Realist explanatory theory building method for social epidemiology: a protocol for a mixed method multilevel study of neighbourhood context and postnatal depression.

PubMed

Eastwood, John G; Jalaludin, Bin B; Kemp, Lynn A

2014-01-01

A recent criticism of social epidemiological studies, and multi-level studies in particular has been a paucity of theory. We will present here the protocol for a study that aims to build a theory of the social epidemiology of maternal depression. We use a critical realist approach which is trans-disciplinary, encompassing both quantitative and qualitative traditions, and that assumes both ontological and hierarchical stratification of reality. We describe a critical realist Explanatory Theory Building Method comprising of an: 1) emergent phase, 2) construction phase, and 3) confirmatory phase. A concurrent triangulated mixed method multilevel cross-sectional study design is described. The Emergent Phase uses: interviews, focus groups, exploratory data analysis, exploratory factor analysis, regression, and multilevel Bayesian spatial data analysis to detect and describe phenomena. Abductive and retroductive reasoning will be applied to: categorical principal component analysis, exploratory factor analysis, regression, coding of concepts and categories, constant comparative analysis, drawing of conceptual networks, and situational analysis to generate theoretical concepts. The Theory Construction Phase will include: 1) defining stratified levels; 2) analytic resolution; 3) abductive reasoning; 4) comparative analysis (triangulation); 5) retroduction; 6) postulate and proposition development; 7) comparison and assessment of theories; and 8) conceptual frameworks and model development. The strength of the critical realist methodology described is the extent to which this paradigm is able to support the epistemological, ontological, axiological, methodological and rhetorical positions of both quantitative and qualitative research in the field of social epidemiology. The extensive multilevel Bayesian studies, intensive qualitative studies, latent variable theory, abductive triangulation, and Inference to Best Explanation provide a strong foundation for Theory Construction. The study will contribute to defining the role that realism and mixed methods can play in explaining the social determinants and developmental origins of health and disease.

A Multilevel Analysis of Student Perceptions of School Climate: The Effect of Social and Academic Risk Factors

ERIC Educational Resources Information Center

Fan, Weihua; Williams, Cathy M.; Corkin, Danya Marie

2011-01-01

This multilevel study examines the extent to which individual- and school-level variables are predictive of three aspects of students' perceived school climate (order, safety, and discipline; fairness and clarity of school rules; and teacher-student relationship) by using a nationally representative sample. A wide range of social and academic risk…

Differences in within- and between-person factor structure of positive and negative affect: analysis of two intensive measurement studies using multilevel structural equation modeling.

PubMed

Rush, Jonathan; Hofer, Scott M

2014-06-01

The Positive and Negative Affect Schedule (PANAS) is a widely used measure of emotional experience. The factor structure of the PANAS has been examined predominantly with cross-sectional designs, which fails to disaggregate within-person variation from between-person differences. There is still uncertainty as to the factor structure of positive and negative affect and whether they constitute 2 distinct independent factors. The present study examined the within-person and between-person factor structure of the PANAS in 2 independent samples that reported daily affect over 7 and 14 occasions, respectively. Results from multilevel confirmatory factor analyses revealed that a 2-factor structure at both the within-person and between-person levels, with correlated specific factors for overlapping items, provided good model fit. The best-fitting solution was one where within-person factors of positive and negative affect were inversely correlated, but between-person factors were independent. The structure was further validated through multilevel structural equation modeling examining the effects of cognitive interference, daily stress, physical symptoms, and physical activity on positive and negative affect factors.

Co-occurrences Between Adolescent Substance Use and Academic Performance: School Context Inuences a Multilevel-Longitudinal Perspective

PubMed Central

Andrade, Fernando H.

2014-01-01

A growing body of literature has linked substance use and academic performance exploring substance use as a predictor of academic performance or vice versa. This study uses a different approach conceptualizing substance use and academic performance as parallel outcomes and exploring two topics: its multilevel-longitudinal association and school contextual effects on both outcomes. Using multilevel Confirmatory Factor Analysis and multilevel-longitudinal analyses, the empirical estimates relied on 7843 students nested in 114 schools (Add Health study). The main finding suggests that the correlation between substance use and academic performance was positive at the school level in contraposition to the negative relationship at the individual level. Additional findings suggest a positive effect of a school risk factor on substance use and a positive effect of academic pressure on academic performance. These findings represent a contribution to our understanding of how schools could affect the relationship between academic performance and substance use. PMID:25057764

Exploratory Two-Level Analysis of Individual- and School-Level Factors on Truant Youth Emotional/Psychological Functioning

ERIC Educational Resources Information Center

Dembo, Richard; Wareham, Jennifer; Schmeidler, James; Winters, Ken C.

2016-01-01

Research on samples of truant adolescents is limited, with little known about mental health problems among truant youths. This study provided an exploratory, multilevel examination of mental health problems for a sample of 300 truant adolescents. Confirmatory factor analysis indicated a single factor of multiple mental health problems at the…

Exploring Pattern of Socialisation Conditions and Human Development by Nonlinear Multivariate Analysis.

ERIC Educational Resources Information Center

Grundmann, Matthias

Following the assumptions of ecological socialization research, adequate analysis of socialization conditions must take into account the multilevel and multivariate structure of social factors that impact on human development. This statement implies that complex models of family configurations or of socialization factors are needed to explain the…

Translating multilevel theory into multilevel research: Challenges and opportunities for understanding the social determinants of psychiatric disorders

PubMed Central

Dunn, Erin C.; Masyn, Katherine E.; Yudron, Monica; Jones, Stephanie M.; Subramanian, S.V.

2014-01-01

The observation that features of the social environment, including family, school, and neighborhood characteristics, are associated with individual-level outcomes has spurred the development of dozens of multilevel or ecological theoretical frameworks in epidemiology, public health, psychology, and sociology, among other disciplines. Despite the widespread use of such theories in etiological, intervention, and policy studies, challenges remain in bridging multilevel theory and empirical research. This paper set out to synthesize these challenges and provide specific examples of methodological and analytical strategies researchers are using to gain a more nuanced understanding of the social determinants of psychiatric disorders, with a focus on children’s mental health. To accomplish this goal, we begin by describing multilevel theories, defining their core elements, and discussing what these theories suggest is needed in empirical work. In the second part, we outline the main challenges researchers face in translating multilevel theory into research. These challenges are presented for each stage of the research process. In the third section, we describe two methods being used as alternatives to traditional multilevel modeling techniques to better bridge multilevel theory and multilevel research. These are: (1) multilevel factor analysis and multilevel structural equation modeling; and (2) dynamic systems approaches. Through its review of multilevel theory, assessment of existing strategies, and examination of emerging methodologies, this paper offers a framework to evaluate and guide empirical studies on the social determinants of child psychiatric disorders as well as health across the lifecourse. PMID:24469555

Overweight and obesity in India: policy issues from an exploratory multi-level analysis.

PubMed

Siddiqui, Md Zakaria; Donato, Ronald

2016-06-01

This article analyses a nationally representative household dataset-the National Family Health Survey (NFHS-3) conducted in 2005 to 2006-to examine factors influencing the prevalence of overweight/obesity in India. The dataset was disaggregated into four sub-population groups-urban and rural females and males-and multi-level logit regression models were used to estimate the impact of particular covariates on the likelihood of overweight/obesity. The multi-level modelling approach aimed to identify individual and macro-level contextual factors influencing this health outcome. In contrast to most studies on low-income developing countries, the findings reveal that education for females beyond a particular level of educational attainment exhibits a negative relationship with the likelihood of overweight/obesity. This relationship was not observed for males. Muslim females and all Sikh sub-populations have a higher likelihood of overweight/obesity suggesting the importance of socio-cultural influences. The results also show that the relationship between wealth and the probability of overweight/obesity is stronger for males than females highlighting the differential impact of increasing socio-economic status on gender. Multi-level analysis reveals that states exerted an independent influence on the likelihood of overweight/obesity beyond individual-level covariates, reflecting the importance of spatially related contextual factors on overweight/obesity. While this study does not disentangle macro-level 'obesogenic' environmental factors from socio-cultural network influences, the results highlight the need to refrain from adopting a 'one size fits all' policy approach in addressing the overweight/obesity epidemic facing India. Instead, policy implementation requires a more nuanced and targeted approach to incorporate the growing recognition of socio-cultural and spatial contextual factors impacting on healthy behaviours. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

[Ecological Correlates of Cardiovascular Disease Risk in Korean Blue-collar Workers: A Multi-level Study].

PubMed

Hwang, Won Ju; Park, Yunhee

2015-12-01

The purpose of this study was to investigate individual and organizational level of cardiovascular disease (CVD) risk factors associated with CVD risk in Korean blue-collar workers working in small sized companies. Self-report questionnaires and blood sampling for lipid and glucose were collected from 492 workers in 31 small sized companies in Korea. Multilevel modeling was conducted to estimate effects of related factors at the individual and organizational level. Multilevel regression analysis showed that workers in the workplace having a cafeteria had 1.81 times higher CVD risk after adjusting for factors at the individual level (p=.022). The explanatory power of variables related to organizational level variances in CVD risk was 17.1%. The results of this study indicate that differences in the CVD risk were related to organizational factors. It is necessary to consider not only individual factors but also organizational factors when planning a CVD risk reduction program. The factors caused by having cafeteria in the workplace can be reduced by improvement in the CVD-related risk environment, therefore an organizational-level intervention approach should be available to reduce CVD risk of workers in small sized companies in Korea.

Hierarchical Effects of School-, Classroom-, and Student-Level Factors on the Science Performance of Eighth-Grade Taiwanese Students

NASA Astrophysics Data System (ADS)

Tsai, Liang-Ting; Yang, Chih-Chien

2015-05-01

This study was conducted to understand the effect of student-, classroom-, and school-level factors on the science performance of 8th-grade Taiwanese students in the Trends in International Mathematics and Science Study (TIMSS) 2011 by using multilevel analysis. A total of 5,042 students from 153 classrooms of 150 schools participated in the TIMSS 2011 study, in which they were required to complete questionnaires. A 3-level multilevel analysis was used to assess the influence of factors at 3 levels on the science performance of 8th-grade Taiwanese students. The results showed that the provision of education resources at home, teachers' level of education, and school climate were the strongest predictor of science performance at the student, classroom, and school level, respectively. It was concluded that the science performance of 8th-grade Taiwanese students is driven largely by individual factors. Classroom-level factors accounted for a smaller proportion of the total variance in science performance than did school-level factors.

International students' enrollment in IPTA by using multilevel analysis

NASA Astrophysics Data System (ADS)

Wai, Phoong Seuk; Ismail, Mohd Tahir; Karim, Samsul Ariffin Abdul

2012-09-01

The increases of demand on knowledge-based and production-based market force the growth of higher education. International students' enrollment contributes to economic growth and increase country's income, university reputation and name; promote the competitive of education and training markets. This paper used multilevel analysis to study the international students' enrollment in Malaysia public university. Student's background variables and institution background variables were study in this paper and the relationship among them also been investigated. Result shows that institution type is a significance factor on international students' enrollment in Malaysia public university.

The Psychosocial Work Environment, Employee Mental Health and Organizational Interventions: Improving Research and Practice by Taking a Multilevel Approach.

PubMed

Martin, Angela; Karanika-Murray, Maria; Biron, Caroline; Sanderson, Kristy

2016-08-01

Although there have been several calls for incorporating multiple levels of analysis in employee health and well-being research, studies examining the interplay between individual, workgroup, organizational and broader societal factors in relation to employee mental health outcomes remain an exception rather than the norm. At the same time, organizational intervention research and practice also tends to be limited by a single-level focus, omitting potentially important influences at multiple levels of analysis. The aims of this conceptual paper are to help progress our understanding of work-related determinants of employee mental health by the following: (1) providing a rationale for routine multilevel assessment of the psychosocial work environment; (2) discussing how a multilevel perspective can improve related organizational interventions; and (3) highlighting key theoretical and methodological considerations relevant to these aims. We present five recommendations for future research, relating to using appropriate multilevel research designs, justifying group-level constructs, developing group-level measures, expanding investigations to the organizational level and developing multilevel approaches to intervention design, implementation and evaluation. Copyright © 2014 John Wiley & Sons, Ltd. Copyright © 2014 John Wiley & Sons, Ltd.

On the Multilevel Nature of Meta-Analysis: A Tutorial, Comparison of Software Programs, and Discussion of Analytic Choices.

PubMed

Pastor, Dena A; Lazowski, Rory A

2018-01-01

The term "multilevel meta-analysis" is encountered not only in applied research studies, but in multilevel resources comparing traditional meta-analysis to multilevel meta-analysis. In this tutorial, we argue that the term "multilevel meta-analysis" is redundant since all meta-analysis can be formulated as a special kind of multilevel model. To clarify the multilevel nature of meta-analysis the four standard meta-analytic models are presented using multilevel equations and fit to an example data set using four software programs: two specific to meta-analysis (metafor in R and SPSS macros) and two specific to multilevel modeling (PROC MIXED in SAS and HLM). The same parameter estimates are obtained across programs underscoring that all meta-analyses are multilevel in nature. Despite the equivalent results, not all software programs are alike and differences are noted in the output provided and estimators available. This tutorial also recasts distinctions made in the literature between traditional and multilevel meta-analysis as differences between meta-analytic choices, not between meta-analytic models, and provides guidance to inform choices in estimators, significance tests, moderator analyses, and modeling sequence. The extent to which the software programs allow flexibility with respect to these decisions is noted, with metafor emerging as the most favorable program reviewed.

Co-occurrences between adolescent substance use and academic performance: school context influences a multilevel-longitudinal perspective.

PubMed

Andrade, Fernando H

2014-08-01

A growing body of literature has linked substance use and academic performance exploring substance use as a predictor of academic performance or vice versa. This study uses a different approach conceptualizing substance use and academic performance as parallel outcomes and exploring two topics: its multilevel-longitudinal association and school contextual effects on both outcomes. Using multilevel Confirmatory Factor Analysis and multilevel-longitudinal analyses, the empirical estimates relied on 7843 students nested in 114 schools (Add Health study). The main finding suggests that the correlation between substance use and academic performance was positive at the school level in contraposition to the negative relationship at the individual level. Additional findings suggest a positive effect of a school risk factor on substance use and a positive effect of academic pressure on academic performance. These findings represent a contribution to our understanding of how schools could affect the relationship between academic performance and substance use. Copyright © 2014 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Multilevel Confirmatory Factor Analysis of the Teacher My Class Inventory-Short Form

ERIC Educational Resources Information Center

Villares, Elizabeth; Mariani, Melissa; Sink, Christopher A.; Colvin, Kimberly

2016-01-01

Researchers analyzed data from elementary teachers (N = 233) to further establish the psychometric soundness of the Teacher My Class Inventory-Short Form. Supporting previous psychometric research, confirmatory factor analyses findings supported the factorial validity of the hypothesized five-factor solution. Internal reliability estimates were…

A multilevel analysis of the effects of the Practice Environment Scale of the Nursing Work Index on nurse outcomes.

PubMed

Gabriel, Allison S; Erickson, Rebecca J; Moran, Christina M; Diefendorff, James M; Bromley, Gail E

2013-12-01

Few researchers have examined how the components of the Practice Environment Scale of the Nursing Work Index (PES-NWI) relate to nurses' well-being at multiple organizational levels. The objective of the study was to perform a multilevel assessment of the relationships of the PES-NWI subscales with three nurse outcomes: job satisfaction, emotional exhaustion, and turnover intentions. Additionally, we tested the multilevel factor structure of the PES-NWI. In a sample of 699 full-time registered nurses in 79 units and 9 branches of a hospital system, relationships of the NWI with nurse outcomes were fairly consistent across levels of analysis. However, subscales contributed differently to the three outcomes, demonstrating the complexity of environmental influences on nurses' work experience. © 2013 Wiley Periodicals, Inc.

Collinear Latent Variables in Multilevel Confirmatory Factor Analysis: A Comparison of Maximum Likelihood and Bayesian Estimations

ERIC Educational Resources Information Center

Can, Seda; van de Schoot, Rens; Hox, Joop

2015-01-01

Because variables may be correlated in the social and behavioral sciences, multicollinearity might be problematic. This study investigates the effect of collinearity manipulated in within and between levels of a two-level confirmatory factor analysis by Monte Carlo simulation. Furthermore, the influence of the size of the intraclass correlation…

Measuring psychosocial environments using individual responses: an application of multilevel factor analysis to examining students in schools.

PubMed

Dunn, Erin C; Masyn, Katherine E; Jones, Stephanie M; Subramanian, S V; Koenen, Karestan C

2015-07-01

Interest in understanding how psychosocial environments shape youth outcomes has grown considerably. School environments are of particular interest to prevention scientists as many prevention interventions are school-based. Therefore, effective conceptualization and operationalization of the school environment is critical. This paper presents an illustration of an emerging analytic method called multilevel factor analysis (MLFA) that provides an alternative strategy to conceptualize, measure, and model environments. MLFA decomposes the total sample variance-covariance matrix for variables measured at the individual level into within-cluster (e.g., student level) and between-cluster (e.g., school level) matrices and simultaneously models potentially distinct latent factor structures at each level. Using data from 79,362 students from 126 schools in the National Longitudinal Study of Adolescent to Adult Health (formerly known as the National Longitudinal Study of Adolescent Health), we use MLFA to show how 20 items capturing student self-reported behaviors and emotions provide information about both students (within level) and their school environment (between level). We identified four latent factors at the within level: (1) school adjustment, (2) externalizing problems, (3) internalizing problems, and (4) self-esteem. Three factors were identified at the between level: (1) collective school adjustment, (2) psychosocial environment, and (3) collective self-esteem. The finding of different and substantively distinct latent factor structures at each level emphasizes the need for prevention theory and practice to separately consider and measure constructs at each level of analysis. The MLFA method can be applied to other nested relationships, such as youth in neighborhoods, and extended to a multilevel structural equation model to better understand associations between environments and individual outcomes and therefore how to best implement preventive interventions.

Individual and institutional factors associated with functional disability in nursing home residents: An observational study with multilevel analysis.

PubMed

Serrano-Urrea, Ramón; Gómez-Rubio, Virgilio; Palacios-Ceña, Domingo; Fernández-de-Las-Peñas, César; García-Meseguer, María José

2017-01-01

High prevalence of functional limitations has been previously observed in nursing homes. Disability may depend not only on the characteristics of the residents but also on the facility characteristics. The aims of this study were: 1, to describe the prevalence of functional disability in older people living in Spanish nursing homes; and 2, to analyze the relationships between individual and nursing home characteristics and residents' functional disability. A cross-sectional study with data collected from 895 residents in 34 nursing homes in the province of Albacete (Spain) was conducted. Functional status was assessed by the Barthel Index. Taking into account both levels of data (individual and institutional characteristics) we resorted to a multilevel analysis in order to take different sources of variability in the data. The prevalence of functional disability of the total sample was 79.8%. The best fitting multilevel model showed that female gender, older age, negative self-perception of health, and living in private nursing homes were factors significantly associated with functional disability. After separating individual and institutional effects, the institutions showed significant differences. In line with previous findings, our study found high levels of functional dependence among institutionalized elders. Gender, age, self-perception of health, and institution ownership were associated with functional status. Disentangling individual and institutional effects by means of multilevel models can help evaluate the quality of the residences.

Multi-level analysis in information systems research: the case of enterprise resource planning system usage in China

NASA Astrophysics Data System (ADS)

Sun, Yuan; Bhattacherjee, Anol

2011-11-01

Information technology (IT) usage within organisations is a multi-level phenomenon that is influenced by individual-level and organisational-level variables. Yet, current theories, such as the unified theory of acceptance and use of technology, describe IT usage as solely an individual-level phenomenon. This article postulates a model of organisational IT usage that integrates salient organisational-level variables such as user training, top management support and technical support within an individual-level model to postulate a multi-level model of IT usage. The multi-level model was then empirically validated using multi-level data collected from 128 end users and 26 managers in 26 firms in China regarding their use of enterprise resource planning systems and analysed using the multi-level structural equation modelling (MSEM) technique. We demonstrate the utility of MSEM analysis of multi-level data relative to the more common structural equation modelling analysis of single-level data and show how single-level data can be aggregated to approximate multi-level analysis when multi-level data collection is not possible. We hope that this article will motivate future scholars to employ multi-level data and multi-level analysis for understanding organisational phenomena that are truly multi-level in nature.

Economic and Sociological Correlates of Suicides: Multilevel Analysis of the Time Series Data in the United Kingdom.

PubMed

Sun, Bruce Qiang; Zhang, Jie

2016-03-01

For the effects of social integration on suicides, there have been different and even contradictive conclusions. In this study, the selected economic and social risks of suicide for different age groups and genders in the United Kingdom were identified and the effects were estimated by the multilevel time series analyses. To our knowledge, there exist no previous studies that estimated a dynamic model of suicides on the time series data together with multilevel analysis and autoregressive distributed lags. The investigation indicated that unemployment rate, inflation rate, and divorce rate are all significantly and positively related to the national suicide rates in the United Kingdom from 1981 to 2011. Furthermore, the suicide rates of almost all groups above 40 years are significantly associated with the risk factors of unemployment and inflation rate, in comparison with the younger groups. © 2016 American Academy of Forensic Sciences.

[Multilevel model analysis on the relevant factors influencing the total amount of drinking water consumed daily by Beijing residents].

PubMed

Zhao, Jinhui; Wei, Jianrong; Chen, Huajie; Liu, Yumin; Li, Tiantian; Sun, Qinghua; Liu, Qiaolan

2012-09-01

To investigate the influencing factors for daily water intake of Beijing residents. A multi-stage sampling method was constructed to interview 270 Beijing residents in the winter of 2009 and in the summer of 2010 by using a questionnaire to collect data on daily drinking water consumption. Multilevel models were used to analyze the variation and influencing factors for the amount of water intake. Multilevel model results showed that the average daily water intake of residents living in different villages or neighborhood committees was statistically significant (sigma2 mu0 = = 0.030 (0.009), P < 0.05). The individual variation in the same village or neighborhood committee was also significant (sigma2 e0 = 0.157 (0.010), P < 0.05). Season, gender, and body weight affected the daily water intake (P < 0.05). There were interaction between season and source of water supply. The average daily water intake of residents was affected by several factors. In the health risk assessment of drinking water, it needs considering not only the individual characteristics but also the differences of villages/neighborhood committees and the seasonal variation.

The Impact of Sample Size and Other Factors When Estimating Multilevel Logistic Models

ERIC Educational Resources Information Center

Schoeneberger, Jason A.

2016-01-01

The design of research studies utilizing binary multilevel models must necessarily incorporate knowledge of multiple factors, including estimation method, variance component size, or number of predictors, in addition to sample sizes. This Monte Carlo study examined the performance of random effect binary outcome multilevel models under varying…

Using multi-level data to estimate the effect of an 'alcogenic' environment on hazardous alcohol consumption in the former Soviet Union.

PubMed

Murphy, Adrianna; Roberts, Bayard; Ploubidis, George B; Stickley, Andrew; McKee, Martin

2014-05-01

The purpose of this study was to assess whether alcohol-related community characteristics act collectively to influence individual-level alcohol consumption in the former Soviet Union (fSU). Using multi-level data from nine countries in the fSU we conducted a factor analysis of seven alcohol-related community characteristics. The association between any latent factors underlying these characteristics and two measures of hazardous alcohol consumption was then analysed using a population average regression modelling approach. Our factor analysis produced one factor with an eigenvalue >1 (EV=1.28), which explained 94% of the variance. This factor was statistically significantly associated with increased odds of CAGE problem drinking (OR=1.40 (1.08-1.82)). The estimated association with EHD was not statistically significant (OR=1.10 (0.85-1.44)). Our findings suggest that a high number of beer, wine and spirit advertisements and high alcohol outlet density may work together to create an 'alcogenic' environment that encourages hazardous alcohol consumption in the fSU. Copyright © 2014 Elsevier Ltd. All rights reserved.

Social inequalities in alcohol consumption in the Czech Republic: a multilevel analysis.

PubMed

Dzúrová, Dagmara; Spilková, Jana; Pikhart, Hynek

2010-05-01

Czech Republic traditionally ranks among the countries with the highest alcohol, consumption. This paper examines both risk and protective factors for frequent of alcohol, consumption in the Czech population using multilevel analysis. Risk factors were measured at the, individual level and at the area level. The individual-level data were obtained from a survey for a, sample of 3526 respondents aged 18-64 years. The area-level data were obtained from the Czech, Statistical Office. The group most inclinable to risk alcohol consumption and binge drinking are mainly, men, who live as single, with low education and also unemployed. Only the variable for divorce rate, showed statistical significance at both levels, thus the individual and the aggregated one. No cross-level interactions were found to be statistically significant. Copyright 2010 Elsevier Ltd. All rights reserved.

Racial/Ethnic Differences in Cigarette Smoking Initiation and Progression to Daily Smoking: A Multilevel Analysis

PubMed Central

Kandel, Denise B.; Kiros, Gebre-Egziabher; Schaffran, Christine; Hu, Mei-Chen

2004-01-01

Objectives. We sought to identify individual and contextual predictors of adolescent smoking initiation and progression to daily smoking by race/ethnicity. Methods. We used data from the National Longitudinal Study of Adolescent Health to estimate the effects of individual (adolescent, family, peer) and contextual (school and state) factors on smoking onset among nonsmokers (n = 5374) and progression to daily smoking among smokers (n = 4474) with multilevel regression models. Results. Individual factors were more important predictors of smoking behaviors than were contextual factors. Predictors of smoking behaviors were mostly common across racial/ethnic groups. Conclusions. The few identified racial/ethnic differences in predictors of smoking behavior suggest that universal prevention and intervention efforts could reach most adolescents regardless of race/ethnicity. With 2 exceptions, important contextual factors remain to be identified. PMID:14713710

Teen Dating Violence Victimization among High School Students: A Multilevel Analysis of School-Level Risk Factors

ERIC Educational Resources Information Center

Parker, Elizabeth M.; Johnson, Sarah Lindstrom; Debnam, Katrina J.; Milam, Adam J.; Bradshaw, Catherine P.

2017-01-01

Background: Much etiologic research has focused on individual-level risk factors for teen dating violence (TDV); therefore, less is known about school-level and neighborhood-level risk factors. We examined the association between alcohol outlet density around high schools and TDV victimization and the association between markers of physical…

Factors Affecting Online Groupwork Interest: A Multilevel Analysis

ERIC Educational Resources Information Center

Du, Jianxia; Xu, Jianzhong; Fan, Xitao

2013-01-01

The purpose of the present study is to examine the personal and contextual factors that may affect students' online groupwork interest. Using the data obtained from graduate students in an online course, both student- and group-level predictors for online groupwork interest were analyzed within the framework of hierarchical linear modeling…

Teacher-Student Power Relations as a Reflection of Multileveled Intertwined Interactions

ERIC Educational Resources Information Center

Wong, Mei-Yee

2016-01-01

This paper examines the factors shaping teacher-student power relations, based on observations, interviews and document analysis from a Hong Kong study. It identifies and examines six factors: China's traditional culture of respect, examination-oriented teaching and religious culture were found to encourage imbalanced teacher-student power…

Ecological influences of early childhood obesity: a multilevel analysis.

PubMed

Boonpleng, Wannaporn; Park, Chang Gi; Gallo, Agatha M; Corte, Colleen; McCreary, Linda; Bergren, Martha Dewey

2013-07-01

This study aims to determine the contributing factors for early childhood overweight/obesity within the contexts of the child's home, school, and community, and to determine how much each of the ecological contexts contributes to childhood overweight/obesity. The framework was developed from Bronfenbrenner's ecological systems theory. Data for 2,100 children from the Early Childhood Longitudinal Study, Birth Cohort, were used in a series of multilevel modeling analyses. There was significant variation in childhood overweight/obesity by school and community. The majority of variation in childhood overweight/obesity was explained by the child and family factors in addition to school and community factors. Explained variance of childhood overweight/obesity at the school level was 27% and at the community level, 2%. The variance composition at children's family level alone was 71%. Therefore, overweight/obesity prevention efforts should focus primarily on child, family, and school factors and then community factors, to be more effective.

Multilevel model of safety climate for furniture industries.

PubMed

Rodrigues, Matilde A; Arezes, Pedro M; Leão, Celina P

2015-01-01

Furniture companies can analyze their safety status using quantitative measures. However, the data needed are not always available and the number of accidents is under-reported. Safety climate scales may be an alternative. However, there are no validated Portuguese scales that account for the specific attributes of the furniture sector. The current study aims to develop and validate an instrument that uses a multilevel structure to measure the safety climate of the Portuguese furniture industry. The Safety Climate in Wood Industries (SCWI) model was developed and applied to the safety climate analysis using three different scales: organizational, group and individual. A multilevel exploratory factor analysis was performed to analyze the factorial structure. The studied companies' safety conditions were also analyzed. Different factorial structures were found between and within levels. In general, the results show the presence of a group-level safety climate. The scores of safety climates are directly and positively related to companies' safety conditions; the organizational scale is the one that best reflects the actual safety conditions. The SCWI instrument allows for the identification of different safety climates in groups that comprise the same furniture company and it seems to reflect those groups' safety conditions. The study also demonstrates the need for a multilevel analysis of the studied instrument.

Multilevel Correlates of Satisfaction with Neighborhood Availability of Fresh Fruits and Vegetables

PubMed Central

Zenk, Shannon N.; Schulz, Amy J.; Lachance, Laurie L.; Mentz, Graciela; Kannan, Srimathi; Ridella, William; Galea, Sandro

2009-01-01

Background Little is known about influences on perceptions of neighborhood food environments, despite their relevance for food-shopping behaviors and food choices. Purpose This study examined relationships between multilevel factors (neighborhood structure, independently observed neighborhood food environment, individual socioeconomic position) and satisfaction with neighborhood availability of fruits and vegetables. Methods The multilevel regression analysis drew on data from a community survey of urban adults, in-person audit and mapping of food stores, and the 2000 Census. Results Satisfaction with neighborhood availability of fruits and vegetables was lower in neighborhoods that were further from a supermarket and that had proportionately more African-American residents. Neighborhood poverty and independently observed neighborhood fruit and vegetable characteristics (variety, prices, quality) were not associated with satisfaction. Individual education modified relationships between neighborhood availability of smaller food stores (small grocery stores, convenience stores, liquor stores) and satisfaction. Conclusions Individual-level and neighborhood-level factors affect perceptions of neighborhood food environments. PMID:19809859

Deepening our Understanding of Quality in Australia (DUQuA): a study protocol for a nationwide, multilevel analysis of relationships between hospital quality management systems and patient factors

PubMed Central

Taylor, Natalie; Clay-Williams, Robyn; Hogden, Emily; Pye, Victoria; Li, Zhicheng; Groene, Oliver; Suñol, Rosa; Braithwaite, Jeffrey

2015-01-01

Introduction Despite the growing body of research on quality and safety in healthcare, there is little evidence of the association between the way hospitals are organised for quality and patient factors, limiting our understanding of how to effect large-scale change. The ‘Deepening our Understanding of Quality in Australia’ (DUQuA) study aims to measure and examine relationships between (1) organisation and department-level quality management systems (QMS), clinician leadership and culture, and (2) clinical treatment processes, clinical outcomes and patient-reported perceptions of care within Australian hospitals. Methods and analysis The DUQuA project is a national, multilevel, cross-sectional study with data collection at organisation (hospital), department, professional and patient levels. Sample size calculations indicate a minimum of 43 hospitals are required to adequately power the study. To allow for rejection and attrition, 70 hospitals across all Australian jurisdictions that meet the inclusion criteria will be invited to participate. Participants will consist of hospital quality management professionals; clinicians; and patients with stroke, acute myocardial infarction and hip fracture. Organisation and department-level QMS, clinician leadership and culture, patient perceptions of safety, clinical treatment processes, and patient outcomes will be assessed using validated, evidence-based or consensus-based measurement tools. Data analysis will consist of simple correlations, linear and logistic regression and multilevel modelling. Multilevel modelling methods will enable identification of the amount of variation in outcomes attributed to the hospital and department levels, and the factors contributing to this variation. Ethics and dissemination Ethical approval has been obtained. Results will be disseminated to individual hospitals in de-identified national and international benchmarking reports with data-driven recommendations. This ground-breaking national study has the potential to influence decision-making on the implementation of quality and safety systems and processes in Australian and international hospitals. PMID:26644128

[Predictors of Turnover among New Nurses using Multilevel Survival Analysis].

PubMed

Kim, Suhee; Lee, Kyongeun

2016-10-01

The purpose of this study was to examine factors influencing new graduate nurse turnover. This study was carried out as a secondary analysis of data from the 2010 Graduates Occupational Mobility Survey (GOMS). A total of 323 nurses were selected for analysis concerning reasons for turnover. Data were analyzed using descriptive statistics and multilevel survival analysis. About 24.5% of new nurses left their first job within 1 year of starting their jobs. Significant predictors of turnover among new nurse were job status, monthly income, job satisfaction, the number of hospitals in region, and the number of nurses per 100 beds. New graduate nurses are vulnerable to turnover. In order to achieve the best health of the nation, policy approaches and further studies regarding reducing new graduate nurse turnover are needed.

[A multilevel model analysis of correlation between population characteristics and work ability of employees].

PubMed

Zhang, Lei; Huang, Chunping; Lan, Yajia; Wang, Mianzhen

2015-12-01

To analyze the correlation between population characteristics and work ability of employees with a multilevel model, to investigate the important influencing factors for work ability, and to provide a basis for improvement in work ability. Work ability index (WAI)was applied to measure the work ability of 1686 subjects from different companies (n=6). MLwi N2.0 software was applied for two-level variance component model fitting. The WAI of employees showed differences between various companies (χ2=3.378 6, P=0.0660); working years was negatively correlated with WAI (χ2=38.229 2, P=0.0001), and the WAI of the employees with 20 or more working years was 1.63 lower than that of the employees with less than 20 working years; the work ability of manual workers was lower than that of mental-manual workers (χ2=8.2726, P=0.0040), and the work ability showed no significant difference between mental workers and mental-manual workers (χ2=2.086 0, P=0.148 7). From the perspective of probability, the multilevel model analysis reveals the differences in work ability of employees between different companies, and suggests that company, work type, and working years are the important influencing factors for work ability of employees. These factors should be improved and adjusted to protect or enhance the work ability of employees.

Factors Predicting Science Achievement of Immigrant and Non-Immigrant Students: A Multilevel Analysis

ERIC Educational Resources Information Center

Areepattamannil, Shaljan; Kaur, Berinderjeet

2013-01-01

This study, employing hierarchical linear modeling (HLM), sought to investigate the student-level and school-level factors associated with the science achievement of immigrant and non-immigrant students among a national sample of 22,646 students from 896 schools in Canada. While student background characteristics such as home language, family…

Variations in Reading Achievement across 14 Southern African School Systems: Which Factors Matter?

ERIC Educational Resources Information Center

Hungi, Njora; Thuku, Florence W.

2010-01-01

In this study the authors employed a multilevel analysis procedure in order to examine the pupil and school levels factors that contributed to variation in reading achievement among Grade 6 primary school pupils in 14 southern African school systems (Botswana, Kenya, Lesotho, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa,…

Factors Influencing Students' Adaptability in School: A Production Function Model and Multilevel Analysis

ERIC Educational Resources Information Center

Du, Ping

2008-01-01

This study used sampling survey data from rural elementary schools in western China to analyze school adaptability, which is the representative noncognitive development of rural elementary students. It also investigated factors influencing the school adaptability of elementary school students at an individual and school level by using production…

A multilevel analysis of long-term psychological distress among Belarusians affected by the Chernobyl disaster.

PubMed

Beehler, G P; Baker, J A; Falkner, K; Chegerova, T; Pryshchepava, A; Chegerov, V; Zevon, M; Bromet, E; Havenaar, J; Valdismarsdottir, H; Moysich, K B

2008-11-01

Radiation contamination and sociopolitical instability following the Chernobyl nuclear power plant disaster have had a profound impact on Belarus. To investigate the factors that impact long-term mental health outcomes of this population almost 20 years after the disaster. Cross-sectional study. In-person interviews were conducted with 381 men and women from two geographic areas of differing radiation contamination within Belarus. Participants completed surveys of demographics, psychosocial factors and psychological distress. Individual-level characteristics were combined with household-level measures of radiation contamination exposure and family characteristics to create multilevel predictive models of psychological distress. Between-household effects accounted for 20% of variability in depression and anxiety scores, but only 8% of variability in somatization scores. Degree of chronic daily stressors showed a significant positive relationship with psychological distress, whereas mastery/controllability showed a significant inverse relationship with distress. At household level, perceived family problems, but not level of residential radiation contamination, was the best predictor of distress. Multilevel modelling indicates that long-term psychological distress among Belarusians affected by the Chernobyl disaster is better predicted by stress-moderating psychosocial factors present in one's daily life than by level of residential radiation contamination.

Collective Socialization and Child Conduct Problems: A Multilevel Analysis with an African American Sample

ERIC Educational Resources Information Center

Simons, Leslie Gordon; Simons, Ronald L.; Conger, Rand D.; Brody, Gene H.

2004-01-01

This article uses hierarchical linear modeling with a sample of African American children and their primary caregivers to examine the association between various community factors and child conduct problems. The analysis revealed a rather strong inverse association between level of collective socialization and conduct problems. This relationship…

Multi-Level Family Factors and Affective and Behavioral Symptoms of Oppositional Defiant Disorder in Chinese Children

PubMed Central

Tang, Yixin; Lin, Xiuyun; Chi, Peilian; Zhou, Qing; Hou, Xiangning

2017-01-01

Given the important role of family environment in children's psychological development, the objective of this study was to examine the linkages between family factors at the whole, dyadic, and individual levels and two dimensions (affective and behavioral) of Oppositional Defiant Disorder (ODD) symptoms in Chinese children. Participants comprised of 80 father-child dyads and 169 mother-child dyads from families with ODD children. The results indicated that multilevel family factors were differently associated with children's affective and behavioral ODD symptoms. All the family factors at the dyadic and individual levels were significantly associated with child affective ODD symptoms. However, only the most proximal factors (parent-child relationship and child emotion regulation, which were directly related to child) were significantly related to child behavioral ODD symptoms. The present study extends the current knowledge regarding the relationships between family factors and two dimensions of child ODD symptoms by testing the comprehensive multilevel family factors model. This study also recommends that future interventions for ODD children should consider the multi-level family factors to enhance intervention efficacy. PMID:28713321

Risk Factors in the Development of Behaviour Difficulties among Students with Special Educational Needs and Disabilities: A Multilevel Analysis

ERIC Educational Resources Information Center

Oldfield, Jeremy; Humphrey, Neil; Hebron, Judith

2017-01-01

Background: Students with special educational needs and disabilities (SEND) are more likely to exhibit behaviour difficulties than their typically developing peers. Aim: The aim of this study was to identify specific risk factors that influence variability in behaviour difficulties among individuals with SEND. Sample: The study sample comprised…

The Effects of Community Factors on School Participation in Turkey: A Multilevel Analysis

ERIC Educational Resources Information Center

Gumus, Sedat

2014-01-01

Turkey, like many developing countries, is facing considerable problems in terms of low school attendance rates, late enrolment and early dropout of girls in particular. Numerous studies have already been conducted, both in Turkey and elsewhere, to determine the factors affecting school enrolment of boys and girls. Existing studies in Turkey,…

"Rebuilding our community": hearing silenced voices on Aboriginal youth suicide.

PubMed

Walls, Melissa L; Hautala, Dane; Hurley, Jenna

2014-02-01

This paper brings forth the voices of adult Aboriginal First Nations community members who gathered in focus groups to discuss the problem of youth suicide on their reserves. Our approach emphasizes multilevel (e.g., individual, family, and broader ecological systems) factors viewed by participants as relevant to youth suicide. Wheaton's conceptualization of stressors and Evans-Campbell's multilevel classification of the impacts of historical trauma are used as theoretical and analytic guides. Thematic analysis of qualitative data transcripts revealed a highly complex intersection of stressors, traumas, and social problems seen by community members as underlying mechanisms influencing heightened levels of Aboriginal youth suicidality. Our multilevel coding approach revealed that suicidal behaviors were described by community members largely as a problem with deep historical and contemporary structural roots, as opposed to being viewed as individualized pathology.

The importance of contextual, relational and cognitive factors for novice nurses' emotional state and affective commitment to the profession. A multilevel study.

PubMed

Hoeve, Yvonne Ten; Brouwer, Jasperina; Roodbol, Petrie F; Kunnen, Saskia

2018-05-13

This study explored the effects of contextual, relational and cognitive factors derived from novice nurses' work experiences on emotions and affective commitment to the profession. With an increasing demand for well-trained nurses, it is imperative to investigate which work-related factors most affect their commitment to develop effective strategies to improve work conditions, work satisfaction and emotional attachment. A repeated-measures within subjects design. From September 2013 - September 2014 eighteen novice nurses described work-related experiences in unstructured diaries and scored their emotional state and affective commitment on a scale. The themes that emerged from the 18 diaries (with 580 diary entries) were quantified as contextual, relational and cognitive factors. Contextual factors refer to complexity of care and existential events; relational factors to experiences with patients, support from colleagues, supervisors and physicians; cognitive factors to nurses' perceived competence. The first multilevel regression analysis, based on the 18 diaries with 580 entries, showed that complexity of care, lack of support and lack of competence were negatively related to novice nurses' affective commitment, whereas received support was positively related. The next multilevel regression analyses showed that all contextual, relational and cognitive factors were either related to negative or positive emotions. To retain novice nurses in the profession, it is important to provide support and feedback. This enables novice nurses to deal with the complexity of care and feelings of incompetence and to develop a professional commitment. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Longitudinal analysis of the strengths and difficulties questionnaire scores of the Millennium Cohort Study children in England using M-quantile random-effects regression.

PubMed

Tzavidis, Nikos; Salvati, Nicola; Schmid, Timo; Flouri, Eirini; Midouhas, Emily

2016-02-01

Multilevel modelling is a popular approach for longitudinal data analysis. Statistical models conventionally target a parameter at the centre of a distribution. However, when the distribution of the data is asymmetric, modelling other location parameters, e.g. percentiles, may be more informative. We present a new approach, M -quantile random-effects regression, for modelling multilevel data. The proposed method is used for modelling location parameters of the distribution of the strengths and difficulties questionnaire scores of children in England who participate in the Millennium Cohort Study. Quantile mixed models are also considered. The analyses offer insights to child psychologists about the differential effects of risk factors on children's outcomes.

Multilevel Analysis of Neighborhood Characteristics and Prostate Cancer

DTIC Science & Technology

2012-09-01

widely by a number of key factors that may influence one’s well-being, stress level, lifestyle , and ultimately, disease susceptibility. These factors...outcomes, our work is helping to identify many neighborhood affects on prostate cancer, which include SES and lifestyle factors. The mechanisms of...Charnita Zeigler-Johnson 5d. PROJECT NUMBER 5e. TASK NUMBER E-Mail: czj@mail.med.upenn.edu 5f. WORK UNIT NUMBER 7. PERFORMING

A Multilevel Analysis of the Impact of a Professional Learning Community, Faculty Trust in Colleagues and Collective Efficacy on Teacher Commitment to Students

ERIC Educational Resources Information Center

Lee, John Chi-kin; Zhang, Zhonghua; Yin, Hongbiao

2011-01-01

This study investigated the relationships between a professional learning community (PLC), faculty trust in colleagues, teachers' collective efficacy, and their commitment to students. The findings from exploratory factor analysis indicated that three clear components could be extracted from the scale of Professional Learning Communities…

Exploring Differential Science Performance in Korea and South Africa: A Multilevel Analysis

ERIC Educational Resources Information Center

Cho, Mee-Ok; Scherman, Vanessa; Gaigher, Estelle

2014-01-01

This paper reports on secondary analysis of TIMSS 2003 data with the aim of explaining the difference in science achievement of Korean and South African learners. The question asked by this research, i.e. which factors at various educational levels influence science achievement in Korea and South Africa respectively, is addressed from the…

Municipal unemployment and municipal typologies as predictors of disability pensioning in Norway: a multilevel analysis.

PubMed

Reime, Leif Jostein; Claussen, Bjørgulf

2013-03-01

The rise in the number of disability pensioners in Norway has been given much attention by the government and by researchers due to the resulting financial and societal challenges entailed. Eligibility for a disability pension is decided by The Norwegian Labour and Welfare Administration (NAV), and is closely correlated with several socioeconomic predictors. Geographical differences have also been observed in the allocations to recipients of disability pensions, and the purpose of this study was to investigate whether municipal unemployment rates and municipal typologies in Norway may explain some of the geographical variance in individual disability pensioning. 436 municipalities in Norway and all 1,507,192 Norwegian males and females between the ages of 30-55 years in 1997 were included in the analysis. Multilevel random intercept analysis was performed to assess the influence on disability pensioning of the individual factors age, education and income together with the contextual factors municipal unemployment, centrality, industry affiliation and residential density. Individuals in high unemployment municipalities had a 7-17% higher risk of disability pension. Of the total variability in disability pensioning, 2.5% for males and 1.9% for females was between municipalities. The other municipal factors had only small influences. In addition to individual socioeconomic factors, contextual factors seem to be important determinants of disability pension rates. Municipal unemployment had the greatest influence.

Multilevel structural equation models for assessing moderation within and across levels of analysis.

PubMed

Preacher, Kristopher J; Zhang, Zhen; Zyphur, Michael J

2016-06-01

Social scientists are increasingly interested in multilevel hypotheses, data, and statistical models as well as moderation or interactions among predictors. The result is a focus on hypotheses and tests of multilevel moderation within and across levels of analysis. Unfortunately, existing approaches to multilevel moderation have a variety of shortcomings, including conflated effects across levels of analysis and bias due to using observed cluster averages instead of latent variables (i.e., "random intercepts") to represent higher-level constructs. To overcome these problems and elucidate the nature of multilevel moderation effects, we introduce a multilevel structural equation modeling (MSEM) logic that clarifies the nature of the problems with existing practices and remedies them with latent variable interactions. This remedy uses random coefficients and/or latent moderated structural equations (LMS) for unbiased tests of multilevel moderation. We describe our approach and provide an example using the publicly available High School and Beyond data with Mplus syntax in Appendix. Our MSEM method eliminates problems of conflated multilevel effects and reduces bias in parameter estimates while offering a coherent framework for conceptualizing and testing multilevel moderation effects. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

The influence of regional deprivation index on personal happiness using multilevel analysis

PubMed Central

Kim, Kil Hun; Chun, Jin-Ho; Sohn, Hae Sook

2015-01-01

OBJECTIVES: The objective of the present study was to identify the factors that influence the happiness index of community residents, by considering personal and regional aspects, and to use as evidence of efforts for improvement of the happiness index. METHODS: The study was conducted based on information from 16,270 participants who met the data requirement among those who participated in the 2011 South Gyeongsang Community Health Survey. Of the factors that can influence the happiness index, socioeconomic characteristics, health behavior, morbidity, and healthcare use, social contact, and participation in social activities were classified as personal factors; for regional factors, data from the 2010 census were used to extrapolate the regional deprivation indices at the submunicipal-level (eup, myeon, and dong) in South Gyeongsang Province. The happiness index for each characteristic was compared to that for others via t-test and ANOVA, and multilevel analysis was performed, using four models: a basic model for identification of only random effects, model 1 for identification of personal factors, model 2 for identification of regional factors, and model 3 for simultaneous consideration of both personal and regional factors. RESULTS: The mean happiness index was 63.2 points (64.6 points in males and 62.0 points in females), while the mean deprivation index was -1.58 points. In the multilevel analysis, the regional-level variance ratio of the basic model was 10.8%, confirming interregional differences. At the personal level, higher happiness indices were seen in groups consisting of males with high educational level, high income, high degree of physical activity, sufficient sleep, active social contact, and participation in social activities; whereas lower happiness indices were seen in people who frequently skipped breakfast, had unmet healthcare needs, and had accompanying diseases, as well as those with higher deprivation index. CONCLUSIONS: The study confirmed that the happiness index of community residents was influenced by not only personal aspects but also various regional characteristics. To increase the happiness index, interests at both personal and regional levels, as well as community emphasis on creating social rapport and engaging in selective efforts, are needed in vulnerable regions with relatively high deprivation index. PMID:26725223

The influence of regional deprivation index on personal happiness using multilevel analysis.

PubMed

Kim, Kil Hun; Chun, Jin-Ho; Sohn, Hae Sook

2015-01-01

The objective of the present study was to identify the factors that influence the happiness index of community residents, by considering personal and regional aspects, and to use as evidence of efforts for improvement of the happiness index. The study was conducted based on information from 16,270 participants who met the data requirement among those who participated in the 2011 South Gyeongsang Community Health Survey. Of the factors that can influence the happiness index, socioeconomic characteristics, health behavior, morbidity, and healthcare use, social contact, and participation in social activities were classified as personal factors; for regional factors, data from the 2010 census were used to extrapolate the regional deprivation indices at the submunicipal-level (eup, myeon, and dong) in South Gyeongsang Province. The happiness index for each characteristic was compared to that for others via t-test and ANOVA, and multilevel analysis was performed, using four models: a basic model for identification of only random effects, model 1 for identification of personal factors, model 2 for identification of regional factors, and model 3 for simultaneous consideration of both personal and regional factors. The mean happiness index was 63.2 points (64.6 points in males and 62.0 points in females), while the mean deprivation index was -1.58 points. In the multilevel analysis, the regional-level variance ratio of the basic model was 10.8%, confirming interregional differences. At the personal level, higher happiness indices were seen in groups consisting of males with high educational level, high income, high degree of physical activity, sufficient sleep, active social contact, and participation in social activities; whereas lower happiness indices were seen in people who frequently skipped breakfast, had unmet healthcare needs, and had accompanying diseases, as well as those with higher deprivation index. The study confirmed that the happiness index of community residents was influenced by not only personal aspects but also various regional characteristics. To increase the happiness index, interests at both personal and regional levels, as well as community emphasis on creating social rapport and engaging in selective efforts, are needed in vulnerable regions with relatively high deprivation index.

Review of family relational stress and pediatric asthma: the value of biopsychosocial systemic models.

PubMed

Wood, Beatrice L; Miller, Bruce D; Lehman, Heather K

2015-06-01

Asthma is the most common chronic disease in children. Despite dramatic advances in pharmacological treatments, asthma remains a leading public health problem, especially in socially disadvantaged minority populations. Some experts believe that this health gap is due to the failure to address the impact of stress on the disease. Asthma is a complex disease that is influenced by multilevel factors, but the nature of these factors and their interrelations are not well understood. This paper aims to integrate social, psychological, and biological literatures on relations between family/parental stress and pediatric asthma, and to illustrate the utility of multilevel systemic models for guiding treatment and stimulating future research. We used electronic database searches and conducted an integrated analysis of selected epidemiological, longitudinal, and empirical studies. Evidence is substantial for the effects of family/parental stress on asthma mediated by both disease management and psychobiological stress pathways. However, integrative models containing specific pathways are scarce. We present two multilevel models, with supporting data, as potential prototypes for other such models. We conclude that these multilevel systems models may be of substantial heuristic value in organizing investigations of, and clinical approaches to, the complex social-biological aspects of family stress in pediatric asthma. However, additional systemic models are needed, and the models presented herein could serve as prototypes for model development. © 2015 Family Process Institute.

Multilevel Exploration of Factors Contributing to the Overrepresentation of Black Students in Office Disciplinary Referrals

ERIC Educational Resources Information Center

Bradshaw, Catherine P.; Mitchell, Mary M.; O'Brennan, Lindsey M.; Leaf, Philip J.

2010-01-01

Although there is increasing awareness of the overrepresentation of ethic minority students--particularly Black students--in disciplinary actions, the extant research has rarely empirically examined potential factors that may contribute to these disparities. The current study used a multilevel modeling approach to examine factors at the child…

Repeated measures from FIA data facilitates analysis across spatial scales of tree growth responses to nitrogen deposition from individual trees to whole ecoregions

Treesearch

Charles H. (Hobie) Perry; Kevin J. Horn; R. Quinn Thomas; Linda H. Pardo; Erica A.H. Smithwick; Doug Baldwin; Gregory B. Lawrence; Scott W. Bailey; Sabine Braun; Christopher M. Clark; Mark Fenn; Annika Nordin; Jennifer N. Phelan; Paul G. Schaberg; Sam St. Clair; Richard Warby; Shaun Watmough; Steven S. Perakis

2015-01-01

The abundance of temporally and spatially consistent Forest Inventory and Analysis data facilitates hierarchical/multilevel analysis to investigate factors affecting tree growth, scaling from plot-level to continental scales. Herein we use FIA tree and soil inventories in conjunction with various spatial climate and soils data to estimate species-specific responses of...

Associations between macrolevel economic factors and weight distributions in low- and middle-income countries: a multilevel analysis of 200,000 adults in 40 countries.

PubMed

Nandi, Arijit; Sweet, Elizabeth; Kawachi, Ichiro; Heymann, Jody; Galea, Sandro

2014-02-01

We examined associations between macrolevel economic factors hypothesized to drive changes in distributions of weight and body mass index (BMI) in a representative sample of 200,796 men and women from 40 low- and middle-income countries. We used meta-regressions to describe ecological associations between macrolevel factors and mean BMIs across countries. Multilevel regression was used to assess the relation between macrolevel economic characteristics and individual odds of underweight and overweight relative to normal weight. In multilevel analyses adjusting for individual-level characteristics, a 1-standard-deviation increase in trade liberalization was associated with 13% (95% confidence interval [CI] = 0.76, 0.99), 17% (95% CI = 0.71, 0.96), 13% (95% CI = 0.76, 1.00), and 14% (95% CI = 0.75, 0.99) lower odds of underweight relative to normal weight among rural men, rural women, urban men, and urban women, respectively. Economic development was consistently associated with higher odds of overweight relative to normal weight. Among rural men, a 1-standard-deviation increase in foreign direct investment was associated with 17% (95% CI = 1.02, 1.35) higher odds of overweight relative to normal weight. Macrolevel economic factors may be implicated in global shifts in epidemiological patterns of weight.

Associations Between Macrolevel Economic Factors and Weight Distributions in Low- and Middle-Income Countries: A Multilevel Analysis of 200 000 Adults in 40 Countries

PubMed Central

Sweet, Elizabeth; Kawachi, Ichiro; Heymann, Jody; Galea, Sandro

2014-01-01

Objectives. We examined associations between macrolevel economic factors hypothesized to drive changes in distributions of weight and body mass index (BMI) in a representative sample of 200 796 men and women from 40 low- and middle-income countries. Methods. We used meta-regressions to describe ecological associations between macrolevel factors and mean BMIs across countries. Multilevel regression was used to assess the relation between macrolevel economic characteristics and individual odds of underweight and overweight relative to normal weight. Results. In multilevel analyses adjusting for individual-level characteristics, a 1–standard-deviation increase in trade liberalization was associated with 13% (95% confidence interval [CI] = 0.76, 0.99), 17% (95% CI = 0.71, 0.96), 13% (95% CI = 0.76, 1.00), and 14% (95% CI = 0.75, 0.99) lower odds of underweight relative to normal weight among rural men, rural women, urban men, and urban women, respectively. Economic development was consistently associated with higher odds of overweight relative to normal weight. Among rural men, a 1–standard-deviation increase in foreign direct investment was associated with 17% (95% CI = 1.02, 1.35) higher odds of overweight relative to normal weight. Conclusions. Macrolevel economic factors may be implicated in global shifts in epidemiological patterns of weight. PMID:24228649

Two-bit multi-level phase change random access memory with a triple phase change material stack structure

NASA Astrophysics Data System (ADS)

Gyanathan, Ashvini; Yeo, Yee-Chia

2012-11-01

This work demonstrates a novel two-bit multi-level device structure comprising three phase change material (PCM) layers, separated by SiN thermal barrier layers. This triple PCM stack consisted of (from bottom to top), Ge2Sb2Te5 (GST), an ultrathin SiN barrier, nitrogen-doped GST, another ultrathin SiN barrier, and Ag0.5In0.5Sb3Te6. The PCM layers can selectively amorphize to form 4 different resistance levels ("00," "01," "10," and "11") using respective voltage pulses. Electrical characterization was extensively performed on these devices. Thermal analysis was also done to understand the physics behind the phase changing characteristics of the two-bit memory devices. The melting and crystallization temperatures of the PCMs play important roles in the power consumption of the multi-level devices. The electrical resistivities and thermal conductivities of the PCMs and the SiN thermal barrier are also crucial factors contributing to the phase changing behaviour of the PCMs in the two-bit multi-level PCRAM device.

Associations between state minimum wage policy and health care access: a multi-level analysis of the 2004 Behavioral Risk Factor survey.

PubMed

McCarrier, Kelly P; Martin, Diane P; Ralston, James D; Zimmerman, Frederick J

2010-05-01

Minimum wage policies have been advanced as mechanisms to improve the economic conditions of the working poor. Both positive and negative effects of such policies on health care access have been hypothesized, but associations have yet to be thoroughly tested. To examine whether the presence of minimum wage policies in excess of the federal standard of $5.15 per hour was associated with health care access indicators among low-skilled adults of working age, a cross-sectional analysis of 2004 Behavioral Risk Factor Surveillance System data was conducted. Self-reported health insurance status and experience with cost-related barriers to needed medical care were adjusted in multi-level logistic regression models to control for potential confounding at the state, county, and individual levels. State-level wage policy was not found to be associated with insurance status or unmet medical need in the models, providing early evidence that increased minimum wage rates may neither strengthen nor weaken access to care as previously predicted.

Grounding a new information technology implementation framework in behavioral science: a systematic analysis of the literature on IT use.

PubMed

Kukafka, Rita; Johnson, Stephen B; Linfante, Allison; Allegrante, John P

2003-06-01

Many interventions to improve the success of information technology (IT) implementations are grounded in behavioral science, using theories, and models to identify conditions and determinants of successful use. However, each model in the IT literature has evolved to address specific theoretical problems of particular disciplinary concerns, and each model has been tested and has evolved using, in most cases, a more or less restricted set of IT implementation procedures. Functionally, this limits the perspective for taking into account the multiple factors at the individual, group, and organizational levels that influence use behavior. While a rich body of literature has emerged, employing prominent models such as the Technology Adoption Model, Social-Cognitive Theory, and Diffusion of Innovation Theory, the complexity of defining a suitable multi-level intervention has largely been overlooked. A gap exists between the implementation of IT and the integration of theories and models that can be utilized to develop multi-level approaches to identify factors that impede usage behavior. We present a novel framework that is intended to guide synthesis of more than one theoretical perspective for the purpose of planning multi-level interventions to enhance IT use. This integrative framework is adapted from PRECEDE/PROCEDE, a conceptual framework used by health planners in hundreds of published studies to direct interventions that account for the multiple determinants of behavior. Since we claim that the literature on IT use behavior does not now include a multi-level approach, we undertook a systematic literature analysis to confirm this assertion. Our framework facilitated organizing this literature synthesis and our analysis was aimed at determining if the IT implementation approaches in the published literature were characterized by an approach that considered at least two levels of IT usage determinants. We found that while 61% of studies mentioned or referred to theory, none considered two or more levels. In other words, although the researchers employ behavioral theory, they omit two fundamental propositions: (1) IT usage is influenced by multiple factors and (2) interventions must be multi-dimensional. Our literature synthesis may provide additional insight into the reason for high failure rates associated with underutilized systems, and underscores the need to move beyond the current dominant approach that employs a single model to guide IT implementation plans that aim to address factors associated with IT acceptance and subsequent positive use behavior.

Individual and contextual factors associated to the self-perception of oral health in Brazilian adults.

PubMed

Silva, Janmille Valdivino da; Oliveira, Angelo Giuseppe Roncalli da Costa

2018-04-09

To analyze how individual characteristics and the social context, together, are associated with self-perception of the oral health. A multilevel cross-sectional study with data from the Brazilian National Health Survey 2013, the United Nations Development Program, and the National Registry of Health Establishments. The explanatory variables for the "oral health perception" outcome were grouped, according to the study framework, into biological characteristics (sex, color, age), proximal social determinants (literacy, household crowding, and socioeconomic stratification), and distal (years of schooling expectancy at age 18, GINI, Human Development Index, and per capita income). The described analysis was performed, along with bivariate Poisson analysis and multilevel Poisson analysis for the construction of the explanatory model of oral health perception. All analyzes considered the sample weights. Both the biological characteristics and the proximal and distal social determinants were associated with the perception of oral health in the bivariate analysis. A higher prevalence of bad oral health was associated to lower years of schooling expectancy (PR = 1.31), lower per capita income (PR = 1.45), higher income concentration (PR = 1.41), and worse human development (PR = 1.45). Inversely, oral health services in both primary and secondary care were negatively associated with oral health perception. All the biological and individual social characteristics, except reading and writing, made up the final explanatory model along with the distal social determinants of the Human Development Index and coverage of basic care in the multilevel analysis. Biological factors, individual and contextual social determinants were associate synergistically with the population's perception of oral health. It is necessary to improve individual living conditions and the implementation of public social policies to improve the oral health of the population.

Social cohesion matters in health.

PubMed

Chuang, Ying-Chih; Chuang, Kun-Yang; Yang, Tzu-Hsuan

2013-10-28

The concept of social cohesion has invoked debate due to the vagueness of its definition and the limitations of current measurements. This paper attempts to examine the concept of social cohesion, develop measurements, and investigate the relationship between social cohesion and individual health. This study used a multilevel study design. The individual-level samples from 29 high-income countries were obtained from the 2000 World Value Survey (WVS) and the 2002 European Value Survey. National-level social cohesion statistics were obtained from Organization of Economic Cooperation and Development datasets, World Development Indicators, and Asian Development Bank key indicators for the year 2000, and from aggregating responses from the WVS. In total 47,923 individuals were included in this study. The factor analysis was applied to identify dimensions of social cohesion, which were used as entities in the cluster analysis to generate a regime typology of social cohesion. Then, multilevel regression models were applied to assess the influences of social cohesion on an individual's self-rated health. Factor analysis identified five dimensions of social cohesion: social equality, social inclusion, social development, social capital, and social diversity. Then, the cluster analysis revealed five regimes of social cohesion. A multi-level analysis showed that respondents in countries with higher social inclusion, social capital, and social diversity were more likely to report good health above and beyond individual-level characteristics. This study is an innovative effort to incorporate different aspects of social cohesion. This study suggests that social cohesion was associated with individual self-rated after controlling individual characteristics. To achieve further advancement in population health, developed countries should consider policies that would foster a society with a high level of social inclusion, social capital, and social diversity. Future research could focus on identifying possible pathways by which social cohesion influences various health outcomes.

“Rebuilding our community”: Hearing silenced voices on Aboriginal youth suicide

PubMed Central

Walls, Melissa L.; Hautala, Dane; Hurley, Jenna

2014-01-01

This paper brings forth the voices of adult Aboriginal First Nations community members who gathered in focus groups to discuss the problem of youth suicide on their reserves. Our approach emphasizes multilevel (e.g., individual, family, and broader ecological systems) factors viewed by participants as relevant to youth suicide. Wheaton’s conceptualization of stressors (1994; 1999) and Evans-Campbell’s (2008) multilevel classification of the impacts of historical trauma are used as theoretical and analytic guides. Thematic analysis of qualitative data transcripts revealed a highly complex intersection of stressors, traumas, and social problems seen by community members as underlying mechanisms influencing heightened levels of Aboriginal youth suicidality. Our multilevel coding approach revealed that suicidal behaviors were described by community members largely as a problem with deep historical and contemporary structural roots as opposed to being viewed as individualized pathology. PMID:24097414

Quantitative analysis of organizational culture in occupational health research: a theory-based validation in 30 workplaces of the organizational culture profile instrument.

PubMed

Marchand, Alain; Haines, Victor Y; Dextras-Gauthier, Julie

2013-05-04

This study advances a measurement approach for the study of organizational culture in population-based occupational health research, and tests how different organizational culture types are associated with psychological distress, depression, emotional exhaustion, and well-being. Data were collected over a sample of 1,164 employees nested in 30 workplaces. Employees completed the 26-item OCP instrument. Psychological distress was measured with the General Health Questionnaire (12-item); depression with the Beck Depression Inventory (21-item); and emotional exhaustion with five items from the Maslach Burnout Inventory general survey. Exploratory factor analysis evaluated the dimensionality of the OCP scale. Multilevel regression models estimated workplace-level variations, and the contribution of organizational culture factors to mental health and well-being after controlling for gender, age, and living with a partner. Exploratory factor analysis of OCP items revealed four factors explaining about 75% of the variance, and supported the structure of the Competing Values Framework. Factors were labeled Group, Hierarchical, Rational and Developmental. Cronbach's alphas were high (0.82-0.89). Multilevel regression analysis suggested that the four culture types varied significantly between workplaces, and correlated with mental health and well-being outcomes. The Group culture type best distinguished between workplaces and had the strongest associations with the outcomes. This study provides strong support for the use of the OCP scale for measuring organizational culture in population-based occupational health research in a way that is consistent with the Competing Values Framework. The Group organizational culture needs to be considered as a relevant factor in occupational health studies.

Multi-level obstruction in obstructive sleep apnoea: prevalence, severity and predictive factors.

PubMed

Phua, C Q; Yeo, W X; Su, C; Mok, P K H

2017-11-01

To characterise multi-level obstruction in terms of prevalence, obstructive sleep apnoea severity and predictive factors, and to collect epidemiological data on upper airway morphology in obstructive sleep apnoea patients. Retrospective review of 250 obstructive sleep apnoea patients. On clinical examination, 171 patients (68.4 per cent) had multi-level obstruction, 49 (19.6 per cent) had single-level obstruction and 30 (12 per cent) showed no obstruction. Within each category of obstructive sleep apnoea severity, multi-level obstruction was more prevalent. Multi-level obstruction was associated with severe obstructive sleep apnoea (more than 30 events per hour) (p = 0.001). Obstructive sleep apnoea severity increased with the number of obstruction sites (correlation coefficient = 0.303, p < 0.001). Multi-level obstruction was more likely in younger (p = 0.042), male (p = 0.045) patients, with high body mass index (more than 30 kg/m2) (p < 0.001). Palatal (p = 0.004), tongue (p = 0.026) and lateral pharyngeal wall obstructions (p = 0.006) were associated with severe obstructive sleep apnoea. Multi-level obstruction is more prevalent in obstructive sleep apnoea and is associated with increased severity. Obstruction at certain anatomical levels contributes more towards obstructive sleep apnoea severity.

