When Effects Cannot be Estimated: Redefining Estimands to Understand the Effects of Naloxone Access Laws.

ABSTRACT: Violations of the positivity assumption (also called the common support condition) challenge health policy research and can result in significant bias, large variance, and invalid inference. We define positivity in the single- and multiple-timepoint (i.e., longitudinal) health policy evaluation setting, and discuss real-world threats to positivity. We show empirical evidence of the practical positivity violations that can result when attempting to estimate the effects of health policies (in this case, Naloxone Access Laws). In such scenarios, an alternative is to estimate the effect of a shift in law enactment (e.g., the effect if enactment had been delayed by some number of years). Such an effect corresponds to what is called a modified treatment policy, and dramatically weakens the requi

SUBMITTER: Rudolph KE 

PROVIDER: S-EPMC9373236 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature