Almost half of young children in the United States live in poverty or near poverty. The American Academy of Pediatrics is committed to reducing and ultimately eliminating child poverty in the United States. Poverty and related social determinants of health can lead to adverse health outcomes in childhood and across the life course, negatively affecting physical health, socioemotional development, and educational achievement. The American Academy of Pediatrics advocates for programs and policies that have been shown to improve the quality of life and health outcomes for children and families living in poverty. With an awareness and understanding of the effects of poverty on children, pediatricians and other pediatric health practitioners in a family-centered medical home can assess the financial stability of families, link families to resources, and coordinate care with community partners. Further research, advocacy, and continuing education will improve the ability of pediatricians to address the social determinants of health when caring for children who live in poverty. Accompanying this policy statement is a technical report that describes current knowledge on child poverty and the mechanisms by which poverty influences the health and well-being of children.

Poverty and Child Health in the United States

There is strong evidence from around the globe that people who are poor and less educated have more health problems and die earlier than those who are richer and more educated, [1][1] and these disparities exist even in wealthy countries like Canada.[2][2] To make an impact on improving health

/pdf/taking-action-on-the-social-determinants-of-health-in-42d31misub.pdf

Taking action on the social determinants of health in clinical practice: a framework for health professionals

Screening for the social determinants of health in clinical practice is still widely debated. A scoping review was used to (1) explore the various screening tools that are available to identify social risk, (2) examine the impact that screening for social determinants has on health and social outcomes, and (3) identify factors that promote the uptake of screening in routine clinical care. Over the last two decades, a growing number of screening tools have been developed to help frontline health workers ask about the social determinants of health in clinical care. In addition to clinical practice guidelines that recommend screening for specific areas of social risk (e.g., violence in pregnancy), there is also a growing body of evidence exploring the use of screening or case finding for identifying multiple domains of social risk (e.g., poverty, food insecurity, violence, unemployment, and housing problems). There is increasing traction within the medical field for improving social history taking and integrating more formal screening for social determinants of health within clinical practice. There is also a growing number of high-quality evidence-based reviews that identify interventions that are effective in promoting health equity at the individual patient level, and at broader community and structural levels.

/pdf/screening-for-social-determinants-of-health-in-clinical-care-ijn5mhtcnk.pdf

Screening for social determinants of health in clinical care: moving from the margins to the mainstream

BACKGROUND: There is growing interest in clinical screening for pediatric social determinants of health, but little evidence on formats that maximize disclosure rates on a wide range of potentially sensitive topics. We designed a study to examine disclosure rates and hypothesized that there would be no difference in disclosure rates on face-to-face versus electronic screening formats for items other than highly sensitive items.

METHODS: We conducted a randomized trial of electronic versus face-to-face social screening formats in a pediatric emergency department. Consenting English-speaking and Spanish-speaking adult caregivers familiar with the presenting child’s household were randomized to social screening via tablet computer (with option for audio assist) versus a face-to-face interview conducted by a fully bilingual/bicultural researcher.

RESULTS: Almost all caregivers (96.8%) reported at least 1 social need, but rates of reporting on the more sensitive issues (household violence and substance abuse) were significantly higher in electronic format, and disclosure was marginally higher in electronic format for financial insecurity and neighborhood and school safety. There was a significant difference in the proportion of social needs items with higher endorsement in the computer-based group (70%) than the face-to-face group (30%).

CONCLUSIONS: Pediatric clinical sites interested in incorporating caregiver-reported socioeconomic, environmental, and behavioral needs screening should consider electronic screening when feasible, particularly when assessing sensitive topics such as child safety and household member substance use.

https://pediatrics.aappublications.org/content/pediatrics/early/2014/10/29/peds.2014-1439.full.pdf

A Randomized Trial on Screening for Social Determinants of Health: the iScreen Study

Aim
To examine how the social determinants of health have been considered in conceptualizations of multimorbidity in older adults in the literature and to identify implications for nursing practice, research and health-care planning and policy.

Background
The common conceptualization of multimorbidity is the presence of multiple chronic conditions where one is not more central than others.

Design
The integrative review methodology of Whittemore and Knafl was employed. The World Health Organization Social Determinants of Health framework was used to determine how the social determinants of health have been considered in conceptualizations of multimorbidity.

Data sources
A search of electronic databases (2000-2015) generated 22 relevant articles, including quantitative and qualitative studies and grey literature reports.

Review methods
A systematic process was used to appraise the quality of the documents, conduct qualitative data analysis procedures of data extraction, coding and theme development and synthesize conclusions.

Results
Current conceptualizations of multimorbidity provide limited consideration of the complex interplay of multimorbidity with the broader social determinants of health. Gender, education, behaviours and the health system were the most commonly cited determinants. Ethnicity, socioeconomic status/social class and material circumstances received little attention. Most of the dimensions of socioeconomic political context were not discussed.

Conclusion
The predominant conceptualization of multimorbidity focuses on the biomedical dimensions of multimorbidity. Consequently, nursing practice, research and policy informed by this literature could inadvertently sustain the mismatch between the needs of older adults with multimorbidity and the services they receive. Future research to inform a new conceptualization is necessary.

This article is protected by copyright. All rights reserved.

Integrative review of the social determinants of health in older adults with multimorbidity

Objective. The goal of this pilot study was to develop and field-test questions for use as a poverty case-finding tool to assist primary care providers in identifying poverty in clinical practice. Methods. 156 questionnaires were completed by a convenience sample of urban and rural primary care patients presenting to four family practices in British Columbia, Canada. Univariate and multivariate logistic regression analyses compared questionnaire responses with low-income cut-off (LICO) levels calculated for each respondent. Results. 35% of respondents were below the “poverty line” (LICO). The question “Do you (ever) have difficulty making ends meet at the end of the month?” was identified as a good predictor of poverty (sensitivity 98%; specificity 60%; OR 32.3, 95% CI 5.4–191.5). Multivariate analysis identified a 3-item case-finding tool including 2 additional questions about food and housing security (sensitivity 64.3%; specificity 94.4%; OR 30.2, 95% CI 10.3–88.1). 85% of below-LICO respondents felt that poverty screening was important and 67% felt comfortable speaking to their family physician about poverty. Conclusions. Asking patients directly about poverty may help identify patients with increased needs in primary care.

/pdf/development-of-a-tool-to-identify-poverty-in-a-family-44uk8rzaly.pdf

Development of a tool to identify poverty in a family practice setting: a pilot study.

N,N-Dimethyltryptamine: DMT-induced psychosis.

In the paper “Development of a Tool to Identify Poverty in a Family Practice Setting: A Pilot Study” [1], two different specificity values were provided in the paper for the study question “Do you [ever] have difficulty making ends meet at the end of the month?” The correct values for this question are a sensitivity 98%; specificity 40%; OR 32.3, 95% CI 5.4–191.5. The specificity was incorrectly reported as 60% in the abstract and in page 2.

/pdf/corrigendum-to-development-of-a-tool-to-identify-poverty-in-h3lbtsu1hy.pdf

Corrigendum to "Development of a Tool to Identify Poverty in a Family Practice Setting: A Pilot Study".

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Development of a tool to identify poverty in a family practice setting: a pilot study.

N,N-Dimethyltryptamine: DMT-induced psychosis.

Corrigendum to "Development of a Tool to Identify Poverty in a Family Practice Setting: A Pilot Study".