Family Psychosocial Risk, Neighborhood Opportunity, and Language in Pediatric Cancer

Abstract

Background: Psychosocial risk in pediatric cancer includes consideration of broader systems. The Psychosocial Assessment Tool (PAT) is a brief caregiver report screener of family psychosocial risk. Based on the Pediatric Psychosocial Preventative Health Model (PPPHM), scores are classified into tiers-Universal, Targeted, and Clinical. In this paper, relationships between scores on English and Spanish versions of the PAT and neighborhood characteristics for families of children newly diagnosed with cancer are reported.

Procedure: De-identified PAT data from 457 English- and 81 Spanish-speaking families from 18 U.S. pediatric cancer programs are compared with neighborhood risk levels on the Child Opportunity Index (COI 3.0). Records were associated with zip codes to assign COI level. Ordinal logistic regression (OLR) tested the association between COI level and PAT tier.

Results: PAT score distributions were consistent with prior studies-61.0% Universal, 30.9% Targeted, and 8.2% Clinical. Spanish-language PATs had higher proportions of Targeted and Clinical records (42.0% Targeted, 9.9% Clinical) than English-language PATs (28.9% Targeted, 7.9% Clinical). COI level had a statistically significant association with risk tier (OR = 0.850). As COI scores increased, the odds of a higher than Universal PAT tier decreased. A similar relationship was observed for English PATs (OR = 0.804) but not for Spanish PATs.

Conclusions: Screening with the PAT provides clinically relevant information about families' neighborhoods. In general, and for English PATs, lower psychosocial risk was associated with higher COI. For Spanish PATs, this relationship was not identified. Spanish-speaking families may face unique psychosocial risks independent of environmental conditions.

Keywords: Child Opportunity Index (COI); Psychosocial Assessment Tool (PAT); childhood cancer; neighborhood; psychosocial; risk; social determinants of health.