Multi-level Analysis in Epidemiologic Research on Health Behaviors and Outcomes

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Abstract
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

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