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Leung CW, Patel MR, Miller M, Spring E, Wang Z, Wolfson JA, Cohen AJ, Heisler M, Hao W. Food Insecurity Prevalence and Risk Factors at a Large Academic Medical Center in Michigan. JAMA Netw Open 2024; 7:e243723. [PMID: 38530312 DOI: 10.1001/jamanetworkopen.2024.3723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Importance Health care systems are increasingly adopting methods to screen for and integrate food insecurity and other social risk factors into electronic health records. However, there remain knowledge gaps regarding the cumulative burden of food insecurity in large clinical settings, which patients are most at risk, and the extent to which patients are interested in social assistance through their health care system. Objective To evaluate the 5-year prevalence and associated risk factors of food insecurity among adult primary care patients, and to examine factors associated with patients' interest in social assistance among those with food insecurity. Design, Setting, and Participants This cross-sectional analysis of a retrospective cohort study took place at a tertiary care academic medical center (encompassing 20 primary care clinics) in Michigan. Participants included adult patients who completed screening for social risk factors between August 1, 2017, and August 1, 2022. Data analysis was performed from November 2022 to June 2023. Exposure Food insecurity was assessed using the Hunger Vital Sign. Main Outcomes and Measures The primary outcome was patients' interest in social assistance, and associated factors were examined using multivariate logistic regression models, adjusting for patients' demographic and health characteristics. Results Over the 5-year period, 106 087 adult primary care patients (mean [SD] age, 52.9 [17.9] years; 61 343 women [57.8%]) completed the standardized social risk factors questionnaire and were included in the analysis. The overall prevalence of food insecurity was 4.2% (4498 patients), with monthly trends ranging from 1.5% (70 positive screens) in August 2018 to 5.0% (193 positive screens) in June 2022. Food insecurity was significantly higher among patients who were younger, female, non-Hispanic Black or Hispanic, unmarried or unpartnered, and with public health insurance. Food insecurity was significantly associated with a higher cumulative burden of social needs, including social isolation, medical care insecurity, medication nonadherence, housing instability, and lack of transportation. Only 20.6% of patients with food insecurity (927 patients) expressed interest in social assistance. Factors associated with interest in social assistance including being non-Hispanic Black, unmarried or unpartnered, a current smoker, and having a higher burden of other social needs. Conclusions and Relevance In this retrospective cohort study, the overall prevalence of food insecurity was 4.2%, of whom approximately 1 in 5 patients with food insecurity expressed interest in assistance. This study highlights ongoing challenges in ensuring all patients complete routine social determinants of health screening and gaps in patients' interest in assistance for food insecurity and other social needs through their health care system.
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Affiliation(s)
- Cindy W Leung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Minal R Patel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
| | | | | | - Zixi Wang
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
| | - Julia A Wolfson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alicia J Cohen
- Center for Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, Rhode Island
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, Brown University School of Public Health Providence, Rhode Island
| | - Michele Heisler
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Wei Hao
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
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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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Lutz MR, Garg A, Solomon BS. Addressing Social Determinants of Health in Practice. Pediatr Clin North Am 2023; 70:695-708. [PMID: 37422309 DOI: 10.1016/j.pcl.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
This review summarizes the current pediatric literature related to social determinants of health, including strengths and weaknesses of screening practices and intervention strategies, common concerns and potential unintended consequences, opportunities for further research, and provides evidence-informed practical strategies for clinicians.
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Affiliation(s)
- Melissa R Lutz
- Department of Pediatrics, Johns Hopkins University School of Medicine, 200 North Wolfe Street, Room 2088, Baltimore, MD 21287, USA
| | - Arvin Garg
- Department of Pediatrics, Child Health Equity Center, UMass Chan Medical School, UMass Memorial Children's Medical Center, 55 Lake Avenue North, Suite S5-856, Worcester, MA 01655, USA
| | - Barry S Solomon
- Department of Pediatrics, Johns Hopkins University School of Medicine, 200 North Wolfe Street, Room 2055, Baltimore, MD 21287, USA.