School staff perpetration of physical violence against students in Uganda: a multilevel analysis of risk factors

PubMed Central

Merrill, Katherine G; Knight, Louise; Glynn, Judith R; Allen, Elizabeth; Naker, Dipak; Devries, Karen M

2017-01-01

Objective To conduct a multilevel analysis of risk factors for physical violence perpetration by school staff against Ugandan students. Design Multilevel logistic regression analysis of cross-sectional survey data from 499 staff and 828 caregivers of students at 38 primary schools, collected in 2012 and 2014 during the Good Schools Study. Setting Luwero District, Uganda. Main outcome measure Past-week use of physical violence by school staff against students was measured using the International Society for the Prevention of Child Abuse and Neglect ‘Child Abuse Screening Tool- Child International’ and the WHO Multi-Country Study on Women’s Health and Domestic Violence against Women. Results Of 499 staff, 215 (43%) reported perpetration of physical violence against students in the past week. Individual risk factors associated with physical violence perpetration included being a teacher versus another type of staff member (p<0.001), approving of physical discipline practices (p<0.001), having children (p<0.01), being age 30–39 years (p<0.05), using physical violence against non-students (p<0.05) and being a victim of intimate partner violence (IPV) (p<0.05). We observed weak evidence (p=0.06) that male staff members who had been a victim of IPV showed higher odds of violence perpetration compared with male staff who had not been a victim of IPV. No evidence was observed for school- or community-level risk factors. Conclusions Physical violence perpetration from school staff is widespread, and interventions are needed to address this issue. Staff who have been victims of violence and who use violence against people other than students may benefit from additional interventions. Researchers should further investigate how school and community contexts influence staff’s physical violence usage, given a lack of associations observed in this study. PMID:28821514

School staff perpetration of physical violence against students in Uganda: a multilevel analysis of risk factors.

PubMed

Merrill, Katherine G; Knight, Louise; Glynn, Judith R; Allen, Elizabeth; Naker, Dipak; Devries, Karen M

2017-08-18

To conduct a multilevel analysis of risk factors for physical violence perpetration by school staff against Ugandan students. Multilevel logistic regression analysis of cross-sectional survey data from 499 staff and 828 caregivers of students at 38 primary schools, collected in 2012 and 2014 during the Good Schools Study. Luwero District, Uganda. Past-week use of physical violence by school staff against students was measured using the International Society for the Prevention of Child Abuse and Neglect 'Child Abuse Screening Tool- Child International' and the WHO Multi-Country Study on Women's Health and Domestic Violence against Women. Of 499 staff, 215 (43%) reported perpetration of physical violence against students in the past week. Individual risk factors associated with physical violence perpetration included being a teacher versus another type of staff member (p<0.001), approving of physical discipline practices (p<0.001), having children (p<0.01), being age 30-39 years (p<0.05), using physical violence against non-students (p<0.05) and being a victim of intimate partner violence (IPV) (p<0.05). We observed weak evidence (p=0.06) that male staff members who had been a victim of IPV showed higher odds of violence perpetration compared with male staff who had not been a victim of IPV. No evidence was observed for school- or community-level risk factors. Physical violence perpetration from school staff is widespread, and interventions are needed to address this issue. Staff who have been victims of violence and who use violence against people other than students may benefit from additional interventions. Researchers should further investigate how school and community contexts influence staff's physical violence usage, given a lack of associations observed in this study. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Factors behind the success story of under-five stunting in Peru: a district ecological multilevel analysis.

PubMed

Huicho, Luis; Huayanay-Espinoza, Carlos A; Herrera-Perez, Eder; Segura, Eddy R; Niño de Guzman, Jessica; Rivera-Ch, María; Barros, Aluisio J D

2017-01-19

Stunting prevalence in children less than 5 years has remained stagnated in Peru from 1992 to 2007, with a rapid reduction thereafter. We aimed to assess the role of different predictors on stunting reduction over time and across departments, from 2000 to 2012. We used various secondary data sources to describe time trends of stunting and of possible predictors that included distal to proximal determinants. We determined a ranking of departments by annual change of stunting and of different predictors. To account for variation over time and across departments, we used an ecological hierarchical approach based on a multilevel mixed-effects regression model, considering stunting as the outcome. Our unit of analysis was one department-year. Stunting followed a decreasing trend in all departments, with differing slopes. The reduction pace was higher from 2007-2008 onwards. The departments with the highest annual stunting reduction were Cusco (-2.31%), Amazonas (-1.57%), Puno (-1.54%), Huanuco (-1.52%), and Ancash (-1.44). Those with the lowest reduction were Ica (-0.67%), Ucayali (-0.64%), Tumbes (-0.45%), Lima (-0.37%), and Tacna (-0.31%). Amazon and Andean departments, with the highest baseline poverty rates and concentrating the highest rural populations, showed the highest stunting reduction. In the multilevel analysis, when accounting for confounding, social determinants seemed to be the most important factors influencing annual stunting reduction, with significant variation between departments. Stunting reduction may be explained by the adoption of anti-poverty policies and sustained implementation of equitable crosscutting interventions, with focus on poorest areas. Inclusion of quality indicators for reproductive, maternal, neonatal and child health interventions may enable further analyses to show the influence of these factors. After a long stagnation period, Peru reduced dramatically its national and departmental stunting prevalence, thanks to a combination of social determinants and crosscutting factors. This experience offers useful lessons to other countries trying to improve their children's nutrition.

Hospital organizational factors influence work-family conflict in registered nurses: Multilevel modeling of a nation-wide cross-sectional survey in Sweden.

PubMed

Leineweber, C; Chungkham, H S; Westerlund, H; Tishelman, C; Lindqvist, R

2014-05-01

The present shortage of registered nurses (RNs) in many European countries is expected to continue and worsen, which poses a substantial threat to the maintenance of healthcare in this region. Work-family conflict is a known risk factor for turnover and sickness absence. This paper empirically examines whether the nurse practice environment is associated with experienced work-family conflict. A multilevel model was fit with the individual RN at the 1st, and the hospital department at the 2nd level using cross-sectional RN survey data from the Swedish part of RN4CAST, an EU 7th framework project. The data analyzed here is based on a national sample of 8356 female and 592 male RNs from 369 hospital departments. We found that 6% of the variability in work-family conflict experienced by RNs was at the department level. Organizational level factors significantly accounted for most of the variability at this level with two of the work practice environment factors examined, staffing adequacy and nurse involvement in hospital affairs, significantly related to work-family conflict. Due to the design of the study, factors on ward and work group levels could not be analyzed, but are likely to account for additional variance which in the present analysis appears to be on the individual level, with private life factors likely explaining another major part. These results suggest that higher level organizational factors in health care have a significant impact on the risk of work-family conflict among RNs through their impact on the nurse practice environment. Lower level organizational factors should be investigated in future studies using hierarchical multilevel sampling. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Contextual determinants of neonatal mortality using two analysis methods, Rio Grande do Sul, Brazil.

PubMed

Zanini, Roselaine Ruviaro; Moraes, Anaelena Bragança de; Giugliani, Elsa Regina Justo; Riboldi, João

2011-02-01

To analyze neonatal mortality determinants using multilevel logistic regression and classic hierarchical models. Cohort study including 138,407 live births with birth certificates and 1,134 neonatal deaths recorded in 2003, in the state of Rio Grande do Sul, Southern Brazil. The Information System on Live Births and mortality records were linked for gathering information on individual-level exposures. Sociodemographic data and information on the pregnancy, childbirth care and characteristics of the children at birth were collected. The associated factors were estimated and compared by traditional and multilevel logistic regression analysis. The neonatal mortality rate was 8.19 deaths per 1,000 live births. Low birth weight, 1- and 5-minute Apgar score below eight, congenital malformation, pre-term birth and previous fetal loss were associated with neonatal death in the traditional model. Elective cesarean section had a protective effect. Previous fetal loss did not remain significant in the multilevel model, but the inclusion of a contextual variable (poverty rate) showed that 15% of neonatal mortality variation can be explained by varying poverty rates in the microregions. The use of multilevel models showed a small effect of contextual determinants on the neonatal mortality rate. There was found a positive association with the poverty rate in the general model, and the proportion of households with water supply among preterm newborns.

The effects of community factors on school participation in Turkey: A multilevel analysis

NASA Astrophysics Data System (ADS)

Gumus, Sedat

2014-05-01

Turkey, like many developing countries, is facing considerable problems in terms of low school attendance rates, late enrolment and early dropout of girls in particular. Numerous studies have already been conducted, both in Turkey and elsewhere, to determine the factors affecting school enrolment of boys and girls. Existing studies in Turkey, however, have focused extensively on the association between household-level factors and school participation, ignoring the role of the broader environment in which children live. Using a recent, large-scale and nationally representative data set, this paper investigates school participation at both primary and secondary levels in Turkey, giving specific attention to community- level factors. In taking into account socioeconomic context variables using the multilevel modelling method, this study contributes significantly to current school participation literature in Turkey. The author's findings highlight the importance of community/context factors in explaining low school enrolment in Turkey. The results of the study can help policy makers develop a systematic understanding of the relationship between socioeconomic context and school participation, and enable them to make more appropriate decisions for improving school participation across the country.

Bridging the gap between biologic, individual, and macroenvironmental factors in cancer: a multilevel approach.

PubMed

Lynch, Shannon M; Rebbeck, Timothy R

2013-04-01

To address the complex nature of cancer occurrence and outcomes, approaches have been developed to simultaneously assess the role of two or more etiologic agents within hierarchical levels including the: (i) macroenvironment level (e.g., health care policy, neighborhood, or family structure); (ii) individual level (e.g., behaviors, carcinogenic exposures, socioeconomic factors, and psychologic responses); and (iii) biologic level (e.g., cellular biomarkers and inherited susceptibility variants). Prior multilevel approaches tend to focus on social and environmental hypotheses, and are thus limited in their ability to integrate biologic factors into a multilevel framework. This limited integration may be related to the limited translation of research findings into the clinic. We propose a "Multi-level Biologic and Social Integrative Construct" (MBASIC) to integrate macroenvironment and individual factors with biology. The goal of this framework is to help researchers identify relationships among factors that may be involved in the multifactorial, complex nature of cancer etiology, to aid in appropriate study design, to guide the development of statistical or mechanistic models to study these relationships, and to position the results of these studies for improved intervention, translation, and implementation. MBASIC allows researchers from diverse fields to develop hypotheses of interest under a common conceptual framework, to guide transdisciplinary collaborations, and to optimize the value of multilevel studies for clinical and public health activities.

Individual and couple-level risk factors for hepatitis C infection among heterosexual drug users: a multilevel dyadic analysis.

PubMed

McMahon, James M; Pouget, Enrique R; Tortu, Stephanie

2007-06-01

Hepatitis C virus (HCV) is the most common bloodborne pathogen in the United States and is a leading cause of liver-related morbidity and mortality. Although it is known that HCV is most commonly transmitted among injection drug users, the role of sexual transmission in the spread of HCV remains controversial because of inconsistent findings across studies involving heterosexual couples. A novel multilevel modeling technique designed to overcome the limitations of previous research was performed to assess multiple risk factors for HCV while partitioning the source of risk at the individual and couple level. The analysis was performed on risk exposure and HCV screening data obtained from 265 drug-using couples in East Harlem, New York City. In multivariable analysis, significant individual risk factors for HCV included a history of injection drug use, tattooing, and older age. At the couple level, HCV infection tended to cluster within couples, and this interdependence was accounted for by couples' drug-injection behavior. Individual and couple-level sexual behavior was not associated with HCV infection. Our results are consistent with prior research indicating that sexual contact plays little role in HCV transmission. Rather, couples' injection behavior appears to account for the clustering of HCV within heterosexual dyads.

Multilevel Motivation and Engagement: Assessing Construct Validity across Students and Schools

ERIC Educational Resources Information Center

Martin, Andrew J.; Malmberg, Lars-Erik; Liem, Gregory Arief D.

2010-01-01

Statistical biases associated with single-level analyses underscore the importance of partitioning variance/covariance matrices into individual and group levels. From a multilevel perspective based on data from 21,579 students in 58 high schools, the present study assesses the multilevel factor structure of motivation and engagement with a…

Student Perceptions of Classroom Achievement Goal Structure: Is It Appropriate to Aggregate?

ERIC Educational Resources Information Center

Lam, Arena C.; Ruzek, Erik A.; Schenke, Katerina; Conley, AnneMarie M.; Karabenick, Stuart A.

2015-01-01

Student reports are a common approach to characterizing how students experience their classrooms. We used a recently developed method--multilevel confirmatory factor analysis--to determine whether commonly employed measures of achievement goal structure constructs (mastery and performance) typically verified at the student level can be verified at…

A spatially filtered multilevel model to account for spatial dependency: application to self-rated health status in South Korea

PubMed Central

2014-01-01

Background This study aims to suggest an approach that integrates multilevel models and eigenvector spatial filtering methods and apply it to a case study of self-rated health status in South Korea. In many previous health-related studies, multilevel models and single-level spatial regression are used separately. However, the two methods should be used in conjunction because the objectives of both approaches are important in health-related analyses. The multilevel model enables the simultaneous analysis of both individual and neighborhood factors influencing health outcomes. However, the results of conventional multilevel models are potentially misleading when spatial dependency across neighborhoods exists. Spatial dependency in health-related data indicates that health outcomes in nearby neighborhoods are more similar to each other than those in distant neighborhoods. Spatial regression models can address this problem by modeling spatial dependency. This study explores the possibility of integrating a multilevel model and eigenvector spatial filtering, an advanced spatial regression for addressing spatial dependency in datasets. Methods In this spatially filtered multilevel model, eigenvectors function as additional explanatory variables accounting for unexplained spatial dependency within the neighborhood-level error. The specification addresses the inability of conventional multilevel models to account for spatial dependency, and thereby, generates more robust outputs. Results The findings show that sex, employment status, monthly household income, and perceived levels of stress are significantly associated with self-rated health status. Residents living in neighborhoods with low deprivation and a high doctor-to-resident ratio tend to report higher health status. The spatially filtered multilevel model provides unbiased estimations and improves the explanatory power of the model compared to conventional multilevel models although there are no changes in the signs of parameters and the significance levels between the two models in this case study. Conclusions The integrated approach proposed in this paper is a useful tool for understanding the geographical distribution of self-rated health status within a multilevel framework. In future research, it would be useful to apply the spatially filtered multilevel model to other datasets in order to clarify the differences between the two models. It is anticipated that this integrated method will also out-perform conventional models when it is used in other contexts. PMID:24571639

Migration and HIV prevention programmes: linking structural factors, culture, and individual behaviour--an Israeli experience.

PubMed

Soskolne, Varda; Shtarkshall, Ronny A

2002-10-01

Migration is one of the structural factors associated with HIV infections, but the dynamic and complex role of migrant situations as determinants of HIV-related vulnerability is still a major issue for social science research. Moreover, interventions to address the specific structural and contextual factors inherent in this association are limited and many do not take into account the cultural components. This paper presents a multi-level framework for analysis of the links between migration and HIV. It includes the association of migration with structural macro factors-lower socio-economic status and limited power in the new society; intermediate structural factors-limited social capital and bi-directional interaction of cultural norms; and individual-level factors-stressors unique to the migration context, depleted psychosocial resources, loss of cultural beliefs and low use of health services. All these factors affect risky sexual behaviour and transmission of HIV. The paper utilises those elements of the framework that are relevant to the specific needs of immigrant populations from the former Soviet Union and from Ethiopia in Israel. We demonstrate their application to integrated, multi-level HIV prevention interventions and propose several special principles for development of migration-related HIV prevention programmes.

Contextual effects and cancer outcomes in the United States: a systematic review of characteristics in multilevel analyses.

PubMed

Zahnd, Whitney E; McLafferty, Sara L

2017-11-01

There is increasing call for the utilization of multilevel modeling to explore the relationship between place-based contextual effects and cancer outcomes in the United States. To gain a better understanding of how contextual factors are being considered, we performed a systematic review. We reviewed studies published between January 1, 2002 and December 31, 2016 and assessed the following attributes: (1) contextual considerations such as geographic scale and contextual factors used; (2) methods used to quantify contextual factors; and (3) cancer type and outcomes. We searched PubMed, Scopus, and Web of Science and initially identified 1060 studies. One hundred twenty-two studies remained after exclusions. Most studies utilized a two-level structure; census tracts were the most commonly used geographic scale. Socioeconomic factors, health care access, racial/ethnic factors, and rural-urban status were the most common contextual factors addressed in multilevel models. Breast and colorectal cancers were the most common cancer types, and screening and staging were the most common outcomes assessed in these studies. Opportunities for future research include deriving contextual factors using more rigorous approaches, considering cross-classified structures and cross-level interactions, and using multilevel modeling to explore understudied cancers and outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Prevalence of cardiovascular risk factors among Latin American adolescents: a multilevel analysis.

PubMed

de Moraes, A C F; Musso, C; Graffigna, M N; Soutelo, J; Migliano, M; Carvalho, H B; Berg, G

2014-03-01

High blood pressure (HBP) and obesity is a well-established major risk factor for stroke and coronary heart disease. However, the literatures are scarce about these informations in adolescents from low-and-middle income countries. This school-based survey was carried out among students from Maringá (Brazil) and Buenos Aires (Argentina) selected random sampling. We studied 991 Brazilian adolescents (54.5% girls) in the age range of 14-18 years. In Argentina, we studied 933 adolescents (45.9% female) in the age range of 11-17 years. The outcomes of this study are general obesity, abdominal obesity and HBP. The associated factors analysed were gender, age and health behaviours. The prevalence of obesity was 5.8% in Brazil and 2.8% in Argentina, the prevalence of abdominal obesity was 32.7% in Brazil and 11.1% in Argentina, the prevalence of HBP was 14.9% in Brazil and 13.5% in Argentina. The multilevel analysis showed that older adolescents (>14 years old) have a little likelihood of being overweight, whereas male adolescents are more likely to be obese and have HBP. The abdominal obesity in both indicators were not associated with the independent variables. The prevalence of cardiovascular risk factors is high in Latin American adolescents independent of each country, and was associated with male gender.

A Multilevel Modelling Approach to Investigating Factors Impacting Science Achievement for Secondary School Students: PISA Hong Kong Sample

ERIC Educational Resources Information Center

Sun, Letao; Bradley, Kelly D.; Akers, Kathryn

2012-01-01

This study utilized data from the 2006 Programme for International Student Assessment Hong Kong sample to investigate the factors that impact the science achievement of 15-year-old students. A multilevel model was used to examine the factors from both student and school perspectives. At the student level, the results indicated that male students,…

Area-level poverty and preterm birth risk: A population-based multilevel analysis

PubMed Central

DeFranco, Emily A; Lian, Min; Muglia, Louis A; Schootman, Mario

2008-01-01

Background Preterm birth is a complex disease with etiologic influences from a variety of social, environmental, hormonal, genetic, and other factors. The purpose of this study was to utilize a large population-based birth registry to estimate the independent effect of county-level poverty on preterm birth risk. To accomplish this, we used a multilevel logistic regression approach to account for multiple co-existent individual-level variables and county-level poverty rate. Methods Population-based study utilizing Missouri's birth certificate database (1989–1997). We conducted a multilevel logistic regression analysis to estimate the effect of county-level poverty on PTB risk. Of 634,994 births nested within 115 counties in Missouri, two levels were considered. Individual-level variables included demographics factors, prenatal care, health-related behavioral risk factors, and medical risk factors. The area-level variable included the percentage of the population within each county living below the poverty line (US census data, 1990). Counties were divided into quartiles of poverty; the first quartile (lowest rate of poverty) was the reference group. Results PTB < 35 weeks occurred in 24,490 pregnancies (3.9%). The rate of PTB < 35 weeks was 2.8% in counties within the lowest quartile of poverty and increased through the 4th quartile (4.9%), p < 0.0001. High county-level poverty was significantly associated with PTB risk. PTB risk (< 35 weeks) was increased for women who resided in counties within the highest quartile of poverty, adjusted odds ratio (adjOR) 1.18 (95% CI 1.03, 1.35), with a similar effect at earlier gestational ages (< 32 weeks), adjOR 1.27 (95% CI 1.06, 1.52). Conclusion Women residing in socioeconomically deprived areas are at increased risk of preterm birth, above other underlying risk factors. Although the risk increase is modest, it affects a large number of pregnancies. PMID:18793437

Area-level poverty and preterm birth risk: a population-based multilevel analysis.

PubMed

DeFranco, Emily A; Lian, Min; Muglia, Louis A; Schootman, Mario

2008-09-15

Preterm birth is a complex disease with etiologic influences from a variety of social, environmental, hormonal, genetic, and other factors. The purpose of this study was to utilize a large population-based birth registry to estimate the independent effect of county-level poverty on preterm birth risk. To accomplish this, we used a multilevel logistic regression approach to account for multiple co-existent individual-level variables and county-level poverty rate. Population-based study utilizing Missouri's birth certificate database (1989-1997). We conducted a multilevel logistic regression analysis to estimate the effect of county-level poverty on PTB risk. Of 634,994 births nested within 115 counties in Missouri, two levels were considered. Individual-level variables included demographics factors, prenatal care, health-related behavioral risk factors, and medical risk factors. The area-level variable included the percentage of the population within each county living below the poverty line (US census data, 1990). Counties were divided into quartiles of poverty; the first quartile (lowest rate of poverty) was the reference group. PTB < 35 weeks occurred in 24,490 pregnancies (3.9%). The rate of PTB < 35 weeks was 2.8% in counties within the lowest quartile of poverty and increased through the 4th quartile (4.9%), p < 0.0001. High county-level poverty was significantly associated with PTB risk. PTB risk (< 35 weeks) was increased for women who resided in counties within the highest quartile of poverty, adjusted odds ratio (adj OR) 1.18 (95% CI 1.03, 1.35), with a similar effect at earlier gestational ages (< 32 weeks), adj OR 1.27 (95% CI 1.06, 1.52). Women residing in socioeconomically deprived areas are at increased risk of preterm birth, above other underlying risk factors. Although the risk increase is modest, it affects a large number of pregnancies.

Teaching ESL in a Multilevel Classroom. Adult Education Series #13. Refugee Education Guide.

ERIC Educational Resources Information Center

Center for Applied Linguistics, Washington, DC. Language and Orientation Resource Center.

Adult refugee English as a second language (ESL) programs are often mandated to serve all who sign up for instruction, a requirement that results in multilevel classes. This guide describes and discusses this and other factors which contribute to the existence of multilevel and/or heterogeneous classes, and provides some practical approaches and…

A Multilevel Evaluation of a Comprehensive Child Abuse Prevention Program

ERIC Educational Resources Information Center

Lawson, Michael A.; Alameda-Lawson, Tania; Byrnes, Edward C.

2012-01-01

Objectives: The purpose of this study is to examine the extent to which participation in a county-wide prevention program leads to improvements in protective factors associated with child abuse prevention (CAP) and whether improvements in measured protective factors relate to decreased odds of child abuse. Method: Using multilevel growth modeling,…

Moral Orientation and Relationships in School and Adolescent Pro- and Antisocial Behaviors: A Multilevel Study

ERIC Educational Resources Information Center

Wissink, Inge B.; Dekovic, Maja; Stams, Geert-Jan; Asscher, Jessica J.; Rutten, Esther; Zijlstra, Bonne J. H.

2014-01-01

This multilevel study examined the relationships between moral climate factors and prosocial as well as antisocial behaviors inside and outside the school (school misconduct, delinquent behavior, and vandalism). The moral climate factors were punishment-and victim-based moral orientation, relationships among students, and teacher-student…

A Bayesian Multi-Level Factor Analytic Model of Consumer Price Sensitivities across Categories

ERIC Educational Resources Information Center

Duvvuri, Sri Devi; Gruca, Thomas S.

2010-01-01

Identifying price sensitive consumers is an important problem in marketing. We develop a Bayesian multi-level factor analytic model of the covariation among household-level price sensitivities across product categories that are substitutes. Based on a multivariate probit model of category incidence, this framework also allows the researcher to…

Challenges for Multilevel Health Disparities Research in a Transdisciplinary Environment

PubMed Central

Holmes, John H.; Lehman, Amy; Hade, Erinn; Ferketich, Amy K.; Sarah, Gehlert; Rauscher, Garth H.; Abrams, Judith; Bird, Chloe E.

2008-01-01

Numerous factors play a part in health disparities. Although health disparities are manifested at the level of the individual, other contexts should be considered when investigating the associations of disparities with clinical outcomes. These contexts include families, neighborhoods, social organizations, and healthcare facilities. This paper reports on health disparities research as a multilevel research domain from the perspective of a large national initiative. The Centers for Population Health and Health Disparities (CPHHD) program was established by the NIH to examine the highly dimensional, complex nature of disparities and their effects on health. Because of its inherently transdisciplinary nature, the CPHHD program provides a unique environment in which to perform multilevel health disparities research. During the course of the program, the CPHHD centers have experienced challenges specific to this type of research. The challenges were categorized along three axes: sources of subjects and data, data characteristics, and multilevel analysis and interpretation. The CPHHDs collectively offer a unique example of how these challenges are met; just as importantly, they reveal a broad range of issues that health disparities researchers should consider as they pursue transdisciplinary investigations in this domain, particularly in the context of a large team science initiative. PMID:18619398

Multilevel modeling and panel data analysis in educational research (Case study: National examination data senior high school in West Java)

NASA Astrophysics Data System (ADS)

Zulvia, Pepi; Kurnia, Anang; Soleh, Agus M.

2017-03-01

Individual and environment are a hierarchical structure consist of units grouped at different levels. Hierarchical data structures are analyzed based on several levels, with the lowest level nested in the highest level. This modeling is commonly call multilevel modeling. Multilevel modeling is widely used in education research, for example, the average score of National Examination (UN). While in Indonesia UN for high school student is divided into natural science and social science. The purpose of this research is to develop multilevel and panel data modeling using linear mixed model on educational data. The first step is data exploration and identification relationships between independent and dependent variable by checking correlation coefficient and variance inflation factor (VIF). Furthermore, we use a simple model approach with highest level of the hierarchy (level-2) is regency/city while school is the lowest of hierarchy (level-1). The best model was determined by comparing goodness-of-fit and checking assumption from residual plots and predictions for each model. Our finding that for natural science and social science, the regression with random effects of regency/city and fixed effects of the time i.e multilevel model has better performance than the linear mixed model in explaining the variability of the dependent variable, which is the average scores of UN.

Quantitative analysis of organizational culture in occupational health research: a theory-based validation in 30 workplaces of the organizational culture profile instrument

PubMed Central

2013-01-01

Background This study advances a measurement approach for the study of organizational culture in population-based occupational health research, and tests how different organizational culture types are associated with psychological distress, depression, emotional exhaustion, and well-being. Methods Data were collected over a sample of 1,164 employees nested in 30 workplaces. Employees completed the 26-item OCP instrument. Psychological distress was measured with the General Health Questionnaire (12-item); depression with the Beck Depression Inventory (21-item); and emotional exhaustion with five items from the Maslach Burnout Inventory general survey. Exploratory factor analysis evaluated the dimensionality of the OCP scale. Multilevel regression models estimated workplace-level variations, and the contribution of organizational culture factors to mental health and well-being after controlling for gender, age, and living with a partner. Results Exploratory factor analysis of OCP items revealed four factors explaining about 75% of the variance, and supported the structure of the Competing Values Framework. Factors were labeled Group, Hierarchical, Rational and Developmental. Cronbach’s alphas were high (0.82-0.89). Multilevel regression analysis suggested that the four culture types varied significantly between workplaces, and correlated with mental health and well-being outcomes. The Group culture type best distinguished between workplaces and had the strongest associations with the outcomes. Conclusions This study provides strong support for the use of the OCP scale for measuring organizational culture in population-based occupational health research in a way that is consistent with the Competing Values Framework. The Group organizational culture needs to be considered as a relevant factor in occupational health studies. PMID:23642223

[Multilevel analysis of the technical efficiency of hospitals in the Spanish National Health System by property and type of management].

PubMed

Pérez-Romero, Carmen; Ortega-Díaz, M Isabel; Ocaña-Riola, Ricardo; Martín-Martín, José Jesús

2018-05-11

To analyze technical efficiency by type of property and management of general hospitals in the Spanish National Health System (2010-2012) and identify hospital and regional explanatory variables. 230 hospitals were analyzed combining data envelopment analysis and fixed effects multilevel linear models. Data envelopment analysis measured overall, technical and scale efficiency, and the analysis of explanatory factors was performed using multilevel models. The average rate of overall technical efficiency of hospitals without legal personality is lower than hospitals with legal personality (0.691 and 0.876 in 2012). There is a significant variability in efficiency under variable returns (TE) by direct, indirect and mixed forms of management. The 29% of the variability in TE es attributable to the Region. Legal personality increased the TE of the hospitals by 11.14 points. On the other hand, most of the forms of management (different to those of the traditional hospitals) increased TE in varying percentages. At regional level, according to the model considered, insularity and average annual income per household are explanatory variables of TE. Having legal personality favours technical efficiency. The regulatory and management framework of hospitals, more than public or private ownership, seem to explain technical efficiency. Regional characteristics explain the variability in TE. Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Social capital and leisure time physical activity: a population based multilevel analysis in Malmö, Sweden

PubMed Central

Lindstrom, M; Moghaddassi, M; Merlo, J

2003-01-01

Objective: To investigate the influence of social capital and individual factors on the level of leisure time physical inactivity in the neighbourhoods. Methods: The public health survey in Malmö 1994 is a cross sectional study. A total of 5600 people aged 20–80 years were invited to answer a postal questionnaire. The participation rate was 71%. A multilevel logistic regression model, with individuals at the first level and neighbourhoods at the second, was performed. The effect (intra-area correlation, cross level modification, and odds ratios) was analysed of individual and neighbourhood (the 1993 migration out of an area as a proxy for social capital) factors on leisure time physical inactivity after adjustment for individual factors. Results: Neighbourhood factors accounted for 5.0% of the crude total variance in physical inactivity. This effect was significantly reduced when the individual factors, especially country of origin, education, and social participation, were included in the model. In contrast, it was not reduced by the introduction of the contextual social capital variable. Conclusion: This study suggests that in the neighbourhoods of Malmö leisure time physical inactivity is mainly affected by individual factors. PMID:12490644

Interactive and independent associations between the socioeconomic and objective built environment on the neighbourhood level and individual health: a systematic review of multilevel studies.

PubMed

Schüle, Steffen Andreas; Bolte, Gabriele

2015-01-01

The research question how contextual factors of neighbourhood environments influence individual health has gained increasing attention in public health research. Both socioeconomic neighbourhood characteristics and factors of the built environment play an important role for health and health-related behaviours. However, their reciprocal relationships have not been systematically reviewed so far. This systematic review aims to identify studies applying a multilevel modelling approach which consider both neighbourhood socioeconomic position (SEP) and factors of the objective built environment simultaneously in order to disentangle their independent and interactive effects on individual health. The three databases PubMed, PsycINFO, and Web of Science were systematically searched with terms for title and abstract screening. Grey literature was not included. Observational studies from USA, Canada, Australia, New Zealand, and Western European countries were considered which analysed simultaneously factors of neighbourhood SEP and the objective built environment with a multilevel modelling approach. Adjustment for individual SEP was a further inclusion criterion. Thirty-three studies were included in qualitative synthesis. Twenty-two studies showed an independent association between characteristics of neighbourhood SEP or the built environment and individual health outcomes or health-related behaviours. Twenty-one studies found cross-level or within-level interactions either between neighbourhood SEP and the built environment, or between neighbourhood SEP or the built environment and individual characteristics, such as sex, individual SEP or ethnicity. Due to the large variation of study design and heterogeneous reporting of results the identification of consistent findings was problematic and made quantitative analysis not possible. There is a need for studies considering multiple neighbourhood dimensions and applying multilevel modelling in order to clarify their causal relationship towards individual health. Especially, more studies using comparable characteristics of neighbourhood SEP and the objective built environment and analysing interactive effects are necessary to disentangle health impacts and identify vulnerable neighbourhoods and population groups.

Interactive and Independent Associations between the Socioeconomic and Objective Built Environment on the Neighbourhood Level and Individual Health: A Systematic Review of Multilevel Studies

PubMed Central

Schüle, Steffen Andreas; Bolte, Gabriele

2015-01-01

Background The research question how contextual factors of neighbourhood environments influence individual health has gained increasing attention in public health research. Both socioeconomic neighbourhood characteristics and factors of the built environment play an important role for health and health-related behaviours. However, their reciprocal relationships have not been systematically reviewed so far. This systematic review aims to identify studies applying a multilevel modelling approach which consider both neighbourhood socioeconomic position (SEP) and factors of the objective built environment simultaneously in order to disentangle their independent and interactive effects on individual health. Methods The three databases PubMed, PsycINFO, and Web of Science were systematically searched with terms for title and abstract screening. Grey literature was not included. Observational studies from USA, Canada, Australia, New Zealand, and Western European countries were considered which analysed simultaneously factors of neighbourhood SEP and the objective built environment with a multilevel modelling approach. Adjustment for individual SEP was a further inclusion criterion. Results Thirty-three studies were included in qualitative synthesis. Twenty-two studies showed an independent association between characteristics of neighbourhood SEP or the built environment and individual health outcomes or health-related behaviours. Twenty-one studies found cross-level or within-level interactions either between neighbourhood SEP and the built environment, or between neighbourhood SEP or the built environment and individual characteristics, such as sex, individual SEP or ethnicity. Due to the large variation of study design and heterogeneous reporting of results the identification of consistent findings was problematic and made quantitative analysis not possible. Conclusions There is a need for studies considering multiple neighbourhood dimensions and applying multilevel modelling in order to clarify their causal relationship towards individual health. Especially, more studies using comparable characteristics of neighbourhood SEP and the objective built environment and analysing interactive effects are necessary to disentangle health impacts and identify vulnerable neighbourhoods and population groups. PMID:25849569

HIV sexual risk behaviors and multilevel determinants among male labor migrants from Tajikistan.

PubMed

Weine, Stevan; Bahromov, Mahbat; Loue, Sana; Owens, Linda

2013-08-01

The purpose of this study was to investigate HIV risk behaviors and their multilevel determinants in male labor migrants from Tajikistan to Moscow. In Russia and Central Asia, where AIDS rates are amongst the world's highest, conditions in both sending and receiving countries pose serious challenges to HIV prevention. A survey of Tajik married male seasonal labor migrants in Moscow was completed by 200 workers from 4 bazaars and 200 workers from 18 construction sites as part of a mixed method study. The quantitative results indicated that male labor migrants were at risk for HIV due to higher sexual behaviors including sexual relations with sex workers (92 %), multiple partnering in the past month (86 %), unprotected sex with sex workers (33 %), and reduced frequency of condom use while drinking alcohol (57 %). Multivariate tests indicated the multilevel factors that increased HIV sexual risks including: pre-migration factors (e.g. used sex workers in Tajikistan); migrant work and lifestyle factors (e.g. greater number of times visited Moscow); migrant sexual and relational factors (e.g. regular partner in Moscow); and migrant health and mental health factors (e.g. increased frequency of alcohol use). Qualitative findings from longitudinal ethnographic interviews and observations of a subset of 40 purposively sampled Tajik male migrants demonstrated how these multilevel pre-migration and migration factors account for HIV risk and protective behaviors in context. These findings underscore the seriousness of HIV risk for labor migrants and call both for multilevel approaches to prevention and for further study.

Social capital and neo-materialist contextual determinants of sense of insecurity in the neighbourhood: a multilevel analysis in Southern Sweden.

PubMed

Lindström, Martin; Lindström, Christine; Moghaddassi, Mahnaz; Merlo, Juan

2006-12-01

The aim of this study was to investigate the influence of contextual (social capital and neo-materialist) and individual factors on sense of insecurity in the neighbourhood. The 2000 public health survey in Scania is a cross-sectional study. A total of 13,715 persons answered a postal questionnaire, which is 59% of the random sample. A multilevel logistic regression model, with individuals at the first level and municipalities at the second, was performed. The effect (median odds ratios, intra-class correlation, cross-level modification and odds ratios) of individual and municipality/city quarter (social capital and police district) factors on sense of insecurity was analysed. The crude variance between municipalities/city quarters was not affected by individual factors. The introduction of administrative police district in the model reduced the municipality variance, although some of the significant variance between municipalities remained. The introduction of social capital did not affect the municipality variance. This study suggests that the neo-materialist factor administrative police district may partly explain the individual's sense of insecurity in the neighbourhood.

Neighbourhood effects on body constitution-A case study of Hong Kong.

PubMed

Low, Chien Tat; Lai, Poh Chin; Li, Han Dong; Ho, Wai Kit; Wong, Paulina; Chen, Si; Wong, Wing Cheung

2016-06-01

Traditional Chinese Medicine (TCM) has long perceived environment as an integral part of the development of body constitution, which is a personal state of health closely related to disease presence. Despite of the ever-growing studies on the clinical effectiveness of TCM and the scientific linking between body constitution and diseases, the geographical influence on body constitution has yet remained an unexplored territory. This study sought to investigate whether the neighbourhood environment is relevant to the composition of body type of a population through statistical multilevel and Geographic Information Systems modelling. The analysis comprised 3277 participants who had completed their body type assessment between 2009 and 2012 inclusive. The multilevel analysis also took simultaneous accounts of both individual-level (gender, age, BMI, type of housing) and area-level (percent greenery, percent road surface, total road intersection, sky view factor, temperature, relative humidity, rainfall and social deprivation index) characteristics to explain geographical variation by body types. Significant random or place effects (p < 0.001) were identified in the multilevel models. The spatial variation of body constitution involved the dynamic interplay between individual and environmental factors. The findings amassed the first scientific indications to back the common belief that place does play a role in the development of body constitution and is worthy of further investigation. By considering spatial and personal attributes simultaneously, the study can yield valuable insights into the patterning of area variation in body constitution and disease presence. Copyright © 2016 Elsevier Ltd. All rights reserved.

Analysis of early life influences on cognitive development in childhood using multilevel ordinal models

PubMed Central

Li, Leah

2012-01-01

Summary Studies of cognitive development in children are often based on tests designed for specific ages. Examination of the changes of these scores over time may not be meaningful. This paper investigates the influence of early life factors on cognitive development using maths and reading test scores at ages 7, 11, and 16 years in a British birth cohort born in 1958. The distributions of these test scores differ between ages, for example, 20% participants scored the top mark in the reading test at 7 and the distribution of reading score at 16 is heavily skewed. In this paper, we group participants into 5 ordered categories, approximately 20% in each category according to their test scores at each age. Multilevel models for a repeated ordinal outcome are applied to relate the ordinal scale of maths and reading ability to early life factors. PMID:22661923

Neighborhood-Level Correlates of Consistent Condom Use among Men Who have Sex with Men: A Multi-Level Analysis

PubMed Central

Koblin, Beryl; Chin, John; Beard, John; Blaney, Shannon; Halkitis, Perry; Vlahov, David; Galea, Sandro

2014-01-01

There is growing evidence that the neighborhood environment influences sexual behavior and related outcomes, but little work has focused specifically on men who have sex with men (MSM). Using interview data from a probability sample of 385 young MSM living in New York City, recruited at public venues in 1999 and 2000 as part of the Young Men’s Survey-New York City, and data on neighborhood characteristics obtained from the U.S. Census 2000, we conducted multi-level analyses of the associations between neighborhood-level characteristics and consistent condom use during anal intercourse, while controlling for individual-level sociodemographic and other factors. After adjusting for individual-level factors, neighborhood-level gay presence remained significantly and positively associated with consistent condom use during anal intercourse. This finding suggests that neighborhoods with a significant gay presence may have norms that act to discourage high risk sexual activity. PMID:18712593

Multilevel Examination of Job Satisfaction and Career Intentions of Collegiate Athletic Trainers: A Quantitative Approach.

PubMed

Eason, Christianne M; Mazerolle, Stephanie M; Denegar, Craig R; Pitney, William A; McGarry, Jennifer

2018-01-01

  Recent employment data from collegiate athletic training settings have demonstrated departure trends among men and women. These trends have been hypothesized to be related to work-life balance. However, work-life balance is only 1 aspect of a myriad of factors. Due to the complex nature of the work-life interface, a multilevel examination is needed to better understand the precipitators of departure.   To quantitatively examine factors that may influence collegiate athletic trainers' (ATs') job satisfaction and career intentions via a multilevel examination of the work-life interface.   Cross-sectional study.   Web-based questionnaire.   Athletic trainers employed in National Collegiate Athletic Association Division I, II, or III or National Association of Intercollegiate Athletics colleges or universities (N = 299: 56.5% female, 43.5% male). The average age of participants was 33.6 ± 8.3 years, and their average experience was 10.3 ± 7.6 years.   Participants responded to an online questionnaire consisting of demographic questions, 9 Likert-scale surveys, and open-ended questions. Job-satisfaction Scores (JSSs) and intention-to-leave scores (ITLSs) served as the dependent variables and factors from individual, organizational, and sociocultural levels were the independent variables. Hierarchical regression analysis was run to determine the predictability of factors.   No sex differences in ITLS or JSS were found in our sample. Independent variables explained 68.5% of the variance in JSS and 28.8% of the variance in ITLS. Additions of factor levels increased the percentage of explained variance in both scores.   A combination of individual-, organizational-, and sociocultural-level factors was able to best predict JSS and ITLS among collegiate ATs.

Sb-rich Si-Sb-Te phase change material for multilevel data storage: The degree of disorder in the crystalline state

NASA Astrophysics Data System (ADS)

Zhou, Xilin; Wu, Liangcai; Song, Zhitang; Rao, Feng; Cheng, Yan; Peng, Cheng; Yao, Dongning; Song, Sannian; Liu, Bo; Feng, Songlin; Chen, Bomy

2011-07-01

The phase change memory with monolayer chalcogenide film (Si18Sb52Te30) is investigated for the feasibility of multilevel data storage. During the annealing of the film, a relatively stable intermediate resistance can be obtained at an appropriate heating rate. The transmission electron microscopy in situ analysis reveals a conversion of crystallization mechanism from nucleation to crystal growth, which leads a continuous reduction in the degree of disorder. It is indicated from the electrical properties of the devices that the fall edge of the voltage pulse is the critical factor that determines a reliable triple-level resistance state of the phase change memory cell.

Predicting research use in nursing organizations: a multilevel analysis.

PubMed

Estabrooks, Carole A; Midodzi, William K; Cummings, Greta G; Wallin, Lars

2007-01-01

No empirical literature was found that explained how organizational context (operationalized as a composite of leadership, culture, and evaluation) influences research utilization. Similarly, no work was found on the interaction of individuals and contextual factors, or the relative importance or contribution of forces at different organizational levels to either such proposed interactions or, ultimately, to research utilization. To determine independent factors that predict research utilization among nurses, taking into account influences at individual nurse, specialty, and hospital levels. Cross-sectional survey data for 4,421 registered nurses in Alberta, Canada were used in a series of multilevel (three levels) modeling analyses to predict research utilization. A multilevel model was developed in MLwiN version 2.0 and used to: (a) estimate simultaneous effects of several predictors and (b) quantify the amount of explained variance in research utilization that could be apportioned to individual, specialty, and hospital levels. There was significant variation in research utilization (p <.05). Factors (remaining in the final model at statistically significant levels) found to predict more research utilization at the three levels of analysis were as follows. At the individual nurse level (Level 1): time spent on the Internet and lower levels of emotional exhaustion. At the specialty level (Level 2): facilitation, nurse-to-nurse collaboration, a higher context (i.e., of nursing culture, leadership, and evaluation), and perceived ability to control policy. At the hospital level (Level 3): only hospital size was significant in the final model. The total variance in research utilization was 1.04, and the intraclass correlations (the percent contribution by contextual factors) were 4% (variance = 0.04, p <.01) at the hospital level and 8% (variance = 0.09, p <.05) at the specialty level. The contribution attributable to individual factors alone was 87% (variance = 0.91, p <.01). Variation in research utilization was explained mainly by differences in individual characteristics, with specialty- and organizational-level factors contributing relatively little by comparison. Among hospital-level factors, hospital size was the only significant determinant of research utilization. Although organizational determinants explained less variance in the model, they were still statistically significant when analyzed alone. These findings suggest that investigations into mechanisms that influence research utilization must address influences at multiple levels of the organization. Such investigations will require careful attention to both methodological and interpretative challenges present when dealing with multiple units of analysis.

The Association Among Individual and Contextual Factors and Unmet Healthcare Needs in South Korea: A Multilevel Study Using National Data.

PubMed

Lee, Seung Eun; Yeon, Miyeon; Kim, Chul-Woung; Yoon, Tae-Ho

2016-09-01

The objective of this study is to investigate associations between contextual characteristics and unmet healthcare needs in South Korea after accounting for individual factors. The present study used data from the 2012 Korean Community Health Survey (KCHS) of 228 902 adults residing within 253 municipal districts in South Korea. A multilevel analysis was conducted to investigate how contextual characteristics, defined by variables that describe the regional deprivation, degree of urbanity, and healthcare supply, are associated with unmet needs after controlling for individual-level variables. Of the surveyed Korean adults, 12.1% reported experiencing unmet healthcare needs in the past. This figure varied with the 253 districts surveyed, ranging from 2.6% to 26.2%. A multilevel analysis found that the association between contextual characteristics and unmet needs varied according to the factors that caused the unmet needs. The degree of urbanity was associated with unmet need due to "financial burden" (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.42 to 0.66 for rural vs. metropolitan), but not unmet need due to "service not available when needed." There were no significant associations between these unmet need measures and regional deprivation. Among individual-level variables, income level showed the highest association with unmet need due to "financial burden" (OR, 5.63; 95% CI, 4.76 to 6.66), while employment status showed a strong association with unmet need due to "service not available when needed." Our finding suggests that different policy interventions should be considered for each at-risk population group to address the root cause of unmet healthcare needs.

Transformational Leadership Related to School Climate: A Multi-Level Analysis

ERIC Educational Resources Information Center

McCarley, Troy A.; Peters, Michelle L.; Decman, John M.

2016-01-01

Across the nation, quality leadership and positive school climate are critical to the success of every principal, student, and school. As a result, this study examined the relationship between teacher perceptions of the degree to which a principal displays the factors of transformational leadership and the perceived school climate. A purposeful…

Exploring What Leads High School Students to Enroll in Hispanic-Serving Institutions: A Multilevel Analysis

ERIC Educational Resources Information Center

Nunez, Anne-Marie; Bowers, Alex J.

2011-01-01

This study examined the student and high school contextual factors associated with high school students' enrollment in Hispanic-Serving Institutions (HSIs). The authors drew on a conceptual framework of college choice involving the concepts of multiple capitals and individual and organizational habitus to examine the postsecondary trajectories of…

Global Citizenship and the Importance of Education in a Globally Integrated World

ERIC Educational Resources Information Center

Smith, William C.; Fraser, Pablo; Chykina, Volha; Ikoma, Sakiko; Levitan, Joseph; Liu, Jing; Mahfouz, Julia

2017-01-01

As national borders dissipate and technology allows different cultures and nationalities to communicate on a regular basis, more individuals are self-identifying as a global citizen. Using Social Network Analysis and multi-level modelling, this study explores factors associated with global citizen affinity and finds that education plays an…

Occupational Propensity for Training in a Late Industrial Society: Evidence from Russia

ERIC Educational Resources Information Center

Anikin, Vasiliy A.

2017-01-01

What factors best explain the low incidence of skills training in a late industrial society like Russia? This research undertakes a multilevel analysis of the role of occupational structure in the probability of training. The explanatory power of occupation-specific determinants and skills polarization are evaluated, using a representative 2012…

Testing a Developmental-Ecological Model of Student Engagement: A Multilevel Latent Growth Curve Analysis

ERIC Educational Resources Information Center

You, Sukkyung; Sharkey, Jill

2009-01-01

US schools fail to engage a significant proportion of adolescent students. Although student engagement is significantly related to academic achievement, there is a dearth of longitudinal research simultaneously examining the impact of personal and contextual factors on student engagement at both individual and school levels. Using a…

Cross-validation of the factorial structure of the Neighborhood Environment Walkability Scale (NEWS) and its abbreviated form (NEWS-A)

USDA-ARS?s Scientific Manuscript database

The Neighborhood Environment Walkability Scale (NEWS) and its abbreviated form (NEWS-A) assess perceived environmental attributes believed to influence physical activity. A multilevel confirmatory factor analysis (MCFA) conducted on a sample from Seattle, WA, showed that, at the respondent level, th...

The Functions of Immediate Echolalia in Autistic Children.

ERIC Educational Resources Information Center

Prizant, Barry M.; Duchan, Judith F.

1981-01-01

A multilevel analysis of verbal and nonverbal factors, response latency, and intonation, in four autistic boys (4 to 9 years old) revealed that immediate echolalia is far more than a meaningless behavior. Seven functional categories of echolalia were discovered and are discussed in reference to behavioral and linguistic features of each category.…

Family Influences on Science Learning among Hong Kong Adolescents: What We Learned from PISA

ERIC Educational Resources Information Center

Ho, Esther Sui Chu

2010-01-01

This study investigated the relationship between family factors and students' scientific literacy performance in Hong Kong, which has excelled in science performance in previous international studies. Data were obtained from the 2006 Programme for International Student Assessment. Multilevel analysis was used to examine the relationship between…

Factors That Impact Teacher Power in Decision-Making in U.S. Public Schools: A Multilevel Analysis

ERIC Educational Resources Information Center

Wang, Yuling

2015-01-01

The teacher empowerment process emphasizes professional development and participation (i.e., increasing professional status, skills, knowledge and providing the opportunity to participate in decision-making); however, whether these efforts eventually lead to the realization of teacher power remains a critical concern, especially considering that…

Deepening our Understanding of Quality in Australia (DUQuA): a study protocol for a nationwide, multilevel analysis of relationships between hospital quality management systems and patient factors.

PubMed

Taylor, Natalie; Clay-Williams, Robyn; Hogden, Emily; Pye, Victoria; Li, Zhicheng; Groene, Oliver; Suñol, Rosa; Braithwaite, Jeffrey

2015-12-07

Despite the growing body of research on quality and safety in healthcare, there is little evidence of the association between the way hospitals are organised for quality and patient factors, limiting our understanding of how to effect large-scale change. The 'Deepening our Understanding of Quality in Australia' (DUQuA) study aims to measure and examine relationships between (1) organisation and department-level quality management systems (QMS), clinician leadership and culture, and (2) clinical treatment processes, clinical outcomes and patient-reported perceptions of care within Australian hospitals. The DUQuA project is a national, multilevel, cross-sectional study with data collection at organisation (hospital), department, professional and patient levels. Sample size calculations indicate a minimum of 43 hospitals are required to adequately power the study. To allow for rejection and attrition, 70 hospitals across all Australian jurisdictions that meet the inclusion criteria will be invited to participate. Participants will consist of hospital quality management professionals; clinicians; and patients with stroke, acute myocardial infarction and hip fracture. Organisation and department-level QMS, clinician leadership and culture, patient perceptions of safety, clinical treatment processes, and patient outcomes will be assessed using validated, evidence-based or consensus-based measurement tools. Data analysis will consist of simple correlations, linear and logistic regression and multilevel modelling. Multilevel modelling methods will enable identification of the amount of variation in outcomes attributed to the hospital and department levels, and the factors contributing to this variation. Ethical approval has been obtained. Results will be disseminated to individual hospitals in de-identified national and international benchmarking reports with data-driven recommendations. This ground-breaking national study has the potential to influence decision-making on the implementation of quality and safety systems and processes in Australian and international hospitals. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Modeling the Factors Associated with Children's Mental Health Difficulties in Primary School: A Multilevel Study

ERIC Educational Resources Information Center

Humphrey, Neil; Wigelsworth, Michael

2012-01-01

The current study explores some of the factors associated with children's mental health difficulties in primary school. Multilevel modeling with data from 628 children from 36 schools was used to determine how much variation in mental health difficulties exists between and within schools, and to identify characteristics at the school and…

Defending Victims of Bullying in Early Adolescence: A Multilevel Analysis.

PubMed

Yun, Hye-Young; Graham, Sandra

2018-05-29

Adolescents' defending behaviors in school bullying situations is likely determined by individual characteristics, social status variables, and classroom/school contextual factors operating simultaneously in the peer ecology. However, there is little research on defending behavior that utilizes this multilevel approach. This study investigated how students' willingness to defend victims of bullying was affected by feelings of empathy, perceived popularity, and classroom-level perceived prosocial norms. Participants were 1373 adolescents (40% girls, Mage: 14 yrs) from 54 classrooms in six middle schools in South Korea. These youth reported on their feelings of empathy and how prosocial they perceived their classmates to be. Peer-ratings and peer nominations were used to estimate defending behaviors and which students were perceived as popular. Multilevel analyses showed that participants were more likely to defend victims when they had greater empathy and perceived popularity and when classroom-level prosocial norms were higher. The findings have implications for interventions to reduce school bullying and for studying defending behavior in multiple cultural contexts.

Timely immunization completion among children in Vietnam from 2000 to 2011: a multilevel analysis of individual and contextual factors

PubMed Central

Minh An, Dao Thi; Lee, Jong-Koo; Van Minh, Hoang; Trang, Nguyen Thi Huyen; Thu Huong, Nguyen Thi; Nam, You-Seon; Van Dung, Do

2016-01-01

Background Since the beginning of 2014, there have been nearly 6,000 confirmed measles cases in northern Vietnam. Of these, more than 86% had neither been immunized nor was their vaccination status confirmed. Objective To establish the likelihood that children under five in Vietnam had ‘timely immunization completion’ (2000–2011) and identify factors that account for variations in timely immunization completion. Design Secondary data from the Multiple Indicator Cluster Survey (MICS), which sampled women aged 15–49 from the 1999 Vietnamese Population and Housing Census frame, were analyzed. Multilevel analysis using Poisson regression was undertaken. Results Proportions of children under five who had timely immunization completion were low, especially for HBV dose 2 and HBV dose 3, which decreased between 2000 and 2011. Among seven vaccines used in the National Expanded Program of Immunization (EPI) in 2000, 2006, and 2011, measles dose 1 had the highest timely immunization completion at 65.3%, 66.7%, and 73.6%, respectively, and hepatitis B dose 1 had the lowest at 17.5%, 19.3%, and 45.5%, respectively. Timely immunization completion was less common among children whose mothers had relatively less household wealth, were from ethnic minorities, lived in rural areas, and had less education. At the community level, the child's region of residence was the main predictor of timely immunization completion, and the availability of hospital delivery and community prenatal care in the local community were also determinants. Conclusion The EPI should include ‘timely immunization completion’ as a quality indicator. There should also be greater focus and targeting in rural areas, and among women who have relatively low education, belong to minority groups, and have less household wealth. Further research on this topic using multilevel analysis is needed to better understand how these factors interact. PMID:26950555

Relating Measurement Invariance, Cross-Level Invariance, and Multilevel Reliability.

PubMed

Jak, Suzanne; Jorgensen, Terrence D

2017-01-01

Data often have a nested, multilevel structure, for example when data are collected from children in classrooms. This kind of data complicate the evaluation of reliability and measurement invariance, because several properties can be evaluated at both the individual level and the cluster level, as well as across levels. For example, cross-level invariance implies equal factor loadings across levels, which is needed to give latent variables at the two levels a similar interpretation. Reliability at a specific level refers to the ratio of true score variance over total variance at that level. This paper aims to shine light on the relation between reliability, cross-level invariance, and strong factorial invariance across clusters in multilevel data. Specifically, we will illustrate how strong factorial invariance across clusters implies cross-level invariance and perfect reliability at the between level in multilevel factor models.

Relationships between community social capital and injury in Canadian adolescents: a multilevel analysis

PubMed Central

Vafaei, Afshin; Pickett, William; Alvarado, Beatriz E

2015-01-01

Background Characteristics of social environments are potential risk factors for adolescent injury. Impacts of social capital on the occurrence of such injuries have rarely been explored. Methods General health questionnaires were completed by 8910 youth aged 14 years and older as part of the 2010 Canadian Health Behaviour in School-Aged Children study. These were supplemented with community-level data from the 2006 Canada Census of Population. Multilevel logistic regression models with random intercepts were fit to examine associations of interest. The reliability and validity of variables used in this analysis had been established in past studies, or in new analyses that employed factor analysis. Results Between school differences explained 2% of the variance in the occurrence of injuries. After adjustment for all confounders, community social capital did not have any impact on the occurrence of injuries in boys: OR: 1.01, 95% CI 0.80 to 1.29. However, living in areas with low social capital was associated with lower occurrence of injuries in girls (OR 0.78, 95% CI 0.63 to 0.96). Other factors that were significantly related to injuries in both genders were younger age, engagement in more risky behaviours, and negative behavioural influences from peers. Conclusions After simultaneously taking into account the influence of community-level and individual-level factors, community levels of social capital remained a relatively strong predictor of injury among girls but not boys. Such gender effects provide important clues into the social aetiology of youth injury. PMID:26294708

Individual and contextual factors associated with community health workers' performance in Nyanza Province, Kenya: a multilevel analysis.

PubMed

Kawakatsu, Yoshito; Sugishita, Tomohiko; Tsutsui, Junya; Oruenjo, Kennedy; Wakhule, Stephen; Kibosia, Kennedy; Were, Eric; Honda, Sumihisa

2015-10-01

Several African and South Asian countries are currently investing in new cadres of community health workers (CHWs) as a major part of strategies aimed at reaching the Millennium Development Goals. However, one review concluded that community health workers did not consistently provide services likely to have substantial effects on health and that quality was usually poor. The objective of this research was to assess the CHWs' performance in Western Kenya and describe determinants of that performance using a multilevel analysis of the two levels, individual and supervisor/community. This study conducted three surveys between August and September 2011 in Nyanza Province, Kenya. The participants of the three surveys were all 1,788 active CHWs, all their supervisors, and 2,560 randomly selected mothers who had children aged 12 to 23 months. CHW performance was generated by three indicators: reporting rate, health knowledge and household coverage. Multilevel analysis was performed to describe the determinants of that performance. The significant factors associated with the CHWs' performance were their marital status, educational level, the size of their household, their work experience, personal sanitation practice, number of supervisions received and the interaction between their supervisors' better health knowledge and the number of supervisions. A high quality of routine supervisions is one of the key interventions in sustaining a CHW's performance. In addition, decreasing the dropout rate of CHWs is important both for sustaining their performance and for avoiding the additional cost of replacing them. As for the selection criteria of new CHWs, good educational status, availability of supporters for household chores and good sanitation practices are all important in selecting CHWs who can maintain their high performance level.

Individual self-reported health, social participation and neighbourhood: a multilevel analysis in Malmö, Sweden.

PubMed

Lindström, Martin; Moghaddassi, Mahnaz; Merlo, Juan

2004-07-01

The influence of neighbourhood and individual factors on self-reported health was investigated. The public health survey in Malmö 1994 is a cross-sectional study. A total of 3,602 individuals aged 20-80 living in 75 neighbourhoods answered a postal questionnaire. The participation rate was 71%. A multilevel logistic regression model, with individuals at the first level and neighbourhoods at the second, was performed. We analysed the effect (intra-area correlation, cross-level modification and odds ratios) of neighbourhood on self-reported health after adjustment for individual factors. The neighbourhoods accounted for 2.8% of the crude total variance in self-reported health status. This effect was significantly reduced when individual factors such as country of origin, education and social participation were included in the model. In fact, no significant variance in self-reported health remained after the introduction of the individual factors in the model. In Malmö, the neighbourhood variance in self-reported health is mainly affected by individual factors, especially country of origin, socioeconomic status measured as level of education and individual social participation. Copyright 2004 The Institute for Cancer Prevention and Elsevier Inc.

What Factors Influence the Decision to Share Suicidal Thoughts? A Multilevel Social Network Analysis of Disclosure Among Individuals with Serious Mental Illness.

PubMed

Fulginiti, Anthony; Pahwa, Rohini; Frey, Laura M; Rice, Eric; Brekke, John S

2016-08-01

Nondisclosure of suicidal thoughts limits suicide risk management. Consistent with disclosure models for other stigmatized statuses, understanding suicidal disclosure requires accounting for features of the discloser (individual factors) and the discloser-recipient relationship (relational factors). In a sample of 30 adults with schizophrenia, bipolar disorder, or major depressive disorder (Level 2) who nominated 436 social network members (Level 1), we examined disclosure patterns and identified individual and relational correlates of disclosure intent. Most individuals disclosed in the past (77%; n = 23) and all intended on disclosing (100%; n = 30). Disclosure was highly selective, with 14% (n = 62) of network members identified as prior confidants and 23% (n = 99) identified as intended confidants. Multilevel modeling indicated that relational factors were more central to disclosure than individual factors. Network members who were prior confidants and who provided social support were attractive targets for intended disclosure. Our findings suggest that "targeted" gatekeeper training may be a promising strategy and reveal relational characteristics to identify "high-probability confidants." © 2015 The American Association of Suicidology.

Social cohesion matters in health

PubMed Central

2013-01-01

Introduction The concept of social cohesion has invoked debate due to the vagueness of its definition and the limitations of current measurements. This paper attempts to examine the concept of social cohesion, develop measurements, and investigate the relationship between social cohesion and individual health. Methods This study used a multilevel study design. The individual-level samples from 29 high-income countries were obtained from the 2000 World Value Survey (WVS) and the 2002 European Value Survey. National-level social cohesion statistics were obtained from Organization of Economic Cooperation and Development datasets, World Development Indicators, and Asian Development Bank key indicators for the year 2000, and from aggregating responses from the WVS. In total 47,923 individuals were included in this study. The factor analysis was applied to identify dimensions of social cohesion, which were used as entities in the cluster analysis to generate a regime typology of social cohesion. Then, multilevel regression models were applied to assess the influences of social cohesion on an individual’s self-rated health. Results and discussion Factor analysis identified five dimensions of social cohesion: social equality, social inclusion, social development, social capital, and social diversity. Then, the cluster analysis revealed five regimes of social cohesion. A multi-level analysis showed that respondents in countries with higher social inclusion, social capital, and social diversity were more likely to report good health above and beyond individual-level characteristics. Conclusions This study is an innovative effort to incorporate different aspects of social cohesion. This study suggests that social cohesion was associated with individual self-rated after controlling individual characteristics. To achieve further advancement in population health, developed countries should consider policies that would foster a society with a high level of social inclusion, social capital, and social diversity. Future research could focus on identifying possible pathways by which social cohesion influences various health outcomes. PMID:24165541

Scaling up prevention of mother-to-child HIV transmission programs in sub-Saharan African countries: a multilevel assessment of site-, program- and country-level determinants of performance.

PubMed

Audureau, Etienne; Kahn, James G; Besson, Marie-Hélène; Saba, Joseph; Ladner, Joël

2013-04-01

Uptake of prevention of mother-to-child HIV transmission (PMTCT) programs remains challenging in sub-Saharan Africa because of multiple barriers operating at the individual or health facility levels. Less is known regarding the influence of program-level and contextual determinants. In this study, we explored the multilevel factors associated with coverage in single-dose nevirapine PMTCT programs. We analyzed aggregate routine data collected within the framework of the Viramune(®) Donation Programme (VDP) from 269 sites in 20 PMTCT programs and 15 sub-Saharan countries from 2002 to 2005. Site performance was measured using a nevirapine coverage ratio (NCR), defined as the reported number of women receiving nevirapine divided by the number of women who should have received nevirapine (observed HIV prevalence x number of women in antenatal care [ANC]). Data on program-level determinants were drawn from the initial application forms, and country-level determinants from the Demographic and Health Surveys (DHS) and the World Bank (World Development Indicators). Multilevel linear mixed models were used to identify independent factors associated with NCR at the site-, program- and country-level. Of 283,410 pregnant women attending ANC in the included sites, 174,312 women (61.5%) underwent HIV testing after receiving pre-test counselling, of whom 26,700 tested HIV positive (15.3%), and 22,591 were dispensed NVP (84.6%). Site performance was highly heterogeneous between and within programs. Mean NCR by site was 43.8% (interquartile range: 19.1-63.9). Multilevel analysis identified higher HIV prevalence (Beta coefficient: 25.1, 95% confidence interval [CI] 18.7 to 31.6), higher proportion of persons with knowledge of PMTCT (8.3; CI 0.5 to 16.0), higher health expenditure as a proportion of Gross Domestic Product (3.9 per %; CI 2.0 to 5.8) and lower percentage of rural population (-0.7 per %; CI -1.0 to -0.5) as significant country-level predictors of higher NCR at the p<0.05 level. A medium ANC monthly activity (30-100/month) was the only site-level predictor found (-7.6; CI -15.1 to -0.1). Heterogeneity of nevirapine coverage between sites and programs was high. Multilevel analysis identified several significant contextual determinants, which may warrant additional research to further define important multi-level and potentially modifiable determinants of performance of PMTCT programs.

A multilevel analysis of lifestyle variations in symptoms of acute respiratory infection among young children under five in Nigeria.

PubMed

Adesanya, Oluwafunmilade A; Chiao, Chi

2016-08-25

Nigeria has the second highest estimated number of deaths due to acute respiratory infection (ARI) among children under five in the world. A common hypothesis is that the inequitable distribution of socioeconomic resources shapes individual lifestyles and health behaviors, which leads to poorer health, including symptoms of ARI. This study examined whether lifestyle factors are associated with ARI risk among Nigerian children aged less than 5 years, taking individual-level and contextual-level risk factors into consideration. Data were obtained from the nationally representative 2013 Nigeria Demographic and Health Survey. A total of 28,596 surviving children aged 5 years or younger living in 896 communities were analyzed. We employed two-level multilevel logistic regressions to model the relationship between lifestyle factors and ARI symptoms. The multivariate results from multilevel regressions indicated that the odds of having ARI symptoms were increased by a number of lifestyle factors such as in-house biomass cooking (OR = 2.30; p < 0.01) and no hand-washing (OR = 1.66; p < 0.001). An increased risk of ARI symptoms was also significantly associated with living in the North West region and the community with a high proportion of orphaned/vulnerable children (OR = 1.74; p < 0.001). Our findings underscore the importance of Nigerian children's lifestyle within the neighborhoods where they reside above their individual characteristics. Program-based strategies that are aimed at reducing ARI symptoms should consider policies that embrace making available basic housing standards, providing improved cooking stoves and enhancing healthy behaviors.

Social participation, social capital and daily tobacco smoking: a population-based multilevel analysis in Malmö, Sweden.

PubMed

Lindström, Martin; Moghaddassi, Mahnaz; Bolin, Kristian; Lindgren, Björn; Merlo, Juan

2003-01-01

The aim of this study was to investigate the influence of contextual and individual factors on daily tobacco smoking. The public-health survey in Malmö 1994 is a cross-sectional study. A total of 5600 individuals aged 20-80 years were invited to answer a postal questionnaire. The participation rate was 71%. A multilevel logistic regression model, with individuals at the first level and neighbourhoods at the second, was performed. We analysed the effect (intra-area correlation, cross-level modification and odds ratios) of individual and neighbourhood factors on smoking after adjustment for individual factors. Neighbourhood factors accounted for 2.5% of the crude total variance in daily tobacco smoking. This effect was significantly reduced when the individual factors such as education were included in the model. However, individual social capital, measured by social participation, only marginally affected the total neighbourhood variance in daily tobacco smoking. In fact, no significant variance in daily tobacco smoking remained after the introduction of the individual factors other than individual social capital in the model. In Malmö, the neighbourhood variance in daily tobacco smoking is mainly affected by individual factors other than individual social capital, especially socioeconomic status measured as level of education.

The influence of compositional and contextual factors on non-receipt of basic vaccines among children of 12-23-month old in India: a multilevel analysis.

