Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “multilevel analysis”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 91 records · Page 5Linked to original sources
PubMed2003

Effect of neighborhood social participation on individual use of hormone replacement therapy and antihypertensive medication: a multilevel analysis.

The authors investigated a possible contextual effect of neighborhood on individual use of hormone replacement therapy (HRT) and antihypertensive medication (AHM) and the impact of neighborhood social participation on individual use of these medications. They attempted to disentangle contextual from individual influences. Multilevel logistic regression modeling was used to analyze data on 15,456 women aged 45-73 years (first level) residing in 95 neighborhoods (second level) of the city of Malmö, Sweden (250,000 inhabitants) who participated in the Malmö Diet and Cancer Study (1991-1996). AHM use was studied among 7,558 participants with defined hypertension. Of the total variability in medication use in this population, only 1.7% (HRT) and 0.5% (AHM) was between neighborhoods. After adjustment for age, individual socioeconomic factors, individual low levels of social participation, and health and behavioral variables, no neighborhood effect on AHM use was found. However, women living in neighborhoods with low social participation were much less likely to use HRT (odds ratio = 0.36, 95% confidence interval: 0.21, 0.63), especially if they themselves experienced low social participation (synergy index, 1.53) or were immigrants (synergy index, 1.68). The Malmö neighborhoods were homogeneous with regard to HRT and especially AHM use. However, differences in neighborhood social participation affected HRT use independently of individual characteristics.

Age Distribution↗
PubMed2003

A multilevel analysis of change in alcohol consumption in Québec, 1993-98.

AIMS: Changes in drinking are subgroup-specific and vary by dimensions of drinking pattern. This study investigates changes in drinking patterns between 1993 and 1998 within various subgroups of Québec society. DESIGN: A multilevel design was used in which respondents (level 1) were nested within demographic groups (level 2). PARTICIPANTS: Based on the 1993 and 1998 Québec Health and Social Surveys, 40 598 respondents (level 1) were nested within 220 groups (level 2) based on age, SES status, gender and the year of survey. MEASUREMENTS: The effect of group characteristics were assessed for various dimensions of drinking pattern. FINDINGS: A significant part of the variance in drinking pattern is attributed to group membership (ranging from 8.6% to 18.3%). Except for the frequency of heavy drinking episodes, the data revealed a significant increase between 1993 and 1998 on all drinking pattern dimensions, which was more marked for higher SES groups for current drinking status. However, the frequency of heavy drinking decreased among the lower SES groups and remained stable among the higher SES groups. CONCLUSIONS: These results call for an increase in public health vigilance in monitoring trends in drinking patterns and their potential acute and chronic consequences.

Adolescent↗
PubMed2005

Are international differences in the outcomes of acute coronary syndromes apparent or real? A multilevel analysis.

STUDY OBJECTIVE: International variation in the outcomes of patients with acute coronary syndromes (ACS) has been well reported. The relative contributions of patient, hospital, and country level factors on clinical outcomes, however, remain unclear, and thus, was the objective of this study. DESIGN: Multilevel logistic regression models were developed for death/(re)infarction (MI) at 30 days and death in one year, with patients (1st level) nested in hospitals (2nd level) and hospitals in countries (3rd level). SETTINGS: The GUSTO IV ACS clinical trial was carried out at 458 hospital sites in 24 countries. PATIENTS: 7800 non-ST segment elevation (NSTE) ACS patients. MAIN RESULTS: There were substantial variations among countries in the processes and outcomes of care at 30 days, ranging from 5.4% to 50.0% for percutaneous coronary intervention, 4.3% to 21.2% for coronary artery bypass graft surgery, 5.0% to 13.9% for 30 day death/(re)MI, and 4.9% to 14.8% for one year mortality. However, the residual inter-country variations in 30 day death/(re)MI and one year mortality became non-significant and nearly disappeared (p > 0.500 for both) after adjusting for key baseline patient characteristics and hospital factors, which became significant (p < 0.01 for both). Patient level factors accounted for 96%-99% of total variation in these end points, leaving the remaining 1% and 4% of variance attributable to hospital level factors. CONCLUSION: The international differences in clinical outcomes in this study of NSTE ACS are primarily accounted for by the patient level factors, with hospital level factors playing a minor part, and the country level factors a negligible one. These findings have significant policy and research implications involving international collaboration and comparisons.

Abciximab↗
PubMed2006

Does area-based social capital matter for the health of Australians? A multilevel analysis of self-rated health in Tasmania.

