Welcome back. This is the third of three modules for week two, or lecture two.

In this module, we're going to be talking about multilevel phenomena. This is another slippery issue, but I want to introduce it to you early so you can be thinking about it. And as we go through the remainder of the course, hopefully any ideas that are unclear now will become clear before we finish. The first key idea is we want to make distinctions between groups or contexts and individual persons. Now, persons make up groups, but groups can have a life of their own. Sort of like a pack of wolves or a fun party. Groups can do things on their own, and individuals in certain groups will behave differently given the rest of the characteristics of the groups. So this is the core idea and this idea of groups in contexts is the idea of multilevel phenomena. That is at one level, there's the person or the individual. Addive at another level, a higher level if you will, is the group or the context. Now the whole point of this module is to reinforce the idea that groups make people, and people make groups. In other words, we can say that cultures make people. Your culture might make what food you eat, what clothes you wear, what you think is valuable. And people also make up cultures. That is the behaviors, the attitudes, the actions of individuals within a culture reinforce and continue to make that culture. Another way to say this, is that macroeconomic forces impact microeconomic forces. But in some, often complicated way, a whole bunch of microeconomic decisions yield macroeconomic outcomes. So that's this idea of multi-level thinking. Again, a person might behave a certain way in context A, but that very same person behaves differently in context B. Now, most people understand that contexts affect persons, but a point I want to emphasize is in addition to that, persons affect contexts. Let me try to map that out for you.

First, we need to recognize that persons have influence on their group. One key example, is charismatic leaders, such as Martin Luther King Jr. Or perhaps Mahatma Gandhi. These leaders did great to influence their cultures, their context. By their actions, their ideas, and what they did and stood for. It's important to note however, that one's influence need not always be good. There can be leaders who have negative influences on their contexts. Just let me lay out here a conceptual model of multilevel phenomena for you. This is just to hopefully orient you to some thinking about how all this stuff works. Let's start with a group or society. a work place at time 1. And imagine that the percentage of obese persons in that workplace, that society, that culture, is 33% at time 1. This is not an unreasonable percentage. In fact, the average percent of obese persons in America at this time is approximately 33%. Here's a simple CDC, Centers for Disease Control Prevention, slide of obesity percentages in the United States. And it's broken out by age groups and by men and women, and on average, it's 33%. As epidemiologists, we can ask hm, what happens to that same group at time 2, whose obesity percentage now went to 43%? So we have a group at time 1, a society, a culture, a workplace, with 33% obesity at time 1. At time 2, has 43% obesity. So the task of the social epidemiologist is to explain why this happens. And this is a multilevel phenomena. What matters here, is that members of the group at time 1 are influenced by the group. So perhaps there's a group with 33% obesity, and they don't exercise a lot, and they don't eat very well. That can affect the non-obese members of that group. It's part of the culture, they go out to lunch with them, they stay on the couch with them, they do whatever with them. And that social influence affectses, affects the person in the group of time 1. That influence of the group on the individual is called socialization, and there are libraries written about this. All kinds of ways individuals are

socialized by their groups. We'll come back to that in a theory module later on in the course. What's critical is that the socialization occurs in many ways. It might be advertising by fast-food chains, such as McDonald's. It can be the influence of friends saying, Let's go eat at McDonald's; the food is terrific. There's lots of ways socialization occurs. But that individual who's influenced by the group, must change his or her behavior. They might, super size themselves, if you will. This famous documentary movie, about a person eating lots of McDonald's food. So here, the idea is, that the group influence the individual, then, the individual changes, and they might become obese. So now the group affect the individual, and the individual changed. That individual has to feed back their change back into the group. They have to stay a member of the group. They might actually impact other persons in the group with their own change. And this is the critical point of the individual now feeding back, no pun intended, into the group. And this is a function not of socialization, but of collective action and other group efforts that yield a change at the group level. And so now, we have a model where the socialization occurs from the indi, from the group to the individual. The individual him or herself has some sort of change, and then that person feeds back into the group and changes part of the percent, in our case, of persons obese in the same group at time 2. So consider some context to ground this. Imagine the impact of these contexts, a near desire to say exercise. Perhaps run to take a nice walk with a dog in these various contexts. These are photographs from outside of Mobile, Alabama, and at least for me, it doesn't seem very conducive to running on the road and getting some good exercise. Places such as this, which is not far from the first place, might actually be very uncomfortable for certain people to exercise. So the idea here is that the context, the

group, the microculture is affecting one's propensity for exercise. By contrast, here's a photo from Boulder, Colorado, where it seems all the environment is inducing people to exercise. And in fact, people in Boulder tend to exercise a lot more. So the key idea here is that one context pushes people to exercise. Another tends not to. But what we have to ask ourselves as social epidemiologists, is not just how contexts or groups affect persons, but how persons in fact, affect groups. Why is it that there is not nice house paint on certain homes? Why isn't there trash in some streets? Why are the trails nice in certain areas? Bike paths in certain cities. These are political questions often, and the question is, why is the political work not getting done? These are the questions of people through the social system, creating their environment. And it's that part of the equation that is so slippery. So slippery for social epidemiology, it makes questions and understanding and inference and conclusions in social epi so difficult. So we want to, as social epidemiologists, think about disentangling the effects of contexts on people, and the effect of persons themselves on the contexts. And this is a great challenge, scientifically. Simply put, we can ask, does McDonald's force people to eat there? Does their advertising actually require persons to eat there? Or, in fact, do people want and demand McDonald's in their local neighborhood because they enjoy the food? This great tension of being exposed to it and wanting it is a key feature of social epidemiology, and it makes it very difficult. These key questions are central to our scientific effort in social epidemiology. The key idea is that social systems affect people, and that people affect social systems, and there is very difficult, very challenging feedback loops. All this means that social epidemiology's influent inferences and policy recommendations ought to be read and understood with caution.

In the remainder of this course, I want to show you why this caution is warranted in some paths through to have firmer relationships, further, deeper, more credible scientific understanding in the things we wish to study.