Using Generalized Additive Models to Analyze Single-Case Designs

ERIC Educational Resources Information Center

Shadish, William; Sullivan, Kristynn

2013-01-01

Many analyses for single-case designs (SCDs)--including nearly all the effect size indicators-- currently assume no trend in the data. Regression and multilevel models allow for trend, but usually test only linear trend and have no principled way of knowing if higher order trends should be represented in the model. This paper shows how Generalized…

Couples at Risk Following the Death of Their Child: Predictors of Grief versus Depression

ERIC Educational Resources Information Center

Wijngaards-de Meij, Leoniek; Stroebe, Margaret; Schut, Henk; Stroebe, Wolfgang; van den Bout, Jan; van der Heijden, Peter; Dijkstra, Iris

2005-01-01

This longitudinal study examined the relative impact of major variables for predicting adjustment (in terms of both grief and depression) among bereaved parents following the death of their child. Couples (N = 219) participated 6, 13, and 20 months postloss. Use of multilevel regression analyses enabled assessment of the impact of several…

Exploring Person Fit with an Approach Based on Multilevel Logistic Regression

ERIC Educational Resources Information Center

Walker, A. Adrienne; Engelhard, George, Jr.

2015-01-01

The idea that test scores may not be valid representations of what students know, can do, and should learn next is well known. Person fit provides an important aspect of validity evidence. Person fit analyses at the individual student level are not typically conducted and person fit information is not communicated to educational stakeholders. In…

Trauma cognitions are related to symptoms up to 10 years after cognitive behavioral treatment for posttraumatic stress disorder.

PubMed

Scher, Christine D; Suvak, Michael K; Resick, Patricia A

2017-11-01

This study examined (a) relationships between trauma-related cognitions and posttraumatic stress disorder (PTSD) symptoms from pretreatment through a long-term period after cognitive-behavioral therapy (CBT) for PTSD and (b) whether these relationships were impacted by treatment type. Participants were 171 women randomized into treatment for PTSD after rape. Measures of self-reported trauma-related cognitions and interviewer-assessed PTSD symptoms (i.e., Posttraumatic Maladaptive Beliefs Scale, Trauma-Related Guilt Inventory, and Clinician-Administered PTSD Scale) were obtained at pretreatment, posttreatment, and 3-month, 9-month, and 5-10 year follow-ups. Multilevel regression analyses were used to examine relationships between trauma-related cognitions and PTSD symptoms throughout the study period and whether these relationships differed as a function of treatment type (i.e., Cognitive Processing Therapy or Prolonged Exposure). Initial multilevel regression analyses that examined mean within-participant associations suggested that beliefs regarding Reliability and Trustworthiness of Others, Self-Worth and Judgment, Threat of Harm, and Guilt were related to PTSD symptoms throughout follow-up. Growth curve modeling suggested that patterns of belief change throughout follow-up were similar to those previously observed in PTSD symptoms over the same time period. Finally, multilevel mediation analyses that incorporated time further suggested that change in beliefs was related to change in symptoms throughout follow-up. With 1 minor exception, relationships between beliefs and symptoms were not moderated by treatment type. These data suggest that trauma-related cognitions are a potential mechanism for long-term maintenance of treatment gains after CBT for PTSD. Moreover, these cognitions may be a common, rather than specific, treatment maintenance mechanism. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Implications of Interactions among Society, Education and Technology: A Comparison of Multiple Linear Regression and Multilevel Modeling in Mathematics Achievement Analyses

ERIC Educational Resources Information Center

Deering, Pamela Rose

2014-01-01

This research compares and contrasts two approaches to predictive analysis of three years' of school district data to investigate relationships between student and teacher characteristics and math achievement as measured by the state-mandated Maryland School Assessment mathematics exam. The sample for the study consisted of 3,514 students taught…

Improvement of the Work Environment and Work-Related Stress: A Cross-Sectional Multilevel Study of a Nationally Representative Sample of Japanese Workers.

PubMed

Watanabe, Kazuhiro; Tabuchi, Takahiro; Kawakami, Norito

2017-03-01

This cross-sectional multilevel study aimed to investigate the relationship between improvement of the work environment and work-related stress in a nationally representative sample in Japan. The study was based on a national survey that randomly sampled 1745 worksites and 17,500 nested employees. The survey asked the worksites whether improvements of the work environment were conducted; and it asked the employees to report the number of work-related stresses they experienced. Multilevel multinominal logistic and linear regression analyses were conducted. Improvement of the work environment was not significantly associated with any level of work-related stress. Among men, it was significantly and negatively associated with the severe level of work-related stress. The association was not significant among women. Improvements to work environments may be associated with reduced work-related stress among men nationwide in Japan.