PubMed

Sissoko, Daouda; Trottier, Helen; Malvy, Denis; Johri, Mira

2014-01-01

Children unreached by vaccination are at higher risk of poor health outcomes and India accounts for nearly a quarter of unvaccinated children worldwide. The objective of this study was to investigate compositional and contextual determinants of non-receipt of childhood vaccines in India using multilevel modelling. We studied characteristics of unvaccinated children using the District Level Health and Facility Survey 3, a nationally representative probability sample containing 65 617 children aged 12-23 months from 34 Indian states and territories. We developed four-level Bayesian binomial regression models to examine the determinants of non-vaccination. The analysis considered two outcomes: completely unvaccinated (CUV) children who had not received any of the eight vaccine doses recommended by India's Universal Immunization Programme, and children who had not received any dose from routine immunisation services (no RI). The no RI category includes CUV children and those who received only polio doses administered via mass campaigns. Overall, 4.83% (95% CI: 4.62-5.06) of children were CUV while 12.01% (11.68-12.35) had received no RI. Individual compositional factors strongly associated with CUV were: non-receipt of tetanus immunisation for mothers during pregnancy (OR = 3.65 [95% CrI: 3.30-4.02]), poorest household wealth index (OR = 2.44 [1.81-3.22] no maternal schooling (OR = 2.43 [1.41-4.05]) and no paternal schooling (OR = 1.83 [1.30-2.48]). In rural settings, the influence of maternal illiteracy disappeared whereas the role of household wealth index was reinforced. Factors associated with no RI were similar to those for CUV, but effect sizes for individual compositional factors were generally larger. Low maternal education was the strongest risk factor associated with no RI in all models. All multilevel models found significant variability at community, district, and state levels net of compositional factors. Non-vaccination in India is strongly related to compositional characteristics and is geographically distinct. Tailored strategies are required to overcome current barriers to immunisation.

The effect of contextual factors on unintentional injury hospitalization: from the Korea National Hospital Discharge Survey.

PubMed

Lee, Hye Ah; Han, Hyejin; Lee, Seonhwa; Park, Bomi; Park, Bo Hyun; Lee, Won Kyung; Park, Ju Ok; Hong, Sungok; Kim, Young Taek; Park, Hyesook

2018-03-13

It has been suggested that health risks are affected by geographical area, but there are few studies on contextual effects using multilevel analysis, especially regarding unintentional injury. This study investigated trends in unintentional injury hospitalization rates over the past decade in Korea, and also examined community-level risk factors while controlling for individual-level factors. Using data from the 2004 to 2013 Korea National Hospital Discharge Survey (KNHDS), trends in age-adjusted injury hospitalization rate were conducted using the Joinpoint Regression Program. Based on the 2013 KNHDS, we collected community-level factors by linking various data sources and selected dominant factors related to injury hospitalization through a stepwise method. Multilevel analysis was performed to assess the community-level factors while controlling for individual-level factors. In 2004, the age-adjusted unintentional injury hospitalization rate was 1570.1 per 100,000 population and increased to 1887.1 per 100,000 population in 2013. The average annual percent change in rate of hospitalizations due to unintentional injury was 2.31% (95% confidence interval: 1.8-2.9). It was somewhat higher for females than for males (3.25% vs. 1.64%, respectively). Both community- and individual-level factors were found to significantly influence unintentional injury hospitalization risk. As community-level risk factors, finance utilization capacity of the local government and neighborhood socioeconomic status, were independently associated with unintentional injury hospitalization after controlling for individual-level factors, and accounted for 19.9% of community-level variation in unintentional injury hospitalization. Regional differences must be considered when creating policies and interventions. Further studies are required to evaluate specific factors related to injury mechanism.

Multilevel analysis of self-perception in oral health and associated factors in Southern Brazilian adults: a cross-sectional study.

PubMed

Gabardo, Marilisa Carneiro Leão; Moysés, Samuel Jorge; Moysés, Simone Tetu; Olandoski, Marcia; Olinto, Maria Teresa Anselmo; Pattussi, Marcos Pascoal

2015-01-01

The aim of this study was to evaluate the association between individual and contextual variables related to self-perception in oral health among residents in the municipality of São Leopoldo, Rio Grande do Sul State, Brazil. The cross-sectional design involved 1,100 adults in 38 census tracts. The self-perception was evaluated using the Oral Health Impact Profile (OHIP-14) tool. A logistic multilevel analysis was performed. The multivariate analysis revealed that those who are of the female gender, older, with lower scores of quality of life and less social support, with poor healthy eating habits, smokers and those living in low-income census tracts presented higher odds of reporting worse oral health self-perception (OHIP-1). We concluded that individual and contextual variables are associated with oral health self-perception. This is essential information for planning health services wishing to meet the health needs of the population.

Comprehensive multilevel in vivo and in vitro analysis of heart rate fluctuations in mice by ECG telemetry and electrophysiology.

PubMed

Fenske, Stefanie; Pröbstle, Rasmus; Auer, Franziska; Hassan, Sami; Marks, Vanessa; Pauza, Danius H; Biel, Martin; Wahl-Schott, Christian

2016-01-01

The normal heartbeat slightly fluctuates around a mean value; this phenomenon is called physiological heart rate variability (HRV). It is well known that altered HRV is a risk factor for sudden cardiac death. The availability of genetic mouse models makes it possible to experimentally dissect the mechanism of pathological changes in HRV and its relation to sudden cardiac death. Here we provide a protocol that allows for a comprehensive multilevel analysis of heart rate (HR) fluctuations. The protocol comprises a set of techniques that include in vivo telemetry and in vitro electrophysiology of intact sinoatrial network preparations or isolated single sinoatrial node (SAN) cells. In vitro preparations can be completed within a few hours, with data acquisition within 1 d. In vivo telemetric ECG requires 1 h for surgery and several weeks for data acquisition and analysis. This protocol is of interest to researchers investigating cardiovascular physiology and the pathophysiology of sudden cardiac death.

Educational Inequality in Colombia: Family Background, School Quality and Student Achievement in Cartagena

ERIC Educational Resources Information Center

Rangel, Claudia; Lleras, Christy

2010-01-01

This study examines the effects of family socio-economic disadvantage and differences in school resources on student achievement in the city of Cartagena, Colombia. Using data from the ICFES and C-600 national databases, we conduct a multilevel analysis to determine the unique contribution of school-level factors above and beyond family…

Student-Student Relations from the Teacher versus Student Perspective: A Multi-Level Confirmatory Factor Analysis

ERIC Educational Resources Information Center

Heemsoth, Tim; Retelsdorf, Jan

2018-01-01

Educational research emphasizes the advantages of multimethod designs. However, if the design comprises different perspectives, the question of construct validity emerges. We related this question to student and teacher ratings of student-student relations, which are of high interest in research on physical education. In our study, 2,160 students…

Adolescent Self-Reported Health in Relation to School Factors: A Multilevel Analysis

ERIC Educational Resources Information Center

Nygren, Karina; Bergström, Erik; Janlert, Urban; Nygren, Lennart

2014-01-01

The aim of the study was to examine school-related determinants of self-reported health among adolescents. Questionnaire survey data comprising 4,972 students, Grades 7 through 9, from 20 schools in northern Sweden were used. Also, complimentary data about each school were collected from the Swedish National Agency for Education. Using multilevel…

Turkish Students' Scientific Literacy Scores: A Multilevel Analysis of Data from Program for International Student Assessment

ERIC Educational Resources Information Center

Yilmaz, Haci Bayram

2009-01-01

A vast majority of the studies exploring the associations between student and school related factors and standardized test scores were conducted in developed countries. On the other hand, research suggests that the generalization of the findings of those studies to developing countries often leads to incorrect conclusions. The purpose of this…

A multivariate multilevel Gaussian model with a mixed effects structure in the mean and covariance part.

PubMed

Li, Baoyue; Bruyneel, Luk; Lesaffre, Emmanuel

2014-05-20

A traditional Gaussian hierarchical model assumes a nested multilevel structure for the mean and a constant variance at each level. We propose a Bayesian multivariate multilevel factor model that assumes a multilevel structure for both the mean and the covariance matrix. That is, in addition to a multilevel structure for the mean we also assume that the covariance matrix depends on covariates and random effects. This allows to explore whether the covariance structure depends on the values of the higher levels and as such models heterogeneity in the variances and correlation structure of the multivariate outcome across the higher level values. The approach is applied to the three-dimensional vector of burnout measurements collected on nurses in a large European study to answer the research question whether the covariance matrix of the outcomes depends on recorded system-level features in the organization of nursing care, but also on not-recorded factors that vary with countries, hospitals, and nursing units. Simulations illustrate the performance of our modeling approach. Copyright © 2013 John Wiley & Sons, Ltd.

[Associations between dormitory environment/other factors and sleep quality of medical students].

PubMed

Zheng, Bang; Wang, Kailu; Pan, Ziqi; Li, Man; Pan, Yuting; Liu, Ting; Xu, Dan; Lyu, Jun

2016-03-01

To investigate the sleep quality and related factors among medical students in China, understand the association between dormitory environment and sleep quality, and provide evidence and recommendations for sleep hygiene intervention. A total of 555 undergraduate students were selected from a medical school of an university in Beijing through stratified-cluster random-sampling to conduct a questionnaire survey by using Chinese version of Pittsburgh Sleep Quality Index (PSQI) and self-designed questionnaire. Analyses were performed by using multiple logistic regression model as well as multilevel linear regression model. The prevalence of sleep disorder was 29.1%(149/512), and 39.1%(200/512) of the students reported that the sleep quality was influenced by dormitory environment. PSQI score was negatively correlated with self-reported rating of dormitory environment (γs=-0.310, P<0.001). Logistic regression analysis showed the related factors of sleep disorder included grade, sleep regularity, self-rated health status, pressures of school work and employment, as well as dormitory environment. RESULTS of multilevel regression analysis also indicated that perception on dormitory environment (individual level) was associated with sleep quality with the dormitory level random effects under control (b=-0.619, P<0.001). The prevalence of sleep disorder was high in medical students, which was associated with multiple factors. Dormitory environment should be taken into consideration when the interventions are taken to improve the sleep quality of students.

Income inequality and mortality: a multilevel prospective study of 521 248 individuals in 50 US states.

PubMed

Backlund, Eric; Rowe, Geoff; Lynch, John; Wolfson, Michael C; Kaplan, George A; Sorlie, Paul D

2007-06-01

Some of the most consistent evidence in favour of an association between income inequality and health has been among US states. However, in multilevel studies of mortality, only two out of five studies have reported a positive relationship with income inequality after adjustment for the compositional characteristics of the state's inhabitants. In this study, we attempt to clarify these mixed results by analysing the relationship within age-sex groups and by applying a previously unused analytical method to a database that contains more deaths than any multilevel study to date. The US National Longitudinal Mortality Study (NLMS) was used to model the relationship between income inequality in US states and mortality using both a novel and previously used methodologies that fall into the general framework of multilevel regression. We adjust age-sex specific models for nine socioeconomic and demographic variables at the individual level and percentage black and region at the state level. The preponderance of evidence from this study suggests that 1990 state-level income inequality is associated with a 40% differential in state level mortality rates (95% CI = 26-56%) for men 25-64 years and a 14% (95% CI = 3-27%) differential for women 25-64 years after adjustment for compositional factors. No such relationship was found for men or women over 65. The relationship between income inequality and mortality is only robust to adjustment for compositional factors in men and women under 65. This explains why income inequality is not a major driver of mortality trends in the United States because most deaths occur at ages 65 and over. This analysis does suggest, however, the certain causes of death that occur primarily in the population under 65 may be associated with income inequality. Comparison of analytical techniques also suggests coefficients for income inequality in previous multilevel mortality studies may be biased, but further research is needed to provide a definitive answer.

Stages of syphilis in South China - a multilevel analysis of early diagnosis.

PubMed

Wong, Ngai Sze; Huang, Shujie; Zheng, Heping; Chen, Lei; Zhao, Peizhen; Tucker, Joseph D; Yang, Li Gang; Goh, Beng Tin; Yang, Bin

2017-01-31

Early diagnosis of syphilis and timely treatment can effectively reduce ongoing syphilis transmission and morbidity. We examined the factors associated with the early diagnosis of syphilis to inform syphilis screening strategic planning. In an observational study, we analyzed reported syphilis cases in Guangdong Province, China (from 2014 to mid-2015) accessed from the national case-based surveillance system. We categorized primary and secondary syphilis cases as early diagnosis and categorized latent and tertiary syphilis as delayed diagnosis. Univariate analyses and multivariable logistic regressions were performed to identify the factors associated with early diagnosis. We also examined the factors associated with early diagnosis at the individual and city levels in multilevel logistic regression models with cases nested by city (n = 21), adjusted for age at diagnosis and gender. Among 83,944 diagnosed syphilis cases, 22% were early diagnoses. The city-level early diagnosis rate ranged from 7 to 46%, consistent with substantial geographic variation as shown in the multilevel model. Early diagnosis was associated with cases presenting to specialist clinics for screening, being male and attaining higher education level. Cases received syphilis testing in institutions and hospitals, and diagnosed in hospitals were less likely to be in early diagnosis. At the city-level, cases living in a city equipped with more hospitals per capita were less likely to be early diagnosis. To enhance early diagnosis of syphilis, city-specific syphilis screening strategies with a mix of passive and client/provider-initiated testing might be a useful approach.

Multilevel Factorial Experiments for Developing Behavioral Interventions: Power, Sample Size, and Resource Considerations†

PubMed Central

Dziak, John J.; Nahum-Shani, Inbal; Collins, Linda M.

2012-01-01

Factorial experimental designs have many potential advantages for behavioral scientists. For example, such designs may be useful in building more potent interventions, by helping investigators to screen several candidate intervention components simultaneously and decide which are likely to offer greater benefit before evaluating the intervention as a whole. However, sample size and power considerations may challenge investigators attempting to apply such designs, especially when the population of interest is multilevel (e.g., when students are nested within schools, or employees within organizations). In this article we examine the feasibility of factorial experimental designs with multiple factors in a multilevel, clustered setting (i.e., of multilevel multifactor experiments). We conduct Monte Carlo simulations to demonstrate how design elements such as the number of clusters, the number of lower-level units, and the intraclass correlation affect power. Our results suggest that multilevel, multifactor experiments are feasible for factor-screening purposes, because of the economical properties of complete and fractional factorial experimental designs. We also discuss resources for sample size planning and power estimation for multilevel factorial experiments. These results are discussed from a resource management perspective, in which the goal is to choose a design that maximizes the scientific benefit using the resources available for an investigation. PMID:22309956

Multilevel factorial experiments for developing behavioral interventions: power, sample size, and resource considerations.

PubMed

Dziak, John J; Nahum-Shani, Inbal; Collins, Linda M

2012-06-01

Factorial experimental designs have many potential advantages for behavioral scientists. For example, such designs may be useful in building more potent interventions by helping investigators to screen several candidate intervention components simultaneously and to decide which are likely to offer greater benefit before evaluating the intervention as a whole. However, sample size and power considerations may challenge investigators attempting to apply such designs, especially when the population of interest is multilevel (e.g., when students are nested within schools, or when employees are nested within organizations). In this article, we examine the feasibility of factorial experimental designs with multiple factors in a multilevel, clustered setting (i.e., of multilevel, multifactor experiments). We conduct Monte Carlo simulations to demonstrate how design elements-such as the number of clusters, the number of lower-level units, and the intraclass correlation-affect power. Our results suggest that multilevel, multifactor experiments are feasible for factor-screening purposes because of the economical properties of complete and fractional factorial experimental designs. We also discuss resources for sample size planning and power estimation for multilevel factorial experiments. These results are discussed from a resource management perspective, in which the goal is to choose a design that maximizes the scientific benefit using the resources available for an investigation. (c) 2012 APA, all rights reserved

The JOINT model of nurse absenteeism and turnover: a systematic review.

PubMed

Daouk-Öyry, Lina; Anouze, Abdel-Latef; Otaki, Farah; Dumit, Nuhad Yazbik; Osman, Ibrahim

2014-01-01

Absenteeism and turnover among healthcare workers have a significant impact on overall healthcare system performance. The literature captures variables from different levels of measurement and analysis as being associated with attendance behavior among nurses. Yet, it remains unclear how variables from different contextual levels interact to impact nurses' attendance behaviors. The purpose of this review is to develop an integrative multilevel framework that optimizes our understanding of absenteeism and turnover among nurses in hospital settings. We therefore systematically examine English-only studies retrieved from two major databases, PubMed and CINAHL Plus and published between January, 2007 and January, 2013 (inclusive). Our review led to the identification of 7619 articles out of which 41 matched the inclusion criteria. The analysis yielded a total of 91 antecedent variables and 12 outcome variables for turnover, and 29 antecedent variables and 9 outcome variables for absenteeism. The various manifested variables were analyzed using content analysis and grouped into 11 categories, and further into five main factors: Job, Organization, Individual, National and inTerpersonal (JOINT). Thus, we propose the JOINT multilevel conceptual model for investigating absenteeism and turnover among nurses. The JOINT model can be adapted by researchers for fitting their hypothesized multilevel relationships. It can also be used by nursing managers as a lens for holistically managing nurses' attendance behaviors. Copyright © 2013 Elsevier Ltd. All rights reserved.

Neighborhood contextual factors, maternal smoking, and birth outcomes: multilevel analysis of the South Carolina PRAMS survey, 2000-2003.

PubMed

Nkansah-Amankra, Stephen

2010-08-01

Previous studies investigating relationships among neighborhood contexts, maternal smoking behaviors, and birth outcomes (low birth weight [LBW] or preterm births) have produced mixed results. We evaluated independent effects of neighborhood contexts on maternal smoking behaviors and risks of LBW or preterm birth outcomes among mothers participating in the South Carolina Pregnancy Risk Assessment and Monitoring System (PRAMS) survey, 2000-2003. The PRAMS data were geocoded to 2000 U.S. Census data to create a multilevel data structure. We used a multilevel regression analysis (SAS PROC GLIMMIX) to estimate odds ratios (OR) and corresponding 95% confidence intervals (CI). In multivariable logistic regression models, high poverty, predominantly African American neighborhoods, upper quartiles of low education, and second quartile of neighborhood household crowding were significantly associated with LBW. However, only mothers resident in predominantly African American Census tract areas were statistically significantly at an increased risk of delivering preterm (OR 2.2, 95% CI 1.29-3.78). In addition, mothers resident in medium poverty neighborhoods remained modestly associated with smoking after adjustment for maternal-level covariates. The results also indicated that maternal smoking has more consistent effects on LBW than preterm births, particularly for mothers living in deprived neighborhoods. Interventions seeking to improve maternal and child health by reducing smoking during pregnancy need to engage specific community factors that encourage maternal quitting behaviors and reduce smoking relapse rates. Inclusion of maternal-level covariates in neighborhood models without careful consideration of the causal pathway might produce misleading interpretation of the results.

Performance Analysis of Multilevel Parallel Applications on Shared Memory Architectures

NASA Technical Reports Server (NTRS)

Biegel, Bryan A. (Technical Monitor); Jost, G.; Jin, H.; Labarta J.; Gimenez, J.; Caubet, J.

2003-01-01

Parallel programming paradigms include process level parallelism, thread level parallelization, and multilevel parallelism. This viewgraph presentation describes a detailed performance analysis of these paradigms for Shared Memory Architecture (SMA). This analysis uses the Paraver Performance Analysis System. The presentation includes diagrams of a flow of useful computations.

Social capital and sense of insecurity in the neighbourhood: a population-based multilevel analysis in Malmö, Sweden.

PubMed

Lindström, Martin; Merlo, Juan; Ostergren, Per Olof

2003-03-01

The aim of this study was to investigate the influence of social capital on self-reported sense of insecurity in the neighbourhood. The public health survey in Malmö, Sweden in 1994 was a cross-sectional study. A total of 5600 individuals aged 20-80 years were asked to answer a postal questionnaire. The participation rate was 71%. A multilevel logistic regression model, with individuals at the first level and neighbourhoods at the second, was performed. We analysed the effect (intra-area correlation, cross-level modification and odds ratios) of individual (social participation) and neighbourhood social capital (electoral participation in the 1994 municipal election) on sense of insecurity after adjustment for compositional factors. Neighbourhood factors accounted for 7.2% of the total variance in individual insecurity. This effect was marginally reduced when the individual factors were included in the model. In contrast, it was reduced by 70% by the introduction of the contextual variable. This study suggests that social capital, measured as electoral participation, may partly explain the individual's sense of insecurity in the neighbourhood.

Micro-epidemiology and spatial heterogeneity of P. vivax parasitaemia in riverine communities of the Peruvian Amazon: A multilevel analysis.

PubMed

Carrasco-Escobar, Gabriel; Gamboa, Dionicia; Castro, Marcia C; Bangdiwala, Shrikant I; Rodriguez, Hugo; Contreras-Mancilla, Juan; Alava, Freddy; Speybroeck, Niko; Lescano, Andres G; Vinetz, Joseph M; Rosas-Aguirre, Angel; Llanos-Cuentas, Alejandro

2017-08-14

Malaria has steadily increased in the Peruvian Amazon over the last five years. This study aimed to determine the parasite prevalence and micro-geographical heterogeneity of Plasmodium vivax parasitaemia in communities of the Peruvian Amazon. Four cross-sectional active case detection surveys were conducted between May and July 2015 in four riverine communities in Mazan district. Analysis of 2785 samples of 820 individuals nested within 154 households for Plasmodium parasitaemia was carried out using light microscopy and qPCR. The spatio-temporal distribution of Plasmodium parasitaemia, dominated by P. vivax, was shown to cluster at both household and community levels. Of enrolled individuals, 47% had at least one P. vivax parasitaemia and 10% P. falciparum, by qPCR, both of which were predominantly sub-microscopic and asymptomatic. Spatial analysis detected significant clustering in three communities. Our findings showed that communities at small-to-moderate spatial scales differed in P. vivax parasite prevalence, and multilevel Poisson regression models showed that such differences were influenced by factors such as age, education, and location of households within high-risk clusters, as well as factors linked to a local micro-geographic context, such as travel and occupation. Complex transmission patterns were found to be related to human mobility among communities in the same micro-basin.

Individual and contextual determinants of self-reported poor psychological health: a population-based multilevel analysis in southern Sweden.

PubMed

Lindström, Martin; Moghaddassi, Mahnaz; Merlo, Juan

2006-01-01

To investigate the influence of contextual and individual factors on self-reported psychological health. The 2000 public health survey in Scania is a cross-sectional postal questionnaire study with a 59% participation rate. A total of 13,715 persons aged 18-80 answered the questionnaire. A multilevel logistic regression model, with individuals at the first level and municipalities/city quarters at the second, was performed. The effect (intra-class correlation, cross-level modification, and odds ratios) of individual and municipality/city quarter factors on self-reported psychological health was analysed. The crude variance between municipalities/city quarters was small but significant. It was particularly affected and lowered by individual civil status, country of origin, economic stress, and social participation. The inclusion of all individual factors age, sex, civil status, country of origin, education, economic stress, and social participation lowered the between municipality variance to not-significant levels, which is the reason why no contextual variables were included in the calculations. The results of this study suggest that poor self-reported psychological health is affected mainly by individual characteristics of the population and not by contextual factors at the municipality/city quarter level.

The role of supervisor emotional support on individual job satisfaction: A multilevel analysis.

PubMed

Pohl, Sabine; Galletta, Maura

2017-02-01

Supervisor emotional support is a strong determinant of job satisfaction. There is no study examining the effect of supervisor emotional support at the group level on job satisfaction. Multilevel statistical techniques can help disentangle the effects of subjective assessments from those of group factors. The study's aim was to examine the moderating role of supervisor emotional support (group-level variable) on the relationship between work engagement and job satisfaction (individual-level variables). A cross-sectional study was performed in 39units from three Belgian hospitals. A total of 323 nurses completed a self-reported questionnaire. We carried out a multilevel analysis by using Hierarchical Linear Modeling. The results showed that the cross-level interaction was significant. Hence, at individual-level, the nurses with high levels of work engagement showed high levels of job satisfaction and this relationship was stronger when supervisor emotional support at group-level was high. Contextual differences among groups had an impact on the form of the work engagement-job satisfaction relationship. This relationship between work engagement and job satisfaction is an individual and group level phenomenon. Ways to enhance emotional supervisor support include training supervisors in providing support and enhancing communication between nurses and supervisors. Copyright © 2016 Elsevier Inc. All rights reserved.

The multi-level perspective analysis: Indonesia geothermal energy transition study

NASA Astrophysics Data System (ADS)

Wisaksono, A.; Murphy, J.; Sharp, J. H.; Younger, P. L.

2018-01-01

The study adopts a multi-level perspective in technology transition to analyse how the transition process in the development of geothermal energy in Indonesia is able to compete against the incumbent fossil-fuelled energy sources. Three levels of multi-level perspective are socio-technical landscape (ST-landscape), socio-technical regime (ST-regime) and niche innovations in Indonesia geothermal development. The identification, mapping and analysis of the dynamic relationship between each level are the important pillars of the multi-level perspective framework. The analysis considers the set of rules, actors and controversies that may arise in the technological transition process. The identified geothermal resource risks are the basis of the emerging geothermal technological innovations in Indonesian geothermal. The analysis of this study reveals the transition pathway, which yields a forecast for the Indonesian geothermal technology transition in the form of scenarios and probable impacts.

Multilevel Analysis for Identifying Factors Influencing Academic Achievement of Students in Higher Education Institution: The Case of Wollo University

ERIC Educational Resources Information Center

Beyene, Kassu Mehari; Yimam, Jemal Ayalew

2016-01-01

Education is a process by which man transmits his experiences, new findings, and values accumulated over the years, in his struggle for survival and development, through generations. Accordingly, one of the aims of education is to strengthen the individual's and societies' problem solving capacity, ability and culture starting from basic education…

Placement Decisions and Disparities among Aboriginal Groups: An Application of the Decision Making Ecology through Multi-Level Analysis

ERIC Educational Resources Information Center

Fluke, John D.; Chabot, Martin; Fallon, Barbara; MacLaurin, Bruce; Blackstock, Cindy

2010-01-01

Objective: This paper examined the relative influence of clinical and organizational characteristics on the decision to place a child in out-of-home care at the conclusion of a child maltreatment investigation. It tested the hypothesis that extraneous factors, specifically, organizational characteristics, impact the decision to place a child in…

Using Course-Level Factors as Predictors of Online Course Outcomes: A Multi-Level Analysis at a US Urban Community College

ERIC Educational Resources Information Center

Wladis, Claire; Conway, Katherine; Hachey, Alyse C.

2017-01-01

Research has documented lower retention rates in online versus face-to-face courses. However, little research has focused on the impact of course-level characteristics (e.g. elective versus distributional versus major requirements; difficulty level; STEM status) on online course outcomes. Yet, focusing interventions at the course level versus the…

Race/Ethnicity and the Start of Child Care: A Multi-Level Analysis of Factors Influencing First Child Care Experiences

ERIC Educational Resources Information Center

Fram, Maryah Stella; Kim, Jinseok

2008-01-01

Early childhood education and care experiences play an important role in children's development and school readiness with, in general, sustained exposure to high quality, center-based care leading to positive outcomes. Hispanic parents have been shown to be less likely than others to place their children in center-based care, particularly when…

Multilevel analysis of the impact of school-level tobacco policies on adolescent smoking: the case of Michigan.

PubMed

Paek, Hye-Jin; Hove, Thomas; Oh, Hyun Jung

2013-10-01

In efforts to curb and prevent youth smoking, school tobacco policies have become an important and effective strategy. This study explores the degrees and types of tobacco-free school policy (TFSP) enforcement that are associated with adolescent smoking. A multilevel analysis was performed using 983 students who are nested in 14 schools. The individual-level data are drawn from the 2009 Michigan Youth Risk Behavior Survey. The school-level data are drawn from the 2008 School Health Profiles survey. Two factors are associated with lower adolescent smoking: greater punishment for TFSP violation and more tobacco control communication efforts. By contrast, the factors associated with higher adolescent smoking are designation of a tobacco-free school zone and school-level smoking. This study theoretically and methodologically guides researchers to test TFSP effectiveness in other states. Three strategic implications emerge: (1) schools should provide a consistent antismoking message in smoke-free environments; (2) schools should integrate TFSP into a comprehensive tobacco control initiative, including community-wide tobacco control programs and messages; and (3) the way a specific TFSP is promoted and communicated could determine how effective it is. © 2013, American School Health Association.

Multi-level tree analysis of pulmonary artery/vein trees in non-contrast CT images

NASA Astrophysics Data System (ADS)

Gao, Zhiyun; Grout, Randall W.; Hoffman, Eric A.; Saha, Punam K.

2012-02-01

Diseases like pulmonary embolism and pulmonary hypertension are associated with vascular dystrophy. Identifying such pulmonary artery/vein (A/V) tree dystrophy in terms of quantitative measures via CT imaging significantly facilitates early detection of disease or a treatment monitoring process. A tree structure, consisting of nodes and connected arcs, linked to the volumetric representation allows multi-level geometric and volumetric analysis of A/V trees. Here, a new theory and method is presented to generate multi-level A/V tree representation of volumetric data and to compute quantitative measures of A/V tree geometry and topology at various tree hierarchies. The new method is primarily designed on arc skeleton computation followed by a tree construction based topologic and geometric analysis of the skeleton. The method starts with a volumetric A/V representation as input and generates its topologic and multi-level volumetric tree representations long with different multi-level morphometric measures. A new recursive merging and pruning algorithms are introduced to detect bad junctions and noisy branches often associated with digital geometric and topologic analysis. Also, a new notion of shortest axial path is introduced to improve the skeletal arc joining two junctions. The accuracy of the multi-level tree analysis algorithm has been evaluated using computer generated phantoms and pulmonary CT images of a pig vessel cast phantom while the reproducibility of method is evaluated using multi-user A/V separation of in vivo contrast-enhanced CT images of a pig lung at different respiratory volumes.

Assessing a multilevel model of young children’s oral health with national survey data

PubMed Central

Bramlett, Matthew D.; Soobader, Mah-J; Fisher-Owens, Susan A.; Weintraub, Jane A.; Gansky, Stuart A.; Platt, Larry J.; Newacheck, Paul W.

2010-01-01

Objectives To empirically test a multilevel conceptual model of children’s oral health incorporating 22 domains of children’s oral health across four levels: child, family, neighborhood and state. Data source The 2003 National Survey of Children’s Health, a module of the State and Local Area Integrated Telephone Survey conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics, is a nationally representative telephone survey of caregivers of children. Study design We examined child-, family-, neighborhood-, and state-level factors influencing parent’s report of children’s oral health using a multilevel logistic regression model, estimated for 26 736 children ages 1–5 years. Principal findings Factors operating at all four levels were associated with the likelihood that parents rated their children’s oral health as fair or poor, although most significant correlates are represented at the child or family level. Of 22 domains identified in our conceptual model, 15 domains contained factors significantly associated with young children’s oral health. At the state level, access to fluoridated water was significantly associated with favorable oral health for children. Conclusions Our results suggest that efforts to understand or improve children’s oral health should consider a multilevel approach that goes beyond solely child-level factors. PMID:20370808

A multi-level approach for investigating socio-economic and agricultural risk factors associated with rates of reported cases of Escherichia coli O157 in humans in Alberta, Canada.

PubMed

Pearl, D L; Louie, M; Chui, L; Doré, K; Grimsrud, K M; Martin, S W; Michel, P; Svenson, L W; McEwen, S A

2009-10-01

Using negative binomial and multi-level Poisson models, the authors determined the statistical significance of agricultural and socio-economic risk factors for rates of reported disease associated with Escherichia coli O157 in census subdivisions (CSDs) in Alberta, Canada, 2000-2002. Variables relating to population stability, aboriginal composition of the CSDs, and the economic relationship between CSDs and urban centres were significant risk factors. The percentage of individuals living in low-income households was not a statistically significant risk factor for rates of disease. The statistical significance of cattle density, recorded at a higher geographical level, depended on the method used to correct for overdispersion, the number of levels included in the multi-level models, and the choice of using all reported cases or only sporadic cases. Our results highlight the importance of local socio-economic risk factors in determining rates of disease associated with E. coli O157, but their relationship with individual risk factors requires further evaluation.

Variations in the prevalence of antibody to brucella infection in cattle by farm, area and district in Kenya.

PubMed Central

Kadohira, M.; McDermott, J. J.; Shoukri, M. M.; Kyule, M. N.

1997-01-01

Variations in the sero-prevalence of antibody to brucella infection by cow, farm and area factors were investigated for three contrasting districts in Kenya: Samburu, an arid and pastoral area: Kiambu, a tropical highland area; and Kilifi, a typical tropical coastal area. Cattle were selected by a two-stage cluster sampling procedure and visited once between August 1991 and 1992. Schall's algorithm, a statistical model suitable for multi-level analysis was used. Using this model, older age, free grazing and large herd size (> or = 31) were associated with higher seroprevalence. Also, significant farm-to-farm, area-to-area and district-to-district variations were estimated. The patterns of high risk districts and areas seen were consistent with known animal husbandry and movement risk factors, but the larger than expected farm-to-farm variation within high risk areas and districts could not be explained. Thus, a multi-level method provided additional information beyond conventional analyses of sero-prevalence data. PMID:9042033

Mass media, stigma, and disclosure of HIV test results: multilevel analysis in the Eastern Cape, South Africa.

PubMed

Hutchinson, P L; Mahlalela, X; Yukich, Josh

2007-12-01

In this article, we examine the role of mass media and interpersonal communication in affecting knowledge of HIV/AIDS, reducing stigma, using condoms, and increasing the likelihood of disclosing HIV test results to sexual partners and family members. Data from a 2002 household survey in the Eastern Cape Province of South Africa are used to measure levels of stigma, interpersonal communication, willingness to disclosure HIV test results and condom use. We use a multilevel framework that accounts for the social context in which individuals access information, gauge social norms, and make decisions about the costs and benefits of HIV testing and disclosure. The results provide support for the positive effects of both media exposure and informal social networks on ideational factors, namely changes in knowledge and stigma, which lead to behavior change. Consistent with common models of health communication dynamics, these latter factors dominate decisions regarding disclosure of HIV test results and condom use.

[Nutritional status of elderly Brazilians: a multilevel approach].

PubMed

Pereira, Ingrid Freitas da Silva; Spyrides, Maria Helena Constantino; Andrade, Lára de Melo Barbosa

2016-06-03

The objectives of this study were to diagnose the nutritional status of the elderly Brazilian population and to identify associated factors. The study used data from the Brazilian Household Budget Survey (2008/2009) for 20,114 elderly, whose nutritional status was assessed by body mass index (BMI). Associated factors were tested with the Pearson chi-square test and multilevel linear models. The hierarchical analysis showed a significant effect of state of Brazil on BMI variance (p-value = 0.001). The individual level showed a negative association (p-value < 0.001) with Asian-descendant race, male gender, living alone, and older age and a positive association with per capita income. Underweight was more prevalent among elderly in rural areas (26.3%) and in the Northeast (23.7%) and Central regions (20.9%), and obesity was more prevalent in the South (45.1%) and Southeast (38.3%) and in cities (39%). The study suggests the importance of further in-depth research on nutritional status of elderly based on contextual variables.

Development and application of optimum sensitivity analysis of structures

NASA Technical Reports Server (NTRS)

Barthelemy, J. F. M.; Hallauer, W. L., Jr.

1984-01-01

The research focused on developing an algorithm applying optimum sensitivity analysis for multilevel optimization. The research efforts have been devoted to assisting NASA Langley's Interdisciplinary Research Office (IRO) in the development of a mature methodology for a multilevel approach to the design of complex (large and multidisciplinary) engineering systems. An effort was undertaken to identify promising multilevel optimization algorithms. In the current reporting period, the computer program generating baseline single level solutions was completed and tested out.

Caregiver satisfaction with paediatric HIV treatment and care in Nigeria and equity implications for children living with HIV.

PubMed

Chamla, Dick; Asadu, Chukwuemeka; Adejuyigbe, Ebun; Davies, Abiola; Ugochukwu, Ebele; Umar, Lawal; Oluwafunke, Ilesanmi; Hassan-Hanga, Fatimah; Onubogu, Chinyere; Tunde-Oremodu, Immaculata; Madubuike, Chinelo; Umeadi, Esther; Epundu, Obed; Omosun, Adenike; Anigilaje, Emmanuel; Adeyinka, Daniel

2016-03-01

Caregiver satisfaction has the potential to promote equity for children living with HIV, by influencing health-seeking behaviour. We measured dimensions of caregiver satisfaction with paediatric HIV treatment in Nigeria, and discuss its implications for equity by conducting facility-based exit interviews for caregivers of children receiving antiretroviral therapy in 20 purposively selected facilities within 5 geopolitical zones. Descriptive analysis and factor analysis were performed. Due to the hierarchical nature of the data, multilevel regression modelling was performed to investigate relationships between satisfaction factors and socio-demographic variables. Of 1550 caregivers interviewed, 63% (95% CI: 60.6-65.4) reported being very satisfied overall; however, satisfaction varied in some dimensions: only 55.6% (53.1-58.1) of caregivers could talk privately with health workers, 56.9% (54.4-59.3) reported that queues to see health workers were too long, and 89.9% (88.4-91.4) said that some health workers did not treat patients living with HIV with sufficient respect. Based on factor analysis, two underlying factors, labelled Availability and Attitude, were identified. In multilevel regression, the satisfaction with availability of services correlated with formal employment status (p < .01), whereas caregivers receiving care in private facilities were less likely satisfied with both availability (p < .01) and attitude of health workers (p < .05). State and facility levels influenced attitudes of the health workers (p < .01), but not availability of services. We conclude that high levels of overall satisfaction among caregivers masked dissatisfaction with some aspects of services. The two underlying satisfaction factors are part of access typology critical for closing equity gaps in access to HIV treatment between adults and children, and across socio-economic groups.

Caregiver satisfaction with paediatric HIV treatment and care in Nigeria and equity implications for children living with HIV

PubMed Central

Chamla, Dick; Asadu, Chukwuemeka; Adejuyigbe, Ebun; Davies, Abiola; Ugochukwu, Ebele; Umar, Lawal; Oluwafunke, Ilesanmi; Hassan-Hanga, Fatimah; Onubogu, Chinyere; Tunde-Oremodu, Immaculata; Madubuike, Chinelo; Umeadi, Esther; Epundu, Obed; Omosun, Adenike; Anigilaje, Emmanuel; Adeyinka, Daniel

2016-01-01

ABSTRACT Caregiver satisfaction has the potential to promote equity for children living with HIV, by influencing health-seeking behaviour. We measured dimensions of caregiver satisfaction with paediatric HIV treatment in Nigeria, and discuss its implications for equity by conducting facility-based exit interviews for caregivers of children receiving antiretroviral therapy in 20 purposively selected facilities within 5 geopolitical zones. Descriptive analysis and factor analysis were performed. Due to the hierarchical nature of the data, multilevel regression modelling was performed to investigate relationships between satisfaction factors and socio-demographic variables. Of 1550 caregivers interviewed, 63% (95% CI: 60.6–65.4) reported being very satisfied overall; however, satisfaction varied in some dimensions: only 55.6% (53.1–58.1) of caregivers could talk privately with health workers, 56.9% (54.4–59.3) reported that queues to see health workers were too long, and 89.9% (88.4–91.4) said that some health workers did not treat patients living with HIV with sufficient respect. Based on factor analysis, two underlying factors, labelled Availability and Attitude, were identified. In multilevel regression, the satisfaction with availability of services correlated with formal employment status (p < .01), whereas caregivers receiving care in private facilities were less likely satisfied with both availability (p < .01) and attitude of health workers (p < .05). State and facility levels influenced attitudes of the health workers (p < .01), but not availability of services. We conclude that high levels of overall satisfaction among caregivers masked dissatisfaction with some aspects of services. The two underlying satisfaction factors are part of access typology critical for closing equity gaps in access to HIV treatment between adults and children, and across socio-economic groups. PMID:27392010

Multi-level factors influence the implementation and use of complex innovations in cancer care: a multiple case study of synoptic reporting.

PubMed

Urquhart, Robin; Porter, Geoffrey A; Sargeant, Joan; Jackson, Lois; Grunfeld, Eva

2014-09-16

The implementation of innovations (i.e., new tools and practices) in healthcare organizations remains a significant challenge. The objective of this study was to examine the key interpersonal, organizational, and system level factors that influenced the implementation and use of synoptic reporting tools in three specific areas of cancer care. Using case study methodology, we studied three cases in Nova Scotia, Canada, wherein synoptic reporting tools were implemented within clinical departments/programs. Synoptic reporting tools capture and present information about a medical or surgical procedure in a structured, checklist-like format and typically report only items critical for understanding the disease and subsequent impacts on patient care. Data were collected through semi-structured interviews with key informants, document analysis, nonparticipant observation, and tool use/examination. Analysis involved production of case histories, in-depth analysis of each case, and a cross-case analysis. Numerous techniques were used during the research design, data collection, and data analysis stages to increase the rigour of this study. The analysis revealed five common factors that were particularly influential to implementation and use of synoptic reporting tools across the three cases: stakeholder involvement, managing the change process (e.g., building demand, communication, training and support), champions and respected colleagues, administrative and managerial support, and innovation attributes (e.g., complexity, compatibility with interests and values). The direction of influence (facilitating or impeding) of each of these factors differed across and within cases. The findings demonstrate the importance of a multi-level contextual analysis to gaining both breadth and depth to our understanding of innovation implementation and use in health care. They also provide new insights into several important issues under-reported in the literature on moving innovations into healthcare practice, including the role of middle managers in implementation efforts and the importance of attending to the interpersonal aspects of implementation.

Conducting Multilevel Analyses in Medical Education

ERIC Educational Resources Information Center

Zyphur, Michael J.; Kaplan, Seth A.; Islam, Gazi; Barsky, Adam P.; Franklin, Michael S.

2008-01-01

A significant body of education literature has begun using multilevel statistical models to examine data that reside at multiple levels of analysis. In order to provide a primer for medical education researchers, the current work gives a brief overview of some issues associated with multilevel statistical modeling. To provide an example of this…

Variability in adherence to clinical practice guidelines and recommendations in COPD outpatients: a multi-level, cross-sectional analysis of the EPOCONSUL study.

PubMed

Calle Rubio, Myriam; López-Campos, José Luis; Soler-Cataluña, Juan J; Alcázar Navarrete, Bernardino; Soriano, Joan B; Rodríguez González-Moro, José Miguel; Fuentes Ferrer, Manuel E; Rodríguez Hermosa, Juan Luis

2017-12-02

Clinical audits have reported considerable variability in COPD medical care and frequent inconsistencies with recommendations. The objectives of this study were to identify factors associated with a better adherence to clinical practice guidelines and to explore determinants of this variability at the the hospital level. EPOCONSUL is a Spanish nationwide clinical audit that evaluates the outpatient management of COPD. Multilevel logistic regression with two levels was performed to assess the relationships between individual and disease-related factors, as well as hospital characteristics. A total of 4508 clinical records of COPD patients from 59 Spanish hospitals were evaluated. High variability was observed among hospitals in terms of medical care. Some of the patient's characteristics (airflow obstruction, degree of dyspnea, exacerbation risk, presence of comorbidities), the hospital factors (size and respiratory nurses available) and treatment at a specialized COPD outpatient clinic were identified as factors associated with a better adherence to recommendations, although this only explains a small proportion of the total variance. To be treated at a specialized COPD outpatient clinic and some intrinsic patient characteristics were factors associated with a better adherence to guideline recommendations, although these variables were only explaining part of the high variability observed among hospitals in terms of COPD medical care.

Social and individual risk factors for suicide ideation among Chinese children and adolescents: A multilevel analysis.

PubMed

Tan, Ling; Xia, Tiansheng; Reece, Christy

2018-04-01

The objective of this study was to investigate the prevalence and predictors of suicide ideation among primary, middle and high school students. We used multilevel modelling to investigate suicide ideation among 12,733 Chinese children and adolescents aged 9-18 years from wide range of areas across China. Approximately, 32.09% of children and adolescents reported suicide ideation, with females were more likely to report suicide ideation than males (38.09% vs. 29.95%). Our results showed that the risk factors in primary school students were different from middle and high school student groups, whereas significant risk factors for middle and high school students were similar. The city's standard of living as indicated by the Engel coefficient and the city's divorce rate were positively associated with the prevalence of suicide ideation; in contrast, the school's pupil-to-teacher ratio was negatively correlated with elevated suicide ideation. Significant risk factors for suicide ideation included study anxiety, self-accusation tendency, impulsive tendency, terror tendency and physical symptoms. These results have important implications for the prevention of suicide, suggesting that both contextual (city-level) and compositional (individual-level) factors could be important targets for prevention and intervention for children and adolescents at risk of suicide ideation. © 2016 International Union of Psychological Science.

Constructing and validating readability models: the method of integrating multilevel linguistic features with machine learning.

PubMed

Sung, Yao-Ting; Chen, Ju-Ling; Cha, Ji-Her; Tseng, Hou-Chiang; Chang, Tao-Hsing; Chang, Kuo-En

2015-06-01

Multilevel linguistic features have been proposed for discourse analysis, but there have been few applications of multilevel linguistic features to readability models and also few validations of such models. Most traditional readability formulae are based on generalized linear models (GLMs; e.g., discriminant analysis and multiple regression), but these models have to comply with certain statistical assumptions about data properties and include all of the data in formulae construction without pruning the outliers in advance. The use of such readability formulae tends to produce a low text classification accuracy, while using a support vector machine (SVM) in machine learning can enhance the classification outcome. The present study constructed readability models by integrating multilevel linguistic features with SVM, which is more appropriate for text classification. Taking the Chinese language as an example, this study developed 31 linguistic features as the predicting variables at the word, semantic, syntax, and cohesion levels, with grade levels of texts as the criterion variable. The study compared four types of readability models by integrating unilevel and multilevel linguistic features with GLMs and an SVM. The results indicate that adopting a multilevel approach in readability analysis provides a better representation of the complexities of both texts and the reading comprehension process.

Development of a multilevel health and safety climate survey tool within a mining setting.

PubMed

Parker, Anthony W; Tones, Megan J; Ritchie, Gabrielle E

2017-09-01

This study aimed to design, implement and evaluate the reliability and validity of a multifactorial and multilevel health and safety climate survey (HSCS) tool with utility in the Australian mining setting. An 84-item questionnaire was developed and pilot tested on a sample of 302 Australian miners across two open cut sites. A 67-item, 10 factor solution was obtained via exploratory factor analysis (EFA) representing prioritization and attitudes to health and safety across multiple domains and organizational levels. Each factor demonstrated a high level of internal reliability, and a series of ANOVAs determined a high level of consistency in responses across the workforce, and generally irrespective of age, experience or job category. Participants tended to hold favorable views of occupational health and safety (OH&S) climate at the management, supervisor, workgroup and individual level. The survey tool demonstrated reliability and validity for use within an open cut Australian mining setting and supports a multilevel, industry specific approach to OH&S climate. Findings suggested a need for mining companies to maintain high OH&S standards to minimize risks to employee health and safety. Future research is required to determine the ability of this measure to predict OH&S outcomes and its utility within other mine settings. As this tool integrates health and safety, it may have benefits for assessment, monitoring and evaluation in the industry, and improving the understanding of how health and safety climate interact at multiple levels to influence OH&S outcomes. Copyright © 2017 National Safety Council and Elsevier Ltd. All rights reserved.

The relationship between group size, intoxication and continuing to drink after bar attendance.

PubMed

Reed, Mark B; Clapp, John D; Martell, Brandi; Hidalgo-Sotelo, Alexandra

2013-11-01

The present study was undertaken to explore multilevel determinants of planning to continue to drink alcohol after leaving public drinking events. We assessed whether individual-level factors, group-related factors, or event-level bar characteristics were associated with post-bar drinking. We recruited a total of 642 participants from 30 participating bars in urban Southern California. Groups who arrived to patron a bar were interviewed upon their entrance and exit. Given data nesting, we employed a multilevel modeling approach to data analysis. More than one-third (40%) of our sample reported the intention to continue drinking as they exited the bar. Results of our multilevel model indicated eight individual-level variables significantly associated with intending to continue to drink. Time of night moderated the relationship between BrAC change and intentions to continue to drink. Although none of the group factors were significant in our model, a significant cross-level interaction between BrAC change and number of group members indicated the effect of intoxication on planning to continue to drink increases as group members increase. At the bar level, the presence of temporary bars and server offers of non-alcoholic drinks significantly decreased intentions to continue to drink. Given the large percentage of participants who reported the intention to continue drinking after exiting a bar, this study draws attention to the fact that field studies of drinking behavior may assess drinking mid-event rather than at the end of a drinking event. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Inequitable childhood immunization uptake in Nigeria: a multilevel analysis of individual and contextual determinants

PubMed Central

2009-01-01

Background Immunization coverage in many parts of Nigeria is far from optimal, and far from equitable. Nigeria accounts for half of the deaths from Measles in Africa, the highest prevalence of circulating wild poliovirus in the world, and the country is among the ten countries in the world with vaccine coverage below 50 percent. Studies focusing on community-level determinants therefore have serious policy implications Methods Multilevel multivariable regression analysis was used on a nationally-representative sample of women aged 15-49 years from the 2003 Nigeria Demographic and Health Survey. Multilevel regression analysis was performed with children (level 1) nested within mothers (level 2), who were in turn nested within communities (level 3). Results Results show that the pattern of full immunization clusters within families and communities, and that socio-economic characteristics are important in explaining the differentials in full immunization among the children in the study. At the individual level, ethnicity, mothers' occupation, and mothers' household wealth were characteristics of the mothers associated with full immunization of the children. At the community level, the proportion of mothers that had hospital delivery was a determinant of full immunization status. Conclusion Significant community-level variation remaining after having controlled for child- and mother-level characteristics is indicative of a need for further research on community-levels factors, which would enable extensive tailoring of community-level interventions aimed at improving full immunization and other child health outcomes. PMID:19930573

Alternatives to Multilevel Modeling for the Analysis of Clustered Data

ERIC Educational Resources Information Center

Huang, Francis L.

2016-01-01

Multilevel modeling has grown in use over the years as a way to deal with the nonindependent nature of observations found in clustered data. However, other alternatives to multilevel modeling are available that can account for observations nested within clusters, including the use of Taylor series linearization for variance estimation, the design…

The Effects of Autonomy and Empowerment on Employee Turnover: Test of a Multilevel Model in Teams

ERIC Educational Resources Information Center

Liu, Dong; Zhang, Shu; Wang, Lei; Lee, Thomas W.

2011-01-01

Extending research on voluntary turnover in the team setting, this study adopts a multilevel self-determination theoretical approach to examine the unique roles of individual and social-contextual motivational precursors, autonomy orientation and autonomy support, in reducing team member voluntary turnover. Analysis of multilevel time-lagged data…

A Social-Ecological Framework of Theory, Assessment, and Prevention of Suicide

PubMed Central

Cramer, Robert J.; Kapusta, Nestor D.

2017-01-01

The juxtaposition of increasing suicide rates with continued calls for suicide prevention efforts begs for new approaches. Grounded in the Centers for Disease Control and Prevention (CDC) framework for tackling health issues, this personal views work integrates relevant suicide risk/protective factor, assessment, and intervention/prevention literatures. Based on these components of suicide risk, we articulate a Social-Ecological Suicide Prevention Model (SESPM) which provides an integration of general and population-specific risk and protective factors. We also use this multi-level perspective to provide a structured approach to understanding current theories and intervention/prevention efforts concerning suicide. Following similar multi-level prevention efforts in interpersonal violence and Human Immunodeficiency Virus (HIV) domains, we offer recommendations for social-ecologically informed suicide prevention theory, training, research, assessment, and intervention programming. Although the SESPM calls for further empirical testing, it provides a suitable backdrop for tailoring of current prevention and intervention programs to population-specific needs. Moreover, the multi-level model shows promise to move suicide risk assessment forward (e.g., development of multi-level suicide risk algorithms or structured professional judgments instruments) to overcome current limitations in the field. Finally, we articulate a set of characteristics of social-ecologically based suicide prevention programs. These include the need to address risk and protective factors with the strongest degree of empirical support at each multi-level layer, incorporate a comprehensive program evaluation strategy, and use a variety of prevention techniques across levels of prevention. PMID:29062296

The associations of indoor environment and psychosocial factors on the subjective evaluation of Indoor Air Quality among lower secondary school students: a multilevel analysis.

PubMed

Finell, E; Haverinen-Shaughnessy, U; Tolvanen, A; Laaksonen, S; Karvonen, S; Sund, R; Saaristo, V; Luopa, P; Ståhl, T; Putus, T; Pekkanen, J

2017-03-01

Subjective evaluation of Indoor Air Quality (subjective IAQ) reflects both building-related and psychosocial factors, but their associations have rarely been studied other than on the individual level in occupational settings and their interactions have not been assessed. Therefore, we studied whether schools' observed indoor air problems and psychosocial factors are associated with subjective IAQ and their potential interactions. The analysis was performed with a nationwide sample (N = 195 schools/26946 students) using multilevel modeling. Two datasets were merged: (i) survey data from students, including information on schools' psychosocial environment and subjective IAQ, and (ii) data from school principals, including information on observed indoor air problems. On the student level, school-related stress, poor teacher-student relationship, and whether the student did not easily receive help from school personnel, were significantly associated with poor subjective IAQ. On the school level, observed indoor air problem (standardized β = -0.43) and poor teacher-student relationship (standardized β = -0.22) were significant predictors of poor subjective IAQ. In addition, school-related stress was associated with poor subjective IAQ, but only in schools without observed indoor air problem (standardized β = -0.44). © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A Multilevel Analysis of Students' Science Achievements in Relation to Their Self-Regulation, Epistemological Beliefs, Learning Environment Perceptions, and Teachers' Personal Characteristics

ERIC Educational Resources Information Center

Pamuk, Savas; Sungur, Semra; Oztekin, Ceren

2017-01-01

This study adopted a cross-sectional and correlational research design in an attempt to add our understanding of student- and teacher-level factors that help explain variability in students' science achievement to the existing literature. More specifically, the present article examined students' science achievement in relation to their…

Different Levels of Leadership for Learning: Investigating Differences between Teachers Individually and Collectively Using Multilevel Factor Analysis of the 2011-2012 Schools and Staffing Survey

ERIC Educational Resources Information Center

Boyce, Jared; Bowers, Alex J.

2018-01-01

This study investigated the differences between how individual teachers perceive leadership for learning and how teachers collectively perceive leadership for learning, using a large nationally generalizable data-set of 7070 schools from the National Center for Education Statistics 2011-2012 Schools and Staffing Survey. This study used…

A Comparison of Classroom and Online Asynchronous Problem-Based Learning for Students Undertaking Statistics Training as Part of a Public Health Masters Degree

ERIC Educational Resources Information Center

de Jong, N.; Verstegen, D. M. L.; Tan, F. E. S.; O'Connor, S. J.

2013-01-01

This case-study compared traditional, face-to-face classroom-based teaching with asynchronous online learning and teaching methods in two sets of students undertaking a problem-based learning module in the multilevel and exploratory factor analysis of longitudinal data as part of a Masters degree in Public Health at Maastricht University. Students…

Child-and School-Level Predictors of Children's Bullying Behavior: A Multilevel Analysis in 648 Primary Schools

ERIC Educational Resources Information Center

Fink, Elian; Patalay, Praveetha; Sharpe, Helen; Wolpert, Miranda

2018-01-01

A great deal of bullying behavior takes place at school, however, existing literature has predominantly focused on individual characteristics of children associated with bullying with less attention on school-level factors. The current study, comprising 23,215 children (51% boys) recruited from Year 4 or Year 5 (M = 9.06 years, SD = 0.56 years)…

Career stress and female managers' health in Taiwan's hospitals: a multilevel model approach.

PubMed

Chen, Duan-Rung; Lin, Yeh-Yun; Chung, Kuo-Piao

2008-01-01

This study investigates how perception-induced stress (barrier) and social capital (facilitator) affect the health of female managers. On the basis of the responses of 229 valid questionnaires of middle- and high-level female managers in large-scale hospitals, using a multilevel data analysis approach, this study investigates how perception-induced stress and social capital influence self-reported poor health of female managers. Analysis results indicate that all 3 perception-induced stresses (i.e., promotion-related procedural justice, promotion rate, and work-family conflict) and 2 social capital variables (i.e., mentor-assisted promotion and higher ranking mentor in other departments) are significantly associated with the health of female mangers. Factors involving the career success of women also affect their health. Health care organizations expecting to benefit from the long-term contribution of female elites must promote organizational equity and more heavily emphasize flexible work schedules, family-friendly policies, and perception management practices. In addition, adequately designed mentorship practices can greatly benefit female managers.

Embedding Multilevel Survival Analysis of Dyadic Social Interaction in Structural Equation Models: Hazard Rates as Both Outcomes and Predictors

PubMed Central

Snyder, James

2014-01-01

Objective Demonstrate multivariate multilevel survival analysis within a larger structural equation model. Test the 3 hypotheses that when confronted by a negative parent, child rates of angry, sad/fearful, and positive emotion will increase, decrease, and stay the same, respectively, for antisocial compared with normal children. This same pattern will predict increases in future antisocial behavior. Methods Parent–child dyads were videotaped in the fall of kindergarten in the laboratory and antisocial behavior ratings were obtained in the fall of kindergarten and third grade. Results Kindergarten antisocial predicted less child sad/fear and child positive but did not predict child anger given parent negative. Less child positive and more child neutral given parent negative predicted increases in third-grade antisocial behavior. Conclusions The model is a useful analytic tool for studying rates of social behavior. Lack of positive affect or excess neutral affect may be a new risk factor for child antisocial behavior. PMID:24133296

Geographic and Individual Differences in Healthcare Access for U.S. Transgender Adults: A Multilevel Analysis.

PubMed

White Hughto, Jaclyn M; Murchison, Gabriel R; Clark, Kirsty; Pachankis, John E; Reisner, Sari L

2016-12-01

To identify geographic and individual-level factors associated with healthcare access among transgender people in the United States. Multilevel analyses were conducted to investigate lifetime healthcare refusal using national data from 5831 U.S. transgender adults. Hierarchical generalized linear models examined associations between individual (age, gender, race, income, insurance, and healthcare avoidance) and state-level factors (percent voting Republican, percent same-sex couple households, income inequality, and transgender protective laws) and lifetime refusal of care. Results show that individual-level factors (being older; trans feminine; Native American, multiracial, or other racial/ethnic minority; having low income; and avoiding care due to discrimination) are positively associated with care refusal (all P-values <0.05). Adjusting for individual-level factors, variation was observed across U.S. states, with a greater proportion of states in the Southern and Western United States with transgender residents at increased odds of experiencing care refusal, relative to other regions of the United States. When adjusting for state-level factors, the percentage of the state population voting Republican was positively associated with care refusal among the transgender adults sampled (P < 0.01). Transgender adults surveyed reported differential access to healthcare by geographic region. Identifying geographic and individual-level factors associated with healthcare barriers allows for the development of targeted educational and policy interventions to improve healthcare access for transgender people most in need of services.

Spousal Violence in 5 Transitional Countries: A Population-Based Multilevel Analysis of Individual and Contextual Factors.

PubMed

Ismayilova, Leyla

2015-11-01

I examined the individual- and community-level factors associated with spousal violence in post-Soviet countries. I used population-based data from the Demographic and Health Survey conducted between 2005 and 2012. My sample included currently married women of reproductive age (n = 3932 in Azerbaijan, n = 4053 in Moldova, n = 1932 in Ukraine, n = 4361 in Kyrgyzstan, and n = 4093 in Tajikistan). I selected respondents using stratified multistage cluster sampling. Because of the nested structure of the data, multilevel logistic regressions for survey data were fitted to examine factors associated with spousal violence in the last 12 months. Partner's problem drinking was the strongest risk factor associated with spousal violence in all 5 countries. In Moldova, Ukraine, and Kyrgyzstan, women with greater financial power than their spouses were more likely to experience violence. Effects of community economic deprivation and of empowerment status of women in the community on spousal violence differed across countries. Women living in communities with a high tolerance of violence faced a higher risk of spousal violence in Moldova and Ukraine. In more traditional countries (Azerbaijan, Kyrgyzstan, and Tajikistan), spousal violence was lower in conservative communities with patriarchal gender beliefs or higher financial dependency on husbands. My findings underscore the importance of examining individual risk factors in the context of community-level factors and developing individual- and community-level interventions.

Geographic variation in work injuries: a multilevel analysis of individual-level data and area-level factors within Canada.

PubMed

Morassaei, Sara; Breslin, F Curtis; Ibrahim, Selahadin A; Smith, Peter M; Mustard, Cameron A; Amick, Benjamin C; Shankardass, Ketan; Petch, Jeremy

2013-05-01

This study sought to examine provincial variation in work injuries and to assess whether contextual factors are associated with geographic variation in work injuries. Individual-level data from the 2003 and 2005 Canadian Community Health Survey was obtained for a representative sample of 89,541 Canadians aged 15 to 75 years old who reported working in the past 12 months. A multilevel regression model was conducted to identify geographic variation and contextual factors associated with the likelihood of reporting an activity limiting work injury [corrected], while adjusting for demographic and work variables. Provincial differences in work injuries were observed, even after controlling for other risk factors. Workers in western provinces such as Saskatchewan (adjusted odds ratio [AOR], 1.30; 95% confidence interval [CI], 1.09-1.55), Alberta (AOR, 1.31; 95% CI, 1.13-1.51), and British Columbia (AOR, 1.46; 95% CI, 1.26-1.71) had a higher risk of work injuries compared with Ontario workers. Indicators of area-level material and social deprivation were not associated with work injury risk. Provincial differences in work injuries suggest that broader factors acting as determinants of work injuries are operating across workplaces at a provincial level. Future research needs to identify the provincial determinants and whether similar large area-level factors are driving work injuries in other countries. Copyright © 2013 Elsevier Inc. All rights reserved.

Phantom Effects in Multilevel Compositional Analysis: Problems and Solutions

ERIC Educational Resources Information Center

Pokropek, Artur

2015-01-01

This article combines statistical and applied research perspective showing problems that might arise when measurement error in multilevel compositional effects analysis is ignored. This article focuses on data where independent variables are constructed measures. Simulation studies are conducted evaluating methods that could overcome the…

Multilevel Interventions: Measurement and Measures

PubMed Central

Charns, Martin P.; Alligood, Elaine C.; Benzer, Justin K.; Burgess, James F.; Mcintosh, Nathalie M.; Burness, Allison; Partin, Melissa R.; Clauser, Steven B.

2012-01-01

Background Multilevel intervention research holds the promise of more accurately representing real-life situations and, thus, with proper research design and measurement approaches, facilitating effective and efficient resolution of health-care system challenges. However, taking a multilevel approach to cancer care interventions creates both measurement challenges and opportunities. Methods One-thousand seventy two cancer care articles from 2005 to 2010 were reviewed to examine the state of measurement in the multilevel intervention cancer care literature. Ultimately, 234 multilevel articles, 40 involving cancer care interventions, were identified. Additionally, literature from health services, social psychology, and organizational behavior was reviewed to identify measures that might be useful in multilevel intervention research. Results The vast majority of measures used in multilevel cancer intervention studies were individual level measures. Group-, organization-, and community-level measures were rarely used. Discussion of the independence, validity, and reliability of measures was scant. Discussion Measurement issues may be especially complex when conducting multilevel intervention research. Measurement considerations that are associated with multilevel intervention research include those related to independence, reliability, validity, sample size, and power. Furthermore, multilevel intervention research requires identification of key constructs and measures by level and consideration of interactions within and across levels. Thus, multilevel intervention research benefits from thoughtful theory-driven planning and design, an interdisciplinary approach, and mixed methods measurement and analysis. PMID:22623598

Multilevel and Community-Level Interventions with Native Americans: Challenges and Opportunities.

PubMed

Blue Bird Jernigan, Valarie; D'Amico, Elizabeth J; Duran, Bonnie; Buchwald, Dedra

2018-06-02

Multilevel and community-level interventions that target the social determinants of health and ultimately health disparities are seldom conducted in Native American communities. To contextualize the importance of multilevel and community-level interventions, major contributors to and causes of health disparities in Native communities are highlighted. Among the many documented socioeconomic factors influencing health are poverty, low educational attainment, and lack of insurance. Well-recognized health disparities include obesity, diabetes, and hypertension. Selected challenges of implementing community-level and multilevel interventions in Native communities are summarized such as the shortage of high-quality population health data and validated measurement tools. To address the lack of multilevel and community-level interventions, the National Institutes of Health created the Intervention Research to Improve Native American Health (IRINAH) program which solicits proposals that develop, adapt, and test strategies to address these challenges and create interventions appropriate for Native populations. A discussion of the strategies that four of the IRINAH grantees are implementing underscores the importance of community-based participatory policy work, the development of new partnerships, and reconnection with cultural traditions. Based on the work of the nearly 20 IRINAH grantees, ameliorating the complex social determinants of health disparities among Native people will require (1) support for community-level and multilevel interventions that examine contemporary and historical factors that shape current conditions; (2) sustainability plans; (3) forefronting the most challenging issues; (4) financial resources and time to collaborate with tribal leaders; and (5) a solid evidence base.

Using Visual Analysis to Evaluate and Refine Multilevel Models of Single-Case Studies

ERIC Educational Resources Information Center

Baek, Eun Kyeng; Petit-Bois, Merlande; Van den Noortgate, Wim; Beretvas, S. Natasha; Ferron, John M.

2016-01-01

In special education, multilevel models of single-case research have been used as a method of estimating treatment effects over time and across individuals. Although multilevel models can accurately summarize the effect, it is known that if the model is misspecified, inferences about the effects can be biased. Concern with the potential for model…

Distribution and Determinants of 90-Day Payments for Multilevel Posterior Lumbar Fusion: A Medicare Analysis.

PubMed

Jain, Nikhil; Phillips, Frank M; Khan, Safdar N

2018-04-01

A retrospective, economic analysis. The objective of this article is to analyze the distribution of 90-day payments, sources of variation, and reimbursement for complications and readmissions for primary ≥3-level posterior lumbar fusion (PLF) from Medicare data. A secondary objective was to identify risk factors for complications. Bundled payments represent a single payment system to cover all costs associated with a single episode of care, typically over 90 days. The dollar amount spent on different health service providers and the variation in payments for ≥3-level PLF have not been analyzed from a bundled perspective. Administrative claims data were used to study 90-day Medicare (2005-2012) reimbursements for primary ≥3-level PLF for deformity and degenerative conditions of the lumbar spine. Distribution of payments, sources of variation, and reimbursements for managing complications were studied using linear regression models. Risk factors for complications were studied by stepwise multiple-variable logistic regression analysis. Hospital payments comprised 73.8% share of total 90-day payment. Adjusted analysis identified several factors for variation in index hospital payments. The average 90-day Medicare payment for all multilevel PLFs without complications was $35,878 per patient. The additional average cost of treating complications with/without revision surgery within 90 days period ranged from $17,284 to $68,963. A 90-day bundle for ≥3-level PLF with readmission ranges from $88,648 (3 levels) to $117,215 (8+ levels). Rates and risk factors for complications were also identified. The average 90-day payment per patient from Medicare was $35,878 with several factors such as levels of surgery, comorbidities, and development of complications influencing the cost. The study also identifies the risks and costs associated with complications and readmissions and emphasize the significant effect these would have on bundled payments (additional burden of up to 192% the cost of an average uncomplicated procedure over 90 days). Level 3.

