Risks and wrongs in social science research. An evaluator's guide to the IRB

Longitudinal Studies of Wearables in Patients with Diabetes: Key Issues and Solutions

Glucose monitoring is key to the management of diabetes mellitus to maintain optimal glucose control whilst avoiding hypoglycemia. Non-invasive continuous glucose monitoring techniques have evolved considerably to replace finger prick testing, but still require sensor insertion. Physiological variables, such as heart rate and pulse pressure, change with blood glucose, especially during hypoglycemia, and could be used to predict hypoglycemia. To validate this approach, clinical studies that contemporaneously acquire physiological and continuous glucose variables are required. In this work, we provide insights from a clinical study undertaken to study the relationship between physiological variables obtained from a number of wearables and glucose levels. The clinical study included three screening tests to assess neuropathy and acquired data using wearable devices from 60 participants for four days. We highlight the challenges and provide recommendations to mitigate issues that may impact the validity of data capture to enable a valid interpretation of the outcomes.

The effect of a multidimensional teaching strategy on the self-efficacy and critical thinking dispositions of nursing students: A quasi-experimental study

BACKGROUND

Internships in pediatric nursing often reveal that nursing students lack critical thinking dispositions and self-confidence, which are important and necessary for nursing practice. Therefore, preparing nursing students to engage in critical thinking is an important goal for educators.

OBJECTIVES

The purpose of this study was to explore whether a teaching model combining the 5E learning model and self-efficacy would be effective in enhancing participants' self-efficacy and critical thinking dispositions in a course on child-friendly care.

DESIGN

The quasi-experimental method was single-blind, as the study was conducted with two parallel and unequal groups to address the research questions.

SETTING

Two campuses of a university located in Northern and Southern Taiwan.

PARTICIPANTS

Fifty-eight participants completed this study.

METHODS

Participants completed the pre-test questionnaire in Week 1, after which participants in the experimental group learned via the teaching strategy that combined the 5E learning model and self-efficacy, while participants in the control group were taught the same course via conventional teaching methods. A post-test questionnaire was completed in Week 18. An independent sample t-test was used to determine any mean differences of outcome variables between groups over time.

RESULTS

Significant improvements were found in self-efficacy, t (56) = 3.93, p < 0.01, but non-significant results for the outcome of critical thinking disposition t (56) = 0.88, p > 0.05. A t-test was also performed on the four subscales of critical thinking disposition for the two groups, showing that the only difference for overall reflective thinking was statistically significant, t (56) = 2.09, p < 0.05).

CONCLUSIONS

The multidimensional teaching strategy introduced in this study is more effective than conventional teaching strategies in improving students' self-efficacy and the overall reflective thinking aspect of critical thinking disposition.

Process, Power, and Impact of the Institutional Review Board in Criminology and Criminal Justice Research

While research on Institutional Review Boards (IRBs) has been conducted on issues ranging from quality, process, and effectiveness, gaps remain. Social science researchers have raised issues regarding decisions by IRBs applied to the social sciences based on biomedical research. To date, little is known about the experience of social scientists in criminology and criminal justice with IRBs and this research seeks to fill this gap. An online survey, including open- and closed-ended questions drawn from the validated IRB-Researcher Assessment Tool, was administered to members of the Academy of Criminal Justice Sciences and the American Society of Criminology about their experiences with IRBs. Results revealed that researchers report experiencing challenges with their IRBs including timeline delays of their research, bias against their research, and decisions that protect legal liability rather than human subjects ethics. Recommendations for improving IRB reviews of protocols and challenges unique to criminology and criminal justice are discussed.

Compliance with National Ethics Requirements for Human-Subject Research in Non-biomedical Sciences in Brazil: A Changing Culture?