BACKGROUND: Material circumstances and collective psychosocial processes have been invoked as potential explanations for socioeconomic inequalities in health; and, linking social capital has been proposed as a way of reconciling these apparently opposing explanations. METHODS: We conducted multilevel logistic regression of self-rated health (fair or poor vs excellent, very good, or good) on 14 495 individuals living within 41 statistical local areas who were respondents to the 1998 Tasmanian Healthy Communities Study. We modelled the effects of area-level socioeconomic disadvantage and social capital (neighbourhood integration, neighbourhood alienation, neighbourhood safety, social trust, trust in public/private institutions, and political participation), and adjusted for the effects of individual characteristics. RESULTS: Area-level socioeconomic disadvantage was associated with poor self-rated health (beta = 0.0937, P < 0.001) an effect that was attenuated, but remained significant, after adjusting for individual characteristics (beta = 0.0419, P < 0.001). Social trust was associated with a reduction in poor self-rated health (beta = -0.0501, p = 0.008) and remained significant when individual characteristics (beta = -0.0398, P = 0.005) were included. Political participation was non-significant in the unadjusted model but became significant when adjusted for individual characteristics (beta = -0.2557, P = 0.045). The effects of social trust and political participation were attenuated and became non-significant when area-level socioeconomic disadvantage was included. CONCLUSION: Area-based socioeconomic disadvantage is a determinant of self-rated health in Tasmania, but we did not find an independent effect of area-level social capital. These findings suggest that in Tasmania investments in improving the material circumstances in which people live are likely to lead to greater improvements in population health than attempts to increase area-level social capital.

Adolescent↗
PubMed2004

Population effects on individual systolic blood pressure: a multilevel analysis of the World Health Organization MONICA Project.

Individuals from the same population share a number of contextual circumstances that may condition a common level of blood pressure over and above individual characteristics. Understanding this population effect is relevant for both etiologic research and prevention strategies. Using multilevel regression analyses, the authors quantified the extent to which individual differences in systolic blood pressure (SBP) could be attributed to the population level. They also investigated possible cross-level interactions between the population in which a person lived and pharmacological (antihypertensive medication) and nonpharmacological (body mass index) effects on individual SBP. They analyzed data on 23,796 men and 24,986 women aged 35-64 years from 39 worldwide Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study populations participating in the final survey of this World Health Organization project (1989-1997). SBP was positively associated with low educational achievement, high body mass index, and use of antihypertensive medication and, for women, was negatively associated with smoking. About 7-8% of all SBP differences between subjects were attributed to the population level. However, this population effect was particularly strong (i.e., 20%) in antihypertensive medication users and overweight women. This empirical evidence of a population effect on individual SBP emphasizes the importance of developing population-wide strategies to reduce individual risk of hypertension.

Adult↗
PubMed2003

Can the school make a difference? A multilevel analysis of adolescent risk and health behaviour.

The main aim of this article is to assess the relationship between the structural and (health) policy variables of the school and characteristics of the individual on the risk and health behaviour of adolescents. Individual and school level effects on seven health-related behaviours are simultaneously estimated, using multilevel modelling. The data are from the Flemish health behaviour in school-aged children study in Belgium. Data are used from 29 Flemish schools in which students (N=3225), school administrators (N=29) and teachers (N=1132) were surveyed with anonymous written questions. The analysis confirms previous findings concerning individual level effects. Although differences between schools in risk and health behaviour were found to originate mainly from differences in pupil characteristics, substantial variation between schools remained with regard to regular smoking, drinking habits and tooth brushing after controlling for individual effects. A wide range of school structure and policy variables were taken into account, but only few of them were found to influence the health and risk behaviour of young people. Moreover, the study could not detect an effect of health promotion policy at school. The analysis therefore only partially confirms the hypothesis that the school has an impact on the health behaviour of young people. The findings demonstrate the need for a more thorough examination of the paths by which schools can influence the health behaviour of their pupils.

Adolescent↗
PubMed2006

Environmental and individual predictors of error in field estimates of blood alcohol concentration: a multilevel analysis.

OBJECTIVE: Using self-report survey data and measures of breath alcohol concentration (BrAC), this study examined the validity of an estimate of blood alcohol concentration (eBAC). Differences between eBAC and BrAC were modeled to identify sources of error related to survey-derived eBAC. Further, using hierarchical multilevel analyses, environmental event characteristics were examined as sources of eBAC error. METHOD: College students were interviewed and provided breath samples at randomly selected parties on Friday and Saturday nights. Interviews included items assessing the total number of drinks consumed, duration of drinking event, gender, and weight, which allowed for the calculation of eBAC. RESULTS: Overall, eBACs were inaccurate. Total number of drinks consumed was associated with underestimates of eBAC, whereas time drinking was associated with overestimates of eBAC. Environmental variables, including party size, rowdy behavior, having food present, and observing many intoxicated partygoers, were also associated with eBAC errors. CONCLUSIONS: Current self-report survey methodology to calculate eBAC may be insufficient to estimate BAC with any accuracy. Environmental factors associated with the last drinking event for which BAC is being estimated should be considered when calculating eBAC.

