Disparities in Caregiver-reported Knowledge, Attitudes, Behaviors, and Clinical Guidance regarding Primary Prevention of Peanut Allergy.

Abstract

Objective: Significant differences have been observed in the prevalence of peanut allergy across different US racial and ethnic groups. We aimed to characterize current patterns of infant peanut introduction across racial, ethnic, and socioeconomic strata, and their clinical, behavioral and attitudinal correlates.

Methods: Surveys assessing parental knowledge, attitudes and infant feeding behavior were administered to a US population-based sample of 3062 parents/caregivers of children aged 7-42 months. Complex survey-weighted test statistics estimated differences across relevant racial/ethnic, household income, and caregiver educational attainment strata.

Results: Cumulative rates of peanut introduction in the first 11 months of age were significantly higher among White, non-Hispanic caregivers (F=7.7; p<.001), caregivers with higher annual household incomes (F=5.6; p<0.001) and caregivers reporting higher educational attainment (F=2.5; p=0.002). Similar racial, ethnic, and socioeconomic differences emerged regarding perceived safety of peanut introduction during the first year, as well as the perceived effectiveness of early dietary introduction for peanut allergy prevention. Caregivers reporting lower household incomes and educational attainment were less likely to think peanut introduction during the first year was safe or effective in peanut allergy prevention than those reporting higher socioeconomic status. Similarly, caregivers of non-Hispanic Black children, those with lower incomes, and those with lower educational attainment were less likely to report receiving timely guidance from their child's primary care provider regarding peanut allergy prevention.

Conclusions: Differences in the timing of peanut introduction may contribute to observed racial, ethnic, and socioeconomic disparities in peanut allergy prevalence. Equitable FA prevention guidance from providers could address these disparities.