Placing individuals in a multileveled context
Idea: Different or even contradictory associations can be detected at different levels of aggregation (e.g., individual, region, nation), but not all influences can be assigned to properties of the individual—Membership in a larger aggregation can influence outcomes even after conditioning on the attributes of the individuals.
Prepare for class as follows:
Ecological & atomistic fallacies:
- Bring one example of an ecological fallacy not in the readings and be ready to explain it to the other students.
- Extract one example of an effect that is obscured by focusing only on one level, i.e., all individuals in a population. This example may come from the readings. Be ready to explain it to the other students (and to explain where you get confused, if applicable).
- Diez-Roux (2002a) notes in her commentary that “…many of the analytic issues that arise when examining neighborhood effects on health are present throughout the continuum from society to molecules. These analytic issues include, for example, nested data structures, variables and units of analysis at multiple levels, contextual effects, distal causes, and complex causal chains with feedback loops and reciprocal effects” (p.516).
- Do you find that the issues referenced above have been successfully addressed in the studies by Balfour & Kaplan (2002) and Coulton, Korbin & Su (1999), Friedman et al. (2016), and Holmes & Marcelli (2012)?
From neighborhoods to networks:
- Friedman et al. (2015) propose that "Many of the interventions [re: HIV prevention] are not best conceived of as interventions with individuals but rather with networks, cultures of risks, or communities."
- Makes a case that "interventions in one key population affect HIV epidemics in other key populations" and recommends "more research... at metropolitan area, network, and individual levels into HIV bridging across key populations."
- Friedman et al. (2014) also advocates attention to networks across key populations.
Income inequality, stature, and obesity:
- Describe (and evaluate) the proposed pathway (see p. 26ff) from income inequality to weight gain in the study by Marcelli (2006).
Notes and annotations from 2007 course
Common readings and cases: Freedman 2001 (Ecological and atomistic fallacies), Diez-Roux 2002a, b (Neighborhood effects), Marcelli 2006 (Obesity)
Supplementary Reading: Balfour 2002, Coulton 1999, Dunn 2007, Korbin 2000, Lawlor 2005, Marcelli 2005, Oakes 2004
- Balfour, J. L. and G. A. Kaplan (2002). "Neighborhood Environment and Loss of Physical Function in Older Adults: Evidence from the Alameda County Study." American Journal of Epidemiology 155: 507-515.
- Coulton, C. J., J. E. Korbin, et al. (1999). "Neighborhoods and Child Maltreatment: A Multi-Level Study." Child Abuse & Neglect 23(11): 1019–1040.
- Diez Roux, A. V. (2002a). "Invited Commentary: Places, People, and Health." American Journal of Epidemiology 155: 516-519.
- Diez Roux, A. V. (2002b). "A glossary for multilevel analysis." Journal of Epidemiology and Community Health 56: 588-594.
- Dunn, J. R. and S. Cummins (2007). "Placing health in context." Social Science & Medicine 65: 1821-1824
- Friedman, S. R., B. S. West, et al. (2014). "Do metropolitan HIV epidemic histories and programs for people who inject drugs and men who have sex with men predict AIDS incidence and mortality among heterosexuals?" Annals of Epidemiology 24(4): 304-311.
- Friedman, S. R., D. C. Perlman, et al. (2015). "The flawed reliance on randomized controlled trials in studies of HIV behavioral prevention interventions for people who inject drugs and other populations." Substance Use and Misuse, in press.
- Holmes, L. M. and E. A. Marcelli (2012). "Neighborhoods and systemic inflammation: High CRP among legal and unauthorized Brazilian migrants." Health & Place 18: 683-693.
- Korbin, J. E., C. J. Coulton, et al. (2000). "Neighborhood Views On The Definition And Etiology Of Child Maltreatment." Child Abuse & Neglect 24(12): 1509–1527.
- Lawlor, D. A., G. Davey-Smith, et al. (2005). "Life-Course Socioeconomic Position, Area Deprivation, and Coronary Heart Disease: Findings From the British Women's Heart and Health Study." American Journal of Public Health 95: 91-97.
- Marcelli, E., C. Jencks, et al. (2005). "The Impact of Family Socioeconomic Status and Income Inequality on Stature in the United States." Paper for Meeting of the Population Association of America, Philadelphia, PA.
- Marcelli, E., D. M. Cutler, et al. (2006ms). "An Estimate of the Effects of Income Inequality, Racial Segregation, and Food Prices on Adult Obesity in the United States."
- Marmot, M. and R. G. Wilkinson (2001). "Psychosocial and material pathways in the relation between income and health: a response to Lynch et al " British Medical Journal 322: 1233-1236.
- Oakes, J. M. (2004). "The (mis)estimation of neighborhood effects: Causal inference for a practicable social epidemiology." Social Science & Medicine 58: 1929-1952.
Annotations on common readings
Ana V. Diez Roux
Invited Commentary: Places, People, and Health
American Journal of Epidemiology Vol. 155, No. 6
In epidemiology, the triads of “agent, host, and environment” and “person, time, and
place” have been traditionally emphasized as important interactions in understanding the causes of ill health. Diez Roux argues that modern epidemiology’s disproportionate interest in personhood (individual characteristics) suggests that the effects of “places” can be ignored once individual-level risk factors have been accounted for. Well-established is the fact that health tends to exhibit gradients across geographic locations. The purveying putative explanation for this phenomenon being: the cumulative characteristics of people within a geographic locality giving rise to a distinct neighborhood health profile. Diez Roux notes a resurgent interest, among social scientists, to determine the ways in which neighborhood contexts may affect individual-level health outcomes.
Contextual and multilevel analyses have been the vehicles employed for investigating area effects on health. Diez Roux posits that area itself is consequential to the health of its residents. Previous studies document an independent effect of neighborhood socioeconomic characteristics on health, which persists after controlling for individual-level factors. Diez Roux concedes that the magnitude of neighborhood effects and their relative importance did vary. Empirically demonstrating that neighborhood environments are causally related to health is slated to have implications for disease prevention and health policy. However, Diez Roux underscores that determination of whether processes mediated by neighborhood environments are causally related to heath is often impeded by complexities. The principal quandary is establishing whether the derived associations truly reflect causal processes. Thus, they are not simply the artifices of model misspecification at the individual level or residual confounding by individual-level variables. Compounding this matter, analytic approaches commonly used in epidemiology are proposed to be ill-suited for examining complex causal models. In this commentary, Diez Roux critically reviews Balfour and Kaplan’s paper, ‘Neighborhood Environment and Loss of Physical Function in Older Adults: Evidence from the Alameda County Study;’ subsequently endorsing their analytical approaches to addressing several complex issues involved in assessing neighborhood effects.
“Neighborhood differences are not “naturally” determined but rather result from social and economic processes influenced by specific policies. As such, they are eminently modifiable and susceptible to intervention. In addition, the improvement of neighborhood environments is likely to have a multitude of benefits for people and society as a whole (Diez Roux).” (SY)
Annotated additions by students
(In alphabetical order by author's name with contributor's initials and date at the end.)