What's New About the Newest Vital Sign?

In the original version of the Newest Vital Sign (NVS) health literacy assessment tool, one of the questions asks whether it is safe for someone with a peanut allergy to eat food containing peanut oil. The scoring sheet indicates that the correct answer is “no,” it is not safe. In the Perspective article by Schol et al. (2024), the authors point out that, in fact, it is safe for someone with a peanut allergy to eat food containing refined peanut oil. Peanut allergies are related to peanut proteins, not oils. Thus, the “correct” answer on the scoring sheet is not correct.

As the lead investigator of the team that created the NVS, each month I receive numerous inquiries about the NVS from researchers around the world. In the nearly 20 years since the NVS was created (Weiss et al., 2005), this is only the third time that someone raised the issue of peanut oil actually being safe for individuals with a peanut allergy.

My thought on those occasions has been that while people with peanut allergies may know that they can eat peanut oil, it is likely that few others are aware. Indeed, none of the health professionals involved in creating the NVS knew that. Similarly, some 98% of the population does not have peanut allergies (Warren et al., 2021), and likely would not know the difference between the allergenic potential of peanuts versus peanut oil. Furthermore, the few people in the general public who do know that peanut oil is safe would probably have a high level of health literacy. They would likely get all of the other NVS questions correct and responding “incorrectly” that it is not safe to eat peanut oil would not likely misclassify them as having inadequate health literacy.

That said, given that the NVS is one of the most widely used health literacy assessment tools, there are some new changes related to the NVS that readers should know. One is related to the peanut allergy issue, but there are other, potentially more important changes, too.

NVS Changes

Development of the NVS was funded by the Pfizer pharmaceutical company. They retained the copyrights to the tool, although anyone was allowed to use it for free, and they did not require permission to use it unless a researcher was planning to modify the NVS or create a version in another language. Even then, permission was freely granted.

In 2023, however, Pfizer sold the copyrights for the NVS and numerous other questionnaires and assessment instruments to IQVIA, a worldwide company that develops analytics and research services for the life sciences. So, IQVIA now owns the copyrights. The NVS nutrition label can be viewed on the IQVIA website (https://coas.iqvia.com/coa?recordId=a037S000002rG8lQAE), along with the scoring sheet and instructions for administration. Note that this weblink should be viewed in Chrome; it does not load well in Firefox.

I have been in communication with staff at IQVIA numerous times, and they have indicated that they will generally continue the practice of granting permission for use of the NVS at no cost to individuals (eg, students) using it for self-funded research that is not related to commercial activity. However, they will still require potential users of the NVS to request permission to use it, stating that use without permission is a “breech of copyright.” Use for commercial purposes will incur a fee. Permission for use in research funded by a non-profit organization or government agency may be granted either with no fee, or for a reduced fee, depending on the specific circumstances.

The overall process for requesting permission (ie, a “license”) to use the NVS, to translate it, or to receive support in using it is outlined here: https://coas.iqvia.com/COAs/a037S000002rG8lQAE/newest-vital-sign-nvs.

Permission requests must be submitted via email to IQVIA_COAs@iqvia.com. A permission request form will then be provided, and the user must complete and submit the form. It will then take 10 to 15 working days to receive permission, and another 2 to 5 days to receive ready-to-use copies of the NVS. However, I have heard from a few individuals that the process sometimes takes longer.

Finally, getting back to the issue of peanut allergies, IQVIA is taking their acquisition of the NVS as an opportunity to revise the nutrition label to eliminate the potential wrong answer. Their research team is currently evaluating optimal new wording, with plans to update the ingredients list on the nutrition label to indicate that the ice cream contains a component of actual peanuts (eg, ground peanuts or something similar, rather than peanut oil, with the final wording still to be determined), so that “no” will still be a correct answer to the question about whether it is safe to eat the ice cream.