Navigation Guide
Strategy to bridge the gap between clinicians and environmental health

Navigation Guide

An Evidence-Based Medicine Methodology to Bridge the Gap Between Clinical and Environmental Health Sciences

The scientific evidence linking environmental exposures to adverse health outcomes has yet to be compiled using systematic methods with the capacity to inform effective healthcare and policy decision-making. The relevant evidence is largely unfamiliar to health professionals caring for women and men of childbearing age, patients, communities, consumers, and other impacted populations. There is currently no trusted reference or compendium that provides them with timely, evidence-based advice about exposure to environmental contaminants.

To bridge the gap between clinical and environmental health sciences, PRHE has undertaken an interdisciplinary collaboration to develop a systematic and transparent methodology to evaluate the quality of evidence and strength of recommendations about the relationship between the environment and reproductive health. The result of this collaboration, the---Navigation Guide---was published in the May 2011 issue of the journal Health Affairs. View the paper here.

Application of the Navigation Guide will result in uniform, simple, and transparent summaries that integrate the best practices of evaluation in environmental and clinical health sciences.

Publications on the Navigation Guide

Bero, L., Chartres, N., Diong, J., Fabbri, A., Ghersi, D., Lam, J., Lau, A., McDonald, S., Mintzes, B., Sutton, P., Turton, J.L., & Woodruff, T. J. (2018). The risk of bias in observational studies of exposures (ROBINS-E) tool: concerns arising from application to observational studies of exposures. Systematic Reviews, 7(1), 242. doi: 10.1186/s13643-018-0915-2. View in PubMed or read it here.

Lam J., Lanphear B.P., Bellinger D., Axelrad D.A., McPartland J., Sutton P., Davidson L., Daniels N., Sen S., & Woodruff, T. J. (2017). Developmental PBDE Exposure and IQ/ADHD in Childhood: A Systematic Review and Meta-Analysis. Environmental Health Perspectives, 2017 Aug 3;125(8):086001. doi: 10.1289/EHP1632. View in PubMed or read it here.

Vesterinen, H. M., Morello-Frosch, R., Sen, S., Zeise, L., & Woodruff, T. J. (2017). Cumulative effects of prenatal-exposure to exogenous chemicals and psychosocial stress on fetal growth: Systematic-review of the human and animal evidence. PLoS One, 12(7), e0176331. doi: 10.3390/ijerph14010024. View in PubMed or read it here.

Lam, J., Sutton, P., Kalkbrenner, A., Windham, G., Halladay, A., Koustas, E., ... & Woodruff, T. (2016). A Systematic Review and Meta-Analysis of Multiple Airborne Pollutants and Autism Spectrum Disorder. PLoS One, 11(9), 1-27. doi: 10.1371/journal.pone.0161851. View in PubMed or read it here

Whaley, P., Halsall, C., Agerstrand, M., Aiassa, E., Benford, D., Bilotta, G., ... & Taylor, D. (2016). Implementing systematic review techniques in chemical risk assessment: Challenges, opportunities and recommendations. Environment International, 92-93, 556-564. doi: 10.1016/j.envint.2015.11.002. View in PubMed or read it here.

Vandenberg, L. N., Ågerstrand, M., Beronius, A., Beausoleild, C., Bergman, A., Bero, L. A., ... & Ruden, C. (2016). A proposed framework for the systematic review and integrated assessment (SYRINA) of endocrine disrupting chemicals. Environmental Health, 15(1), 74. doi: 10.1186/s12940-016-0156-6. View in PubMed or read it here.

Stephens, M. L., Betts, K., Beck, N. B., Cogliano, V., Dickersin, K., Fitzpatrick, S., ... & Hoffmann, S. (2016). The Emergence of Systematic Review in Toxicology. Toxicological Sciences, 152(1), 10-16. doi: 10.1093/toxsci/kfw059. View in PubMed or read here.

Johnson, P.  I., Koustas, E., Vesterinen, H. M., Sutton, P., Atchley, D.S., Kim, A.N., ... & Woodruff, T. J. (2016). Application of the Navigation Guide systematic review methodology for developmental and reproductive toxicity of triclosan. Environment International. doi: 10.1016/j.envint.2016.03.009. View in PubMed or read it here.

Sheehan, M. C., Lam, J., Navas-Acien, A., & Chang, H. H. (2016). Ambient air pollution epidemiology systematic review and meta-analysis: A review of reporting and methods practice. Environment International, 92-93, 647-656. doi: 10.1016/j.envint.2016.02.016. View in PubMed or read it here.

Rooney, A. A., Cooper, G. S., Jahnke, G. D., Lam, J., Morgan, R. L., Boyles, A. L., ... & Lunn, R. M. (2016). How credible are the study results? Evaluating and applying internal validity tools to literature-based assessments of environmental health hazards. Environment International, 92-93, 617-629. doi:10.1016/j.envint.2016.01.005. View in PubMed or read it here.

