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Multilevel Modeling

3. Multilevel Framework

A contextual perspective to raising and answering research questions is intrinsically multilevel, i.e., factors that affect health are viewed as simultaneously operating at the level of individuals and at the level of contexts.

The term multilevel relates to the levels of analysis in public health research, which usually, but not always, consists of individuals (at lower level) who are nested within spatial units (at higher levels).

The term ‘multilevel’ has also been used to advocate a multidisciplinary perspective of public health (Anderson, 1999). In this chapter, however, ‘multilevel’ refers to an analytical perspective, that is, in relation to the levels of analysis in research, which involves taking a multidisciplinary perspective on the questions of epidemiologic interest.

Image representating different individual organization levels as described in text.Multilevel methods, meanwhile, consist of statistical procedures that are pertinent when:

  1. The observations that are being analyzed are correlated or clustered along spatial, non-spatial, or/and temporal dimensions; or
  2. The causal processes are thought to operate simultaneously at more than one level; and/or
  3. There is an intrinsic interest in describing the variability and heterogeneity in the population, over and above the focus on average relationships (Diez Roux, 2002; Subramanian, Jones et al., 2003; Subramanian, 2004; Subramanian, 2004).

It is clear that individuals are organized within a nearly infinite number of levels of organization, from the individual up (e.g., families, neighborhoods, counties, states, regions), from the individual down (e.g., body organs, cellular matrices, DNA), and for overlapping units (e.g., area of residence and work environment).

Therefore it is necessary that links should be made between these possible levels of analysis (Susser, 1998; McKinlay and Marceau, 2000).

Subramanian, S. (2004) Multilevel methods, theory and analysis. In: N. Anderson (Ed.). Encyclopedia on Health and Behavior. Thousand Oaks, CA: Sage Publications. 602-608.
Subramanian, S., Jones, K., et al. (2003) Multilevel methods for public health research. In: I. Kawachi and L. Berkman (Eds.). Neighborhoods and Health. New York: Oxford Press. 65-111.
Diez Roux, A. V. (2002) A glossary for multilevel analysis. Journal of Epidemiology and Community Health 56(8): 588-594.