Surgical and Functional Outcomes After Multilevel Cervical Fusion for Degenerative Disc Disease Compared With Fusion for Radiculopathy: A Study of Workers' Compensation Population.

PubMed

Faour, Mhamad; Anderson, Joshua T; Haas, Arnold R; Percy, Rick; Woods, Stephen T; Ahn, Uri M; Ahn, Nicholas U

2017-05-01

Retrospective cohort comparative study. To evaluate presurgical and surgical factors that affect return to work (RTW) status after multilevel cervical fusion, and to compare outcomes after multilevel cervical fusion for degenerative disc disease (DDD) versus radiculopathy. Cervical fusion provides more than 90% of symptomatic relief for radiculopathy and myelopathy. However, cervical fusion for DDD without radiculopathy is considered controversial. In addition, multilevel fusion is associated with poorer surgical outcomes with increased levels fused. Data of cervical comorbidities was collected from Ohio Bureau of Workers' Compensation for subjects with work-related injuries. The study population included subjects who underwent multilevel cervical fusion. Patients with radiculopathy or DDD were identified. Multivariate logistic regression was performed to identify factors that affect RTW status. Surgical and functional outcomes were compared between groups. Stable RTW status within 3 years after multilevel cervical fusion was negatively affected by: fusion for DDD, age > 55 years, preoperative opioid use, initial psychological evaluation before surgery, injury-to-surgery > 2 years and instrumentation.DDD group had lower rate of achieving stable RTW status (P= 0.0001) and RTW within 1 year of surgery (P= 0.0003) compared with radiculopathy group. DDD patients were less likely to have a stable RTW status [odds ratio, OR = 0.63 (0.50-0.79)] or RTW within 1 year after surgery [OR = 0.65 (0.52-0.82)].DDD group had higher rate of opioid use (P= 0.001), and higher rate of disability after surgery (P= 0.002). Multiple detriments affect stable RTW status after multilevel cervical fusion including DDD. DDD without radiculopathy was associated with lower RTW rates, less likelihood to return to work, higher disability, and higher opioid use after surgery. Multilevel cervical fusion for DDD may be counterproductive. Future studies should investigate further treatment options of DDD, and optimize patient selection criteria for surgical intervention. 3.

Social Context and Dental Pain in Adults of Colombian Ethnic Minority Groups: A Multilevel Cross-Sectional Study.

PubMed

Ardila, Carlos M; Agudelo-Suárez, Andrés A

2016-01-01

To estimate the effect of social context on dental pain in adults of Colombian ethnic minority groups (CEGs). Information from 34,843 participants was used. A multilevel model was constructed that had ethnic groups (ie, CEGs and non-CEGs) at level 1 and Colombian states at level 2. Contextual variables included gross domestic product (GDP), Human Development Index (HDI), and Unmet Basic Needs Index (UBNI). Dental pain was observed in 12.3% of 6,440 CEGs. In an unadjusted logistic regression model, dental pain was associated with being a CEG (odds ratio [95% confidence interval], 1.34 [1.22-1.46]; P = .0001). This association remained significant after adjusting for possible confounding variables. An unconditional multilevel analysis showed that the variance in dental pain was statistically significant at the ethnic group level (β = 0.047 ± 0.015; P = .0009) and at the state level (β = 0.038 ± 0.019; P = .02) and that the variation between ethnic groups was higher than the variation between states (55% vs 45%, respectively). In a multivariate model, the variance in dental pain was also statistically significant at the ethnic group level (β = 0.029 ± 0.012; P = .007) and the state level (β = 0.042 ± .019; P = .01), but the variation between states was higher (40% vs 60%). The results of multilevel multivariate analyses showed that dental pain was associated with increasing age (β = 0.009 ± 0.001; P = .0001), lower education level (β = 0.302 ± 0.103; P = .0001), female sex (β = 0.031 ± 0.069; P = .003), GDP (β = 5.136 ± 2.009; P = .002) and HDI (β = 6.862 ± 5.550; P = .004); however, UBNI was not associated with dental pain. The variance in dental pain was higher between states than between ethnic groups in the multivariate multilevel model. Dental pain in CEGs was associated with contextual and individual factors. Considering contextual factors, GDP and HDI may play a major role in dental pain prevalence.

Effects of individual characteristics and school environment on cigarette smoking among students ages 13-15: A multilevel analysis of the 2007 Global Youth Tobacco Survey (GYTS) data from Vietnam.

PubMed

Van Minh, Hoang; Hai, Phan Thi; Giang, Kim Bao; Nga, Pham Quynh; Khanh, Pham Huyen; Lam, Nguyen Tuan; Kinh, Ly Ngoc

2011-01-01

This paper aims to estimate the prevalence of cigarette smoking among students in Vietnam ages 13-15 and examines its relationship with compositional and contextual factors. The data used in this paper were obtained from the 2007 Global Youth Tobacco Survey conducted in nine provinces in Vietnam. A multilevel logistic regression model was applied to analyse the association between the current incidence of cigarette smoking and factors on both the individual and school level. The prevalence of cigarette smoking among students was 3.3% overall. The prevalence of smoking among male students (5.9%) was higher than that among females (1.2%). Parental smoking was a significant risk factor for smoking among the students. Having a friend who smoked was the strongest predictor of smoking status among the study subjects. We have demonstrated that school-level factors appeared to impact the prevalence of cigarette smoking among students ages 13-15. This paper highlights the importance of utilising an extensive range of actions to prevent students from using tobacco in Vietnam. These actions should include providing specific curricula for students that address both individual characteristics and the school environment. Further, prevention programmes should also target both parental- and peer-smoking issues.

Associations of all-cause mortality with census-based neighbourhood deprivation and population density in Japan: a multilevel survival analysis.

PubMed

Nakaya, Tomoki; Honjo, Kaori; Hanibuchi, Tomoya; Ikeda, Ai; Iso, Hiroyasu; Inoue, Manami; Sawada, Norie; Tsugane, Shoichiro

2014-01-01

Despite evidence that neighbourhood conditions affect residents' health, no prospective studies of the association between neighbourhood socio-demographic factors and all-cause mortality have been conducted in non-Western societies. Thus, we examined the effects of areal deprivation and population density on all-cause mortality in Japan. We employed census and survival data from the Japan Public Health Center-based Prospective Study, Cohort I (n = 37,455), consisting of middle-aged residents (40 to 59 years at the baseline in 1990) living in four public health centre districts. Data spanned between 1990 and 2010. A multilevel parametric proportional-hazard regression model was applied to estimate the hazard ratios (HRs) of all-cause mortality by two census-based areal variables--areal deprivation index and population density--as well as individualistic variables such as socioeconomic status and various risk factors. We found that areal deprivation and population density had moderate associations with all-cause mortality at the neighbourhood level based on the survival data with 21 years of follow-ups. Even when controlling for individualistic socio-economic status and behavioural factors, the HRs of the two areal factors (using quartile categorical variables) significantly predicted mortality. Further, this analysis indicated an interaction effect of the two factors: areal deprivation prominently affects the health of residents in neighbourhoods with high population density. We confirmed that neighbourhood socio-demographic factors are significant predictors of all-cause death in Japanese non-metropolitan settings. Although further study is needed to clarify the cause-effect relationship of this association, the present findings suggest that health promotion policies should consider health disparities between neighbourhoods and possibly direct interventions towards reducing mortality in densely populated and highly deprived neighbourhoods.

Associations of All-Cause Mortality with Census-Based Neighbourhood Deprivation and Population Density in Japan: A Multilevel Survival Analysis

PubMed Central

Nakaya, Tomoki; Honjo, Kaori; Hanibuchi, Tomoya; Ikeda, Ai; Iso, Hiroyasu; Inoue, Manami; Sawada, Norie; Tsugane, Shoichiro

2014-01-01

Background Despite evidence that neighbourhood conditions affect residents' health, no prospective studies of the association between neighbourhood socio-demographic factors and all-cause mortality have been conducted in non-Western societies. Thus, we examined the effects of areal deprivation and population density on all-cause mortality in Japan. Methods We employed census and survival data from the Japan Public Health Center-based Prospective Study, Cohort I (n = 37,455), consisting of middle-aged residents (40 to 59 years at the baseline in 1990) living in four public health centre districts. Data spanned between 1990 and 2010. A multilevel parametric proportional-hazard regression model was applied to estimate the hazard ratios (HRs) of all-cause mortality by two census-based areal variables —areal deprivation index and population density—as well as individualistic variables such as socioeconomic status and various risk factors. Results We found that areal deprivation and population density had moderate associations with all-cause mortality at the neighbourhood level based on the survival data with 21 years of follow-ups. Even when controlling for individualistic socio-economic status and behavioural factors, the HRs of the two areal factors (using quartile categorical variables) significantly predicted mortality. Further, this analysis indicated an interaction effect of the two factors: areal deprivation prominently affects the health of residents in neighbourhoods with high population density. Conclusions We confirmed that neighbourhood socio-demographic factors are significant predictors of all-cause death in Japanese non-metropolitan settings. Although further study is needed to clarify the cause-effect relationship of this association, the present findings suggest that health promotion policies should consider health disparities between neighbourhoods and possibly direct interventions towards reducing mortality in densely populated and highly deprived neighbourhoods. PMID:24905731

Streaming, Tracking and Reading Achievement: A Multilevel Analysis of Students in 40 Countries

ERIC Educational Resources Information Center

Chiu, Ming Ming; Chow, Bonnie Wing-Yin; Joh, Sung Wook

2017-01-01

Grouping similar students together within schools ("streaming") or classrooms ("tracking") based on past literacy skills (reported by parents), family socioeconomic status (SES) or reading attitudes might affect their reading achievement. Our multilevel analysis of the reading tests of 208,057 fourth-grade students across 40…

Single-Level and Multilevel Mediation Analysis

ERIC Educational Resources Information Center

Tofighi, Davood; Thoemmes, Felix

2014-01-01

Mediation analysis is a statistical approach used to examine how the effect of an independent variable on an outcome is transmitted through an intervening variable (mediator). In this article, we provide a gentle introduction to single-level and multilevel mediation analyses. Using single-level data, we demonstrate an application of structural…

The Impact of Misspecifying the Within-Subject Covariance Structure in Multiwave Longitudinal Multilevel Models: A Monte Carlo Study

ERIC Educational Resources Information Center

Kwok, Oi-man; West, Stephen G.; Green, Samuel B.

2007-01-01

This Monte Carlo study examined the impact of misspecifying the [big sum] matrix in longitudinal data analysis under both the multilevel model and mixed model frameworks. Under the multilevel model approach, under-specification and general-misspecification of the [big sum] matrix usually resulted in overestimation of the variances of the random…

National Profiles of Classroom Quality and Family Involvement: A Multilevel Examination of Proximal Influences on Head Start Children's School Readiness

ERIC Educational Resources Information Center

Bulotsky-Shearer, Rebecca J.; Wen, Xiaoli; Faria, Ann-Marie; Hahs-Vaughn, Debbie L.; Korfmacher, Jon

2012-01-01

Guided by a developmental and ecological model, the study employed latent profile analysis to identify a multilevel typology of family involvement and Head Start classroom quality. Using the nationally representative Head Start Family and Child Experiences Survey (FACES 1997; N = 1870), six multilevel latent profiles were estimated, characterized…

Multilevel geometry optimization

NASA Astrophysics Data System (ADS)

Rodgers, Jocelyn M.; Fast, Patton L.; Truhlar, Donald G.

2000-02-01

Geometry optimization has been carried out for three test molecules using six multilevel electronic structure methods, in particular Gaussian-2, Gaussian-3, multicoefficient G2, multicoefficient G3, and two multicoefficient correlation methods based on correlation-consistent basis sets. In the Gaussian-2 and Gaussian-3 methods, various levels are added and subtracted with unit coefficients, whereas the multicoefficient Gaussian-x methods involve noninteger parameters as coefficients. The multilevel optimizations drop the average error in the geometry (averaged over the 18 cases) by a factor of about two when compared to the single most expensive component of a given multilevel calculation, and in all 18 cases the accuracy of the atomization energy for the three test molecules improves; with an average improvement of 16.7 kcal/mol.

Individual- and Neighbourhood-Level Indicators of Subjective Well-Being in a Small and Poor Eastern Cape Township: The Effect of Health, Social Capital, Marital Status, and Income

ERIC Educational Resources Information Center

Cramm, J. M.; Moller, V.; Nieboer, A. P.

2012-01-01

Our study used multilevel regression analysis to identify individual- and neighbourhood-level factors that determine individual-level subjective well-being in Rhini, a deprived suburb of Grahamstown in the Eastern Cape province of South Africa. The Townsend index and Gini coefficient were used to investigate whether contextual neighbourhood-level…

[How to fit and interpret multilevel models using SPSS].

PubMed

Pardo, Antonio; Ruiz, Miguel A; San Martín, Rafael

2007-05-01

Hierarchic or multilevel models are used to analyse data when cases belong to known groups and sample units are selected both from the individual level and from the group level. In this work, the multilevel models most commonly discussed in the statistic literature are described, explaining how to fit these models using the SPSS program (any version as of the 11 th ) and how to interpret the outcomes of the analysis. Five particular models are described, fitted, and interpreted: (1) one-way analysis of variance with random effects, (2) regression analysis with means-as-outcomes, (3) one-way analysis of covariance with random effects, (4) regression analysis with random coefficients, and (5) regression analysis with means- and slopes-as-outcomes. All models are explained, trying to make them understandable to researchers in health and behaviour sciences.

Prevention of secondary household transmission during Shiga toxin-producing Escherichia coli outbreaks.

PubMed

Tokuda, K; Yahata, Y; Sunagawa, T

2016-10-01

Prevention of secondary household transmission of Shiga toxin-producing Escherichia coli (STEC) is important in outbreak settings. We examined factors contributing to secondary household transmission during STEC outbreaks in daycare centres in Japan. Suspected STEC outbreaks in daycare centres were identified by the National Epidemiological Surveillance of Infectious Diseases. Questionnaires were sent to local health centres that responded to outbreaks. Secondary household transmission rates were calculated, and factors affecting secondary household transmission rate were analysed by multilevel analysis. The secondary household transmission rates in 16 outbreaks ranged from 0% to 34·4% (median 4·4%). The highest rate (23·0%) was observed in siblings aged 6-9 years, and the infection rate was significantly higher for mothers than for fathers and grandparents (P < 0·05). Using multilevel analysis, the following variables were selected in the best model: information provided face-to-face (vs. letter or telephone) to families of children in daycare centres (at initial response), STEC type and lag time (days) between onset and providing information. Early response and hygiene education by visiting local health centre staff may be effective measures to prevent secondary household transmission in STEC outbreaks. Hygiene education should be emphasized for children aged 6-9 years, as well as for younger children.

Predictors of professional placement outcome: cultural background, English speaking and international student status.

PubMed

Attrill, Stacie; McAllister, Sue; Lincoln, Michelle

2016-08-01

Placements provide opportunities for students to develop practice skills in professional settings. Learning in placements may be challenging for culturally and linguistically diverse (CALD) students, international students, or those without sufficient English proficiency for professional practice. This study investigated whether these factors, which are hypothesized to influence acculturation, predict poor placement outcome. Placement outcome data were collected for 854 students who completed 2747 placements. Placement outcome was categorized into 'Pass' or 'At risk' categories. Multilevel binomial regression analysis was used to determine whether being CALD, an international student, speaking 'English as an additional language', or a 'Language other than English at home' predicted placement outcome. In multiple multilevel analysis speaking English as an additional language and being an international student were significant predictors of 'at risk' placements, but other variables tested were not. Effect sizes were small indicating untested factors also influenced placement outcome. These results suggest that students' English as an additional language or international student status influences success in placements. The extent of acculturation may explain the differences in placement outcome for the groups tested. This suggests that learning needs for placement may differ for students undertaking more acculturative adjustments. Further research is needed to understand this and to identify placement support strategies.

Multilevel Factor Analyses of Family Data from the Hawai'i Family Study of Cognition

ERIC Educational Resources Information Center

McArdle, John J.; Hamagami, Fumiaki; Bautista, Randy; Onoye, Jane; Hishinuma, Earl S.; Prescott, Carol A.; Takeshita, Junji; Zonderman, Alan B.; Johnson, Ronald C.

2014-01-01

In this study, we reanalyzed the classic Hawai'i Family Study of Cognition (HFSC) data using contemporary multilevel modeling techniques. We used the HFSC baseline data ("N" = 6,579) and reexamined the factorial structure of 16 cognitive variables using confirmatory (restricted) measurement models in an explicit sequence. These models…

Stakeholder conceptualisation of multi-level HIV and AIDS determinants in a Black epicentre.

PubMed

Brawner, Bridgette M; Reason, Janaiya L; Hanlon, Kelsey; Guthrie, Barbara; Schensul, Jean J

2017-09-01

HIV has reached epidemic proportions among African Americans in the USA but certain urban contexts appear to experience a disproportionate disease burden. Geographic information systems mapping in Philadelphia indicates increased HIV incidence and prevalence in predominantly Black census tracts, with major differences across adjacent communities. What factors shape these geographic HIV disparities among Black Philadelphians? This descriptive study was designed to refine and validate a conceptual model developed to better understand multi-level determinants of HIV-related risk among Black Philadelphians. We used an expanded ecological approach to elicit reflective perceptions from administrators, direct service providers and community members about individual, social and structural factors that interact to protect against or increase the risk for acquiring HIV within their community. Gender equity, social capital and positive cultural mores (e.g., monogamy, abstinence) were seen as the main protective factors. Historical negative contributory influences of racial residential segregation, poverty and incarceration were among the most salient risk factors. This study was a critical next step toward initiating theory-based, multi-level community-based HIV prevention initiatives.

Theoretical and software considerations for nonlinear dynamic analysis

NASA Technical Reports Server (NTRS)

Schmidt, R. J.; Dodds, R. H., Jr.

1983-01-01

In the finite element method for structural analysis, it is generally necessary to discretize the structural model into a very large number of elements to accurately evaluate displacements, strains, and stresses. As the complexity of the model increases, the number of degrees of freedom can easily exceed the capacity of present-day software system. Improvements of structural analysis software including more efficient use of existing hardware and improved structural modeling techniques are discussed. One modeling technique that is used successfully in static linear and nonlinear analysis is multilevel substructuring. This research extends the use of multilevel substructure modeling to include dynamic analysis and defines the requirements for a general purpose software system capable of efficient nonlinear dynamic analysis. The multilevel substructuring technique is presented, the analytical formulations and computational procedures for dynamic analysis and nonlinear mechanics are reviewed, and an approach to the design and implementation of a general purpose structural software system is presented.

A multilevel model for comorbid outcomes: obesity and diabetes in the US.

PubMed

Congdon, Peter

2010-02-01

Multilevel models are overwhelmingly applied to single health outcomes, but when two or more health conditions are closely related, it is important that contextual variation in their joint prevalence (e.g., variations over different geographic settings) is considered. A multinomial multilevel logit regression approach for analysing joint prevalence is proposed here that includes subject level risk factors (e.g., age, race, education) while also taking account of geographic context. Data from a US population health survey (the 2007 Behavioral Risk Factor Surveillance System or BRFSS) are used to illustrate the method, with a six category multinomial outcome defined by diabetic status and weight category (obese, overweight, normal). The influence of geographic context is partly represented by known geographic variables (e.g., county poverty), and partly by a model for latent area influences. In particular, a shared latent variable (common factor) approach is proposed to measure the impact of unobserved area influences on joint weight and diabetes status, with the latent variable being spatially structured to reflect geographic clustering in risk.

A Multilevel Analysis of Neighborhood Socioeconomic Disadvantage and Transactional Sex with Casual Partners Among Young Men Who Have Sex with Men Living in Metro Detroit.

PubMed

Bauermeister, José; Eaton, Lisa; Stephenson, Rob

2016-01-01

The role of structural factors when evaluating the vulnerability of human immunodeficiency virus/sexually transmitted infection (HIV/STI) risks among young gay, bisexual, and other men who have sex with men is an important area of focus for HIV prevention. Using cross-sectional data from young men living in Metro Detroit (N = 319; aged 18-29 years; 50% black, 25% white, 15% Latino, 9% other race/ethnicity; 9% HIV-positive), we examined whether transactional sex with casual partners was associated with neighborhood-level socioeconomic disadvantage and individual-level factors (race/ethnicity and sexual identity, socioeconomic status, HIV/STI diagnoses, and substance use). Youth living in greater socioeconomic disadvantage reported more transactional sex (b = 0.11; SE = 0.04; p ≤ 0.01). This relationship was mitigated once individual-level correlates were entered into the model. Multilevel efforts to counteract socioeconomic deficits through community and individual level strategies may alleviate youth's exposure to transactional sex and reduce their vulnerability to HIV/STI risks.

Design and Analysis of an Axisymmetric Phased Array Fed Gregorian Reflector System for Limited Scanning

DTIC Science & Technology

2016-01-22

Numerical electromagnetic simulations based on the multilevel fast multipole method (MLFMM) were used to analyze and optimize the antenna...and are not necessarily endorsed by the United States Government. numerical simulations with the multilevel fast multipole method (MLFMM...and optimized using numerical simulations conducted with the multilevel fast multipole method (MLFMM) using FEKO software (www.feko.info). The

Help Seeking in Online Collaborative Groupwork: A Multilevel Analysis

ERIC Educational Resources Information Center

Du, Jianxia; Xu, Jianzhong; Fan, Xitao

2015-01-01

This study examined predictive models for students' help seeking in the context of online collaborative groupwork. Results from multilevel analysis revealed that most of the variance in help seeking was at the individual student level, and multiple variables at the individual level were predictive of help-seeking behaviour. Help seeking was…

Neighborhoods, Social Support, and African American Adolescents' Mental Health Outcomes: A Multilevel Path Analysis

ERIC Educational Resources Information Center

Hurd, Noelle M.; Stoddard, Sarah A.; Zimmerman, Marc A.

2013-01-01

This study explored how neighborhood characteristics may relate to African American adolescents' internalizing symptoms via adolescents' social support and perceptions of neighborhood cohesion. Participants included 571 urban, African American adolescents (52% female; "M" age = 17.8). A multilevel path analysis testing both direct and…

Using Multilevel Analysis to Monitor Test Performance across Administrations. Research Report. ETS RR-14-29

ERIC Educational Resources Information Center

Wei, Youhua; Qu, Yanxuan

2014-01-01

For a testing program with frequent administrations, it is important to understand and monitor the stability and fluctuation of test performance across administrations. Different methods have been proposed for this purpose. This study explored the potential of using multilevel analysis to understand and monitor examinees' test performance across…

Multilevel Safety Climate and Safety Performance in the Construction Industry: Development and Validation of a Top-Down Mechanism

PubMed Central

Gao, Ran; Chan, Albert P.C.; Utama, Wahyudi P.; Zahoor, Hafiz

2016-01-01

The character of construction projects exposes front-line workers to dangers and accidents. Safety climate has been confirmed to be a predictor of safety performance in the construction industry. This study aims to explore the underlying mechanisms of the relationship between multilevel safety climate and safety performance. An integrated model was developed to study how particular safety climate factors of one level affect those of other levels, and then affect safety performance from the top down. A questionnaire survey was administered on six construction sites in Vietnam. A total of 1030 valid questionnaires were collected from this survey. Approximately half of the data were used to conduct exploratory factor analysis (EFA) and the remaining data were submitted to structural equation modeling (SEM). Top management commitment (TMC) and supervisors’ expectation (SE) were identified as factors to represent organizational safety climate (OSC) and supervisor safety climate (SSC), respectively, and coworkers’ caring and communication (CCC) and coworkers’ role models (CRM) were identified as factors to denote coworker safety climate (CSC). SEM results show that OSC factor is positively related to SSC factor and CSC factors significantly. SSC factor could partially mediate the relationship between OSC factor and CSC factors, as well as the relationship between OSC factor and safety performance. CSC factors partially mediate the relationship between OSC factor and safety performance, and the relationship between SSC factor and safety performance. The findings imply that a positive safety culture should be established both at the organizational level and the group level. Efforts from all top management, supervisors, and coworkers should be provided to improve safety performance in the construction industry. PMID:27834823

Multilevel Safety Climate and Safety Performance in the Construction Industry: Development and Validation of a Top-Down Mechanism.

PubMed

Gao, Ran; Chan, Albert P C; Utama, Wahyudi P; Zahoor, Hafiz

2016-11-08

The character of construction projects exposes front-line workers to dangers and accidents. Safety climate has been confirmed to be a predictor of safety performance in the construction industry. This study aims to explore the underlying mechanisms of the relationship between multilevel safety climate and safety performance. An integrated model was developed to study how particular safety climate factors of one level affect those of other levels, and then affect safety performance from the top down. A questionnaire survey was administered on six construction sites in Vietnam. A total of 1030 valid questionnaires were collected from this survey. Approximately half of the data were used to conduct exploratory factor analysis (EFA) and the remaining data were submitted to structural equation modeling (SEM). Top management commitment (TMC) and supervisors' expectation (SE) were identified as factors to represent organizational safety climate (OSC) and supervisor safety climate (SSC), respectively, and coworkers' caring and communication (CCC) and coworkers' role models (CRM) were identified as factors to denote coworker safety climate (CSC). SEM results show that OSC factor is positively related to SSC factor and CSC factors significantly. SSC factor could partially mediate the relationship between OSC factor and CSC factors, as well as the relationship between OSC factor and safety performance. CSC factors partially mediate the relationship between OSC factor and safety performance, and the relationship between SSC factor and safety performance. The findings imply that a positive safety culture should be established both at the organizational level and the group level. Efforts from all top management, supervisors, and coworkers should be provided to improve safety performance in the construction industry.

Multilevel sparse functional principal component analysis.

PubMed

Di, Chongzhi; Crainiceanu, Ciprian M; Jank, Wolfgang S

2014-01-29

We consider analysis of sparsely sampled multilevel functional data, where the basic observational unit is a function and data have a natural hierarchy of basic units. An example is when functions are recorded at multiple visits for each subject. Multilevel functional principal component analysis (MFPCA; Di et al. 2009) was proposed for such data when functions are densely recorded. Here we consider the case when functions are sparsely sampled and may contain only a few observations per function. We exploit the multilevel structure of covariance operators and achieve data reduction by principal component decompositions at both between and within subject levels. We address inherent methodological differences in the sparse sampling context to: 1) estimate the covariance operators; 2) estimate the functional principal component scores; 3) predict the underlying curves. Through simulations the proposed method is able to discover dominating modes of variations and reconstruct underlying curves well even in sparse settings. Our approach is illustrated by two applications, the Sleep Heart Health Study and eBay auctions.

Analyzing Multiple Outcomes in Clinical Research Using Multivariate Multilevel Models

PubMed Central

Baldwin, Scott A.; Imel, Zac E.; Braithwaite, Scott R.; Atkins, David C.

2014-01-01

Objective Multilevel models have become a standard data analysis approach in intervention research. Although the vast majority of intervention studies involve multiple outcome measures, few studies use multivariate analysis methods. The authors discuss multivariate extensions to the multilevel model that can be used by psychotherapy researchers. Method and Results Using simulated longitudinal treatment data, the authors show how multivariate models extend common univariate growth models and how the multivariate model can be used to examine multivariate hypotheses involving fixed effects (e.g., does the size of the treatment effect differ across outcomes?) and random effects (e.g., is change in one outcome related to change in the other?). An online supplemental appendix provides annotated computer code and simulated example data for implementing a multivariate model. Conclusions Multivariate multilevel models are flexible, powerful models that can enhance clinical research. PMID:24491071

Does it really matter where women live? A multilevel analysis of the determinants of postnatal care in Nigeria.

PubMed

Ononokpono, Dorothy N; Odimegwu, Clifford O; Imasiku, Eunice N S; Adedini, Sunday A

2014-05-01

Although postnatal care is one of the major interventions recommended for the reduction of maternal and newborn deaths worldwide, almost two-third (56 %) of women in Nigeria do not receive postnatal care. Attempts to explain this situation have focused on individual and household level factors, but the role of community characteristics has received less attention.This study examines community factors associated with the receipt of postnatal care in Nigeria and the moderating effects of community factors on the association between individual factors and postnatal care. Data was drawn from the 2008 Nigeria Demographic and Health Survey, and a sample of 17,846 women aged 15-49 years was selected. We employed a multilevel logistic regression analysis to identify community factors associated with postnatal care. Our findings showed that significant variations in receiving postnatal care exist across communities. Specifically, Nigerian women's likelihood of receiving postnatal care is a function of where they reside. Living in communities with a high proportion of educated women (OR = 2.04; 95 % CI = 1.32-3.16; p < 0.001) and a high proportion of those who have had a health facility delivery (OR = 17.86; 95 % CI = 8.34-38.24; p < 0.001) was significantly associated with an increased likelihood of receiving postnatal care. Community women's education moderated the association between ethnic origin and postnatal care. Community variance in postnatal care was significant (τ = 10.352, p = 0.001). Community interventions aimed at improving postnatal care should take into account the community context in which women live. To close the gap in community variations in postnatal care, secondary and higher education for women, and health facility delivery should be increased in disadvantaged communities.

REGIONAL VARIATIONS IN INFANT AND CHILD MORTALITY IN NIGERIA: A MULTILEVEL ANALYSIS.

PubMed

Adedini, Sunday A; Odimegwu, Clifford; Imasiku, Eunice N S; Ononokpono, Dorothy N; Ibisomi, Latifat

2015-03-01

There are substantial regional disparities in under-five mortality in Nigeria, and evidence suggests that both individual- and community-level characteristics have an influence on health outcomes. Using 2008 Nigeria Demographic and Health Survey data, this study (1) examines the effects of individual- and community-level characteristics on infant/child mortality in Nigeria and (2) determines the extent to which characteristics at these levels influence regional variations in infant/child mortality in the country. Multilevel Cox proportional hazard analysis was performed on a nationally representative sample of 28,647 children nested within 18,028 mothers of reproductive age, who were also nested within 886 communities. The results indicate that community-level variables (such as region, place of residence, community infrastructure, community hospital delivery and community poverty level) and individual-level factors (including child's sex, birth order, birth interval, maternal education, maternal age and wealth index) are important determinants of infant/child mortality in Nigeria. For instance, the results show a lower risk of death in infancy for children of mothers residing in communities with a high proportion of hospital delivery (HR: 0.70, p < 0.05) and for children whose mothers had secondary or higher education (HR: 0.84, p < 0.05). Although community factors appear to influence the association between individual-level factors and death during infancy and childhood, the findings consistently indicate that community-level characteristics are more important in explaining regional variations in child mortality, while individual-level factors are more important for regional variations in infant mortality. The results of this study underscore the need to look beyond the influence of individual-level factors in addressing regional variations in infant and child mortality in Nigeria.

The role of healthcare system in dental check-ups in 27 European countries: multilevel analysis.

PubMed

Kino, Shiho; Bernabé, Eduardo; Sabbah, Wael

2017-06-01

To examine whether public expenditure on health and Euro Health Consumer Index (EHCI) are associated with dental check-ups in European countries. Individual data were from Eurobarometer 72.3, 2009 a cross-national survey of 27 European countries. Eligible participants were those aged 18 years and older in 27 European countries. Dental check-ups reflected dental visits for oral examination and getting advice on oral health in the last 12 months. Individual factors included age, gender, marital status, urbanisation, education, subjective social status, and difficulty in paying bills. Public expenditure on health as a percentage of gross domestic product (GDP) and EHCI were used as contextual factors. A set of multilevel logistic regression models was used to examine the relationship between dental check-ups and each of healthcare expenditure and EHCI adjusting for demographic factors, GDP per capita and socioeconomic indicators. Total number included in the analysis was 23,842. Participants in countries with greater healthcare expenditure and higher score of EHCI were significantly 1.17 (95% CI: 1.03, 1.32) and 1.30 times (95% CI: 1.04, 1.64) more likely to report dental check-ups within the past 12 months after accounting for demographic characteristics, GDP per capita, and all socioeconomic indicators. The findings suggest that greater governmental support for the healthcare and better characteristics of healthcare system are positively associated with routine dental attendance. © 2017 American Association of Public Health Dentistry.

Multilevel Factor Structure and Concurrent Validity of the Teacher Version of the Authoritative School Climate Survey.

PubMed

Huang, Francis L; Cornell, Dewey G; Konold, Timothy; Meyer, Joseph P; Lacey, Anna; Nekvasil, Erin K; Heilbrun, Anna; Shukla, Kathan D

2015-12-01

School climate is well recognized as an important influence on student behavior and adjustment to school, but there is a need for theory-guided measures that make use of teacher perspectives. Authoritative school climate theory hypothesizes that a positive school climate is characterized by high levels of disciplinary structure and student support. A teacher version of the Authoritative School Climate Survey (ASCS) was administered to a statewide sample of 9099 7th- and 8th-grade teachers from 366 schools. The study used exploratory and multilevel confirmatory factor analyses (MCFA) that accounted for the nested data structure and allowed for the modeling of the factor structures at 2 levels. Multilevel confirmatory factor analyses conducted on both an exploratory (N = 4422) and a confirmatory sample (N = 4677) showed good support for the factor structures investigated. Factor correlations at 2 levels indicated that schools with greater levels of disciplinary structure and student support had higher student engagement, less teasing and bullying, and lower student aggression toward teachers. The teacher version of the ASCS can be used to assess 2 key domains of school climate and associated measures of student engagement and aggression toward peers and teachers. © 2015, American School Health Association.

A Multilevel Model of Minority Opinion Expression and Team Decision-Making Effectiveness

ERIC Educational Resources Information Center

Park, Guihyun; DeShon, Richard P.

2010-01-01

The consideration of minority opinions when making team decisions is an important factor that contributes to team effectiveness. A multilevel model of minority opinion influence in decision-making teams is developed to address the conditions that relate to adequate consideration of minority opinions. Using a sample of 57 teams working on a…

Geographic and Individual Differences in Healthcare Access for U.S. Transgender Adults: A Multilevel Analysis

PubMed Central

Murchison, Gabriel R.; Clark, Kirsty; Pachankis, John E.; Reisner, Sari L.

2016-01-01

Abstract Purpose: To identify geographic and individual-level factors associated with healthcare access among transgender people in the United States. Methods: Multilevel analyses were conducted to investigate lifetime healthcare refusal using national data from 5831 U.S. transgender adults. Hierarchical generalized linear models examined associations between individual (age, gender, race, income, insurance, and healthcare avoidance) and state-level factors (percent voting Republican, percent same-sex couple households, income inequality, and transgender protective laws) and lifetime refusal of care. Results: Results show that individual-level factors (being older; trans feminine; Native American, multiracial, or other racial/ethnic minority; having low income; and avoiding care due to discrimination) are positively associated with care refusal (all P-values <0.05). Adjusting for individual-level factors, variation was observed across U.S. states, with a greater proportion of states in the Southern and Western United States with transgender residents at increased odds of experiencing care refusal, relative to other regions of the United States. When adjusting for state-level factors, the percentage of the state population voting Republican was positively associated with care refusal among the transgender adults sampled (P < 0.01). Conclusion: Transgender adults surveyed reported differential access to healthcare by geographic region. Identifying geographic and individual-level factors associated with healthcare barriers allows for the development of targeted educational and policy interventions to improve healthcare access for transgender people most in need of services. PMID:27636030

Spousal Violence in 5 Transitional Countries: A Population-Based Multilevel Analysis of Individual and Contextual Factors

PubMed Central

2015-01-01

Objectives. I examined the individual- and community-level factors associated with spousal violence in post-Soviet countries. Methods. I used population-based data from the Demographic and Health Survey conducted between 2005 and 2012. My sample included currently married women of reproductive age (n = 3932 in Azerbaijan, n = 4053 in Moldova, n = 1932 in Ukraine, n = 4361 in Kyrgyzstan, and n = 4093 in Tajikistan). I selected respondents using stratified multistage cluster sampling. Because of the nested structure of the data, multilevel logistic regressions for survey data were fitted to examine factors associated with spousal violence in the last 12 months. Results. Partner’s problem drinking was the strongest risk factor associated with spousal violence in all 5 countries. In Moldova, Ukraine, and Kyrgyzstan, women with greater financial power than their spouses were more likely to experience violence. Effects of community economic deprivation and of empowerment status of women in the community on spousal violence differed across countries. Women living in communities with a high tolerance of violence faced a higher risk of spousal violence in Moldova and Ukraine. In more traditional countries (Azerbaijan, Kyrgyzstan, and Tajikistan), spousal violence was lower in conservative communities with patriarchal gender beliefs or higher financial dependency on husbands. Conclusions. My findings underscore the importance of examining individual risk factors in the context of community-level factors and developing individual- and community-level interventions. PMID:26378858

Student and school factors associated with school suspension: A multilevel analysis of students in Victoria, Australia and Washington State, United States.

PubMed

Sheryl, A Hemphill; Stephanie, M Plenty; Herrenkohl, Todd I; Toumbourou, John W; Catalano, Richard F

2014-01-01

One of the common issues schools face is how best to handle challenging student behaviors such as violent behavior, antisocial behavior, bullying, school rule violations, and interrupting other students' learning. School suspension may be used to remove students engaging in challenging behaviors from the school for a period of time. However, the act of suspending students from school may worsen rather than improve their behavior. Research shows that suspensions predict a range of student outcomes, including crime, delinquency, and drug use. It is therefore crucial to understand the factors associated with the use of school suspension, particularly in sites with different policy approaches to problem behaviors. This paper draws on data from state-representative samples of 3,129 Grade 7 and 9 students in Washington State, United States and Victoria, Australia sampled in 2002. Multilevel modeling examined student and school level factors associated with student-reported school suspension. Results showed that both student (being male, previous student antisocial and violent behavior, rebelliousness, academic failure) and school (socioeconomic status of the school, aggregate measures of low school commitment) level factors were associated with school suspension and that the factors related to suspension were similar in the two states. The implications of the findings for effective school behavior management policy are that, rather than focusing only on the student, both student and school level factors need to be addressed to reduce the rates of school suspension.

Student and school factors associated with school suspension: A multilevel analysis of students in Victoria, Australia and Washington State, United States

PubMed Central

Sheryl, A. Hemphill; Stephanie, M. Plenty; Herrenkohl, Todd I.; Toumbourou, John W.; Catalano, Richard F.

2014-01-01

One of the common issues schools face is how best to handle challenging student behaviors such as violent behavior, antisocial behavior, bullying, school rule violations, and interrupting other students’ learning. School suspension may be used to remove students engaging in challenging behaviors from the school for a period of time. However, the act of suspending students from school may worsen rather than improve their behavior. Research shows that suspensions predict a range of student outcomes, including crime, delinquency, and drug use. It is therefore crucial to understand the factors associated with the use of school suspension, particularly in sites with different policy approaches to problem behaviors. This paper draws on data from state-representative samples of 3,129 Grade 7 and 9 students in Washington State, United States and Victoria, Australia sampled in 2002. Multilevel modeling examined student and school level factors associated with student-reported school suspension. Results showed that both student (being male, previous student antisocial and violent behavior, rebelliousness, academic failure) and school (socioeconomic status of the school, aggregate measures of low school commitment) level factors were associated with school suspension and that the factors related to suspension were similar in the two states. The implications of the findings for effective school behavior management policy are that, rather than focusing only on the student, both student and school level factors need to be addressed to reduce the rates of school suspension. PMID:24860205

INFLUENCE OF THE CIVIC COMMUNITY RELIGIOUS ENVIRONMENT ON FAMILY POVERTY: A MULTILEVEL ANALYSIS

PubMed Central

Myers, Candice A.

2016-01-01

This study integrates research in the civic community tradition and structuralist and individualist perspectives on poverty to assess the relationship between religious-based civic community structures and family poverty in the United States. Using multilevel analyses of 2006–2008 American Community Survey, 2000 Census of Population and Housing, and 2000 Religious Congregations and Membership Survey data, results demonstrate that the presence of Mainline Protestant and Catholics adherents within communities – measured as the percentage of a community’s population comprised of Mainline Protestant and Catholic adherents – is significantly and negatively associated with family poverty risks, net of other family and community factors. That is, in communities with a greater presence of Mainline Protestants and Catholics, there were also lower risks of families being in poverty. These findings suggest the importance of the ecology of religion within communities in understanding poverty outcomes for families. PMID:28580372

Geography of underweight and overweight among women in India: A multilevel analysis of 3204 neighborhoods in 26 states

PubMed Central

Ackerson, Leland K.; Kawachi, Ichiro; Barbeau, Elizabeth M.; Subramanian, S.V.

2009-01-01

We investigated the geographic distribution and the relationship with neighborhood wealth of underweight and overweight in India. Using multilevel modeling techniques, we calculated state-specific smoothed shrunken state residuals of overweight and underweight, neighborhood and state variation of nutritional status, and the relationships between neighborhood wealth and nutritional status of 76,681 women living in 3204 neighborhoods in 26 Indian states. We found a substantial variation in overweight and underweight at the neighborhood and state levels, net of what could be attributed to individual-level factors. Neighborhood wealth was associated with increased levels of overweight and decreased levels of underweight, and was found to modify the relationship between personal living standard and nutritional status. These findings suggest that interventions to address the double burden of undernutrition and overnutrition in India must take into account state and neighborhood characteristics in order to be successful. PMID:18602351

[Prevalence of common mental disorders and the relationship to the social context: multilevel analysis of the São Paulo Ageing & Health Study (SPAH)].

PubMed

Coutinho, Letícia Maria Silva; Matijasevich, Alícia; Scazufca, Márcia; Menezes, Paulo Rossi

2014-09-01

Social context can play a important role in the etiology and prevalence of mental disorders. The aim of the present study was to investigate risk factors for common mental disorders (CMD), considering different contextual levels: individual, household, and census tract. The study used a population-based sample of 2,366 respondents from the São Paulo Ageing & Health Study. Presence of CMD was identified by the SRQ-20. Sex, age, education, and occupation were individual characteristics associated with prevalence of CMD. Multilevel logistic regression models showed that part of the variance in prevalence of CMD was associated with the household level, showing associations between crowding, family income, and CMD, even after controlling for individual characteristics. These results suggest that characteristics of the environment where people live can influence their mental health status.

The effects of school policies and practices on eighth-grade science achievement: A multilevel analysis of TIMSS

NASA Astrophysics Data System (ADS)

Smyth, Carol Ann Mary

Identifying the relative importance of both alterable school policies and fairly stable contextual factors as they relate to middle level science achievement, a domain of identified national concern, requires simultaneous investigation of multilevel predictors (i.e., student level and school level) specific to the grade level and academic subject area. The school level factors are predictors associated with both the school (e.g., average socioeconomic status, tracking, and instructional time) and the classroom (e.g., average academic press of peers, teacher collaboration, and instructional strategies). The current study assessed the effects of school policies, practices, and contextual factors on the science achievement of eighth grade students. These influences were considered to be both additive (i.e., influencing the mean achievement in a school after controlling for student characteristics) and interactive (i.e., affecting the relationships between student background characteristics and individual achievement). To account for the nested structure of predictors and cross level interactions among predictors, a multilevel model for middle level science achievement was estimated using hierarchical linear modeling (HLM) with data collected from eighth grade students, science teachers, and administrators in 1995 as part of the Third International Mathematics and Science Study (TIMSS). The major findings of this research suggest that although average eighth grade science achievement in a school was primarily associated with the contextual characteristics of the classroom and the school (e.g., average socioeconomic status and average academic press), both the academic differentiating influence of prior achievement and the social differentiating influence of parental education on the science achievement of eighth grade students were related not only to contextual characteristics of the classroom and the school, but also to the instructional policies of the classroom. Using these results, policy makers can identify factors that can be modified to advance academic excellence in eighth grade science while promoting an equitable distribution of that achievement across students of varying backgrounds.

Multilevel Latent Class Analysis: An Application of Adolescent Smoking Typologies with Individual and Contextual Predictors

ERIC Educational Resources Information Center

Henry, Kimberly L.; Muthen, Bengt

2010-01-01

Latent class analysis (LCA) is a statistical method used to identify subtypes of related cases using a set of categorical or continuous observed variables. Traditional LCA assumes that observations are independent. However, multilevel data structures are common in social and behavioral research and alternative strategies are needed. In this…

Institutional Disparities in the Cost Effectiveness of GCE A-Level Provision: A Multi-Level Approach.

ERIC Educational Resources Information Center

Fielding, A.

1995-01-01

Reanalyzes H. Thomas's 1980s data, which used teaching group as the unit of analysis and illuminated some institutional disparities in provision of General Certificate of Education (GCE) A-levels. Uses multilevel analysis to focus on individual students in a hierarchical framework. Among the study institutions, school sixth forms appear less…

A Multilevel Analysis of Japanese Middle School Student and School Socioeconomic Status Influence on Mathematics Achievement

ERIC Educational Resources Information Center

Takashiro, Naomi

2017-01-01

The author examined the simultaneous influence of Japanese middle school student and school socioeconomic status (SES) on student math achievement with two-level multilevel analysis models by utilizing the Trends in International Mathematics and Science Study (TIMSS) Japan data sets. The theoretical framework used in this study was…

Examining the Influence of Campus Climate on Students' Time to Degree: A Multilevel Discrete-Time Survival Analysis

ERIC Educational Resources Information Center

Zhou, Ji; Castellanos, Michelle

2013-01-01

Utilizing longitudinal data of 3477 students from 28 institutions, we examine the effects of structural diversity and quality of interracial relation on students' persistence towards graduation within six years. We utilize multilevel discrete-time survival analysis to account for the longitudinal persistence patterns as well as the nested…

Illustration of a Multilevel Model for Meta-Analysis

ERIC Educational Resources Information Center

de la Torre, Jimmy; Camilli, Gregory; Vargas, Sadako; Vernon, R. Fox

2007-01-01

In this article, the authors present a multilevel (or hierarchical linear) model that illustrates issues in the application of the model to data from meta-analytic studies. In doing so, several issues are discussed that typically arise in the course of a meta-analysis. These include the presence of non-zero between-study variability, how multiple…

Brief Report: Multilevel Analysis of School Smoking Policy and Pupil Smoking Behaviour in Wales

ERIC Educational Resources Information Center

Wiium, Nora; Burgess, Stephen; Moore, Laurence

2011-01-01

A multilevel analysis of cross-sectional data from a survey involving 1941 pupils (in grades 10 and 11) and policy indicators developed from interviews with staff from 45 secondary schools in Wales examined the hypotheses that pupil smoking prevalence would be associated with: restrictive staff and pupil smoking policies; dissemination of school…

Three-Level Models for Indirect Effects in School- and Class-Randomized Experiments in Education

ERIC Educational Resources Information Center

Pituch, Keenan A.; Murphy, Daniel L.; Tate, Richard L.

2009-01-01

Due to the clustered nature of field data, multi-level modeling has become commonly used to analyze data arising from educational field experiments. While recent methodological literature has focused on multi-level mediation analysis, relatively little attention has been devoted to mediation analysis when three levels (e.g., student, class,…

Predicting Performance on State Achievement Tests Using Curriculum-Based Measurement in Reading: A Multilevel Meta-Analysis

ERIC Educational Resources Information Center

Yeo, Seungsoo

2010-01-01

The purpose of this synthesis was to examine the relationship between Curriculum-Based Measurement (CBM) and statewide achievement tests in reading. A multilevel meta-analysis was used to calculate the correlation coefficient of the population for 27 studies that met the inclusion criteria. Results showed an overall large correlation coefficient…

Explaining Technology Integration in K-12 Classrooms: A Multilevel Path Analysis Model

ERIC Educational Resources Information Center

Liu, Feng; Ritzhaupt, Albert D.; Dawson, Kara; Barron, Ann E.

2017-01-01

The purpose of this research was to design and test a model of classroom technology integration in the context of K-12 schools. The proposed multilevel path analysis model includes teacher, contextual, and school related variables on a teacher's use of technology and confidence and comfort using technology as mediators of classroom technology…

Computational Tools for Probing Interactions in Multiple Linear Regression, Multilevel Modeling, and Latent Curve Analysis

ERIC Educational Resources Information Center

Preacher, Kristopher J.; Curran, Patrick J.; Bauer, Daniel J.

2006-01-01

Simple slopes, regions of significance, and confidence bands are commonly used to evaluate interactions in multiple linear regression (MLR) models, and the use of these techniques has recently been extended to multilevel or hierarchical linear modeling (HLM) and latent curve analysis (LCA). However, conducting these tests and plotting the…

Multiple imputation by chained equations for systematically and sporadically missing multilevel data.

PubMed

Resche-Rigon, Matthieu; White, Ian R

2018-06-01

In multilevel settings such as individual participant data meta-analysis, a variable is 'systematically missing' if it is wholly missing in some clusters and 'sporadically missing' if it is partly missing in some clusters. Previously proposed methods to impute incomplete multilevel data handle either systematically or sporadically missing data, but frequently both patterns are observed. We describe a new multiple imputation by chained equations (MICE) algorithm for multilevel data with arbitrary patterns of systematically and sporadically missing variables. The algorithm is described for multilevel normal data but can easily be extended for other variable types. We first propose two methods for imputing a single incomplete variable: an extension of an existing method and a new two-stage method which conveniently allows for heteroscedastic data. We then discuss the difficulties of imputing missing values in several variables in multilevel data using MICE, and show that even the simplest joint multilevel model implies conditional models which involve cluster means and heteroscedasticity. However, a simulation study finds that the proposed methods can be successfully combined in a multilevel MICE procedure, even when cluster means are not included in the imputation models.

Individual, Social-Normative, and Policy Predictors of Smoking Cessation: A Multilevel Longitudinal Analysis

PubMed Central

Hamilton, William L.; Siegel, Michael; Sullivan, Eileen M.

2010-01-01

Objectives. We assessed the prospective impact of individual, social-normative, and policy predictors of quit attempts and smoking cessation among Massachusetts adults. Methods. We interviewed a representative sample of current and recent smokers in Massachusetts by telephone in 2001 through 2002 and then again twice at 2-year intervals. The unit of analysis was the 2-year transition from wave 1 to wave 2 and from wave 2 to wave 3. Predictors of quit attempts and abstinence of longer than 3 months were analyzed using multilevel analysis. Predictors included individual, social-normative, and policy factors. Results. Multivariate analyses of 2-year transitions showed that perceptions of strong antismoking town norms were predictive of abstinence (odds ratio = 2.06; P < .01). Household smoking bans were the only policy associated with abstinence, but smoking bans at one's worksite were significant predictors of quit attempts. Conclusions. Although previous research showed a strong relation between local policy and norms, we found no observable, prospective impact of local policy on smoking cessation over 2 years. Our findings provide clear support for the importance of strong antismoking social norms as a facilitator of smoking cessation. PMID:19696387

The Association Between County-Level Injury Rates and Racial Segregation Revisited: A Multilevel Analysis

PubMed Central

Sauber-Schatz, Erin K.; Barbour, Kamil E.; Li, Wei

2009-01-01

Objectives. We investigated whether within-county racial segregation was associated with increased odds of violent injury beyond individual risk. Methods. In a cross-sectional study, data on 75 310 patients admitted with an injury to Pennsylvania hospitals from 1997 to 1999 were analyzed to determine the association between county-level racial segregation and violent injury. We used multilevel analysis to adjust for individual- and county-level factors. Principal components analysis allowed us to separate the effect of segregation from other county-level variables. Results. After adjustment, greater segregation was associated with increased odds of violent injury among Whites (odds ratio [OR] = 1.20; 95% confidence interval [CI] = 1.11, 1.30) and non-Whites (OR = 1.45; 95% CI = 1.28, 1.64). The association was stronger for non-Whites. Conclusions. Our results suggested that living in a county with high levels of racial segregation was associated with increased odds of violence not explained by an individual's own risk. These findings represent an important step in understanding the nature of observed links between race and violence. Future work should develop prevention strategies that simultaneously target community and individual risks. PMID:19150902

A multilevel analysis of factors affecting the difference in dental patients' and caregivers' evaluation of oral quality of life.

PubMed

Sampogna, F; Johansson, V; Axtelius, B; Abeni, D; Söderfeldt, B

2008-12-01

In a previous study, we observed that the concordance between patients' and caregivers' evaluation of oral health-related quality of life (OHRQoL) was low. The aim of this study was to use multilevel analysis to investigate the possible determinants of the low concordance, taking into account different patients' demographic and clinical variables, the financial system used by patients to pay for dental treatment, and the role of the different caregivers and clinics. The OHRQoL of patients was assessed both by the patients and by their caregivers, using the Oral Health Impact Profile (OHIP)-14. Data were collected in four clinics, and patients were evaluated by one of 27 caregivers. We tested eight multilevel models, using the difference (caregivers OHIP - patients OHIP) as the dependent variable. Data were complete for 432 patients. The mean difference was 4.4 (standard deviation = 8.2; higher scores indicated a higher impact on OHRQoL). The variance due to patients was partly explained by their age, gender, and number of teeth, with a greater OHIP difference for older vs. younger patients, for women than for men, and in patients with fewer teeth. Almost 30% of the variance was due to caregivers, while the effect of clinics was not significant. It is important to study the possible causes of the different judgments concerning patients' OHRQoL by patients and caregivers, in order to improve the patients' satisfaction with care.

Neighbourhood socioeconomic deprivation and health-related quality of life: A multilevel analysis

PubMed Central

Ribeiro, Ana Isabel; Severo, Milton; Barros, Henrique; Fraga, Sílvia

2017-01-01

Objective To assess the relationship between socioeconomic deprivation and health-related quality of life in urban neighbourhoods, using a multilevel approach. Methods Of the population-based cohort EPIPorto, 1154 georeferenced participants completed the 36-Item Short-Form Health Survey. Neighbourhood socioeconomic deprivation classes were estimated using latent-class analysis. Multilevel models measured clustering and contextual effects of neighbourhood deprivation on physical and mental HRQoL. Results Residents from the least deprived neighbourhoods had higher physical HRQoL. Neighbourhood socioeconomic deprivation together with individual-level variables (age, gender and education) and health-related factors (smoking, alcohol consumption, sedentariness and chronic diseases) explained 98% of the total between-neighbourhood variance. Neighbourhood socioeconomic deprivation was significantly associated with physical health when comparing least and most deprived neighbourhoods (class 2—beta coefficient: -0.60; 95% confidence interval:-1.76;-0.56; class 3 –beta coefficient: -2.28; 95% confidence interval:-3.96;-0.60), and as neighbourhood deprivation increases, a decrease in all values of physical health dimensions (physical functioning, role physical, bodily pain and general health) was also observed. Regarding the mental health dimension, no neighbourhood clustering or contextual effects were found. However, as neighbourhood deprivation increases, the values of vitality and role emotional dimensions significantly decreased. Conclusion Neighbourhood socioeconomic deprivation is associated with HRQoL, affecting particularly physical health. This study suggests that to improve HRQoL, people and places should be targeted simultaneously. PMID:29236719

Factors Associated With Care Workers' Intention to Leave Employment in Nursing Homes: A Secondary Data Analysis of the Swiss Nursing Homes Human Resources Project.

PubMed

Gaudenz, Clergia; De Geest, Sabina; Schwendimann, René; Zúñiga, Franziska

2017-07-01

The emerging care personnel shortage in Swiss nursing homes is aggravated by high turnover rates. As intention to leave is a predictor of turnover, awareness of its associated factors is essential. This study applied a secondary data analysis to evaluate the prevalence and variability of 3,984 nursing home care workers' intention to leave. Work environment factors and care worker outcomes were tested via multiple regression analysis. Although 56% of care workers reported intention to leave, prevalences varied widely between facilities. Overall, intention to leave showed strong inverse relationships with supportive leadership and affective organizational commitment and weaker positive relationships with stress due to workload, emotional exhaustion, and care worker health problems. The strong direct relationship of nursing home care workers' intention to leave with affective organizational commitment and perceptions of leadership quality suggest that multilevel interventions to improve these factors might reduce intention to leave.

EFFECT OF INDIVIDUAL AND COMMUNITY FACTORS ON MATERNAL HEALTH CARE SERVICE USE IN INDIA: A MULTILEVEL APPROACH.

PubMed

Yadav, Awdhesh; Kesarwani, Ranjana

2016-01-01

This study aimed to assess empirically the influence of individual and community (neighbourhood) factors on the use of maternal health care services in India through three outcomes: utilization of full antenatal care (ANC) services, safe delivery and utilization of postnatal care services. Data were from the third round of the National Family Health Survey (2005-06). The study sample constituted ever-married women aged 15-49 from 29 Indian states. Multilevel logistic regression analysis was performed for the three outcomes of interest accounting for individual- and community-level factors associated with the use of maternal health care services. A substantial amount of variation was observed at the community level. About 45%, 51% and 62% of the total variance in the use of full ANC, safe delivery and postnatal care, respectively, could be attributed to differences across the community. There was significant variation in the use of maternal health care services at the individual level, with socioeconomic status and mother's education being the most prominent factors associated with the use of maternal health care services. At the community level, urban residence and poverty concentration were found to be significantly associated with maternal health care service use. The results suggest that an increased focus on community-level interventions could lead to an increase in the utilization of maternal health care services in India.

Individual and contextual factors influencing dental health care utilization by preschool children: a multilevel analysis

PubMed

Piovesan, Chaiana; Ardenghi, Thiago Machado; Mendes, Fausto Medeiros; Agostini, Bernardo Antonio; Michel-Crosato, Edgard

2017-03-30

The effect of contextual factors on dental care utilization was evaluated after adjustment for individual characteristics of Brazilian preschool children. This cross-sectional study assessed 639 preschool children aged 1 to 5 years from Santa Maria, a town in Rio Grande do Sul State, located in southern Brazil. Participants were randomly selected from children attending the National Children's Vaccination Day and 15 health centers were selected for this research. Visual examinations followed the ICDAS criteria. Parents answered a questionnaire about demographic and socioeconomic characteristics. Contextual influences on children's dental care utilization were obtained from two community-related variables: presence of dentists and presence of workers' associations in the neighborhood. Unadjusted and adjusted multilevel logistic regression models were used to describe the association between outcome and predictor variables. A prevalence of 21.6% was found for regular use of dental services. The unadjusted assessment of the associations of dental health care utilization with individual and contextual factors included children's ages, family income, parents' schooling, mothers' participation in their children's school activities, dental caries, and presence of workers' associations in the neighborhood as the main outcome covariates. Individual variables remained associated with the outcome after adding contextual variables in the model. In conclusion, individual and contextual variables were associated with dental health care utilization by preschool children.

Are Environmental Influences on Physical Activity Distinct for Urban, Suburban, and Rural Schools? A Multilevel Study among Secondary School Students in Ontario, Canada

ERIC Educational Resources Information Center

Hobin, Erin P.; Leatherdale, Scott; Manske, Steve; Dubin, Joel A.; Elliott, Susan; Veugelers, Paul

2013-01-01

Background: This study examined differences in students' time spent in physical activity (PA) across secondary schools in rural, suburban, and urban environments and identified the environment-level factors associated with these between school differences in students' PA. Methods: Multilevel linear regression analyses were used to examine the…

Taiwanese Students' Science Learning Self-Efficacy and Teacher and Student Science Hardiness: A Multilevel Model Approach

ERIC Educational Resources Information Center

Wang, Ya-Ling; Tsai, Chin-Chung

2016-01-01

This study aimed to investigate the factors accounting for science learning self-efficacy (the specific beliefs that people have in their ability to complete tasks in science learning) from both the teacher and the student levels. We thus propose a multilevel model to delineate its relationships with teacher and student science hardiness (i.e.,…

Probabilistic Multi-Scale, Multi-Level, Multi-Disciplinary Analysis and Optimization of Engine Structures

NASA Technical Reports Server (NTRS)

Chamis, Christos C.; Abumeri, Galib H.

2000-01-01

Aircraft engines are assemblies of dynamically interacting components. Engine updates to keep present aircraft flying safely and engines for new aircraft are progressively required to operate in more demanding technological and environmental requirements. Designs to effectively meet those requirements are necessarily collections of multi-scale, multi-level, multi-disciplinary analysis and optimization methods and probabilistic methods are necessary to quantify respective uncertainties. These types of methods are the only ones that can formally evaluate advanced composite designs which satisfy those progressively demanding requirements while assuring minimum cost, maximum reliability and maximum durability. Recent research activities at NASA Glenn Research Center have focused on developing multi-scale, multi-level, multidisciplinary analysis and optimization methods. Multi-scale refers to formal methods which describe complex material behavior metal or composite; multi-level refers to integration of participating disciplines to describe a structural response at the scale of interest; multidisciplinary refers to open-ended for various existing and yet to be developed discipline constructs required to formally predict/describe a structural response in engine operating environments. For example, these include but are not limited to: multi-factor models for material behavior, multi-scale composite mechanics, general purpose structural analysis, progressive structural fracture for evaluating durability and integrity, noise and acoustic fatigue, emission requirements, hot fluid mechanics, heat-transfer and probabilistic simulations. Many of these, as well as others, are encompassed in an integrated computer code identified as Engine Structures Technology Benefits Estimator (EST/BEST) or Multi-faceted/Engine Structures Optimization (MP/ESTOP). The discipline modules integrated in MP/ESTOP include: engine cycle (thermodynamics), engine weights, internal fluid mechanics, cost, mission and coupled structural/thermal, various composite property simulators and probabilistic methods to evaluate uncertainty effects (scatter ranges) in all the design parameters. The objective of the proposed paper is to briefly describe a multi-faceted design analysis and optimization capability for coupled multi-discipline engine structures optimization. Results are presented for engine and aircraft type metrics to illustrate the versatility of that capability. Results are also presented for reliability, noise and fatigue to illustrate its inclusiveness. For example, replacing metal rotors with composites reduces the engine weight by 20 percent, 15 percent noise reduction, and an order of magnitude improvement in reliability. Composite designs exist to increase fatigue life by at least two orders of magnitude compared to state-of-the-art metals.

Multi-level significance of vulnerability indicators. Case study: Eastern Romania

NASA Astrophysics Data System (ADS)

Stanga, I. C.; Grozavu, A.

2012-04-01

Vulnerability assessment aims, most frequently, to emphasize internal fragility of a system comparing to a reference standard, to similar systems or in relation to a given hazard. Internal fragility, either biophysical or structural, may affect the capacity to predict, to prepare for, to cope with or to recover from a disaster. Thus, vulnerability is linked to resilience and adaptive capacity. From local level to global one, vulnerability factors and corresponding indicators are different and their significance must be tested and validated in a well-structured conceptual and methodological framework. In this paper, the authors aim to show the real vulnerability of rural settlements in Eastern Romania in a multi-level approach. The research area, Tutova Hills, counts about 3421 sq.km and more than 200.000 inhabitants in 421 villages characterized by deficient accessibility, lack of endowments, subsistential agriculture, high pressure on natural environment (especially on forest and soil resources), poverty and aging process of population. Factors that could influence the vulnerability of these rural settlements have been inventoried and assigned into groups through a cluster analysis: habitat and technical urban facilities, infrastructure, economical, social and demographical indicators, environment quality, management of emergency situations etc. Firstly, the main difficulty was to convert qualitative variable in quantitative indicators and to standardize all values to make possible mathematical and statistical processing of data. Secondly, the great variability of vulnerability factors, their different measuring units and their high amplitude of variation require different method of standardization in order to obtain values between zero (minimum vulnerability) and one (maximum vulnerability). Final vulnerability indicators were selected and integrated in a general scheme, according to their significance resulted from an appropriate factor analysis: linear and logistic regression, varimax rotation, multiple-criteria decision analysis, weight of evidence, multi-criteria evaluation method etc. The approach started from the local level which allows a functional and structural analysis and was progressively translated to an upper level and to a spatial analysis. The model shows that changing the level of analysis diminishes the functional significance of some indicators and increases the capacity of discretization in the case of others, highlighting the spatial and functional complexity of vulnerability.

Does the Neighborhood Area of Residence Influence Non-Attendance in an Urban Mammography Screening Program? A Multilevel Study in a Swedish City

PubMed Central

Lagerlund, Magdalena; Merlo, Juan; Vicente, Raquel Pérez; Zackrisson, Sophia

2015-01-01

Background and aim The public health impact of population-based mammography screening programs depends on high participation rates. Thus, monitoring participation rates, as well as understanding and considering the factors influencing attendance, is important. With the goal to acquire information on the appropriate level of intervention for increasing screening participation our study aimed to (1) examine whether, over and above individual factors, the neighborhood of residence influences a woman’s mammography non-attendance, and (2) evaluate, whether knowing a woman’s neighborhood of residence would be sufficient to predict non-attendance. Methods We analyze all women invited to mammography screening in 2005–09, residing in the city of Malmö, Sweden. Information regarding mammography screening attendance was linked to data on area of residence, demographic and socioeconomic characteristics available from Statistics Sweden. The influence of individual and neighborhood factors was assessed by multilevel logistic regression analysis with 29,901 women nested within 212 neighborhoods. Results The prevalence of non-attendance among women was 18.3%. After adjusting for individual characteristics, the prevalence in the 212 neighborhoods was 3.6%. Neighborhood of residence had little influence on non-attendance. The multilevel analysis indicates that 8.4% of the total individual differences in the propensity of non-attendance were at the neighborhood level. However, when adjusting for specific individual characteristics this general contextual effect decreased to 1.8%. This minor effect was explained by the sociodemographic characteristic of the neighborhoods. The discriminatory accuracy of classifying women according to their non-attendance was 0.747 when considering only individual level variables, and 0.760 after including neighborhood level as a random effect. Conclusion Our results suggest that neighborhoods of residence in Malmö, Sweden (as defined by small-area market statistics (SAMS) areas) do not condition women’s participation in population based mammography screening. Thus, interventions should be directed to the whole city and target women with a higher risk of non-attendance. PMID:26460609

Multilevel mixed effects parametric survival models using adaptive Gauss-Hermite quadrature with application to recurrent events and individual participant data meta-analysis.

PubMed

Crowther, Michael J; Look, Maxime P; Riley, Richard D

2014-09-28

Multilevel mixed effects survival models are used in the analysis of clustered survival data, such as repeated events, multicenter clinical trials, and individual participant data (IPD) meta-analyses, to investigate heterogeneity in baseline risk and covariate effects. In this paper, we extend parametric frailty models including the exponential, Weibull and Gompertz proportional hazards (PH) models and the log logistic, log normal, and generalized gamma accelerated failure time models to allow any number of normally distributed random effects. Furthermore, we extend the flexible parametric survival model of Royston and Parmar, modeled on the log-cumulative hazard scale using restricted cubic splines, to include random effects while also allowing for non-PH (time-dependent effects). Maximum likelihood is used to estimate the models utilizing adaptive or nonadaptive Gauss-Hermite quadrature. The methods are evaluated through simulation studies representing clinically plausible scenarios of a multicenter trial and IPD meta-analysis, showing good performance of the estimation method. The flexible parametric mixed effects model is illustrated using a dataset of patients with kidney disease and repeated times to infection and an IPD meta-analysis of prognostic factor studies in patients with breast cancer. User-friendly Stata software is provided to implement the methods. Copyright © 2014 John Wiley & Sons, Ltd.

Multilevel Latent Class Analysis for Large-Scale Educational Assessment Data: Exploring the Relation between the Curriculum and Students' Mathematical Strategies

ERIC Educational Resources Information Center

Fagginger Auer, Marije F.; Hickendorff, Marian; Van Putten, Cornelis M.; Béguin, Anton A.; Heiser, Willem J.

