Bringing Context Back into Epidemiology:Variable and Fallacies in Multilevel Analysis

Introduction In this century, the growing importance of chronic diseases led to the search for new causal factors. Emphasis shifted from environmental factors to individuallevel factors, and research focused on behavioral and biological characteristics as risk factors for chronic diseases. This individualization of risk has perpetuated1the idea that risk is individually determined rather than socially determined, discouraging research into the effects of macro-level or group-level variables on individual-level outcomes. "Lifestyle" and "behaviors" are regarded as matters of free individual choice and dissociated from the social contexts that shape and constrain them. "facts about society and social phenomena are to be explained solely in terms of facts about individuals. Its logical correlate is that all variables are best measured at the individual level, rather than at the group or macro level. Group-level variables are included in the analyses only as rough approximations for individual-level data when the latter are unavailable. Ignoring the role of group or macro-level variables may lead to an incomplete understanding of the determinants of disease in individuals as well as in populations. Group- or macro-level variables affect individuals directly and also constrain the choices that individuals make. Contextual Analysis or Multilevel Analysis Types of Group-Level Variables Used in Multilevel or Contextual Analysis Levels of Analysis Problems: Fallacies in Studies Involving Multiple Levels Additional Issue Relevant to Multilevel or Contextual Analysis Conclusion References Source Related Papers The Words Footnotes 1. perpetuate: to make something such as a bad situation, a belief, etc. continue for a long time.