Social Determinants Of Health Research Articles

American Headache Society white paper on treatment of post-traumatic headache from concussion in youth.

To provide healthcare professionals guidance on youth at risk for prolonged recovery and post-traumatic headache (PTH), and on pharmacologic and non-pharmacologic management of PTH due to concussion and mild traumatic brain injury. Headache is the most common persistent post-concussive symptom affecting 8% of youth for >3 months after concussion. Over the past decade, many studies have explored the treatment of PTH in youth, but there are no established guidelines. This white paper is based on a synthesis of an updated systematic review of the literature on treatment of PTH and a narrative review of the literature on risk factors for prolonged recovery and health disparities. Results were interpreted by a group of expert providers in PTH in children and adolescents through collaboration of the PTH and pediatric special interest groups of the American Headache Society. Factors that consistently were associated with prolonged recovery from concussion and persistent PTH included female sex, a high number of acute symptoms, and adolescent age. Social determinants of health also likely play an important role in PTH and deserve consideration in the clinical and research settings. A total of 33 studies met the criteria for inclusion in the systematic review of PTH treatment in youth, although most were retrospective and of fair-to-poor quality. Treatment strategies included acute and preventive pharmacologic management, procedures, neuro-modulatory devices, physical therapy, physical activity, and behavioral health support. A collaborative care approach that includes a thoughtful combination of these management strategies is likely most effective. This white paper provides a roadmap for tailoring the treatment of PTH based on factors influencing prolonged headache, the timing of therapies, and therapies with the most evidence for treating PTH in youth. We also highlight research needed for developing more definitive guidelines on PTH management in youth.

Social Needs Screening in Academic Health Systems: A Landscape Assessment.

Screening for social needs has gained traction as an approach to addressing social determinants of health, but it faces challenges regarding standardization, resource allocation, and follow-up care. The year-long study, conducted by the Association of American Medical Colleges, integrated data from conferences, surveys, and key informant interviews to examine the integration of social needs screening into health care services within Academic Health Systems (AHS). The authors' analysis unveiled eight key themes, showcasing AHS's active involvement in targeted social needs screening alongside persistent resource allocation obstacles. AHS are dedicated to efficiently identifying high-risk populations, fostering partnerships with community-based organizations, and embracing technology for closed-loop referrals. However, concerns endure about the utilization of reimbursement codes for social needs and regulatory compliance. AHS confront staffing issues, resource allocation intricacies, and the imperative for seamless integration across clinical and nonclinical departments. Notably, opportunities arise in standardized training, alignment of AHS priorities, exploration of social investment models, and engagement with state-level health information exchanges. Aligning clinical care, research pursuits, and community engagement endeavors holds promise for AHS in effectively addressing social needs.

Patients Experience Significant Long-term Social and Health Challenges after Major Lower Extremity Amputation

Major lower extremity amputation is a significant life-changing event that can have long-term implications. The goal of this study was to assess long-term medical outcomes and social determinants of health (SDH) challenges in this population. A retrospective review of major lower extremity (above ankle) amputations (2018-2022) was performed at a safety-net tertiary care center. Patients who participated in a SDH survey between 6-months to 1.5 years postoperatively were included for survey analysis. Patient demographics, comorbidities, and perioperative and long-term outcomes were analyzed. There were 100 patients included. Mean age was 61.5 years and 23% were of female gender. The majority (57%) were Black race, 20% White race, and 21% Hispanic ethnicity. Comorbidities included diabetes (78%), chronic kidney disease (51%), coronary artery disease (31%), congestive heart failure (23%), previous cerebrovascular events (19%), and 37% used opioids preadmission. At baseline, the majority (62%) lived at home. Guillotine amputation was performed in 24%, with definitive amputation below and above knee in 67% and 33%, respectively. Median length of stay was 7 days. Readmission at 30, 90 days, and 1-year was 13%, 30%, and 43% respectively. The average follow-up was 839 days. At long-term follow-up, 55% lived at home, 25% used opioids, and only 25% were independently ambulatory. In the SDH survey at follow-up, 32% identified at least one SDH challenge, with younger patients more often affected (58 vs. 63 years, P=.031). SDH challenges consisted of food insecurity (17%), housing insecurity (13%), transportation challenges (13%), seeking employment (8%), difficulty paying for utilities (5%) and medications (4%), seeking further education (5%), and difficulty caring for family/friends (4%). On multivariable analysis, having at least one SDH challenge was independently associated with 1-year readmission (OR 6.7, 95% CI 1.3-35.8, P<.001). Older age was associated with lower long-term independent ambulation (OR 0.92, 95% CI 0.85-0.99, P=.025). After major lower extremity amputation, patients have significant medical and social challenges with fewer living at home, the majority were not independently ambulatory, and one third having at least one SDH challenge. Improvements in long-term support including medical, social, and rehabilitation services are required for this vulnerable population.

