The PhenX Toolkit: Establishing Standard Measures for COVID-19 Research

The PhenX Toolkit: Recommended Measurement Protocols for Social Determinants of Health Research

Health disparities are driven by unequal conditions in the environments in which people are born, live, learn, work, play, worship, and age, commonly termed the Social Determinants of Health (SDoH). The availability of recommended measurement protocols for SDoH will enable investigators to consistently collect data for SDoH constructs. The PhenX (consensus measures for Phenotypes and eXposures) Toolkit is a web-based catalog of recommended measurement protocols for use in research studies with human participants. Using standard protocols from the PhenX Toolkit makes it easier to compare and combine studies, potentially increasing the impact of individual studies, and aids in comparability across literature. In 2018, the National Institute on Minority Health and Health Disparities provided support for an initial expert Working Group to identify and recommend established SDoH protocols for inclusion in the PhenX Toolkit. In 2022, a second expert Working Group was convened to build on the work of the first SDoH Working Group and address gaps in the SDoH Toolkit Collections. The SDoH Collections consist of a Core Collection and Individual and Structural Specialty Collections. This article describes a Basic Protocol for using the PhenX Toolkit to select and implement SDoH measurement protocols for use in research studies. © 2024 The Authors. Current Protocols published by Wiley Periodicals LLC. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA. Basic Protocol: Using the PhenX Toolkit to select and implement SDoH protocols.

Greater executive dysfunction in patients post-COVID-19 compared to those not infected

BACKGROUND

A number of patients post-coronavirus disease-19 (COVID-19) report cognitive impairment (CI), even months after acute infection. We aimed to assess if COVID-19 is associated with increased incidence of CI in comparison to controls.

METHODS

We analyzed data from the Mount Sinai Health System Post-COVID-19 Registry in New York City, a prospective cohort of patients post-COVID-19 ≥18 years of age and non-infected controls. CI was defined by scores ≥ 1.0 standard deviation below population norms, and was assessed using well-validated measures of attention, working memory, processing speed, executive functioning/cognitive flexibility, language, learning, and memory. Logistic regression models assessed odds for CI in each domain in patients post-COVID-19 vs. controls after adjusting for potential confounders. In exploratory analyses, we assessed odds for CI by site of acute COVID-19 care as a proxy for disease severity.

FINDINGS

417 patients post-COVID-19 and 151 controls (mean age 49 years, 63% female, 21% Black, 17% Latinx) were included. In adjusted analyses, patients were significantly more likely than controls to have CI in executive functioning (odds ratio [OR]: 2.19; 95% confidence interval [CI]: 1.03 to 4.67), particularly those treated in outpatient (OR: 2.22; 95% CI: 1.02 to 4.82) and inpatient hospital (OR: 3.59; 95% CI: 1.27 to 10.16) settings. There were no significant associations between CI in other domains and history of COVID-19 or site of acute care.

INTERPRETATION

Patients post-COVID-19 have greater odds of executive dysfunction, suggesting that focused cognitive screening may be prudent, even in those with mild to moderate disease. Studies should explore the pathophysiology and potential treatments for CI in this population.

FUNDING

This work was funded by the Icahn School of Medicine at Mount Sinai.

The PhenX Toolkit: Measurement Protocols for Assessment of Social Determinants of Health

INTRODUCTION

Social determinants are structures and conditions in the biological, physical, built, and social environments that affect health, social and physical functioning, health risk, quality of life, and health outcomes. The adoption of recommended, standard measurement protocols for social determinants of health will advance the science of minority health and health disparities research and provide standard social determinants of health protocols for inclusion in all studies with human participants.

METHODS

A PhenX (consensus measures for Phenotypes and eXposures) Working Group of social determinants of health experts was convened from October 2018 to May 2020 and followed a well-established consensus process to identify and recommend social determinants of health measurement protocols. The PhenX Toolkit contains data collection protocols suitable for inclusion in a wide range of research studies. The recommended social determinants of health protocols were shared with the broader scientific community to invite review and feedback before being added to the Toolkit.

RESULTS

Nineteen social determinants of health protocols were released in the PhenX Toolkit (https://www.phenxtoolkit.org) in May 2020 to provide measures at the individual and structural levels for built and natural environments, structural racism, economic resources, employment status, occupational health and safety, education, environmental exposures, food environment, health and health care, and sociocultural community context.

CONCLUSIONS

Promoting the adoption of well-established social determinants of health protocols can enable consistent data collection and facilitate comparing and combining studies, with the potential to increase their scientific impact.

