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Unmet Social Needs and Adherence to Pediatric Weight Management Interventions: Massachusetts, 2017-2019
Micaela Atkins1, Ines Castro1, Mona Sharifi1
1Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston.
Insights
Unmet social needs, particularly housing insecurity, negatively impact adherence to pediatric weight management interventions (PWMI). Addressing these needs is crucial for improving outcomes and reducing childhood obesity disparities.
Area of Science:
- Public Health
- Pediatrics
- Health Disparities
Background:
- Pediatric weight management interventions (PWMIs) aim to combat childhood obesity.
- Adherence to PWMIs is critical for intervention success.
- Unmet social needs may present barriers to consistent engagement in healthcare interventions.
Purpose of the Study:
- To investigate the association between unmet social needs and adherence to pediatric weight management interventions.
- To identify specific social needs that most significantly affect intervention adherence.
Main Methods:
- A comparative effectiveness trial of two high-intensity PWMIs involving children in Massachusetts (2017-2019).
- Assessment of individual social needs (parental stress, parental depression, food insecurity, housing insecurity) and cumulative social needs.
- Statistical models adjusted for child age, BMI, parent BMI, and intervention arm to determine adherence (contact hours).
Main Results:
- Families experiencing housing insecurity had significantly lower intervention contact hours compared to those without.
- Children in families with 3-4 unmet social needs showed significantly reduced adherence.
- After full adjustment, housing insecurity was associated with an average decrease of 3.14 contact hours, and 3-4 unmet social needs with a decrease of 3.74 contact hours.
Conclusions:
- Adherence to pediatric weight management interventions is significantly lower for children with housing insecurity.
- Families facing multiple (3-4) unmet social needs demonstrate reduced engagement in PWMIs.
- Integrating social needs assessment and support into PWMIs is essential to enhance adherence and mitigate childhood obesity disparities.
Abstract:
Objectives. To examine effects of unmet social needs on adherence to pediatric weight management intervention (PWMI).Methods. We examined individual associations of positive screens for parental stress, parental depression, food insecurity, and housing insecurity with intervention adherence, and associations of 0, 1 or 2, and 3 or 4 unmet social needs with adherence, among children enrolled in a 2017-2019 comparative effectiveness trial for 2 high-intensity PWMIs in Massachusetts. Models were adjusted for child age, body mass index (BMI), parent BMI, and intervention arm.Results. Families with versus without housing insecurity received a mean of 5.3 (SD = 8.0) versus 8.3 (SD = 10.9) contact hours (P < .01). There were no statistically significant differences in adherence for families reporting other unmet social needs. Children with 3 to 4 unmet social needs versus without received a mean of 5.2 (SD = 8.1) versus 9.2 (SD = 11.8) contact hours (P < .01). In fully adjusted models, those with housing insecurity attended a mean difference of -3.14 (95% confidence interval [CI] = -5.41, -0.88) hours versus those without. Those with 3 or 4 unmet social needs attended -3.74 (95% CI = -6.64, -0.84) hours less than those with none.Conclusions. Adherence to PWMIs was lower among children with housing insecurity and in families with 3 or 4 unmet social needs. Addressing social needs should be a priority of PWMIs to improve intervention adherence and reduce disparities in childhood obesity.Trial Registration: ClinicalTrials.gov identifier: NCT03012126.
