly vital for maintaining good health. Unaffordable and inadequate household energy presents adverse consequences that are amplified by poverty and a changing climate. To date, the connections between energy, socioeconomic disadvantage, and well-being are generally underappreciated, and household energy connection with climate change is under-researched. Building on the energy insecurity framework, this review explores literature related to household energy, poverty, and health in order to highlight the disproportionate burdens borne by vulnerable populations in adequately meeting household energy needs. This paper is based on a comprehensive review of books, peer-reviewed articles, and reports published between 1990 and 2019, identified via databases including JSTOR and PubMed. A total of 406 publications were selected as having potential for full review, 203 received full review, and 162 were included in this paper on the basis of set inclusion criteria. From the literature review, we created an original heuristic model that describes energy insecurity as either acute or chronic, and we further explore the mediators and pathways that link energy insecurity to health. In the discussion, we posit that the extant literature does not sufficiently consider that vulnerable communities often experience energy insecurity bundled with other hardships. We also discuss energy, poverty, and health through the lens of climate change, making the criticism that most research on household energy does not consider climate change. This evidence is important for enhancing research in this field and developing programmatic and policy interventions as they pertain to energy access, affordability, and health, with special emphasis on vulnerable populations, climate change, and social inequality.
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Affiliation(s)
- Sonal Jessel
- Helibrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Samantha Sawyer
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Diana Hernández
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
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Material Hardships and Health Care Utilization Among Low-Income Children with Special Health Care Needs. Acad Pediatr 2019; 19:733-739. [PMID: 30853575 DOI: 10.1016/j.acap.2019.01.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/21/2018] [Accepted: 01/23/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Material hardships, defined as difficulty meeting basic needs, are associated with adverse child health outcomes, including suboptimal health care utilization. Children with special health care needs (CSHCN) may be more vulnerable to the effects of hardships. Our objective was to determine associations between material hardships and health care utilization among CSHCN. METHODS We conducted a cross-sectional study surveying caregivers of 2- to 12-year-old CSHCN in a low-income, urban area. Independent variables were parent-reported material hardships: difficulty paying bills, food insecurity, housing insecurity, and health care hardship. Dependent variables were parent-reported number of emergency department (ED) visits, any hospital admission, and any unmet health care need. We used negative binomial and logistic regression to assess for associations between each hardship and each outcome. RESULTS We surveyed 205 caregivers between July 2017 and May 2018 and analyzed the data in 2018. After adjustment, difficulty paying bills (incidence rate ratio [IRR], 1.51; 95% confidence interval [CI], 1.08-2.12) and health care hardship (IRR, 1.72; 95% CI, 1.08-2.75) were associated with higher rates of ED visits. There were no associations between hardships and hospital admission. Difficulty paying bills (adjusted odds ratio [AOR], 2.13; 95% CI, 1.14-3.98), food insecurity (AOR, 1.95; 95% CI, 1.02-3.71), and housing insecurity (AOR, 2.71; 95% CI, 1.36-5.40) were associated with higher odds of unmet health care need. CONCLUSIONS Material hardships were associated with higher rates of ED visits and greater unmet health care need among low-income CSHCN. Future examination of the mechanisms of these associations is needed to enhance support for families of CSHCN.
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Vásquez-Vera H, Fernández A, Novoa AM, Delgado L, Barcala J, Macías C, Borrell C. Our lives in boxes: perceived community mediators between housing insecurity and health using a PHOTOVOICE approach. Int J Equity Health 2019; 18:52. [PMID: 30917833 PMCID: PMC6438010 DOI: 10.1186/s12939-019-0943-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/25/2019] [Indexed: 11/24/2022] Open
Abstract
Background While the negative effects of housing insecurity on health are well known, the mechanisms and mediators of these effects have been less well studied. The aim of this study is to identify perceived mediators involved in the relationship between housing insecurity and health. Methods We used a participatory action research approach, the Photovoice methodology. It promotes a reflective process where participants critically discuss housing insecurity and human health and make recommendations to find solutions for the issues identified. This study was conducted with 18 members of the Platform for People Affected by Mortgages who were living in a situation of housing insecurity in Barcelona during the first half of 2017. Results Participants took 990 photographs, of which 147 were printed for analysis in discussion sessions. 109 of these photographs were then selected for categorization by the participants. 11 major categories emerged, representing various factors related to housing insecurity and health. Most categories were acknowledged as possible mediators of the housing/health problem, including: psychological changes; housing-related material aspects; health-related behaviors; eviction; harassment by financial institutions; and family, neighbors and social network. Others were considered as modifiers that could alter the effects of housing insecurity on health. Co-existing determinants may interact with housing insecurity, thereby increasing negative effects on health. Conclusions Through this participatory approach, the Photovoice project gives insight into the mechanisms underlying the relationship between housing insecurity and human health, and provides valuable recommendations to combat this serious public health issue. Electronic supplementary material The online version of this article (10.1186/s12939-019-0943-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hugo Vásquez-Vera
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, ES-08023, Barcelona, Spain. .,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain. .,CEES-Departamento de Salud Pública, Universidad de La Frontera, Temuco, Chile. .,Institut d'Investigació Biomèdica (IIB-Sant Pau), Barcelona, Spain.
| | - Ana Fernández
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, ES-08023, Barcelona, Spain.,CIBER de Epidemiología y Salud pública (CIBERESP), Madrid, Spain
| | - Ana M Novoa
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, ES-08023, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB-Sant Pau), Barcelona, Spain
| | - Lucía Delgado
- Plataforma de Afectados por la Hipoteca de Barcelona, Barcelona, Spain
| | - Joaquín Barcala
- Plataforma de Afectados por la Hipoteca de Barcelona, Barcelona, Spain
| | - Carlos Macías
- Plataforma de Afectados por la Hipoteca de Barcelona, Barcelona, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, ES-08023, Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,CIBER de Epidemiología y Salud pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB-Sant Pau), Barcelona, Spain
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Household composition and experiences of food insecurity in Nigeria: the role of social capital, education, and time use. Food Secur 2019. [DOI: 10.1007/s12571-019-00886-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hernández D, Siegel E. Energy insecurity and its ill health effects: A community perspective on the energy-health nexus in New York City. ENERGY RESEARCH & SOCIAL SCIENCE 2019; 47:78-83. [PMID: 32280598 PMCID: PMC7147484 DOI: 10.1016/j.erss.2018.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This study examines the effects of a novel construct - energy insecurity - on adverse health in a community-based sample in New York City. Using a 2015 cross-sectional study of 2,494 households in Washington Heights, we described the socio-demographic characteristics of energy insecure households and examined the association between energy insecurity and health outcomes using logistic regression models. Twenty-seven percent of participants were energy insecure. Racial/ethnic minorities, households with children, long-term neighborhood residents, and those with poor housing conditions were more likely to be energy insecure; meanwhile, middle income households were not fully protect against energy insecurity. Energy insecurity was significantly associated with poor respiratory, mental health, and sleep outcomes; it was not associated with metabolic disorders, accidents, or neighborhood violence and cohesion. This study indicates that energy insecurity may explain some existing respiratory and mental health-related disparities in vulnerable populations. More research on energy insecurity is needed along with refinement of its measurement.
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Affiliation(s)
- Diana Hernández
- Sociomedical Sciences, Columbia University, Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, USA
- Corresponding author. (D. Hernández), (E. Siegel)
| | - Eva Siegel
- Epidemiology, Columbia University, Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, USA
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