Impact of systematic screening for social determinants of health in a level IV neonatal intensive care unit.

Objective : To determine whether screening for social determinants of health (SDoH) in a level IV neonatal intensive care unit (NICU) could uncover additional family needs. Methods : Secondary analysis of a prospective study in a level IV NICU. Participants filled out the Protocol for Responding to and Assessing Patients' Assets, Risks and Experiences (PRAPARE) tool, which includes economic, housing, transportation, and safety questions. Questionnaires were completed via secure tablet; the research team notified social workers of reported needs. Illness and demographic characteristics were compared between families who did and did not report resource needs. Manual chart review assessed subsequent response to reported SDoH needs. Results : Of 319 respondents, 61(19%) reported resource needs. Of 61 families, 88% received repeat social work encounter to re-assess for resources; 59% received new resource referrals. Conclusions : Systematic SDoH screening can identify needs throughout the NICU stay, even among families already connected to social work support.

Multi-modality risk prediction of cardiovascular diseases for breast cancer cohort in the All of Us Research Program.

This study leverages the rich diversity of the All of Us Research Program (All of Us)'s dataset to devise a predictive model for cardiovascular disease (CVD) in breast cancer (BC) survivors. Central to this endeavor is the creation of a robust data integration pipeline that synthesizes electronic health records (EHRs), patient surveys, and genomic data, while upholding fairness across demographic variables. We have developed a universal data wrangling pipeline to process and merge heterogeneous data sources of the All of Us dataset, address missingness and variance in data, and align disparate data modalities into a coherent framework for analysis. Utilizing a composite feature set including EHR, lifestyle, and social determinants of health (SDoH) data, we then employed Adaptive Lasso and Random Forest regression models to predict 6 CVD outcomes. The models were evaluated using the c-index and time-dependent Area Under the Receiver Operating Characteristic Curve over a 10-year period. The Adaptive Lasso model showed consistent performance across most CVD outcomes, while the Random Forest model excelled particularly in predicting outcomes like transient ischemic attack when incorporating the full multi-model feature set. Feature importance analysis revealed age and previous coronary events as dominant predictors across CVD outcomes, with SDoH clustering labels highlighting the nuanced impact of social factors. The development of both Cox-based predictive model and Random Forest Regression model represents the extensive application of the All of Us, in integrating EHR and patient surveys to enhance precision medicine. And the inclusion of SDoH clustering labels revealed the significant impact of sociobehavioral factors on patient outcomes, emphasizing the importance of comprehensive health determinants in predictive models. Despite these advancements, limitations include the exclusion of genetic data, broad categorization of CVD conditions, and the need for fairness analyses to ensure equitable model performance across diverse populations. Future work should refine clinical and social variable measurements, incorporate advanced imputation techniques, and explore additional predictive algorithms to enhance model precision and fairness. This study demonstrates the liability of the All of Us's diverse dataset in developing a multi-modality predictive model for CVD in BC survivors risk stratification in oncological survivorship. The data integration pipeline and subsequent predictive models establish a methodological foundation for future research into personalized healthcare.

US State and Territorial Indigenous Consultation Laws: A Potential Strategy to Improve the Social Determinants of Health.