2016-01-01

A first application of multilevel latent class analysis (MLCA) to educational large-scale assessment data is demonstrated. This statistical technique addresses several of the challenges that assessment data offers. Importantly, MLCA allows modeling of the often ignored teacher effects and of the joint influence of teacher and student variables.…

Multilevel Analysis of the Impact of School-Level Tobacco Policies on Adolescent Smoking: The Case of Michigan

ERIC Educational Resources Information Center

Paek, Hye-Jin; Hove, Thomas; Oh, Hyun Jung

2013-01-01

Background: In efforts to curb and prevent youth smoking, school tobacco policies have become an important and effective strategy. This study explores the degrees and types of tobacco-free school policy (TFSP) enforcement that are associated with adolescent smoking. Methods: A multilevel analysis was performed using 983 students who are nested in…

Employees' Willingness to Participate in Work-Related Learning: A Multilevel Analysis of Employees' Learning Intentions

ERIC Educational Resources Information Center

Kyndt, Eva; Onghena, Patrick; Smet, Kelly; Dochy, Filip

2014-01-01

The current study focuses on employees' learning intentions, or the willingness to undertake formal work-related learning. This cross-sectional survey study included a sample of 1,243 employees that are nested within 21 organisations. The results of the multilevel analysis show that self-directedness in career processes, time management,…

The Association between Overweight and School Policies on Physical Activity: A Multilevel Analysis among Elementary School Youth in the PLAY-On Study

ERIC Educational Resources Information Center

Leatherdale, Scott T.

2010-01-01

The objective is to examine school-level program and policy characteristics and student-level behavioural characteristics associated with being overweight. Multilevel logistic regression analysis were used to examine the school- and student-level characteristics associated with the odds of a student being overweight among 1264 Grade 5-8 students…

A Multilevel Shape Fit Analysis of Neutron Transmission Data

NASA Astrophysics Data System (ADS)

Naguib, K.; Sallam, O. H.; Adib, M.; Ashry, A.

A multilevel shape fit analysis of neutron transmission data is presented. A multilevel computer code SHAPE is used to analyse clean transmission data obtained from time-of-flight (TOF) measurements. The shape analysis deduces the parameters of the observed resonances in the energy region considered in the measurements. The shape code is based upon a least square fit of a multilevel Briet-Wigner formula and includes both instrumental resolution and Doppler broadenings. Operating the SHAPE code on a test example of a measured transmission data of 151Eu, 153Eu and natural Eu in the energy range 0.025-1 eV accquired a good result for the used technique of analysis.Translated AbstractAnalyse von Neutronentransmissionsdaten mittels einer VielniveauformanpassungNeutronentransmissionsdaten werden in einer Vielniveauformanpassung analysiert. Dazu werden bereinigte Daten aus Flugzeitmessungen mit dem Rechnerprogramm SHAPE bearbeitet. Man erhält die Parameter der beobachteten Resonanzen im gemessenen Energiebereich. Die Formanpassung benutzt eine Briet-Wignerformel und berücksichtigt Linienverbreiterungen infolge sowohl der Meßeinrichtung als auch des Dopplereffekts. Als praktisches Beispiel werden 151Eu, 153Eu und natürliches Eu im Energiebereich 0.025 bis 1 eV mit guter Übereinstimmung theoretischer und experimenteller Werte behandelt.

Use of modern contraceptives among married women in Vietnam: a multilevel analysis using the Multiple Indicator Cluster Survey (2011) and the Vietnam Population and Housing Census (2009).

PubMed

Vu, Lan Thi Hoang; Oh, Juhwan; Bui, Quyen Thi-Tu; Le, Anh Thi-Kim

2016-01-01

The prevalence of modern contraceptive use is an important indicator that reflects accessibility to reproductive health services. Satisfying unmet needs for family planning alone could reduce the number of maternal deaths by almost a third. This study uses multiple data sources to examine multilevel factors associated with the use of modern contraceptives among married women in Vietnam aged 15-49 years. Data from different national surveys (Vietnam Population and Housing Census, Vietnam Living Standard Survey, and Multiple Indicator Cluster Survey) were linked to create a dataset including individual and contextual (provincial) variables (N=8,341). Multilevel modeling was undertaken to examine the impact of both individual and provincial characteristics on modern contraceptive use. Odds ratios (ORs) and 95% confidence intervals (CIs) are reported. Individual factors significantly associated with the use of modern contraceptives were age 30-34 years (reference 15-19 years) (OR=1.63); high socioeconomic status (SES) (OR=0.8); having two living children (OR=2.4); and having a son (OR=1.4). The provincial poverty rate mediated the association between the individual's SES and the likelihood of using modern contraceptives. The proportion of women in Vietnam using modern contraceptive methods has remained relatively high in recent years with significant variation across Vietnam's 63 provinces. Women of lower SES are more likely to use modern contraceptive methods, especially in the poorer provinces. Achieving access to universal reproductive health is one of the Millennium Development Goals. Vietnam must continue to make progress in this area.

A Multilevel Model for Comorbid Outcomes: Obesity and Diabetes in the US

PubMed Central

Congdon, Peter

2010-01-01

Multilevel models are overwhelmingly applied to single health outcomes, but when two or more health conditions are closely related, it is important that contextual variation in their joint prevalence (e.g., variations over different geographic settings) is considered. A multinomial multilevel logit regression approach for analysing joint prevalence is proposed here that includes subject level risk factors (e.g., age, race, education) while also taking account of geographic context. Data from a US population health survey (the 2007 Behavioral Risk Factor Surveillance System or BRFSS) are used to illustrate the method, with a six category multinomial outcome defined by diabetic status and weight category (obese, overweight, normal). The influence of geographic context is partly represented by known geographic variables (e.g., county poverty), and partly by a model for latent area influences. In particular, a shared latent variable (common factor) approach is proposed to measure the impact of unobserved area influences on joint weight and diabetes status, with the latent variable being spatially structured to reflect geographic clustering in risk. PMID:20616977

Multilevel selection analysis of a microbial social trait

PubMed Central

de Vargas Roditi, Laura; Boyle, Kerry E; Xavier, Joao B

2013-01-01

The study of microbial communities often leads to arguments for the evolution of cooperation due to group benefits. However, multilevel selection models caution against the uncritical assumption that group benefits will lead to the evolution of cooperation. We analyze a microbial social trait to precisely define the conditions favoring cooperation. We combine the multilevel partition of the Price equation with a laboratory model system: swarming in Pseudomonas aeruginosa. We parameterize a population dynamics model using competition experiments where we manipulate expression, and therefore the cost-to-benefit ratio of swarming cooperation. Our analysis shows that multilevel selection can favor costly swarming cooperation because it causes population expansion. However, due to high costs and diminishing returns constitutive cooperation can only be favored by natural selection when relatedness is high. Regulated expression of cooperative genes is a more robust strategy because it provides the benefits of swarming expansion without the high cost or the diminishing returns. Our analysis supports the key prediction that strong group selection does not necessarily mean that microbial cooperation will always emerge. PMID:23959025

Comparisons of Multilevel Modeling and Structural Equation Modeling Approaches to Actor-Partner Interdependence Model.

PubMed

Hong, Sehee; Kim, Soyoung

2018-01-01

There are basically two modeling approaches applicable to analyzing an actor-partner interdependence model: the multilevel modeling (hierarchical linear model) and the structural equation modeling. This article explains how to use these two models in analyzing an actor-partner interdependence model and how these two approaches work differently. As an empirical example, marital conflict data were used to analyze an actor-partner interdependence model. The multilevel modeling and the structural equation modeling produced virtually identical estimates for a basic model. However, the structural equation modeling approach allowed more realistic assumptions on measurement errors and factor loadings, rendering better model fit indices.

Risk factors for prelacteal feeding in sub-Saharan Africa: a multilevel analysis of population data from twenty-two countries.

PubMed

Berde, Anselm S; Ozcebe, Hilal

2017-08-01

To examine the risk factors of prelacteal feeding (PLF) among mothers in sub-Saharan Africa (SSA). We pooled data from Demographic and Health Surveys in twenty-two SSA countries. The key outcome variable was PLF. A multilevel logistic regression model was used to explore factors associated with PLF. Demographic and Health Surveys in twenty-two SSA countries. Mother-baby pairs (n 95348). Prevalence of PLF in SSA was 32·2 %. Plain water (22·1 %), milk other than breast milk (5·0 %) and sugar or glucose water (4·1 %) were the predominant prelacteal feeds. In the multivariable analysis, mothers who had caesarean section delivery had 2·25 times the odds of giving prelacteal feeds compared with mothers who had spontaneous vaginal delivery (adjusted OR=2·25; 95 % CI 2·06, 2·46). Other factors that were significantly associated with increased likelihood of PLF were mother's lower educational status, first birth rank, fourth or above birth rank with preceding birth interval less than or equal to 24 months, lower number of antenatal care visits, home delivery, multiple birth, male infant, as well as having an average or small sized baby at birth. Mothers aged 20-34 years were less likely to give prelacteal feeds compared with mothers aged ≤19 years. Belonging to the second, middle or fourth wealth quintile was associated with lower likelihood of PLF compared with the highest quintile. To achieve optimal breast-feeding, there is a need to discourage breast-feeding practices such as PLF. Breast-feeding promotion programmes should target the at-risk sub-population groups discovered in our study.

Mind the Gap! A Multilevel Analysis of Factors Related to Variation in Published Cost-Effectiveness Estimates within and between Countries.

PubMed

Boehler, Christian E H; Lord, Joanne

2016-01-01

Published cost-effectiveness estimates can vary considerably, both within and between countries. Despite extensive discussion, little is known empirically about factors relating to these variations. To use multilevel statistical modeling to integrate cost-effectiveness estimates from published economic evaluations to investigate potential causes of variation. Cost-effectiveness studies of statins for cardiovascular disease prevention were identified by systematic review. Estimates of incremental costs and effects were extracted from reported base case, sensitivity, and subgroup analyses, with estimates grouped in studies and in countries. Three bivariate models were developed: a cross-classified model to accommodate data from multinational studies, a hierarchical model with multinational data allocated to a single category at country level, and a hierarchical model excluding multinational data. Covariates at different levels were drawn from a long list of factors suggested in the literature. We found 67 studies reporting 2094 cost-effectiveness estimates relating to 23 countries (6 studies reporting for more than 1 country). Data and study-level covariates included patient characteristics, intervention and comparator cost, and some study methods (e.g., discount rates and time horizon). After adjusting for these factors, the proportion of variation attributable to countries was negligible in the cross-classified model but moderate in the hierarchical models (14%-19% of total variance). Country-level variables that improved the fit of the hierarchical models included measures of income and health care finance, health care resources, and population risks. Our analysis suggested that variability in published cost-effectiveness estimates is related more to differences in study methods than to differences in national context. Multinational studies were associated with much lower country-level variation than single-country studies. These findings are for a single clinical question and may be atypical. © The Author(s) 2015.

Validity analysis on merged and averaged data using within and between analysis: focus on effect of qualitative social capital on self-rated health.

PubMed

Shin, Sang Soo; Shin, Young-Jeon

2016-01-01

With an increasing number of studies highlighting regional social capital (SC) as a determinant of health, many studies are using multi-level analysis with merged and averaged scores of community residents' survey responses calculated from community SC data. Sufficient examination is required to validate if the merged and averaged data can represent the community. Therefore, this study analyzes the validity of the selected indicators and their applicability in multi-level analysis. Within and between analysis (WABA) was performed after creating community variables using merged and averaged data of community residents' responses from the 2013 Community Health Survey in Korea, using subjective self-rated health assessment as a dependent variable. Further analysis was performed following the model suggested by WABA result. Both E-test results (1) and WABA results (2) revealed that single-level analysis needs to be performed using qualitative SC variable with cluster mean centering. Through single-level multivariate regression analysis, qualitative SC with cluster mean centering showed positive effect on self-rated health (0.054, p<0.001), although there was no substantial difference in comparison to analysis using SC variables without cluster mean centering or multi-level analysis. As modification in qualitative SC was larger within the community than between communities, we validate that relational analysis of individual self-rated health can be performed within the group, using cluster mean centering. Other tests besides the WABA can be performed in the future to confirm the validity of using community variables and their applicability in multi-level analysis.

A Multilevel Study of Students in Vietnam: Drinking Motives and Drinking Context as Predictors of Alcohol Consumption

PubMed Central

Diep, Pham Bich; Tan, Frans E. S.; Knibbe, Ronald A.; De Vries, Nanne

2016-01-01

Background: This study used multi-level analysis to estimate which type of factor explains most of the variance in alcohol consumption of Vietnamese students. Methods: Data were collected among 6011 students attending 12 universities/faculties in four provinces in Vietnam. The three most recent drinking occasions were investigated per student, resulting in 12,795 drinking occasions among 4265 drinkers. Students reported on 10 aspects of the drinking context per drinking occasion. A multi-level mixed-effects linear regression model was constructed in which aspects of drinking context composed the first level; the age of students and four drinking motives comprised the second level. The dependent variable was the number of drinks. Results: Of the aspects of context, drinking duration had the strongest association with alcohol consumption while, at the individual level, coping motive had the strongest association. The drinking context characteristics explained more variance than the individual characteristics in alcohol intake per occasion. Conclusions: These findings suggest that, among students in Vietnam, the drinking context explains a larger proportion of the variance in alcohol consumption than the drinking motives. Therefore, measures that reduce the availability of alcohol in specific drinking situations are an essential part of an effective prevention policy. PMID:27420089

Assessment of Differential Item Functioning in Health-Related Outcomes: A Simulation and Empirical Analysis with Hierarchical Polytomous Data

PubMed Central

Sharafi, Zahra

2017-01-01

Background The purpose of this study was to evaluate the effectiveness of two methods of detecting differential item functioning (DIF) in the presence of multilevel data and polytomously scored items. The assessment of DIF with multilevel data (e.g., patients nested within hospitals, hospitals nested within districts) from large-scale assessment programs has received considerable attention but very few studies evaluated the effect of hierarchical structure of data on DIF detection for polytomously scored items. Methods The ordinal logistic regression (OLR) and hierarchical ordinal logistic regression (HOLR) were utilized to assess DIF in simulated and real multilevel polytomous data. Six factors (DIF magnitude, grouping variable, intraclass correlation coefficient, number of clusters, number of participants per cluster, and item discrimination parameter) with a fully crossed design were considered in the simulation study. Furthermore, data of Pediatric Quality of Life Inventory™ (PedsQL™) 4.0 collected from 576 healthy school children were analyzed. Results Overall, results indicate that both methods performed equivalently in terms of controlling Type I error and detection power rates. Conclusions The current study showed negligible difference between OLR and HOLR in detecting DIF with polytomously scored items in a hierarchical structure. Implications and considerations while analyzing real data were also discussed. PMID:29312463

Assessment of Differential Item Functioning in Health-Related Outcomes: A Simulation and Empirical Analysis with Hierarchical Polytomous Data.

PubMed

Sharafi, Zahra; Mousavi, Amin; Ayatollahi, Seyyed Mohammad Taghi; Jafari, Peyman

2017-01-01

The purpose of this study was to evaluate the effectiveness of two methods of detecting differential item functioning (DIF) in the presence of multilevel data and polytomously scored items. The assessment of DIF with multilevel data (e.g., patients nested within hospitals, hospitals nested within districts) from large-scale assessment programs has received considerable attention but very few studies evaluated the effect of hierarchical structure of data on DIF detection for polytomously scored items. The ordinal logistic regression (OLR) and hierarchical ordinal logistic regression (HOLR) were utilized to assess DIF in simulated and real multilevel polytomous data. Six factors (DIF magnitude, grouping variable, intraclass correlation coefficient, number of clusters, number of participants per cluster, and item discrimination parameter) with a fully crossed design were considered in the simulation study. Furthermore, data of Pediatric Quality of Life Inventory™ (PedsQL™) 4.0 collected from 576 healthy school children were analyzed. Overall, results indicate that both methods performed equivalently in terms of controlling Type I error and detection power rates. The current study showed negligible difference between OLR and HOLR in detecting DIF with polytomously scored items in a hierarchical structure. Implications and considerations while analyzing real data were also discussed.

Risk factors of chronic periodontitis on healing response: a multilevel modelling analysis.

PubMed

Song, J; Zhao, H; Pan, C; Li, C; Liu, J; Pan, Y

2017-09-15

Chronic periodontitis is a multifactorial polygenetic disease with an increasing number of associated factors that have been identified over recent decades. Longitudinal epidemiologic studies have demonstrated that the risk factors were related to the progression of the disease. A traditional multivariate regression model was used to find risk factors associated with chronic periodontitis. However, the approach requirement of standard statistical procedures demands individual independence. Multilevel modelling (MLM) data analysis has widely been used in recent years, regarding thorough hierarchical structuring of the data, decomposing the error terms into different levels, and providing a new analytic method and framework for solving this problem. The purpose of our study is to investigate the relationship of clinical periodontal index and the risk factors in chronic periodontitis through MLM analysis and to identify high-risk individuals in the clinical setting. Fifty-four patients with moderate to severe periodontitis were included. They were treated by means of non-surgical periodontal therapy, and then made follow-up visits regularly at 3, 6, and 12 months after therapy. Each patient answered a questionnaire survey and underwent measurement of clinical periodontal parameters. Compared with baseline, probing depth (PD) and clinical attachment loss (CAL) improved significantly after non-surgical periodontal therapy with regular follow-up visits at 3, 6, and 12 months after therapy. The null model and variance component models with no independent variables included were initially obtained to investigate the variance of the PD and CAL reductions across all three levels, and they showed a statistically significant difference (P < 0.001), thus establishing that MLM data analysis was necessary. Site-level had effects on PD and CAL reduction; those variables could explain 77-78% of PD reduction and 70-80% of CAL reduction at 3, 6, and 12 months. Other levels only explain 20-30% of PD and CAL reductions. Site-level had the greatest effect on PD and CAL reduction. Non-surgical periodontal therapy with regular follow-up visits had a remarkable curative effect. All three levels had a substantial influence on the reduction of PD and CAL. Site-level had the largest effect on PD and CAL reductions.

Detecting Intervention Effects in a Cluster-Randomized Design Using Multilevel Structural Equation Modeling for Binary Responses

ERIC Educational Resources Information Center

Cho, Sun-Joo; Preacher, Kristopher J.; Bottge, Brian A.

2015-01-01

Multilevel modeling (MLM) is frequently used to detect group differences, such as an intervention effect in a pre-test--post-test cluster-randomized design. Group differences on the post-test scores are detected by controlling for pre-test scores as a proxy variable for unobserved factors that predict future attributes. The pre-test and post-test…

Urban sustainable energy development: A case study of the city of Philadelphia

NASA Astrophysics Data System (ADS)

Argyriou, Iraklis

This study explores the role of cities in sustainable energy development through a governance-informed analysis. Despite the leading position of municipalities in energy sustainability, cities have been mostly conceptualized as sites where energy development is shaped by external policy scales, i.e. the national level. A growing body of research, however, critiques this analytical perspective, and seeks to better understand the type of factors and dynamics that influence energy sustainability within a multi-level policy context for urban energy. Given that particular circumstances are applicable across cities, a context-specific analysis can provide insight regarding how sustainable energy development takes place in urban areas. In applying such an analytical perspective on urban energy sustainability, this study undertakes a qualitative case study analysis for the city of Philadelphia, Pennsylvania, by looking at four key local policy initiatives relevant to building energy efficiency and solar electricity development at the municipal government and city-wide level. The evaluation of the initiatives suggests that renewable electricity use has increased substantially in the city over the last years but the installed capacity of local renewable electricity systems, including solar photovoltaics, is low. On the other hand, although the city has made little progress in meeting its building energy efficiency targets, more comprehensive action is taken in this area. The study finds that the above outcomes have been shaped mainly by four factors. The first is the city government's incremental policy approach aiming to develop a facilitative context for local action. The second is the role that a diverse set of stakeholders have in local sustainable energy development. The third is the constraints that systemic policy barriers create for solar power development. The fourth is the ways through which the relevant multi-level policy environment structures the city's possibilities on sustainable energy. In this context, the study identifies four areas of policy recommendation that could enhance Philadelphia's prospects for energy sustainability: integrated municipal energy planning; stable financing for market development; enhanced actor interactions; and multi-level policymaking that facilitates local action. These policy directions could be of interest to a broader body of metropolitan cities regarding their efforts in sustainable energy development.

Weighted graph cuts without eigenvectors a multilevel approach.

PubMed

Dhillon, Inderjit S; Guan, Yuqiang; Kulis, Brian

2007-11-01

A variety of clustering algorithms have recently been proposed to handle data that is not linearly separable; spectral clustering and kernel k-means are two of the main methods. In this paper, we discuss an equivalence between the objective functions used in these seemingly different methods--in particular, a general weighted kernel k-means objective is mathematically equivalent to a weighted graph clustering objective. We exploit this equivalence to develop a fast, high-quality multilevel algorithm that directly optimizes various weighted graph clustering objectives, such as the popular ratio cut, normalized cut, and ratio association criteria. This eliminates the need for any eigenvector computation for graph clustering problems, which can be prohibitive for very large graphs. Previous multilevel graph partitioning methods, such as Metis, have suffered from the restriction of equal-sized clusters; our multilevel algorithm removes this restriction by using kernel k-means to optimize weighted graph cuts. Experimental results show that our multilevel algorithm outperforms a state-of-the-art spectral clustering algorithm in terms of speed, memory usage, and quality. We demonstrate that our algorithm is applicable to large-scale clustering tasks such as image segmentation, social network analysis and gene network analysis.

Smoking in young adolescents: an approach with multilevel discrete choice models

PubMed Central

Pinilla, J; Gonzalez, B; Barber, P; Santana, Y

2002-01-01

Design: Cross sectional analysis performed by multilevel logistic regression with pupils at the first level and schools at the second level. The data came from a stratified sample of students surveyed on their own, their families' and their friends' smoking habits, their schools, and their awareness of cigarette prices and advertising. Setting: The study was performed in the Island of Gran Canaria, Spain. Participants: 1877 students from 30 secondary schools in spring of 2000 (model's effective sample sizes 1697 and 1738) . Main results: 14.2% of the young teenagers surveyed use tobacco, almost half of them (6.3% of the total surveyed) on a daily basis. According to the ordered logistic regression model, to have a smoker as the best friend increases significantly the probability of smoking (odds ratio: 6.96, 95% confidence intervals (CI) (4.93 to 9.84), and the same stands for one smoker living at home compared with a smoking free home (odds ratio: 2.03, 95% CI 1.22 to 3.36). Girls smoke more (odds ratio: 1.85, 95% CI 1.33 to 2.59). Experience with alcohol, and lack of interest in studies are also significant factors affecting smoking. Multilevel models of logistic regression showed that factors related to the school affect the smoking behaviour of young teenagers. More specifically, whether a school complies with antismoking rules or not is the main factor to predict smoking prevalence in schools. The remainder of the differences can be attributed to individual and family characteristics, tobacco consumption by parents or other close relatives, and peer group. Conclusions: A great deal of the individual differences in smoking are explained by factors at the school level, therefore the context is very relevant in this case. The most relevant predictors for smoking in young adolescents include some factors related to the schools they attend. One variable stood out in accounting for the school to school differences: how well they enforced the no smoking rule. Therefore we can prevent or delay tobacco smoking in adolescents not only by publicising health risks, but also by better enforcing no smoking rules in schools. PMID:11854347

Multi-Level Discourse Analysis in a Physics Teaching Methods Course from the Psychological Perspective of Activity Theory

ERIC Educational Resources Information Center

Vieira, Rodrigo Drumond; Kelly, Gregory J.

2014-01-01

In this paper, we present and apply a multi-level method for discourse analysis in science classrooms. This method is based on the structure of human activity (activity, actions, and operations) and it was applied to study a pre-service physics teacher methods course. We argue that such an approach, based on a cultural psychological perspective,…

A Multilevel Multivariate Analysis of Academic Performances in College Based on NCAA Student-Athletes

ERIC Educational Resources Information Center

McArdle, John J.; Paskus, Thomas S.; Boker, Steven M.

2013-01-01

This is an application of contemporary multilevel regression modeling to the prediction of academic performances of 1st-year college students. At a first level of analysis, the data come from N greater than 16,000 students who were college freshman in 1994-1995 and who were also participants in high-level college athletics. At a second level of…

The Quadratic Relationship between Socioeconomic Status and Learning Performance in China by Multilevel Analysis: Implications for Policies to Foster Education Equity

ERIC Educational Resources Information Center

Zhao, Ningning; Valcke, Martin; Desoete, Annemie; Verhaeghe, JeanPierre

2012-01-01

The purpose of the present study is to explore the relationship between family socioeconomic status and mathematics performance on the base of a multi-level analysis involving a large sample of Chinese primary school students. A weak relationship is found between socioeconomic status and performance in the Chinese context. The relationship does…

The Number of Feedbacks Needed for Reliable Evaluation. A Multilevel Analysis of the Reliability, Stability and Generalisability of Students' Evaluation of Teaching

ERIC Educational Resources Information Center

Rantanen, Pekka

2013-01-01

A multilevel analysis approach was used to analyse students' evaluation of teaching (SET). The low value of inter-rater reliability stresses that any solid conclusions on teaching cannot be made on the basis of single feedbacks. To assess a teacher's general teaching effectiveness, one needs to evaluate four randomly chosen course implementations.…

A Multilevel Analysis of the Compositional and Contextual Association of Social Capital and Subjective Well-Being in Seoul, South Korea

ERIC Educational Resources Information Center

Han, Sehee; Kim, Heaseung; Lee, Hee-Sun

2013-01-01

The purpose of this study is to examine the association between social capital and subjective well-being (life satisfaction) by using multilevel analysis considering both individual and area-level social capital while adjusting for various control variables at multiple-levels in Seoul, South Korea. The data was from the 2010 (Wave 2) Seoul Welfare…

Syringe Sharing in Drug Injecting Dyads: A Cross-Classified Multilevel Analysis of Social Networks.

PubMed

Shahesmaeili, Armita; Mirzazadeh, Ali; McFarland, Willi; Sharifi, Hamid; Haghdoost, Ali Akbar; Soori, Hamid

2018-05-15

We examined the association of dyadic-level factors with syringe sharing among people who inject drugs (PWID) in Kerman, Iran. In a cross-sectional study, we collected data on 329 drug-injecting dyads by individual face-to-face interviews. An injecting dyad was defined as 2 PWID who knew each other and injected drugs together during the last 6 months. If they reported at least 1 occasion of syringe sharing, the dyad was considered high-risk. Dyadic-level factors associated with syringe sharing were assessed using cross-classified multilevel logistic regression. The rate of syringe sharing was significantly higher for dyads who were more intimate (adjusted odds ratio [AOR] 4.5, CI 95%, 2.3-8.6), who had instrumental support (AOR 2.1, 95% CI 1.1-4.5), and who pooled money for drugs (AOR 4.1, 95% CI 2.0-8.3). The rate was lower in same-sex dyads (AOR 0.4, 95% CI 0.2-0.9) and in dyads who shared health information (AOR 0.5, 95% CI 0.2-0.9). Findings highlight close-peer influences on syringe-sharing behavior.

[Relationship between perceptions of safety climate at workplace and depressive disorders in manufacturing workers].

PubMed

Liu, Xu-hua; Xiao, Ya-ni; Huang, Zhi-xiong; Huang, Shao-bin; Cao, Xiao-ou; Guan, Dong-bo; Chen, Wei-qing

2013-04-01

To investigate the risk factors for depressive disorders in manufacturing workers and to provide a basis for developing health promotion measures at workplace. A questionnaire survey was performed in 8085 front-line production workers from 33 manufacturing enterprises in Nanhai District of Foshan, Guangdong Province, China. The questionnaire contained a survey of demographic characteristics, the Safety Climate Scale, the Center for Epidemiological Studies Depression Scale, etc. The multilevel logistic regression analysis was applied to investigate the risk factors for depressive disorders in workers. A total of 6260 workers completed the survey; their mean age was 31.1 ± 8.6 years, and 53.2% of them were males. The multilevel logistic regression analysis showed that after adjustment for sociodemographic factors such as age, sex, and martial status, more depressive disorders were reported in the enterprises with higher score of "production safety training" than in those with lower score (OR = 1.46, 95%CI = 1.07 ∼ 1.97); fewer depressive disorders were reported in the enterprises with higher score of "colleagues concerned about production safety" than in those with lower score (OR = 0.08, 95%CI = 0.03 ∼ 0.26); the relationships of "safety warnings and precautions" and "managers concerned about production safety" with workers' depressive disorders were not statistically significant (OR = 0.78, 95%CI = 0.48 ∼ 1.28; OR = 1.08, 95%CI = 0.68 ∼ 1.72). Depressive disorders in manufacturing workers are related to the safety climate at workplace, which indicates that a good safety climate at workplace should be created to prevent and control depressive disorders in workers.

A Multilevel AR(1) Model: Allowing for Inter-Individual Differences in Trait-Scores, Inertia, and Innovation Variance.

PubMed

Jongerling, Joran; Laurenceau, Jean-Philippe; Hamaker, Ellen L

2015-01-01

In this article we consider a multilevel first-order autoregressive [AR(1)] model with random intercepts, random autoregression, and random innovation variance (i.e., the level 1 residual variance). Including random innovation variance is an important extension of the multilevel AR(1) model for two reasons. First, between-person differences in innovation variance are important from a substantive point of view, in that they capture differences in sensitivity and/or exposure to unmeasured internal and external factors that influence the process. Second, using simulation methods we show that modeling the innovation variance as fixed across individuals, when it should be modeled as a random effect, leads to biased parameter estimates. Additionally, we use simulation methods to compare maximum likelihood estimation to Bayesian estimation of the multilevel AR(1) model and investigate the trade-off between the number of individuals and the number of time points. We provide an empirical illustration by applying the extended multilevel AR(1) model to daily positive affect ratings from 89 married women over the course of 42 consecutive days.

Country- and individual-level socioeconomic determinants of depression: multilevel cross-national comparison.

PubMed

Rai, Dheeraj; Zitko, Pedro; Jones, Kelvyn; Lynch, John; Araya, Ricardo

2013-03-01

The prevalence and correlates of depression vary across countries. Contextual factors such as country-level income or income inequalities have been hypothesised to contribute to these differences. To investigate associations of depression with socioeconomic factors at the country level (income inequality, gross national income) and individual (education, employment, assets and spending) level, and to investigate their relative contribution in explaining the cross-national variation in the prevalence of depression. Multilevel study using interview data of 187 496 individuals from 53 countries participating in the World Health Organization World Health Surveys. Depression prevalence varied between 0.4 and 15.7% across countries. Individual-level factors were responsible for 86.5% of this variance but there was also reasonable variation at the country level (13.5%), which appeared to increase with decreasing economic development of countries. Gross national income or country-level income inequality had no association with depression. At the individual level, fewer material assets, lower education, female gender, economic inactivity and being divorced or widowed were associated with increased odds of depression. Greater household spending, unlike material assets, was associated with increasing odds of depression (adjusted analysis). The variance of depression prevalence attributable to country-level factors seemed to increase with decreasing economic development of countries. However, country-level income inequality or gross national income explained little of this variation, and individual-level factors appeared more important than contextual factors as determinants of depression. The divergent relationship of assets and spending with depression emphasise that different socioeconomic measures are not interchangeable in their associations with depression.

Multilevel Green's function interpolation method for scattering from composite metallic and dielectric objects.

PubMed

Shi, Yan; Wang, Hao Gang; Li, Long; Chan, Chi Hou

2008-10-01

A multilevel Green's function interpolation method based on two kinds of multilevel partitioning schemes--the quasi-2D and the hybrid partitioning scheme--is proposed for analyzing electromagnetic scattering from objects comprising both conducting and dielectric parts. The problem is formulated using the surface integral equation for homogeneous dielectric and conducting bodies. A quasi-2D multilevel partitioning scheme is devised to improve the efficiency of the Green's function interpolation. In contrast to previous multilevel partitioning schemes, noncubic groups are introduced to discretize the whole EM structure in this quasi-2D multilevel partitioning scheme. Based on the detailed analysis of the dimension of the group in this partitioning scheme, a hybrid quasi-2D/3D multilevel partitioning scheme is proposed to effectively handle objects with fine local structures. Selection criteria for some key parameters relating to the interpolation technique are given. The proposed algorithm is ideal for the solution of problems involving objects such as missiles, microstrip antenna arrays, photonic bandgap structures, etc. Numerical examples are presented to show that CPU time is between O(N) and O(N log N) while the computer memory requirement is O(N).

Multilevel Interventions: Study Design and Analysis Issues

PubMed Central

Gross, Cary P.; Zaslavsky, Alan M.; Taplin, Stephen H.

2012-01-01

Multilevel interventions, implemented at the individual, physician, clinic, health-care organization, and/or community level, increasingly are proposed and used in the belief that they will lead to more substantial and sustained changes in behaviors related to cancer prevention, detection, and treatment than would single-level interventions. It is important to understand how intervention components are related to patient outcomes and identify barriers to implementation. Designs that permit such assessments are uncommon, however. Thus, an important way of expanding our knowledge about multilevel interventions would be to assess the impact of interventions at different levels on patients as well as the independent and synergistic effects of influences from different levels. It also would be useful to assess the impact of interventions on outcomes at different levels. Multilevel interventions are much more expensive and complicated to implement and evaluate than are single-level interventions. Given how little evidence there is about the value of multilevel interventions, however, it is incumbent upon those arguing for this approach to do multilevel research that explicates the contributions that interventions at different levels make to the desired outcomes. Only then will we know whether multilevel interventions are better than more focused interventions and gain greater insights into the kinds of interventions that can be implemented effectively and efficiently to improve health and health care for individuals with cancer. This chapter reviews designs for assessing multilevel interventions and analytic ways of controlling for potentially confounding variables that can account for the complex structure of multilevel data. PMID:22623596

Analysis of prevertebral soft-tissue swelling and dysphagia in multilevel anterior cervical discectomy and fusion with recombinant human bone morphogenetic protein-2 in patients at risk for pseudarthrosis.

PubMed

Stachniak, Joseph B; Diebner, Jeffrey D; Brunk, Estee S; Speed, Shelley M

2011-02-01

The goal of this study was to demonstrate the incidence of fusion and soft-tissue swelling in multilevel anterior cervical discectomies and fusions (ACDFs) using polyetheretherketone (PEEK) spacers with recombinant human bone morphogenetic protein-2 (rhBMP-2) impregnated in a Type I collagen sponge and titanium plates. A single surgeon performed 30 multilevel ACDFs using PEEK spacers with an rhBMP-2 impregnated collagen sponge (0.4 ml, or the equivalent of 0.6 mg rhBMP-2). Soft-tissue swelling was assessed using cervical spine radiographs on postoperative Day 1 and at 2, 6, and 10 weeks and 6 months after surgery. Incidence of dysphagia was assessed with the Cervical Spine Research Society Swallowing-Quality of Life tool. Clinical success was evaluated with the Neck Disability Index, neck pain scores, and arm pain scores. Final fusion was assessed with CT by an independent neuroradiologist. Patients were followed for 6 months unless they had an incomplete fusion; those patients were reassessed at 9 months. Twenty-four patients underwent 2-level ACDFs and 6 underwent 3-level ACDFs were performed on patients with the following risk factors for pseudarthrosis: smoking (33%), diabetes (13%), and obesity (body mass index ≥ 30 [43%]). Seventeen percent of the patients had multiple risk factors. Soft-tissue swelling peaked at 2 weeks regardless of level of surgery or number of levels treated surgically and decreased to near preoperative levels by 6 months. At 2 weeks, Swallowing-Quality of Life evaluation showed 19% of patients frequently choking on food, 4.8% frequently choking when drinking, and 47.6% with frequent food sticking in the throat. Scores continued to improve, and at 6 months, 0% had frequent choking on food, 6.7% had frequent difficulty drinking, and 6.7% had frequent food sticking in the throat. The Neck Disability Index, neck pain, and arm pain scores all improved progressively over 6 months. Incidence of fusion was 95% at 6 months and 100% at 9 months. There were no rehospitalizations or reoperations for soft-tissue swelling or dysphagia. Multilevel ACDF procedures using PEEK grafts and rhBMP-2 can be performed safely in patients with multiple risk factors for pseudarthrosis with excellent fusion outcomes.

Data-Powered Participatory Decision Making: Leveraging Systems Thinking and Simulation to Guide Selection and Implementation of Evidence-Based Colorectal Cancer Screening Interventions.

PubMed

Wheeler, Stephanie B; Leeman, Jennifer; Hassmiller Lich, Kristen; Tangka, Florence K L; Davis, Melinda M; Richardson, Lisa C

A robust evidence base supports the effectiveness of timely colorectal cancer (CRC) screening, follow-up of abnormal results, and referral to care in reducing CRC morbidity and mortality. However, only two-thirds of the US population is current with recommended screening, and rates are much lower for those who are vulnerable because of their race/ethnicity, insurance status, or rural location. Multiple, multilevel factors contribute to observed disparities, and these factors vary across different populations and contexts. As highlighted by the Cancer Moonshot Blue Ribbon Panel working groups focused on Prevention and Early Detection and Implementation Science inadequate CRC screening and follow-up represent an enormous missed opportunity in cancer prevention and control. To measurably reduce CRC morbidity and mortality, the evidence base must be strengthened to guide the identification of (1) multilevel factors that influence screening across different populations and contexts, (2) multilevel interventions and implementation strategies that will be most effective at targeting those factors, and (3) combinations of strategies that interact synergistically to improve outcomes. Systems thinking and simulation modeling (systems science) provide a set of approaches and techniques to aid decision makers in using the best available data and research evidence to guide implementation planning in the context of such complexity. This commentary summarizes current challenges in CRC prevention and control, discusses the status of the evidence base to guide the selection and implementation of multilevel CRC screening interventions, and describes a multi-institution project to showcase how systems science can be leveraged to optimize selection and implementation of CRC screening interventions in diverse populations and contexts.

Research on comprehensive performance evaluation technology of wind turbine based on Analytic Hierarchy Process

NASA Astrophysics Data System (ADS)

Huang, Xiangsheng; Zhong, Mingqiu; Li, Ying; Yang, Hongyuan

2018-05-01

High-power of the offshore wind turbine is in the early stage of development, then how to establish a scientific and impartial performance evaluation system of the offshore wind turbine becomes the key to the health development of the industry. This paper adopts the method of multi-level analysis and site testing, which can reduce the impact of human factors on evaluation to the most extent. A more reasonable judging criterion with the relative importance of different factors of the same criterion level is also put forward, which constructs a more scientific and fair evaluation system of the high-power offshore wind turbine.

Keeping in touch with children after separation: the point of view of fathers.

PubMed

Le Bourdais, Céline; Juby, Heather; Marcil-Gratton, Nicole

2002-01-01

The amount of father-child contact after separation is closely linked to the probability that father fulfill their financial obligations towards their children. Determining the factors that encourage this contact is, therefore, crucial to the process of reducing the risk of poverty to which children of separated parents are exposed. Based on data collected from fathers at the 1995 Canadian General Social Survey of the Family, this paper uses multi-level regression analysis to identify factors associated with higher levels of contact between fathers and children, including socio-demographic characteristics of children and fathers, variables associated with attitudes, and fathers' satisfaction with custody and access arrangements.

Familial violence socialization in childhood and later life approval of corporal punishment: a cross-cultural perspective.

PubMed

Douglas, Emily M

2006-01-01

The use of corporal punishment has been associated with several negative outcomes for children. As a result, scholars have begun to study factors that are associated with the approval of corporal punishment. Using data from the International Dating Violence Study, the author implemented analysis of covariance and multilevel modeling analyses to determine that there were significant associations among culture, personal and group experiences of familial violence socialization, and attitudes about corporal punishment. 2006 APA, all rights reserved

Multilevel Effects of Student and Classroom Factors on Elementary Science Achievement in Five Countries

ERIC Educational Resources Information Center

Kaya, Sibel; Rice, Diana C.

2010-01-01

This study examined the effects of individual student factors and classroom factors on elementary science achievement within and across five countries. The student-level factors included gender, self-confidence in science and home resources. The classroom-level factors included teacher characteristics, instructional variables and classroom…

The median hazard ratio: a useful measure of variance and general contextual effects in multilevel survival analysis.

PubMed

Austin, Peter C; Wagner, Philippe; Merlo, Juan

2017-03-15

Multilevel data occurs frequently in many research areas like health services research and epidemiology. A suitable way to analyze such data is through the use of multilevel regression models (MLRM). MLRM incorporate cluster-specific random effects which allow one to partition the total individual variance into between-cluster variation and between-individual variation. Statistically, MLRM account for the dependency of the data within clusters and provide correct estimates of uncertainty around regression coefficients. Substantively, the magnitude of the effect of clustering provides a measure of the General Contextual Effect (GCE). When outcomes are binary, the GCE can also be quantified by measures of heterogeneity like the Median Odds Ratio (MOR) calculated from a multilevel logistic regression model. Time-to-event outcomes within a multilevel structure occur commonly in epidemiological and medical research. However, the Median Hazard Ratio (MHR) that corresponds to the MOR in multilevel (i.e., 'frailty') Cox proportional hazards regression is rarely used. Analogously to the MOR, the MHR is the median relative change in the hazard of the occurrence of the outcome when comparing identical subjects from two randomly selected different clusters that are ordered by risk. We illustrate the application and interpretation of the MHR in a case study analyzing the hazard of mortality in patients hospitalized for acute myocardial infarction at hospitals in Ontario, Canada. We provide R code for computing the MHR. The MHR is a useful and intuitive measure for expressing cluster heterogeneity in the outcome and, thereby, estimating general contextual effects in multilevel survival analysis. © 2016 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd. © 2016 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.

The median hazard ratio: a useful measure of variance and general contextual effects in multilevel survival analysis

PubMed Central

Wagner, Philippe; Merlo, Juan

2016-01-01

Multilevel data occurs frequently in many research areas like health services research and epidemiology. A suitable way to analyze such data is through the use of multilevel regression models (MLRM). MLRM incorporate cluster‐specific random effects which allow one to partition the total individual variance into between‐cluster variation and between‐individual variation. Statistically, MLRM account for the dependency of the data within clusters and provide correct estimates of uncertainty around regression coefficients. Substantively, the magnitude of the effect of clustering provides a measure of the General Contextual Effect (GCE). When outcomes are binary, the GCE can also be quantified by measures of heterogeneity like the Median Odds Ratio (MOR) calculated from a multilevel logistic regression model. Time‐to‐event outcomes within a multilevel structure occur commonly in epidemiological and medical research. However, the Median Hazard Ratio (MHR) that corresponds to the MOR in multilevel (i.e., ‘frailty’) Cox proportional hazards regression is rarely used. Analogously to the MOR, the MHR is the median relative change in the hazard of the occurrence of the outcome when comparing identical subjects from two randomly selected different clusters that are ordered by risk. We illustrate the application and interpretation of the MHR in a case study analyzing the hazard of mortality in patients hospitalized for acute myocardial infarction at hospitals in Ontario, Canada. We provide R code for computing the MHR. The MHR is a useful and intuitive measure for expressing cluster heterogeneity in the outcome and, thereby, estimating general contextual effects in multilevel survival analysis. © 2016 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd. PMID:27885709

Evaluation of a Partial Genome Screening of Two Asthma Susceptibility Regions Using Bayesian Network Based Bayesian Multilevel Analysis of Relevance

PubMed Central

Antal, Péter; Kiszel, Petra Sz.; Gézsi, András; Hadadi, Éva; Virág, Viktor; Hajós, Gergely; Millinghoffer, András; Nagy, Adrienne; Kiss, András; Semsei, Ágnes F.; Temesi, Gergely; Melegh, Béla; Kisfali, Péter; Széll, Márta; Bikov, András; Gálffy, Gabriella; Tamási, Lilla; Falus, András; Szalai, Csaba

2012-01-01

Genetic studies indicate high number of potential factors related to asthma. Based on earlier linkage analyses we selected the 11q13 and 14q22 asthma susceptibility regions, for which we designed a partial genome screening study using 145 SNPs in 1201 individuals (436 asthmatic children and 765 controls). The results were evaluated with traditional frequentist methods and we applied a new statistical method, called Bayesian network based Bayesian multilevel analysis of relevance (BN-BMLA). This method uses Bayesian network representation to provide detailed characterization of the relevance of factors, such as joint significance, the type of dependency, and multi-target aspects. We estimated posteriors for these relations within the Bayesian statistical framework, in order to estimate the posteriors whether a variable is directly relevant or its association is only mediated. With frequentist methods one SNP (rs3751464 in the FRMD6 gene) provided evidence for an association with asthma (OR = 1.43(1.2–1.8); p = 3×10−4). The possible role of the FRMD6 gene in asthma was also confirmed in an animal model and human asthmatics. In the BN-BMLA analysis altogether 5 SNPs in 4 genes were found relevant in connection with asthma phenotype: PRPF19 on chromosome 11, and FRMD6, PTGER2 and PTGDR on chromosome 14. In a subsequent step a partial dataset containing rhinitis and further clinical parameters was used, which allowed the analysis of relevance of SNPs for asthma and multiple targets. These analyses suggested that SNPs in the AHNAK and MS4A2 genes were indirectly associated with asthma. This paper indicates that BN-BMLA explores the relevant factors more comprehensively than traditional statistical methods and extends the scope of strong relevance based methods to include partial relevance, global characterization of relevance and multi-target relevance. PMID:22432035

[Two-level logistic modeling analysis on the factors that influence birth in hospitals in poor rural areas of Sichuan province].

PubMed

Yu, Chuan; Li, Xiao-song

2008-11-01

To identify the determinants of birth in hospitals in the poor rural areas. A questionnaire survey in eight poor counties in Sichuan province was conducted. Multilevel logistic regression analysis was performed to identify the factors that influenced birth in hospitals. Hospitals delivered 61.4% of babies in the selected counties. Education, eligibility to poverty relief, numbers of pre-natal examinations and abnormalities found in pre-natal examinations had a significant impact on birth in hospitals. Education of women and medical relief in the poor rural areas need to be strengthened to increase the proportion of babies delivered in hospitals in the poor rural areas. Systematic management of pregnant women and increased pre-natal examinations could also contribute to hospital delivery of babies.

Dispositional and Environmental Predictors of the Development of Internalizing Problems in Childhood: Testing a Multilevel Model.

PubMed

Hastings, Paul D; Helm, Jonathan; Mills, Rosemary S L; Serbin, Lisa A; Stack, Dale M; Schwartzman, Alex E

2015-07-01

This investigation evaluated a multilevel model of dispositional and environmental factors contributing to the development of internalizing problems from preschool-age to school-age. In a sample of 375 families (185 daughters, 190 sons) drawn from three independent samples, preschoolers' behavioral inhibition, cortisol and gender were examined as moderators of the links between mothers' negative parenting behavior, negative emotional characteristics, and socioeconomic status when children were 3.95 years, and their internalizing problems when they were 8.34 years. Children's dispositional characteristics moderated all associations between these environmental factors and mother-reported internalizing problems in patterns that were consistent with either diathesis-stress or differential-susceptibility models of individual-environment interaction, and with gender models of developmental psychopathology. Greater inhibition and lower socioeconomic status were directly predictive of more teacher reported internalizing problems. These findings highlight the importance of using multilevel models within a bioecological framework to understand the complex pathways through which internalizing difficulties develop.

Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas

PubMed Central

Liu, Nancy H.; Daumit, Gail L.; Dua, Tarun; Aquila, Ralph; Charlson, Fiona; Cuijpers, Pim; Druss, Benjamin; Dudek, Kenn; Freeman, Melvyn; Fujii, Chiyo; Gaebel, Wolfgang; Hegerl, Ulrich; Levav, Itzhak; Munk Laursen, Thomas; Ma, Hong; Maj, Mario; Elena Medina‐Mora, Maria; Nordentoft, Merete; Prabhakaran, Dorairaj; Pratt, Karen; Prince, Martin; Rangaswamy, Thara; Shiers, David; Susser, Ezra; Thornicroft, Graham; Wahlbeck, Kristian; Fekadu Wassie, Abe; Whiteford, Harvey; Saxena, Shekhar

2017-01-01

Excess mortality in persons with severe mental disorders (SMD) is a major public health challenge that warrants action. The number and scope of truly tested interventions in this area remain limited, and strategies for implementation and scaling up of programmes with a strong evidence base are scarce. Furthermore, the majority of available interventions focus on a single or an otherwise limited number of risk factors. Here we present a multilevel model highlighting risk factors for excess mortality in persons with SMD at the individual, health system and socio‐environmental levels. Informed by that model, we describe a comprehensive framework that may be useful for designing, implementing and evaluating interventions and programmes to reduce excess mortality in persons with SMD. This framework includes individual‐focused, health system‐focused, and community level and policy‐focused interventions. Incorporating lessons learned from the multilevel model of risk and the comprehensive intervention framework, we identify priorities for clinical practice, policy and research agendas. PMID:28127922

Using Multilevel Modeling in Language Assessment Research: A Conceptual Introduction

ERIC Educational Resources Information Center

Barkaoui, Khaled

2013-01-01

This article critiques traditional single-level statistical approaches (e.g., multiple regression analysis) to examining relationships between language test scores and variables in the assessment setting. It highlights the conceptual, methodological, and statistical problems associated with these techniques in dealing with multilevel or nested…

Perceived and Objective Measures of Neighborhood Walkability and Physical Activity among Adults in Japan: A Multilevel Analysis of a Nationally Representative Sample.

PubMed

Hanibuchi, Tomoya; Nakaya, Tomoki; Yonejima, Mayuko; Honjo, Kaori

2015-10-23

Although associations between a person's neighborhood and their health have been studied internationally, most studies have been limited to a few cities or towns. Therefore, we used a nationally representative sample to explore whether perceived and objective neighborhood walkability was associated with the physical activity of residents. Data were analyzed from the Japanese General Social Surveys of 2010 (n = 2395; 1114 men and 1281 women). Perceived walkability was scored using factor analysis for the respondents' perceptions of neighborhood conditions, while objective walkability was measured using the geographic information system approach. Finally, multilevel logistic regression analysis was performed to examine whether neighborhood walkability was associated with the frequency of leisure-time physical activity (LTPA) among respondents. We found that perceived walkability was positively associated with the frequency of LTPA (odds ratio of the highest quartile was 1.53 (1.14-2.05) compared with the lowest quartile); however, objective walkability showed no association. When stratified by gender, an association between perceived walkability and LTPA was observed among women, but only a marginally significant association was present between objective walkability and LTPA among men. We conclude that the association between neighborhood walkability and LTPA can be partially generalized across Japan.

Perceived and Objective Measures of Neighborhood Walkability and Physical Activity among Adults in Japan: A Multilevel Analysis of a Nationally Representative Sample

PubMed Central

Hanibuchi, Tomoya; Nakaya, Tomoki; Yonejima, Mayuko; Honjo, Kaori

2015-01-01

Although associations between a person’s neighborhood and their health have been studied internationally, most studies have been limited to a few cities or towns. Therefore, we used a nationally representative sample to explore whether perceived and objective neighborhood walkability was associated with the physical activity of residents. Data were analyzed from the Japanese General Social Surveys of 2010 (n = 2395; 1114 men and 1281 women). Perceived walkability was scored using factor analysis for the respondents’ perceptions of neighborhood conditions, while objective walkability was measured using the geographic information system approach. Finally, multilevel logistic regression analysis was performed to examine whether neighborhood walkability was associated with the frequency of leisure-time physical activity (LTPA) among respondents. We found that perceived walkability was positively associated with the frequency of LTPA (odds ratio of the highest quartile was 1.53 (1.14–2.05) compared with the lowest quartile); however, objective walkability showed no association. When stratified by gender, an association between perceived walkability and LTPA was observed among women, but only a marginally significant association was present between objective walkability and LTPA among men. We conclude that the association between neighborhood walkability and LTPA can be partially generalized across Japan. PMID:26512682

Contextual and individual determinants of periodontal disease: Multilevel analysis based on Andersen's model.

PubMed

Valente, Maria I B; Vettore, Mario V

2018-04-01

To investigate the relationship of contextual and individual factors with periodontal disease in dentate adults and older people using the Andersen's behavioural model. Secondary individual data from 6011 adults and 2369 older people from the Brazilian Oral Health Survey (2010) were combined with contextual data for 27 cities. Attachment loss (AL) categories for each sextant were coded and summed to obtain the periodontal disease measure. The association of predisposing, enabling and need characteristics at city and individual level with periodontal disease was assessed using an adapted version of the Andersen's behavioural model. Multilevel Poisson regression was used to estimate rate ratios (RR) and 95% CIs. Periodontal disease was associated with contextual predisposing (RR 0.93; 95% CI = 0.87-0.99) and enabling factors (RR 0.99; 95% CI = 0.98-0.99) in adults. Contextual predisposing was also associated with periodontal disease in older people (RR 0.82; 95% CI = 0.73-0.92). Individual predisposing (age, sex and schooling) and need characteristics (perceived treatment need) were common predictors of periodontal disease in adults and older people. Periodontal disease was also associated with behaviours in the latter age group. Contextual predisposing factors and individual characteristics influenced periodontal disease experience in adults and older people. Contextual enabling factors were also meaningful determinants of periodontal disease in the former age group. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Individual and neighbourhood determinants of social participation and social capital: a multilevel analysis of the city of Malmö, Sweden.

PubMed

Lindström, Martin; Merlo, Juan; Ostergren, Per-Olof

2002-06-01

The aim of this study was to analyse the impact of neighbourhood on individual social capital (measured as social participation). The study population consisted of 14,390 individuals aged 45-73 that participated in the Malmö diet and cancer study in 1992-1994, residing in 90 neighbourhoods of Malmö, Sweden (population 250,000). A multilevel logistic regression model, with individuals at the first level and neighbourhoods at the second level, was performed. The study analysed the effect (intra-area correlation and cross-level modification) of the neighbourhood on individual social capital after adjustment for compositional factors (e.g. age, sex, educational level, occupational status, disability pension, living alone, sick leave, unemployment) and, finally, one contextual migration factor. The prevalence of low social participation varied from 23.0% to 39.7% in the first and third neighbourhood quartiles, respectively. Neighbourhood factors accounted for 6.3% of the total variance in social participation, and this effect was reduced but not eliminated when adjusting for all studied variables (-73%), especially the occupational composition of the neighbourhoods (-58%). The contextual migration variable further reduced the variance in social participation at the neighbourhood level to some extent. Our study supports Putnam's notion that social capital, which is suggested to be an important factor for population health and possibly for health equity, is an aspect that is partly contextual in its nature.

The importance of intersectoral factors in promoting equity-oriented universal health coverage: a multilevel analysis of social determinants affecting neonatal infant and under-five mortality in Bangladesh.

PubMed

Huda, Tanvir M; Tahsina, Tazeen; El Arifeen, Shams; Dibley, Michael J

2016-01-01

Health is multidimensional and affected by a wide range of factors, many of which are outside the health sector. To improve population health and reduce health inequality, it is important that we take into account the complex interactions among social, environmental, behavioural, and biological factors and design our health interventions accordingly. This study examines mortality differentials in children of different age groups by key social determinants of health (SDH) including parental education and employment, mother's level of autonomy, age, asset index, living arrangements (utilities), and other geographical contextual factors (area of residence, road conditions). We used data from the two rounds of Bangladesh Health and Demographic Survey, a nationally representative sample survey of the population residing in Bangladesh. Multilevel logistic models were used to study the impact of SDH on child mortality. The study found that the mother's age, the education of both parents, the mother's autonomy to take decisions about matters linked to the health of her child, the household socio-economic conditions, the geographical region of residence, and the condition of the roads were significantly associated with higher risks of neonatal, infant, and under-five mortality in Bangladesh. The study findings suggest there are complex relationships among different SDH. Thus larger intersectoral actions will be needed to reduce disparities in child health and mortality and achieve meaningful progress towards equity-oriented universal health coverage.

Quantifying neighbourhood socioeconomic effects in clustering of behaviour-related risk factors: a multilevel analysis.

PubMed

Halonen, Jaana I; Kivimäki, Mika; Pentti, Jaana; Kawachi, Ichiro; Virtanen, Marianna; Martikainen, Pekka; Subramanian, S V; Vahtera, Jussi

2012-01-01

The extent to which neighbourhood characteristics explain accumulation of health behaviours is poorly understood. We examined whether neighbourhood disadvantage was associated with co-occurrence of behaviour-related risk factors, and how much of the neighbourhood differences in the co-occurrence can be explained by individual and neighbourhood level covariates. The study population consisted of 60 694 Finnish Public Sector Study participants in 2004 and 2008. Neighbourhood disadvantage was determined using small-area level information on household income, education attainment, and unemployment rate, and linked with individual data using Global Positioning System-coordinates. Associations between neighbourhood disadvantage and co-occurrence of three behaviour-related risk factors (smoking, heavy alcohol use, and physical inactivity), and the extent to which individual and neighbourhood level covariates explain neighbourhood differences in co-occurrence of risk factors were determined with multilevel cumulative logistic regression. After adjusting for age, sex, marital status, and population density we found a dose-response relationship between neighbourhood disadvantage and co-occurrence of risk factors within each level of individual socioeconomic status. The cumulative odds ratios for the sum of health risks comparing the most to the least disadvantaged neighbourhoods ranged between 1.13 (95% confidence interval (CI): 1.03-1.24) and 1.75 (95% CI, 1.54-1.98). Individual socioeconomic characteristics explained 35%, and neighbourhood disadvantage and population density 17% of the neighbourhood differences in the co-occurrence of risk factors. Co-occurrence of poor health behaviours associated with neighbourhood disadvantage over and above individual's own socioeconomic status. Neighbourhood differences cannot be captured using individual socioeconomic factors alone, but neighbourhood level characteristics should also be considered.

My baby, my move: examination of perceived barriers and motivating factors related to antenatal physical activity.

PubMed

Leiferman, Jenn; Swibas, Tracy; Koiness, Kacey; Marshall, Julie A; Dunn, Andrea L

2011-01-01

Based on a socioecological model, the present study examined multilevel barriers and facilitators related to physical activity engagement during pregnancy in women of low socioeconomic status. Individual and paired interviews were conducted with 25 pregnant women (aged 18-46 years, 17-40 weeks' gestation) to ask about motivational factors and to compare differences in activity level and parity. Atlas/Ti software was used to code verbatim interview transcripts by organizing codes into categories that reflect symbolic domains of meaning, relational patterns, and overarching themes. Perceived barriers and motivating factors differed between exercisers and nonexercisers at intrapersonal, interpersonal, and environmental levels. Future interventions should take into account key motivating multilevel factors and barriers to tailor more meaningful advice for pregnant women. © 2011 by the American College of Nurse-Midwives.

The multilevel determinants of workers' mental health: results from the SALVEO study.

PubMed

Marchand, Alain; Durand, Pierre; Haines, Victor; Harvey, Steve

2015-03-01

This study examined the contribution of work, non-work and individual factors on workers' symptoms of psychological distress, depression and emotional exhaustion based on the multilevel determinants of workers' mental health model. Data from the SALVEO Study were collected in 2009-2012 from a sample of 1,954 employees nested in 63 workplaces in the province of Quebec (Canada). Multilevel regression models were used to analyse the data. Altogether, variables explain 32.2 % of psychological distress, 48.4 % of depression and 48.8 % of emotional exhaustion. Mental health outcomes varied slightly between workplaces and skill utilisation, physical and psychological demands, abusive supervision, interpersonal conflicts and job insecurity are related to the outcomes. Living in couple, having young children at home, family-to-work conflict, work-to-family conflict, strained marital and parental relations, and social support outside the workplace associated with the outcomes. Most of the individual characteristics also correlated with the three outcomes. Importantly, non-work and individual factors modulated the number and type of work factors related to the three outcomes. The results of this study suggest expanding perspectives on occupational mental health that fully recognise the complexity of workers' mental health determinants.

Social capital and administrative contextual determinants of lack of access to a regular doctor: a multilevel analysis in southern Sweden.

PubMed

Lindström, Martin; Axén, Elin; Lindström, Christine; Beckman, Anders; Moghaddassi, Mahnaz; Merlo, Juan

2006-12-01

The aim of this study was to investigate the influence of contextual (social capital and administrative/neo-materialist) and individual factors on lack of access to a regular doctor. The 2000 public health survey in Scania is a cross-sectional study. A total of 13,715 persons answered a postal questionnaire, which is 59% of the random sample. A multilevel logistic regression model, with individuals at the first level and municipalities at the second, was performed. The effect (intra-class correlations, cross-level modification and odds ratios) of individual and municipality (social capital and health care district) factors on lack of access to a regular doctor was analysed using simulation method. The Deviance Information Criterion (DIC) was used as information criterion for the models. The second level municipality variance in lack of access to a regular doctor is substantial even in the final models with all individual and contextual variables included. The model that results in the largest reduction in DIC is the model including age, sex and individual social participation (which is a network aspect of social capital), but the models which include administrative and social capital second level factors also reduced the DIC values. This study suggests that both administrative health care district and social capital may partly explain the individual's self reported lack of access to a regular doctor.

STATE-LEVEL DIETARY DIVERSITY AS A CONTEXTUAL DETERMINANT OF NUTRITIONAL STATUS OF CHILDREN IN INDIA: A MULTILEVEL APPROACH.

PubMed

Borkotoky, Kakoli; Unisa, Sayeed; Gupta, Ashish Kumar

2018-01-01

This study aimed to identify the determinants of nutritional status of children in India with a special focus on dietary diversity at the state level. Household-level consumption data from three rounds of the Consumer Expenditure Survey of the National Sample Survey Organization (1993-2012) were used. Information on the nutritional status of children was taken from the National Family Health Survey (2005-06). Dietary diversity indices were constructed at the state level to examine diversity in quantity of food consumed and food expenditure. Multilevel regression analysis was applied to examine the association of state-level dietary diversity and other socioeconomic factors with the nutritional status of children. It was observed that significant variation in childhood stunting, wasting and underweight could be explained by community- and state-level factors. The results indicate that dietary diversity has increased in India over time, and that dietary diversity at the state level is significantly associated with the nutritional status of children. Moreover, percentage of households with a regular salaried income in a state, percentage of educated mothers and mothers receiving antenatal care in a community are important factors for improving the nutritional status of children. Diversity in complementary child feeding is another significant determinant of nutritional status of children. The study thus concludes that increasing dietary diversity at the state level is an effective measure to reduce childhood malnutrition in India.

Health worker performance in rural health organizations in low- and middle-income countries: do organizational factors predict non-task performance?

PubMed

Jayasuriya, Rohan; Jayasinghe, Upali W; Wang, Qian

2014-07-01

Health worker (HW) performance is a critical issue facing many low- and middle-income countries (LMICs). The aim of this study was to test the effects of factors in the work environment, such as organizational culture and climate, on HW non-task performance in rural health work settings in a LMIC. The data for the study is from a sample of 963 HWs from rural health centres (HCs) in 16 of the 20 provinces in Papua New Guinea. The reliability and validity of measures for organizational citizenship behaviour (OCB), counterproductive work behaviour (CWB) and work climate (WC) were tested. Multilevel linear regression models were used to test the relationship of individual and HC level factors with non-task performance. The survey found that 62 per cent of HCs practised OCB "often to always" and 5 percent practised CWB "often to always". Multilevel analysis revealed that WC had a positive effect on organizational citizenship behaviour (OCB) and a negative effect on CWB. The mediation analyses provided evidence that the relationship between WC and OCB was mediated through CWB. Human resource policies that improve WC in rural health settings would increase positive non-task behaviour and improve the motivation and performance of HWs in rural settings in LMICs. Copyright © 2014 Elsevier Ltd. All rights reserved.

The nonmedical use of prescription medicines among high school students: a cross-sectional study in Southern China.

PubMed

Wang, Hui; Deng, Jianxiong; Zhou, Xiaolan; Lu, Ciyong; Huang, Jinghui; Huang, Guoliang; Gao, Xue; He, Yuan

2014-08-01

The objective of this study was to examine the prevalence of the nonmedical use of prescription medicines (NMUPM) and the association between NMUPM and demographic, family and school factors. A cross-sectional study was conducted from 2007 to 2009. A total of 21,672 middle and high school students were surveyed in seven cities of Guangdong Province. Self-reported NMUPM and information regarding family and school factors were collected. Multilevel logistic regression analyses were used to explore potentially influential factors. Of the total sample, the mean age was 16 (±1.9) years. Approximately 6.0% of respondents reported lifetime NMUPM. The most common nonmedically used prescription drug among NMUPM users was scattered analgesics, at approximately 3.9%, followed by cough medicine with codeine (2.1%). Multilevel logistic regression analysis indicated that living arrangements, available money, social friends, and smoking were significantly correlated with NMUPM among boys and girls. Academic achievement and family relationships were only significantly correlated with NMUPM among girls, and communication with parents was only associated with NMUPM among boys. These results indicate that NMUPM represented a considerable problem for particular subgroups of adolescents. A well-established surveillance system and target intervention programs are needed given the potential long-term negative outcomes of NMUPM. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Linking Health System Responsiveness to Political Rights and Civil Liberties: A Multilevel Analysis Using Data From 44 Countries.

PubMed

Witvliet, Margot I; Stronks, Karien; Kunst, Anton E; Mahapatra, Tanmay; Arah, Onyebuchi A

2015-01-01

Responsiveness is a dimension of health system functioning and might be dependent upon contextual factors related to politics. Given this, we performed cross-national comparisons with the aim of investigating: 1) the associations of political factors with patients' reports of health system responsiveness and 2) the extent to which health input and output might explain these associations. World Health Survey data were analyzed for 44 countries (n = 103 541). Main outcomes included, respectively, 8 and 7 responsiveness domains for inpatient and outpatient care. Linear multilevel regressions were used to assess the associations of politics (namely, civil liberties and political rights), socioeconomic development, health system input, and health system output (measured by maternal mortality) with responsiveness domains, adjusted for demographic factors. Political rights showed positive associations with dignity (regression coefficient = 0.086 [standard error = 0.039]), quality (0.092 [0.049]), and support (0.113 [0.048]) for inpatient care and with dignity (0.075 [0.040]), confidentiality (0.089 [0.043]), and quality (0.124 [0.053]) for outpatient care. Positive associations were observed for civil liberties as well. Health system input and output reduced observed associations. Results tentatively suggest that strengthening political rights and, to a certain extent, civil liberties might improve health system responsiveness, in part through their effect on health system input and output. © The Author(s) 2015.

