The Navigation Guide Systematic Review Methodology: A Rigorous and Transparent Method for Translating Environmental Health Science into Better Health Outcomes
Open accessAbstract
BACKGROUND: Synthesizing what is known about the environmental drivers of health is instrumental to taking prevention-oriented action. Methods of research synthesis commonly used in environmental health lag behind systematic review methods developed in the clinical sciences over the past 20 years. OBJECTIVES: We sought to develop a proof of concept of the "Navigation Guide," a systematic and transparent method of research synthesis in environmental health. DISCUSSION: The Navigation Guide methodology builds on best practices in research synthesis in evidence-based medicine and environmental health. Key points of departure from current methods of expert-based narrative review prevalent in environmental health include a prespecified protocol, standardized and transparent documentation including expert judgment, a comprehensive search strategy, assessment of "risk of bias," and separation of the science from values and preferences. Key points of departure from evidence-based medicine include assigning a "moderate" quality rating to human observational studies and combining diverse evidence streams. CONCLUSIONS: The Navigation Guide methodology is a systematic and rigorous approach to research synthesis that has been developed to reduce bias and maximize transparency in the evaluation of environmental health information. Although novel aspects of the method will require further development and validation, our findings demonstrated that improved methods of research synthesis under development at the National Toxicology Program and under consideration by the U.S. Environmental Protection Agency are fully achievable. The institutionalization of robust methods of systematic and transparent review would provide a concrete mechanism for linking science to timely action to prevent harm.
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Systematic review methods have only recently been developed and utilized in environmental health sciences.
“such methods have only recently been developed and utilized in environmental health sciences [23–30].”
From A Systematic Review and Meta-Analysis of Multiple Airborne Pollutants and Autism Spectrum Disorder (2016) · cites this paper as [26]
Recently-developed tools for risk-of-bias assessment in observational epidemiologic studies have moved away from numeric scores based on checklists to tools based on assessments within specific domains of bias.
“Recently-developed tools for this purpose have moved away from numeric scores based on checklists (which often combined elements of risk of bias with other considerations such as of applicability) to tools based on assessments within specific domains of bias.”
From A tool to assess risk of bias in non-randomized follow-up studies of exposure effects (ROBINS-E) (2024) · cites this paper as Woodruff and Sutton, 2014
Several tools for observational epidemiologic studies provide significant methodological advances over previously used tools.
“Several such tools for observational epidemiologic studies provide significant methodological advances over previously used tools (National Toxicology Program, 2015, 2015; Woodruff and Sutton, 2014; U.S. Environmental Protection Agency, 2022).”
From A tool to assess risk of bias in non-randomized follow-up studies of exposure effects (ROBINS-E) (2024) · cites this paper as Woodruff and Sutton, 2014
According to the US Agency for Healthcare Research and Quality and the US National Toxicology Program, funding source is recommended as a factor to consider when evaluating risk of bias of individual studies for selective reporting and then again for evaluating the body of evidence for publication bias.
“According to the US Agency for Healthcare Research and Quality and the US National Toxicology Program, funding source is recommended as a factor to consider when evaluating risk of bias of individual studies for selective reporting and then again for evaluating the body of evidence for publication bias [67, 68, 70].”
The Navigation Guide already includes funding source and author conflicts of interest as a risk of bias domain in both human and animal studies.
“The Navigation Guide already includes both as a risk of bias domain in both human and animal studies [67, 68], while Cochrane and GRADE are considering it, but have not yet adopted it [69].”
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Reproductive and Developmental Toxicology
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Self-citationHeat exposure impacts on urban health: A meta-analysis.
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Donzelli, G., Llopis-González, A., Llopis-Morales, A., Cioni, L., & Morales-Suarez-Varela, M. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17010067 · Cited by 50 · see citing works
Nyadanu, S. D., Dunne, J., Tessema, G. A., Mullins, B. J., Kumi-Boateng, B., Bell, M. L., Duko, B., & Pereira, G. F. (2024) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2024.170236 · Cited by 66 · see citing works
Dorman, D. C., Chiu, W. A., Hales, B. F., Hauser, R. B., Johnson, K. J., Mantus, E., Martel, S., Robinson, K. A., Rooney, A. A., Rudel, R. A., et al. (2018) · Journal of Toxicology and Environmental Health Part B · doi:10.1080/10937404.2018.1514829 · Cited by 63 · see citing works
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Endocrine disruptors: Challenges and future directions in epidemiologic research
Ho, V., Pelland-St-Pierre, L., Gravel, S., Bouchard, M. F., Verner, M.-A., & Labrèche, F. (2021) · Environmental Research · doi:10.1016/j.envres.2021.111969 · Cited by 61 · see citing works
- Authors
- Woodruff, T. J., & Sutton, P.
- Affiliations
- University of California, San Francisco (US)
- Corresponding author
- Woodruff, Tracey J.
- ORCID
- Woodruff, Tracey J.
- Venue
- Environmental Health Perspectives
- Publisher
- American Chemical Society (ACS)
- Published
- 2014-06-25
- Volume
- 122
- Issue
- 10
- Pages
- 1007-1014
- ISSN
- 0091-6765 (ISSN-L)
- 1552-9924
- PMC
- PMC4181919
- OpenAlex
- W1997898721
- Cited by
- 427
- References
- 89
- Citations by year
- 2026: 36 · 2025: 33 · 2024: 48 · 2023: 37 · 2022: 43 · 2021: 59 · 2020: 52 · 2019: 31 · 2018: 33 · 2017: 16 · 2016: 19 · 2015: 13 · 2014: 7
- FWCI
- 5.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- public-domain
- creativecommons.org/licenses/by/4.0/ (vor, 1283 d)
- Locations
- Environmental Health Perspectives (publishedVersion, public-domain)
- PubMed Central (publishedVersion, public-domain)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- U.S. Environmental Protection Agency (RD-83543301)
- New York Community Trust
- Heinz Endowments
- Johnson Family Foundation
- Rose Foundation for Communities and the Environment
- Kaiser Permanente
- University of California, San Francisco
- National Institute of Environmental Health Sciences (ESO22841, ES018135, P01ES022841, ES022841, P20ES018135)
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Health, Environment, Cognitive Aging
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Keywords
- systematic review methodology, risk of bias assessment, expert opinion, science-policy interface, National Toxicology Program, Environmental Protection Agency
- MeSH terms
- Decision Support Techniques, Environmental Health, Humans, Review Literature as Topic, Hazardous Substances, Bias, Interdisciplinary Communication
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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