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Patel MR, Anthony Tolentino D, Smith A, Heisler M. Economic burden, financial stress, and cost-related coping among people with uncontrolled diabetes in the U.S. Prev Med Rep 2023; 34:102246. [PMID: 37252071 PMCID: PMC10209691 DOI: 10.1016/j.pmedr.2023.102246] [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: 09/18/2022] [Revised: 01/02/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023] Open
Abstract
Granular information on material deprivation including financial and economic well-being among people with diabetes can better inform policy, practice and interventions to support diabetes management. The purpose of this study was to describe in-depth the state of economic burden, financial stress, and coping among people with high A1c. Data came from the 2019-2021 baseline assessment in an ongoing U.S. trial that addresses social determinants of health among people with diabetes and high A1c who report at least one financial burden or cost-related non-adherence (CRN) (n = 600). Mean age of participants was 53 years. Planning behaviors were the most common financial well-being behavior, while savings was least frequently endorsed. Nearly a quarter of participants report spending more than $300 per month out-of-pocket to manage all of their health conditions. Participants reported spending the most out-of-pocket on medications (52%), special foods (40%), doctor's visits (27%), and blood glucose supplies (22%). Along with health insurance, these were also the most cited as sources of financial stress and where assistance. Seventy-two percent reported high levels of financial stress. Maladaptive coping was evident through CRN, and less than half engaged in adaptive coping such as talking to a doctor about cost or using a resource to address their needs. Economic burden, financial stress, and cost-related coping are highly relevant constructs among people with diabetes and high A1cs. More evidence-generation is needed for diabetes self-management programs to address sources of financial stress, facilitate behaviors to enhance financial well-being, and address unmet social needs to alleviate economic burdens.
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Affiliation(s)
- Minal R. Patel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, United States
| | | | - Alyssa Smith
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, United States
| | - Michele Heisler
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, United States
- Department of Internal Medicine, Michigan Medicine, United States
- U.S. Department of Veterans Affairs VA Ann Arbor Healthcare System, United States
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Patel MR, Smith A, Torby M, Isaacson N, Cohen AJ. Predictors of Interest in Offered Social Care Assistance Among People with Uncontrolled Diabetes. Popul Health Manag 2022; 25:744-752. [PMID: 36315180 PMCID: PMC10024070 DOI: 10.1089/pop.2022.0186] [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] [Indexed: 12/29/2022] Open
Abstract
Despite increasing resources dedicated to identifying and addressing social risks in health care settings, many patients screening positive for social risks either decline assistance or do not follow up with offered resources. This study assessed predictors of engagement with offered social care assistance through guided self-navigation or in-person assistance. Data came from a cross-sectional analysis of 6-month follow-up survey data from an ongoing trial of participants with poorly controlled diabetes and a positive social risk screen randomized to guided online self-navigation or in-person social care assistance. Multivariable logistic regression models estimated participant characteristics associated with engagement with offered assistance. Mean age was 55 years (standard deviation = 12). Of 407 participants, 41% (n = 165) engaged with offered assistance: 76% (n = 137) of those in the guided self-navigation arm and 13% (n = 28) of those in the in-person assistance arm. A sizable proportion of participants endorsed already using assistance for medications (30%), food (26%), and employment (22%). Female gender [OR 1.57, 95% CI (1.03-2.40), P < 0.05] and being out of the workforce [OR 1.71, 95% CI (1.07-2.73), P < 0.05] predicted engagement with social care assistance. Those already using assistance for medications [OR 4.71, 95% CI (1.69-13.15), P < 0.05] and blood glucose supplies [OR 6.25, 95% CI (1.45-26.78) P < 0.05] were also more likely to engage with offered assistance. Fewer than half of individuals engaged with offered social assistance through either guided online self-navigation or in-person assistance; limited demographic and clinical factors predicted uptake. More investments are needed to understand how best to support uptake of offered assistance.
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Affiliation(s)
- Minal R. Patel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Alyssa Smith
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Michelle Torby
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Nicole Isaacson
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Alicia J. Cohen
- Department of Family Medicine, VA Providence Healthcare System, Providence, Rhode Island, USA
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
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Fichtenberg CM, De Marchis EH, Gottlieb LM. Understanding Patients' Interest in Healthcare-Based Social Assistance Programs. Am J Prev Med 2022; 63:S109-S115. [PMID: 35987522 DOI: 10.1016/j.amepre.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/13/2022] [Accepted: 04/17/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Caroline M Fichtenberg
- Social Interventions Research & Evaluation Network (SIREN), University of California San Francisco, San Francisco, California; Department of Family and Community Medicine, University of California San Francisco, San Francisco, California.
| | - Emilia H De Marchis
- Social Interventions Research & Evaluation Network (SIREN), University of California San Francisco, San Francisco, California; Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - Laura M Gottlieb
- Social Interventions Research & Evaluation Network (SIREN), University of California San Francisco, San Francisco, California; Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
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