Ethics regulation for human-subject research (HSR) has been established for about 20 years in Brazil. However, compliance with this regulation is controversial for non-biomedical sciences, particularly for human and social sciences (HSS), the source of a recent debate at the National Commission for Research Ethics. We hypothesized that for these fields, formal requirements for compliance with HSR regulation in graduate programs, responsible for the greatest share of Brazilian science, would be small in number. We analyzed institutional documents (collected from June 2014 to May 2015) from 171 graduate programs at six prestigious Brazilian universities in São Paulo and Rio de Janeiro, the states that fund most of the science conducted in Brazil. Among these programs, 149 were in HSS. The results suggest that non-compliance with standard regulation seems to be the rule in most of these programs. The data may reflect not only a resistance from scientists in these fields to comply with standard regulations for ethics in HSR but also a disciplinary tradition that seems prevalent when it comes to research ethics in HSR. However, recent encounters between Brazilian biomedical and non-biomedical scientists for debates over ethics in HSR point to a changing culture in the approach to research ethics in the country.

In defence of governance: ethics review and social research

There is a growing body of literature that has sought to undermine systems of ethical regulation, and governance more generally, within the social sciences. In this paper, we argue that any general claim for a system of research ethics governance in social research depends on clarifying the nature of the stake that society has in research. We show that certain accounts of this stake-protecting researchers' freedoms; ensuring accountability for resources; safeguarding welfare; and supporting democracy-raise relevant ethical considerations that are reasonably contested. However, these accounts cannot underpin a general claim in favour of, or against, a system of research ethics governance. Instead, we defend governance in social research on the grounds that research, as an institutionalised form of enquiry, is a constitutive element of human flourishing, and that society ought to be concerned with the flourishing of its members. We conclude by considering the governance arrangements that follow from, and are justified by, our arguments.

Research Ethics Governance in Times of Ebola

The Médecins Sans Frontières (MSF) ethics review board (ERB) has been solicited in an unprecedented way to provide advice and review research protocols in an ‘emergency’ mode during the recent Ebola epidemic. Twenty-seven Ebola-related study protocols were reviewed between March 2014 and August 2015, ranging from epidemiological research, to behavioural research, infectivity studies and clinical trials with investigational products at (very) early development stages. This article examines the MSF ERB’s experience addressing issues related to both the process of review and substantive ethical issues in this context. These topics include lack of policies regarding blood sample collection and use, and engaging communities regarding their storage and future use; exclusion of pregnant women from clinical and vaccine trials; and the difficulty of implementing timely and high-quality qualitative/anthropological research to consider potential upfront harms. Having noticed different standards across ethics committees (ECs), we propose that when multiple ethics reviews of clinical and vaccine trials are carried out during a public health emergency they should be accompanied by transparent communication between the ECs involved. The MSF ERB experience should trigger a broader discussion on the ‘optimal’ ethics review in an emergency outbreak and what enduring structural changes are needed to improve the ethics review process.

Variation in university research ethics review: Reflections following an inter-university study in England

Conducting large multi-site research within universities highlights inconsistencies between universities in approaches, requirements and responses of research ethics committees. Within the context of a social science research study, we attempted to obtain ethical approval from 101 universities across England to recruit students for a short online survey. We received varied responses from research ethics committees of different universities with the steps to obtaining ethics approval ranging from those that only required proof of approval from our home institution, to universities that facilitated fast-track applications to those that required a full ethics review. Some universities also completely refused. After contacting all 101 universities in England, 60 universities gave clearance to our study. In this article, we present the different approaches universities adopted in response to our application to sample from students in their institution. We consider a number of conceptual and ethical issues pertinent to considering ethics approval for researchers from other universities in England and critically discuss three possible models of ethics governance that would cover all universities in England.

A Social Work Perspective on Paediatric and Adolescent Research Vulnerability

Children’s and adolescents’ capacity to provide valid informed consent is one of the key ethical concerns in pediatric research. This review of adolescent vulnerability is presented to highlight the complex interplay between capacity and other forms of vulnerability. This review is offered as an interdisciplinary analysis to better understand why the study of vulnerable populations is critical to the ethical advancement of clinical research. Results from this analysis suggest the need for enhanced screening techniques as well as the utilization of specialized staff to identify and reduce the impact of different forms of vulnerability. These findings also provide insights into ways to ethically involve youth in complex biomedical research.

