Target Validity and the Hierarchy of Study Designs…

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Target Validity and the

Hierarchy of Study Designs
Daniel Westreich , Jessie K Edwards,
Catherine R Lesko, Stephen R Cole, Elizabeth A Stuart

American Journal of Epidemiology, Volume 188, Issue 2,

February 2019, Pages 438–443,
https://doi.org/10.1093/aje/kwy228
Published: 09 October 2018 Article history

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Abstract
In recent years, increasing attention has been
paid to problems of external validity,
specifically to methodological approaches for
both quantitative generalizability and
transportability of study results. However, most
approaches to these issues have considered
external validity separately from internal
validity. Here we argue that considering either
internal or external validity in isolation may be
problematic. Further, we argue that a joint
measure of the validity of an effect estimate
with respect to a specific population of interest
may be more useful: We call this proposed
measure target validity. In this work, we
introduce and formally define target bias as the
total difference between the true causal effect in
the target population and the estimated causal
effect in the study sample, and target validity as
target bias = 0. We illustrate this measure with a
series of examples and show how this measure
may help us to think more clearly about
comparisons between experimental and
nonexperimental research results. Specifically,
we show that even perfect internal validity does
not ensure that a causal effect will be unbiased
in a specific target population.

Keywords: causal inference, external validity,

generalizability, internal validity, study design,
target population, target validity, transportability
 Topic: epidemiologic causality, internal validity,
external validity
Issue Section: PRACTICE OF EPIDEMIOLOGY

© The Author(s) 2018. Published by Oxford University Press on

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Health. All rights reserved. For permissions, please e-mail:
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American Journal of Epidemiology

Online ISSN 1476-6256

Print ISSN 0002-9262
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