Implementation of Diaper Insecurity Screening

To describe the integration of routine diaper insecurity screening and diaper resource program within a safety net health system and to report diaper insecurity prevalence, demographic characteristics, co-existing social drivers of health (SDOH), and associated health outcomes.

A retrospective cross-sectional study was conducted in 9 urban Federally Qualified Health Centers (FQHC). Pediatric patients, aged 0 to 36 months, were screened for diaper insecurity from June 2022 to July 2024. Data from 16 677 unique patients were extracted and analyzed from the electronic health record.

Of 16 677 pediatric patients potentially eligible for screening, 7700 (46%) were screened for diaper insecurity. Diaper insecurity prevalence was 41% (n = 3147). The highest diaper insecurity prevalence was reported by non-Hispanic Black 45% (n = 1462) and Hispanic 39.9% (n = 1352) patients, and those preferring to communicate in Haitian Creole (n = 748, 66%). Screening rates were equitable by race/ethnicity but inequitable for most preferred languages other than English.Diaper insecurity often co-occurs with other SDOH with 78% (n = 951) also reporting food insecurity; 65% (n = 963) transportation insecurity; 72% (n = 97) unhoused/homeless; 71% (n = 484) rent/mortgage payment insecurity; and 88% (n = 445) with financial insecurity; 48% (n = 1042) of households report receiving Supplemental Nutrition Assistance Program benefits.Maternal depression, low birth weight, fewer toilet training difficulties, and increased emergency department visits were all associated with diaper insecurity.

Integration of diaper insecurity screening within a health system reveals frequent reports of diaper insecurity with significant differences in prevalence among racial, ethnic, and language subgroups. Conducting this screening in the context of a health care visit provides opportunities to connect patients to essential resources.