Abstract:
:A large portion of current epidemiologic research is based on methodologic individualism: the notion that the distribution of health and disease in populations can be explained exclusively in terms of the characteristics of individuals. The present paper discusses the need to include group- or macro-level variables in epidemiologic studies, thus incorporating multiple levels of determination in the study of health outcomes. These types of analyses, which have been called contextual or multi-level analyses, challenge epidemiologists to develop theoretical models of disease causation that extend across levels and explain how group-level and individual-level variables interact in shaping health and disease. They also raise a series of methodological issues, including the need to select the appropriate contextual unit and contextual variables, to correctly specify the individual-level model, and, in some cases, to account for residual correlation between individuals within contexts. Despite its complexities, multilevel analysis holds potential for reemphasizing the role of macro-level variables in shaping health and disease in populations.
journal_name
Am J Public Healthjournal_title
American journal of public healthauthors
Diez-Roux AVdoi
10.2105/ajph.88.2.216subject
Has Abstractpub_date
1998-02-01 00:00:00pages
216-22issue
2eissn
0090-0036issn
1541-0048journal_volume
88pub_type
杂志文章abstract::The author reviews scientific and societal developments in artificial reproductive technologies during the past year in the U.S., the United Kingdom, and Australia. Successful births resulted from surrogate embryo transfer and from transfer of an embryo following in vivo fertilization. Recommendations on social poli...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/ajph.74.12.1415
更新日期:1984-12-01 00:00:00
abstract::Subsidized rural clinics and providers have long depended on the rural hospital for the care of some of their patients; the hospital has also been a source of revenue for these providers and programs. We studied a representative national sample of 116 subsidized rural clinics, focusing on the impact on rural clinic co...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/ajph.75.7.749
更新日期:1985-07-01 00:00:00
abstract:OBJECTIVES:We determined factors associated with hearing aid acquisition in older adults. METHODS:We conducted a population-based, prospective study that used information from 3 examinations performed on study participants as part of the Epidemiology of Hearing Loss Study (1993-2005). We included participants (n = 718...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/AJPH.2010.300078
更新日期:2011-08-01 00:00:00
abstract::Disability is often considered a health outcome disproportionately experienced by minority groups. It is also possible to view people with disabilities as a minority group that itself experiences health disparities. Calls to reduce these disparities necessitate the inclusion of people with developmental disabilities i...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/AJPH.2013.301286
更新日期:2013-12-01 00:00:00
abstract::Conventional methods for classifying patients with respect to utilization of health care resources are based almost exclusively on diagnostic criteria. We review a new severity of illness index which is generic to most medical and surgical conditions in a hospital, and which has been found to produce subgroups of pati...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/ajph.73.1.25
更新日期:1983-01-01 00:00:00
abstract::[This corrects the article DOI: 10.2105/AJPH.2018.304412.]. ...
journal_title:American journal of public health
pub_type: 已发布勘误
doi:10.2105/AJPH.2018.304412e
更新日期:2018-09-01 00:00:00
abstract:OBJECTIVES:This paper explores the relationship of state hospital and general hospital psychiatric caseloads in a statewide system of care. METHODS:Probabilistic population estimation was applied to general hospital and state hospital data sets. RESULTS:General hospitals provide inpatient psychiatric services to more...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/ajph.88.3.448
更新日期:1998-03-01 00:00:00
abstract::The accepted wisdom about the US overdose crisis singles out prescribing as the causative vector. Although drug supply is a key factor, we posit that the crisis is fundamentally fueled by economic and social upheaval, its etiology closely linked to the role of opioids as a refuge from physical and psychological trauma...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/AJPH.2017.304187
更新日期:2018-02-01 00:00:00
abstract::Of 10,524 homeless veterans assessed in a 43-site VA program, 50 percent served during the Vietnam War era, compared to only 29 percent of all veterans in the general population. This reflects the greater risk of homelessness among men aged 30-44 rather than the impact of Vietnam Era service. The proportion of homeles...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/ajph.81.5.643
更新日期:1991-05-01 00:00:00
abstract::The Protection of Lawful Commerce in Arms Act (PLCAA), enacted in 2005, grants the firearm industry broad immunity from liability. The PLCAA not only prevents most people from receiving compensation for their firearm-related injuries, it erodes litigation's ability to serve its public health role of providing manufact...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/AJPH.2006.092544
更新日期:2007-11-01 00:00:00
abstract::Intensification of polio eradication efforts worldwide raises concerns about costs and benefits for poor countries. A major argument for global funding is the high benefit-cost ratio of eradication; however, financial benefits are greatest for rich countries. By contrast, the greatest costs are borne by poor countries...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/ajph.87.6.922
更新日期:1997-06-01 00:00:00
abstract:OBJECTIVES:We sought to assess 6-month outcomes for HIV-infected people released from New York City jails with a transitional care plan. METHODS:Jail detainees in New York City living with HIV who accepted a transitional care plan during incarceration were asked to participate in a multi-site evaluation aimed at impro...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/AJPH.2014.302234
更新日期:2015-02-01 00:00:00
abstract::The Centers for Disease Control (CDC) has proposed revising the AIDS surveillance definition to include any HIV-seropositive person with a CD4 cell count of less than 200 cells per microliter. Based on a study of persons receiving treatment for HIV infection, this new definition would lead to an estimated 50% increase...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/ajph.82.11.1531
更新日期:1992-11-01 00:00:00
abstract::The classification of disease burdens is an important topic that receives little attention or debate. One common classification scheme, the broad cause grouping, is based on etiology and health transition theory and is mainly concerned with distinguishing communicable from noncommunicable diseases. This may be of limi...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/ajph.94.3.384