Best (but oft-forgotten) practices: designing, analyzing, and reporting cluster randomized controlled trials

Cluster randomized controlled trials (cRCTs; also known as group randomized trials and community-randomized trials) are multilevel experiments in which units that are randomly assigned to experimental conditions are sets of grouped individuals, whereas outcomes are recorded at the individual level. In human cRCTs, clusters that are randomly assigned are typically families, classrooms, schools, worksites, or counties. With growing interest in community-based, public health, and policy interventions to reduce obesity or improve nutrition, the use of cRCTs has increased. Errors in the design, analysis, and interpretation of cRCTs are unfortunately all too common. This situation seems to stem in part from investigator confusion about how the unit of randomization affects causal inferences and the statistical procedures required for the valid estimation and testing of effects. In this article, we provide a brief introduction and overview of the importance of cRCTs and highlight and explain important considerations for the design, analysis, and reporting of cRCTs by using published examples.

PAlliative Care in chronic Kidney diSease: the PACKS study--quality of life, decision making, costs and impact on carers in people managed without dialysis

Background

The number of patients with advanced chronic kidney disease opting for conservative management rather than dialysis is unknown but likely to be growing as increasingly frail patients with advanced renal disease present to renal services. Conservative kidney management includes ongoing medical input and support from a multidisciplinary team. There is limited evidence concerning patient and carer experience of this choice. This study will explore quality of life, symptoms, cognition, frailty, performance decision making, costs and impact on carers in people with advanced chronic kidney disease managed without dialysis and is funded by the National Institute of Health Research in the UK.

Methods

In this prospective, multicentre, longitudinal study, patients will be recruited in the UK, by renal research nurses, once they have made the decision not to embark on dialysis. Carers will be asked to ‘opt-in’ with consent from patients. The approach includes longitudinal quantitative surveys of quality of life, symptoms, decision making and costs for patients and quality of life and costs for carers, with questionnaires administered quarterly over 12 months. Additionally, the decision making process will be explored via qualitative interviews with renal physicians/clinical nurse specialists.

Discussion

The study is designed to capture patient and carer profiles when conservative kidney management is implemented, and understand trajectories of care-receiving and care-giving with the aim of optimising palliative care for this population. It will explore the interactions that lead to clinical care decisions and the impact of these decisions on informal carers with the intention of improving clinical outcomes for patients and the experiences of care givers.

"Protecting" or "Policing": Academic Researchers' View of IRBs in an Arab Context

A recent surge of research universities and human subjects research funding in the Arab world raises concerns about applied research ethics and oversight. In-depth interviews conducted with 52 researchers in Lebanon and Qatar about their research conduct and the problems they face while conducting it indicate that although researchers admit to the added value of institutional review board (IRB) functions, the researchers have several complaints, such as rigid and contextually insensitive requirements, delays, and inadequate resources at IRBs, and a lack of outreach and effective communication with researchers. The study discusses these challenges pointing to the need for socioculturally adaptive regulations and forms and strengthening outreach and communication between IRBs and their users to improve ethical practices. Implications for future research are also presented.

Distress, need for help, and positive feelings derived from participation in sex research: findings of a population study in The Netherlands

To inform cost-benefit analyses of potential harms and benefits for participants in sex research, the current study investigated potential effects of completing a self-report sex survey. The data stem from a sexual health study in a population sample in the Netherlands (N = 8,064; 15 to 70 years old). Three measures assessed potential effects of participation: distress, need for help, and positive feelings related to research participation. Analyses showed that levels of experienced distress and need for help resulting from participation in a self-report sex survey were low, while participants reported positive feelings to a considerable extent. Only few participants reported levels of positive experiences that were lower than the levels of distress (4.8%) or need for help (1.7%) they experienced. Although differences were found according to sociodemographic characteristics and sexual experiences, the proportion of variance explained by these variables was generally small. While the findings of this study show that the balance between potential harm and positive outcomes seems disturbed for few participants, researchers should provide participants with the details of care providers in case they experience any distress or need for help.