Diet Quality of Older African Americans: Impact of Knowledge and Perceived Threat of COVID-19

Confusing health messages and environmental changes intended to prevent the spread of the COVID-19 virus have affected the dietary behavior of older African Americans. We investigated the impact of COVID-19-related factors on diet quality and the relationship between food access and diet quality. We surveyed 150 African Americans aged 55 years and above during the COVID-19 pandemic. The data obtained included socio-demographic and health information, and COVID-19-related knowledge and perceptions. Dietary intake data was obtained using the Diet History Questionnaire III. Analyses included bivariate and multivariable statistics. Overall, based on United States Department of Agriculture guidelines, the diet quality of older African Americans was poor. Lower knowledge and a lower perceived threat of COVID-19 were significantly associated with poor diet quality. Additionally, older African Americans with chronic diseases and food insecurity had poor diet quality. The COVID-19 pandemic has highlighted the fragility of diet quality. The combined impact of poor knowledge and perceived threat of COVID-19, chronic disease, and food insecurity contribute to poor diet quality in this population. This study adds to the well-known need for strategies to support the right to a healthy diet, particularly during COVID-19 and future pandemics. Proactive interventions to counteract the potential consequences of poor diets are needed.

Delayed Medical Care of Underserved Middle-Aged and Older African Americans with Chronic Disease during COVID-19 Pandemic

Background: While African American middle-aged and older adults with chronic disease are particularly vulnerable during the COVID-19 pandemic, it is unknown which subgroups of this population may delay seeking care. The aim of this study was to examine demographic, socioeconomic, COVID-19-related, and health-related factors that correlate with delayed care in African American middle-aged and older adults with chronic disease. Methods: In this cross-sectional study, 150 African American middle-aged and older adults who had at least one chronic disease were recruited from faith-based organizations. We measured the following exploratory variables: demographic factors (age and gender), socioeconomic status (education), marital status, number of chronic diseases, depressive symptoms, financial strain, health literacy, COVID-19 vaccination history, COVID-19 diagnosis history, COVID-19 knowledge, and COVID-19 perceived threat. The outcome was delay in chronic disease care. Results: According to the Poisson log-linear regression, higher level of education, higher number of chronic diseases, and depressive symptoms were associated with a higher level of delayed care. Age, gender, COVID-19 vaccination history, COVID-19 diagnosis history, COVID-19 perceived threat, COVID-19 knowledge, financial strain, marital status, and health literacy were not correlated with delayed care. Discussion: Given that higher healthcare needs in terms of multiple chronic medical diseases and depressive symptomatology but not COVID-19-related constructs (i.e., vaccination history, diagnosis history, and perceived threat) were associated with delayed care, there is a need for programs and interventions that assist African American middle-aged and older adults with chronic disease to seek the care that they need. More research is needed to understand why educational attainment is associated with more delayed care of chronic disease in African American middle-aged and older adults with chronic illness.

Factors Associated with Telehealth Utilization among Older African Americans in South Los Angeles during the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic transformed healthcare delivery with the expansive use of telemedicine. However, health disparities may result from lower adoption of telehealth among African Americans. This study examined how under-resourced, older African Americans with chronic illnesses use telehealth, including related sociodemographic and COVID-19 factors.

METHODS

Using a cross-sectional design, 150 middle-aged and older African Americans were recruited from faith-based centers from March 2021 to August 2022. Data collected included sociodemographics, comorbidities, technological device ownership, internet usage, and attitudes toward COVID-19 disease and vaccination. Descriptive statistics and multivariable regression models were conducted to identify factors associated with telehealth use.

RESULTS

Of the 150 participants, 32% had not used telehealth since the COVID-19 pandemic, with 75% reporting no home internet access and 38% having no cellular/internet network on their mobile device. Age, access to a cellular network on a mobile device, and wireless internet at home were significantly associated with the utilization of telehealth care. Higher anxiety and stress with an increased perceived threat of COVID-19 and positive attitudes toward COVID-19 vaccination were associated with telehealth utilization.

DISCUSSION

Access and integration of telehealth services were highlighted as challenges for this population of African Americans. To reduce disparities, expansion of subsidized wireless internet access in marginalized communities is necessitated. Education outreach and training by healthcare systems and community health workers to improve uptake of telehealth currently and post-COVID-19 should be considered.