Immigrants' health in Europe: a cross-classified multilevel approach to examine origin country, destination country, and community effects.

PubMed

Huijts, Tim; Kraaykamp, Gerbert

2012-01-01

In this study, we examined origin, destination, and community effects on first- and second-generation immigrants' health in Europe. We used information from the European Social Surveys (2002–2008) on 19,210 immigrants from 123 countries of origin, living in 31 European countries. Cross-classified multilevel regression analyses reveal that political suppression in the origin country and living in countries with large numbers of immigrant peers have a detrimental influence on immigrants' health. Originating from predominantly Islamic countries and good average health among natives in the destination country appear to be beneficial. Additionally, the results point toward health selection mechanisms into migration.

The Association between Adolescent Life Satisfaction, Family Structure, Family Affluence and Gender Differences in Parent-Child Communication

ERIC Educational Resources Information Center

Levin, Kate Ann; Dallago, Lorenza; Currie, Candace

2012-01-01

The study sought to examine young people's life satisfaction in the context of the family environment, using data from the 2006 HBSC: WHO-collaborative Study in Scotland (N = 5,126). Multilevel linear regression analyses were carried out for 11-, 13- and 15-year old boys and girls, with outcome measure ridit-transformed life satisfaction. The…

Publication bias in obesity treatment trials?

PubMed

Allison, D B; Faith, M S; Gorman, B S

1996-10-01

The present investigation examined the extent of publication bias (namely the tendency to publish significant findings and file away non-significant findings) within the obesity treatment literature. Quantitative literature synthesis of four published meta-analyses from the obesity treatment literature. Interventions in these studies included pharmacological, educational, child, and couples treatments. To assess publication bias, several regression procedures (for example weighted least-squares, random-effects multi-level modeling, and robust regression methods) were used to regress effect sizes onto their standard errors, or proxies thereof, within each of the four meta-analysis. A significant positive beta weight in these analyses signified publication bias. There was evidence for publication bias within two of the four published meta-analyses, such that reviews of published studies were likely to overestimate clinical efficacy. The lack of evidence for publication bias within the two other meta-analyses might have been due to insufficient statistical power rather than the absence of selection bias. As in other disciplines, publication bias appears to exist in the obesity treatment literature. Suggestions are offered for managing publication bias once identified or reducing its likelihood in the first place.

A Tutorial on Multilevel Survival Analysis: Methods, Models and Applications

PubMed Central

Austin, Peter C.

2017-01-01

Summary Data that have a multilevel structure occur frequently across a range of disciplines, including epidemiology, health services research, public health, education and sociology. We describe three families of regression models for the analysis of multilevel survival data. First, Cox proportional hazards models with mixed effects incorporate cluster-specific random effects that modify the baseline hazard function. Second, piecewise exponential survival models partition the duration of follow-up into mutually exclusive intervals and fit a model that assumes that the hazard function is constant within each interval. This is equivalent to a Poisson regression model that incorporates the duration of exposure within each interval. By incorporating cluster-specific random effects, generalised linear mixed models can be used to analyse these data. Third, after partitioning the duration of follow-up into mutually exclusive intervals, one can use discrete time survival models that use a complementary log–log generalised linear model to model the occurrence of the outcome of interest within each interval. Random effects can be incorporated to account for within-cluster homogeneity in outcomes. We illustrate the application of these methods using data consisting of patients hospitalised with a heart attack. We illustrate the application of these methods using three statistical programming languages (R, SAS and Stata). PMID:29307954

A Tutorial on Multilevel Survival Analysis: Methods, Models and Applications.

PubMed

Austin, Peter C

2017-08-01

Data that have a multilevel structure occur frequently across a range of disciplines, including epidemiology, health services research, public health, education and sociology. We describe three families of regression models for the analysis of multilevel survival data. First, Cox proportional hazards models with mixed effects incorporate cluster-specific random effects that modify the baseline hazard function. Second, piecewise exponential survival models partition the duration of follow-up into mutually exclusive intervals and fit a model that assumes that the hazard function is constant within each interval. This is equivalent to a Poisson regression model that incorporates the duration of exposure within each interval. By incorporating cluster-specific random effects, generalised linear mixed models can be used to analyse these data. Third, after partitioning the duration of follow-up into mutually exclusive intervals, one can use discrete time survival models that use a complementary log-log generalised linear model to model the occurrence of the outcome of interest within each interval. Random effects can be incorporated to account for within-cluster homogeneity in outcomes. We illustrate the application of these methods using data consisting of patients hospitalised with a heart attack. We illustrate the application of these methods using three statistical programming languages (R, SAS and Stata).

Work stress and patient safety: observer-rated work stressors as predictors of characteristics of safety-related events reported by young nurses.

