Tutorial on directed acyclic graphs

Digitale, Jean; Martin, Jeffrey N.; Glymour, M. Maria

doi:10.1016/j.jclinepi.2021.08.001

Cited by 118 publications

(81 citation statements)

References 16 publications

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“…Given the cost and logistics associated with establishing non‐clinic, community‐based PrEP services (e.g. operational and fixed costs akin to a community pharmacy dispensing site), referrals for clinic‐based PrEP services are likely to be more feasible and cost‐effective for large‐scale HIV prevention programs, especially due to the large number of existing non‐government organization and community health worker programs already providing community‐based health services in South Africa [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ]. However, leveraging community‐based platforms for other HIV prevention services, such as injectable PrEP, will be strongly influenced by the cold‐chain requirements of the injectable formulation.…”

Section: Discussionmentioning

confidence: 99%

“…This analysis was restricted to the home‐based modality because there was near‐universal same‐day initiation from the pop‐up testing modality (Figure 2 ). Variable selection for our model was based on a directed acyclic graph, which included factors hypothesized or documented in the literature to be associated with HIV prevention behaviours and PrEP uptake [ 37 ]. First, crude logistic regression was used to estimate associations between presentation and each factor individually.…”

Section: Methodsmentioning

confidence: 99%

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Acceptability and feasibility of leveraging community‐based HIV counselling and testing platforms for same‐day oral PrEP initiation among adolescent girls and young women in Eastern Cape, South Africa

et al. 2022

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Introduction Community‐based delivery of HIV pre‐exposure prophylaxis (PrEP) to South African adolescent girls and young women's (AGYW) could increase access but needs evaluation. We integrated PrEP services via home‐based services and pop‐up tents into existing community‐based HIV testing services (CB‐HTS) in Eastern Cape Province, South Africa. Methods After accessing CB‐HTS via a “pop‐up” tent or home‐based services, HIV‐negative AGYW aged 16–25 years were invited to complete a baseline questionnaire and referred for PrEP services at a community‐based PrEP site co‐located with pop‐up HTS tents. A 30‐day supply of PrEP was dispensed. PrEP uptake, time‐to‐initiation, cohort characteristics and first medication refill within 90 days were measured using descriptive statistics. Results Of the 1164 AGYW who tested for HIV, 825 (74.3%) completed a questionnaire and 806 (97.7%) were referred for community‐based PrEP. Of those, 624 (77.4%) presented for PrEP (482/483 [99.8%] from pop‐up HTS and 142/323 [44.0%] from home‐based HTS), of which 603 (96.6%) initiated PrEP. Of those initiating PrEP following home‐based HTS, 59.1% initiated within 0–3 days, 25.6% within 4–14 days and 15.3% took ≥15 days to initiate; 100% of AGYW who used pop‐up HTS initiated PrEP the same day. Among AGWY initiating PrEP, 37.5% had a detectable sexually transmitted infection (STI). Although AGYW reported a low self‐perception of HIV risk, post‐hoc application of HIV risk assessment measures to available data classified most study participants as high risk for HIV acquisition. Cumulatively, 329 (54.6%) AGYW presented for a first medication refill within 90 days of accepting their first bottle of PrEP. Conclusions Leveraging CB‐HTS platforms to provide same‐day PrEP initiation and refill services was acceptable to AGYW. A higher proportion of AGYW initiated PrEP when co‐located with CB‐HTS sites compared to those referred following home‐based HTS, suggesting that proximity of CB‐HTS and PrEP services facilitates PrEP uptake among AGYW. The high prevalence of STIs among those initiating PrEP necessitates the integration of STI and HIV prevention programs for AGYW. Eligibility for PrEP initiation should not be required among AHYW in high HIV burden communities. Community‐based service delivery will be crucial to maintaining access to PrEP services during the COVID‐19 pandemic and future health and humanitarian emergencies.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Acceptability and feasibility of leveraging community‐based HIV counselling and testing platforms for same‐day oral PrEP initiation among adolescent girls and young women in Eastern Cape, South Africa

et al. 2022

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“…An ideal and comprehensive approach would be to develop the full structural model as directed acyclic graphs [ 48 ] and collect all relevant factors needed to tease out the causal effects of interest. Alternatively, partial causal models that employ quasi-experimental designs may be used to establish causality.…”

Section: Discussionmentioning

confidence: 99%

Myopia and Depression among Middle School Students in China—Is There a Mediating Role for Wearing Eyeglasses?

