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Assessing the impact of the local environment on birth outcomes: a case for HLM

Journal of Exposure Science & Environmental Epidemiology volume 17, pages 445–457 (2007)Cite this article

Abstract

Hierarchical linear Models (HLM) is a useful way to analyze the relationships between community level environmental data, individual risk factors, and birth outcomes. With HLM we can determine the effects of potentially remediable environmental conditions (e.g., air pollution) after controlling for individual characteristics such as health factors and socioeconomic factors. Methodological limitations of ecological studies of birth outcomes and a detailed analysis of the varying models that predict birth weight will be discussed. Ambient concentrations of criterion air pollutants (e.g., lead and sulfur dioxide) demonstrated a sizeable negative effect on birth weight; while the economic characteristics of the mother's residential census tract (ex. poverty level) also negatively influenced birth weight.

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References

  • Ahern J., Pickett K.E., Selvin S., and Abrams B. Preterm birth among African American and white women: a multilevel analysis of socioeconomic characteristics and cigarette smoking. J Epidemiol Community Health 2003: 57 (8): 606–611.

    Article  CAS  Google Scholar 

  • Alexander G.R., Kogan M., Bader D., Carlo W., Allen M., and Mor J. US birth weight/gestational age-specific neonatal mortality: 1995 to 1997 rates for whites, hispanics, and blacks. Pediatrics 2003: 111 (1): e61–e66.

    Article  Google Scholar 

  • Ashton D. Prematurity — infant mortality: the scourge remains. Ethn Dis 2006: 16 (2 Suppl 3): S3–S58–S62.

    PubMed  Google Scholar 

  • Beckman A., Merlo J., Lynch J.W., Gerdtham U.G., Lindstrom M., and Lithman T. Country of birth, socioeconomic position, and healthcare expenditure: a multilevel analysis of Malmo, Sweden. J Epidemiol Community Health 2004: 58 (2): 145–149.

    Article  CAS  Google Scholar 

  • Beland F., Birch S., and Stoddart G. Unemployment and health: contextual-level influences on the production of health in populations. Soc Sci Med 2002: 55 (11): 2033–2052.

    Article  Google Scholar 

  • Blakely T.A., Lochner K., and Kawachi I. Metropolitan area income inequality and self-rated health — a multi-level study. Soc Sci Med 2002: 54 (1): 65–77.

    Article  Google Scholar 

  • Bock R.D. Multilevel analysis of educational data. NY: Academic Press, 1989.

    Google Scholar 

  • Bryk A.S., and Raudenbush S.W. Hierarchical Linear Models: Applications and Data Analysis Methods. Newbury Park, CA, Sage, 1992.

    Google Scholar 

  • Chakraborty J. Acute exposure to extremely hazardous substances: an analysis of environmental equity. Risk Anal 2001: 21 (5): 883–895.

    Article  CAS  Google Scholar 

  • Cherpitel C.J., Ye Y., and Bond J. Alcohol and injury: multi-level analysis from the emergency room collaborative alcohol analysis project (ERCAAP). Alcohol 2004: 39 (6): 552–558.

    Article  Google Scholar 

  • Cohen J., and Cohen P. Applied multiple regression/correlation analysis for the behavioral sciences. Hillsdale, NJ: Erlbaum, 1983.

    Google Scholar 

  • Dargent-Molina P., James S.A., Strogatz D.S., and Savitz D.A. Association between maternal education and infant diarrhea in different households and community environments of Cebu, Philippines. Social Science and Medicine 1994: 38: 343–350.

    Article  CAS  Google Scholar 

  • Davey-Smith G., and Hart C. Re: Use of census-based aggregate variables to proxy for socioeconomic group: evidence from national samples. Am J Epidemiol 1999: 150: 996–997.

    Article  Google Scholar 

  • Diez-Roux A.V. Bringing context back into epidemiology: variables and fallacies in multilevel analysis. Am J Public Health 1998: 88 (2): 216–222.

    Article  CAS  Google Scholar 

  • Diez-Roux A.V. Multilevel analysis in public health research. Annu Rev Public Health 2000: 21: 171–192.

    Article  CAS  Google Scholar 

  • Diez-Roux A.V. Investigating neighborhood and area effects on health. Am J Public Health 2001: 91 (11): 1783–1789.

    Article  CAS  Google Scholar 

  • Diez-Roux A.V. The study of group-level factors in epidemiology: rethinking variables, study designs, and analytical approaches. Epidemiol Rev 2004: 26: 104–111.

    Article  Google Scholar 

  • Diez-Roux A.V. Commentary: estimating and understanding area health effects. Int J Epidemiol 2005: 34 (2): 284–285.

    Article  Google Scholar 

  • Diez-Roux A.V., and Aiello A.E. Multilevel analysis of infectious diseases. J Infect Dis 2005: 191 (Suppl 1): S25–S33.