Understanding Classrooms through Social Network Analysis: A Primer for Social Network Analysis in Education Research

Social interactions between students are a major and underexplored part of undergraduate education. Understanding how learning relationships form in undergraduate classrooms, as well as the impacts these relationships have on learning outcomes, can inform educators in unique ways and improve educational reform. Social network analysis (SNA) provides the necessary tool kit for investigating questions involving relational data. We introduce basic concepts in SNA, along with methods for data collection, data processing, and data analysis, using a previously collected example study on an undergraduate biology classroom as a tutorial. We conduct descriptive analyses of the structure of the network of costudying relationships. We explore generative processes that create observed study networks between students and also test for an association between network position and success on exams. We also cover practical issues, such as the unique aspects of human subjects review for network studies. Our aims are to convince readers that using SNA in classroom environments allows rich and informative analyses to take place and to provide some initial tools for doing so, in the process inspiring future educational studies incorporating relational data.

Methods for Assessing and Addressing Participant Protection Concerns in Intimate Partner Violence Research

Research on intimate partner violence (IPV) is highly sensitive and may put some participants at increased psychological, emotional, and physical risk. Still, we know little about the risks posed by most social science methods and have minimal guidance regarding appropriate practices for carrying out various forms of research. This study collected data from 59 IPV researchers regarding the most commonly used participant protection methods, the efficacy of those methods, number and nature of adverse events (AE) experienced, and experiences with institutional review boards (IRBs). Participants were invited via e-mail to complete an anonymous online survey. Findings indicate an overall low incidence of AEs as well as a minimal relationship between AEs and IPV inquiry. These findings may provide researchers with preliminary data on the effectiveness of various participant protection methods. Results may also facilitate more innovative and effective participant protections measures, help researchers prevent and cope with AE, and create more mutually beneficial relationships with IRBs.

Social science and ethics review: A question of practice not principle

In his article ‘The case against ethics review in the social sciences’, Schrag asserts that the social sciences should not be subject to ethical review. He recounts a number of examples where ethical review has seemingly failed. He further suggests some alternative models for dealing with ethical review in the social sciences. Finally, he concludes, and we concur, that there is a lack of empirical evidence as to the benefit of research ethics review.

Doing more good than harm? The effects of participation in sex research on young people in the Netherlands

Ethical guidelines for research with human participants stress the importance of minimizing risks and maximizing benefits. In order to assist Institutional Review Boards (IRBs) and researchers to make more informed risk/benefit analyses with regard to sex research among adolescents, the current study examined the effects of participation in sex research among 899 young people (15-25 years old). Participants completed three questionnaires on a wide range of sexuality-related measures. They also completed scales measuring their levels of distress, need for help, and positive feelings due to their research participation. In general, negative effects of research participation seemed limited, while benefits of participation appeared substantial. Several differences with regard to sociodemographic characteristics were found (e.g., females experienced more distress then males and younger or lower educated participants experienced more positive feelings). In addition, victims of sexual coercion reported more distress and need for help due to their participation, but also experienced more positive feelings. No significant differences were found in relation to experience with sexual risk behaviors (e.g., experience with one-night-stands). Several limitations of the study were discussed, as were implications for future research. Overall, the findings caution IRBs and researchers against being overly protective regarding the inclusion of young people in sex research.

Legal and Ethical Considerations in Forensic Pathology Research

A robust legal and ethical framework for biomedical research has developed with regard to living subjects. This framework applies incompletely to research on autopsies, particularly medicolegal autopsies authorized by law rather than the consent of the next-of-kin. Many patient rights extinguish at death. No traditional physician-patient relationship exists with regard to the pathologist and an autopsied body. U.S. federal biomedical research regulation, the “Common Rule”, is specifically limited to living human subjects. Nonetheless, it may be wise to obtain consent of the next-of-kin for research involving tissues, invasive procedures, and family interviews, unless an Institutional Review Board waives the requirement due to “minimal risk” of harm. Similarly, privacy laws and regulations may not apply fully, but maintenance of confidentiality and anonymization of data may be prudent. Compliance with other research concerns, such as avoidance of conflicts of interest, “good laboratory practice”, and adherence to ethical norms are important. We recommend legislation to clarify and facilitate research in forensic pathology.

