Barriers to and solutions for representative inclusion across the lifespan and in life course research: The need for structural competency highlighted by the COVID-19 pandemic.

Exclusion of special populations (older adults; pregnant women, children, and adolescents; individuals of lower socioeconomic status and/or who live in rural communities; people from racial and ethnic minority groups; individuals from sexual or gender minority groups; and individuals with disabilities) in research is a pervasive problem, despite efforts and policy changes by the National Institutes of Health and other organizations. These populations are adversely impacted by social determinants of health (SDOH) that reduce access and ability to participate in biomedical research. In March 2020, the Northwestern University Clinical and Translational Sciences Institute hosted the "Lifespan and Life Course Research: integrating strategies" "Un-Meeting" to discuss barriers and solutions to underrepresentation of special populations in biomedical research. The COVID-19 pandemic highlighted how exclusion of representative populations in research can increase health inequities. We applied findings of this meeting to perform a literature review of barriers and solutions to recruitment and retention of representative populations in research and to discuss how findings are important to research conducted during the ongoing COVID-19 pandemic. We highlight the role of SDOH, review barriers and solutions to underrepresentation, and discuss the importance of a structural competency framework to improve research participation and retention among special populations.

Correlation Between New York City Hot Spotting Policy and Mobility to Reduce COVID-19 Spread

Study Objective: In October 2020, New York State initiated a micro-cluster strategy (“hot spotting”) that divides into three categories based on COVID-19 cases and hospital capacity, each with successively more restrictions: Yellow, Orange, and Red Zones. Our objectives were to evaluate the influence of hot spotting on mobility and subsequent mortality, and then to identify underlying social determinants of health associated with the neighborhoods most affected by hot spotting. Study Design: We combine several data sources in our analysis. Time-dependent data were obtained from SafeGraph for cellphone mobility at the Census Block Group, New York State Governor’s Office for hot spotting, school and indoor dining, and NYC Department of Health and Mental Hygiene (DOHMH) for COVID-19 cases and mortality. Using the DOHMH’s “Modified Zip Code Tabulation Areas” (MODZCTA), we matched these to community-level data obtained from 2018 American Community Survey 5-year estimates for population density. Our main outcomes are Average Median Percentage Time Home (AMPTH) and Device-Weighted Average Median Percentage Time Home (DWAMPTH) from SafeGraph Social Distancing Metrics summarized to MODZCTA boundaries. Home is defined as the common nighttime location of each mobile device over a 6-week period to a Geohash-7 granularity (∼153m x ∼153m). We implemented the Wilcoxon rank-sum test with a <0.05 p-value threshold for each day since hot spotting policy to compare MODZCTA with any of the Zone's designation to those without designation. Our main outcomes are Average Median Percentage Time Home (AMPTH) and Device-Weighted Average Median Percentage Time Home (DWAMPTH) from SafeGraph Social Distancing Metrics summarized to MODZCTA boundaries. Population Studied: NYC residents from October 5, 2020, to December 31, 2020 (87 days total) using the 177 MODZCTA within NYC as geographic unit of analysis. Results: For the AMPTH measurement, MODZCTAs with hot spotting Zone's designation had 84 days (95% of the days) with statistically significantly lower mobility than non-intervention MODZCTAs, and for the DWAMPTH measurement, 83 days (97% of the days) had statistically significantly lower mobility. 58 of the days had p-value<0.001 for AMPTH and 49 had p-value<0.001 for DWAMPTH, and only a minority of days had p-value>0.1 (2 days for AMPTH and 3 for DWAMPTH). Looking at individual boroughs, Brooklyn had 42 statistically significant days for AMPTH and 49 for DWAMPTH, while Queens had 12 statistically significant days for AMPTH and 7 for DWAMPTH. Conclusions: New York State’s micro-cluster focus Zones is associated with decreased mobility in high COVID-19 prevalence areas. Our study suggests that shutdowns targeted at small geographic areas may reduce mobility and thus can potentially help control COVID-19 spread.