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Cited by 385Health disparities and outcomesStatistical Methods in EpidemiologyHistorical and modern epidemiology studies

Ecological effects in multi-level studies

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Blakely, Tony A, Woodward, Alistair J·2000·Journal of Epidemiology and Community Health
DOI 10.1136/jech.54.5.367PMC PMC1731678
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Abstract

Multi-level research that attempts to describe ecological effects in themselves (for example, the effect on individual health from living in deprived communities), while also including individual level effects (for example, the effect of personal socioeconomic disadvantage), is now prominent in research on the socioeconomic determinants of health and disease. Such research often involves the application of advanced statistical multi-level methods. It is hypothesised that such research is at risk of reaching beyond an epidemiological understanding of what constitutes an ecological effect, and what sources of error may be influencing any observed ecological effect. This paper aims to present such an epidemiological understanding. Three basic types of ecological effect are described: a direct cross level effect (for example, living in a deprived community directly affects individual personal health), cross level effect modification (for example, living in a deprived community modifies the effect of individual socioeconomic status on individual health), and an indirect cross level effect (for example, living in a deprived community increases the risk of smoking, which in turn affects individual health). Sources of error and weaknesses in study design that may affect estimates of ecological effects include: a lack of variation in the ecological exposure (and health outcome) in the available data; not allowing for intraclass correlation; selection bias; confounding at both the ecological and individual level; misclassification of variables; misclassification of units of analysis and assignment of individuals to those units; model mis-specification; and multicollinearity. Identification of ecological effects requires the minimisation of these sources of error, and a study design that captures sufficient variation in the ecological exposure of interest.

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  • Blakely and Woodward described three principal mechanisms through which ecological constructs can affect individual-level outcomes: cross-level effect modification, direct cross-level effects, and indirect cross-level effects.

    “Blakely and Woodward (2000) described three principal mechanisms through which ecological constructs can affect individual-level outcomes: cross-level effect modification (e.g. the association between men’s beliefs about gender roles and women’s experience of intimate partner violence is modified by laws disadvantaging women relative to men in their access to resources and factors of production),”

    From Syndemics: a theory in search of data or data in search of a theory? (2018) · cites this paper as Blakely and Woodward (2000)

  • Teachers and administrators may be less reluctant to suspend students who already have a suspension history, particularly Black students, who are especially affected by implicit racial bias.

    “Teachers and administrations may be less reluctant to issue suspensions to students who already have a track record of suspensions (Blakely & Woodward, 2000) and especially to already-suspended Black students—a group particularly impacted by implicit racial bias (Okonofua et al., 2016).”

    From The Impact of Restorative Practices on the Use of Out-of-School Suspensions: Results from a Cluster Randomized Controlled Trial (2023) · cites this paper as Blakely & Woodward, 2000

    The citation to Blakely and Woodward is attached to the claim that teachers and administrators may be less reluctant to suspend students with prior suspensions; the racial-bias clause cites a different source. The Background and bias sections discuss multilevel epidemiological research, not school discipline. Searches for suspension history and school discipline found no relevant passage in our copy. (LLM, conf=0.77)

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Research works printed but not linked: 11

  1. Diez-Roux A, Nieto F, Muntaner C, et al. Neighourhood environment and coronary heart disease: a multilevel analysis. Am J Epidemiol 1997;146:48-63.
  2. Durkheim E. Suicide. Glencoe, IL: Free Press, 1951. [Origi- nal work published in 1898].
  3. van den Eeden P, Huttner H. Multi-level research. The Jour- nal of the International Sociological Association 1982;30:1- 182.
  4. Blau P. Structural eVects. American Sociological Review 1960;25:178-93.
  5. Hauser R. Reply to Barton. American Journal of Sociology 1970;76:517-20.
  6. Morgenstern H. Ecologic studies. In: Rothman K, Green- land S, eds. Modern epidemiology. 2nd ed. Philadelphia: Lippincott-Raven, 1998:459-80.
  7. Susser M. Causal thinking in the health sciences: concepts and strategies in the health sciences. New York: Oxford University Press, 1973.
  8. Rothman K, Greenland S. Modern epidemiology. 2nd ed. Philadelphia: Lippincott-Raven, 1998.
  9. Brenner H, Greenland S, Jockel K-H, et al. EVects of non-diVerential exposure misclassification in ecologic studies. Am J Epidemiol 1992;135:85-95.
  10. Boyle M, Willms J. Place eVects for areas defined by admin- istrative boundaries. Am J Epidemiol 1999;149:577-85.
  11. Brenner H, Greenland S, Savitz D. The eVects of non-diVerential confounder misclassification in ecologic studies. Epidemiology 1992;3:456-9.

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Authors
Blakely, T. A., & Woodward, A. J.
Affiliations
University of Otago (NZ)
Corresponding author
Blakely, Tony A
ORCID
Venue
Journal of Epidemiology and Community Health
Publisher
BMJ
Published
2000-05-01
Volume
54
Issue
5
Pages
367-374
ISSN
  • 0141-7681 (ISSN-L)
  • 0143-005X
  • 1470-2738
DOI
10.1136/jech.54.5.367
PMC
PMC1731678
OpenAlex
W2143847340
Cited by
385
References
44
Citations by year
2026: 4 · 2025: 8 · 2024: 10 · 2023: 8 · 2022: 14 · 2021: 16 · 2020: 10 · 2019: 12 · 2018: 16 · 2017: 6 · 2016: 17 · 2015: 12 · 2014: 17 · 2013: 27 · 2012: 23
FWCI
20.85
Type
journal article
Language
en
Open access
Locations
  • Journal of Epidemiology & Community Health (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
  • Social Sciences › Sociology and Political Science › Historical and modern epidemiology studies
Keywords
ecological effects, multilevel analysis, socioeconomic determinants of health, ecological fallacy, intraclass correlation coefficient, selection bias, confounding, misclassification, model misspecification, multicollinearity, unit of analysis, socioeconomic deprivation, underserved areas
MeSH terms
Data Collection, Data Interpretation, Statistical, Environment, Humans, Socioeconomic Factors, Epidemiologic Research Design, Bias, Confounding Factors, Epidemiologic

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