Ethics Review in a Developing Country: A Survey of South African Social Scientists' Experiences

We report the findings of a preliminary study of social science researchers' experiences of ethics review from a developing country perspective. Social science researchers' experiences of ethics review were coded as negative (42.6%), positive (21.3%), or mixed (36.2%). Ethics review was primarily experienced as negative for pragmatic reasons such as slow turnaround time, inadequate review and problems with the centralization of review. Our finding that South African researchers experience the same problems and frustrations with RECs as developed country researchers affirms that South Africa's problems with ethics review are not due to it being a less developed system, but to general review practices as they arise naturally in institutions. Developing countries thus have a unique opportunity to learn from the reported dissatisfactions and mistakes of developed countries, to avoid procedures that have hindered ethics review of much social science research in developed countries, and to fashion their own review procedures in ways that are more appropriate to key ethical issues arising in social science research and local conditions and resources.

Ethical guidelines for designing and conducting evaluations of social work practice

We review selected aspects of current ethical guidelines pertaining to the design and conduct of social work evaluation and research studies. We contend that there are significant differences between social science research and evaluation studies, and that the uncritical application of ethical guidelines suitable for regulating social science research may hinder social workers undertaking clinical and program evaluations. What is needed are ethical guidelines that distinguish between retrospective and prospectively designed studies, which enumerate when voluntary and informed consent may not be necessary in order to use data obtained from clients, and clearer standards pertaining to exempting evaluation studies from oversight by Institutional Review Boards.

Piercing the veil: ethical issues in ethnographic research

It is not unusual for researchers in ethnography (and sometimes Institutional Review Boards) to assume that research of "public" behavior is morally unproblematic. I examine an historical case of ethnographic research and the sustained moral outrage to the research expressed by the subjects of that research. I suggest that the moral outrage was legitimate and articulate some of the ethical issues underlying that outrage. I argue that morally problematic Ethnographic research of public behavior can derive from research practice that includes a tendency to collapse the distinction between harm and moral wrong, a failure to take account of recent work on ethical issues in privacy; failure to appreciate the deception involved in ethnographers' failure to reveal their role as researchers to subjects and finally a failure to appropriately weigh the moral significance of issues of invasion of privacy and inflicted insight in both the research process and subsequent publication of research.

Regulatory Issues Encountered when Conducting Longitudinal Substance Abuse Research

OBJECTIVE: To summarize challenges unique to obtaining Institutional Review Board (IRB) approval for longitudinal substance abuse research, focusing on solutions and lessons learned. METHODS: Thirteen senior Principal Investigators with experience conducting research on substance abuse treatment and health services outcomes recalled instances from the prior 5 years when obtaining UCLA and non-UCLA IRB approval was hampered by differences in the interpretation of regulatory guidelines and how those differences were resolved. PRINCIPAL FINDINGS: Comprehensive yet flexible research protocols regarding (1) informed and voluntary consent, (2) participant payment, and (3) re-contact efforts are essential for securing IRB approval of longitudinal substance abuse studies. Specific examples of lessons learned are provided. CONCLUSIONS: Experiences can help researchers to provide appropriate and explicit justification for longitudinal substance abuse research protocols, thereby minimizing the burden and cost associated with meeting regulatory requirements as well as enhancing the efficiency, quantity, and quality of data collected.

Combining ethical considerations with recruitment and follow-up strategies for partner violence victimization research

In general, the literature on research ethics and the literature on recruitment and retention of research participants tend to be separated by different purposes and principles. This article uses multiple methods to compile information about research ethics with vulnerable participants as well as with recruitment and follow-up strategies, including (a) literature reviews, (b) key informant interviews, (c) focus group interviews, (d) a pilot study to test ideas for study implementation, and (e) documentation of recruitment and follow-up efforts for a longitudinal study of 757 women with partner violence victimization experiences. This article shows how considering research ethics may actually enhance recruitment and follow-up strategies with women experiencing partner violence victimization.

