Associations Between Prenatal Food Insecurity and Prematurity, Pediatric Health Care Utilization, and Postnatal Social Needs

Sandoval, Vida S.; Jackson, Ashaki; Saleeby, Erin; Smith, Lynne M.; Schickedanz, Adam

doi:10.1016/j.acap.2020.11.020

Cited by 20 publications

(13 citation statements)

References 35 publications

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“…Studies were heterogenous in terms of method, design, sample size, age of participants, social screening tools and housing questions included in screening tools. Study types varied; cross-sectional,30 47 57 65–79 randomised controlled trials,43 44 80–84 pre and post studies,85–88 prospective,89 90 QI,59 91–96 mixed methods,97 98 tool adaptation and validation,99 retrospective100–102 and secondary data analysis 103. Sample sizes ranged from 45 to 56 253 participants.…”

Section: Resultsmentioning

confidence: 99%

“…Housing instability, insecurity or homelessness were the most common housing-related screening questions across the studies, with questions about homelessness, risk of homelessness, sleeping in a shelter, sleeping outside or in a place not meant for sleeping, sleeping in unsafe housing, frequent moving and temporary or unsafe housing 30 43 44 57 65 67 68 71–80 82–84 86–90 92–97 101 102 105 107. Utilities as an unmet need, especially in relation to home heating, were included as a common housing issue captured in the social screening tools of studies in this review.…”

Section: Resultsmentioning

confidence: 99%

“…The Injury Prevention tool was tested for reliability 91. Insufficient information was provided on the validity, feasibility or acceptability of the tools used in 14 studies 30 65 68 69 73 82 85 88 91 93 100–102 105. The information provided for the Quick Risks and Assets Family Triage tool showed some indication of content, construct and predictive validity, however it is unclear whether it was validated 97.…”

Section: Resultsmentioning

confidence: 99%

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Screening and social prescribing in healthcare and social services to address housing issues among children and families: a systematic review

et al. 2022

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ObjectivesHousing is a social determinant of health that impacts the health and well-being of children and families. Screening and referral to address social determinants of health in clinical and social service settings has been proposed to support families with housing problems. This study aims to identify housing screening questions asked of families in healthcare and social services, determine validated screening tools and extract information about recommendations for action after screening for housing issues.MethodsThe electronic databases MEDLINE, PsycINFO, EMBASE, Ovid Emcare, Scopus and CINAHL were searched from 2009 to 2021. Inclusion criteria were peer-reviewed literature that included questions about housing being asked of children or young people aged 0–18 years and their families accessing any healthcare or social service. We extracted data on the housing questions asked, source of housing questions, validity and descriptions of actions to address housing issues.ResultsForty-nine peer-reviewed papers met the inclusion criteria. The housing questions in social screening tools vary widely. There are no standard housing-related questions that clinical and social service providers ask families. Fourteen screening tools were validated. An action was embedded as part of social screening activities in 27 of 42 studies. Actions for identified housing problems included provision of a community-based or clinic-based resource guide, and social prescribing included referral to a social worker, care coordinator or care navigation service, community health worker, social service agency, referral to a housing and child welfare demonstration project or provided intensive case management and wraparound services.ConclusionThis review provides a catalogue of housing questions that can be asked of families in the clinical and/or social service setting, and potential subsequent actions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Screening and social prescribing in healthcare and social services to address housing issues among children and families: a systematic review

et al. 2022

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“…Food insecurity during pregnancy has important implications for the health of the mother and the newborn. Food insecurity during pregnancy has been associated with maternal stress, weight gain, and gestational diabetes [1,2], low birth weight [3], certain birth defects [4], premature birth and hospitalizations for infants less than 6 months of age [5], and inadequate infant feeding practices [6]. Food insecurity can impact dietary quality during pregnancy, which also contributes to negative maternal health and birth outcomes [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…This is particularly important in prenatal care settings, given mounting evidence that supports interventions to reduce risk factors such as food insecurity [13]. Screening for food insecurity during prenatal care visits identifies those at-risk and provides an early opportunity for intervention to support the health of mother and child [5]. Health care settings and their staff can help address food needs among patients by implementing evidence-based screening approaches, referring to community-based resources, connecting patients to public nutrition assistance programs, and providing onsite food and nutrition support [14].…”

