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Our research demonstrates a link between a child’s health and developmental outcomes and their social determinants of health, such as food insecurity, social connectedness, and parental stress.
It’s a story that is too common: A child comes to the pediatrician’s office with poorly controlled asthma and struggling to reach developmental milestones. The parents are worried about their child’s health and feel stressed about making ends meet. In healthcare, particularly in pediatrics, we know that health outcomes do not appear in a vacuum. The child we see is part of a family and a community that impacts their health, which is affected by greater historical and current structural conditions.
In our clinic, we wanted to understand the complex interplay between many of these social determinants of health (SDOH) so we can develop, implement, and continue to assess screening and response to SDOH in the primary care setting.
Our recent studies, including one recently published in the Journal of Developmental and Behavioral Pediatrics, another presented at the Pediatric Academic Societies, and an upcoming Family and Community Health article, are helping us build this framework. We have found that food insecurity, parental stress, housing quality, and social connection impact child health and well-being, but also that the effects of these social stressors on parental stress are profound, which in turn likely directly impacts child health.
Figure 1: Our research is helping us build a framework for the complex interplay between social determinants of health. These connections show moderate to strong correlations with child health outcomes. Parental stress is also related to these social stressors and can be a mediator with child development and emotional health outcomes.
Other social health factors link to social connections.
In our article published in the Journal of Developmental and Behavioral Pediatrics entitled “Social Connectedness as a Determinant of Health in African-American Low-Income Families with Young Children: A Cross-Sectional Cohort Study,” we looked more closely at this relatively new area of study of social connectedness (SC) in families with young children.
Social connection is feeling a sense of belonging to a group or community that shares your values and knowing there are people or a community around to share life’s joys and support you when you need it. The U.S. Surgeon General’s 2023 Advisory, “Our Epidemic of Loneliness and Isolation,” laid out the science and the stakes behind social connection and health. It notes that even before the COVID-19 pandemic, about half of U.S. adults said they had measurable levels of loneliness. Health risks from social isolation are comparable to smoking cigarettes every day, the Surgeon General said, including a 60% higher rate of premature death. There is a growing body of literature linking social connections to health outcomes, but there is very little in the pediatric literature.
Using data from our Healthy Children and Families Program research examining food insecurity, we performed a cross-sectional study of 27 families in an urban pediatric clinic that serves primarily low-income African Americans. We measured the connection of SC to other SDOHs using three screening tools:
- The Social Provisions Scale five-question short form to measure social connectedness
- A modified version of the U.S. Department of Agriculture’s Food Security Module
- The Parental Stress Index Short Form
After statistical analysis, our data revealed that social connection shares complex interactions with food insecurity and parental stress. We postulate how these factors intersect with other SDOHs, like housing insecurity and access to education, healthcare, and transportation.
For instance, food insecurity can cause caregivers to feel the social stigma that contributes to increased social isolation. Likewise, social isolation can cause or exacerbate food insecurity due to having fewer financial buffers and fewer possibilities for meal sharing. A lack of social connection can cause parental stress because parents may not have the support with daily tasks and challenges of parenting. Parents with mental health challenges can have a difficult time building and maintaining social connections. While more research is needed to explore cause and effect, these findings demonstrate the value of incorporating assessments for social connection into routine primary pediatric care.
These findings align with The Surgeon General’s Advisory, which presents a national strategy to advance social connection: “support a whole-of-society approach to advancing social connection. In Pillar 3, “Mobilize the Health Sector,” the report recommends “integrating social connection into primary, secondary, and tertiary level prevention and care efforts.”
Fortunately, social connection, food insecurity, and parental stress are adjustable on the family and community levels. Now that we know how much these interrelated factors impact health outcomes, we are working toward expanding our services to screen for and address these SDOHs and toward solutions for structural change in our community.
For the child mentioned in the article, along with many others like him, we have realized that simply treating his asthma and referring him for developmental testing, only to see him again next year, is not enough. Upon learning more about his family’s well-being, it has become apparent that they recently moved from another state and lack support in the area, which has left them feeling socially isolated. Despite working two jobs, they struggle to make ends meet and put food on the table. Additionally, their apartment is frequently infested with roaches and rodents.
In our clinic, through the support of the A. James and Alice B. Clark Foundation/D.C. Safe Babies Safe Moms, the J. Willard and Alice S. Marriott Foundation, and D.C. Health, we have established a holistic, integrated team as part of our primary care services to screen for and address these needs and have forged strong relationships with community partners. For example, we have built a Food as Medicine program that delivers fresh fruits, vegetables, and groceries to families with partners such as Power of 10, Dreaming Out Loud, and Fresh Farms. We have a long partnership with Yachad Healthy Homes and Georgetown Health Justice Alliance to help families live in safe and clean housing. We have integrated mental health services into our practice for children and parents.
As we have learned more about the power and complexity of social connection on child health, we intentionally support strong social and community connections and promote self-efficacy and self-advocacy with our partners at the Power of 10, Georgetown University School of Nursing and Spaces in Action. With our partners at Georgetown Law, the MedStar Health Research Institute, and Georgetown’s McCourt School of Public Policy, we are building an innovative medical-financial partnership to help families achieve sustainable financial health.