The United Nations (UN) has articulated the right to self-determination as a human right for Indigenous people; however, US states and territories have been slow to operationalize this aspect of the UN Declaration on the Rights of Indigenous Peoples. Indigenous consultation laws require all federal executive agencies to consult with tribal nations before implementing policies that have a "tribal implication," and these form the cornerstone of US efforts to implement the UN Declaration on the Rights of Indigenous Peoples. Despite these federal efforts, less is known about the degree to which state and territorial laws require consultation with Indigenous communities. We reviewed all Indigenous consultation laws identified through a search of 50 US states, the District of Columbia, and 5 territories to provide a holistic picture of how jurisdictions have regulated Indigenous consultation efforts. Of the 56 states, 49 (87.5%) had at least 1 Indigenous consultation law; the remaining 7 jurisdictions had none. States engaged in Indigenous consultation in various ways, generally falling into 1 of 3 categories: (1) centralized consultation facilitated through an agency or department, (2) indirect consultation through a designated commission, and (3) fragmented Indigenous consultation through discrete laws. Important gaps were identified, including the lack of a definition for Indigenous consultation, the absence of an appeal process, and the need to train state officials on existing policies. The results provide a baseline on the degree to which US states and territories consult with Indigenous communities and can be used to identify gaps in US compliance with UN human rights mandates.

How can healthcare organisations improve the social determinants of health for their local communities? Findings from realist-informed case studies among secondary healthcare organisations in England

ObjectivesIncreasingly, healthcare and public health strategists invite us to look at healthcare organisations as not just care providers but as anchor institutions (ie, large community-rooted organisations with significant impact in...

Neighborhood-level Social Determinants of Health Burden among AYA Cancer Patients and Impact on Overall Survival.

Neighborhood socioeconomic deprivation has been linked to adverse health outcomes, yet it is unclear if neighborhood-level social determinants of health (SDOH) measures impact overall survival in adolescent and young adult (AYA) cancer patients. This study utilized a diverse cohort of AYA cancer patients (N = 10,261) seen at MD Anderson Cancer Center. Zip codes were linked to Area Deprivation Index (ADI) values, a validated neighborhood-level SDOH measure, with higher ADI representing worse SDOH. ADI was significantly worse (p < .05) for Black (61.7) and Hispanic (65.3), compared to White (51.2) patients. Analysis of ADI by cancer type showed significant differences, mainly driven by worse ADI in patients with cervical cancer (62.3) than other cancers. In multivariable models including sex, age at diagnosis, cancer diagnosis, and race/ethnicity, risk of shorter survival for people residing in neighborhoods with the least favorable ADI quartile was greater than those in the most favorable ADI quartile (HR: 1.09, 95% CI: 1.00-1.19, p = .043). AYA cancer patients with the worst ADI experienced a nearly 10% increase in risk of dying compared to those with more favorable ADI and this effect was strongest among White AYA survivors. Although the magnitude of the effect of ADI on survival was moderate, the presence of a relationship between neighborhood-level SDOH and survival among patients who received care at a tertiary cancer center suggests ADI is a meaningful predictor of survival. These findings provide intriguing evidence for potential interventions aimed at supporting AYA cancer patients from disadvantaged neighborhoods.

Influence of socio-environmental factors on stress and chronic disease in an urban population

IntroductionThe primary purpose of this project is to identify the modifiable individual, social and environmental factors associated with stress and to investigate and quantify the effect of persistent stress on chronic disease in a marginalized, primarily minority, urban community.MethodsThis study leveraged data collected as part of Temple Health: Block-By-Block, a longitudinal cohort study conducted over five years in an underserved community. Through in-home visits, 385 subjects completed a Visit 5 Social & Environmental Assessment which measured individual, social, neighborhood, and environmental factors as reported through each participant’s perspectives. A Perceived Stress Scale and a Cumulative Chronic Disease Index was also completed during this visit.ResultsFive of sixteen modifiable risk factors were identified as significant, independent predictors of stress, including general health, employment status, difficulties in paying for basics, home ownership and overall neighborhood quality. These health determinants combined with stress scores significantly predicted chronic disease burden.ConclusionsThis study provides unique, individualized evidence regarding the impact of social determinants of health on levels of stress among community residents, and suggests that stress is an intervening factor in the path to chronic disease. While addressing social determinants of health must be a priority, this study indicates that actionable behavioral and pharmacologic interventions to reduce stress may provide more immediate improvements in prevention and reduction of chronic disease in diverse urban communities.