Adolescent↗
PubMed2000

Organizational and individual factors affecting mental health and job satisfaction: a multilevel analysis of job control and personality.

This study evaluated variation at the individual and work unit levels in the relations of job control, hostility, and trait anxiety to mental health and job satisfaction. Questionnaire data from a sample of 2,900 employees working at 152 hospital wards were analyzed by means of multilevel regression analyses. Results showed that mental health (General Health Questionnaire-12), varying mainly at the individual level, was explained mostly by hostility and trait anxiety. Job satisfaction varied significantly at the individual and the ward level. Job control accounted for most of this multilevel variation. Thus, this study demonstrated the significance of individual characteristics and organizational effects in explaining the mental health and job satisfaction of employees.

Adult↗
PubMed2006

Individual-, neighborhood-, and state-level socioeconomic predictors of cervical carcinoma screening among U.S. black women: a multilevel analysis.

BACKGROUND: Cervical carcinoma is the fifth most common cancer among African American women in the U.S. Although the Papanicolaou (Pap) smear is an efficacious screening tool in the early detection of the disease, disparities are known to persist in the utilization of this procedure across socioeconomic groups. METHODS: Data regarding cervical carcinoma screening and covariates were obtained from the 59,090 Black Women's Health Study participants across the U.S. via a mailed questionnaire in 1995. Logistic regression and multilevel techniques were used to assess the independent effects of the covariates on nonrecent cervical carcinoma screening. RESULTS: In all, 8.3% of the 40,009 women in the present analysis had not undergone a Pap smear examination within the previous 2 years (nonrecent screening). Lower educational attainment, older age, obesity, smoking, and neighborhood poverty were found to be independently related to increased risk of nonrecent screening. The adjusted odds ratio for nonrecent screening was 1.2 (95% confidence interval [95% CI], 1.1-1.4) for women residing in neighborhoods with 20% or more poverty compared with those in neighborhoods with less than 5% poverty. State of residence was also associated with nonrecent cervical carcinoma screening. CONCLUSION: These results suggest that among black women, residence in high-poverty (20%) neighborhoods is associated with an increased risk of nonrecent cervical carcinoma screening, independent of individual level risk factors.

Adult↗
PubMed2002

A multilevel analysis of neighborhood context and youth alcohol and drug problems.

Various sources of data were used to examine hypothesized relations among neighborhood variables and youth alcohol and drug problems. Family members (N = 1186) were from 55 neighborhoods: 57% female, 41% African American, and 59% White. Data were clustered by neighborhood and analyzed within a multilevel design. At the neighborhood level, the study examined relations among poverty, stores selling alcohol, neighborhood social cohesion, neighborhood problems with youth alcohol and drug use, and drug and alcohol arrests. At the individual level, gender, ethnicity, adult versus child status, neighborhood social cohesion, and neighborhood problems were examined. Results indicated that more stores sold alcohol in higher poverty neighborhoods, which was associated with less social cohesion. Lower social cohesion was related to greater perceived neighborhood problems with youth alcohol and drug use, which was positively related to neighborhood youth drug and alcohol arrests. The study showed significant variation across neighborhoods and demonstrates the utility of combining different sources of neighborhood data to examine relations of interest.

Adolescent↗
PubMed2006

Individual and contextual determinants of self-reported poor psychological health: a population-based multilevel analysis in southern Sweden.

OBJECTIVE: To investigate the influence of contextual and individual factors on self-reported psychological health. DESIGN/SETTING/PARTICIPANTS/MEASUREMENTS: The 2000 public health survey in Scania is a cross-sectional postal questionnaire study with a 59% participation rate. A total of 13,715 persons aged 18-80 answered the questionnaire. A multilevel logistic regression model, with individuals at the first level and municipalities/city quarters at the second, was performed. The effect (intra-class correlation, cross-level modification, and odds ratios) of individual and municipality/city quarter factors on self-reported psychological health was analysed. RESULTS: The crude variance between municipalities/city quarters was small but significant. It was particularly affected and lowered by individual civil status, country of origin, economic stress, and social participation. The inclusion of all individual factors age, sex, civil status, country of origin, education, economic stress, and social participation lowered the between municipality variance to not-significant levels, which is the reason why no contextual variables were included in the calculations. CONCLUSIONS: The results of this study suggest that poor self-reported psychological health is affected mainly by individual characteristics of the population and not by contextual factors at the municipality/city quarter level.