Use of modern contraceptives among married women in Vietnam: a multilevel analysis using the Multiple Indicator Cluster Survey (2011) and the Vietnam Population and Housing Census (2009)

PubMed Central

Vu, Lan Thi Hoang; Oh, Juhwan; Bui, Quyen Thi-Tu; Le, Anh Thi-Kim

2016-01-01

Background The prevalence of modern contraceptive use is an important indicator that reflects accessibility to reproductive health services. Satisfying unmet needs for family planning alone could reduce the number of maternal deaths by almost a third. This study uses multiple data sources to examine multilevel factors associated with the use of modern contraceptives among married women in Vietnam aged 15–49 years. Design Data from different national surveys (Vietnam Population and Housing Census, Vietnam Living Standard Survey, and Multiple Indicator Cluster Survey) were linked to create a dataset including individual and contextual (provincial) variables (N=8,341). Multilevel modeling was undertaken to examine the impact of both individual and provincial characteristics on modern contraceptive use. Odds ratios (ORs) and 95% confidence intervals (CIs) are reported. Results Individual factors significantly associated with the use of modern contraceptives were age 30–34 years (reference 15–19 years) (OR=1.63); high socioeconomic status (SES) (OR=0.8); having two living children (OR=2.4); and having a son (OR=1.4). The provincial poverty rate mediated the association between the individual's SES and the likelihood of using modern contraceptives. Conclusions The proportion of women in Vietnam using modern contraceptive methods has remained relatively high in recent years with significant variation across Vietnam's 63 provinces. Women of lower SES are more likely to use modern contraceptive methods, especially in the poorer provinces. Achieving access to universal reproductive health is one of the Millennium Development Goals. Vietnam must continue to make progress in this area. PMID:26950565

Multi-Level Factors Affecting Entry into and Engagement in the HIV Continuum of Care in Iringa, Tanzania

PubMed Central

Layer, Erica H.; Kennedy, Caitlin E.; Beckham, Sarah W.; Mbwambo, Jessie K.; Likindikoki, Samuel; Davis, Wendy W.; Kerrigan, Deanna L.; Brahmbhatt, Heena

2014-01-01

Progression through the HIV continuum of care, from HIV testing to lifelong retention in antiretroviral therapy (ART) care and treatment programs, is critical to the success of HIV treatment and prevention efforts. However, significant losses occur at each stage of the continuum and little is known about contextual factors contributing to disengagement at these stages. This study sought to explore multi-level barriers and facilitators influencing entry into and engagement in the continuum of care in Iringa, Tanzania. We used a mixed-methods study design including facility-based assessments and interviews with providers and clients of HIV testing and treatment services; interviews, focus group discussions and observations with community-based providers and clients of HIV care and support services; and longitudinal interviews with men and women living with HIV to understand their trajectories in care. Data were analyzed using narrative analysis to identify key themes across levels and stages in the continuum of care. Participants identified multiple compounding barriers to progression through the continuum of care at the individual, facility, community and structural levels. Key barriers included the reluctance to engage in HIV services while healthy, rigid clinic policies, disrespectful treatment from service providers, stock-outs of supplies, stigma and discrimination, alternate healing systems, distance to health facilities and poverty. Social support from family, friends or support groups, home-based care providers, income generating opportunities and community mobilization activities facilitated engagement throughout the HIV continuum. Findings highlight the complex, multi-dimensional dynamics that individuals experience throughout the continuum of care and underscore the importance of a holistic and multi-level perspective to understand this process. Addressing barriers at each level is important to promoting increased engagement throughout the continuum. PMID:25119665

Multilevel Analysis Methods for Partially Nested Cluster Randomized Trials

ERIC Educational Resources Information Center

Sanders, Elizabeth A.

2011-01-01

This paper explores multilevel modeling approaches for 2-group randomized experiments in which a treatment condition involving clusters of individuals is compared to a control condition involving only ungrouped individuals, otherwise known as partially nested cluster randomized designs (PNCRTs). Strategies for comparing groups from a PNCRT in the…

College on Credit: A Multilevel Analysis of Student Loan Default

ERIC Educational Resources Information Center

Hillman, Nicholas W.

2014-01-01

This study updates and expands the literature on student loan default. By applying multilevel regression to the Beginning Postsecondary Students survey, four key findings emerge. First, attending proprietary institutions is strongly associated with default, even after accounting for students' socioeconomic and academic backgrounds. Second,…

Impact of sacropelvic fixation on the development of postoperative sacroiliac joint pain following multilevel stabilization for degenerative spine disease.

PubMed

Finger, T; Bayerl, S; Bertog, M; Czabanka, M; Woitzik, J; Vajkoczy, P

2016-11-01

We hypothesised, that the inclusion of the ilium for multilevel lumbosacral fusions reduces the incidence of postoperative sacroiliac joint (SIJ) pain. The primary objective of this study was to compare the frequency of postoperative SIJ pain in patients undergoing multilevel stabilization with and without sacropelvic fixation for multilevel degenerative spine disease. In addition, we aimed at identifying factors that may predict the worsening or new onset of postoperative SIJ pain. A total of 63 patients with multisegmental fusion surgery with a minimum follow up of 12 months were evaluated. 34 patients received sacral fixation (SF group) and 29 patients received an additional sacropelvic fixation device (SPF group). Primary outcome parameters were changes in SIJ pain between the groups and the influence of pelvic parameters, the patient́s age, the patient́s body mass index (BMI) and the length of the stabilization on the SIJ pain. Between the two surgical groups there were no differences concerning age (p=0.3), BMI (p=0.56), length of follow up (p=0.96), length of the construct (p=0.56). In total 31.7% of the patients had a worsening/new onset of SIJ pain after surgery. An additional fixation of the SIJ with iliac screws or iliosacral plate did not have an influence on the SIJ pain (p=0.67). Likewise, pelvic parameters were not predictive for the outcome of the SIJ pain. Only an increased preoperative BMI correlated with a higher chance of a new onset of SIJ pain (p=0.037). In our retrospective study there was no influence of a sacropelvic fixation techniques on the SIJ pain in patients with multilevel degenerative spine disease after multilevel stabilization surgeries. The patients' BMI is the only preoperative factor that correlated with a higher incidence to develop postoperative SIJ pain, independently of the implantation of a sacropelvic fixation device. Copyright © 2016 Elsevier B.V. All rights reserved.

Environmental Profile of a Community’s Health (EPOCH): An Ecometric Assessment of Measures of the Community Environment Based on Individual Perception

PubMed Central

Corsi, Daniel J.; Subramanian, S. V.; McKee, Martin; Li, Wei; Swaminathan, Sumathi; Lopez-Jaramillo, Patricio; Avezum, Alvaro; Lear, Scott A.; Dagenais, Gilles; Rangarajan, Sumathy; Teo, Koon; Yusuf, Salim; Chow, Clara K.

2012-01-01

Background Public health research has turned towards examining upstream, community-level determinants of cardiovascular disease risk factors. Objective measures of the environment, such as those derived from direct observation, and perception-based measures by residents have both been associated with health behaviours. However, current methods are generally limited to objective measures, often derived from administrative data, and few instruments have been evaluated for use in rural areas or in low-income countries. We evaluate the reliability of a quantitative tool designed to capture perceptions of community tobacco, nutrition, and social environments obtained from interviews with residents in communities in 5 countries. Methodology/ Principal Findings Thirteen measures of the community environment were developed from responses to questionnaire items from 2,360 individuals residing in 84 urban and rural communities in 5 countries (China, India, Brazil, Colombia, and Canada) in the Environmental Profile of a Community’s Health (EPOCH) study. Reliability and other properties of the community-level measures were assessed using multilevel models. High reliability (>0.80) was demonstrated for all community-level measures at the mean number of survey respondents per community (n = 28 respondents). Questionnaire items included in each scale were found to represent a common latent factor at the community level in multilevel factor analysis models. Conclusions/ Significance Reliable measures which represent aspects of communities potentially related to cardiovascular disease (CVD)/risk factors can be obtained using feasible sample sizes. The EPOCH instrument is suitable for use in different settings to explore upstream determinants of CVD/risk factors. PMID:22973446

Disparities and menthol marketing: additional evidence in support of point of sale policies.

PubMed

Moreland-Russell, Sarah; Harris, Jenine; Snider, Doneisha; Walsh, Heidi; Cyr, Julianne; Barnoya, Joaquin

2013-09-25

This study examined factors associated with point-of-sale tobacco marketing in St. Louis, an urban city in the United States. Using spatial analysis, descriptive statistics, and multilevel modeling, we examined point-of-sale data and the proportion of mentholated cigarette and total cigarette marketing from 342 individual tobacco retail stores within St. Louis census tracts characterized by the percent of black adults and children. Menthol and total tobacco product marketing was highest in areas with the highest percentages of black residents. When examining menthol marketing to children, we did not find as strong of a relationship, however results of multilevel modeling indicate that as the proportion of black children in a census tract increased, the proportion of menthol marketing near candy also increased. These results indicate the need for communities globally to counter this targeted marketing by taking policy action specifically through the enactment of marketing restrictions provided by the 2009 Family Smoking Prevention and Tobacco Control Act and the Framework Convention of Tobacco Control.

Individual relocation decisions after tornadoes: a multi-level analysis.

PubMed

Cong, Zhen; Nejat, Ali; Liang, Daan; Pei, Yaolin; Javid, Roxana J

2018-04-01

This study examines how multi-level factors affected individuals' relocation decisions after EF4 and EF5 (Enhanced Fujita Tornado Intensity Scale) tornadoes struck the United States in 2013. A telephone survey was conducted with 536 respondents, including oversampled older adults, one year after these two disaster events. Respondents' addresses were used to associate individual information with block group-level variables recorded by the American Community Survey. Logistic regression revealed that residential damage and homeownership are important predictors of relocation. There was also significant interaction between these two variables, indicating less difference between homeowners and renters at higher damage levels. Homeownership diminished the likelihood of relocation among younger respondents. Random effects logistic regression found that the percentage of homeownership and of higher income households in the community buffered the effect of damage on relocation; the percentage of older adults reduced the likelihood of this group relocating. The findings are assessed from the standpoint of age difference, policy implications, and social capital and vulnerability. © 2018 The Author(s). Disasters © Overseas Development Institute, 2018.

Disparities and Menthol Marketing: Additional Evidence in Support of Point of Sale Policies

PubMed Central

Moreland-Russell, Sarah; Harris, Jenine; Snider, Doneisha; Walsh, Heidi; Cyr, Julianne; Barnoya, Joaquin

2013-01-01

This study examined factors associated with point-of-sale tobacco marketing in St. Louis, an urban city in the United States. Using spatial analysis, descriptive statistics, and multilevel modeling, we examined point-of-sale data and the proportion of mentholated cigarette and total cigarette marketing from 342 individual tobacco retail stores within St. Louis census tracts characterized by the percent of black adults and children. Menthol and total tobacco product marketing was highest in areas with the highest percentages of black residents. When examining menthol marketing to children, we did not find as strong of a relationship, however results of multilevel modeling indicate that as the proportion of black children in a census tract increased, the proportion of menthol marketing near candy also increased. These results indicate the need for communities globally to counter this targeted marketing by taking policy action specifically through the enactment of marketing restrictions provided by the 2009 Family Smoking Prevention and Tobacco Control Act and the Framework Convention of Tobacco Control. PMID:24071922

Characterization of biosurfactant produced by petrofilic bacteria isolated from hydrocarbon impacted soil and its potential application in bioremediation

NASA Astrophysics Data System (ADS)

Arsyah, D. M.; Kardena, E.; Helmy, Q.

2018-01-01

The study adopts a multi-level perspective in technology transition to analyse how the transition process in the development of geothermal energy in Indonesia is able to compete against the incumbent fossil-fuelled energy sources. Three levels of multi-level perspective are socio-technical landscape (ST-landscape), socio-technical regime (ST-regime) and niche innovations in Indonesia geothermal development. The identification, mapping and analysis of the dynamic relationship between each level are the important pillars of the multi-level perspective framework. The analysis considers the set of rules, actors and controversies that may arise in the technological transition process. The identified geothermal resource risks are the basis of the emerging geothermal technological innovations in Indonesian geothermal. The analysis of this study reveals the transition pathway, which yields a forecast for the Indonesian geothermal technology transition in the form of scenarios and probable impacts.

A multi-level qualitative analysis of Telehomecare in Ontario: challenges and opportunities.

PubMed

Hunting, Gemma; Shahid, Nida; Sahakyan, Yeva; Fan, Iris; Moneypenny, Crystal R; Stanimirovic, Aleksandra; North, Taylor; Petrosyan, Yelena; Krahn, Murray D; Rac, Valeria E

2015-12-09

Despite research demonstrating the potential effectiveness of Telehomecare for people with Chronic Obstructive Pulmonary Disease and Heart Failure, broad-scale comprehensive evaluations are lacking. This article discusses the qualitative component of a mixed-method program evaluation of Telehomecare in Ontario, Canada. The objective of the qualitative component was to explore the multi-level factors and processes which facilitate or impede the implementation and adoption of the program across three regions where it was first implemented. The study employs a multi-level framework as a conceptual guide to explore the facilitators and barriers to Telehomecare implementation and adoption across five levels: technology, patients, providers, organizations, and structures. In-depth semi-structured interviews and ethnographic observations with program stakeholders, as well as a Telehomecare document review were used to elicit key themes. Study participants (n = 89) included patients and/or informal caregivers (n = 39), health care providers (n = 23), technicians (n = 2), administrators (n = 12), and decision makers (n = 13) across three different Local Health Integration Networks in Ontario. Key facilitators to Telehomecare implementation and adoption at each level of the multi-level framework included: user-friendliness of Telehomecare technology, patient motivation to participate in the program, support for Telehomecare providers, the integration of Telehomecare into broader health service provision, and comprehensive program evaluation. Key barriers included: access-related issues to using the technology, patient language (if not English or French), Telehomecare provider time limitations, gaps in health care provision for patients, and structural barriers to patient participation related to geography and social location. Though Telehomecare has the potential to positively impact patient lives and strengthen models of health care provision, a number of key challenges remain. As such, further implementation and expansion of Telehomecare must involve continuous assessments of what is working and not working with all stakeholders. Increased dialogue, evaluation, and knowledge translation within and across regions to understand the contextual factors influencing Telehomecare implementation and adoption is required. This can inform decision-making that better reflects and addresses the needs of all program stakeholders.

Chinese insurance agents in "bad barrels": a multilevel analysis of the relationship between ethical leadership, ethical climate and business ethical sensitivity.

PubMed

Zhang, Na; Zhang, Jian

2016-01-01

The moral hazards and poor public image of the insurance industry, arising from insurance agents' unethical behavior, affect both the normal operation of an insurance company and decrease applicants' confidence in the company. Contrarily, these scandals may demonstrate that the organizations were "bad barrels" in which insurance agents' unethical decisions were supported or encouraged by the organization's leadership or climate. The present study brings two organization-level factors (ethical leadership and ethical climate) together and explores the role of ethical climate on the relationship between the ethical leadership and business ethical sensitivity of Chinese insurance agents. Through the multilevel analysis of 502 insurance agents from 56 organizations, it is found that organizational ethical leadership is positively related to the organizational ethical climate; organizational ethical climate is positively related to business ethical sensitivity, and organizational ethical climate fully mediates the relationship between organizational ethical leadership and business ethical sensitivity. Organizational ethical climate plays a completely mediating role in the relationship between organizational ethical leadership and business ethical sensitivity. The integrated model of ethical leadership, ethical climate and business ethical sensitivity makes several contributions to ethics theory, research and management.

Interviewer effects on non-response propensity in longitudinal surveys: a multilevel modelling approach

PubMed Central

Vassallo, Rebecca; Durrant, Gabriele B; Smith, Peter W F; Goldstein, Harvey

2015-01-01

The paper investigates two different multilevel approaches, the multilevel cross-classified and the multiple-membership models, for the analysis of interviewer effects on wave non-response in longitudinal surveys. The models proposed incorporate both interviewer and area effects to account for the non-hierarchical structure, the influence of potentially more than one interviewer across waves and possible confounding of area and interviewer effects arising from the non-random allocation of interviewers across areas. The methods are compared by using a data set: the UK Family and Children Survey. PMID:25598587

Meteorological analysis of symptom data for people with seasonal affective disorder.

PubMed

Sarran, Christophe; Albers, Casper; Sachon, Patrick; Meesters, Ybe

2017-11-01

It is thought that variation in natural light levels affect people with Seasonal Affective Disorder (SAD). Several meteorological factors related to luminance can be forecast but little is known about which factors are most indicative of worsening SAD symptoms. The aim of this meteorological analysis is to determine which factors are linked to SAD symptoms. The symptoms of 291 individuals with SAD in and near Groningen have been evaluated over the period 2003-2009. Meteorological factors linked to periods of low natural light (sunshine, global radiation, horizontal visibility, cloud cover and mist) and others (temperature, humidity and pressure) were obtained from weather observation stations. A Bayesian zero adjusted auto-correlated multilevel Poisson model was carried out to assess which variables influence the SAD symptom score BDI-II. The outcome of the study suggests that the variable sunshine duration, for both the current and previous week, and global radiation for the previous week, are significantly linked to SAD symptoms. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

A socio-ecological analysis of barriers to the adoption, sustainablity and consistent use of sanitation facilities in rural Ethiopia.

PubMed

Alemu, Fikralem; Kumie, Abera; Medhin, Girmay; Gebre, Teshome; Godfrey, Phoebe

2017-09-13

Despite evidence showing that access to and use of improved sanitation is associated with healthier households and communities, barriers influencing the adoption and sustainablity of sanitation facilities remain unclear. We conducted a qualitative case study to explore barriers influencing the adoption, sustainablity and consistent use of sanitation facilities in rural Ethiopia. A qualitative study was conducted in the rural district of Becho, in central Ethiopia, from June to August 2016. A socio-ecological model and Integrated Behavioural Model (IBM) for a Water Hygiene and Sanitation (WASH) framework were employed to design the study and analyse data. A total of 10 in-depth interviews (IDI) were conducted with latrine adopters (n = 3), latrine non-adopters (n = 3), health extension workers (n = 3) and the district WASH coordinator (n = 1). Eight Focus Group Discussions (FGD) were undertaken with 75 participants, of which 31 were women. The FGDs and IDIs were tape-recorded, transcribed verbatim and translated into English. The analysis was supported using Nvivo version 10 software. Barriers to sustained adoption and use of sanitation facilities were categorized into 1) individual level factors (e.g., past latrine experience, lack of demand and perceived high cost to improved latrines), 2) household level factors (e.g., unaffordability, lack of space and absence of a physically strong family member), 3) community level factors (e.g., lack of access to public latrines, lack of shared rules against open defecation, lack of financial access for the poor), and 4) societal level factors (e.g., lack of strong local leadership, flooding, soil conditions, lack of appropriate sanitation technology, lack of promotion and demand creation for improved latrines). The use of the socio-ecological model and IBM-WASH framework helped to achieve a better understanding of multi-level and multi-dimensional barriers to sustained latrine adoption. The results indicate that there is a need to consider interventions that address multi-level factors concurrently.

Diagnoses have the greatest impact on variation in sick-leave certification rate among primary-care patients in Sweden: A multilevel analysis including patient, physician and primary health-care centre levels.

PubMed

Starzmann, Karin; Hjerpe, Per; Dalemo, Sofia; Ohlsson, Henrik; Björkelund, Cecilia; Bengtsson Boström, Kristina

2015-11-01

The aims of this study were to determine and evaluate simultaneously the importance of factors known to influence sick-leave certification such as the sick leave-related diagnoses, the patients' socio-economic status, and characteristics of the physicians. Computerised medical records from 24 public primary health-care centres (PHCC) were used in a multilevel logistic regression analysis at three levels: patients (n=64,354; sex, age, socio-economic status, workplace factors and diagnoses), physicians (n=574; sex and level of experience) and PHCC (n=24). The variation of sick-leave certification at each level was the outcome. Most of the variation was attributed to the patient level and only 3.5% to the physician and 1.2% to the PHCC levels. Among the patient characteristics, psychiatric diagnoses (mostly acute stress) had the highest odds ratio (OR) for sick leave (OR=16.0; 95% confidence interval [CI] 15-17.2), followed by musculoskeletal diagnoses (OR=6.1; 95% CI 5.8-6.5). Other factors with increased OR were low education (OR=1.7; 95% CI 1.6-1.8), use of social allowance (OR=1.4; 95% CI 1.2-1.7) and certain workplaces (manufacture and health and social care). Being older was not associated with increased certified sick leave. The greatest variation in sick-leave certification rate was seen at the patient level, specifically psychiatric diagnoses. Socio-economic factors increasing the risk for sick-leave certification were education, social allowance and occupations in manufacture and caregiving. Understanding the impact of the different factors that influence certified sick leave is important both for targeted interventions in order to facilitate patients' return to work. © 2015 the Nordic Societies of Public Health.

Does Group-Level Commitment Predict Employee Well-Being?: A Prospective Analysis.

PubMed

Clausen, Thomas; Christensen, Karl Bang; Nielsen, Karina

2015-11-01

To investigate the links between group-level affective organizational commitment (AOC) and individual-level psychological well-being, self-reported sickness absence, and sleep disturbances. A total of 5085 care workers from 301 workgroups in the Danish eldercare services participated in both waves of the study (T1 [2005] and T2 [2006]). The three outcomes were analyzed using linear multilevel regression analysis, multilevel Poisson regression analysis, and multilevel logistic regression analysis, respectively. Group-level AOC (T1) significantly predicted individual-level psychological well-being, self-reported sickness absence, and sleep disturbances (T2). The association between group-level AOC (T1) and psychological well-being (T2) was fully mediated by individual-level AOC (T1), and the associations between group-level AOC (T1) and self-reported sickness absence and sleep disturbances (T2) were partially mediated by individual-level AOC (T1). Group-level AOC is an important predictor of employee well-being in contemporary health care organizations.

Multivariate Longitudinal Analysis with Bivariate Correlation Test

PubMed Central

Adjakossa, Eric Houngla; Sadissou, Ibrahim; Hounkonnou, Mahouton Norbert; Nuel, Gregory

2016-01-01

In the context of multivariate multilevel data analysis, this paper focuses on the multivariate linear mixed-effects model, including all the correlations between the random effects when the dimensional residual terms are assumed uncorrelated. Using the EM algorithm, we suggest more general expressions of the model’s parameters estimators. These estimators can be used in the framework of the multivariate longitudinal data analysis as well as in the more general context of the analysis of multivariate multilevel data. By using a likelihood ratio test, we test the significance of the correlations between the random effects of two dependent variables of the model, in order to investigate whether or not it is useful to model these dependent variables jointly. Simulation studies are done to assess both the parameter recovery performance of the EM estimators and the power of the test. Using two empirical data sets which are of longitudinal multivariate type and multivariate multilevel type, respectively, the usefulness of the test is illustrated. PMID:27537692

Multivariate Longitudinal Analysis with Bivariate Correlation Test.

PubMed

Adjakossa, Eric Houngla; Sadissou, Ibrahim; Hounkonnou, Mahouton Norbert; Nuel, Gregory

2016-01-01

In the context of multivariate multilevel data analysis, this paper focuses on the multivariate linear mixed-effects model, including all the correlations between the random effects when the dimensional residual terms are assumed uncorrelated. Using the EM algorithm, we suggest more general expressions of the model's parameters estimators. These estimators can be used in the framework of the multivariate longitudinal data analysis as well as in the more general context of the analysis of multivariate multilevel data. By using a likelihood ratio test, we test the significance of the correlations between the random effects of two dependent variables of the model, in order to investigate whether or not it is useful to model these dependent variables jointly. Simulation studies are done to assess both the parameter recovery performance of the EM estimators and the power of the test. Using two empirical data sets which are of longitudinal multivariate type and multivariate multilevel type, respectively, the usefulness of the test is illustrated.

Bullying involvement and adolescent substance use: A multilevel investigation of individual and neighbourhood risk factors.

PubMed

Lambe, Laura J; Craig, Wendy M

2017-09-01

Youth involved with school bullying are vulnerable to many negative outcomes, including substance use. Research has yet to examine how this vulnerability operates in the context of other individual and neighbourhood differences. The current study aimed to fill this gap by using multilevel modeling to investigate both the individual and neighbourhood risk factors associated with frequent drunkenness and frequent cannabis use among adolescents. Data from the 2010 Canadian Health Behaviours in School-Aged Children (HBSC) survey were analyzed. Participants consisted of 8971 students from 173 neighbourhoods across Canada. Multilevel modeling was used to examine both individual (age, gender, bullying, victimization, peer deviancy, negative affect) and neighbourhood (socioeconomic status, crime, physical neighbourhood disorder, residential instability) risk factors. We tested whether the links between bullying involvement and frequent substance use were mediated by other risk factors. Both individual and neighbourhood risk factors were associated with an increased likelihood of frequent substance use. Specifically, bullying served as a unique risk factor for frequent substance use over and above more traditional risk factors. A cross-level interaction was observed between residential instability and peer deviancy, such that the link between peer deviancy and frequent drunkenness was stronger in more residentially-unstable neighbourhoods. Peer deviancy partially mediated the link between bullying and both types of frequent substance use, whereas both peer deviancy and negative affect mediated the link between victimization and both types of frequent substance use. Youth who bully others are vulnerable to frequent substance use across peer and neighbourhood contexts. Copyright © 2017 Elsevier B.V. All rights reserved.

Correlation analysis between change in thoracic kyphosis and multilevel facetectomy and screw density in main thoracic adolescent idiopathic scoliosis surgery.

PubMed

Sudo, Hideki; Abe, Yuichiro; Kokabu, Terufumi; Ito, Manabu; Abumi, Kuniyoshi; Ito, Yoichi M; Iwasaki, Norimasa

2016-09-01

Controversy exists regarding the effects of multilevel facetectomy and screw density on deformity correction, especially thoracic kyphosis (TK) restoration in adolescent idiopathic scoliosis (AIS) surgery. This study aimed to evaluate the effects of multilevel facetectomy and screw density on sagittal plane correction in patients with main thoracic (MT) AIS curve. A retrospective correlation and comparative analysis of prospectively collected, consecutive, non-randomized series of patients at a single institution was undertaken. Sixty-four consecutive patients with Lenke type 1 AIS treated with posterior correction and fusion surgery using simultaneous double-rod rotation technique were included. Patient demographics and preoperative and 2-year postoperative radiographic measurements were the outcome measures for this study. Multiple stepwise linear regression analysis was conducted between change in TK (T5-T12) and the following factors: age at surgery, Risser sign, number of facetectomy level, screw density, preoperative main thoracic curve, flexibility in main thoracic curve, coronal correction rate, preoperative TK, and preoperative lumbar lordosis. Patients were classified into two groups: TK<15° group defined by preoperative TK below the mean degree of TK for the entire cohort (<15°) and the TK≥15° group, defined by preoperative TK above the mean degree of kyphosis (≥15°). Independent sample t tests were used to compare demographic data as well as radiographic outcomes between the two groups. There were no study-specific biases related to conflicts of interest. The average preoperative TK was 14.0°, which improved significantly to 23.1° (p<.0001) at the 2-year final follow-up. Greater change in TK was predicted by a low preoperative TK (p<.0001). The TK <15° group showed significant correlation between change in TK and number of facetectomy level (r=0.492, p=.002). Similarly, significant correlation was found between change in TK and screw density (r=0.333, p=.047). Conversely, in the TK ≥15° group, correlation was found neither between change in TK and number of facetectomy level (r=0.047, p=.812), nor with screw density (r=0.030, p=.880). Furthermore, in patients with preoperative TK<15°, change in TK was significantly correlated with screw density at the concave side (r=0.351, p=.036) but not at the convex side (r=0.144, p=.402). In patients with hypokyphotic thoracic spine, significant positive correlation was found between change in TK and multilevel facetectomy or screw density at the concave side. This indicates that in patients with AIS who have thoracic hypokyphosis as part of their deformity, the abovementioned factors must be considered in preoperative planning to correct hypokyphosis. Copyright © 2016 Elsevier Inc. All rights reserved.

Individual and institutional push and pull factors as predictors of retirement timing in Europe: A multilevel analysis.

PubMed

De Preter, Hanne; Van Looy, Dorien; Mortelmans, Dimitri

2013-12-01

The number of retired people in Europe has increased significantly in recent decades. It remains unclear, however, whether individuals are more likely to be pulled toward retirement by their expectations about life after retirement than they are to be pushed out of the labour market due to poor health or dislike of one's job. The fact that retirement timing differs rather considerably between European countries suggests that not only micro, but also macro push (i.e. labour market constraints) and pull (i.e. economic incentives) factors influence retirement decisions. This duality heightens the need to determine the influence of micro-level and macro-level push and pull indicators on the retirement timing of older workers (50+) in Europe. Results are obtained performing multilevel event history analysis using longitudinal micro data from the first (2004/05) and second (2006/07) waves of the Survey of Health, Ageing and Retirement in Europe and macro data derived from the Organisation for Economic Cooperation and Development (OECD) and Eurostat. The results indicate that at the individual level, older workers are pushed out due to health problems as well as being attracted towards retirement to spend time with their grandchildren. At the institutional level, financial incentives such as a high implicit tax on continued work and high expenditures on early exit schemes make retirement attractive, whereas the institutional push context is of lesser importance. © 2013.

Performance Analysis of Multilevel Parallel Applications on Shared Memory Architectures

NASA Technical Reports Server (NTRS)

Jost, Gabriele; Jin, Haoqiang; Labarta, Jesus; Gimenez, Judit; Caubet, Jordi; Biegel, Bryan A. (Technical Monitor)

2002-01-01

In this paper we describe how to apply powerful performance analysis techniques to understand the behavior of multilevel parallel applications. We use the Paraver/OMPItrace performance analysis system for our study. This system consists of two major components: The OMPItrace dynamic instrumentation mechanism, which allows the tracing of processes and threads and the Paraver graphical user interface for inspection and analyses of the generated traces. We describe how to use the system to conduct a detailed comparative study of a benchmark code implemented in five different programming paradigms applicable for shared memory

The Effects of Socioeconomic Vulnerability, Psychosocial Services, and Social Service Spending on Family Reunification: A Multilevel Longitudinal Analysis

PubMed Central

Esposito, Tonino; Delaye, Ashleigh; Chabot, Martin; Trocmé, Nico; Rothwell, David; Hélie, Sonia; Robichaud, Marie-Joelle

2017-01-01

Socio-environmental factors such as poverty, psychosocial services, and social services spending all could influence the challenges faced by vulnerable families. This paper examines the extent to which socioeconomic vulnerability, psychosocial service consultations, and preventative social services spending impacts the reunification for children placed in out-of-home care. This study uses a multilevel longitudinal research design that draws data from three sources: (1) longitudinal administrative data from Quebec’s child protection agencies; (2) 2006 and 2011 Canadian Census data; and, (3) intra-province health and social services data. The final data set included all children (N = 39,882) placed in out-of-home care for the first time between 1 April 2002 and 31 March 2013, and followed from their initial out-of-home placement. Multilevel hazard results indicate that socioeconomic vulnerability, controlling for psychosocial services and social services spending, contributes to the decreased likelihood of reunification. Specifically, socioeconomic vulnerability, psychosocial services, and social services spending account for 24.0% of the variation in jurisdictional reunification for younger children less than 5 years of age, 12.5% for children age 5 to 11 years and 21.4% for older children age 12 to 17 years. These findings have implications for decision makers, funding agencies, and child protection agencies to improve jurisdictional resources to reduce the socioeconomic vulnerabilities of reunifying families. PMID:28891940

The Effects of Socioeconomic Vulnerability, Psychosocial Services, and Social Service Spending on Family Reunification: A Multilevel Longitudinal Analysis.

PubMed

Esposito, Tonino; Delaye, Ashleigh; Chabot, Martin; Trocmé, Nico; Rothwell, David; Hélie, Sonia; Robichaud, Marie-Joelle

2017-09-09

Socio-environmental factors such as poverty, psychosocial services, and social services spending all could influence the challenges faced by vulnerable families. This paper examines the extent to which socioeconomic vulnerability, psychosocial service consultations, and preventative social services spending impacts the reunification for children placed in out-of-home care. This study uses a multilevel longitudinal research design that draws data from three sources: (1) longitudinal administrative data from Quebec's child protection agencies; (2) 2006 and 2011 Canadian Census data; and, (3) intra-province health and social services data. The final data set included all children ( N = 39,882) placed in out-of-home care for the first time between 1 April 2002 and 31 March 2013, and followed from their initial out-of-home placement. Multilevel hazard results indicate that socioeconomic vulnerability, controlling for psychosocial services and social services spending, contributes to the decreased likelihood of reunification. Specifically, socioeconomic vulnerability, psychosocial services, and social services spending account for 24.0% of the variation in jurisdictional reunification for younger children less than 5 years of age, 12.5% for children age 5 to 11 years and 21.4% for older children age 12 to 17 years. These findings have implications for decision makers, funding agencies, and child protection agencies to improve jurisdictional resources to reduce the socioeconomic vulnerabilities of reunifying families.

A Multilevel Conceptual Framework to Understand the Role of Food Insecurity on Antiretroviral Therapy Adherence in Low-Resource Settings: From Theory to Practice

PubMed Central

Masa, Rainier; Chowa, Gina

2018-01-01

The objective of this study was to describe a multilevel conceptual framework to understand the role of food insecurity on antiretroviral therapy adherence. The authors illustrated an example of how they used the multilevel framework to develop an intervention for poor people living with HIV in a rural and low-resource community. The framework incorporates intra-personal, interpersonal, and structural-level theories of understanding and changing health behaviors. The framework recognizes the role of personal, social, and environmental factors on cognition and behavior, with particular attention to ways in which treatment adherence is enabled or prevented by structural conditions, such as food insecurity. PMID:28368779

An Integrated Multilevel Converter with Sigma Delta Control for LED Lighting

NASA Astrophysics Data System (ADS)

Gerber, Daniel L.

High brightness LEDs have become a mainstream lighting technology due to their efficiency, life span, and environmental benefits. As such, the lighting industry values LED drivers with low cost, small form factor, and long life span. Additional specifications that define a high quality LED driver are high efficiency, high power factor, wide-range dimming, minimal flicker, and a galvanically isolated output. The flyback LED driver is a popular topology that satisfies all these specifications, but it requires a bulky and costly flyback transformer. In addition, its passive methods for cancelling AC power ripple require electrolytic capacitors, which have been known to have life span issues. This dissertation details the design, construction, and verification of a novel LED driver that satisfies all the specifications. In addition, it does not require a flyback transformer or electrolytic capacitors, thus marking an improvement over the flyback driver on size, cost, and life span. This dissertation presents an integrated circuit (IC) LED driver, which features a pair of generalized multilevel converters that are controlled via sigma-delta modulation. The first is a multilevel rectifier responsible for power factor correction (PFC) and dimming. The PFC rectifier employs a second order sigma-delta loop to precisely control the input current harmonics and amplitude. The second is a bidirectional multilevel inverter used to cancel AC power ripple from the DC bus. This ripple-cancellation module transfers energy to and from a storage capacitor. It uses a first order sigma-delta loop with a preprogrammed waveform to swing the storage capacitor voltage. The system also contains an output stage that powers the LEDs with DC and provides for galvanic isolation. The output stage consists of an H-bridge stack that connects to the output through a small toroid transformer. The IC LED driver was simulated and prototyped on an ABCD silicon test chip. Testing and verification indicates functional performance for all the modules in the LED driver. The driver exhibits moderate efficiency at half voltage. Although the part was only testable to half voltage, loss models predict that its efficiency would be much higher at full voltage. The driver also meets specifications on the line current harmonics and ripple cancellation. This dissertation introduces multilevel circuit techniques to the IC and LED research space. The prototype's functional performance indicates that integrated multilevel converters are a viable topology for lighting and other similar applications.

The influence of the macro-environment on physical activity: a multilevel analysis of 38 countries worldwide

PubMed Central

2012-01-01

Background As indicated by the ANGELO framework and similar models, various environmental factors influence population levels of physical activity (PA). To date attention has focused on the micro-level environment, while evidence on the macro-level environment remains scarce and mostly limited to high-income countries. This study aims to investigate whether environmental factors at macro-level are associated with PA among a broader range of countries. Methods Data from the World Health Survey (WHS) was used to analyze 177,035 adults from 38 (mostly low and middle income) countries. The International Physical Activity Questionnaire-Short Form (IPAQ-S) was used to measure PA. Respondents were classified as active or inactive for vigorous PA, moderate PA and walking. Multilevel logistic regression was performed to assess associations between macro-level environmental factors and the prevalence of PA, with control for individual-level socioeconomic factors. Results The prevalence of PA varied widely between countries and types of PA (5.0%-93.8%). A negative association was found between gross domestic product and PA, odds ratios for men were 0.76 (95% CI: 0.65-0.89) for moderate PA and 0.79 (95% CI: 0.63-0.98) for walking. A higher temperature was associated with less PA (all types) and higher urbanization was associated with less vigorous and moderate PA. More gender equality was also associated with more walking for women. Governmental functioning and literacy rate were not found to be associated with any type of PA. Conclusions This exploratory study indicates that factors such as climate, economic development and cultural factors are determinants of the level of overall PA at national levels. This underlines the suggestion that the macro-environment should be regarded as an important influence on PA. PMID:22967164

Socioeconomic inequalities in adolescent smoking across 35 countries: a multilevel analysis of the role of family, school and peers.

PubMed

Moor, Irene; Rathmann, Katharina; Lenzi, Michela; Pförtner, Timo-Kolja; Nagelhout, Gera E; de Looze, Margreet; Bendtsen, Pernille; Willemsen, Marc; Kannas, Lasse; Kunst, Anton E; Richter, Matthias

2015-06-01

Tobacco-related heath inequalities are a major public health concern, with smoking being more prevalent among lower socioeconomic groups. The aim of this study is to investigate the mechanisms leading to socioeconomic inequalities in smoking among 15-year-old adolescents by examining the mediating role of psychosocial factors in the peer group, family and school environment. Data were derived from the international WHO-collaborative 'Health Behaviour in School-aged Children (HBSC)' study 2005/2006, including 52 907 15-year-old students from 35 European and North American countries. Socioeconomic position was measured by the Family Affluence Scale. Multilevel logistic regression models were conducted to examine the contribution of family, school and peer factors in explaining the association between family affluence and weekly smoking. Across countries, adolescents from low affluent families had an increased risk of weekly smoking (OR(boys) 1.14, confidence interval (CI) 1.05-1.23; OR(girls) 1.36, CI 1.26-1.46) compared with adolescents from high affluent families. Family and school factors mediated the association between family affluence and smoking to a high extent up to 100% (boys) and 81% (girls) in joint analyses. The most important single factors were family structure, relationships with parents, academic achievement and school satisfaction. Peer factors did not mediate the association between family affluence and adolescent smoking. The association between socioeconomic status and adolescent weekly smoking can largely be explained by an unequal distribution of family- and school-related factors. Focusing on the parent-adolescent relationship and adolescent school achievement can help to better understand inequalities in adolescent smoking behaviour. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Determinants of access to health care for depression in 49 countries: A multilevel analysis.

PubMed

Araya, Ricardo; Zitko, Pedro; Markkula, Niina; Rai, Dheeraj; Jones, Kelvyn

2018-07-01

The relative importance of individual and country-level factors influencing access to diagnosis and treatment for depression across the world is fairly unknown. We analysed cross-national data from the WHO World Health Surveys. Depression diagnosis and access to health care were ascertained using a structured interview. Logistic Bayesian Multilevel analyses were performed to establish individual and country level factors associated with: (1) receiving a diagnosis and (2) accessing treatment for depression if a diagnosis was ascertained. The sample included 7870 individuals from 49 countries who met ICD-10 criteria for depressive episode in the past 12 months. A third (32%) of these individuals had ever been diagnosed with depression in their lifetime. Among those diagnosed with depression, 66% reported to have ever received treatment for depression. Although individual factors were more important determinants of access to treatment for depression, country-level factors explained 27.6% of the variance in access to diagnosis and 24.1% in access to treatment. Access to treatment for depression improved with increasing country income. Female gender, better education, the presence of physical co-morbidity, more material assets, and living in urban areas were individual level determinants of better access. Data on other contextual factors was not available. Unmet need was likely underestimated, since only lifetime treatment data was available. This study highlights major inequalities in access to a diagnosis and treatment of depression. Unlike the prevalence of depression, where contextual factors have shown to have less importance, a significant proportion of the variance in access to depression care was explained by country-level income. Copyright © 2018 Elsevier B.V. All rights reserved.

The influence of the macro-environment on physical activity: a multilevel analysis of 38 countries worldwide.

PubMed

Bosdriesz, Jizzo R; Witvliet, Margot I; Visscher, Tommy L S; Kunst, Anton E

2012-09-11

As indicated by the ANGELO framework and similar models, various environmental factors influence population levels of physical activity (PA). To date attention has focused on the micro-level environment, while evidence on the macro-level environment remains scarce and mostly limited to high-income countries. This study aims to investigate whether environmental factors at macro-level are associated with PA among a broader range of countries. Data from the World Health Survey (WHS) was used to analyze 177,035 adults from 38 (mostly low and middle income) countries. The International Physical Activity Questionnaire-Short Form (IPAQ-S) was used to measure PA. Respondents were classified as active or inactive for vigorous PA, moderate PA and walking. Multilevel logistic regression was performed to assess associations between macro-level environmental factors and the prevalence of PA, with control for individual-level socioeconomic factors. The prevalence of PA varied widely between countries and types of PA (5.0%-93.8%). A negative association was found between gross domestic product and PA, odds ratios for men were 0.76 (95% CI: 0.65-0.89) for moderate PA and 0.79 (95% CI: 0.63-0.98) for walking. A higher temperature was associated with less PA (all types) and higher urbanization was associated with less vigorous and moderate PA. More gender equality was also associated with more walking for women. Governmental functioning and literacy rate were not found to be associated with any type of PA. This exploratory study indicates that factors such as climate, economic development and cultural factors are determinants of the level of overall PA at national levels. This underlines the suggestion that the macro-environment should be regarded as an important influence on PA.

Changing drug users' risk environments: peer health advocates as multi-level community change agents.

PubMed

Weeks, Margaret R; Convey, Mark; Dickson-Gomez, Julia; Li, Jianghong; Radda, Kim; Martinez, Maria; Robles, Eduardo

2009-06-01

Peer delivered, social oriented HIV prevention intervention designs are increasingly popular for addressing broader contexts of health risk beyond a focus on individual factors. Such interventions have the potential to affect multiple social levels of risk and change, including at the individual, network, and community levels, and reflect social ecological principles of interaction across social levels over time. The iterative and feedback dynamic generated by this multi-level effect increases the likelihood for sustained health improvement initiated by those trained to deliver the peer intervention. The Risk Avoidance Partnership (RAP), conducted with heroin and cocaine/crack users in Hartford, Connecticut, exemplified this intervention design and illustrated the multi-level effect on drug users' risk and harm reduction at the individual level, the social network level, and the larger community level. Implications of the RAP program for designing effective prevention programs and for analyzing long-term change to reduce HIV transmission among high-risk groups are discussed from this ecological and multi-level intervention perspective.

Cascaded H-bridge multilevel inverter for renewable energy generation

NASA Astrophysics Data System (ADS)

Pandey, Ravikant; Nath Tripathi, Ravi; Hanamoto, Tsuyoshi

2016-04-01

In this paper cascaded H-bridge multilevel inverter (CHBMLI) has been investigated for the application of renewable energy generation. Energy sources like solar, wind, hydro, biomass or combination of these can be manipulated to obtain alternative sources for renewable energy generation. These renewable energy sources have different electrical characteristics like DC or AC level so it is challenging to use generated power by connecting to grid or load directly. The renewable energy source require specific power electronics converter as an interface for conditioning generated power .The multilevel inverter can be utilized for renewable energy sources in two different modes, the power generation mode (stand-alone mode), and compensator mode (statcom). The performance of the multilevel inverter has been compared with two level inverter. In power generation mode CHBMLI supplies the active and reactive power required by the different loads. For operation in compensator mode the indirect current control based on synchronous reference frame theory (SRFT) ensures the grid operating in unity power factor and compensate harmonics and reactive power.

Socio-demographic predictors and average annual rates of caesarean section in Bangladesh between 2004 and 2014.

PubMed

Khan, Md Nuruzzaman; Islam, M Mofizul; Shariff, Asma Ahmad; Alam, Md Mahmudul; Rahman, Md Mostafizur

2017-01-01

Globally the rates of caesarean section (CS) have steadily increased in recent decades. This rise is not fully accounted for by increases in clinical factors which indicate the need for CS. We investigated the socio-demographic predictors of CS and the average annual rates of CS in Bangladesh between 2004 and 2014. Data were derived from four waves of nationally representative Bangladesh Demographic and Health Survey (BDHS) conducted between 2004 and 2014. Rate of change analysis was used to calculate the average annual rate of increase in CS from 2004 to 2014, by socio-demographic categories. Multi-level logistic regression was used to identify the socio-demographic predictors of CS in a cross-sectional analysis of the 2014 BDHS data. CS rates increased from 3.5% in 2004 to 23% in 2014. The average annual rate of increase in CS was higher among women of advanced maternal age (≥35 years), urban areas, and relatively high socio-economic status; with higher education, and who regularly accessed antenatal services. The multi-level logistic regression model indicated that lower (≤19) and advanced maternal age (≥35), urban location, relatively high socio-economic status, higher education, birth of few children (≤2), antenatal healthcare visits, overweight or obese were the key factors associated with increased utilization of CS. Underweight was a protective factor for CS. The use of CS has increased considerably in Bangladesh over the survey years. This rising trend and the risk of having CS vary significantly across regions and socio-economic status. Very high use of CS among women of relatively high socio-economic status and substantial urban-rural difference call for public awareness and practice guideline enforcement aimed at optimizing the use of CS.

Socio-demographic predictors and average annual rates of caesarean section in Bangladesh between 2004 and 2014

PubMed Central

Khan, Md. Nuruzzaman; Islam, M. Mofizul; Shariff, Asma Ahmad; Alam, Md. Mahmudul; Rahman, Md. Mostafizur

2017-01-01

Background Globally the rates of caesarean section (CS) have steadily increased in recent decades. This rise is not fully accounted for by increases in clinical factors which indicate the need for CS. We investigated the socio-demographic predictors of CS and the average annual rates of CS in Bangladesh between 2004 and 2014. Methods Data were derived from four waves of nationally representative Bangladesh Demographic and Health Survey (BDHS) conducted between 2004 and 2014. Rate of change analysis was used to calculate the average annual rate of increase in CS from 2004 to 2014, by socio-demographic categories. Multi-level logistic regression was used to identify the socio-demographic predictors of CS in a cross-sectional analysis of the 2014 BDHS data. Result CS rates increased from 3.5% in 2004 to 23% in 2014. The average annual rate of increase in CS was higher among women of advanced maternal age (≥35 years), urban areas, and relatively high socio-economic status; with higher education, and who regularly accessed antenatal services. The multi-level logistic regression model indicated that lower (≤19) and advanced maternal age (≥35), urban location, relatively high socio-economic status, higher education, birth of few children (≤2), antenatal healthcare visits, overweight or obese were the key factors associated with increased utilization of CS. Underweight was a protective factor for CS. Conclusion The use of CS has increased considerably in Bangladesh over the survey years. This rising trend and the risk of having CS vary significantly across regions and socio-economic status. Very high use of CS among women of relatively high socio-economic status and substantial urban-rural difference call for public awareness and practice guideline enforcement aimed at optimizing the use of CS. PMID:28493956

A multilevel control system for the large space telescope. [numerical analysis/optimal control

NASA Technical Reports Server (NTRS)

Siljak, D. D.; Sundareshan, S. K.; Vukcevic, M. B.

1975-01-01

A multilevel scheme was proposed for control of Large Space Telescope (LST) modeled by a three-axis-six-order nonlinear equation. Local controllers were used on the subsystem level to stabilize motions corresponding to the three axes. Global controllers were applied to reduce (and sometimes nullify) the interactions among the subsystems. A multilevel optimization method was developed whereby local quadratic optimizations were performed on the subsystem level, and global control was again used to reduce (nullify) the effect of interactions. The multilevel stabilization and optimization methods are presented as general tools for design and then used in the design of the LST Control System. The methods are entirely computerized, so that they can accommodate higher order LST models with both conceptual and numerical advantages over standard straightforward design techniques.

TEMPEST in a gallimaufry: applying multilevel systems theory to person-in-context research.

PubMed

Peck, Stephen C

2007-12-01

Terminological ambiguity and inattention to personal and contextual multilevel systems undermine personality, self, and identity theories. Hierarchical and heterarchical systems theories are used to describe contents and processes existing within and across three interrelated multilevel systems: levels of organization, representation, and integration. Materially nested levels of organization are used to distinguish persons from contexts and personal from social identity. Functionally nested levels of representation are used to distinguish personal identity from the sense of identity and symbolic (belief) from iconic (schema) systems. Levels of integration are hypothesized to unfold separately but interdependently across levels of representation. Multilevel system configurations clarify alternative conceptualizations of traits and contextualized identity. Methodological implications for measurement and analysis (e.g., integrating variable- and pattern-centered methods) are briefly described.

Engineering applications of heuristic multilevel optimization methods

NASA Technical Reports Server (NTRS)

Barthelemy, Jean-Francois M.

1988-01-01

Some engineering applications of heuristic multilevel optimization methods are presented and the discussion focuses on the dependency matrix that indicates the relationship between problem functions and variables. Coordination of the subproblem optimizations is shown to be typically achieved through the use of exact or approximate sensitivity analysis. Areas for further development are identified.

Engineering applications of heuristic multilevel optimization methods

NASA Technical Reports Server (NTRS)

Barthelemy, Jean-Francois M.

1989-01-01

Some engineering applications of heuristic multilevel optimization methods are presented and the discussion focuses on the dependency matrix that indicates the relationship between problem functions and variables. Coordination of the subproblem optimizations is shown to be typically achieved through the use of exact or approximate sensitivity analysis. Areas for further development are identified.

School Climate for Academic Success: A Multilevel Analysis of School Climate and Student Outcomes

ERIC Educational Resources Information Center

Kwong, Darren; Davis, Jonathan Ryan

2015-01-01

This multilevel study examined the relationship between school climate and academic achievement. Using the Educational Longitudinal Survey (ELS, 2002), and a sample of 16,258 students and 1954 schools nationwide, we found that student-level perception of school climate--especially the student learning environment--was highly predictive of academic…

Introduction to Multilevel Item Response Theory Analysis: Descriptive and Explanatory Models

ERIC Educational Resources Information Center

Sulis, Isabella; Toland, Michael D.

2017-01-01

Item response theory (IRT) models are the main psychometric approach for the development, evaluation, and refinement of multi-item instruments and scaling of latent traits, whereas multilevel models are the primary statistical method when considering the dependence between person responses when primary units (e.g., students) are nested within…

"Using Power Tables to Compute Statistical Power in Multilevel Experimental Designs"

ERIC Educational Resources Information Center

Konstantopoulos, Spyros

2009-01-01

Power computations for one-level experimental designs that assume simple random samples are greatly facilitated by power tables such as those presented in Cohen's book about statistical power analysis. However, in education and the social sciences experimental designs have naturally nested structures and multilevel models are needed to compute the…

A Multilevel Analysis of Phase II of the Louisiana School Effectiveness Study.

ERIC Educational Resources Information Center

Kennedy, Eugene; And Others

This paper presents findings of a study that used conventional modeling strategies (student- and school-level) and a new multilevel modeling strategy, Hierarchical Linear Modeling, to investigate school effects on student-achievement outcomes for data collected as part of Phase 2 of the Louisiana School Effectiveness Study. The purpose was to…

Pre- and Postnatal Women's Leisure Time Physical Activity Patterns: A Multilevel Longitudinal Analysis

ERIC Educational Resources Information Center

Cramp, Anita G.; Bray, Steven R.

2009-01-01

The purpose of this study was to examine women's leisure time physical activity (LTPA) before pregnancy, during pregnancy, and through the first 7 months postnatal. Pre- and postnatal women (n = 309) completed the 12-month Modifiable Activity Questionnaire and demographic information. Multilevel modeling was used to estimate a growth curve…

Does the Organization Matter? A Multilevel Analysis of Organizational Effects in Homeless Service Innovations

ERIC Educational Resources Information Center

Cronley, Courtney; Patterson, David A.

2012-01-01

This study examined the effects of organizational culture on staff members' use of management information systems ("N" = 142) within homeless service organizations ("N" = 24), using a multilevel model. The Organizational Social Context Questionnaire was used to measure organizational culture, defined by three sub-constructs: (1) proficiency, (2)…

Newly occurred L4 spondylolysis in the lumbar spine with pre-existence L5 spondylolysis among sports players: case reports and biomechanical analysis.

PubMed

Sairyo, Koichi; Sakai, Toshinori; Yasui, Natsuo; Kiapour, Ali; Biyani, Ashok; Ebraheim, Nabil; Goel, Vijay K

2009-10-01

Case series and a biomechanical study using a finite element (FE) analysis. To report three cases with multi-level spondylolysis and to understand the mechanism biomechanically. Multi-level spondylolysis is a very rare condition. There have been few reports in the literature on multi-level spondylolysis among sports players. We reviewed three cases of the condition, clinically. These patients were very active young sports players and had newly developed fresh L4 spondylolysis and pre-existing L5 terminal stage spondylolysis. Thus, we assumed that L5 spondylolysis may have increased the pars stress at the cranial adjacent levels, leading to newly developed spondylolysis at these levels. Biomechanically, we investigated pars stress at L4 with or without spondylolysis at L5 using the finite element technique. L4 pars stress decreased in the presence of L5 spondylolysis, which does not support our first hypothesis. It seems that multi-level spondylolysis may occur due to genetic and not biomechanical reasons.

Relationship between learning environment characteristics and academic engagement.

PubMed

Opdenakker, Marie-Christine; Minnaert, Alexander

2011-08-01

The relationship between learning environment characteristics and academic engagement of 777 Grade 6 children located in 41 learning environments was explored. Questionnaires were used to tap learning environment perceptions of children, their academic engagement, and their ethnic-cultural background. The basis of the learning environment questionnaire was the International System for Teacher Observation and Feedback (ISTOF). Factor analysis indicated three factors: the teacher as a helpful and good instructor (having good instructional skills, clear instruction), the teacher as promoter of active learning and differentiation, and the teacher as manager and organizer of classroom activities. Multilevel analysis indicated that about 12% of the differences in engagement between children was related to the learning environment. All the mentioned learning environment characteristics mattered, but the teacher as a helpful, good instructor was most important followed by the teacher as promoter of active learning and differentiation.

Individual and areal risk factors for road traffic injury deaths: nationwide study in South Korea.

PubMed

Park, Kunhee; Hwang, Seung-Sik; Lee, Jin-Seok; Kim, Yoon; Kwon, Soonman

2010-07-01

This study determines the individual and areal risk factors for road traffic injury deaths in South Korea. The risk factors that influence road traffic injury deaths are defined by multilevel Poisson regression analysis. It is seen that not only demographic factors but also individual educational level, which represents socioeconomic status, influences road traffic injury deaths. The material deprivation index, which represents areal socioeconomic status, and W statistics, as a measure of the quality of the emergency medical system in an area, also influence road traffic injury deaths. Based on this study, the most vulnerable group for road traffic injury deaths is elderly men with a low level of education who live in the most deprived areas.Therefore, preventive policies focusing on both these areas and this population demographic should be established.

Framing Ethnic Variations in Alcohol Outcomes from Biological Pathways to Neighborhood Context

PubMed Central

Chartier, Karen G.; Scott, Denise M.; Wall, Tamara L.; Covault, Jonathan; Karriker-Jaffe, Katherine J.; Mills, Britain A.; Luczak, Susan E.; Caetano, Raul; Arroyo, Judith A.

2013-01-01

Health disparities research seeks to eliminate disproportionate negative health outcomes experienced in some racial/ethnic minority groups. This brief review presents findings on factors associated with drinking and alcohol-related problems in racial/ethnic groups. Those discussed are: 1) biological pathways to alcohol problems, 2) gene by stress interactions, 3) neighborhood disadvantage, stress, and access to alcohol, and 4) drinking cultures and contexts. These factors and their interrelationships are complex, requiring a multi-level perspective. The use of interdisciplinary teams and an epigenetic focus are suggested to move the research forward. The application of multi-level research to policy, prevention, and intervention programs may help prioritize combinations of the most promising intervention targets. PMID:24483624

Facilitators and barriers to effective scale-up of an evidence-based multilevel HIV prevention intervention.

PubMed

Kegeles, Susan M; Rebchook, Gregory; Tebbetts, Scott; Arnold, Emily

2015-04-17

Since the scale-up of HIV/AIDS prevention evidence-based interventions (EBIs) has not been simple, it is important to examine processes that occur in the translation of the EBIs into practice that affect successful implementation. The goal of this paper is to examine facilitators and barriers to effective implementation that arose among 72 community-based organizations as they moved into practice a multilevel HIV prevention intervention EBI, the Mpowerment Project, for young gay and bisexual men. CBOs that were implementing the Mpowerment Project participated in this study and were assessed at baseline, and 6-months, 1 year, and 2 years post-baseline. Semi-structured telephone interviews were conducted separately with individuals at each CBO. Study data came from 647 semi-structured interviews and extensive notes and commentaries from technical assistance providers. Framework Analysis guided the analytic process. Barriers and facilitators to implementation was the overarching thematic framework used across all the cases in our analysis. Thirteen themes emerged regarding factors that influence the successful implementation of the MP. These were organized into three overarching themes: HIV Prevention System Factors, Community Factors, and Intervention Factors. The entire HIV Prevention System, including coordinators, supervisors, executive directors, funders, and national HIV prevention policies, all influenced implementation success. Other Prevention System Factors that affected the effective translation of the EBI into practice include Knowledge About Intervention, Belief in the Efficacy of the Intervention, Desire to Change Existing Prevention Approach, Planning for Intervention Before Implementation, Accountability, Appropriateness of Individuals for Coordinator Positions, Evaluation of Intervention, and Organizational Stability. Community Factors included Geography and Sociopolitical Climate. Intervention Factors included Intervention Characteristics and Adaptation Issues. The entire ecological system in which an EBI occurs affects implementation. It is imperative to focus capacity-building efforts on getting individuals at different levels of the HIV Prevention System into alignment regarding understanding and believing in the program's goals and methods. For a Prevention Support System to be maximally useful, it must address facilitators or barriers to implementation, address the right people, and use modalities to convey information that are acceptable for users of the system.

Ebola-related stigma in Ghana: Individual and community level determinants.

PubMed

Tenkorang, Eric Y

2017-06-01

Although Ebola-related stigmatization continues to undermine efforts to re-integrate survivors, few studies have examined what influences such stigmatizing attitudes. This paper explores the effects of both individual- and community-level factors on Ebola-related stigma in Ghana. Data were collected from a cross-section of 800 respondents, nested within 40 communities in the Greater Accra Region of Ghana. Multi-level modelling was employed for analysis. Both individual- and community-level factors were significant determinants of stigma. Respondents who endorsed myths about Ebola were significantly more likely to also endorse Ebola-related stigma. Similarly, those who were worried about a potential outbreak of Ebola in the future, had moderate risk perceptions of contracting Ebola, had primary and secondary education, and were not confident of the quality of health care in the event of an outbreak, were more likely to endorse Ebola-related stigma. Knowledge of Ebola was significant at the community level, but not at the individual level. Communities with more knowledge were less likely to endorse Ebola-related stigma. These findings underscore the need to increase the knowledge base while countering myths that undermine preventive behaviours to fight Ebola-related stigma. It is equally important to adopt multi-level interventions that emphasize community-based strategies. Copyright © 2017 Elsevier Ltd. All rights reserved.

Psychosocial and behavioural factors in the explanation of socioeconomic inequalities in adolescent health: a multilevel analysis in 28 European and North American countries.

PubMed

Moor, Irene; Rathmann, Katharina; Stronks, Karien; Levin, Kate; Spallek, Jacob; Richter, Matthias

2014-10-01

The relative contribution of different pathways leading to health inequalities in adolescence was rarely investigated, especially in a cross-national perspective. The aim of the study is to analyse the contribution of psychosocial and behavioural factors in the explanation of inequalities in adolescent self-rated health (SRH) by family wealth in 28 countries. This study was based on the international WHO 'Health Behaviour in School-aged Children' (HBSC) study carried out in 2005/2006. The total sample included 117 460 adolescents aged 11-15 in 28 European and North American countries. Socioeconomic position was measured using the Family Affluence Scale (FAS). Multilevel logistic regression models were conducted to analyse the direct (independent) and indirect contribution of psychosocial and behavioural factors on SRH. Across all countries, adolescents from low affluent families had a higher risk of reporting fair/poor SRH (OR1.76, CI 1.69 to 1.84). Separate adjustments for psychosocial and behavioural factors reduced the OR of students with low family affluence by 39% (psychosocial) and 22% (behavioural). Together, both approaches explained about 50-60% of inequalities by family affluence in adolescent SRH. Separate analyses showed that relationship to father and academic achievement (psychosocial factors) as well as physical activity and consumption of fruits/vegetables (behavioural factors) were the most important factors in explaining inequalities in SRH. More than half of the inequalities by family affluence in adolescent SRH were explained by an unequal distribution of psychosocial and behavioural factors. Combining both approaches showed that the contribution of psychosocial factors was higher due to their direct (independent) and indirect impact through behavioural factors. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Community and household socioeconomic factors associated with pesticide-using, small farm household members' health: a multi-level, longitudinal analysis

PubMed Central

2011-01-01

Background Longitudinal studies using multi-level models to examine health inequalities in lower and middle income countries (LMICs) are rare. We explored socio-economic gradients in health among small farm members participating in a pesticide-related health and agriculture program in highland Ecuador. Methods We profiled 24 communities through key informant interviews, secondary data (percent of population with unsatisfied basic needs), and intervention implementation indicators. Pre (2005) and post (2007) surveys of the primary household and crop managers included common questions (education, age, and the health outcome - digit span scaled 0-10)) and pesticide-related practice questions specific to each. Household assets and pesticide use variables were shared across managers. We constructed multi-level models predicting 2007 digit span for each manager type, with staged introduction of predictor variables. Results 376 household managers (79% of 2005 participants) and 380 crop managers (76% of 2005 participants) had complete data for analysis. The most important predictor of 2007 digit span was 2005 digit span: β (Standard Error) of 0.31(0.05) per unit for household and 0.17(0.04) for crop managers. Household asset score was next most important: 0.14(0.06) per unit for household and 0.14(0.05) for crop managers. Community percent with unsatisfied basic needs was associated with reductions in 2007 digit span: -0.04(0.01) per percent for household and -0.03(0.01) for crop managers. Conclusions The important roles of life endowments and/or persistent neurotoxicity were exemplified by limited change in the health outcome. Gradients by household assets and community deprivation were indicative of ongoing, structural inequities within this LMIC. PMID:22094171

No effect of unemployment on intimate partner-related femicide during the financial crisis: a longitudinal ecological study in Spain.

PubMed

Torrubiano-Domínguez, J; Vives-Cases, C; San-Sebastián, M; Sanz-Barbero, B; Goicolea, I; Álvarez-Dardet, C

2015-09-30

Spain's financial crisis has been characterized by an increase in unemployment. This increase could have produced an increase in deaths of women due to intimate partner-related femicides (IPF). This study aims to determine whether the increase in unemployment among both sexes in different regions in Spain is related to an increase in the rates of IPF during the current financial crisis period. An ecological longitudinal study was carried out in Spain's 17 regions. Two study periods were defined: pre-crisis period (2005-2007) and crisis period (2008-2013). IPF rates adjusted by age and unemployment rates for men and women were calculated. We fitted multilevel linear regression models in which observations at level 1 were nested within regions according to a repeated measurements design. Rates of unemployment have progressively increased in Spain, rising above 20 % from 2008 to 2013 in some regions. IPF rates decreased in some regions during crisis period with respect to pre-crisis period. The multilevel analysis does not support the existence of a significant relationship between the increase in unemployment in men and women and the decrease in IPF since 2008. The increase in unemployment in men and women in Spain does not appear to have an effect on IPF. The results of the multilevel analysis discard the hypothesis that the increase in the rates of unemployment in women and men are related to an increase in IPF rates. The decline in IPF since 2008 might be interpreted as the result of exposure to other factors such as the lower frequency of divorces in recent years or the medium term effects of the integral protection measures of the law on gender violence that began in 2005.

Using iMCFA to Perform the CFA, Multilevel CFA, and Maximum Model for Analyzing Complex Survey Data.

PubMed

Wu, Jiun-Yu; Lee, Yuan-Hsuan; Lin, John J H

2018-01-01

To construct CFA, MCFA, and maximum MCFA with LISREL v.8 and below, we provide iMCFA (integrated Multilevel Confirmatory Analysis) to examine the potential multilevel factorial structure in the complex survey data. Modeling multilevel structure for complex survey data is complicated because building a multilevel model is not an infallible statistical strategy unless the hypothesized model is close to the real data structure. Methodologists have suggested using different modeling techniques to investigate potential multilevel structure of survey data. Using iMCFA, researchers can visually set the between- and within-level factorial structure to fit MCFA, CFA and/or MAX MCFA models for complex survey data. iMCFA can then yield between- and within-level variance-covariance matrices, calculate intraclass correlations, perform the analyses and generate the outputs for respective models. The summary of the analytical outputs from LISREL is gathered and tabulated for further model comparison and interpretation. iMCFA also provides LISREL syntax of different models for researchers' future use. An empirical and a simulated multilevel dataset with complex and simple structures in the within or between level was used to illustrate the usability and the effectiveness of the iMCFA procedure on analyzing complex survey data. The analytic results of iMCFA using Muthen's limited information estimator were compared with those of Mplus using Full Information Maximum Likelihood regarding the effectiveness of different estimation methods.

PrEParing Women to Prevent HIV: An Integrated Theoretical Framework to PrEP Black Women in the United States.

PubMed

Chapman Lambert, Crystal; Marrazzo, Jeanne; Amico, K Rivet; Mugavero, Michael J; Elopre, Latesha

2018-04-05

Preexposure prophylaxis (PrEP) with optimal adherence has demonstrated efficacy in reducing HIV incidence in women. Black women are disproportionately burdened by the HIV epidemic, accounting for more than half of all new HIV cases in women, thereby making PrEP an ideal prevention strategy for this group. However, to date, PrEP uptake by women in the United States has been slow. Further domestic research is needed to understand the multilevel factors related to PrEP awareness, uptake, and implementation in Black women. Our purpose was to review the current status of HIV prevention in Black women. We summarize clinical trials germane to federal approval of PrEP; discuss important PrEP studies focused on women, including non-oral options; and review multilevel barriers to PrEP uptake. Lastly, we discuss the use of an integrated theoretical framework to organize multilevel factors related to PrEP uptake by Black women in order to guide intervention development. Copyright © 2018 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Assessing variance components in multilevel linear models using approximate Bayes factors: A case study of ethnic disparities in birthweight

PubMed Central

Saville, Benjamin R.; Herring, Amy H.; Kaufman, Jay S.

2013-01-01

Racial/ethnic disparities in birthweight are a large source of differential morbidity and mortality worldwide and have remained largely unexplained in epidemiologic models. We assess the impact of maternal ancestry and census tract residence on infant birth weights in New York City and the modifying effects of race and nativity by incorporating random effects in a multilevel linear model. Evaluating the significance of these predictors involves the test of whether the variances of the random effects are equal to zero. This is problematic because the null hypothesis lies on the boundary of the parameter space. We generalize an approach for assessing random effects in the two-level linear model to a broader class of multilevel linear models by scaling the random effects to the residual variance and introducing parameters that control the relative contribution of the random effects. After integrating over the random effects and variance components, the resulting integrals needed to calculate the Bayes factor can be efficiently approximated with Laplace’s method. PMID:24082430

Quality of life in people aged 65+ in Europe: associated factors and models of social welfare-analysis of data from the SHARE project (Wave 5).