Young adults in pandemic financial hardship: implications of the social determinants of mental health

ABSTRACT Using a nationally representative sample of U.S. young adults aged 18–29-year-old, this study investigated the relationship between COVID-induced financial hardship and depression (N = 1080). About 40% of the sample had one or more financial hardships, a quarter reported depressive symptoms. The positive association between financial hardship and depression was cumulative: Those who had four different hardships were almost five times more likely to report depressive symptoms than those reported no hardship. Findings highlight the need to include financial stressors in mental health assessment and suggest a comprehensive policy response to mental health crisis among young adults.

Meeting the Health Needs of Society Through Curricular Innovation in Physical Therapist Education: Examples From 3 Entry-Level Programs.

Entry-level physical therapist (PT) education programs play a critical role in inspiring future leaders to become moral change agents, capable of understanding and addressing evolving societal health needs. Social reconstructionism represents an educational philosophy focused on alleviating pervasive inequities and improving the health of society; however, its application in PT education is not well understood. The purpose of this article is to describe the approach 3 entry-level PT programs used to manifest social reconstructionism within their curricula to foster social consciousness and strengthen moral agency. The Framework for Educating Health Professionals to Address the Social Determinants of Health informed the development of a conceptual framework that illustrates the role of PT education programs in creating transformative learning environments and preparing learners to meet societal health needs. Concepts within this framework were operationalized according to 5 domains put forth by Jensen et al. and related competencies put forth by the Association of American Medical Colleges. Narratives from each program demonstrate how the design and implementation of curricula, grounded in social reconstructionism, can be accomplished through 1) ongoing modifications, 2) thoughtful reconstruction, and 3) initial design. Sample learning activities, objectives, and assessment strategies are provided. The proposed method was effective in guiding meaningful objectives, learning activities, and assessment strategies grounded in social reconstructionism. Such findings can inform the design of curricula that inspire the next generation of transformative leaders who work to alleviate pervasive inequities and improve the health of society.

Representation of Social Determinants of Health terminology in medical subject headings: impact of added terms.

To enhance and evaluate the quality of PubMed search results for Social Determinants of Health (SDoH) through the addition of new SDoH terms to Medical Subject Headings (MeSH). High priority SDoH terms and definitions were collated from authoritative sources, curated based on publication frequencies, and refined by subject matter experts. Descriptive analyses were used to investigate how PubMed search details and best match results were affected by the addition of SDoH concepts to MeSH. Three information retrieval metrics (Precision, Recall, and F measure) were used to quantitatively assess the accuracy of PubMed search results. Pre- and post-update documents were clustered into topic areas using a Natural Language Processing pipeline, and SDoH relevancy assessed. Addition of 35 SDoH terms to MeSH resulted in more accurate algorithmic translations of search terms and more reliable best match results. The Precision, Recall, and F measures of post-update results were significantly higher than those of pre-update results. The percentage of retrieved publications belonging to SDoH clusters was significantly greater in the post- than pre-update searches. This evaluation confirms that inclusion of new SDoH terms in MeSH can lead to qualitative and quantitative enhancements in PubMed search retrievals. It demonstrates the methodology for and impact of suggesting new terms for MeSH indexing. It provides a foundation for future efforts across behavioral and social science research (BSSR) domains. Improving the representation of BSSR terminology in MeSH can improve PubMed search results, thereby enhancing the ability of investigators and clinicians to build and utilize a cumulative BSSR knowledge base.

Relationships of race and area deprivation indices to outcomes in pediatric patients with inflammatory bowel disease.