Adolescent↗
PubMed2006

Impact of a social influence intervention on condom use and sexually transmitted infections among establishment-based female sex workers in the Philippines: a multilevel analysis.

The authors assessed the relative impact of structural and social influence interventions on reducing sexually transmitted infections (STIs) and HIV risk behavior among female sex workers in the Philippines (N = 897). Four conditions included manager influence, peer influence, combined manager-peer influence, and control. Intervention effects were assessed at the establishment level in multilevel models because of statistical dependencies among women employed within the same establishments. Control group membership predicted greater perceived risk, less condom use, less HIV/AIDS knowledge, and more negative condom attitudes. Combination participants reported more positive condom attitudes, more establishment policies favoring condom use, and fewer STIs. Manager-only participants reported fewer STIs, lower condom attitudes, less knowledge, and higher perceived risk than peer-only participants. Because interventions were implemented at the city level, baseline and follow-up city differences were analyzed to rule out intervention effects due to preexisting differences.

Acquired Immunodeficiency Syndrome↗
PubMed2004

A community-based walking trial to improve neighborhood quality of life in older adults: a multilevel analysis.

BACKGROUND: Few studies have considered the neighborhood as a context in which to examine the physical activity and quality of life relationship. PURPOSE: The goal of this study was to evaluate the effects of a neighborhood walking program on quality of life among older adults. It was designed as a randomized trial involving a multilevel design with neighborhoods corresponding to primary sampling units and residents to secondary units. METHODS: Five hundred eighty-two community-dwelling senior residents (65 years of age or older) in neighborhoods in the northeast metropolitan area of Portland, Oregon, were recruited through telephone, direct mail, and referrals. The walking intervention was delivered at the neighborhood level. Neighborhoods (N = 56) were randomly assigned to a 6-month, 3 times per week, leader-led walking group activity (n = 28) or an information-only control group (n = 28). Primary outcome measures included SF-12 (Physical, Mental summary scores) and life satisfaction (SWLS); the secondary outcome measure was neighborhood walking activity, assessed at baseline, 3 months, and 6 months of the study period. RESULTS: Compared to the control neighborhoods, results from multilevel, longitudinal analyses indicated significant improvements in the primary outcomes of SF-12 Physical (p < .05), SF-12 Mental (p < .05) summary scores, and SWLS (p < .05), over the course of the 6-month intervention. A significant increase was also observed in the secondary outcome of walking activity (p < .05). CONCLUSIONS: Implementing a neighborhood-based walking program of low to moderate intensity is feasible and beneficial for promoting quality of life among senior residents at a community level.

Age Factors↗
PubMed2004

Individual self-reported health, social participation and neighbourhood: a multilevel analysis in Malmö, Sweden.

BACKGROUND: The influence of neighbourhood and individual factors on self-reported health was investigated. METHODS: The public health survey in Malmö 1994 is a cross-sectional study. A total of 3,602 individuals aged 20-80 living in 75 neighbourhoods answered a postal questionnaire. The participation rate was 71%. A multilevel logistic regression model, with individuals at the first level and neighbourhoods at the second, was performed. We analysed the effect (intra-area correlation, cross-level modification and odds ratios) of neighbourhood on self-reported health after adjustment for individual factors. RESULTS: The neighbourhoods accounted for 2.8% of the crude total variance in self-reported health status. This effect was significantly reduced when individual factors such as country of origin, education and social participation were included in the model. In fact, no significant variance in self-reported health remained after the introduction of the individual factors in the model. CONCLUSIONS: In Malmö, the neighbourhood variance in self-reported health is mainly affected by individual factors, especially country of origin, socioeconomic status measured as level of education and individual social participation.

Adult↗
PubMed2003

Public and private sector responses to essential drugs policies: a multilevel analysis of drug prescription and selling practices in Mali.

