The Association Between Food Insecurity, Parental Stress, and Child Development.

BACKGROUND AND OBJECTIVES: It is recognized that development in the 0-to-5-year period is predictive of lifelong health and well-being and that early childhood development is influenced by parental mental health. Social stressors such as food insecurity can exacerbate parental mental health issues. METHODS: To improve understanding of this complex interplay, a primary care pediatric practice designed an innovative meal and grocery delivery program for families experiencing food insecurity with at least one child aged 0-5 years. As part of the program, food insecurity, parental mental health, and child development were assessed. RESULTS: Food insecurity was found to be correlated with increased stress in the parent-child system, and increased stress was found to be strongly correlated with delays in early childhood developmental progress. CONCLUSIONS: These findings suggest that changes in the parent-child relationship resulting from increased parental stress due to food insecurity can play a role in influencing early childhood development.

Social Connectedness as a Determinant of Health in African-American Low-Income Families with Young Children: A Cross-Sectional Cohort Study.

OBJECTIVE: This cross-sectional study aimed to assess the level of social connectedness (SC) in African-American low-income families with young children attending a pediatric primary care clinic and examine its relationships with food insecurity and parental well-being. METHODS: This cross-sectional analysis used data from the Healthy Children and Families program, a cohort intervention study addressing food insecurity, conducted by an urban pediatric clinic serving low-income predominantly African-American families. Twenty-seven families completed baseline screening tools, including the Social Provisions Scale five-question short form (SPS-5) to measure SC, a modified version of the United States Department of Agriculture (USDA) Household Food Security Survey Module six-item short form to assess food insecurity, and the Parental Stress Index Short Form to measure parental stress. Descriptive statistics, correlations, and partial correlations were conducted to analyze the data. RESULTS: The average SPS-5 composite score was 14.5 on a scale of 5 to 20. Moderate negative correlations were identified between SC and food insecurity, weaker when controlled for parental stress. Strong negative correlations were identified between SC and parental stress that held when controlled for food insecurity. CONCLUSION: In this study, we propose a conceptual framework highlighting the complex interplay of social connectedness with other social determinants of child health. The findings align with the 2023 Surgeon General's Advisory on the epidemic on the healing effects of social connection and provide insight into the value of incorporating SC assessments into routine screenings in pediatric primary care settings. Further research is needed to explore causal relationships and evaluate the effectiveness of interventions designed to enhance SC in diverse populations.

Women, Infants, and Children (WIC) Enrollment: Learning From Key Informants to Enhance Utilization.

Enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is suboptimal, particularly for eligible children aged 1 to 4 years. We used converged data from key informants from October 2021 to January 2023 to understand the barriers to and opportunities for WIC utilization and the role of the health care provider in links to WIC. Families and WIC staff identified gaps in provider knowledge and an expressed need for improved collaboration between health providers and WIC. (Am J Public Health. 2023;113(S3):S220-S223. https://doi.org/10.2105/AJPH.2023.307443).

Development and Utilization of a Diagnostic Support Tool for Asthma within the Electronic Medical Record.

Asthma in childhood is a common and costly chronic disease. Quality asthma care can lead to better control of asthma thus decreasing use of health services. The gold standard for pediatric asthma diagnosis and management is the National Heart, Lung and Blood Institute (NHLBI) guidelines for Diagnosis and Management of Asthma which center on precisely establishing the severity of asthma, as this precise classification delineates appropriate therapy. However, navigating these guidelines is a challenge for primary care providers that creates a barrier to providing quality care. We aim to improve precision in asthma severity classification in the community healthcare setting through the development of an electronic asthma decision support tool (eADST) incorporating NHLBI guidelines embedded within the electronic health record system. We developed an algorithm for the eADST to guide the health care provider to the appropriate classification and subsequent therapy. We engaged our health system's electronic health record informatics team and together developed and revised the tool. We launched the tool in three academic community clinics and measured precision in asthma classification in the twelve months prior to the availability of the tool and the twelve months following the launch. We found a significant improvement in precision of asthma severity classification following the launch, a necessary first step in improvement of asthma care. The next step will be to evaluate the impact of the tool on asthma outcomes.

Strategies to improve enrollment in The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): examining high coverage states and leveraging successful COVID-19 pandemic adjustments.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an essential program in the USA providing food benefits and nutritional and breast-feeding support to low-income pregnant or postpartum women, infants and children at nutritional risk. Despite similarities amongst federal regulations shared across WIC programs at the state level, important differences in the operations, policies and technologies between states exist. Nationally, nearly half of women, infants and children who were eligible to receive WIC benefits in 2018 were not participating in the program. In this paper, we evaluate common practices exhibited by states with the highest and lowest WIC coverage rates to identify strategies that may improve enrollment and retention rates in regions with low WIC coverage rates. We use WIC as a case study for identifying strategies that can be broadly applied to improve utilisation of similar food assistance programs globally, particularly those benefiting low-income women and children. The four strategies discussed here include utilising data to check adjunctive eligibility and reach eligible non-participants, increasing public awareness of WIC through outreach and referral efforts, implementing a centralised smartphone app and linking personal electronic benefits and streamlining the use of technologies for online applications, participant portals and remote communication. In most states, the COVID-19 pandemic and the federal waivers issued in response have offered the opportunity to promptly implement some of these strategies, particularly with regard to remote communication capabilities. With proper resources and implementation, these strategies can improve utilisation of WIC and similar programs globally.

Sociodemographic predictors of exclusive breast-feeding among low-income women attending a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programme.

OBJECTIVE: To describe infant feeding practices and predictors of exclusive breast-feeding among women attending a local Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programme. DESIGN: Cross-sectional survey. Outcomes included reported infant feeding practices at 3 and 6 months, timing and reasons for introduction of formula. Descriptive statistics, χ 2 tests and logistic regression were used describe the sample and explore relationships between variables. SETTING: Loudoun County, VA, USA. SUBJECTS: A sample of 190 predominantly Hispanic women attending local WIC clinics. RESULTS: Overall, 84 % of women reported ever breast-feeding and 61 % of infants received formula in the first few days of life. Mothers who reported on infant feeding practices were less likely to exclusively breast-feed (34 v. 45 %) and more likely to provide mixed feeding (50 v. 20 %) at 3 months compared with 6 months, respectively. Significant (P<0·05) predictors of exclusive breast-feeding at 3 months included setting an exclusive breast-feeding goal and completing some high school (compared with completing high school or more). Only education remained a significant predictor of exclusive breast-feeding at 6 months. CONCLUSIONS: A high proportion of women reported giving formula in the first few days of life and many changed from mixed to exclusive breast-feeding or formula by 6 months, suggesting possibly modifiable factors. Further investigation can help drive direct service- as well as policy and systems-based interventions to improve exclusive breast-feeding.