How the powerful decide: access to research participation by those at the margins

How do those in power decide to include and exclude those at the margins from community life? We used simulated review of research vignettes to examine how researchers and members of Institutional Review Boards make decisions concerning the research participation of adults with and without intellectual disabilities. Results indicate that decision-makers are influenced by the disability status of the sample, characteristics of the research in which they are engaged, and their attitudes toward the research participation of adults with intellectual disabilities as well as their own relationship to the research process. For example, decision-makers may create situations that limit the self-determination of adults with intellectual disabilities and adults without disabilities within the research context, particularly when the research poses some risk of harm to participants. Implications for theory, action and research are explored.

An HIV prevention protocol reviewed at 15 national sites: how do ethics committees protect communities?

To learn whether ethics committees reviewing community-based participatory research concentrate on the protection of communities, in addition to individual participants, data from 15 sites were analyzed. Eighty-two ethics committee concerns related to consent (35%), protocol procedures (49%), data collection (17%), and HIPAA (6%) were identified. Concerns generally involved individual level subject issues; only 17% were related to community issues. To improve community-level protections in research, the authors recommend that both ethics committee members and research staff receive education concerning protection and respect for communities, that a community member group be established to advise researchers throughout the planning and implementation of community-level studies and that local ethics committee boards include members with community-level experience.

The HIPAA authorization form and effects on survey response rates, nonresponse bias, and data quality: a randomized community study

BACKGROUND

There has been speculation that the Health Insurance Portability and Accountability Act (HIPAA) has muted participation in research but little direct evidence to substantiate those claims exists.

OBJECTIVE

To evaluate the effects of including a HIPAA authorization form (HAF) on multiple measures of survey performance. RESEARCH DESIGN, SUBJECTS: A community survey of Olmsted County, Minnesota residents conducted between September 2005 and April 2006. A total of 6939 cases were randomly assigned to 2 experimental conditions where half of the subjects received a 1-page HAF (n = 3469) and the other half did not (n = 3470).

MAIN OUTCOME MEASURES

Response rate, nonresponse bias, and data quality.

RESULTS

At the end of data collection, a response rate of 39.8% was observed in the HAF condition and 55.0% in the No HAF condition (P < 0.0001). There was a negligible but statistically significant (P < or = 0.001) over-representation of males in the No HAF condition but no difference in the amount of missing data between the 2 groups. However, reports of general health and the percentage of respondents indicating that they were nonsmokers were both significantly (P < or = 0.01) lower in the No HAF condition than in the HAF condition.

CONCLUSIONS

Inclusion of a minimally burdensome version of the HAF reduced survey response rates by up to 15 percentage points. This could have implications for a study's statistical power. There was little evidence that the form affected nonresponse bias or data quality.

A review finds that multicenter studies face substantial challenges but strategies exist to achieve Institutional Review Board approval

BACKGROUND AND OBJECTIVES

To characterize the impact of multiple Institutional Review Board (IRB) reviews on multicenter observational research studies, and identify strategies for overcoming the identified challenges.

MATERIALS AND METHODS

Using PubMed, we identified empirical studies, anecdotal reports, and opinion pieces addressing the process of obtaining initial IRB approval for multicenter clinical trials and observational studies. We also reviewed relevant information from federal and other national sources.

RESULTS

A total of 40 peer-reviewed articles were synthesized, plus six reports from commissions or other key sources. These sources identified numerous challenges that researchers may encounter when multicenter studies undergo review by multiple IRBs, such as added time for initial review and approval and different requirements across IRBs. Strategies to alleviate these challenges include planning to accommodate multiple reviews and determining upfront whether certain variations to study protocols are tolerable across sites. Many researchers and commissions have proposed comprehensive reforms, such as centralized review for multicenter projects.