Morgan, R. L., Thayer, K. A., Bero, L., Bruce, N., Falck-Ytter, Y., Ghersi, D., ... & Schunemann, H. J. (2016). GRADE: Assessing the quality of evidence in environmental and occupational health. Environment International, 92-93, 611-616. doi: 10.1016/j.envint.2016.01.004. View in PubMed or read it here.

Woodruff, T. J. (2015). Making it real--the environmental burden of disease. What does it take to make people pay attention to the environment and health? Journal of Clinical Endocrinology and Metabolism, 100(4), 1241-1244. doi: 10.1210/jc.2015-1622. View in PubMed or read it here.

Woodruff, T. J. & Sutton, P. (2014). The Navigation Guide systematic review methodology: a rigorous and transparent method for translating environmental health science into better health outcomes. Environmental Health Perspectives, 122(10), 1007-1014. doi: 10.1289/ehp.1307175. View in PubMed or read it here.

Vesterinen, H., Johnson, P., Atchley, D., Sutton, P., Lam, J., Zlatnik, M., ... & Woodruff, T. J. (2014). Fetal growth and maternal glomerular filtration rate: a systematic review. Journal of Maternal-Fetal and Neonatal Medicine, 28(18), 2176-2181. doi: 10.3109/14767058.2014.980809. View in PubMed or read it here.

Lam, J., Sutton, P., Koustas, E., Johnson, P., Atchley, D. S., Sen, S., ... & Woodruff, T. J. (2014). The Navigation Guide—evidence-based medicine meets environmental health: integration of animal and human evidence for PFOA effects on fetal growth. Environmental Health Perspectives,122(10), 1041-1051. doi: 10.1289/ehp.1307923. View in PubMed or read it here.

Koustas, E., Lam, J., Sutton, P., Johnson, P. I., Atchley, D. S., Sen, S., ... & Woodruff, T. J. (2014). The Navigation Guide—Evidence-Based Medicine Meets Environmental Health: Systematic Review of Nonhuman Evidence for PFOA Effects on Fetal Growth. Environmental Health Perspectives, 122(10), 1015-1027. doi: 10.1289/ehp.1307177. View in PubMed or read it here.

Johnson, P. I., Sutton, P., Atchley, D. S., Koustas, E., Lam, J., ... & Woodruff, T. J. (2014). The Navigation Guide—Evidence-Based Medicine Meets Environmental Health: Systematic Review of Human Evidence for PFOA Effects on Fetal Growth. Environmental Health Perspectives, 122(10), 1028-1039. doi: 10.1289/ehp.1307893. View in PubMed or read it here.

Vesterinen, H. M., Johnson, P. I., Koustas, E., Lam, J., Sutton, P., & Woodruff, T. J. (2013). In Support of EHP’s Proposal to Adopt the ARRIVE Guidelines. Environmental Health Perspectives, 121(11-12), A325-A325. doi: 10.1289/ehp.1307775. View in PubMed or read it here

Sutton, P. & Woodruff, T. J. (2013). Risk communication and decision tools for children's health protection. Birth Defects Research Embryo Today, 99(1), 45-49. doi: 10.1002/bdrc.21029. View in PubMed or read it here.

Krauth, D., Woodruff, T. J., & Bero, L. (2013). Instruments for assessing risk of bias and other methodological criteria of published animal studies: a systematic review. Environmental Health Perspectives, 121(9), 985-992. doi: 10.1289/ehp.1206389. View in PubMed or read it here.

Woodruff, T. J., Sutton, P., & The Navigation Guide Network Group. (2011). An Evidence-Based Medicine Methodology To Bridge The Gap Between Clinical And Environmental Health Sciences. Health Affairs (Millwood), 30(5), 931-937. doi: 10.1377/hlthaff.2010.1219. View in PubMed or read it here.

Sutton, P., Woodruff, T. J., Vogel, S., & Bero, L. A. (2011). Conrad and Becker’s “10 Criteria” Fall Short of Addressing Conflicts of Interest in Chemical Safety Studies. Environmental Health Perspectives, 119(12), a506-a507. doi: 10.1289/ehp.1104385. View in PubMed or read it here

Sutton, P., Conry, J., Rodriguez, P., & Woodruff, T. J. (2010). The Navigation Guide: The Science Behind Practice. San Francisco Medicine. Journal of the San Francisco Medical Society, 85(3), 25-26.  Read it here.

Woodruff, T. J. & Sutton, P. (2010). Pulling back the curtain: improving reviews in environmental health. Environmental Health Perspectives, 118(8), a326- 327. doi: 10.1289/ehp.1002691. View in PubMed or read it here


Case Study Protocols

  1. Application of the Navigation Guide: Case Study of PFOA Effects on Fetal Growth
  1. Triclosan Protocol
  2. Glomerular Filtration Rate and Fetal Growth Protocol
  3. Developmental Exposures to Ambient Air Pollution and Autism
  4. Developmental Exposures to PBDEs and Human Neurodevelopment
  5. Formaldehyde Exposure and Asthma


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