Section: Introductionmentioning

confidence: 99%

Missed opportunities to improve food security for pregnant people: a qualitative study of prenatal care settings in Northern New England during the COVID-19 pandemic

et al. 2022

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Background Food insecurity during pregnancy has important implications for maternal and newborn health. There is increasing commitment to screening for social needs within health care settings. However, little is known about current screening processes or the capacity for prenatal care clinics to address food insecurity among their patients. We aimed to assess barriers and facilitators prenatal care clinics face in addressing food insecurity among pregnant people and to identify opportunities to improve food security among this population. Methods We conducted a qualitative study among prenatal care clinics in New Hampshire and Vermont. Staff and clinicians engaged in food security screening and intervention processes at clinics affiliated with the Northern New England Perinatal Quality Improvement Network (NNEPQIN) were recruited to participate in key informant interviews. Thematic analysis was used to identify prominent themes in the interview data. Results Nine staff members or clinicians were enrolled and participated in key informant interviews. Key barriers to food security screening and interventions included lack of protocols and dedicated staff at the clinic as well as community factors such as availability of food distribution services and transportation. Facilitators of screening and intervention included a supportive culture at the clinic, trusting relationships between patients and clinicians, and availability of clinic-based and community resources. Conclusion Prenatal care settings present an important opportunity to identify and address food insecurity among pregnant people, yet most practices lack specific protocols for screening. Our findings indicate that more systematic processes for screening and referrals, dedicated staff, and onsite food programs that address transportation and other access barriers could improve the capacity of prenatal care clinics to improve food security during pregnancy.

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Inclusion of Social and Structural Determinants of Health to Advance Understanding of their Influence on the Biology of Chronic Disease

et al. 2022

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Social Determinants of Health (SDOH) consider social, political, and economic factors that contribute to health disparities in patients and populations. The most common health-related SDOH exposures are food and housing insecurity, financial instability, transportation needs, low levels of education, and psychosocial stress. These domains describe risks that can impact health outcomes more than health care. Epidemiologic and translational research demonstrates that SDOH factors represent exposures that predict harm and impact the health of individuals. International and national guidelines urge health professionals to address SDOH in clinical practice and public health. The further implementation of these recommendations into basic and translational research, however, is lagging. Herein, we consider a precision health framework to describe how SDOH contributes to the exposome and exacerbates physiologic pathways that lead to chronic disease. SDOH factors are associated with various forms of stressors that impact physiological processes through epigenetic, inflammatory, and redox regulation. Many SDOH exposures may add to or potentiate the pathologic effects of additional environmental exposures. This overview aims to inform basic life science and translational researchers about SDOH exposures that can confound associations between classic biomedical determinants of disease and health outcomes. To advance the study of toxicology through either qualitative or quantitative assessment of exposures to chemical and biological substances, a more complete environmental evaluation should include SDOH exposures. We discuss common approaches to measure SDOH factors at individual and population levels and review the associations between SDOH risk factors and physiologic mechanisms that influence chronic disease. We provide clinical and policy-based motivation to encourage researchers to consider the impact of SDOH exposures on study results and data interpretation. With valid measures of SDOH factors incorporated into study design and analyses, future toxicological research may contribute to an evidence base that can better inform prevention and treatment options, to improve equitable clinical care and population health.

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Associations Between Prenatal Food Insecurity and Prematurity, Pediatric Health Care Utilization, and Postnatal Social Needs

Cited by 20 publications

References 35 publications

Screening and social prescribing in healthcare and social services to address housing issues among children and families: a systematic review

Screening and social prescribing in healthcare and social services to address housing issues among children and families: a systematic review

Missed opportunities to improve food security for pregnant people: a qualitative study of prenatal care settings in Northern New England during the COVID-19 pandemic

Inclusion of Social and Structural Determinants of Health to Advance Understanding of their Influence on the Biology of Chronic Disease

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