This research was first presented at the American Speech Language Hearing Convention in  November, 2022.

What are social determinants of health (SDoH) and why do they matter?

SDoH describe the factors about the environment in which we live that may impact our health. The Healthy People 2030 campaign groups SDoH into 5 domains:

• Economic Stability: The ability to meet your needs through financial means. This can  include having steady employment and earning a living wage. 
• Education Access and Quality: Access to high-quality educational opportunities, like  having good schools in your neighborhood or resources that allow you to graduate  from high school. 
• Health Care Access and Quality: Access to high-quality healthcare. This can include  having insurance coverage for the care you need and high-quality providers in the area  where you live. 
• Neighborhood and Built Environment: Living in a neighborhood that helps promote  your health, such as neighborhoods with low rates of violence, spaces designed to  facilitate physical activity (i.e., bike lanes, parks), and low levels of pollution.
• Social and Community Context: The support you have available in your community.  This can include things like reducing bullying or learning positive communication  methods. 

There is ample research (see this page for some free literature summaries) that SDoH impact  people’s health, and specifically that SDoH impact preterm infant morbidity, mortality, quality of  care, and post-discharge care. However, there is not yet research about how SDoH may impact  infants’ health as it relates to feeding specifically. 

Our Analysis

Who and Where?

We looked at a group of 204 high-risk infants from a larger study that  examines infant feeding from neonatal intensive care unit through age 2. Infants were recruited  from a regional hospital in the Southeastern United States. For this analysis, we looked at their  data from 2-months, 4-months, and 6-months adjusted age. These infants were mostly Black  (44.12%) or White (47.06%), male (54.9%) and had at least one medical risk factor (50.98%). 

What?

Parents filled out online surveys about their infant’s feeding problems, the feeding related care they accessed and their satisfaction with it, and the impact feeding had on them  and their family. We also pulled data from the infant’s medical record to see if their health  status, sex, or race impacted their outcomes. 

The SDOH of health we looked at were: 

• Economic Stability: Family Income 
• Education Access and Quality: Parental Education
• Health Care Access and Quality: Type of Healthcare Coverage (Medicaid/Need-Based  versus Private Insurance)
• Neighborhood and Built Environment: Food Insecurity

We used statistical analyses to answer the question: do SDoH or infant health/demographic  factors impact: (a) whether the infant receives feeding-related services in the first 6 months; (b)  parents’ satisfaction with the feeding-related care they receive; (c) how much feeding was  impacting the parent or family? 

Our Findings

Do SDoH or infant health/demographic factors impact whether the infant receives feeding related services after NICU discharge?

Yes. Infants whose parents had a 4-year degree were  more likely to get feeding related services than infants whose parents had a high school  education. Also, being older at discharge was related to being more likely to receive feeding  related services.

Do SDoH or infant health/demographic factors impact parents’ satisfaction with the feeding related care they receive?

Yes. Parents who reported food insecurity also reported lower  satisfaction with the feeding related care their infant received. Infants whose reported race was  White had parents who were more likely to be satisfied with the feeding related care received. 

Do SDoH or infant health/demographic factors impact how much feeding was impacting the  parent or family?

Yes. Parents who had a high school degree or less reported the highest impact  of feeding on their family. Impact was lower in those with a 4-year degree, and lowest in those  with some post-high school education. Also, being older at discharge was related to a greater negative impact that feeding had on the parent.

Key Takeaways

All research has limitations – this was a small group from one hospital, and we only looked at a  few SDoH variables. We also only looked at their outcomes through 6-months corrected age.  

But, we did find evidence that SDoH impact the care infants receive, parent satisfaction with  that care, and the impact of infant feeding on the parent/family in the first 6 months. 

We recommend:

• More and larger scale research on how SDoH impact pediatric feeding
• Screening for SDoH at all feeding assessments. You can find some information and tools  from Texas Children’s Hospital here.
• Exploring the resources in your community for addressing SDoH