Social determinants of health (SDOH) are nonmedical factors that influence health outcomes. Children with chronic illnesses living with socioeconomic risk factors have higher rates of unfavorable health outcomes. Our study aimed to assess the association between area deprivation indices (ADI), as a proxy for SDOH, and outcomes in pediatric patients with inflammatory bowel disease (IBD). A retrospective chart review was conducted on 134 pediatric patients with IBD, ages 0-21 years. Explanatory variables were the patient's ADI and demographics. Outcomes were assessed from time of diagnosis over a 1-year follow-up period. The primary outcome was the ratio of missed to completed appointments; secondary outcomes were the numbers of IBD-related emergency department (ED) visits and IBD-related hospitalizations. Race/ethnicity was significantly associated with ADI (p < 0.001). In a multivariable regression model, no variables were associated with ratio of missed to completed appointments. Notably, ADI was not significantly associated with the ratio of missed to completed appointments. In a Poisson regression, Black (non-Hispanic) and Hispanic race/ethnicity, Medicaid insurance, female gender, and lower age were significantly associated with more IBD-related ED visits; ADI was not. In a similar model, Black (non-Hispanic) race, Medicaid insurance status, and lower age were significantly associated with more IBD-related hospitalizations; ADI was not. In our cohort, ADI was not significantly associated with the ratio of missed to completed appointments, IBD-related ED visits, and IBD-related hospitalizations; however, race/ethnicity, age at diagnosis, insurance, and gender were associated with these outcomes.

Social Determinants of Health Screening, Referral, and Outcomes: Toward an Evidence-Based Simulation Model.

A more complete conceptual model of the social determinants of health (SDOH) screening and referral process is needed to identify effective interventions to address unmet social needs that impact health outcomes. The objective was to develop an evidence-based, complex, multi-factorial model that makes explicit the behaviors and experiences of both patients and the care team (factors) who use an SDOH platform to facilitate patient connections to community resources. The resulting model organized 88 factors among five main stages in the process and among health outcomes. Factors were grouped into eight categories among person, system, and organization levels. Most factors were related to the screening process, with sparse factors related to referral completion. The resulting model is offered as an initial step toward the development of a simulation model to assess interventions before implementation in real-world settings.

Social Determinants Documented Across Individuals from Different Racial and Ethnic Groups in Home Healthcare.

Home healthcare (HHC) enables patients to receive health services within their homes. Social determinants of health (SDOH) influence a patient's health and may disproportionately affect patients from racially and ethnically minoritized groups. This study describes differences in SDOH documentation in clinical notes among individuals from different racial or ethnic groups from one HHC agency in the northeastern United States. Compared to White patients, HHC episodes for patients across racially and ethnically minoritized groups had higher frequencies of SDOH documented. Further, our results suggest that race or ethnicity is significantly associated with SDOH documentation.

Working in the Margins: The Untapped Potential of Disability Inclusion.

People with disabilities (PWD) are considered a historically marginalized population that experiences significant health disparities resulting from the unequal distribution of resources as evidenced in the social determinants of health. Health professions education presents an opportunity to explore the policy, systems, and environmental (PSE) changes that are needed to improve social conditions and address known disparities for PWD. Evidence suggests that inclusion of learners with diverse lived experiences, including students with disabilities (SWD), strengthens our understanding of the influence of social determinants on health and our ability to address known barriers. Unfortunately, PWD and other minoritized individuals are grossly underrepresented in physical therapy. It is imperative that Doctor of Physical Therapy (DPT) education more intentionally promotes the full inclusion of SWD to improve representation and to better support the complex needs of this population. In this perspective we describe key social determinants of health for PWD, offer strategies for increasing representation and inclusion of SWD in DPT education, and summarize how the inclusion of SWD in DPT education can enhance our understanding of and ability to address social barriers for this population.

Power Relations in Optimisation of Therapies and Equity in Access to Antibiotics (PROTEA) Study: investigating the intersection of socio-economic and cultural drivers on antimicrobial resistance (AMR) and its influence on healthcare access and health-providing behaviours in India and South Africa

