Gen Z Youth Want Their Physicians to Ask Them about Social Determinants of Health

Members of GenZ say they want their primary care clinicians to ask them about social determinants of health (SDOHs) such as food and housing insecurity, education, and discrimination, according to a recent survey.

The survey, part of the MyVoice National Poll of Youth, based in the University of Michigan’s Department of Family Medicine, polled more than 1000 young people aged 14 to 24 years who answered questions by text message in March 2021. The findings were published in the June issue of the Journal of Adolescent Health.

The poll comprised a series of 5 open-ended questions inquiring about housing, food, education, safety, and discrimination. The majority of respondents, 81%, said their doctors and other health care staff should ask about those issues.

“It seems obvious that addressing social needs, like food and housing, in clinical settings would benefit patients. But we actually know very little about whether and how patients would want to receive this kind of assistance,” said first author Claire Chang in a news release from the University of Michigan. Chang is a U-M Medical School student. “It is important for us to understand these preferences and desires as social/medical care integration efforts spread across the country.”

Of 1156 youth enrolled in the MyVoice text message survey, there were 1038 responders (response rate 89.8%). Mean age of the group was 19 years with the majority aged 18 to 24 years. The majority were men (48.9%) and non-Hispanic White (62.1%). Nearly 39% of the respondents came from families whose income levels qualified them for free or subsidized school lunch under national criteria.

In response to a question about what would prevent them from seeking or receiving help for SDOH-related difficulties, 30% reported embarrassment, fear, or stigma; cost was the second-most reported barrier (24%). Other barriers indicated were lack of access to resources (14%) and poor knowledge of how or where to seek assistance (11%).

Some believed it was important for clinicians to ask about SDOH because the medical team is in a unique position to do so.

“You say something at a doctor’s appointment that you might not have said anywhere else.”

As to how they would want their physicians and care team members to help, 25% cited providing information on resources available to those with social needs. Offering general advice (22%), providing referrals to outside resources (13%), and listening to their concerns (11%) also were mentioned.

Approximately half (51%) said their preference for recieiving information or assistance would be in person; others were amenable to email (37%), text (34%), telephone (27%), and handouts (11%).

An increasing number of health systems and clinics -- including U-M’s own academic medical center, Michigan Medicine -- now screen for SDOH’s as part of patient care, the researchers said in the news release.

“As a doctor, what I hear is my adolescent and young adult patients want me to ask them about more than their health. They want me to ask about their lives,” said Tammy Chang, MD, MPH, MS, poll director and U-M family physician.

“This opens a door for doctors and other healthcare providers to really understand the root causes of the issues that young people are facing today. Youth in our study didn't expect providers to solve their issues, rather, just listen. I can do that.”

Reference: Chang C, Ceci C, Uberoi M, Waseleski M, Chang T. Youth perspectives on their medical team's rols in screening for and addressing social determinants of health. J Adol Health. 2022;70:P928-P933.