American Journal of Epidemiology Vol. 135, No. 10: 1077-1082
Copyright © 1992 by The Johns Hopkins University School of Hygiene and Public Health
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Multi-level Analysis in Epidemiologic Research on Health Behaviors and Outcomes
1Center for Health Studies, Group Health Cooperative of Puget Sound Seattle, WA
2Department of Health Services, University of Washington School of Public Health Seattle, WA
3Department of Epidemiology, University of Washington School of Public Health Seattle, WA
4Department of Biostatistics, University of Washington School of Public Health Seattle, WA
Dr. Michael Von Korff, Center for Health Studies, Group Health COoperative of Puget Sound, 1730 Minor Avenue, Seattle, WA 98101
Individual-level health behaviors and outcomes have multi-level determinants (individual and environmental). Multi-level analysis seeks to explain individual outcomes in terms of both individual and environmental or aggregate variables. Ecologic fallacy (improper inference about individual-level associations based on associations measured only at the aggregate level) can result from confusion about the level of inference that is of ultimate interest. The perspective of multi-level analysis acknowledges the importance of both individual and environmental variables in determining health behaviors and outcomes at the level of the indivisible unit—the individual. The authors review concepts and methods of multi-level analysis and their application to epidemiologic research on health behavior and health outcomes. Am J Epidemiol 1992; 135: 1077–82
community medicine; epidemiologic methods; health behavior; health promotion; statistics
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