Across social structures within society, including healthcare, power relations manifest according to gender, socioeconomic status, race, ethnicity, and class influencing infection related healthcare access and health providing-behaviours. Therefore, accounting for sociocultural drivers, including gender, race, and class, and their influence on economic status can improve healthcare access and health-providing behaviours in infection prevention and control (IPC) as well as antibiotic use, which in turn helps mitigate the spread of antimicrobial resistance (AMR). This Wellcome funded research will investigate how and why the social determinants of health and economic status influence how people seek, experience, and provide healthcare for suspected or proven (bacterial) infections and how these factors influence antibiotic prescribing and use in South Africa (upper middle-income country) and India (lower middle-income country). The aim of this body of work is to, (1) define and estimate the sociocultural and economic drivers for AMR in different resource settings, (2) design, implement and evaluate context-sensitive IPC and antimicrobial stewardship (AMS) interventions, and (3) inform policy and strategy for AMR mitigation. The population will be healthcare workers (HCWs), patients, and their carers across acute medical and surgical pathways where IPC and antibiotic-related healthcare access and health-providing behaviours will be studied. Qualitative methods will include ethnographic research, semi-structured in-depth interviews, and focus groups with healthcare providers, patients and carers. Quantitative analysis of bedside observational data from hospitals and population level data on antibiotic use will study the various predictors of AMR using bivariable and multivariable regression analyses. The research will provide high-quality evidence on how social determinants intersect with health, social well-being, and vulnerability in IPC practices and antibiotic use. Using this knowledge we will: 1) design, implement, and measure effects of interventions accounting for these factors; 2) provide a toolkit for advocacy for actors in AMR, and healthcare to assist them to promote dialogue, including policy dialogue on this issue. This work directly benefits the target population and informs healthcare services and practice across the participating countries with potential for wider translation. The setting will be hospitals in South Africa (middle-income country) and India (lower middle-income country). The population will be healthcare workers (HCWs), patients, and their carers across acute medical and surgical pathways where IPC and antibiotic-related health-seeking and health-providing behaviours will be studied. These populations represent communities most affected by infections and AMR because existing interventions do not address a) differences in how surgical versus medical teams manage infections; b) the role of the wider social network of individuals on their decision-making, c) intersection of the social determinants of health including race, gender, socioeconomic deprivation with AMR.

Work-related socioeconomic determinants of health: evidence from educational mismatch in Italy.

An educational mismatch is defined as the situation where the education qualifications of an employee do not match the qualifications required for the job they do. A mismatch can be vertical where the level of the employee's qualification is not the one required by the job. This study contributes to the literature on work-related social determinants of health, by carrying out the first assessment of the relationship between educational mismatch and health in Italy. Data come from PLUS, a national survey of labor supply. The risk of suffering from bad or very bad health associated with educational mismatch is investigated through a logistic regression model accounting for the socioeconomic context and occupation. Our findings show women are at greater risk of suffering from bad or very bad health than men, especially if under-educated. Our results show the need to address more research on work-related social determinants of health, which can represent a barrier to achieving health equity.

Development and validation of the Global Adolescent and Child Physical Activity Questionnaire (GAC-PAQ) in 14 countries: study protocol

IntroductionGlobal surveillance of physical activity (PA) of children and adolescents with questionnaires is limited by the use of instruments developed in high-income countries (HICs) lacking sociocultural adaptation, especially in low-...

Lifestyles associated with malaria in pregnancy in northwest Colombia: a mixed study from Latin American critical epidemiology

BackgroundIn the scientific literature on Malaria in Pregnancy (MiP), no studies have been conducted on lifestyles based on critical theory. The objective of this study was to analyse the lifestyles or singular processes of social determination of health in MiP in northwestern Colombia.MethodsMixed QUAN-QUAL convergent triangulation study. In the quantitative component, a psychometric evaluation and a cross-sectional design were conducted in 400 pregnant women to whom the Pender-Walker lifestyle scale and a survey on MiP prevention were applied. In the qualitative study, a critical ethnography was conducted with 46 pregnant women in whom their narratives and practices regarding lifestyles at home and healthcare were described.ResultsThe frequency of MiP was 9%, and a higher occurrence of the disease was identified in those who did not control stagnant water (29%), did not use insecticide-treated net (16%) and went to the hospital (14%) or the microscopist (20%) when they had fever. This coincides with the presence of unhealthy lifestyles, little knowledge about malaria, and a low perception of the risk of getting sick, as well as meanings and experiences about MiP, maternity, and pregnancy that show a high clinical, cultural, and socioeconomic burden for the women studied.ConclusionThis epidemiological profile and the approach to lifestyles based on the postulates of critical theory in health evidence that pregnant women exposed to malaria suffer serious social, cultural and health injustices that are not possible to impact with the current health model of malaria control in Colombia guided by aetiopathogenic, biomedical, positivist and utilitarian theories.