Many African countries have introduced cost recovery mechanisms based on the sale of drugs and measures aimed at improving drug supply. This study compares prescribing and selling practices in Mali, in 3 cities where the public sector contributes differentially to the supply of drugs on the market. Multilevel models are used to analyse the content and cost of 700 medication transactions observed in 14 private and public legal points of sale. Results show that the objective of improving access to drugs seems to have been achieved in the sites studied. Costs of prescriptions were lower where public health services had been revitalized. Affordable generic drugs were accessible and widely used, even in the private sector. However, measures intended to rationalize the prescription and delivery of drugs did not always have the desired effect. While agents in the public sector tended to prescribe fewer antibiotics, injectables, or brand-name drugs, the data confirm the virtual absence of advice concerning the use or the side effects of the drugs in both public and private sectors. In addition, data supported the notion that the public and private sectors are closely intertwined. Notably, availability of drugs in the public sector contributed to diminishing the prices charged in the private sector. Similarly, the use that agents in the public sector made of the opportunities afforded by the presence of the private pharmaceutical sector provided another illustration of interrelatedness. Finally, the data showed that the presence of a private sector, which has not been affected by measures aimed at rationalizing prescription and sales practices, limits the effects of measures implemented in the public sector. More assertive policies, based on strategies encompassing actors in the private sector, are needed to increase the safety and effectiveness of prescription and sales practices.

Community Health Centers↗
PubMed2004

National and school policies on restrictions of teacher smoking: a multilevel analysis of student exposure to teacher smoking in seven European countries.

The paper examines the association between restrictions on teacher tobacco smoking at school and student exposure to teachers who smoke during school hours. The data are taken from a European Commission-funded study 'Control of Adolescent Smoking' (the CAS study) in seven European countries. Multilevel modelling analyses were applied to investigate associations between national legislation concerning tobacco smoking in school, local school smoking restrictions and students' exposure to teachers who smoke at school. The analyses integrate data from three levels: national (types of policy and how restrictive they are), school (survey among teachers, n = 455) and student (survey among 15-year-old students, n = 10890). The results suggest that both national- and school-level policies on restriction of smoking among teachers are associated with a decreased probability of students reporting that they are exposed to teachers who smoke indoors, but an increased probability of being exposed to teachers smoking outdoors.

Adolescent↗
PubMed2004

A multilevel analysis of tobacco use and tobacco consumption levels in France: are there any combination risk groups?

BACKGROUND: Both the predictors for tobacco use and the determinants of the amounts of tobacco consumed by smokers should be taken into account when designing prevention programmes. METHODS: Using a sample of 12,948 individuals representative of the French population in 1999, multilevel models were used to carry out a comparative investigation for the predictors of tobacco use and the determinants of the amount of tobacco consumed by smokers. RESULTS: At the individual level, a combination of risks (higher risk of smoking and larger amounts of tobacco consumed by smokers) was found for males, for individuals with a low level of education and for divorcees. At the level of the area of residence, both the risk of smoking (odds ratio 1.07, 95% confidence interval: 1.01-1.12 for an increase by one standard deviation) and the amount of tobacco consumed among smokers (percentage variation +4%, 95% confidence interval: 0% - +8%) increased with the gross domestic product per capita. CONCLUSION: This study justifies the combined use, in such analyses, of consumption levels for smokers in addition to the risk of smoking, in order to identify the profiles with the highest risk. It was possible to identify various groups with both a high risk of tobacco use and a high level of consumption among smokers, on the basis of individual (male, divorced or less educated) and environmental (living in a high GDP area) factors. The prevention efforts should thus be focused on such groups.

Adolescent↗
PubMed2000

Neighborhood poverty as a predictor of intimate partner violence among White, Black, and Hispanic couples in the United States: a multilevel analysis.

PURPOSE: This study assessed the contribution of neighborhood poverty, measured at the census tract level, to the risk of male-to-female and female-to-male partner violence (MFPV, FMPV) among white, black, and Hispanic couples in the United States. METHODS: As part of the 1995 National Alcohol Survey, a representative sample of married/cohabiting couples was obtained through a multistage, multicluster household probability sampling frame. The outcome variables, MFPV and FMPV, were measured through the Conflict Tactics Scale, Form R. Sociodemographic, psychosocial, and alcohol consumption covariates that were statistically significant through bivariate analysis were retained as individual-level predictors. Neighborhood poverty, indicating residence in a census tract where greater than 20% of the population lived below the Federal poverty line, was assessed by appending 1990 Census data to the primary data set. Multilevel logistic regression models were constructed, with separate analyses performed for each outcome (MFPV, FMPV) among the white, black, and Hispanic couples. RESULTS: Couples residing in impoverished neighborhoods are at increased risk for both MFPV and FMPV. The association between residence in an impoverished neighborhood and MFPV was statistically significant for black couples (Odds Ratio [OR] 2.87; 95% Confidence Interval [CI] 1.36, 6.07). The association between residence in an impoverished neighborhood and FMPV was statistically significant for black couples and white couples. CONCLUSIONS: Characteristics of the socioenvironment, such as neighborhood poverty, are associated with the risk of partner violence, particularly among black couples. Policies aimed at reducing community poverty may contribute to effective partner violence prevention strategies.

Black or African American↗