Huang

Dang

Cai

et al. 2022

IJERPH

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Compared with non-myopic students, myopic students face more barriers to learning (e.g., inability to see the blackboard clearly) and socializing (e.g., being victims of teasing, social exclusion and violence), which may lead to increased stress, anxiety and frustration. The high prevalence of myopia and depression among school-age children naturally raises a question of great policy relevance: are myopic students more vulnerable to mental health problems such as depression? This paper sheds some light on this question by analyzing data from the China Education Panel Survey, a large-scale survey of China’s middle school students. Our analysis first quantifies the association between myopia and sample students’ depression status (measured by the widely adopted CES-D scale) adjusted for potential confounding factors. We then explore whether the myopia–depression relationship is mediated by wearing eyeglasses, a cost-effective means of vision correction. Based on data on 19,299 middle school students, our analysis reveals that myopic students scored 0.12 standard deviations higher on the CES-D scale than their non-myopic counterparts. The adverse effect of myopia is more severe for relatively disadvantaged students: older students (who are more likely to suffer from both myopia and depression), lower-performing students and students from poorer families. Further medication analysis shows that wearing eyeglasses suppresses the myopia–depression relationship but cannot completely offset the adverse effect of myopia.

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“…Other variables, such as age, familiarity, patterns of participation in the research, place of residence and IPVS [ 7 ], were also considered in the causal diagram ( Fig 1 ). Because it can be a list of unmeasured common causes of both place and race, we follow a convention that visually simplifies the DAG by representing all unmeasured variables with the same causal structure (i.e., the same arrows in and out) as a single node [ 47 ]. In this case, we included the concept of “familiarity” as that node representing all common determinants of both, place of residence and race.…”

Section: Methodsmentioning

confidence: 99%

Race (black-white) and sex inequalities in tooth loss: A population-based study

Souza

Díaz-Quijano²,

Barros³

et al. 2022

PLoS ONE

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The effect of health inequalities is determined by different socioeconomic, sex, and race conditions. This study aimed to analyze the association of tooth loss with race (defined by self-reported skin color) and sex. Based on the hypothesis that the association between tooth loss and race may be modified by sex, we also aimed to evaluate possible interactions between race and sex in association with this event, in a population-based study in the city of Campinas, Brazil. A directed acyclic graph was used to select covariates. The prevalence, of tooth loss was 19% higher in black women compared to white men (Prevalence ratio [PR]: 1.19; 95%CI: 1.05–1.34). Moreover, the prevalence of tooth loss in black women was 26% higher than in white women (PR: 1.26; 95%CI: 1.13–1.42); and, within the strata of black people, black women had 14% higher dental loss (PR: 1.14; 95%CI: 1.02–1.27) compared to black men. This study found a significant interaction between race and sex in tooth loss, with a disadvantage for black women. In addition, this work contributes to the discussion of health inequities and can support policies for the provision of universal dental care.

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Tutorial on directed acyclic graphs

Cited by 118 publications

References 16 publications

Acceptability and feasibility of leveraging community‐based HIV counselling and testing platforms for same‐day oral PrEP initiation among adolescent girls and young women in Eastern Cape, South Africa

Acceptability and feasibility of leveraging community‐based HIV counselling and testing platforms for same‐day oral PrEP initiation among adolescent girls and young women in Eastern Cape, South Africa

Myopia and Depression among Middle School Students in China—Is There a Mediating Role for Wearing Eyeglasses?

Race (black-white) and sex inequalities in tooth loss: A population-based study

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