CONCLUSION

Policy-makers, researchers, and IRBs should convene to specifically discuss optimal approaches for multicenter review. However, until structural changes are implemented, observational researchers should develop and implement strategic plans for obtaining IRB approval in multicenter studies, including adopting models successfully employed by clinical trials.

New challenges facing interinstitutional social science and educational program evaluation research at academic health centers: a case study from the ELAM program

Since the mid-1990s, the protection of human subjects through institutional review boards (IRBs) has progressively broadened in scope. In this case study, the authors describe their challenges in effectively handling IRB processes to conduct educational and social sciences research within academic health centers, particularly (1) complications in conducting longitudinal interinstitutional research that involves multiple IRBs, each with different procedures that changed over ten years; and (2) factors affecting consent form and survey response rates when applying the biomedical IRB process to obtain the consent of human subjects for participation in social and educational research. The authors had a unique opportunity to follow the effect of changes in consent forms (from no form to a one-page form to a three-page form requiring signature of a witness), ways of administration (in person or by mail), and time of administration (at the time of the program or years later) on consent form and survey response rates among medical and dental school faculty members. The authors explore the extended timelines required for data collection and increased costs in dealing with these issues, as well as the effects on response rates of consent form language and administration procedures. The authors recommend strategies to lessen adverse effects of dealing with multiple IRBs at different institutions for social science and educational research, and discuss policy implications for funders, institutions and investigators.

Looking into the institutional review board: observations from both sides of the table

Institutional review board (IRB) reviews offer the benefit of perspective afforded by the board's distance from the research and the research subjects. At the same time, distance from research subjects that is geographic, socioeconomic, cognitive, linguistic, and cultural can undermine the positive role of perspective. In addition, distance between IRB and investigators, largely a result of attitudes and communication, can prolong the review process and can obscure its message. The tension that often characterizes IRB-investigator relationships is due, in part, to variability in the application of federal regulations by IRBs across institutions and, on the part of investigators, inexperience, communication problems, and difficulties in anticipating the needs of their subjects. Contributing to the variability are the demographics and the culture of the IRB, attitudes that influence IRB-investigator relationships, and the adequacy of support from the institution. The effects of these factors on review decisions and on the performance of the human subjects protection system are largely unstudied. The movement for IRB accreditation is causing institutions to examine their overall research protection system and promises a more collaborative approach, where IRB and investigators accept their common charge to meet the needs of subjects and to improve the quality of research.

Participatory action research: considerations for ethical review

This paper addresses the distinctive nature of participatory action research (PAR) in relation to ethical review requirements. As a framework for conducting research and reducing health disparities, PAR is gaining increased attention in community and public health research. As a result, PAR researchers and members of Research Ethics Boards could benefit from an increased understanding of the array of ethical concerns that can arise. We discuss these concerns in light of commonly held ethical requirements for clinical research (social or scientific value, scientific validity, fair subject/participant selection, favourable risk-benefit ratio, independent review, informed consent, and respect for potential and enrolled participants) and refer to guidelines specifically developed for participatory research in health promotion. We draw from our community-based experiences in mental health promotion research with immigrant and culturally diverse youth to illustrate the ethical advantages and challenges of applying a PAR approach. We conclude with process suggestions for Research Ethics Boards.

The (mis)estimation of neighborhood effects: causal inference for a practicable social epidemiology

The resurgence of interest in the effect of neighborhood contexts on health outcomes, motivated by advances in social epidemiology, multilevel theories and sophisticated statistical models, too often fails to confront the enormous methodological problems associated with causal inference. This paper employs the counterfactual causal framework to illuminate fundamental obstacles in the identification, explanation, and usefulness of multilevel neighborhood effect studies. We show that identifying useful independent neighborhood effect parameters, as currently conceptualized with observational data, to be impossible. Along with the development of a dependency-based methodology and theories of social interaction, randomized community trials are advocated as a superior research strategy, one that may help social epidemiology answer the causal questions necessary for remediating disparities and otherwise improving the public's health.