The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #72891

Sandro Galea, MD, MPH and David Vlahov, PhD. Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029, 212-822-7378, sgalea@nyam.org

In traditional public health interventions, the determination of a modifiable risk factor for poor health (e.g., drug use) is followed by implementation of a trial that aims to affect this factor in the population. The efficacy of the intervention is assessed by comparing persons in the trial to appropriate controls. While many trials have been demonstrated efficacious, when extended to the general population these interventions frequently do not appreciably improve population health. Explanations for this limited intervention efficiency include: poor adherence to protocols in real-life vs. idealized trial situations, changes in baseline so that the trial conditions are no longer replicable, and the contribution of other community-level factors that make it difficult to extend the trial methods to other communities. In this presentation we will discuss how multilevel community intervention trials can address some of these limitations. Multilevel trials arise from an appreciation that interventions that address a single factor are not likely to have a sustainable impact in the context of multiple competing forces that shape population health in cities. We will discuss (a) how multilevel trials are frequently developed in collaboration with community members with insight factors that may contribute to the efficiency of the intervention, (b) the implementation of these trials including efforts targeting individual (e.g., behavior) and structural factors (e.g., acceptability to community) and (c) methodologic challenges in the evaluation of such trials. We will draw examples from multilevel interventions that we have designed, and implemented, in New York City.

Learning Objectives:

• To compare and contrast traditional public health interventions with multilevel intervention trials.
• To discuss the potential benefits, and the limitations of, multilevel community trials that attempt to intervene on structural factors.
• To articulate an area of local community concern and to design a multilevel intervention that may effectively improve the issue in question.

Keywords: Research,

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.