    Article  Google Scholar 

  • Diez-Roux A.V., Borrell L.N., Haan M., Jackson S.A., and Schultz R. Neighbourhood environments and mortality in an elderly cohort: results from the cardiovascular health study. J Epidemiol Community Health 2004: 58 (11): 917–923.

    Article  Google Scholar 

  • Elliot D., Wilson W., Huizinga D., Sampson R., Elliott A., and Rankin B. The effects of neighborhood disadvantage on adolescent development. J Res Crime Delinquency 1996: 33: 389–426.

    Article  Google Scholar 

  • Fox M.T., Brathwaite A.C., and Sidani S. Evaluating the effectiveness of interventions: exploration of two statistical methods. Can J Nurs Res 2004: 36 (3): 20–30.

    PubMed  Google Scholar 

  • Geronimus A.T., and Bound J. Use of census-based aggregate variables to proxy for socioeconomic group: evidence from national samples. Am J Epidemiol 1998: 148: 475–486.

    Article  CAS  Google Scholar 

  • Gould J.B., Madan A., Qin C., and Chavez G. Perinatal outcomes in two dissimilar immigrant populations in the United States: a dual epidemiologic paradox. Pediatrics 2003: 111 (6 Part 1): e676–e682.

    Article  Google Scholar 

  • Greenland S. Relation of probability of causation to a methodologic error that has become a social problem. Am J Public Health 1999: 89 (8): 1166–1169.

    Article  CAS  Google Scholar 

  • Greenland S., and Robins J. Conceptual problems in the definition and interpretation of attributable fractions. Am J Epidemiol 1988: 128 (6): 1185–1197.

    Article  CAS  Google Scholar 

  • Greenland S., and Robins J. Invited commentary: Ecologic studies-biases, misconceptions, and counterexamples. Am J Epidemiol 1994: 139 (8): 747–760.

    Article  CAS  Google Scholar 

  • Jones K. Using multilevel models for survey analysis. J Market Res Soc 1993: 35 (3): 249–265.

    Article  Google Scholar 

  • Kaufman J.S., Dole N., Savitz D.A., and Herring A.H. Modeling community-level effects on preterm birth. Ann Epidemiol 2003: 13 (5): 377–384.

    Article  Google Scholar 

  • Kramer M.S., Demissie K., Yang H., Platt R.W., Sauve R., and Liston R. The contribution of mild and moderate preterm birth to infant mortality. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. JAMA 2000: 284 (7): 843–849.

    Article  CAS  Google Scholar 

  • Krieger N.G.D. Re: use of census-based aggregate variables to proxy for socioeconomic group: evidence from national samples. Am I Epidemiol 1999: 150: 892–896.

    Article  CAS  Google Scholar 

  • Landry S.H., Denson S.E., and Swank P.R. Effects of medical risk and socioeconomic status on the rate of change in cognitive and social development for low birth weight children. J Clin Exp Neuropsychol 1997: 19 (2): 261–274.

    Article  CAS  Google Scholar 

  • Liu S., Krewski D., Shi Y., Chen Y., and Burnett R.T. Association between maternal exposure to ambient air pollutants during pregnancy and fetal growth restriction. J Expo Sci Environ Epidemiol 2006: http://www.nature.com/jes/journal/vaop/ncurrent/abs/7500503a.html.

  • Matteson D., Burr J., and Marshall J. Infant mortality: a multi-level analysis of individual and community risk factors. Soc Sci Med 1998: 47: 1841–1854.

    Article  CAS  Google Scholar 

  • McLaren L., and Gauvin L. Neighbourhood level versus individual level correlates of women's body dissatisfaction: toward a multilevel understanding of the role of affluence. J Epidemiol Community Health 2002: 56 (3): 193–199.

    Article  CAS  Google Scholar 

  • Montgomery L.E., and Carter-Pokras O. Health status by social class and/or minority status: implications for environmental equity research. Toxicol Ind Health 1993: 9 (5): 729–773.

    Article  CAS  Google Scholar 

  • Morgenstern H. Socioeconomic factors: Concepts, measurement and health effects. In: Measuring Psychosocial Variables in Epidemiological Studies of Cardiovascular Disease: Proceedings of a Workshop. National Institutes of Health, Washington, DC, 1985, pp. 3–35. NIH Publication 85–2270.

    Google Scholar 

  • Northridge M.E., Stover G.N., Rosenthal J.E., and Sherard D. Environmental equity and health: understanding complexity and moving forward. Am J Public Health 2003: 93 (2): 209–214.

    Article  Google Scholar 

  • Novak S.P., and Clayton R.R. The influence of school environment and self-regulation on transitions between stages of cigarette smoking: a multilevel analysis. Health Psychol 2001: 20 (3): 196–207.