PubMed

Conde-Sala, Josep L; Portellano-Ortiz, Cristina; Calvó-Perxas, Laia; Garre-Olmo, Josep

2017-04-01

To analyse the clinical, sociodemographic and socioeconomic factors that influence perceived quality of life (QoL) in a community sample of 33,241 people aged 65+ and to examine the relationship with models of social welfare in Europe. This was a cross-sectional study of data from Wave 5 (2013) of the Survey of Health, Ageing and Retirement in Europe (SHARE). The instruments used in the present study were as follows: sociodemographic data, CASP-12 (QoL), EURO-D (depression), indicators of life expectancy and suicide (WHO), and economic indicators (World Bank). Statistical analysis included bivariate and multilevel analyses. In the multilevel analysis, greater satisfaction in life, less depression, sufficient income, better subjective health, physical activity, an absence of functional impairment, younger age and participation in activities were associated with better QoL in all countries. More education was only associated with higher QoL in Eastern European and Mediterranean countries, and only in the latter was caring for grandchildren also related to better QoL. Socioeconomic indicators were better and QoL scores higher (mean = 38.5 ± 5.8) in countries that had a social democratic (Nordic cluster) or corporatist model (Continental cluster) of social welfare, as compared to Eastern European and Mediterranean countries, which were characterized by poorer socioeconomic conditions, more limited social welfare provision and lower QoL scores (mean = 33.5 ± 6.4). Perceived quality-of-life scores are consistent with the sociodemographic and clinical characteristics of participants, as well as with the socioeconomic indicators and models of social welfare of the countries in which they live.

Using SEM to Analyze Complex Survey Data: A Comparison between Design-Based Single-Level and Model-Based Multilevel Approaches

ERIC Educational Resources Information Center

Wu, Jiun-Yu; Kwok, Oi-man

2012-01-01

Both ad-hoc robust sandwich standard error estimators (design-based approach) and multilevel analysis (model-based approach) are commonly used for analyzing complex survey data with nonindependent observations. Although these 2 approaches perform equally well on analyzing complex survey data with equal between- and within-level model structures…

DIF Analysis with Multilevel Data: A Simulation Study Using the Latent Variable Approach

ERIC Educational Resources Information Center

Jin, Ying; Eason, Hershel

2016-01-01

The effects of mean ability difference (MAD) and short tests on the performance of various DIF methods have been studied extensively in previous simulation studies. Their effects, however, have not been studied under multilevel data structure. MAD was frequently observed in large-scale cross-country comparison studies where the primary sampling…

School Process and Teacher Job Satisfaction at Alternative Schools: A Multilevel Study Using SASS 2007-08 Data

ERIC Educational Resources Information Center

Xia, Jiangang; Izumi, Masashi; Gao, Xingyuan

2015-01-01

This study examined the associations between public alternative schools' teacher job satisfaction and school processes. Based on a multilevel analysis of the national School and Staffing Survey 2007-08 data, we found that among the seven school processes, public alternative schools' administrative support, staff collegiality, career and working…

When Cannabis Is Available and Visible at School--A Multilevel Analysis of Students' Cannabis Use

ERIC Educational Resources Information Center

Kuntsche, Emmanuel

2010-01-01

Aims: To investigate the links between the visibility of cannabis use in school (measured by teachers' reports of students being under the influence of cannabis on school premises), the proportion of cannabis users in the class, perceived availability of cannabis, as well as adolescent cannabis use. Methods: A multilevel regression model was…

A Multilevel Analysis of the Relationship between Shared Leadership and Creativity in Inter-Organizational Teams

ERIC Educational Resources Information Center

Gu, Jibao; Chen, Zhi; Huang, Qian; Liu, Hefu; Huang, Shenglan

2018-01-01

An inter-organizational team, which consists of diverse members from different organizations to conduct an initiative, has been widely treated as a critical method to improve organizational innovation. This study proposes a multilevel model to test the relationship between shared leadership and creativity at both team- and individual level in the…

Role of Linguistic and Sociocultural Diversity in Reading Literacy Achievement: A Multilevel Approach

ERIC Educational Resources Information Center

Netten, Andrea; Luyten, Hans; Droop, Mienke; Verhoeven, Ludo

2016-01-01

This study examined how linguistic and sociocultural diversity have an impact on the reading literacy outcomes of a representative sample of 3,549 first-language (L1) and 208 second-language (L2) fourth-grade students in the Netherlands. A multilevel modelling analysis was conducted using Progress in International Reading Literacy Study 2006 data…

The Dubious Benefits of Multi-Level Modeling

ERIC Educational Resources Information Center

Gorard, Stephen

2007-01-01

This paper presents an argument against the wider adoption of complex forms of data analysis, using multi-level modeling (MLM) as an extended case study. MLM was devised to overcome some deficiencies in existing datasets, such as the bias caused by clustering. The paper suggests that MLM has an unclear theoretical and empirical basis, has not led…

What Is Wrong with ANOVA and Multiple Regression? Analyzing Sentence Reading Times with Hierarchical Linear Models

ERIC Educational Resources Information Center

Richter, Tobias

2006-01-01

Most reading time studies using naturalistic texts yield data sets characterized by a multilevel structure: Sentences (sentence level) are nested within persons (person level). In contrast to analysis of variance and multiple regression techniques, hierarchical linear models take the multilevel structure of reading time data into account. They…

Macroeconomic Knowledge of Higher Education Students in Germany and Japan--A Multilevel Analysis of Contextual and Personal Effects

ERIC Educational Resources Information Center

Zlatkin-Troitschanskaia, Olga; Schmidt, Susanne; Brückner, Sebastian; Förster, Manuel; Yamaoka, Michio; Asano, Tadayoshi

2016-01-01

Recent trends towards harmonising and internationalising business and economics studies in higher education are affecting the structure and content of programmes and courses, and necessitate more transparent and comparable information on students' economic knowledge and skills. In this study, we examine by linear multilevel regression modelling…

Cross-National Differences in the Association between Parental Work Hours and Time with Children in Europe: A Multilevel Analysis

ERIC Educational Resources Information Center

Roeters, Anne

2013-01-01

This study investigates cross-national differences in the association between parental work hours and parent-child interaction time and explains differences in this individual-level association on the basis of country characteristics. It extends prior research by testing the moderating effects of country characteristics through multilevel analyses…

Marital Status, Marital Process, and Parental Resources in Predicting Adolescents' Emotional Adjustment: A Multilevel Analysis

ERIC Educational Resources Information Center

Vandervalk, Inge; Spruijt, Ed; De Goede, Martijn; Meeus, Wim; Maas, Cora

2004-01-01

This study examined the relationship between adolescent emotional adjustment and the family environment (i.e., family status, family process, and parental resources). This was done by way of multilevel analyses, with a sample of 2,636 parent-child couples of both intact and divorced families. The results indicated that adolescent emotional…

School Climate as a Predictor of Incivility and Bullying among Public School Employees: A Multilevel Analysis

ERIC Educational Resources Information Center

Powell, Joshua E.; Powell, Anna L.; Petrosko, Joseph M.

2015-01-01

We surveyed public school educators on the workplace incivility and workplace bullying they experienced and obtained their ratings of the organizational climate of the school. We used multilevel modeling to determine the effects of individual-level and school-level predictors. Ratings of school climate were significantly related to incivility and…

Prevalence and correlates of hypertension in Maharashtra, India: A multilevel analysis

PubMed Central

Bhise, Mahadev D.

2018-01-01

Background and aim In the last few decades, the prevalence of hypertension has been drastically increased in India. The present study estimates the current prevalence of hypertension and its correlates in the state of Maharashtra. The variation in the prevalence of hypertension associated with individual-level characteristics is explained at the community and district level. Methods Data is used from the recent round of District Level Household & Facility Survey (DLHS-4), 2012–13. The DLHS-4 has used the nationally representative sample, collected through multistage stratified sampling procedure. A similar sampling frame, used in NSSO-2007-08, has been followed. The chi-square test is used to show the significance level of the association between the estimated prevalence of hypertension and its correlates. Multilevel regression analysis is carried out to investigate the effects of individual and community level factors on the prevalence of hypertension. Results The overall prevalence of hypertension is 25% in Maharashtra, and a huge variation in the prevalence of hypertension is found across the districts. Dhule, Gadchiroli (with a low HDI rank), Mumbai and Satara (with higher HDI rank) are the districts with the higher (above 30%) prevalence of high blood pressure. The prevalence also significantly varies according to different correlates. The prevalence of high blood pressure is higher among elderly population (40%), among males (28%), in the urban areas (27%) and in the richest wealth quintile (28%). The prevalence is also higher among cigarette smokers (31%), alcohol consumers (30%) and people with obesity (38%) as compared to their counterparts. The results of the multilevel analysis show that the older and obese persons are at four-time higher risk of hypertension. Again, age, sex, marital status, place of residence, wealth status, unhealthy habits (i.e. smoking and alcohol consumption) and BMI are significantly associated with hypertension. The results of VPC statistics show that 14% of hypertension prevalence could be attributed to differences at the community level. Conclusion The prevalence of hypertension largely varies in the districts of Maharashtra irrespective of their level of socio-economic development (i.e. HDI rank). The variation in the rate of prevalence of hypertension is higher in the community (PSU) level as compared to the variation in the prevalence rate at the district level. Hypertension is attributable to the modifiable factors like risky lifestyle practices. PMID:29401464

Prevalence and correlates of hypertension in Maharashtra, India: A multilevel analysis.

PubMed

Bhise, Mahadev D; Patra, Shraboni

2018-01-01

In the last few decades, the prevalence of hypertension has been drastically increased in India. The present study estimates the current prevalence of hypertension and its correlates in the state of Maharashtra. The variation in the prevalence of hypertension associated with individual-level characteristics is explained at the community and district level. Data is used from the recent round of District Level Household & Facility Survey (DLHS-4), 2012-13. The DLHS-4 has used the nationally representative sample, collected through multistage stratified sampling procedure. A similar sampling frame, used in NSSO-2007-08, has been followed. The chi-square test is used to show the significance level of the association between the estimated prevalence of hypertension and its correlates. Multilevel regression analysis is carried out to investigate the effects of individual and community level factors on the prevalence of hypertension. The overall prevalence of hypertension is 25% in Maharashtra, and a huge variation in the prevalence of hypertension is found across the districts. Dhule, Gadchiroli (with a low HDI rank), Mumbai and Satara (with higher HDI rank) are the districts with the higher (above 30%) prevalence of high blood pressure. The prevalence also significantly varies according to different correlates. The prevalence of high blood pressure is higher among elderly population (40%), among males (28%), in the urban areas (27%) and in the richest wealth quintile (28%). The prevalence is also higher among cigarette smokers (31%), alcohol consumers (30%) and people with obesity (38%) as compared to their counterparts. The results of the multilevel analysis show that the older and obese persons are at four-time higher risk of hypertension. Again, age, sex, marital status, place of residence, wealth status, unhealthy habits (i.e. smoking and alcohol consumption) and BMI are significantly associated with hypertension. The results of VPC statistics show that 14% of hypertension prevalence could be attributed to differences at the community level. The prevalence of hypertension largely varies in the districts of Maharashtra irrespective of their level of socio-economic development (i.e. HDI rank). The variation in the rate of prevalence of hypertension is higher in the community (PSU) level as compared to the variation in the prevalence rate at the district level. Hypertension is attributable to the modifiable factors like risky lifestyle practices.

Multilevel multi-informant structure of the authoritative school climate survey.

PubMed

Konold, Timothy; Cornell, Dewey; Huang, Francis; Meyer, Patrick; Lacey, Anna; Nekvasil, Erin; Heilbrun, Anna; Shukla, Kathan

2014-09-01

The Authoritative School Climate Survey was designed to provide schools with a brief assessment of 2 key characteristics of school climate--disciplinary structure and student support--that are hypothesized to influence 2 important school climate outcomes--student engagement and prevalence of teasing and bullying in school. The factor structure of these 4 constructs was examined with exploratory and confirmatory factor analyses in a statewide sample of 39,364 students (Grades 7 and 8) attending 423 schools. Notably, the analyses used a multilevel structural approach to model the nesting of students in schools for purposes of evaluating factor structure, demonstrating convergent and concurrent validity and gauging the structural invariance of concurrent validity coefficients across gender. These findings provide schools with a core group of school climate measures guided by authoritative discipline theory. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Utilization of focused antenatal care in Zambia: examining individual- and community-level factors using a multilevel analysis.

PubMed

Chama-Chiliba, Chitalu M; Koch, Steven F

2015-02-01

We examine the individual- and community-level factors associated with the utilization of antenatal care, following the adoption of the focused antenatal care (FANC) approach in Zambia. Using the 2007 Zambia Demographic and Health Survey, linked with administrative and health facility census data, we specify two multilevel logistic models to assess the factors associated with (1) the inadequate use of antenatal care (ANC) (defined as three or fewer visits) and (2) the non-use of ANC in the first trimester of pregnancy. Although all women in the selected sample had at least one ANC visit, 40% did not have the minimum number required (four), whereas more than 80% of the initial check-ups did not occur in the first trimester. At the individual level, the woman's employment status, quality of ANC received and the husband's educational attainment are negatively associated, while parity, the household childcare burden and wealth are positively associated with inadequate utilization of ANC. Both individual- and community-level characteristics influence inadequate use and non-use of ANC in the first trimester; however, community-level factors are relatively stronger in rural areas. The results suggest that improving the content of care during ANC visits may foster adequate use of ANC and encourage early initiation of ANC visits. Furthermore, health promotion programmes need to further encourage male involvement in pregnant women's decision to seek ANC to encourage adequate use of services. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Revisiting causal neighborhood effects on individual ischemic heart disease risk: a quasi-experimental multilevel analysis among Swedish siblings.

PubMed

Merlo, Juan; Ohlsson, Henrik; Chaix, Basile; Lichtenstein, Paul; Kawachi, Ichiro; Subramanian, S V

2013-01-01

Neighborhood socioeconomic disadvantage is associated to increased individual risk of ischemic heart disease (IHD). However, the value of this association for causal inference is uncertain. Moreover, neighborhoods are often defined by available administrative boundaries without evaluating in which degree these boundaries embrace a relevant socio-geographical context that condition individual differences in IHD risk. Therefore, we performed an analysis of variance, and also compared the associations obtained by conventional multilevel analyses and by quasi-experimental family-based design that provides stronger evidence for causal inference. Linking the Swedish Multi-Generation Register to several other national registers, we analyzed 184,931 families embracing 415,540 full brothers 45-64 years old in 2004, and residing in 8408 small-area market statistics (SAMS) considered as "neighborhoods" in our study. We investigated the association between low neighborhood income (categorized in groups by deciles) and IHD risk in the next four years. We distinguished between family mean and intrafamilial-centered low neighborhood income, which allowed us to investigate both unrelated individuals from different families and full brothers within families. We applied multilevel logistic regression techniques to obtain odds ratios (OR), variance partition coefficients (VPC) and 95% credible intervals (CI). In unrelated individuals a decile unit increase of low neighborhood income increased individual IHD risk (OR = 1.04, 95% CI: 1.03-1.07). In the intrafamilial analysis this association was reduced (OR = 1.02, 95% CI: 1.02-1.04). Low neighborhood income seems associated with IHD risk in middle-aged men. However, despite the family-based design, we cannot exclude residual confounding by genetic and non-shared environmental factors. Besides, the low neighborhood level VPC = 1.5% suggest that the SAMS are a rather inappropriate construct of the socio-geographic context that conditions individual variance in IHD risk. In contrast the high family level VPC = 20.1% confirms the relevance of the family context for understanding IHD risk. Copyright © 2012 Elsevier Ltd. All rights reserved.

Analyzing average and conditional effects with multigroup multilevel structural equation models

PubMed Central

Mayer, Axel; Nagengast, Benjamin; Fletcher, John; Steyer, Rolf

2014-01-01

Conventionally, multilevel analysis of covariance (ML-ANCOVA) has been the recommended approach for analyzing treatment effects in quasi-experimental multilevel designs with treatment application at the cluster-level. In this paper, we introduce the generalized ML-ANCOVA with linear effect functions that identifies average and conditional treatment effects in the presence of treatment-covariate interactions. We show how the generalized ML-ANCOVA model can be estimated with multigroup multilevel structural equation models that offer considerable advantages compared to traditional ML-ANCOVA. The proposed model takes into account measurement error in the covariates, sampling error in contextual covariates, treatment-covariate interactions, and stochastic predictors. We illustrate the implementation of ML-ANCOVA with an example from educational effectiveness research where we estimate average and conditional effects of early transition to secondary schooling on reading comprehension. PMID:24795668

Experimental studies of a prototype model of the multilevel 6KW-power inverter at supply by 12 accumulators

NASA Astrophysics Data System (ADS)

Taissariyeva, K.; Issembergenov, N.; Dzhobalaeva, G.; Usembaeva, S.

2016-09-01

The given paper considers the multilevel 6 kW-power transistor inverter at supply by 12 accumulators for transformation of solar battery energy to the electric power. At the output of the multilevel transistor inverter, it is possible to receive voltage close to a sinusoidal form. The main objective of this inverter is transformation of solar energy to the electric power of industrial frequency. The analysis of the received output curves of voltage on harmonicity has been carried out. In this paper it is set forth the developed scheme of the multilevel transistor inverter (DC-to-ac converter) which allows receiving at the output the voltage close to sinusoidal form, as well as to regulation of the output voltage level. In the paper, the results of computer modeling and experimental studies are presented.

A new rational-based optimal design strategy of ship structure based on multi-level analysis and super-element modeling method

NASA Astrophysics Data System (ADS)

Sun, Li; Wang, Deyu

2011-09-01

A new multi-level analysis method of introducing the super-element modeling method, derived from the multi-level analysis method first proposed by O. F. Hughes, has been proposed in this paper to solve the problem of high time cost in adopting a rational-based optimal design method for ship structural design. Furthermore, the method was verified by its effective application in optimization of the mid-ship section of a container ship. A full 3-D FEM model of a ship, suffering static and quasi-static loads, was used as the analyzing object for evaluating the structural performance of the mid-ship module, including static strength and buckling performance. Research results reveal that this new method could substantially reduce the computational cost of the rational-based optimization problem without decreasing its accuracy, which increases the feasibility and economic efficiency of using a rational-based optimal design method in ship structural design.

Individual and county level predictors of asthma related emergency department visits among children on Medicaid: A multilevel approach.

PubMed

Baltrus, Peter; Xu, Junjun; Immergluck, Lilly; Gaglioti, Anne; Adesokan, Adeola; Rust, George

2017-01-02

Disparities in asthma outcomes are well documented in the United States. Interventions to promote equity in asthma outcomes could target factors at the individual and community levels. The objective of this analysis was to understand the effect of individual (race, gender, age, and preventive inhaler use) and county-level factors (demographic, socioeconomic, health care, air-quality) on asthma emergency department (ED) visits among Medicaid-enrolled children. This was a retrospective cohort study of Medicaid-enrolled children with asthma in 29 states in 2009. Multilevel regression models of asthma ED visits were constructed utilizing individual-level variables (race, gender, age, and preventive inhaler use) from the Medicaid enrollment file and county-level variables reflecting population and health system characteristics from the Area Resource File (ARF). County-level measures of air quality were obtained from Environmental Protection Agency (EPA) data. The primary modifiable risk factor at the individual level was found to be the ratio of long-term controller medications to total asthma medications. County-level factors accounted for roughly 6% of the variance in the asthma ED visit risk. Increasing county-level racial segregation (OR=1.04, 95% CI=1.01-1.08) was associated with increasing risk of asthma ED visits. Greater supply of pulmonary physicians at the county level (OR=0.81, 95% CI=0.68-0.97) was associated with a reduction in risk of asthma ED visits. At the patient care level, proper use of controller medications is the factor most amenable to intervention. There is also a societal imperative to address negative social determinants, such as residential segregation.

Food beliefs and practices in urban poor communities in Accra: implications for health interventions.

PubMed

Boatemaa, Sandra; Badasu, Delali Margaret; de-Graft Aikins, Ama

2018-04-02

Poor communities in low and middle income countries are reported to experience a higher burden of chronic non-communicable diseases (NCDs) and nutrition-related NCDs. Interventions that build on lay perspectives of risk are recommended. The objective of this study was to examine lay understanding of healthy and unhealthy food practices, factors that influence food choices and the implications for developing population health interventions in three urban poor communities in Accra, Ghana. Thirty lay adults were recruited and interviewed in two poor urban communities in Accra. The interviews were audio-taped, transcribed and analysed thematically. The analysis was guided by the socio-ecological model which focuses on the intrapersonal, interpersonal, community, structural and policy levels of social organisation. Food was perceived as an edible natural resource, and healthy in its raw state. A food item retained its natural, healthy properties or became unhealthy depending on how it was prepared (e.g. frying vs boiling) and consumed (e.g. early or late in the day). These food beliefs reflected broader social food norms in the community and incorporated ideas aligned with standard expert dietary guidelines. Healthy cooking was perceived as the ability to select good ingredients, use appropriate cooking methods, and maintain food hygiene. Healthy eating was defined in three ways: 1) eating the right meals; 2) eating the right quantity; and 3) eating at the right time. Factors that influenced food choice included finances, physical and psychological state, significant others and community resources. The findings suggest that beliefs about healthy and unhealthy food practices are rooted in multi-level factors, including individual experience, family dynamics and community factors. The factors influencing food choices are also multilevel. The implications of the findings for the design and content of dietary and health interventions are discussed.

The application of multilevel modeling in the analysis of longitudinal periodontal data--part I: absolute levels of disease.

PubMed

Tu, Yu-Kang; Gilthorpe, Mark S; Griffiths, Gareth S; Maddick, Ian H; Eaton, Kenneth A; Johnson, Newell W

2004-01-01

Statistical analyses of periodontal data that average site measurements to subject mean values are unable to explore the site-specific nature of periodontal diseases. Multilevel modeling (MLM) overcomes this, taking hierarchical structure into account. MLM was used to investigate longitudinal relationships between the outcomes of lifetime cumulative attachment loss (LCAL) and probing depth (PD) in relation to potential risk factors for periodontal disease progression. One hundred males (mean age 17 years) received a comprehensive periodontal examination at baseline and at 12 and 30 months. The resulting data were analyzed in two stages. In stage one (reported here), the absolute levels of disease were analyzed in relation to potential risk factors; in stage two (reported in a second paper), changes in disease patterns over time were analyzed in relation to the same risk factors. Each approach yielded substantially different insights. For absolute levels of disease, subject-level risk factors (covariates) had limited prediction for LCAL/PD throughout the 30-month observation period. Tooth position demonstrated a near linear relationship for both outcomes, with disease increasing from anterior to posterior teeth. Sites with subgingival calculus and bleeding on probing demonstrated more LCAL and PD, and supragingival calculus had an apparently protective effect. Covariates had more "explanatory power" for the variation in PD than for the variation in LCAL, suggesting that LCAL and PD might be generally associated with a different profile of covariates. This study provides, for a relatively young cohort, considerable insights into the factors associated with early-life periodontal disease and its progression at all levels of the natural hierarchy of sites within teeth within subjects.

Comparative assessment of analytical approaches to quantify the risk for introduction of rare animal diseases: the example of avian influenza in Spain.

PubMed

Sánchez-Vizcaíno, Fernando; Perez, Andrés; Martínez-López, Beatriz; Sánchez-Vizcaíno, José Manuel

2012-08-01

Trade of animals and animal products imposes an uncertain and variable risk for exotic animal diseases introduction into importing countries. Risk analysis provides importing countries with an objective, transparent, and internationally accepted method for assessing that risk. Over the last decades, European Union countries have conducted probabilistic risk assessments quite frequently to quantify the risk for rare animal diseases introduction into their territories. Most probabilistic animal health risk assessments have been typically classified into one-level and multilevel binomial models. One-level models are more simple than multilevel models because they assume that animals or products originate from one single population. However, it is unknown whether such simplification may result in substantially different results compared to those obtained through the use of multilevel models. Here, data used on a probabilistic multilevel binomial model formulated to assess the risk for highly pathogenic avian influenza introduction into Spain were reanalyzed using a one-level binomial model and their outcomes were compared. An alternative ordinal model is also proposed here, which makes use of simpler assumptions and less information compared to those required by traditional one-level and multilevel approaches. Results suggest that, at least under certain circumstances, results of the one-level and ordinal approaches are similar to those obtained using multilevel models. Consequently, we argue that, when data are insufficient to run traditional probabilistic models, the ordinal approach presented here may be a suitable alternative to rank exporting countries in terms of the risk that they impose for the spread of rare animal diseases into disease-free countries. © 2012 Society for Risk Analysis.

Mind the Gap! A Multilevel Analysis of Factors Related to Variation in Published Cost-Effectiveness Estimates within and between Countries

PubMed Central

Boehler, Christian E. H.; Lord, Joanne

2016-01-01

Background. Published cost-effectiveness estimates can vary considerably, both within and between countries. Despite extensive discussion, little is known empirically about factors relating to these variations. Objectives. To use multilevel statistical modeling to integrate cost-effectiveness estimates from published economic evaluations to investigate potential causes of variation. Methods. Cost-effectiveness studies of statins for cardiovascular disease prevention were identified by systematic review. Estimates of incremental costs and effects were extracted from reported base case, sensitivity, and subgroup analyses, with estimates grouped in studies and in countries. Three bivariate models were developed: a cross-classified model to accommodate data from multinational studies, a hierarchical model with multinational data allocated to a single category at country level, and a hierarchical model excluding multinational data. Covariates at different levels were drawn from a long list of factors suggested in the literature. Results. We found 67 studies reporting 2094 cost-effectiveness estimates relating to 23 countries (6 studies reporting for more than 1 country). Data and study-level covariates included patient characteristics, intervention and comparator cost, and some study methods (e.g., discount rates and time horizon). After adjusting for these factors, the proportion of variation attributable to countries was negligible in the cross-classified model but moderate in the hierarchical models (14%−19% of total variance). Country-level variables that improved the fit of the hierarchical models included measures of income and health care finance, health care resources, and population risks. Conclusions. Our analysis suggested that variability in published cost-effectiveness estimates is related more to differences in study methods than to differences in national context. Multinational studies were associated with much lower country-level variation than single-country studies. These findings are for a single clinical question and may be atypical. PMID:25878194

A multi-level system quality improvement intervention to reduce racial disparities in hypertension care and control: study protocol

PubMed Central

2013-01-01

Background Racial disparities in blood pressure control have been well documented in the United States. Research suggests that many factors contribute to this disparity, including barriers to care at patient, clinician, healthcare system, and community levels. To date, few interventions aimed at reducing hypertension disparities have addressed factors at all of these levels. This paper describes the design of Project ReD CHiP (Reducing Disparities and Controlling Hypertension in Primary Care), a multi-level system quality improvement project. By intervening on multiple levels, this project aims to reduce disparities in blood pressure control and improve guideline concordant hypertension care. Methods Using a pragmatic trial design, we are implementing three complementary multi-level interventions designed to improve blood pressure measurement, provide patient care management services and offer expanded provider education resources in six primary care clinics in Baltimore, Maryland. We are staggering the introduction of the interventions and will use Statistical Process Control (SPC) charting to determine if there are changes in outcomes at each clinic after implementation of each intervention. The main hypothesis is that each intervention will have an additive effect on improvements in guideline concordant care and reductions in hypertension disparities, but the combination of all three interventions will result in the greatest impact, followed by blood pressure measurement with care management support, blood pressure measurement with provider education, and blood pressure measurement only. This study also examines how organizational functioning and cultural competence affect the success of the interventions. Discussion As a quality improvement project, Project ReD CHiP employs a novel study design that specifically targets multi-level factors known to contribute to hypertension disparities. To facilitate its implementation and improve its sustainability, we have incorporated stakeholder input and tailored components of the interventions to meet the specific needs of the involved clinics and communities. Results from this study will provide knowledge about how integrated multi-level interventions can improve hypertension care and reduce disparities. Trial Registration ClinicalTrials.gov NCT01566864 PMID:23734703

Zero-Profile Spacer Versus Cage-Plate Construct in Anterior Cervical Diskectomy and Fusion for Multilevel Cervical Spondylotic Myelopathy: Systematic Review and Meta-Analysis.

PubMed

Tong, Min-Ji; Xiang, Guang-Heng; He, Zi-Li; Chen, De-Heng; Tang, Qian; Xu, Hua-Zi; Tian, Nai-Feng

2017-08-01

Anterior cervical diskectomy and fusion with plate-screw construct has been gradually applied for multilevel cervical spondylotic myelopathy in recent years. However, long cervical plate was associated with complications including breakage or loosening of plate and screws, trachea-esophageal injury, neurovascular injury, and postoperative dysphagia. To reduce these complications, the zero-profile spacer has been introduced. This meta-analysis was performed to compare the clinical and radiologic outcomes of zero-profile spacer versus cage-plate construct for the treatment of multilevel cervical spondylotic myelopathy. We systematically searched MEDLINE, Springer, and Web of Science databases for relevant studies that compared the clinical and radiologic outcomes of zero-profile spacer versus cage and plate for multilevel cervical spondylotic myelopathy. Risk of bias in included studies was assessed. Pooled estimates and corresponding 95% confidence intervals were calculated. On the basis of predefined inclusion criteria, 7 studies with a total of 409 patients were included in this analysis. The pooled data revealed that zero-profile spacer was associated with a decreased dysphagia rate at 2, 3, and 6 months postoperatively when compared with the cage-plate group. Both techniques had similar perioperative outcomes, functional outcome, radiologic outcome, and dysphagia rate immediately and at >1-year after operation. On the basis of available evidence, zero-profile spacer was more effective in reducing postoperative dysphagia rate for multilevel cervical spondylotic myelopathy. Both devices were safe in anterior cervical surgeries, and they had similar efficacy in improving the functional and radiologic outcomes. More randomized controlled trials are needed to compare these 2 devices. Copyright © 2017 Elsevier Inc. All rights reserved.

Factors associated with maternal healthcare services utilization in nine high focus states in India: a multilevel analysis based on 14 385 communities in 292 districts.

PubMed

Singh, Prashant Kumar; Kumar, Chandan; Rai, Rajesh Kumar; Singh, Lucky

2014-08-01

Studies have often ignored examining the role of community- and district-level factors in the utilization of maternity healthcare services, particularly in Indian contexts. The Social Determinants of Health framework emphasizes the role of governance and government policies, the measures for which are rarely incorporated in single-level individual analysis. This study examines factors associated with maternal healthcare utilization in nine high focus states in India, which shares more than half of the total maternal deaths in the country; accounting for individual-, household-, community- and district-level characteristics. The required data are extracted from the third round of the nationally representative District Level Household and Facility Survey conducted during 2007-08. Multilevel analyses were applied to three maternity outcomes, namely, four or more antenatal care visits, skilled birth attendance and post-natal care after birth. Results show that along with individual-/household-level factors, community and district-level factors influence the pattern of utilization of maternal healthcare services significantly. At the community level, the odds of maternal healthcare utilization were lower in rural areas and in communities with a high concentration of poor and illiterate women. Moreover, the average population coverage of primary health centres (PHCs), availability of labour room in PHC and percentage of registered pregnancies were significant factors at the district level that influenced the use of maternity care services. The study also found a strong association between the extent of previous use of maternal healthcare and its effect on subsequent usage patterns. This study highlights the role of strengthening public health infrastructure at district level in the study area, and promoting awareness about available healthcare services and subsidized schemes in the community. To reach out to rural and underprivileged communities and to apply a participatory approach from the programme officials are issues to delve into. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

What affects response rates in primary healthcare-based programmes? An analysis of individual and unit-related factors associated with increased odds of non-response based on HCV screening in the general population in Poland

PubMed Central

Parda, Natalia; Stępień, Małgorzata; Zakrzewska, Karolina; Madaliński, Kazimierz; Kołakowska, Agnieszka; Godzik, Paulina; Rosińska, Magdalena

2016-01-01

Objectives Response rate in public health programmes may be a limiting factor. It is important to first consider their delivery and acceptability for the target. This study aimed at determining individual and unit-related factors associated with increased odds of non-response based on hepatitis C virus screening in primary healthcare. Design Primary healthcare units (PHCUs) were extracted from the Register of Health Care Centres. Each of the PHCUs was to enrol adult patients selected on a random basis. Data on the recruitment of PHCUs and patients were analysed. Multilevel modelling was applied to investigate individual and unit-related factors associated with non-response. Multilevel logistic model was developed with fixed effects and only a random intercept for the unit. Preliminary analysis included a random effect for unit and each of the individual or PHCU covariates separately. For each of the PHCU covariates, we applied a two-level model with individual covariates, unit random effect and a single fixed effect of this unit covariate. Setting This study was conducted in primary care units in selected provinces in Poland. Participants A total of 242 PHCUs and 24 480 adults were invited. Of them, 44 PHCUs and 20 939 patients agreed to participate. Both PHCUs and patients were randomly selected. Results Data on 44 PHCUs and 24 480 patients were analysed. PHCU-level factors and recruitment strategies were important predictors of non-response. Unit random effect was significant in all models. Larger and private units reported higher non-response rates, while for those with a history of running public health programmes the odds of non-response was lower. Proactive recruitment, more working hours devoted to the project and patient resulted in higher acceptance of the project. Higher number of personnel had no such effect. Conclusions Prior to the implementation of public health programme, several factors that could hinder its execution should be addressed. PMID:27927665

What affects response rates in primary healthcare-based programmes? An analysis of individual and unit-related factors associated with increased odds of non-response based on HCV screening in the general population in Poland.

PubMed

Parda, Natalia; Stępień, Małgorzata; Zakrzewska, Karolina; Madaliński, Kazimierz; Kołakowska, Agnieszka; Godzik, Paulina; Rosińska, Magdalena

2016-12-07

Response rate in public health programmes may be a limiting factor. It is important to first consider their delivery and acceptability for the target. This study aimed at determining individual and unit-related factors associated with increased odds of non-response based on hepatitis C virus screening in primary healthcare. Primary healthcare units (PHCUs) were extracted from the Register of Health Care Centres. Each of the PHCUs was to enrol adult patients selected on a random basis. Data on the recruitment of PHCUs and patients were analysed. Multilevel modelling was applied to investigate individual and unit-related factors associated with non-response. Multilevel logistic model was developed with fixed effects and only a random intercept for the unit. Preliminary analysis included a random effect for unit and each of the individual or PHCU covariates separately. For each of the PHCU covariates, we applied a two-level model with individual covariates, unit random effect and a single fixed effect of this unit covariate. This study was conducted in primary care units in selected provinces in Poland. A total of 242 PHCUs and 24 480 adults were invited. Of them, 44 PHCUs and 20 939 patients agreed to participate. Both PHCUs and patients were randomly selected. Data on 44 PHCUs and 24 480 patients were analysed. PHCU-level factors and recruitment strategies were important predictors of non-response. Unit random effect was significant in all models. Larger and private units reported higher non-response rates, while for those with a history of running public health programmes the odds of non-response was lower. Proactive recruitment, more working hours devoted to the project and patient resulted in higher acceptance of the project. Higher number of personnel had no such effect. Prior to the implementation of public health programme, several factors that could hinder its execution should be addressed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Framing ethnic variations in alcohol outcomes from biological pathways to neighborhood context.

PubMed

Chartier, Karen G; Scott, Denise M; Wall, Tamara L; Covault, Jonathan; Karriker-Jaffe, Katherine J; Mills, Britain A; Luczak, Susan E; Caetano, Raul; Arroyo, Judith A

2014-03-01

Health disparities research seeks to eliminate disproportionate negative health outcomes experienced in some racial/ethnic minority groups. This brief review presents findings on factors associated with drinking and alcohol-related problems in racial/ethnic groups. Those discussed are as follows: (i) biological pathways to alcohol problems, (ii) gene × stress interactions, (iii) neighborhood disadvantage, stress, and access to alcohol, and (iv) drinking cultures and contexts. These factors and their interrelationships are complex, requiring a multilevel perspective. The use of interdisciplinary teams and an epigenetic focus are suggested to move the research forward. The application of multilevel research to policy, prevention, and intervention programs may help prioritize combinations of the most promising intervention targets. Copyright © 2014 by the Research Society on Alcoholism.

The Role of School Culture and Basic Psychological Needs on Iranian Adolescents' Academic Alienation: A Multi-Level Examination

ERIC Educational Resources Information Center

Mahmoudi, Hojjat; Brown, Monica R.; Amani Saribagloo, Javad; Dadashzadeh, Shiva

2018-01-01

This aim of this current research was a multi-level analysis of the relationship between school culture, basic psychological needs, and adolescents' academic alienation. One thousand twenty-nine (N = 1,029) high school students from Qom City were randomly selected through a multi-phase cluster sampling method and answered questions regarding…

Multi-level optimization of a beam-like space truss utilizing a continuum model

NASA Technical Reports Server (NTRS)

Yates, K.; Gurdal, Z.; Thangjitham, S.

1992-01-01

A continuous beam model is developed for approximate analysis of a large, slender, beam-like truss. The model is incorporated in a multi-level optimization scheme for the weight minimization of such trusses. This scheme is tested against traditional optimization procedures for savings in computational cost. Results from both optimization methods are presented for comparison.

Community Social and Place Predictors of Sense of Community: A Multilevel and Longitudinal Analysis

ERIC Educational Resources Information Center

Long, D. Adam; Perkins, Douglas D.

2007-01-01

Sense of community (SOC) is empirically "unpacked" as a multilevel construct with place and social elements. SOC has been studied primarily at the individual level despite researchers acknowledging its effects at the community level. Little attention has been given to the roles of place and place attitudes in SOC. We argue that place and…

Multilevel Analysis of the Effects of Antidiscrimination Policies on Earnings by Sexual Orientation

ERIC Educational Resources Information Center

Klawitter, Marieka

2011-01-01

This study uses the 2000 U.S. Census data to assess the impact of antidiscrimination policies for sexual orientation on earnings for gays and lesbians. Using a multilevel model allows estimation of the effects of state and local policies on earnings and of variation in the effects of sexual orientation across local labor markets. The results…

Subjective Health and Mental Well-Being of Adolescents and the Health Promoting School: A Cross-Sectional Multilevel Analysis

ERIC Educational Resources Information Center

Levin, Kate; Inchley, Jo; Currie, Dorothy; Currie, Candace

2012-01-01

Purpose: The aim of this paper is to examine the impact of the health promoting school (HPS) on adolescent well-being. Design/methodology/approach: Data from the 2006 Health Behaviour in School-aged Children: WHO-collaborative Study in Scotland were analysed using multilevel linear regression analyses for outcome measures: happiness, confidence,…

Estimating Multi-Level Discrete-Time Hazard Models Using Cross-Sectional Data: Neighborhood Effects on the Onset of Adolescent Cigarette Use.

ERIC Educational Resources Information Center

Reardon, Sean F.; Brennan, Robert T.; Buka, Stephen L.

2002-01-01

Developed procedures for constructing a retrospective person-period data set from cross-sectional data and discusses modeling strategies for estimating multilevel discrete-time event history models. Applied the methods to the analysis of cigarette use by 1,979 urban adolescents. Results show the influence of the racial composition of the…

Exploring the Association between Transformational Leadership and Teacher's Self-Efficacy in Greek Education System: A Multilevel SEM Model

ERIC Educational Resources Information Center

Gkolia, Aikaterini; Koustelios, Athanasios; Belias, Dimitrios

2018-01-01

The main aim of this study is to examine the effect of principals' transformational leadership on teachers' self-efficacy across 77 different Greek elementary and secondary schools based on a centralized education system. For the investigation of the above effect multilevel Structural Equation Modelling analysis was conducted, recognizing the…

On the Usefulness of a Multilevel Logistic Regression Approach to Person-Fit Analysis

ERIC Educational Resources Information Center

Conijn, Judith M.; Emons, Wilco H. M.; van Assen, Marcel A. L. M.; Sijtsma, Klaas

2011-01-01

The logistic person response function (PRF) models the probability of a correct response as a function of the item locations. Reise (2000) proposed to use the slope parameter of the logistic PRF as a person-fit measure. He reformulated the logistic PRF model as a multilevel logistic regression model and estimated the PRF parameters from this…

Common mental disorders, neighbourhood income inequality and income deprivation: small-area multilevel analysis.

PubMed

Fone, David; Greene, Giles; Farewell, Daniel; White, James; Kelly, Mark; Dunstan, Frank

2013-04-01

Common mental disorders are more prevalent in areas of high neighbourhood socioeconomic deprivation but whether the prevalence varies with neighbourhood income inequality is not known. To investigate the hypothesis that the interaction between small-area income deprivation and income inequality was associated with individual mental health. Multilevel analysis of population data from the Welsh Health Survey, 2003/04-2010. A total of 88,623 respondents aged 18-74 years were nested within 50,587 households within 1887 lower super output areas (neighbourhoods) and 22 unitary authorities (regions), linked to the Gini coefficient (income inequality) and the per cent of households living in poverty (income deprivation). Mental health was measured using the Mental Health Inventory MHI-5 as a discrete variable and as a 'case' of common mental disorder. High neighbourhood income inequality was associated with better mental health in low-deprivation neighbourhoods after adjusting for individual and household risk factors (parameter estimate +0.70 (s.e. = 0.33), P = 0.036; odds ratio (OR) for common mental disorder case 0.92, 95% CI 0.88-0.97). Income inequality at regional level was significantly associated with poorer mental health (parameter estimate -1.35 (s.e. = 0.54), P = 0.012; OR = 1.13, 95% CI 1.04-1.22). The associations between common mental disorders, income inequality and income deprivation are complex. Income inequality at neighbourhood level is less important than income deprivation as a risk factor for common mental disorders. The adverse effect of income inequality starts to operate at the larger regional level.

School context, friendship ties and adolescent mental health: A multilevel analysis of the Korean Youth Panel Survey (KYPS).

PubMed

Kim, Harris Hyun-Soo

2015-11-01

Research on the social determinants of health suggests that interpersonal networks play a critical role in facilitating individual mental and physical well-being. Prior studies also indicate that ecological or contextual factors contribute to positive health outcomes. This study extends prior research by examining the factors associated with adolescent health in an Asian context. Based on the multilevel analysis of the Korean Youth Panel Survey (2006 & 2007), a longitudinal project funded by the Korean government, it investigates some of the key variables related to the mental health of Korean students. Much of previous research focuses on the functions of social capital. This study contributes to the social epidemiology literature by investigating the possible downside of network ties. Specifically, it asks whether having delinquent friends is associated with negative mental health experiences. In addition, little research has been conducted concerning the associations between adolescent health outcomes and school characteristics. This study moves in that direction by examining the relationship between mental well-being of students and a variety of school related variables (e.g., subjective attitude toward school and quality of relationship with peers and teachers). Hierarchical linear modeling shows that, among the social capital control variables, being properly integrated into the family and frequent peer interaction significantly add to mental health. At the individual (student) level only, ties to delinquent friends are negatively associated with mental health, while at both individual and contextual levels, school characteristics are positively related to adolescent subjective well-being. Copyright © 2015 Elsevier Ltd. All rights reserved.

A multi-level analysis of the relationship between environmental factors and questing Ixodes ricinus dynamics in Belgium

PubMed Central

2012-01-01

Background Ticks are the most important pathogen vectors in Europe. They are known to be influenced by environmental factors, but these links are usually studied at specific temporal or spatial scales. Focusing on Ixodes ricinus in Belgium, we attempt to bridge the gap between current “single-sided” studies that focus on temporal or spatial variation only. Here, spatial and temporal patterns of ticks are modelled together. Methods A multi-level analysis of the Ixodes ricinus patterns in Belgium was performed. Joint effects of weather, habitat quality and hunting on field sampled tick abundance were examined at two levels, namely, sampling level, which is associated with temporal dynamics, and site level, which is related to spatial dynamics. Independent variables were collected from standard weather station records, game management data and remote sensing-based land cover data. Results At sampling level, only a marginally significant effect of daily relative humidity and temperature on the abundance of questing nymphs was identified. Average wind speed of seven days prior to the sampling day was found important to both questing nymphs and adults. At site level, a group of landscape-level forest fragmentation indices were highlighted for both questing nymph and adult abundance, including the nearest-neighbour distance, the shape and the aggregation level of forest patches. No cross-level effects or spatial autocorrelation were found. Conclusions Nymphal and adult ticks responded differently to environmental variables at different spatial and temporal scales. Our results can advise spatio-temporal extents of environment data collection for continuing empirical investigations and potential parameters for biological tick models. PMID:22830528

Socioeconomic inequalities in adolescent depression in South Korea: a multilevel analysis.

PubMed

Park, Hye Yin; Heo, Jongho; Subramanian, S V; Kawachi, Ichiro; Oh, Juhwan

2012-01-01

In recent years, South Korea has witnessed a sustained rise in the prevalence of adolescent depression. In the present study, we sought to investigate family and school environmental influences on adolescent depression. Middle and high school students (N = 75,066) were randomly selected respondents to a web-based survey and answered questions on their academic and socioeconomic backgrounds, parental support, parental education level, physical activities, lifestyle habits and their experience of depression in the past one year. Two-level multilevel analysis was used to investigate the relationship between depression and individual (level 1) and school (level 2) factors. Girls reported having experienced depression in greater numbers than boys (43.96% vs. 32.03%). A significant association was found between adolescent depression experience and gender, grade, self-rated academic achievement, family affluence scale, parental support, parental education level, lifestyle habits, physical activity and sleep dissatisfaction. The students living with rich parents were more likely to be depressive, and maternal higher education was significantly associated with higher probability of boys' depression experience. Low academic achievement was highly associated with the experience of depression. In school level contexts, girls were found to be less likely to be depressive in girls-only schools. The adolescent depression experience is not only an individual phenomenon but is highly associated with other factors such as parents, peers, academic achievement, and even gender mix in the school. Thus, prevention measures on youth depression need to focus on emphasizing less pressure from parents on academic performance, and establishing healthy inter-gender relationships within co-education schools.

Socioeconomic Inequalities in Adolescent Depression in South Korea: A Multilevel Analysis

PubMed Central

Park, Hye Yin; Heo, Jongho; Subramanian, S. V.; Kawachi, Ichiro; Oh, Juhwan

2012-01-01

Background In recent years, South Korea has witnessed a sustained rise in the prevalence of adolescent depression. In the present study, we sought to investigate family and school environmental influences on adolescent depression. Methods and Findings Middle and high school students (N = 75,066) were randomly selected respondents to a web-based survey and answered questions on their academic and socioeconomic backgrounds, parental support, parental education level, physical activities, lifestyle habits and their experience of depression in the past one year. Two-level multilevel analysis was used to investigate the relationship between depression and individual (level 1) and school (level 2) factors. Girls reported having experienced depression in greater numbers than boys (43.96% vs. 32.03%). A significant association was found between adolescent depression experience and gender, grade, self-rated academic achievement, family affluence scale, parental support, parental education level, lifestyle habits, physical activity and sleep dissatisfaction. The students living with rich parents were more likely to be depressive, and maternal higher education was significantly associated with higher probability of boys’ depression experience. Low academic achievement was highly associated with the experience of depression. In school level contexts, girls were found to be less likely to be depressive in girls-only schools. Conclusion The adolescent depression experience is not only an individual phenomenon but is highly associated with other factors such as parents, peers, academic achievement, and even gender mix in the school. Thus, prevention measures on youth depression need to focus on emphasizing less pressure from parents on academic performance, and establishing healthy inter-gender relationships within co-education schools. PMID:23077540

Multilevel analysis of the role of human factors in regional disparities in crash outcomes.

PubMed

Adanu, Emmanuel Kofi; Smith, Randy; Powell, Lars; Jones, Steven

2017-12-01

A growing body of research has examined the disparities in road traffic safety among population groups and geographic regions. These studies reveal disparities in crash outcomes between people and regions with different socioeconomic characteristics. A critical aspect of the road traffic crash epidemic that has received limited attention is the influence of local characteristics on human elements that increase the risk of getting into a crash. This paper applies multilevel logistic regression modeling techniques to investigate the influence of driver residential factors on driver behaviors in an attempt to explain the area-based differences in the severity of road crashes across the State of Alabama. Specifically, the paper reports the effects of characteristics attributable to drivers and the geographic regions they reside on the likelihood of a crash resulting in serious injuries. Model estimation revealed that driver residence (postal code or region) accounted for about 7.3% of the variability in the probability of a driver getting into a serious injury crash, regardless of driver characteristics. The results also reveal disparities in serious injury crash rate as well as significant proportions of serious injury crashes involving no seatbelt usage, driving under influence (DUI), unemployed drivers, young drivers, distracted driving, and African American drivers among some regions. The average credit scores, average commute times, and populations of driver postal codes are shown to be significant predictors for risk of severe injury crashes. This approach to traffic crash analysis presented can serve as the foundation for evidence-based policies and also guide the implementation of targeted countermeasures. Copyright © 2017 Elsevier Ltd. All rights reserved.

Soft-decision decoding techniques for linear block codes and their error performance analysis

NASA Technical Reports Server (NTRS)

Lin, Shu

1996-01-01

The first paper presents a new minimum-weight trellis-based soft-decision iterative decoding algorithm for binary linear block codes. The second paper derives an upper bound on the probability of block error for multilevel concatenated codes (MLCC). The bound evaluates difference in performance for different decompositions of some codes. The third paper investigates the bit error probability code for maximum likelihood decoding of binary linear codes. The fourth and final paper included in this report is concerns itself with the construction of multilevel concatenated block modulation codes using a multilevel concatenation scheme for the frequency non-selective Rayleigh fading channel.

A multilevel study of the impact of project manager's leadership on extra-role performance of project team members

NASA Astrophysics Data System (ADS)

Shokory, Suzyanty Mohd; Suradi, Nur Riza Mohd

2018-04-01

The current study examines the impact of transformational and transactional leadership of project manager on the extra-role performance of project team members. In addition, this study also identifies factor dominant to extra-role performance of project team members when the transformational and transactional leadership of project managers are analyzed simultaneously. The study involved 175 of project team members from 35 project teams (each project team consists of different contracting companies registered in the Selangor (N = 175 from 35 contractors company). A multilevel analysis with hierarchical linear modeling (HLM) approach was used in this study. The analysis showed that transformational and transactional leadership of the project manager is a positive significant with extra-role performance project team members when analyzed separately. However when the two constructs (transformational leadership and transactional leadership of project manager) were analyzed simultaneously, transformational leadership was found to have more impact on extra-role performance project team members compared to transactional leadership. These findings explained that although transformational and transactional leadership of project managers can improve extra-role performance project team members, but this study has proved that transformational leadership of project managers affect extra-role performance project team members more as compared to transactional leadership.

Prevalence and regional correlates of road traffic injury among Chinese urban residents: A 21-city population-based study.

PubMed

Rockett, Ian R H; Jiang, Shuhan; Yang, Qian; Yang, Tingzhong; Yang, Xiaozhao Y; Peng, Sihui; Yu, Lingwei

2017-08-18

This study estimated the prevalence of road traffic injury among Chinese urban residents and examined individual and regional-level correlates. A cross-sectional multistage process was used to sample residents from 21 selected cities in China. Survey respondents reported their history of road traffic injury in the past 12 months through a community survey. Multilevel, multivariable logistic regression analysis was used to identify injury correlates. Based on a retrospective 12-month reporting window, road traffic injury prevalence among urban residents was 13.2%. Prevalence of road traffic injury, by type, was 8.7, 8.7, 8.5, and 7.7% in the automobile, bicycle, motorcycle, and pedestrian categories, respectively. Multilevel analysis showed that prevalence of road traffic injury was positively associated with minority status, income, and mental health disorder score at the individual level. Regionally, road traffic injury was associated with geographic location of residence and prevalence of mental health disorders. Both individual and regional-level variables were associated with road traffic injury among Chinese urban residents, a finding whose implications transcend wholesale imported generic solutions. This descriptive research demonstrates an urgent need for longitudinal studies across China on risk and protective factors, in order to inform injury etiology, surveillance, prevention, treatment, and evaluation.

Tooth-related risk factors for periodontal disease in community-dwelling elderly people.

PubMed

Hirotomi, Toshinobu; Yoshihara, Akihiro; Ogawa, Hiroshi; Miyazaki, Hideo

2010-06-01

While most previous epidemiological studies have focused on subject-level risk factors for periodontal destruction, tooth-related factors have not been fully explored. The purpose of this study was to evaluate both tooth-related and subject-related factors affecting periodontal disease progression using a two-level multilevel model. A longitudinal survey over a period of 10 years was carried out on 286 community-dwelling elderly subjects aged 70 years at baseline. Clinical attachment level (CAL) was measured at six sites per tooth on all teeth present and periodontal disease progression was defined as CAL> or =3 mm. Periodontal disease progression was found in 79% of the subjects and most frequently in maxillary molars. Multilevel logistic regressions revealed that subjects wearing removable dentures were significantly at risk for periodontal disease progression. Abutment teeth for removable/fixed dentures were also significantly more likely to suffer periodontal breakdown. Furthermore, the following tooth-related variables were found to be possible risk factors for periodontal disease progression: maxillary and multirooted teeth. Multirooted teeth and abutments for a fixed denture were possible risk factors for periodontal disease progression.

[Eco-epidemiology: towards epidemiology of complexity].

PubMed

Bizouarn, Philippe

2016-05-01

In order to solve public health problems posed by the epidemiology of risk factors centered on the individual and neglecting the causal processes linking the risk factors with the health outcomes, Mervyn Susser proposed a multilevel epidemiology called eco-epidemiology, addressing the interdependence of individuals and their connection with molecular, individual, societal, environmental levels of organization participating in the causal disease processes. The aim of this epidemiology is to integrate more than a level of organization in design, analysis and interpretation of health problems. After presenting the main criticisms of risk-factor epidemiology focused on the individual, we will try to show how eco-epidemiology and its development could help to understand the need for a broader and integrative epidemiology, in which studies designed to identify risk factors would be balanced by studies designed to answer other questions equally vital to public health. © 2016 médecine/sciences – Inserm.

A multilevel simultaneous equations model for within-cluster dynamic effects, with an application to reciprocal parent-child and sibling effects.

PubMed

Steele, Fiona; Rasbash, Jon; Jenkins, Jennifer

2013-03-01

There has been substantial interest in the social and health sciences in the reciprocal causal influences that people in close relationships have on one another. Most research has considered reciprocal processes involving only 2 units, although many social relationships of interest occur within a larger group (e.g., families, work groups, peer groups, classrooms). This article presents a general longitudinal multilevel modeling framework for the simultaneous estimation of reciprocal relationships among individuals with unique roles operating in a social group. We use family data for illustrative purposes, but the model is generalizable to any social group in which measurements of individuals in the social group occur over time, individuals have unique roles, and clustering of the data is evident. We allow for the possibility that the outcomes of family members are influenced by a common set of unmeasured family characteristics. The multilevel model we propose allows for residual variation in the outcomes of parents and children at the occasion, individual, and family levels and residual correlation between parents and children due to the unmeasured shared environment, genetic factors, and shared measurement. Another advantage of this method over approaches used in previous family research is it can handle mixed family sizes. The method is illustrated in an analysis of maternal depression and child delinquency using data from the Avon Brothers and Sisters Study. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Multilevel social structure and diet shape the gut microbiota of the gelada monkey, the only grazing primate.

PubMed

Trosvik, Pål; de Muinck, Eric J; Rueness, Eli K; Fashing, Peter J; Beierschmitt, Evan C; Callingham, Kadie R; Kraus, Jacob B; Trew, Thomas H; Moges, Amera; Mekonnen, Addisu; Venkataraman, Vivek V; Nguyen, Nga

2018-05-05

The gelada monkey (Theropithecus gelada), endemic to the Ethiopian highlands, is the only graminivorous primate, i.e., it feeds mainly on grasses and sedges. In spite of known dental, manual, and locomotor adaptations, the intestinal anatomy of geladas is similar to that of other primates. We currently lack a clear understanding of the adaptations in digestive physiology necessary for this species to subsist on a graminoid-based diet, but digestion in other graminivores, such as ruminants, relies heavily on the microbial community residing in the gastrointestinal (GI) system. Furthermore, geladas form complex, multilevel societies, making them a suitable system for investigating links between sociality and the GI microbiota. Here, we explore the gastrointestinal microbiota of gelada monkeys inhabiting an intact ecosystem and document how factors like multilevel social structure and seasonal changes in diet shape the GI microbiota. We compare the gelada GI microbiota to those of other primate species, reporting a gradient from geladas to herbivorous specialist monkeys to dietary generalist monkeys and lastly humans, the ultimate ecological generalists. We also compare the microbiotas of the gelada GI tract and the sheep rumen, finding that geladas are highly enriched for cellulolytic bacteria associated with ruminant digestion, relative to other primates. This study represents the first analysis of the gelada GI microbiota, providing insights into the adaptations underlying graminivory in a primate. Our results also highlight the role of social organization in structuring the GI microbiota within a society of wild animals.

A Multilevel Multiset Time-Series Model for Describing Complex Developmental Processes

PubMed Central

Ma, Xin; Shen, Jianping

2017-01-01

The authors sought to develop an analytical platform where multiple sets of time series can be examined simultaneously. This multivariate platform capable of testing interaction effects among multiple sets of time series can be very useful in empirical research. The authors demonstrated that the multilevel framework can readily accommodate this analytical capacity. Given their intention to use the multilevel multiset time-series model to pursue complicated research purposes, their resulting model is relatively simple to specify, to run, and to interpret. These advantages make the adoption of their model relatively effortless as long as researchers have the basic knowledge and skills in working with multilevel growth modeling. With multiple potential extensions of their model, the establishment of this analytical platform for analysis of multiple sets of time series can inspire researchers to pursue far more advanced research designs to address complex developmental processes in reality. PMID:29881094

Intermediate and advanced topics in multilevel logistic regression analysis

PubMed Central

Merlo, Juan

2017-01-01

Multilevel data occur frequently in health services, population and public health, and epidemiologic research. In such research, binary outcomes are common. Multilevel logistic regression models allow one to account for the clustering of subjects within clusters of higher‐level units when estimating the effect of subject and cluster characteristics on subject outcomes. A search of the PubMed database demonstrated that the use of multilevel or hierarchical regression models is increasing rapidly. However, our impression is that many analysts simply use multilevel regression models to account for the nuisance of within‐cluster homogeneity that is induced by clustering. In this article, we describe a suite of analyses that can complement the fitting of multilevel logistic regression models. These ancillary analyses permit analysts to estimate the marginal or population‐average effect of covariates measured at the subject and cluster level, in contrast to the within‐cluster or cluster‐specific effects arising from the original multilevel logistic regression model. We describe the interval odds ratio and the proportion of opposed odds ratios, which are summary measures of effect for cluster‐level covariates. We describe the variance partition coefficient and the median odds ratio which are measures of components of variance and heterogeneity in outcomes. These measures allow one to quantify the magnitude of the general contextual effect. We describe an R 2 measure that allows analysts to quantify the proportion of variation explained by different multilevel logistic regression models. We illustrate the application and interpretation of these measures by analyzing mortality in patients hospitalized with a diagnosis of acute myocardial infarction. © 2017 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd. PMID:28543517

Intermediate and advanced topics in multilevel logistic regression analysis.

PubMed

Austin, Peter C; Merlo, Juan

2017-09-10

Multilevel data occur frequently in health services, population and public health, and epidemiologic research. In such research, binary outcomes are common. Multilevel logistic regression models allow one to account for the clustering of subjects within clusters of higher-level units when estimating the effect of subject and cluster characteristics on subject outcomes. A search of the PubMed database demonstrated that the use of multilevel or hierarchical regression models is increasing rapidly. However, our impression is that many analysts simply use multilevel regression models to account for the nuisance of within-cluster homogeneity that is induced by clustering. In this article, we describe a suite of analyses that can complement the fitting of multilevel logistic regression models. These ancillary analyses permit analysts to estimate the marginal or population-average effect of covariates measured at the subject and cluster level, in contrast to the within-cluster or cluster-specific effects arising from the original multilevel logistic regression model. We describe the interval odds ratio and the proportion of opposed odds ratios, which are summary measures of effect for cluster-level covariates. We describe the variance partition coefficient and the median odds ratio which are measures of components of variance and heterogeneity in outcomes. These measures allow one to quantify the magnitude of the general contextual effect. We describe an R 2 measure that allows analysts to quantify the proportion of variation explained by different multilevel logistic regression models. We illustrate the application and interpretation of these measures by analyzing mortality in patients hospitalized with a diagnosis of acute myocardial infarction. © 2017 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd. © 2017 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.

Workplace assaults on nursing assistants in US nursing homes: a multilevel analysis.

PubMed

Tak, SangWoo; Sweeney, Marie Haring; Alterman, Toni; Baron, Sherry; Calvert, Geoffrey M

2010-10-01

We examined risk factors for injuries to nursing assistants from assaults by nursing home residents at both the individual and the organizational level. We analyzed data from the 2004 National Nursing Assistant Survey that were linked to facility information from the 2004 National Nursing Home Survey by use of multilevel modeling that accounted for the complex survey design effect. Thirty-four percent of nursing assistants surveyed reported experiencing physical injuries from residents' aggression in the previous year. Mandatory overtime (odds ratio [OR] = 1.65; 95% confidence interval [CI] = 1.22, 2.24) and not having enough time to assist residents with their activities of daily living (OR = 1.49; 95% CI = 1.25, 1.78) were strongly associated with experiencing injuries from assaults. Nursing assistants employed in nursing homes with Alzheimer care units were more likely to experience such injuries, including being bitten by residents. Reducing mandatory overtime and having a less demanding workload may reduce the risk of workplace violence. In particular, prevention activities should be targeted at those nursing homes that care for cognitively impaired patients.

Workplace Assaults on Nursing Assistants in US Nursing Homes: A Multilevel Analysis

PubMed Central

Sweeney, Marie Haring; Alterman, Toni; Baron, Sherry; Calvert, Geoffrey M.

2010-01-01

Objectives. We examined risk factors for injuries to nursing assistants from assaults by nursing home residents at both the individual and the organizational level. Methods. We analyzed data from the 2004 National Nursing Assistant Survey that were linked to facility information from the 2004 National Nursing Home Survey by use of multilevel modeling that accounted for the complex survey design effect. Results. Thirty-four percent of nursing assistants surveyed reported experiencing physical injuries from residents' aggression in the previous year. Mandatory overtime (odds ratio [OR] = 1.65; 95% confidence interval [CI] = 1.22, 2.24) and not having enough time to assist residents with their activities of daily living (OR = 1.49; 95% CI = 1.25, 1.78) were strongly associated with experiencing injuries from assaults. Nursing assistants employed in nursing homes with Alzheimer care units were more likely to experience such injuries, including being bitten by residents. Conclusions. Reducing mandatory overtime and having a less demanding workload may reduce the risk of workplace violence. In particular, prevention activities should be targeted at those nursing homes that care for cognitively impaired patients. PMID:20724680

The impact of social and organizational factors on workers' use of personal protective equipment: a multilevel approach.

PubMed

Torp, Steffen; Grøgaard, Jens B; Moen, Bente E; Bråtveit, Magne

2005-08-01

On the basis of the job demands-control-support model by Karasek and Theorell, we investigated how social and organizational factors influence workers' use of personal protective equipment (PPE). A cross-sectional study was performed among 1420 workers in 203 motor vehicle-repair garages. Multilevel modeling was performed to account for the hierarchical structure of the data. Social and management support correlated positively with PPE use at the worker level. Low demands measured at the garage level and having a health and safety management system at the garage also correlated with active use of PPE. An interaction effect between social support and garage-level demands was observed. In addition to health information and provision of PPE, focusing on social and organizational factors seems necessary to get more workers to comply with the instructions on PPE use.

The Impact of Multilevel Factors on Technology Integration: The Case of Taiwanese Grade 1-9 Teachers and Schools

ERIC Educational Resources Information Center

Hsu, Shihkuan; Kuan, Ping-Yin

2013-01-01

Technology integration is influenced by many factors related to the teacher and the school environment. While many studies have examined factors that influence teachers' use of Information and Communication Technology (ICT) at the teacher level, a growing number of studies have suggested that it is beneficial to examine those factors using…

Assessment of Material Solutions of Multi-level Garage Structure Within Integrated Life Cycle Design Process

NASA Astrophysics Data System (ADS)

Wałach, Daniel; Sagan, Joanna; Gicala, Magdalena

2017-10-01

The paper presents an environmental and economic analysis of the material solutions of multi-level garage. The construction project approach considered reinforced concrete structure under conditions of use of ordinary concrete and high-performance concrete (HPC). Using of HPC allowed to significant reduction of reinforcement steel, mainly in compression elements (columns) in the construction of the object. The analysis includes elements of the methodology of integrated lice cycle design (ILCD). By making multi-criteria analysis based on established weight of the economic and environmental parameters, three solutions have been evaluated and compared within phase of material production (information modules A1-A3).

Changing community health service delivery in economically less-developed rural areas in China: impact on service use and satisfaction

PubMed Central

Liu, Yong; Yuan, Zhaokang; Liu, Yuxi; Jayasinghe, Upali W; Harris, Mark F

2014-01-01

Objective To evaluate the impact of a model of rural community health service (CHS) on the use and acceptability of primary healthcare services. Design Quasi-experimental. Setting Two adjacent rural counties in China. Participants 5842 residents in 2009 and 3807 in 2010 from 980 households in 7 intervention townships and 49 villages; 2232 residents in 2009 and 2315 in 2010 from 628 households in 3 comparison townships and 9 villages. All residents were approached to participate, with no significant differences in age or sex between groups. Intervention Multilevel intervention in 2009 including training rural practitioners, encouraging clinic improvements, providing clinical guidelines, standards and subsidies. Data collection Surveys of community members from randomly sampled households in 2009 and 2010. Primary outcome measures Satisfaction with and utilisation of outpatient and public health services. Analysis Factor analysis confirmed two components of satisfaction. Univariate and multilevel analysis was used. Results Satisfaction scores for intervention county respondents increased from 21.4 (95% CI 21.1 to 21.7) to 22.1 (95% CI 21.7 to 22.4) with no change in comparison area. In multilevel analysis, satisfaction with patient-centred care was associated with chronic disease, shorter waiting times and county. Satisfaction with clinic environment and cost was associated with female gender, shorter waiting times but not county. The proportion of children receiving immunisation in intervention village clinics increased from 42.5% (95% CI 27.9% to 47.1%) to 59.2% (95% CI 53.8% to 64.6%) whereas this decreased in comparison villages (16.5%; 95% CI 10.3% to 22.7% to 6.0%; 95% CI 1.3% to 10.7%). Antenatal visits increased in intervention villages (from 69.0%, 95% CI 65.8% to 73.1% to 75.8%, 95% CI 72.2% to 79.4%) with no change in comparison villages. Conclusions Introduction of a CHS model adapted to economically less-developed rural areas was associated with some improvements in satisfaction with care and use of some village-based public health services. Further research is needed to determine its public health impact and application to other areas. PMID:24583760

Detecting a Change in School Performance: A Bayesian Analysis for a Multilevel Join Point Problem. CSE Technical Report 542.

