Objectives: To introduce a new tool for assessing risk of bias in non-randomised studies of exposures, and illustrate its application to studies of environmental and occupational exposure.

Description: Systematic reviews should include rigorous risk-of-bias assessments of included studies. We are adapting the recently published ROBINS-I instrument (for risk of bias in non-randomised studies of interventions) to address non-randomized studies of exposures other than interventions, including environmental and occupational exposures. This workshop will present an overview of the adapted instrument (to be named ROBINS-E), and will explain the proposed changes to ROBINS-I that will make ROBINS-E more suitable for assessing studies of exposures). Key aspects include preliminary consideration of risk of bias within the review protocol, use of signaling questions to inform risk-of-bias judgments, specification of a 'target experiment', detailed assessments of confounding and exposure measurement error, and guidance for interpretation across a body of evidence.
There will be a hands-on exercise to apply the draft ROBINS-E instrument to individual studies of a specific environmental exposure. The workshop will conclude by making a study-level risk-of-bias judgment, and discuss considerations when using ROBINS-E to assess individual studies to inform a systematic review, including making an overall risk-of-bias judgment across a body of evidence for a specific outcome.