School of Social Work, University of Michigan, Ann Arbor, Michigan.
School of Social Work, Wayne State University, Detroit, Michigan.
Am J Prev Med. 2022 Nov;63(5):708-716. doi: 10.1016/j.amepre.2022.06.004. Epub 2022 Jul 26.
Screening youth for negative social determinants of health is a widespread practice across healthcare settings in the U.S., with such systems almost exclusively relying on caregiver reports. Little work has sought to identify the social determinants of health adolescents identify as having the largest influence on their health and well-being or the extent to which adolescents agree with their caregiver. This study sought to (1) identify the most prevalent and influential negative social determinants of health, according to adolescent reports, and (2) assess concordance between adolescent and caregiver reports of social determinants of health.
In Fall 2021, the study team conducted a cross-sectional, observational study within a predominately Latinx urban high school. The team invited all students and their caregivers to participate, resulting in 520 adolescent and 66 caregiver respondents (73% and 9% response rates, respectively). Data analyses occurred in 2022.
The most frequent adolescent-reported negative social determinants of health was stress (67%), followed by financial hardship (27%). The negative social determinant of health with the highest ranking of preventing adolescents from living their best and healthiest lives was depression, followed by isolation and stress. Concordance between caregiver and adolescent report of negative social determinants of health was very low across all negative social determinants of health (Krippendorf's α= -0.08 to 0.21). Caregivers under-reported adolescents' social and mental health needs, whereas adolescents under-reported material needs.
A hybrid informant approach may be a best practice for social determinants of health screening among adolescents, whereby caregivers and adolescents report material needs, and adolescents report social and mental health needs. Future work should evaluate the concordance between adolescent and caregiver social determinants of health reports in other settings.
在美国，医疗保健机构普遍对年轻人进行负面社会决定因素的筛查，而这些系统几乎完全依赖于照顾者的报告。很少有研究试图确定青少年认为对他们的健康和幸福影响最大的社会决定因素，以及青少年在多大程度上同意他们照顾者的观点。本研究旨在：(1) 根据青少年的报告，确定最普遍和最有影响力的负面社会决定因素；(2) 评估青少年和照顾者对社会决定因素的报告之间的一致性。
在 2021 年秋季，研究小组在一所以拉丁裔为主的城市高中内进行了一项横断面观察性研究。该小组邀请所有学生及其照顾者参加，结果有 520 名青少年和 66 名照顾者做出了回应（分别为 73%和 9%的回应率）。数据分析于 2022 年进行。
青少年报告的最常见的负面社会决定因素是压力（67%），其次是经济困难（27%）。对青少年生活质量和健康最具阻碍性的负面社会决定因素是抑郁，其次是孤独和压力。在所有负面社会决定因素中，照顾者和青少年对负面社会决定因素的报告一致性都非常低（克里彭多夫 α 值为-0.08 至 0.21）。照顾者对青少年的社会和心理健康需求的报告不足，而青少年对物质需求的报告不足。
对于青少年的社会决定因素筛查，混合信息源方法可能是一种最佳实践，即照顾者和青少年报告物质需求，而青少年报告社会和心理健康需求。未来的研究应该在其他环境中评估青少年和照顾者社会决定因素报告之间的一致性。
