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Identifying and Addressing Confounding Bias in Violence Prevention Research.

ABSTRACT: Purpose of review:Violence prevention research has enhanced our understanding of individual and community risk and protective factors for aggression and violence. However, our knowledge of risk and protective factors for violence is highly dependent on observational studies, since there are few randomized trials of risk and protective factors for violence. Observational studies are susceptible to systematic errors, specifically confounding, and may lack internal validity. Recent findings:Many violence prevention studies utilize methods that do not correctly identify the set of covariates needed for statistical adjustment. This results in unwarranted matching and restriction leading to further confounding or selection bias. Covariate adjustment based on purely statistical criteria generates inconsistent results and uncertain conclusions. Summary:Conventional methods used to identify confounding in violence prevention research are often inadequate. Causal diagrams have potential to improve the understanding and identification of potential confounding biases in observational violence prevention studies, and methods like sensitivity analysis using quantitative bias analysis can help to address unmeasured confounding. Violence research studies should make more use of these methods.

SUBMITTER: Ranapurwala SI

PROVIDER: S-EPMC7176054 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Identifying and Addressing Confounding Bias in Violence Prevention Research.

Ranapurwala Shabbar I SI

Current epidemiology reports 20190426 2

<h4>Purpose of review</h4>Violence prevention research has enhanced our understanding of individual and community risk and protective factors for aggression and violence. However, our knowledge of risk and protective factors for violence is highly dependent on observational studies, since there are few randomized trials of risk and protective factors for violence. Observational studies are susceptible to systematic errors, specifically confounding, and may lack internal validity.<h4>Recent findi ...[more]

PMID: 32322458

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Project description:IntroductionGiven the severity and impact of the current Zika virus (ZIKV) outbreak in the Americas, numerous countries have rushed to develop research studies to assess ZIKV and its potential health consequences. In an effort to ensure that studies are comprehensive, both internally and externally valid, and with reliable results, the World Health Organization, the Pan American Health Organization, Institut Pasteur, the networks of Fiocruz, the Consortia for the Standardization of Influenza Seroepidemiology (CONSISE) and the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) have generated six standardized clinical and epidemiological research protocols and questionnaires to address key public health questions on ZIKV.MethodsWe conducted a systematic search of ongoing study protocols related to ZIKV research. We analyzed the content of protocols of 32 cohort studies and 13 case control studies for systematic bias that could produce erroneous results. Additionally we aimed to characterize the risks of bias and confounding in observational studies related to ZIKV and to propose ways to minimize them, including the use of six newly standardized research protocols.ResultsObservational studies of ZIKV face an array of challenges, including measurement of exposure and outcomes (microcephaly and Guillain-Barré Syndrome). Potential confounders need to be measured where known and controlled for in the analysis. Selection bias due to non-random selection is a significant issue, particularly in the case-control design, and losses to follow-up is equally important for the cohort design.ConclusionObservational research seeking to answer key questions on the ZIKV should consider these restrictions and take precautions to minimize bias in an effort to provide reliable and valid results. Utilization of the standardized research protocols developed by the WHO, PAHO, Institut Pasteur, and CONSISE will harmonize the key methodological aspects of each study design to minimize bias at different stages of the study. Biases need to be considered by researchers implementing the standardized protocols as well as by users of observational epidemiological studies of ZIKV.

Project description:BackgroundGender-based violence (GBV) and violence against children (VAC) are two prevalent and highly interconnected global health challenges, yet data and research capacities to study these forms of violence and to generate evidence-based policies and programs remain limited. To address critical shortages in research capacity in Vietnam and to establish a model for other Low- and Middle-Income Countries (LMICs), we are establishing CONVERGE-the Consortium for Violence Prevention Research, Implementation, and Leadership Training for Excellence.MethodsBased on a needs assessment with partners in Vietnam, CONVERGE will provide a comprehensive research training program supporting 15 long-term, postdoctoral trainees with multi-disciplinary research training in GBV and VAC. We also will offer in-country trainings and short-courses to 40 short-term mid-career academic trainees and 60 short-term practitioner/stakeholder trainees over 5 years to build productive GBV and VAC academic, scientific, and practitioner networks. The CONVERGE training program has four components: (1) 14 h of virtual/in-person annual mentorship training to prepare research mentors and to create a pipeline of future mentors in Vietnam; (2) a one-month intensive research training for long-term postdoctoral fellows at Emory University; (3) a structured 17-month, in-country mentored research project for long-term trainees that results in a peer-reviewed manuscript and a subsequent grant submission; and, (4) week-long in-country intensive translational trainings on implementation science, advanced topics in leadership, and advanced topics in science dissemination. Opportunities for on-going virtual training and professional networking will be provided for CONVERGE trainees and mentors in Vietnam with other trainees and mentors of D43s focused on injury/violence prevention, D43s housed at Emory, and D43s with other institutions in Southeast Asia. To assess the reach, implementation, fidelity, and effectiveness of these four components, we will implement a rigorous, mixed-methods, multi-level evaluation strategy using process and outcome measures. Findings from the evaluation will be used to refine program components for future trainee and mentor cohorts and to assess long-term program impact.DiscussionLed by Emory University in the US and Hanoi Medical University in Vietnam, CONVERGE represents leading institutions and experts from around the world, with a goal of providing mentorship opportunities for early-career scientists with an interest in violence prevention.

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Identifying and Addressing Confounding Bias in Violence Prevention Research.

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Identifying and Addressing Confounding Bias in Violence Prevention Research.

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