更新日期:2004-03-01 00:00:00
abstract:OBJECTIVES:In a large heterogeneous sample of adults with mental illnesses, we examined the 6-month prevalence and nature of community violence perpetration and victimization, as well as associations between these outcomes. METHODS:Baseline data were pooled from 5 studies of adults with mental illnesses from across th...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/AJPH.2013.301680
更新日期:2014-12-01 00:00:00
abstract::Of the 47 states that participated in a 1983 survey of State Health Departments, 30 were found to have public health standards in place or started. Most states' standards emphasize the range of services to be provided, but substantial variations were found in how standards are formulated, adopted, and used by state an...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/ajph.75.6.649
更新日期:1985-06-01 00:00:00
abstract:OBJECTIVES:We evaluated whether the decline of the racial disparity in preterm birth during the last decade was commensurate with a decline in the contribution of preterm birth to the infant mortality gap. METHODS:We used linked files of 1990 and 2000 data on US infant births and deaths to partition the gap between Bl...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/AJPH.2006.093708
更新日期:2007-07-01 00:00:00
abstract::A parasitic surveillance of farm workers of Puerto Rican background and their children revealed a high prevalence rate (35.5%) of parasites in this population. This high prevalence rate, however, was expected in view of the fact that other researchers have found a high degree of parasitosis in Puerto Rican populations...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/ajph.70.10.1103
更新日期:1980-10-01 00:00:00
abstract:OBJECTIVES:We determined whether a representative national probability sample of US community-dwelling older adults who reported less social support also reported poorer general health status, which is a robust predictor of prospective mortality among elders. METHODS:We analyzed 2 subsamples generated via random sampl...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/AJPH.2008.146894
更新日期:2009-10-01 00:00:00
abstract::Research evidence indicates that 2 forms of racial discrimination-perceived interpersonal discrimination and racial/ethnic residential segregation (a form of institutional discrimination)-may influence children's health and disparities. Although research on these 2 forms of discrimination and health has primarily focu...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/AJPH.2012.300986
更新日期:2013-10-01 00:00:00
abstract:OBJECTIVES:To evaluate how met need for accessibility and availability of primary care among nonelderly individuals in Georgia will be affected by the Patient Protection and Affordable Care Act (ACA) over the next 10 years. METHODS:We used a stock-and-flow model to predict the number of available visits from 2013 to 2...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/AJPH.2016.303222
更新日期:2016-08-01 00:00:00
abstract::Three hundred seventy-two (63%) of 590 enrollees in nine smoking cessation workshops held over a five-year period responded to a follow-up survey. Outcome data were collected retrospectively for six-month intervals from workshop to follow-up. Forty nine per cent of all enrollees graduated, and 56% of the respondents q...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/ajph.70.7.725
更新日期:1980-07-01 00:00:00
abstract::A joint urban planning and public health perspective is articulated here for use, in health impact assessment. Absent a blueprint for a coherent and supportive structure on which to test our thinking, we are bound to fall flat. Such a perspective is made necessary by the sheer number of people living in cities through...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/ajph.93.1.118
更新日期:2003-01-01 00:00:00
abstract:OBJECTIVE:This study examined the relationship between enrollment in the Special Supplemental Nutrition Program for women, Infants, and Children (WIC) and delivery of small-for-gestational-age infants. METHODS:WIC records were linked with birth certificates for 1992 full-term births; 41,234 WIC records and 18,34 non-W...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/ajph.88.9.1374
更新日期:1998-09-01 00:00:00
abstract::State government, university, and local health department (LHD) partners collaborated to build the geographic information system (GIS) capacity of 5 LHDs in North Carolina. Project elements included procuring hardware and software, conducting individualized and group training, developing data layers, guiding the proje...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/AJPH.2004.048785
更新日期:2005-12-01 00:00:00
abstract::A random sample of 2266 women aged 50 to 69 years was used to investigate factors that predict attendance at a free Australian mammographic screening program. The most important predictor was receipt of a personal invitation letter. A letter that included an appointment time increased attendance 132-fold initially and...
journal_title:American journal of public health
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.2105/ajph.84.10.1655
更新日期:1994-10-01 00:00:00
abstract::In 2009 we surveyed 400 tribal members of a midwestern American Indian reservation to assess the prevalence of OxyContin use. Thirty percent of tribal participants reported nonmedical use of OxyContin ever, 18.9% in the past year, and 13.4% in the past month. Participants aged 18 to 25 years were most likely to have u...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/AJPH.2013.301372
更新日期:2013-11-01 00:00:00
abstract:OBJECTIVES:We sought to determine the role of neighborhood poverty and racial composition on race disparities in diabetes prevalence. METHODS:We used data from the 1999-2004 National Health and Nutrition Examination Survey and 2000 US Census to estimate the impact of individual race and poverty and neighborhood racial...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/AJPH.2013.301420
更新日期:2014-11-01 00:00:00
abstract:OBJECTIVES:The purpose of the study was to determine whether the obstetrical judgment of viability makes a difference to fetal and neonatal survival of extremely low birthweight infants (500-749 g). METHODS:We assessed the effect of the antenatal judgment of viability in a group of 66 infants born weighing from 500 to...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/ajph.85.3.362
更新日期:1995-03-01 00:00:00
abstract:OBJECTIVES:Prenatal care is commonly understood to have a beneficial impact on birthweight. This study describes socioeconomic differences in utilization of prenatal medical care and birthweight in a population with universal health insurance. METHODS:Measures of prenatal care utilization, incidence of pregnancy compl...
journal_title:American journal of public health
pub_type: 杂志文章
doi:10.2105/ajph.84.9.1450
更新日期:1994-09-01 00:00:00