Inclusion of Social and Structural Determinants of Health to Advance Understanding of their Influence on the Biology of Chronic Disease

Social Determinants of Health (SDOH) consider social, political, and economic factors that contribute to health disparities in patients and populations. The most common health-related SDOH exposures are food and housing insecurity, financial instability, transportation needs, low levels of education, and psychosocial stress. These domains describe risks that can impact health outcomes more than health care. Epidemiologic and translational research demonstrates that SDOH factors represent exposures that predict harm and impact the health of individuals. International and national guidelines urge health professionals to address SDOH in clinical practice and public health. The further implementation of these recommendations into basic and translational research, however, is lagging. Herein, we consider a precision health framework to describe how SDOH contributes to the exposome and exacerbates physiologic pathways that lead to chronic disease. SDOH factors are associated with various forms of stressors that impact physiological processes through epigenetic, inflammatory, and redox regulation. Many SDOH exposures may add to or potentiate the pathologic effects of additional environmental exposures. This overview aims to inform basic life science and translational researchers about SDOH exposures that can confound associations between classic biomedical determinants of disease and health outcomes. To advance the study of toxicology through either qualitative or quantitative assessment of exposures to chemical and biological substances, a more complete environmental evaluation should include SDOH exposures. We discuss common approaches to measure SDOH factors at individual and population levels and review the associations between SDOH risk factors and physiologic mechanisms that influence chronic disease. We provide clinical and policy-based motivation to encourage researchers to consider the impact of SDOH exposures on study results and data interpretation. With valid measures of SDOH factors incorporated into study design and analyses, future toxicological research may contribute to an evidence base that can better inform prevention and treatment options, to improve equitable clinical care and population health. © 2022 Wiley Periodicals LLC.

Evoking stress reactivity in virtual reality: A systematic review and meta-analysis

BACKGROUND

Virtual reality (VR) research probes stress environments that are infeasible to create in the real world. However, because research simulations are applied to narrow populations, it remains unclear if VR simulations can stimulate a broadly applicable stress-response. This systematic review and meta-analysis was conducted on studies using VR stress tasks and biomarkers.

METHODS

Included papers (N = 52) measured cortisol, heart rate (HR), galvanic skin response (GSR), systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory sinus arrhythmia (RSA), parasympathetic activity (RMSSD), sympathovagal balance (LF/HF), and/or salivary alpha-amylase (sAA). Effect sizes (ES) and confidence intervals (CI) were calculated based on standardized mean change of baseline-to-peak biomarker levels.

RESULTS

From baseline-to-peak (ES, CI), analyses showed a statistically significant change in cortisol (0.56, 0.28-0.83), HR (0.68, 0.53-0.82), GSR (0.59, 0.36-0.82), SBP (.55, 0.19-0.90), DBP (.64, 0.23-1.05), RSA (-0.59, -0.88 to -0.30), and sAA (0.27, 0.092-0.45). There was no effect for RMSSD and LF/HF.

CONCLUSION

VR stress tasks elicited a varied magnitude of physiological stress reactivity. VR may be an effective tool in stress research.

The PhenX Toolkit: Establishing Standard Measures for COVID-19 Research

The PhenX (consensus measures for Phenotypes and eXposures) Toolkit (https://www.phenxtoolkit.org/) is a publicly available, web‐based catalog of recommended, well‐established measurement protocols of phenotypes and exposures. The goal of PhenX is to facilitate the use of standard measures, enhance data interoperability, and promote collaborative and translational research. PhenX is driven by the scientific community and historically has depended on working groups of experts to recommend measures for release in the PhenX Toolkit. The urgent need for recommended, standard measures for COVID‐19 research triggered the development of a “rapid release” process for releasing new content in the PhenX Toolkit. Initially, PhenX collaborated with the National Institutes of Health (NIH) Office of Behavioral and Social Sciences Research, the National Human Genome Research Institute, and the NIH Disaster Research Response (DR2) program to create a library of COVID‐19 measurement protocols. With additional support from NIH, PhenX adapted crowdsourcing techniques to accelerate prioritization and recommendation of protocols for release in the PhenX Toolkit. Prioritized COVID‐19‐specific protocols were used to anchor and define specialty collections of protocols that were subject to review and approval by the PhenX Steering Committee. In addition to the COVID‐19‐specific protocols, the specialty collections include existing, well‐established PhenX protocols, use of which will further enhance data interoperability and cross‐study analysis. The COVID‐19 specialty collections are Behaviors and Risks; Ethnicity, Race and Demographics; History, Treatment and Outcomes; Information Resources; Psychosocial and Mental Health; and Socioeconomic. The development and usage of PhenX COVID‐19 specialty collections are described in this article. © 2021 The Authors.

Basic Protocol: Selecting COVID‐19 protocols