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Implementation of Diaper Insecurity Screening
Deanna Reinoso1,2,3, Haleigh Kampman1,4, Randall W Grout1,2,3,5
1Regenstrief Center for Health Equity Research at Eskenazi Health, Indianapolis, Indiana.
Insights
Diaper insecurity affects 41% of young children in urban health centers, disproportionately impacting minority and non-English speaking populations. Routine screening in healthcare settings can connect families to vital social driver of health resources.
Area of Science:
- Pediatric Health
- Social Determinants of Health
- Public Health Interventions
Background:
- Diaper insecurity, defined as a lack of sufficient diapers, is a critical yet often overlooked social driver of health (SDOH) impacting infant and child well-being.
- Addressing diaper insecurity is essential for maintaining child hygiene, preventing health issues, and supporting overall family stability within vulnerable populations.
Purpose of the Study:
- To evaluate the implementation of routine diaper insecurity screening and a diaper resource program in a safety-net health system.
- To determine the prevalence of diaper insecurity and analyze associated demographic factors, co-occurring SDOH, and health outcomes in pediatric patients.
Main Methods:
- A retrospective cross-sectional study was conducted across 9 urban Federally Qualified Health Centers (FQHCs).
- Pediatric patients aged 0-36 months were screened for diaper insecurity between June 2022 and July 2024, with data extracted from electronic health records for 16,677 unique patients.
Main Results:
- Of 16,677 eligible patients, 46% were screened, revealing a 41% prevalence of diaper insecurity.
- Non-Hispanic Black (45%) and Hispanic (39.9%) patients, and those preferring Haitian Creole (66%), showed the highest prevalence. Screening rates were equitable by race/ethnicity but inequitable by language.
- Diaper insecurity frequently co-occurred with food insecurity (78%), transportation insecurity (65%), homelessness (72%), housing payment insecurity (71%), and financial insecurity (88%). Associated factors included maternal depression, low birth weight, and increased emergency department visits.
Conclusions:
- Routine diaper insecurity screening within a healthcare setting effectively identifies significant prevalence, particularly among specific racial, ethnic, and language groups.
- This integrated approach offers a crucial opportunity to link families facing diaper insecurity with essential community resources and support services.
Objective:
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.
Methods:
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.
Results:
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.
Conclusion:
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.
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