    Article  CAS  Google Scholar 

  • O’Connell A.A., and McCoach D.B. Applications of hierarchical linear models for evaluations of health interventions: demystifying the methods and interpretations of multilevel models. Eval Health Prof 2004: 27 (2): 119–151.

    Article  Google Scholar 

  • Palloni A., and Morenoff J.D. Interpreting the paradoxical in the hispanic paradox: demographic and epidemiologic approaches. Ann NY Acad Sci 2001: 954: 140–174.

    Article  CAS  Google Scholar 

  • Pickett K.E., and Pearl M. Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. J Epidemiol Commun Health 2001: 55 (2): 111–122.

    Article  CAS  Google Scholar 

  • Ponce N.A., Hoggatt K.J., Wilhelm M., and Ritz B. Preterm birth: the interaction of traffic-related air pollution with economic hardship in los angeles neighborhoods. Am J Epidemiol 2005: 162 (2): 140–148.

    Article  Google Scholar 

  • Raudenbush S.W., and Bryk A.S. Hierarchical linear models: Applications and data analysis methods, 2nd ed. Thousand Oaks, CA: Sage, 2002.

    Google Scholar 

  • Ritz B., Wilhelm M., and Zhao Y. Air pollution and infant death in Southern California, 1989 to 2000. Pediatrics 2006: 118 (2): 493–502.

    Article  Google Scholar 

  • Rockhill B. Theorizing about causes at the individual level while estimating effects at the population level: implications for prevention. Epidemiology 2005: 16 (1): 124–129.

    Article  Google Scholar 

  • Rosenheck R., and Stolar M. Access to public mental health services: determinants of population coverage. Med Care 1998: 36 (4): 503–512.

    Article  CAS  Google Scholar 

  • Savitz D.A., Kaufman J.S., Dole N., Siega-Riz A.M., Thorp Jr J.M., and Kaczor D.T. Poverty, education, race, and pregnancy outcome. Ethn Dis 2004: 14 (3): 322–329.

    PubMed  Google Scholar 

  • Scientific Software International (SSI). Scientific Software International (SSI), 2005, available: http://www.ssicentral.com/hlm/hlm00122.htm.

  • Sram R.J., Binkova B., Dejmek J., and Bobak M. Ambient air pollution and pregnancy outcomes: a review of the literature. Environ Health Perspect 2005: 113 (4): 375–382.

    Article  CAS  Google Scholar 

  • Sullivan L.M., Dukes K.A., and Losina E. Tutorial in biostatistics. An introduction to hierarchical linear modelling. Stat Med 1999: 18 (7): 855–888.

    Article  CAS  Google Scholar 

  • Sundquist K., Malmstrom M., and Johansson S.E. Neighbourhood deprivation and incidence of coronary heart disease: a multilevel study of 2.6 million women and men in Sweden. J Epidemiol Commun Health 2004: 58 (1): 71–77.

    Article  CAS  Google Scholar 

  • Susser M. The logic in ecological: I. the logic of analysis. Am J Public Health 1994: 84 (5): 825–829.

    Article  CAS  Google Scholar 

  • Walter S.D. The ecologic method in the study of environmental health Methodologic issues and feasibility. Env Health Perspect 1991: 94: 67–73.

    CAS  Google Scholar 

  • Wen M., Browning C.R., and Cagney K.A. Poverty, affluence, and income inequality: neighborhood economic structure and its implications for health. Soc Sci Med 2003: 57 (5): 843–860.

    Article  Google Scholar 

  • Windsor J., Milbrath R.L., Carney E.J., and Rakowski S.E. General slowing in language impairment: methodological considerations in testing the hypothesis. J Speech Lang Hear Res 2001: 44 (2): 446–461.

    Article  CAS  Google Scholar 

  • Wise P.H., Wampler N., and Barfield W. The importance of extreme prematurity and low birthweight to US neonatal mortality patterns: implications for prenatal care and women's health. J Am Med Womens Assoc 1995: 50 (5): 152–155.

    CAS  Google Scholar 

  • Woodbury R.M. Economic factors in infant mortality. J Am Statist Assoc 1924: 19 (146): 137–155.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA

    Bryan L Williams & Melina S Magsumbol

  2. MPR Psychometric and Statistical Research and Consulting, Falmouth, ME, USA

    María Pennock-Román

  3. Department of Educational Psychology, School Psychology and Special Education, Pennsylvania State University, University Park, PA, USA

    Hoi K Suen

  4. Department of Earth Sciences, University of Memphis, Memphis, TN, USA

    Esra Ozdenerol

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  1. Bryan L Williams
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Correspondence to Bryan L Williams.

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Williams, B., Pennock-Román, M., Suen, H. et al. Assessing the impact of the local environment on birth outcomes: a case for HLM. J Expo Sci Environ Epidemiol 17, 445–457 (2007). https://doi.org/10.1038/sj.jes.7500537

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