Who is in Your Waiting Room? Social Determinants of Health and Adverse Childhood Experiences in Pediatric Surgery Clinics

Ethan Ponton; Tanjot Singh; Matthew Carwana; Damian J Duffy; Rebecca Courtemanche; Douglas J Courtemanche; Christine A Loock; Robert Baird

doi:10.1016/j.jpedsurg.2024.04.001

Who is in Your Waiting Room? Social Determinants of Health and Adverse Childhood Experiences in Pediatric Surgery Clinics

J Pediatr Surg. 2024 Apr 10:S0022-3468(24)00248-3. doi: 10.1016/j.jpedsurg.2024.04.001. Online ahead of print.

Authors

Ethan Ponton¹, Tanjot Singh², Matthew Carwana², Damian J Duffy¹, Rebecca Courtemanche³, Douglas J Courtemanche³, Christine A Loock², Robert Baird⁴

Affiliations

¹ Office of Pediatric Surgical Evaluation and Innovation (OPSEI), BC Children's Hospital, 4480 Oak Street, Vancouver, British Columbia, V6H 3V4, Canada; Department of Surgery, University of British Columbia, BC Children's Hospital, 4480 Oak Street, Vancouver, British Columbia, V6H 3V4, Canada; BC Children's Hospital Research Institute, 938 W 28th Ave, Vancouver, British Columbia, V5Z 4H4, Canada.
² Department of Pediatrics, University of British Columbia, BC Children's Hospital, 4480 Oak Street, Vancouver, British Columbia, V6H 3V4, Canada; BC Children's Hospital Research Institute, 938 W 28th Ave, Vancouver, British Columbia, V5Z 4H4, Canada.
³ Division of Plastic Surgery, University of British Columbia, BC Children's Hospital, 4480 Oak Street, Vancouver, British Columbia, V6H 3V4, Canada; BC Children's Hospital Research Institute, 938 W 28th Ave, Vancouver, British Columbia, V5Z 4H4, Canada.
⁴ Division of Pediatric Surgery, University of British Columbia, BC Children's Hospital, 4480 Oak Street, Vancouver, British Columbia, V6H 3V4, Canada. Electronic address: robert.baird@cw.bc.ca.

PMID: 38744639
DOI: 10.1016/j.jpedsurg.2024.04.001

Abstract

Background: Social determinants of health (SDoH) influence overall health, although little is known about the SDoH for pediatric patients requiring surgical services. This study aims to describe SDoH for pediatric surgical patients attending out-patient, community, and outreach clinics, as well as demonstrate the feasibility of identifying and addressing SDoH and Adverse Childhood Experiences (ACEs) when appropriate.

Methods: A cross-sectional study using surveys evaluating SDoH that were distributed to families attending pediatric surgical clinics over a two-year period. The pilot survey used validated questions and was later refined to a shorter version with questions on: Barriers to care, Economic factors, Adversity, Resiliency and Social capital (BEARS). Data was analyzed with descriptive and inferential statistics.

Results: 851 families across 13 clinics participated. One third of families reported not having a primary health care provider or being unable to turn to them for additional support. One in four families were found to have a household income less than the Canadian after-tax low-income threshold (<$40,000 CAD). Two-thirds of families answered questions about ACEs, and those with more ACEs were more likely to report a low income. Forty percent of families rarely or only sometimes had adequate social support.

Conclusion: This survey tool enabled discussions between families and care providers, which allowed clinicians to appropriately follow-up with families and refer them to social work for further support when indicated. Addressing concerns around SDoH within a busy surgical clinical is feasible and may positively affect long-term health outcomes and equitable resource allocation.

Level of evidence: IV.

Keywords: Adverse childhood experiences; Child; Cross-sectional; Pediatric; Social determinants of health; Surgery.