title: Multilevel Interventions To Address Health Disparities Show Promise In Improving Population Health.
abstract: Multilevel interventions are those that affect at least two levels of influence-for example, the patient and the health care provider. They can be experimental designs or natural experiments caused by changes in policy, such as the implementation of the Affordable Care Act or local policies. Measuring the effects of multilevel interventions is challenging, because they allow for interaction among levels, and the impact of each intervention must be assessed and translated into practice. We discuss how two projects from the National Institutes of Health's Centers for Population Health and Health Disparities used multilevel interventions to reduce health disparities. The interventions, which focused on the uptake of the human papillomavirus vaccine and community-level dietary change, had mixed results. The design and implementation of multilevel interventions are facilitated by input from the community, and more advanced methods and measures are needed to evaluate the impact of the various levels and components of such interventions.
authors: Electra Paskett (electra.paskett@osumc.edu) is a professor of internal medicine at the Ohio State University College of Medicine, in Columbus.
authors: Electra
authors: E
authors: Paskett
authors: Beti Thompson is a professor in the Cancer Prevention Program at the Fred Hutchinson Cancer Research Center, in Seattle, Washington.
authors: Beti
authors: B
authors: Thompson
authors: Alice S. Ammerman is a professor of nutrition in the Gillings School of Global Public Health and director of the Center for Health Promotion and Disease Prevention, both at the University of North Carolina at Chapel Hill.
authors: Alice S
authors: AS
authors: Ammerman
authors: Alexander N. Ortega is a professor in and chair of the Department of Health Management and Policy, Dornsife School of Public Health, at Drexel University, in Philadelphia, Pennsylvania.
authors: Alexander N
authors: AN
authors: Ortega
authors: Jill Marsteller is an associate professor at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland.
authors: Jill
authors: J
authors: Marsteller
authors: DeJuran Richardson is a professor of mathematics at Lake Forest College, in Lake Forest, Illinois, and an adjunct professor of biostatistics at Rush University Medical Center, in Chicago, Illinois.
authors: DeJuran
authors: D
authors: Richardson
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D005260:Female; D006266:Health Education / Q000458:organization & administration*; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008913:Minority Groups / Q000706:statistics & numerical data; D058991:Patient Protection and Affordable Care Act / Q000458:organization & administration*; D000075485:Population Health; D011203:Poverty / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012307:Risk Factors; D014481:United States
keywords: Community interventions; Diet; Disparities; HPV vaccine; Multilevel interventions