ERIC Educational Resources Information Center

Thum, Yeow Meng; Bhattacharya, Suman Kumar

To better describe individual behavior within a system, this paper uses a sample of longitudinal test scores from a large urban school system to consider hierarchical Bayes estimation of a multilevel linear regression model in which each individual regression slope of test score on time switches at some unknown point in time, "kj."…

Level and Change of Bullying Behavior during High School: A Multilevel Growth Curve Analysis

ERIC Educational Resources Information Center

Nocentini, Annalaura; Menesini, Ersilia; Salmivalli, Christina

2013-01-01

The development of bullying behavior was examined across three years in a sample of 515 adolescents (46% females) from 41 classrooms. At time 1, the students were in grades 9 and 10 (mean age = 14.5 years; SD = 0.54). Results of a multilevel growth model showed that both baseline level and change of bullying varied significantly across individuals…

Psychosocial Working Conditions, School Sense of Coherence and Subjective Health Complaints. A Multilevel Analysis of Ninth Grade Pupils in the Stockholm Area

ERIC Educational Resources Information Center

Modin, Bitte; Ostberg, Viveca; Toivanen, Susanna; Sundell, Knut

2011-01-01

This study explores the psychosocial working conditions of 7930 Swedish 9th grade students, distributed over 475 classes and 130 schools, in relation to their subjective health using multilevel modeling. At the individual level, students with "strained" working conditions in school (i.e. those experiencing a high level of demands in…

A Multilevel Analysis of Diverse Learners Playing Life Science Video Games: Interactions between Game Content, Learning Disability Status, Reading Proficiency, and Gender

ERIC Educational Resources Information Center

Israel, Maya; Wang, Shuai; Marino, Matthew T.

2016-01-01

Extant research reports differential effects related to the efficacy of video games as a means to enhance science instruction. However, there are very few studies examining differences in learning outcomes across student-level independent variables. This study used multilevel modeling to examine the effects of three video game-enhanced life…

National and School Policies on Restrictions of Teacher Smoking: A Multilevel Analysis of Student Exposure to Teacher Smoking in Seven European Countries

ERIC Educational Resources Information Center

Wold, Bente; Torsheim, Torbjorn; Currie, Candace; Roberts, Chris

2004-01-01

The paper examines the association between restrictions on teacher tobacco smoking at school and student exposure to teachers who smoke during school hours. The data are taken from a European Commission-funded study "Control of Adolescent Smoking" (the CAS study) in seven European countries. Multilevel modelling analyses were applied to…

Retention of Children and Their Families in the Longitudinal Outcome Study of the Comprehensive Community Mental Health Services for Children and Their Families Program: A Multilevel Analysis

ERIC Educational Resources Information Center

Gebreselassie, Tesfayi; Stephens, Robert L.; Maples, Connie J.; Johnson, Stacy F.; Tucker, Alyce L.

2014-01-01

Predictors of retention of participants in a longitudinal study and heterogeneity between communities were investigated using a multilevel logistic regression model. Data from the longitudinal outcome study of the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families program and information on…

Equity in the Turkish Education System: A Multilevel Analysis of Social Background Influences on the Mathematics Performance of 15-Year-Old Students

ERIC Educational Resources Information Center

Özdemir, Caner

2016-01-01

This paper aims to discover the level of equity in the Turkish education system using maths outcomes of 15-year-old students in the Programme for International Student Assessment (PISA) exam. In order to do that, associations between various social background variables and student performance are analysed via multilevel models. Female pupils,…

Risk Assessment of Groundwater Contamination: A Multilevel Fuzzy Comprehensive Evaluation Approach Based on DRASTIC Model

PubMed Central

Zhang, Yan; Zhong, Ming

2013-01-01

Groundwater contamination is a serious threat to water supply. Risk assessment of groundwater contamination is an effective way to protect the safety of groundwater resource. Groundwater is a complex and fuzzy system with many uncertainties, which is impacted by different geological and hydrological factors. In order to deal with the uncertainty in the risk assessment of groundwater contamination, we propose an approach with analysis hierarchy process and fuzzy comprehensive evaluation integrated together. Firstly, the risk factors of groundwater contamination are identified by the sources-pathway-receptor-consequence method, and a corresponding index system of risk assessment based on DRASTIC model is established. Due to the complexity in the process of transitions between the possible pollution risks and the uncertainties of factors, the method of analysis hierarchy process is applied to determine the weights of each factor, and the fuzzy sets theory is adopted to calculate the membership degrees of each factor. Finally, a case study is presented to illustrate and test this methodology. It is concluded that the proposed approach integrates the advantages of both analysis hierarchy process and fuzzy comprehensive evaluation, which provides a more flexible and reliable way to deal with the linguistic uncertainty and mechanism uncertainty in groundwater contamination without losing important information. PMID:24453883

Exploring alternate specifications to explain agency-level effects in placement decisions regarding aboriginal children: further analysis of the Canadian Incidence Study of Reported Child Abuse and Neglect Part B.

PubMed

Chabot, Martin; Fallon, Barbara; Tonmyr, Lil; MacLaurin, Bruce; Fluke, John; Blackstock, Cindy

2013-01-01

This paper builds upon the analyses presented in two companion papers (Fluke et al., 2010; Fallon et al., 2013) using data from the 1998 and 2003 cycles of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-1998 and CIS-2003) to examine the influence of clinical and organizational characteristics on the decision to place a child in out-of-home care at the conclusion of a child maltreatment investigation. This paper explores various model specifications to explain the effect of an agency-level factor, proportion of Aboriginal reports, which emerged as a stable and significant factor through the two data collection cycles. It addresses the issue of data comparability between the two cycles and explores various re-specifications and descriptive analyses of reported models to evaluate their solidity with regards to the sampling schemes and the precise contribution of a multi-level specification. The decision to place a child in out-of-home care was examined using data from the CIS-2003. This child welfare dataset collected information about the results of nearly 12,000 child maltreatment investigations as well as a description of the characteristics of the workers and organization responsible for conducting those investigations. Multi-level statistical models were developed using MPlus software, which can accommodate dichotomous outcome variables and are more reflective of decision-making in child welfare. The models are thus multi-level binary logistic regressions. Final models revealed that two agency-level variables, 'Education degree of majority of workers' and 'Degree of centralization in the agency' clarify the nature of the effect of 'Proportion of Aboriginal reports', a stable, key second level predictor of the placement decision. The comparability of the effect of this agency-level variable across the 1998 and 2003 cycles becomes further evident through this analysis. By using a unified database including both cycles and various specifications of models, the comparability was found to be robust, in addition to clarifying the precise contribution of a multi-level specification. This third paper in a series establishes the 'Proportion of Aboriginal reports' received by the child welfare agency as an important agency level predictor associated with a child's likelihood of being placed in the Canadian child protection system. While the more complex models give support to the notion that unequal resources subtend those results, more analyses are needed to confirm this hypothesis. Unequal resources for agencies with larger Aboriginal caseloads may explain the persistence of the results. These findings suggest that specific resource constraints related to worker education may be explanatory. Copyright © 2012 Elsevier Ltd. All rights reserved.

High school and college biology: A multi-level model of the effects of high school biology courses on student academic performance in introductory college biology courses

NASA Astrophysics Data System (ADS)

Loehr, John Francis

The issue of student preparation for college study in science has been an ongoing concern for both college-bound students and educators of various levels. This study uses a national sample of college students enrolled in introductory biology courses to address the relationship between high school biology preparation and subsequent introductory college biology performance. Multi-Level Modeling was used to investigate the relationship between students' high school science and mathematics experiences and college biology performance. This analysis controls for student demographic and educational background factors along with factors associated with the college or university attended. The results indicated that high school course-taking and science instructional experiences have the largest impact on student achievement in the first introductory college biology course. In particular, enrollment in courses, such as high school Calculus and Advanced Placement (AP) Biology, along with biology course content that focuses on developing a deep understanding of the topics is found to be positively associated with student achievement in introductory college biology. On the other hand, experiencing high numbers of laboratory activities, demonstrations, and independent projects along with higher levels of laboratory freedom are associated with negative achievement. These findings are relevant to high school biology teachers, college students, their parents, and educators looking beyond the goal of high school graduation.

Relationship between a Centers for Disease Control and Prevention expanded HIV testing initiative and past-year testing by race/ethnicity: a multilevel analysis of the Behavioral Risk Factor Surveillance System.

PubMed

Gaines, Tommi L; Caldwell, Julia T; Ford, Chandra L; Mulatu, Mesfin S; Godette, Dionne C

2016-01-01

The Centers for Disease Control and Prevention's (CDC) expanded testing initiative (ETI) aims to bolster HIV testing among populations disproportionately affected by the HIV epidemic by providing additional funding to health departments serving these communities. ETI prioritizes testing in clinical settings; therefore, we examined the relationship between state-level ETI participation and past-year HIV testing among a racially/ethnically diverse sample of adult respondents to the 2012 Behavioral Risk Factor Surveillance System who accessed health services within the 12 months prior to being interviewed. Controlling for individual- and state-level characteristics in a multilevel logistic regression model, ETI participation was independently and positively associated with past-year testing, but this association varied by race/ethnicity. Hispanics had higher odds (adjusted odds ratio [AOR]: 1.49; 95% CI: 1.11-2.02) and American Indian/Alaska Natives had lower odds (AOR: 0.66; 95% CI: 0.43-0.99) of testing if they resided in states with (vs. without) ETI participation. State-level ETI participation did not significantly alter past-year testing among other racial/ethnic groups. Prioritizing public health resources in states most affected by HIV can improve testing patterns, but other mechanisms likely influence which racial/ethnic groups undergo testing.

A multilevel study of area socio-economic status and food purchasing behaviour.

PubMed

Turrell, Gavin; Bentley, Rebecca; Thomas, Lyndal R; Jolley, Damien; Subramanian, Sv; Kavanagh, Anne M

2009-11-01

The present study examined the association between area socio-economic status (SES) and food purchasing behaviour. Data were collected by mail survey (64.2 % response rate). Area SES was indicated by the proportion of households in each area earning less than $AUS 400 per week, and individual-level socio-economic position was measured using education, occupation and household income. Food purchasing was measured on the basis of compliance with dietary guideline recommendations (for grocery foods) and variety of fruit and vegetable purchase. Multilevel regression analysis examined the association between area SES and food purchase after adjustment for individual-level demographic (age, sex, household composition) and socio-economic factors. Melbourne city, Australia, 2003. Residents of 2564 households located in fifty small areas. Residents of low-SES areas were significantly less likely than their counterparts in advantaged areas to purchase grocery foods that were high in fibre and low in fat, salt and sugar; and they purchased a smaller variety of fruits. There was no evidence of an association between area SES and vegetable variety. In Melbourne, area SES was associated with some food purchasing behaviours independent of individual-level factors, suggesting that areas in this city may be differentiated on the basis of food availability, accessibility and affordability, making the purchase of some types of foods more difficult in disadvantaged areas.

Workplace social capital and co-occurrence of lifestyle risk factors: the Finnish Public Sector Study.

PubMed

Väänänen, A; Kouvonen, A; Kivimäki, M; Oksanen, T; Elovainio, M; Virtanen, M; Pentti, J; Vahtera, J

2009-07-01

The aim of this prospective study was to examine the link between individual and ecological workplace social capital and the co-occurrence of adverse lifestyle risk factors such as smoking, heavy drinking, physical inactivity and overweight. Data on 25 897 female and 5476 male public sector employees were analysed. Questionnaire surveys conducted in 2000-2002 (baseline) and 2004-2005 (follow-up) were used to assess workplace social capital, lifestyle risk factors and other characteristics. Multilevel multinomial logistic regression analysis was used to examine associations between individual and ecological social capital and the co-occurrence of lifestyle risk factors. In the cross-sectional analysis adjusted for age, sex, marital status and employer, low social capital at work at both the individual and ecological level was associated with at least a 1.3 times higher odds of having more than two lifestyle risk factors versus having no risk factors. Similar associations were found in the prospective setting. However, additional adjustment for the co-occurrence of risk factors and socioeconomic status at baseline attenuated the result to non-significant. Social capital at work seems to be associated with a lowered risk of co-occurrence of multiple lifestyle risk factors but does not clearly predict the future risk of this co-occurrence.

The Sero-epidemiology of Coxiella burnetii in Humans and Cattle, Western Kenya: Evidence from a Cross-Sectional Study

PubMed Central

Thomas, Lian F.; Cook, Elizabeth A. J.; de Glanville, William A.; Atkinson, Peter M.; Wamae, Claire N.; Fèvre, Eric M.

2016-01-01

Evidence suggests that the intracellular bacterial pathogen Coxiella burnetii (which causes Q fever) is widespread, with a near global distribution. While there has been increasing attention to Q fever epidemiology in high-income settings, a recent systematic review highlighted significant gaps in our understanding of the prevalence, spatial distribution and risk factors for Q fever infection across Africa. This research aimed to provide a One Health assessment of Q fever epidemiology in parts of Western and Nyanza Provinces, Western Kenya, in cattle and humans. A cross-sectional survey was conducted: serum samples from 2049 humans and 955 cattle in 416 homesteads were analysed for C. burnetii antibodies. Questionnaires covering demographic, socio-economic and husbandry information were also administered. These data were linked to environmental datasets based on geographical locations (e.g., land cover). Correlation and spatial-cross correlation analyses were applied to assess the potential link between cattle and human seroprevalence. Multilevel regression analysis was used to assess the relationships between a range of socio-economic, demographic and environmental factors and sero-positivity in both humans and animals. The overall sero-prevalence of C. burnetii was 2.5% in humans and 10.5% in cattle, but we found no evidence of correlation between cattle and human seroprevalence either within households, or when incorporating spatial proximity to other households in the survey. Multilevel modelling indicated the importance of several factors for exposure to the organism. Cattle obtained from market (as opposed to those bred in their homestead) and those residing in areas with lower precipitation levels had the highest sero-prevalence. For humans, the youngest age group had the highest odds of seropositivity, variations were observed between ethnic groups, and frequent livestock contact (specifically grazing and dealing with abortion material) was also a risk factor. These results illustrate endemicity of C. burnetii in western Kenya, although prevalence is relatively low. The analysis indicates that while environmental factors may play a role in cattle exposure patterns, human exposure patterns are likely to be driven more strongly by livestock contacts. The implication of livestock markets in cattle exposure risks suggests these may be a suitable target for interventions. PMID:27716804

Contextual and individual factors associated with dental services utilisation by Brazilian adults: A multilevel analysis

PubMed Central

2018-01-01

Background Inequalities in the utilisation of dental services in Brazil are remarkable. The aim of this study was to evaluate the association of contextual and individual factors with the utilisation of dental services by Brazilian adults using the Andersen’s behavioural model. Methods Individual-level data from 27,017 adults residents in the State capitals who were interviewed in the 2013 Brazilian National Health Survey were pooled with contextual city-level data. The outcomes were non-utilisation of dental services and last dental visit over 12 months ago. Individual predisposing variables were age, sex, race/skin colour, schooling and social network. Individual enabling variables included income, health insurance and registration in primary health care. Individual need variables were self-perceived dental health and self-reported missing teeth. Multilevel logistic regression models were performed to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) of the association of contextual and individual predisposing, enabling and need-related variables with dental services outcomes. Results Predisposing (OR = 0.89; 95% CI 0.81–0.97) and enabling (OR = 0.90; 95% CI 0.85–0.96) contextual factors were associated with non-utilisation of dental services. Individual predisposing (sex, race/skin colour, schooling), enabling (income, health insurance) and need (self-perceived oral health, missing teeth) were associated with non-utilisation of dental services and last dental visit over 12 months ago. The latter was also associated with other individual predisposing (age, social network) and need (eating difficulties due to oral problems) characteristics. Conclusions Individual and contextual determinants influenced dental services utilisation in Brazilian adults. These factors should be on the policy agenda and considered in the organisation of health services aiming to reduce oral health inequalities related to access and utilisation of dental services. PMID:29420660

Contextual and individual factors associated with dental services utilisation by Brazilian adults: A multilevel analysis.

PubMed

Herkrath, Fernando José; Vettore, Mario Vianna; Werneck, Guilherme Loureiro

2018-01-01

Inequalities in the utilisation of dental services in Brazil are remarkable. The aim of this study was to evaluate the association of contextual and individual factors with the utilisation of dental services by Brazilian adults using the Andersen's behavioural model. Individual-level data from 27,017 adults residents in the State capitals who were interviewed in the 2013 Brazilian National Health Survey were pooled with contextual city-level data. The outcomes were non-utilisation of dental services and last dental visit over 12 months ago. Individual predisposing variables were age, sex, race/skin colour, schooling and social network. Individual enabling variables included income, health insurance and registration in primary health care. Individual need variables were self-perceived dental health and self-reported missing teeth. Multilevel logistic regression models were performed to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) of the association of contextual and individual predisposing, enabling and need-related variables with dental services outcomes. Predisposing (OR = 0.89; 95% CI 0.81-0.97) and enabling (OR = 0.90; 95% CI 0.85-0.96) contextual factors were associated with non-utilisation of dental services. Individual predisposing (sex, race/skin colour, schooling), enabling (income, health insurance) and need (self-perceived oral health, missing teeth) were associated with non-utilisation of dental services and last dental visit over 12 months ago. The latter was also associated with other individual predisposing (age, social network) and need (eating difficulties due to oral problems) characteristics. Individual and contextual determinants influenced dental services utilisation in Brazilian adults. These factors should be on the policy agenda and considered in the organisation of health services aiming to reduce oral health inequalities related to access and utilisation of dental services.

Factors associated with use of maternal health services in Haiti: a multilevel analysis.

PubMed

Babalola, Stella O

2014-07-01

To assess factors associated with utilization of maternal health services (MHS) among women giving birth in Haiti from 2007 - 2012. Observational data derived from the 2012 Haiti Mortality, Morbidity and Service Use Survey are analyzed. Multilevel analytic methods are used to assess factors associated with use of antenatal services and skilled birth attendance (SBA). The strongest adjusted predictors include child's birth rank, household poverty, and community media saturation. The odds of obtaining four antenatal care visits decrease by 53% (odds ratio (OR) = 0.47; 95% confidence interval (CI): 0.37-0.57) with high birth rank and by 37% (OR = 0.63; 95% CI: 0.51-0.78) with household poverty, and increase by 38% (OR = 1.38; 95% CI: 1.01-1.88) with high community media saturation. The odds of using SBA at delivery decrease by 72% (OR = 0.28; 95% CI: 0.22-0.34) with high birth rank and by 42% (OR = 0.58; 95% CI: 0.46-0.73) with household poverty, and increase by 92% (OR = 1.92; 95% CI: 1.41-2.61) with high community media saturation. Use of antenatal services is strongly associated with SBA (OR = 2.20; 95% CI: 1.85-2.61). Significant clustering of use of MHS exists at the community level. Factors associated with use of MHS operate at multiple levels. Efforts to promote such services should identify and pay special attention to the needs of multiparous and uneducated women, address the distance-decay phenomenon, and improve access for the poor. Community mobilization efforts designed to change norms hindering the use of MHS are also relevant.

Factors associated with use of community mental health services by schizophrenia patients using multilevel analysis

PubMed Central

2011-01-01

Background Persons with schizophrenia and related disorders may be particularly sensitive to a number of determinants of service use, including those related with illness, socio-demographic characteristics and organizational factors. The objective of this study is to identify factors associated with outpatient contacts at community mental health services of patients with schizophrenia or related disorders. Methods This cross-sectional study analyzed 1097 patients. The main outcome measure was the total number of outpatient consultations during one year. Independent variables were related to socio-demographic, clinical and use of service factors. Data were collected from clinical records. Results The multilevel linear regression model explained 46.35% of the variance. Patients with significantly more contacts with ambulatory services were not working and were receiving welfare benefits (p = 0.02), had no formal education (p = 0.02), had a global level of severity of two or three (four being the most severe) (p < 0.001), with one or more inpatient admissions (p < 0.001), and in contact with both types of professional (nurses and psychiatrists) (p < 0.001). The patients with the fewest ambulatory contacts were those with diagnoses of persistent delusional disorders (p = 0.04) and those who were attended by four of the 13 psychiatrists (p < 0.001). Conclusions As expected, the variables that explained the use of community service could be viewed as proxies for severity of illness. The most surprising finding, however, was that a group of four psychiatrists was also independently associated with use of ambulatory services by patients with schizophrenia or related disorders. More research is needed to carefully examine how professional support networks interact to affect use of mental health. PMID:21982430

Risk factors for disordered weight control behaviors among Korean adolescents: Multilevel analysis of the Korea Youth Risk Behavior Survey.

PubMed

Kim, Yongjoo; Austin, S Bryn; Subramanian, S V; Thomas, Jennifer J; Eddy, Kamryn T; Franko, Debra L; Rodgers, Rachel F; Kawachi, Ichiro

2018-02-01

To investigate the prevalence and risk factors for disordered weight control behaviors (DWCB) in South Korean adolescents at multiple levels, including individual, family, school, and geographic area. We drew participants from the 11th Korea Youth Risk Behavior Web-based Survey, conducted in 2015, with 65,529 adolescents (31,687 girls, 33,842 boys) aged 12-18 years. DWCB was defined as engaging in any of the following behaviors for weight control over the past month: fasting, one-food diet (eating only one food over an extended period of time for weight control), vomiting, and taking laxatives/diuretics/unprescribed diet pills. Sex-stratified four-level multilevel logistic models examined potential predictors of DWCB, including age, body-mass index, puberty, perceived household economic status, parental education, living structure, school type and sex-composition, percentage of students participating in school nutrition programs, and urbanicity. Overall, 6.2% of Korean adolescents (8.9% of girls, 3.7% of boys) exhibited any DWCB. We found significant between-school variation among girls and boys and between-classroom variation among girls. Older age, overweight/obesity, pubertal maturity, high household economic status (vs. mid-range economic status), and vocational schooling (vs. general) were positively associated with DWCB among girls and boys. Low household economic status (vs. mid-range economic status), higher parental education, and coeducational schooling (vs. single-sex) were positively associated with DWCB among girls only. The findings suggest that DWCB are prevalent among Korean adolescents across age, sex, and socioeconomic status. Social contextual factors including school and familial environmental factors, as well as individual characteristics, should be considered when developing effective prevention strategies. © 2018 Wiley Periodicals, Inc.

Structural synthesis: Precursor and catalyst

NASA Technical Reports Server (NTRS)

Schmit, L. A.

1984-01-01

More than twenty five years have elapsed since it was recognized that a rather general class of structural design optimization tasks could be properly posed as an inequality constrained minimization problem. It is suggested that, independent of primary discipline area, it will be useful to think about: (1) posing design problems in terms of an objective function and inequality constraints; (2) generating design oriented approximate analysis methods (giving special attention to behavior sensitivity analysis); (3) distinguishing between decisions that lead to an analysis model and those that lead to a design model; (4) finding ways to generate a sequence of approximate design optimization problems that capture the essential characteristics of the primary problem, while still having an explicit algebraic form that is matched to one or more of the established optimization algorithms; (5) examining the potential of optimum design sensitivity analysis to facilitate quantitative trade-off studies as well as participation in multilevel design activities. It should be kept in mind that multilevel methods are inherently well suited to a parallel mode of operation in computer terms or to a division of labor between task groups in organizational terms. Based on structural experience with multilevel methods general guidelines are suggested.

Multilevel microvibration test for performance predictions of a space optical load platform

NASA Astrophysics Data System (ADS)

Li, Shiqi; Zhang, Heng; Liu, Shiping; Wang, Yue

2018-05-01

This paper presents a framework for the multilevel microvibration analysis and test of a space optical load platform. The test framework is conducted on three levels, including instrument, subsystem, and system level. Disturbance source experimental investigations are performed to evaluate the vibration amplitude and study vibration mechanism. Transfer characteristics of space camera are validated by a subsystem test, which allows the calculation of transfer functions from various disturbance sources to optical performance outputs. In order to identify the influence of the source on the spacecraft performance, a system level microvibration measurement test has been performed on the ground. From the time domain analysis and spectrum analysis of multilevel microvibration tests, we concluded that the disturbance source has a significant effect on its installation position. After transmitted through mechanical links, the residual vibration reduces to a background noise level. In addition, the angular microvibration of the platform jitter is mainly concentrated in the rotation of y-axes. This work is applied to a real practical application involving the high resolution satellite camera system.

A multilevel meta-analysis of single-case and small-n research on interventions for reducing challenging behavior in persons with intellectual disabilities.

PubMed

Heyvaert, M; Maes, B; Van den Noortgate, W; Kuppens, S; Onghena, P

2012-01-01

The effectiveness of different interventions for challenging behavior (CB) in persons with intellectual disabilities (ID) was reviewed by means of a two-phase study. First, a systematic review of 137 meta-analyses and reviews on group-study interventions for CB in persons with ID was conducted. Based on this review, hypotheses concerning the effectiveness of divergent interventions for CB and concerning the impact of variables moderating treatment effectiveness were systematically generated. Second, these hypotheses were tested by means of a multilevel meta-analysis of single-case and small-n research. Two hundred and eighty-five studies reporting on 598 individuals were examined. The average treatment effect was large and statistically significant. However, this effect varied significantly over the included studies and participants. Compared to the meta-analyses and reviews focusing on group-studies in this research domain, the results of the present multilevel meta-analysis of single-case and small-n intervention research provided more detailed knowledge on which specific CB and intervention components moderate the interventions' effectiveness. Copyright © 2011 Elsevier Ltd. All rights reserved.

Context matters: the impact of unit leadership and empowerment on nurses' organizational commitment.

PubMed

Laschinger, Heather K Spence; Finegan, Joan; Wilk, Piotr

2009-05-01

The aim of this study was to test a multilevel model linking unit-level leader-member exchange quality and structural empowerment to nurses' psychological empowerment and organizational commitment at the individual level of analysis. Few studies have examined the contextual effects of unit leadership on individual nurse outcomes. Workplace empowerment has been related to retention outcomes such as organizational commitment in several studies, but few have studied the impact of specific unit characteristics within which nurses work on these outcomes. We surveyed 3,156 nurses in 217 hospital units to test the multilevel model. A multilevel path analysis revealed significant individual and contextual effects on nurses' organizational commitment. Both unit-level leader-member exchange quality and structural empowerment had significant direct effects on individual-level psychological empowerment and organizational commitment. Psychological empowerment mediated the relationship between core self-evaluations and organizational commitment at the individual level of analysis. The contextual effects of positive supervisor relationships and their influence on empowering working conditions at the unit level and, subsequently, nurses' organizational commitment highlight the importance of leadership for creating conditions that result in a committed nursing workforce.

An Airline-Based Multilevel Analysis of Airfare Elasticity for Passenger Demand

NASA Technical Reports Server (NTRS)

Castelli, Lorenzo; Ukovich, Walter; Pesenti, Raffaele

2003-01-01

Price elasticity of passenger demand for a specific airline is estimated. The main drivers affecting passenger demand for air transportation are identified. First, an Ordinary Least Squares regression analysis is performed. Then, a multilevel analysis-based methodology to investigate the pattern of variation of price elasticity of demand among the various routes of the airline under study is proposed. The experienced daily passenger demands on each fare-class are grouped for each considered route. 9 routes were studied for the months of February and May in years from 1999 to 2002, and two fare-classes were defined (business and economy). The analysis has revealed that the airfare elasticity of passenger demand significantly varies among the different routes of the airline.

The Role of Individual Correlates and Class Norms in Defending and Passive Bystanding Behavior in Bullying: A Multilevel Analysis

ERIC Educational Resources Information Center

Pozzoli, Tiziana; Gini, Gianluca; Vieno, Alessio

2012-01-01

This study investigates possible individual and class correlates of defending and passive bystanding behavior in bullying, in a sample of 1,825 Italian primary school (mean age = 10 years 1 month) and middle school (mean age = 13 years 2 months) students. The findings of a series of multilevel regression models show that both individual (e.g.,…

Individual, Social, and Environmental Correlates of Healthy and Unhealthy Eating

ERIC Educational Resources Information Center

Trapp, Georgina S. A.; Hickling, Siobhan; Christian, Hayley E.; Bull, Fiona; Timperio, Anna F.; Boruff, Bryan; Shrestha, Damber; Giles-Corti, Billie

2015-01-01

Background: Few studies use comprehensive ecological approaches considering multilevel factors to understand correlates of healthy (and unhealthy) dietary intake. The aim of this study was to examine the association between individual, social, and environmental factors on composite measures of healthy and unhealthy dietary intake in adults.…

Regional variations in mortality rates in England and Wales: an analysis using multi-level modelling.

PubMed

Langford, I H; Bentham, G

1996-03-01

Mortality rates in England and Wales display a persistent regional pattern indicating generally poorer health in the North and West. Some of this is simply a reflection of regional differences in the extent of social deprivation which is known to exert a profound influence on health. Part of the pattern may also be the result of regional differences in urbanization which also affect mortality rates. However, there may be important regional differences over and above these compositional effects. This study attempts to establish the magnitude of such independent regional differences in mortality rates by using the techniques of multi-level modelling. Standardized mortality rates (SMRs) for males and females under 65 for 1989-91 in local authority districts are grouped into categories using the ACORN classification scheme. The Townsend Index is included as a measure of social deprivation. Using a cross-classified multi-level model, it is shown that region accounts for approximately four times more variation in SMRs than is explained by the ACORN classification. Analysis of diagnostic residuals show a clear North-South divide in excess mortality when both regional and socio-economic classification of districts are modelled simultaneously, a possibility allowed for by the use of a multi-level model.

Predictors of health-promoting behaviors in children from low-income families: An ecological approach.

PubMed

Park, Jiyoung

2018-03-01

In this study, we investigated the ecological factors that influence health-promoting behaviors in children from low-income families in South Korea using a descriptive correlational design. The participants included 297 elementary school students who used community childcare centers, 297 caregivers, and 68 teachers at the centers. Data were collected using a structured self-report survey, and were subjected to a multi-level regression analysis. The factors influencing the health-promoting behaviors of children were as follows: self-efficacy and self-regulation as intrapersonal factors; caregivers' parenting behavior and peer relationships as interpersonal factors; and the number of months since the centers' establishment, teachers workloads, and centers' perceived environments as institutional factors. The findings emphasize the need to create a healthy environment to promote the health of children from vulnerable groups, and that community-based participatory research might be an effective strategy to address these environmental problems, and ultimately help reduce health disparities between children. © 2018 John Wiley & Sons Australia, Ltd.

Passive Suicide Ideation Among Older Adults in Europe: A Multilevel Regression Analysis of Individual and Societal Determinants in 12 Countries (SHARE).

PubMed

Stolz, Erwin; Fux, Beat; Mayerl, Hannes; Rásky, Éva; Freidl, Wolfgang

2016-09-01

Passive suicide ideation (PSI) is common among older adults, but prevalences have been reported to vary considerably across European countries. The goal of this study was to assess the role of individual-level risk factors and societal contextual factors associated with PSI in old age. We analyzed longitudinal data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) on 6,791 community-dwelling respondents (75+) from 12 countries. Bayesian logistic multilevel regression models were used to assess variance components, individual-level and country-level risk factors. About 4% of the total variance of PSI was located at the country level, a third of which was attributable to compositional effects of individual-level predictors. Predictors for the development of PSI at the individual level were female gender, depression, older age, poor health, smaller social network size, loneliness, nonreligiosity, and low perceived control (R (2) = 25.8%). At the country level, cultural acceptance of suicide, religiosity, and intergenerational cohabitation were associated with the rates of PSI. Cross-national variation in old-age PSI is mostly attributable to individual-level determinants and compositional differences, but there is also evidence for contextual effects of country-level characteristics. Suicide prevention programs should be intensified in high-risk countries and attitudes toward suicide should be addressed in information campaigns. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Increasing Rates of Surgical Management of Multilevel Spinal Curvature in Elderly Patients.

PubMed

Sing, David C; Khanna, Ryan; Shaw, Jeremy D; Metz, Lionel N; Burch, Shane; Berven, Sigurd H

2016-09-01

Retrospective analysis of Nationwide Inpatient Sample (NIS) database. To analyze trends in utilization and hospital charges for multilevel spinal curvature surgery in patients over 60 from 2004 to 2011. Multilevel spinal curvature has been increasingly recognized as a major source of morbidity in patients over sixty years of age. The economic burden of non-operative management for spinal curvature is elusive and likely underestimated. Though patient reported outcomes suggest that surgical treatment of spinal curvature may be superior to non-operative treatment in selected patients, surgical utilization trends remain unclear. Data were obtained from the NIS between 2004 and 2011. The NIS is the largest all-payer inpatient care database with approximately eight million annual patient discharges throughout the United States. Analysis included patients over age 60 with a spinal curvature diagnosis treated with a multi-level spinal fusion (≥3 levels fused) determined by ICD-9-CM diagnosis and procedure codes. Population-based utilization rates were calculated from US census data. A total of 84,302 adult patients underwent multilevel spinal curvature surgery from 2004 to 2011. The annual number of ≥3 level spinal curvature fusions in patients over age 60 increased from 6,571 to 16,526, representing a 107.8% increase from 13.4 cases per 100,000 people in 2004 to 27.9 in 2011 (p < .001). Utilization rates in patients 65-69 years old experienced the greatest growth, increasing by 122% from 15.8 cases per 100,000 people to 35.1. Average hospital charges increased 108% from $90,557 in 2007 to $188,727 in 2011 (p < .001). Rates of surgical management of multilevel spinal curvature increased from 2004 to 2011, exceeding growth of the 60+ age demographic during the same period. Growth was observed in all age demographics, and hospital charges consistently increased from 2004 to 2011 reflecting a per-user increase in expenditure. III. Copyright © 2016 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Toxoplasma gondii in sheep and goats: seroprevalence and potential risk factors under dairy husbandry practices.

PubMed

Tzanidakis, Nikolaos; Maksimov, Pavlo; Conraths, Franz J; Kiossis, Evaggelos; Brozos, Christos; Sotiraki, Smaragda; Schares, Gereon

2012-12-21

Sheep and goats are highly susceptible for infections with Toxoplasma gondii and may play a major role in the transmission of toxoplasmosis to humans. The aim of this study was to obtain up-to-date data on T. gondii infection in small ruminants and to identify putative risk factors in sheep and goats reared under dairy husbandry systems most commonly applied in Greece. To this end, ELISA tests were established for the examination of sheep and goat sera based on the use of TgSAG1, a major surface antigen of T. gondii tachyzoites. Serum samples from 2-4 years old small ruminants, 1501 from sheep and 541 from goats were examined. These samples had been collected on 69 farms in a mountainous and in a costal environment of Northern Greece from September 2008 to January 2009. In addition to farms containing only sheep (n=28) and farms containing only goats (n=9) also mixed farms with both animal species (n=32) were sampled. A standardized questionnaire was used to obtain information on putative risk factors. Sheep showed a higher seroprevalence (48.6% [729/1501]) for T. gondii than goats (30.7% [166/541]). Univariate multi-level modelling assuming random effects by the factor "farm" revealed that goats were statistically significantly less often seropositive than sheep (OR 0.475 [95% CI: 0.318-0.707]). No statistically significant regional differences in seroprevalence were observed. Risk factor analysis using univariate multi-level modelling revealed that sheep and goats that were kept under intensive (OR 4.30 [95% CI: 1.39-13.27]) or semi-intensive (OR 5.35 [95% CI: 2.33-12.28]) conditions had significantly higher odds of being seropositive. Further significant risk factors were "feeding concentrate" (OR 3.88 [95% CI: 1.81-8.29]) and providing "water from the public supply" (OR 1.67 [95% CI: 4.56-12.39]) to small ruminants. Copyright © 2012 Elsevier B.V. All rights reserved.

Quantifying and Adjusting for Disease Misclassification Due to Loss to Follow-Up in Historical Cohort Mortality Studies.

PubMed

Scott, Laura L F; Maldonado, George

2015-10-15

The purpose of this analysis was to quantify and adjust for disease misclassification from loss to follow-up in a historical cohort mortality study of workers where exposure was categorized as a multi-level variable. Disease classification parameters were defined using 2008 mortality data for the New Zealand population and the proportions of known deaths observed for the cohort. The probability distributions for each classification parameter were constructed to account for potential differences in mortality due to exposure status, gender, and ethnicity. Probabilistic uncertainty analysis (bias analysis), which uses Monte Carlo techniques, was then used to sample each parameter distribution 50,000 times, calculating adjusted odds ratios (ORDM-LTF) that compared the mortality of workers with the highest cumulative exposure to those that were considered never-exposed. The geometric mean ORDM-LTF ranged between 1.65 (certainty interval (CI): 0.50-3.88) and 3.33 (CI: 1.21-10.48), and the geometric mean of the disease-misclassification error factor (εDM-LTF), which is the ratio of the observed odds ratio to the adjusted odds ratio, had a range of 0.91 (CI: 0.29-2.52) to 1.85 (CI: 0.78-6.07). Only when workers in the highest exposure category were more likely than those never-exposed to be misclassified as non-cases did the ORDM-LTF frequency distributions shift further away from the null. The application of uncertainty analysis to historical cohort mortality studies with multi-level exposures can provide valuable insight into the magnitude and direction of study error resulting from losses to follow-up.

Identifying factors associated with the uptake of prevention of mother to child HIV transmission programme in Tigray region, Ethiopia: a multilevel modeling approach.

PubMed

Lerebo, Wondwossen; Callens, Steven; Jackson, Debra; Zarowsky, Christina; Temmerman, Marleen

2014-04-23

Prevention of mother to child HIV transmission (PMTCT) remains a challenge in low and middle-income countries. Determinants of utilization occur--and often interact--at both individual and community levels, but most studies do not address how determinants interact across levels. Multilevel models allow for the importance of both groups and individuals in understanding health outcomes and provide one way to link the traditionally distinct ecological- and individual-level studies. This study examined individual and community level determinants of mother and child receiving PMTCT services in Tigray region, Ethiopia. A multistage probability sampling method was used for this 2011 cross-sectional study of 220 HIV positive post-partum women attending child immunization services at 50 health facilities in 46 districts. In view of the nested nature of the data, we used multilevel modeling methods and assessed macro level random effects. Seventy nine percent of mothers and 55.7% of their children had received PMTCT services. Multivariate multilevel modeling found that mothers who delivered at a health facility were 18 times (AOR = 18.21; 95% CI 4.37,75.91) and children born at a health facility were 5 times (AOR = 4.77; 95% CI 1.21,18.83) more likely to receive PMTCT services, compared to mothers delivering at home. For every addition of one nurse per 1500 people, the likelihood of getting PMTCT services for a mother increases by 7.22 fold (AOR = 7.22; 95% CI 1.02,51.26), when other individual and community level factors were controlled simultaneously. In addition, district-level variation was low for mothers receiving PMTCT services (0.6% between districts) but higher for children (27.2% variation between districts). This study, using a multilevel modeling approach, was able to identify factors operating at both individual and community levels that affect mothers and children getting PMTCT services. This may allow differentiating and accentuating approaches for different settings in Ethiopia. Increasing health facility delivery and HCT coverage could increase mother-child pairs who are getting PMTCT. Reducing the distance to health facility and increasing the number of nurses and laboratory technicians are also important variables to be considered by the government.

Multilevel Factor Structure, Concurrent Validity, and Test-Retest Reliability of the High School Teacher Version of the Authoritative School Climate Survey

ERIC Educational Resources Information Center

Huang, Francis L.; Cornell, Dewey G.

2016-01-01

Although school climate has long been recognized as an important factor in the school improvement process, there are few psychometrically supported measures based on teacher perspectives. The current study replicated and extended the factor structure, concurrent validity, and test-retest reliability of the teacher version of the Authoritative…

Preferences for the sex-composition of children in Europe: a multilevel examination of its effect on progression to a third child.

PubMed

Mills, Melinda; Begall, Katia

2010-03-01

Comparative research on the preferred sex of children in Western societies has generally focused on women only and ignored the role of gender equity and the need for children's economic support in old age. A multilevel analysis extends existing research by examining, for both men and women and across 24 European countries, the effect of the preferred sex-composition of offspring on whether parents have or intend to have a third child. Using the European Social Survey (2004/5), a multilevel (random coefficient) ordered logit regression of that intention (N = 3,323) and a binary logistic multilevel model of the transition to a third child (N = 6,502) demonstrate the presence of a mixed-sex preference. In countries with a high risk of poverty in old age, a preference for sons is found, particularly for men. In societies where there is lower gender equity, both men and women have a significant preference for boys.

Association of workplace and population characteristics with prevalence of hypertension among Brazilian industry workers: a multilevel analysis

PubMed Central

Vinholes, Daniele B; Bassanesi, Sérgio L; Chaves Junior, Hilton de Castro; Machado, Carlos Alberto; Melo, Ione M F; Fuchs, Flavio Danni

2017-01-01

Background Exposure to risk factors for hypertension may be influenced by the characteristics of the workplace, where workers spend most of their daily time. Objectives To evaluate the association between features of the companies, particularly the presence of facilities to provide meals, and of population characteristics and the prevalence of hypertension, taking into account individual risk factors for hypertension. Material and methods This multilevel analysis was based on a cross-sectional study with individual and company data from the SESI (Serviço Social da Indústria–Social Service of Industries) study and population-based data from the national census statistics. Workers aged ≥15 years were randomly selected from small (20–99), medium (100–499) and large (≥500 employees) companies per state using multistage sampling. Logistic regression was used to analyse the association between hypertension and individual, workplace and population variables, with odds ratios (ORs; 95% CI) adjusted for three-level variables. Results 4818 Workers from 157 companies were interviewed and their blood pressure, weight and height were measured. Overall, 77% were men, aged 35.4 ±10.7 years, with 8.7 ±4.1 years of schooling and mostly worked in companies with a staff canteen (66%). Besides individual characteristics—being male, ageing, low schooling, alcohol abuse and higher BMI—a workplace with no staff canteen (OR=1.28; 95% CI 1.08 to 1.52), small companies (OR=1.31; 95% CI 1.07 to 1.60) and living in cities with higher economic inequality (OR=1.47; 95% CI 1.23 to 1.76) were associated with a higher risk for hypertension. Conclusion Among Brazilian workers, the prevalence of hypertension is associated with individual risk factors, lack of a canteen at the workplace, small companies and higher economic inequalities of cities. These three-level characteristics help to interpret differences in the prevalence of hypertension between regions or countries. PMID:28827245

Factors affecting utilization of skilled maternal care in Northwest Ethiopia: a multilevel analysis.

PubMed

Worku, Abebaw Gebeyehu; Yalew, Alemayehu Worku; Afework, Mesganaw Fantahun

2013-04-15

The evaluation of all potential sources of low skilled maternal care utilization is crucial for Ethiopia. Previous studies have largely disregarded the contribution of different levels. This study was planned to assess the effect of individual, communal, and health facility characteristics in the utilization of antenatal, delivery, and postnatal care by a skilled provider. A linked facility and population-based survey was conducted over three months (January - March 2012) in twelve "kebeles" of North Gondar Zone, Amhara Region. A total of 1668 women who had births in the year preceding the survey were selected for analysis. Using a multilevel modelling, we examined the effect of cluster variation and a number of individual, communal (kebele), and facility-related variables for skilled maternal care utilization. About 32.3%, 13.8% and 6.3% of the women had the chance to get skilled providers for their antenatal, delivery and postnatal care, respectively. A significant heterogeneity was observed among clusters for each indicator of skilled maternal care utilization. At the individual level, variables related to awareness and perceptions were found to be much more relevant for skilled maternal service utilization. Preference for skilled providers and previous experience of antenatal care were consistently strong predictors of all indicators of skilled maternal health care utilizations. Birth order, maternal education, and awareness about health facilities to get skilled professionals were consistently strong predictors of skilled antenatal and delivery care use. Communal factors were relevant for both delivery and postnatal care, whereas the characteristics of a health facility were more relevant for use of skilled delivery care than other maternity services. Factors operating at individual and "kebele" levels play a significant role in determining utilization of skilled maternal health services. Interventions to create better community awareness and perception about skilled providers and their care, and ensuring the seamless performance of health care facilities have been considered crucial to improve skilled maternal services in the study area. Such interventions should target underprivileged women.

The health literate health care organization 10 item questionnaire (HLHO-10): development and validation.

PubMed

Kowalski, Christoph; Lee, Shoou-Yih D; Schmidt, Anna; Wesselmann, Simone; Wirtz, Markus A; Pfaff, Holger; Ernstmann, Nicole

2015-02-01

While research on individual health literacy is steadily increasing, less attention has been paid to the context of care that may help to increase the patient's ability to navigate health care or to compensate for their limited health literacy. In 2012, Brach et al. introduced the concept of health literate health care organizations (HLHOs) to describe the organizational context of care. This paper presents our effort in developing and validating an HLHO instrument. Ten items were developed to represent the ten attributes of HLHO (HLHO-10) based on a literature review, an expert workshop, a focus group discussion, and qualitative interviews. The instrument was applied in a key informant survey in 51 German hospitals as part of a larger study on patient information and training needs (PIAT-study). Item properties were analyzed and a confirmatory factor analysis (CFA) was conducted to test the instrument's unidimensionality. To investigate the instrument's predictive validity, a multilevel analysis was performed that used the HLHO-10 score to predict the adequacy of information provided to 1,224 newly-diagnosed breast cancer patients treated at the sample hospitals. Cronbach's α of the resulting scale was 0.89. CFA verified the one-factor structure after allowing for the correlation for four pairs of error terms. In the multilevel model, HLHO-10 significantly predicted the adequacy of information as perceived by patients. The instrument has satisfactory reliability and validity. It provides a useful tool to assess the degree to which health care organizations help patients to navigate, understand, and use information and services. Further validation should include participant observation in health care organizations and a sample that is not limited to breast cancer care.

The role of individual, community and societal gender inequality in forming women's attitudes toward intimate-partner violence against women: a multilevel analysis.

PubMed

Uthman, Olalekan A; Lawoko, Stephen; Moradi, Tahereh

2010-01-01

Establishing risk factors for intimate partner violence against women (IPVAW) is crucial for addressing women's health and development. Acceptance of IPVAW has been suggested as one of the strongest predictors of IPVAWs. The aim of this study was to examine the independent contributions of individual, community, and societal measures of gender inequality in forming women's attitudes toward IPVAW. We applied multivariable multilevel logistic regression analysis to Demographic and Health Survey data for 120,467 women nested within 7463 communities from 17 countries in sub-Saharan Africa. We found that women whose husband had higher education (odds ratio [OR] =1.06; 95% confidence interval [CI] 1.02 to 1.10) and women whose husband had more than one wife (OR=1.14; 95% CI 1.09 to 1.19) were more likely to accept IPVAW than other women. Unemployed women with an unemployed partner were more likely to justify IPVAW than employed women with working partners (OR=1.32; 95% CI 1.08 to 1.61). Both community and societal measures of gender inequality were associated with women's attitudes toward IPVAW, even after controlling for gender inequality at the individual level. There was evidence of clustering of women's attitudes within communities and within countries. We provide evidence that community and societal forms of gender inequality influence women's attitudes toward IPVAW beyond individual factors. Choices women make are important, but community and society also impose restraints on women's attitudes toward IPVAW. Thus, policies and programs aimed at reducing or eliminating IPVAW must address people, the communities and societies in which they live in order to be successful.

Common mental disorders, neighbourhood income inequality and income deprivation: small-area multilevel analysis

PubMed Central

Fone, David; Greene, Giles; Farewell, Daniel; White, James; Kelly, Mark; Dunstan, Frank

2013-01-01

Background Common mental disorders are more prevalent in areas of high neighbourhood socioeconomic deprivation but whether the prevalence varies with neighbourhood income inequality is not known. Aims To investigate the hypothesis that the interaction between small-area income deprivation and income inequality was associated with individual mental health. Method Multilevel analysis of population data from the Welsh Health Survey, 2003/04–2010. A total of 88 623 respondents aged 18–74 years were nested within 50 587 households within 1887 lower super output areas (neighbourhoods) and 22 unitary authorities (regions), linked to the Gini coefficient (income inequality) and the per cent of households living in poverty (income deprivation). Mental health was measured using the Mental Health Inventory MHI-5 as a discrete variable and as a ‘case’ of common mental disorder. Results High neighbourhood income inequality was associated with better mental health in low-deprivation neighbourhoods after adjusting for individual and household risk factors (parameter estimate +0.70 (s.e. = 0.33), P = 0.036; odds ratio (OR) for common mental disorder case 0.92, 95% CI 0.88–0.97). Income inequality at regional level was significantly associated with poorer mental health (parameter estimate -1.35 (s.e. = 0.54), P = 0.012; OR = 1.13, 95% CI 1.04–1.22). Conclusions The associations between common mental disorders, income inequality and income deprivation are complex. Income inequality at neighbourhood level is less important than income deprivation as a risk factor for common mental disorders. The adverse effect of income inequality starts to operate at the larger regional level. PMID:23470284

Association between adolescent suicide and sociodemographic factors in Chile: cross-sectional ecological study.

PubMed

Cuadrado, Cristóbal; Zitko, Pedro; Covarrubias, Trinidad; Hernandez, Dunia; Sade, Cristina; Klein, Carolina; Gomez, Alejandro

2015-01-01

Adolescent suicide rates (ASR) are a matter of concern worldwide. Causes of this trend are not understood and could correspond to socioeconomic factors such as inequality. To investigate sociodemographic variables related to ASR, particularly the potential association with indicators of socioeconomic inequality. Cross-sectional ecological study analyzing data from 29 health districts with univariate and multivariable multilevel Poisson models. ASR were higher in male adolescents and at increasing age. No association was found between ASR and inequality (Gini coefficient and 20/20 ratio). Analysis revealed that living in a single-parent family is associated with ASR. The usual demographic patterns of adolescent suicide apply in Chile. An emerging variable of interest is single-parent family. No cross-sectional association between social inequality and ASR was found based on conflicting evidence. These results should be explored in future prospective population studies to further understand associated social factors.

Food beliefs and practices during pregnancy in Ghana: implications for maternal health interventions.

PubMed

de-Graft Aikins, Ama

2014-01-01

Ghanaian women's food beliefs and practices during pregnancy and the scope for developing more effective maternal health interventions were explored in this study. Thirty-five multiethnic Ghanaian women between the ages of 29 and 75 were interviewed about pregnancy food beliefs and practices. I show that, based on the data analysis, their knowledge about food was drawn from lifeworlds (family and friends), educational settings, health professionals, mass media, and body-self knowledge (unique pregnancy experiences). Core lay ideas converged with expert knowledge on maternal health nutrition. Multiple external factors (e.g., economics, cultural representations of motherhood) and internal factors (e.g., the unpredictable demands of the pregnant body) influenced pregnancy food practices. I suggest and discuss a need for culturally situated multilevel interventions.

Theoretical and software considerations for general dynamic analysis using multilevel substructured models

NASA Technical Reports Server (NTRS)

Schmidt, R. J.; Dodds, R. H., Jr.

1985-01-01

The dynamic analysis of complex structural systems using the finite element method and multilevel substructured models is presented. The fixed-interface method is selected for substructure reduction because of its efficiency, accuracy, and adaptability to restart and reanalysis. This method is extended to reduction of substructures which are themselves composed of reduced substructures. The implementation and performance of the method in a general purpose software system is emphasized. Solution algorithms consistent with the chosen data structures are presented. It is demonstrated that successful finite element software requires the use of software executives to supplement the algorithmic language. The complexity of the implementation of restart and reanalysis porcedures illustrates the need for executive systems to support the noncomputational aspects of the software. It is shown that significant computational efficiencies can be achieved through proper use of substructuring and reduction technbiques without sacrificing solution accuracy. The restart and reanalysis capabilities and the flexible procedures for multilevel substructured modeling gives economical yet accurate analyses of complex structural systems.

The Association of Workplace Social Capital With Work Engagement of Employees in Health Care Settings: A Multilevel Cross-Sectional Analysis.

PubMed

Fujita, Sumiko; Kawakami, Norito; Ando, Emiko; Inoue, Akiomi; Tsuno, Kanami; Kurioka, Sumiko; Kawachi, Ichiro

2016-03-01

The aim of the study was to examine the cross-sectional multilevel association between unit-level workplace social capital and individual-level work engagement among employees in health care settings. The data were collected from employees of a Japanese health care corporation using a questionnaire. The analyses were limited to 440 respondents from 35 units comprising five or more respondents per unit. Unit-level workplace social capital was calculated as an average score of the Workplace Social Capital Scale for each unit. Multilevel regression analysis with a random intercept model was conducted. After adjusting for demographic variables, unit-level workplace social capital was significantly and positively associated with respondents' work engagement (P < 0.001). The association remained significant after additionally adjusting for individual-level perceptions of workplace social capital (P < 0.001). Workplace social capital might exert a positive contextual effect on work engagement of employees in health care settings.

Individual and contextual socioeconomic determinants of knowledge of the ABC approach of preventing the sexual transmission of HIV in Nigeria: a multilevel analysis.

PubMed

Uthman, Olalekan A; Kayode, Gbenga A; Adekanmbi, Victor T

2013-12-01

Nigeria has the highest number of people living with HIV/AIDS in the world after India and South Africa. HIV/AIDS places a considerable burden on society's resources, and its prevention is a cost-beneficial solution to address these consequences. To the best of our knowledge, there has been no multilevel study performed to date that examined the separate and independent associations of individual and community socioeconomic status (SES) with HIV prevention knowledge in Nigeria. Multilevel linear regression models were applied to the 2008 Nigeria Demographic and Health Survey on 48871 respondents (Level 1) nested within 886 communities (Level 2) from 37 districts (Level 3). Approximately one-fifth (20%) of respondents were not aware of any of the Abstinence, Being faithful and Condom use (ABC) approach of preventing the sexual transmission of HIV. However, the likelihood of being aware of the ABC approach of preventing the sexual transmission of HIV increased with older age, male gender, greater education attainment, a higher wealth index, living in an urban area and being from least socioeconomically disadvantaged communities. There were significant community and district variations in respondents' knowledge of the ABC approach of preventing the sexual transmission of HIV. The present study provides evidence that both individual- and community-level SES factors are important predictors of knowledge of the ABC approach of preventing the sexual transmission of HIV in Nigeria. The findings underscore the need to implement public health prevention strategies not only at the individual level, but also at the community level.

Cost-utility analysis of minimally invasive versus open multilevel hemilaminectomy for lumbar stenosis.

PubMed

Parker, Scott L; Adogwa, Owoicho; Davis, Brandon J; Fulchiero, Erin; Aaronson, Oran; Cheng, Joseph; Devin, Clinton J; McGirt, Matthew J

2013-02-01

Two-year cost-utility study comparing minimally invasive (MIS) versus open multilevel hemilaminectomy in patients with degenerative lumbar spinal stenosis. The objective of the study was to determine whether MIS versus open multilevel hemilaminectomy for degenerative lumbar spinal stenosis is a cost-effective advancement in lumbar decompression surgery. MIS-multilevel hemilaminectomy for degenerative lumbar spinal stenosis allows for effective treatment of back and leg pain while theoretically minimizing blood loss, tissue injury, and postoperative recovery. No studies have evaluated comprehensive healthcare costs associated with multilevel hemilaminectomy procedures, nor assessed cost-effectiveness of MIS versus open multilevel hemilaminectomy. Fifty-four consecutive patients with lumbar stenosis undergoing multilevel hemilaminectomy through an MIS paramedian tubular approach (n=27) versus midline open approach (n=27) were included. Total back-related medical resource utilization, missed work, and health state values [quality adjusted life years (QALYs), calculated from EuroQuol-5D with US valuation] were assessed after 2-year follow-up. Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts (direct cost) and work-day losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Difference in mean total cost per QALY gained for MIS versus open hemilaminectomy was assessed as incremental cost-effectiveness ratio (ICER: COST(MIS)-COST(OPEN)/QALY(MIS)-QALY(OPEN)). MIS versus open cohorts were similar at baseline. MIS and open hemilaminectomy were associated with an equivalent cumulative gain of 0.72 QALYs 2 years after surgery. Mean direct medical costs, indirect societal costs, and total 2-year cost ($23,109 vs. $25,420; P=0.21) were similar between MIS and open hemilaminectomy. MIS versus open approach was associated with similar total costs and utility, making it a cost equivalent technology compared with the traditional open approach. MIS versus open multilevel hemilaminectomy was associated with similar cost over 2 years while providing equivalent improvement in QALYs. In our experience, MIS versus open multilevel hemilaminectomy is a cost equivalent technology for patients with lumbar stenosis-associated radicular pain.

Estimating trajectories of energy intake through childhood and adolescence using linear-spline multilevel models.

PubMed

Anderson, Emma L; Tilling, Kate; Fraser, Abigail; Macdonald-Wallis, Corrie; Emmett, Pauline; Cribb, Victoria; Northstone, Kate; Lawlor, Debbie A; Howe, Laura D

2013-07-01

Methods for the assessment of changes in dietary intake across the life course are underdeveloped. We demonstrate the use of linear-spline multilevel models to summarize energy-intake trajectories through childhood and adolescence and their application as exposures, outcomes, or mediators. The Avon Longitudinal Study of Parents and Children assessed children's dietary intake several times between ages 3 and 13 years, using both food frequency questionnaires (FFQs) and 3-day food diaries. We estimated energy-intake trajectories for 12,032 children using linear-spline multilevel models. We then assessed the associations of these trajectories with maternal body mass index (BMI), and later offspring BMI, and also their role in mediating the relation between maternal and offspring BMIs. Models estimated average and individual energy intake at 3 years, and linear changes in energy intake from age 3 to 7 years and from age 7 to 13 years. By including the exposure (in this example, maternal BMI) in the multilevel model, we were able to estimate the average energy-intake trajectories across levels of the exposure. When energy-intake trajectories are the exposure for a later outcome (in this case offspring BMI) or a mediator (between maternal and offspring BMI), results were similar, whether using a two-step process (exporting individual-level intercepts and slopes from multilevel models and using these in linear regression/path analysis), or a single-step process (multivariate multilevel models). Trajectories were similar when FFQs and food diaries were assessed either separately, or when combined into one model. Linear-spline multilevel models provide useful summaries of trajectories of dietary intake that can be used as an exposure, outcome, or mediator.

The effects of autonomy and empowerment on employee turnover: test of a multilevel model in teams.

PubMed

Liu, Dong; Zhang, Shu; Wang, Lei; Lee, Thomas W

2011-11-01

Extending research on voluntary turnover in the team setting, this study adopts a multilevel self-determination theoretical approach to examine the unique roles of individual and social-contextual motivational precursors, autonomy orientation and autonomy support, in reducing team member voluntary turnover. Analysis of multilevel time-lagged data collected from 817 employees on 115 teams indicates that psychological empowerment mediates the main effect of autonomy orientation and the interactive effect of autonomy support and its differentiation on a team member's voluntary turnover. The findings have meaningful implications for the turnover and self-determination literatures as well as for managers who endeavor to prevent voluntary turnover in teams. (c) 2011 APA, all rights reserved.

Robust Mediation Analysis Based on Median Regression

PubMed Central

Yuan, Ying; MacKinnon, David P.

2014-01-01

Mediation analysis has many applications in psychology and the social sciences. The most prevalent methods typically assume that the error distribution is normal and homoscedastic. However, this assumption may rarely be met in practice, which can affect the validity of the mediation analysis. To address this problem, we propose robust mediation analysis based on median regression. Our approach is robust to various departures from the assumption of homoscedasticity and normality, including heavy-tailed, skewed, contaminated, and heteroscedastic distributions. Simulation studies show that under these circumstances, the proposed method is more efficient and powerful than standard mediation analysis. We further extend the proposed robust method to multilevel mediation analysis, and demonstrate through simulation studies that the new approach outperforms the standard multilevel mediation analysis. We illustrate the proposed method using data from a program designed to increase reemployment and enhance mental health of job seekers. PMID:24079925

A social ecology of rectal microbicide acceptability among young men who have sex with men and transgender women in Thailand

PubMed Central

Newman, Peter A; Roungprakhon, Surachet; Tepjan, Suchon

2013-01-01

Introduction With HIV-incidence among men who have sex with men (MSM) in Bangkok among the highest in the world, a topical rectal microbicide would be a tremendous asset to prevention. Nevertheless, ubiquitous gaps between clinical trial efficacy and real-world effectiveness of existing HIV preventive interventions highlight the need to address multi-level factors that may impact on rectal microbicide implementation. We explored the social ecology of rectal microbicide acceptability among MSM and transgender women in Chiang Mai and Pattaya, Thailand. Methods We used a qualitative approach guided by a social ecological model. Five focus groups were conducted in Thai using a semi-structured interview guide. All interviews were digitally recorded, transcribed verbatim in Thai and translated into English. We conducted thematic analysis using line-by-line and axial coding and a constant comparative method. Transcripts and codes were uploaded into a customized database programmed in Microsoft Access. We then used content analysis to calculate theme frequencies by group, and Chi-square tests and Fisher's exact test to compare themes by sexual orientation/gender expression and age. Results Participant's (n=37) mean age was 24.8 years (SD=4.2). The majority (70.3%) self-identified as gay, 24.3% transgender women. Product-level themes (side effects, formulation, efficacy, scent, etc.) accounted for 42%, individual (increased sexual risk, packaging/portability, timing/duration of protection) 29%, interpersonal (trust/communication, power/negotiation, stealth) 8% and social–structural (cost, access, community influence, stigma) 21% of total codes, with significant differences by sexual orientation/gender identity. The intersections of multi-level influences included product formulation and timing of use preferences contingent on interpersonal communication and partner type, in the context of constraints posed by stigma, venues for access and cost. Discussion The intersecting influence of multi-level factors on rectal microbicide acceptability suggests that social–structural interventions to ensure widespread access, low cost and to mitigate stigma and discrimination against gay and other MSM and transgender women in the Thai health care system and broader society will support the effectiveness of rectal microbicides, in combination with other prevention technologies, in reducing HIV transmission. Education, outreach and small-group interventions that acknowledge differences between MSM and transgender women may support rectal microbicide implementation among most-at-risk populations in Thailand. PMID:23911116

A social ecology of rectal microbicide acceptability among young men who have sex with men and transgender women in Thailand.

PubMed

Newman, Peter A; Roungprakhon, Surachet; Tepjan, Suchon

2013-08-01

With HIV-incidence among men who have sex with men (MSM) in Bangkok among the highest in the world, a topical rectal microbicide would be a tremendous asset to prevention. Nevertheless, ubiquitous gaps between clinical trial efficacy and real-world effectiveness of existing HIV preventive interventions highlight the need to address multi-level factors that may impact on rectal microbicide implementation. We explored the social ecology of rectal microbicide acceptability among MSM and transgender women in Chiang Mai and Pattaya, Thailand. We used a qualitative approach guided by a social ecological model. Five focus groups were conducted in Thai using a semi-structured interview guide. All interviews were digitally recorded, transcribed verbatim in Thai and translated into English. We conducted thematic analysis using line-by-line and axial coding and a constant comparative method. Transcripts and codes were uploaded into a customized database programmed in Microsoft Access. We then used content analysis to calculate theme frequencies by group, and Chi-square tests and Fisher's exact test to compare themes by sexual orientation/gender expression and age. Participant's (n=37) mean age was 24.8 years (SD=4.2). The majority (70.3%) self-identified as gay, 24.3% transgender women. Product-level themes (side effects, formulation, efficacy, scent, etc.) accounted for 42%, individual (increased sexual risk, packaging/portability, timing/duration of protection) 29%, interpersonal (trust/communication, power/negotiation, stealth) 8% and social-structural (cost, access, community influence, stigma) 21% of total codes, with significant differences by sexual orientation/gender identity. The intersections of multi-level influences included product formulation and timing of use preferences contingent on interpersonal communication and partner type, in the context of constraints posed by stigma, venues for access and cost. The intersecting influence of multi-level factors on rectal microbicide acceptability suggests that social-structural interventions to ensure widespread access, low cost and to mitigate stigma and discrimination against gay and other MSM and transgender women in the Thai health care system and broader society will support the effectiveness of rectal microbicides, in combination with other prevention technologies, in reducing HIV transmission. Education, outreach and small-group interventions that acknowledge differences between MSM and transgender women may support rectal microbicide implementation among most-at-risk populations in Thailand.

Societal characteristics and health in the former communist countries of Central and Eastern Europe and the former Soviet Union: a multilevel analysis.

PubMed

Bobak, Martin; Murphy, Mike; Rose, Richard; Marmot, Michael

2007-11-01

To examine whether, in former communist countries that have undergone profound social and economic transformation, health status is associated with income inequality and other societal characteristics, and whether this represents something more than the association of health status with individual socioeconomic circumstances. Multilevel analysis of cross-sectional data. 13 Countries from Central and Eastern Europe and the former Soviet Union. Population samples aged 18+ years (a total of 15 331 respondents). Poor self-rated health. There were marked differences among participating countries in rates of poor health (a greater than twofold difference between the countries with the highest and lowest rates of poor health), gross domestic product per capita adjusted for purchasing power parity (a greater than threefold difference), the Gini coefficient of income inequality (twofold difference), corruption index (twofold difference) and homicide rates (20-fold difference). Ecologically, the age- and sex-standardised prevalence of poor self-rated health correlated strongly with life expectancy at age 15 (r = -0.73). In multilevel analyses, societal (country-level) measures of income inequality were not associated with poor health. Corruption and gross domestic product per capita were associated with poor health after controlling for individuals' socioeconomic circumstances (education, household income, marital status and ownership of household items); the odds ratios were 1.15 (95% confidence interval 1.03 to 1.29) per 1 unit (on a 10-point scale) increase in the corruption index and 0.79 (95% confidence interval 0.68 to 0.93) per $5000 increase in gross domestic product per capita. The effects of gross domestic product and corruption were virtually identical in people whose household income was below and above the median. Societal measures of prosperity and corruption, but not income inequalities, were associated with health independently of individual-level socioeconomic characteristics. The finding that these effects were similar in persons with lower and higher income suggests that these factors do not operate exclusively through poverty.

A multilevel analysis of individual and community effect on chronic childhood malnutrition in rural Nigeria.

PubMed

Uthman, Olalekan A

2009-04-01

Protein energy malnutrition is the second most important cause of childhood morbidity and mortality in Nigeria after infections. The purpose of this article was to develop and test a model of childhood malnutrition that includes individual-level characteristics along with contextual characteristics defined at the community level. Multilevel logistic regression analysis. A total of 4007 children resident in 96 rural villages in Nigeria. Stunting: height-for-age that is less than the international reference value by >2 standard deviations (SDs). Independent of other factors, children born to underweight mothers were 1.32-times more likely to be stunted [adjusted odds ratio (aOR) 1.32; 95% confidence interval (CI) 1.07-1.64]. For each additional month of breastfeeding the odds of being stunted increased by 4% (aOR 1.04; 95% CI 1.03-1.06). Each SD increase in the household wealth index and maternal health-seeking behaviour index decreased the odds of being stunted by 16% (aOR 0.84; 95% CI 0.76-0.94) and 29% (aOR 0.71; 95% CI 0.60 -0.82), respectively. The study has provided evidence that both individual and community characteristics are important predictors of childhood malnutrition in rural Nigeria; and that scholars trying to understand variation in childhood malnutrition should pay attention to the characteristics of both children and place of residence.