Several indicators of social cohesion (lack of trust in government, crime rates), and social capital (work relations, not voting) were found to predict life expectancy and 1994 mortality rates for Russia, independently of poverty levels and per capita income (Kennedy et al., 1998). Indicators of trust in informal networks and formal, political or government, activities have been applied as measures of social cohesion in several major surveys in Russia, America, and Europe. Relative social inequality and surrounding poverty increase social disorganization through lack of public trust and deterioration of social norms. Formal networks, as civic group memberships, have been related to the maintenance and sustenance of social trust and norms, and consequently to lower rates of violence, assault, and robberies (Kaplan et al., 1996; Kawachi and Kennedy, 1997a, 1997b).

These studies were conducted at either the ecological or individual level, and did not consider the joint or independent effect of each level on health outcomes. The distribution of social connectivity varies with community and geographic conditions, especially in a large and culturally diverse nation like Russia, which requires a complex multi-stage stratified survey design. The effect of this diversity on outcome is lost if analyzed as a single sample at the lowest level. Multilevel models provide greater insight into the causal path by which health habits or psychosocial behaviors influence health given variations in the structure of communities, and prevent making Type I errors by controlling design effects.