{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:38:21Z","timestamp":1790613501428,"version":"4.1.0"},"reference-count":51,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T00:00:00Z","timestamp":1689811200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01 HL141774"],"award-info":[{"award-number":["R01 HL141774"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Children with sickle cell anemia (SCA) have substantial medical needs and more unmet basic needs than children with other medical conditions. Despite a recent focus on social determinants of health (SDoH), there remains an incomplete understanding of the processes linking SDoH and disease management, particularly for youth with SCA. This study elucidated these processes and identified ways to mitigate deleterious effects of adverse SDoH on SCA management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Parents\/primary caregivers (<jats:italic>N<\/jats:italic>\u00a0=\u00a027) of children with SCA (\u226412 years old) participated in semi\u2010structured interviews regarding SCA management and SDoH and completed quantitative measures of basic needs. Qualitative data were systematically coded and analyzed using applied thematic analysis. Quantitative data were presented descriptively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three qualitative themes were identified. First, SCA management is bidirectionally linked with the social environment, whereby challenges of SCA management can hinder basic needs from being met, and unmet basic needs and financial hardship hinder SCA management. Second, due to limited resources, parents\/caregivers are faced with difficult choices between prioritizing basic needs versus SCA management. Third, addressing material, emotional, and informational needs may improve SCA management. Quantitatively, 73% of families endorsed\u00a0\u22651 basic need, including food insecurity (42%), housing instability (62%), and\/or energy insecurity 19% (vs. 20%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Despite documented <jats:italic>associations<\/jats:italic>, there remains a poor understanding of the <jats:italic>processes<\/jats:italic> linking SDoH and health. Findings underscore how day\u2010to\u2010day conditions undermine the management of SCA treatments, symptoms, and complications, limiting treatment effectiveness. Understanding these processes may inform family\u2010centered, health equity interventions and policies to improve living conditions, disease management, and health outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.30539","type":"journal-article","created":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T15:35:34Z","timestamp":1689867334000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Bidirectional processes linking social determinants of health and pediatric sickle cell anemia management: A qualitative study"],"prefix":"10.1002","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8486-2545","authenticated-orcid":false,"given":"Kristin A.","family":"Long","sequence":"first","affiliation":[{"name":"Department of Psychological and Brain Sciences Boston University Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariel O.","family":"Blakey","sequence":"additional","affiliation":[{"name":"Department of Psychological and Brain Sciences Boston University Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina M.","family":"Amaro","sequence":"additional","affiliation":[{"name":"Department of Psychological and Brain Sciences Boston University Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna S.","family":"Eilenberg","sequence":"additional","affiliation":[{"name":"Department of Psychological and Brain Sciences Boston University Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1785-0277","authenticated-orcid":false,"given":"Annelise","family":"Brochier","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Boston Medical Center Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arvin","family":"Garg","sequence":"additional","affiliation":[{"name":"Child Health Equity Center Department of Pediatrics UMass Memorial Children's Medical Center University of Massachusetts Chan Medical School Worcester Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mari\u2010Lynn","family":"Drainoni","sequence":"additional","affiliation":[{"name":"Section of Infectious Diseases Department of Medicine Boston University Chobanian &amp; Avedesian School of Medicine\/Boston Medical Center Boston Massachusetts USA"},{"name":"Department of Health Law Policy &amp; Management Boston University School of Public Health Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2883-0957","authenticated-orcid":false,"given":"Farzana","family":"Pashankar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Yale University School of Medicine New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica B.","family":"Esrick","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Boston Children's Hospital Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia L.","family":"Kavanagh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Boston Medical Center Boston Massachusetts USA"},{"name":"Department of Pediatrics Boston University Chobanian &amp; Avedisian School of Medicine Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,7,20]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.10233"},{"key":"e_1_2_8_3_1","volume-title":"Addressing Sickle Cell Disease: A Strategic Plan and Blueprint for Action","author":"National Academies of Sciences, Engineering, and Medicine","year":"2020"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.24557"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/0033354919881438"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jst049"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPH.0b013e318157fdac"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/27.5.475"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsaa130"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.91.3.465a"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.21977"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPH.0000000000000013"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1586\/ehm.10.22"},{"key":"e_1_2_8_14_1","unstructured":"US Department of Health and Human Services.National Heart Lung and Blood Institute. 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