Walls Alexandra, Boyd Mark, McMichael Gai, Smithers Lisa G
School of Public Health, University of Adelaide, South Australia, Australia.
Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia.
SSM Popul Health. 2022 Mar 11;17:101070. doi: 10.1016/j.ssmph.2022.101070. eCollection 2022 Mar.
Exposure to social risk in early life negatively impacts the health and wellbeing of children. While screening for social determinants of health is recommended, there is little evidence that identifying social risk early in life predicts longer-term poorer outcomes. The purpose of this study is to examine the extent to which assessing social risk using a standardized tool in young children up to age 6 years might predict poor health and academic performance at 10-11 years old. The social risk domains studied were housing instability, food insecurity, financial strain, transport problems, safety, lack of support and unemployment. The predictive validity of these social risk domains measured at 0-5 years was examined using data from the Longitudinal Study of Australian Children. Outcomes at 10-11 years included ongoing diseases and mental health conditions, hospitalization, injury, dental problems, overweight or obesity and academic achievement. Financial strain and inability to access support were the most sensitive measures of poor outcomes. Across all social risks, the positive predictive value was highest for academic outcomes. Across all domains, there was higher sensitivity for children with 2 or more social risks. Items in the social risk screening tool were moderate predictors of academic outcomes, but weak predictors of health outcomes at 10-11 years. This data will be useful for informing screening for social determinants of health.
早年暴露于社会风险会对儿童的健康和幸福产生负面影响。虽然建议对健康的社会决定因素进行筛查，但几乎没有证据表明在生命早期识别社会风险能预测更长期的不良后果。本研究的目的是探讨使用标准化工具评估6岁以下幼儿的社会风险在多大程度上可能预测其10至11岁时的健康状况不佳和学业成绩不佳。所研究的社会风险领域包括住房不稳定、粮食不安全、经济压力、交通问题、安全、缺乏支持和失业。利用澳大利亚儿童纵向研究的数据，检验了在0至5岁时测量的这些社会风险领域的预测效度。10至11岁时的结果包括持续性疾病和心理健康状况、住院、受伤、牙齿问题、超重或肥胖以及学业成绩。经济压力和无法获得支持是不良结果最敏感的指标。在所有社会风险中，学业成绩的阳性预测值最高。在所有领域中，有两种或更多社会风险的儿童敏感性更高。社会风险筛查工具中的项目是学业成绩的中度预测指标，但在10至11岁时是健康结果的弱预测指标。这些数据将有助于为健康的社会决定因素筛查提供信息。