PubMed

Elfering, A; Semmer, N K; Grebner, S

This study investigates the link between workplace stress and the 'non-singularity' of patient safety-related incidents in the hospital setting. Over a period of 2 working weeks 23 young nurses from 19 hospitals in Switzerland documented 314 daily stressful events using a self-observation method (pocket diaries); 62 events were related to patient safety. Familiarity of safety-related events and probability of recurrence, as indicators of non-singularity, were the dependent variables in multilevel regression analyses. Predictor variables were both situational (self-reported situational control, safety compliance) and chronic variables (job stressors such as time pressure, or concentration demands and job control). Chronic work characteristics were rated by trained observers. The most frequent safety-related stressful events included incomplete or incorrect documentation (40.3%), medication errors (near misses 21%), delays in delivery of patient care (9.7%), and violent patients (9.7%). Familiarity of events and probability of recurrence were significantly predicted by chronic job stressors and low job control in multilevel regression analyses. Job stressors and low job control were shown to be risk factors for patient safety. The results suggest that job redesign to enhance job control and decrease job stressors may be an important intervention to increase patient safety.

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.

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.

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

Multilevel Modeling and Ordinary Least Squares Regression: How Comparable Are They?

ERIC Educational Resources Information Center

Huang, Francis L.

2018-01-01

Studies analyzing clustered data sets using both multilevel models (MLMs) and ordinary least squares (OLS) regression have generally concluded that resulting point estimates, but not the standard errors, are comparable with each other. However, the accuracy of the estimates of OLS models is important to consider, as several alternative techniques…

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

[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.

Gender differences in body consciousness and substance use among high-risk adolescents.

PubMed

Black, David Scott; Sussman, Steve; Unger, Jennifer; Pokhrel, Pallav; Sun, Ping

2010-08-01

This study explores the association between private and public body consciousness and past 30-day cigarette, alcohol, marijuana, and hard drug use among adolescents. Self-reported data from alterative high school students in California were analyzed (N = 976) using multilevel regression models to account for student clustering within schools. Separate regression analyses were conducted for males and females. Both cross-sectional baseline data and one-year longitudinal prediction models indicated that body consciousness is associated with specific drug use categories differentially by gender. Findings suggest that body consciousness accounts for additional variance in substance use etiology not explained by previously recognized dispositional variables.

A Multilevel Assessment of Differential Item Functioning.

ERIC Educational Resources Information Center

Shen, Linjun

A multilevel approach was proposed for the assessment of differential item functioning and compared with the traditional logistic regression approach. Data from the Comprehensive Osteopathic Medical Licensing Examination for 2,300 freshman osteopathic medical students were analyzed. The multilevel approach used three-level hierarchical generalized…

The relationship between multilevel models and non-parametric multilevel mixture models: Discrete approximation of intraclass correlation, random coefficient distributions, and residual heteroscedasticity.

PubMed

Rights, Jason D; Sterba, Sonya K

2016-11-01

Multilevel data structures are common in the social sciences. Often, such nested data are analysed with multilevel models (MLMs) in which heterogeneity between clusters is modelled by continuously distributed random intercepts and/or slopes. Alternatively, the non-parametric multilevel regression mixture model (NPMM) can accommodate the same nested data structures through discrete latent class variation. The purpose of this article is to delineate analytic relationships between NPMM and MLM parameters that are useful for understanding the indirect interpretation of the NPMM as a non-parametric approximation of the MLM, with relaxed distributional assumptions. We define how seven standard and non-standard MLM specifications can be indirectly approximated by particular NPMM specifications. We provide formulas showing how the NPMM can serve as an approximation of the MLM in terms of intraclass correlation, random coefficient means and (co)variances, heteroscedasticity of residuals at level 1, and heteroscedasticity of residuals at level 2. Further, we discuss how these relationships can be useful in practice. The specific relationships are illustrated with simulated graphical demonstrations, and direct and indirect interpretations of NPMM classes are contrasted. We provide an R function to aid in implementing and visualizing an indirect interpretation of NPMM classes. An empirical example is presented and future directions are discussed. © 2016 The British Psychological Society.

Impact of high-performance work systems on individual- and branch-level performance: test of a multilevel model of intermediate linkages.

PubMed

Aryee, Samuel; Walumbwa, Fred O; Seidu, Emmanuel Y M; Otaye, Lilian E

2012-03-01

We proposed and tested a multilevel model, underpinned by empowerment theory, that examines the processes linking high-performance work systems (HPWS) and performance outcomes at the individual and organizational levels of analyses. Data were obtained from 37 branches of 2 banking institutions in Ghana. Results of hierarchical regression analysis revealed that branch-level HPWS relates to empowerment climate. Additionally, results of hierarchical linear modeling that examined the hypothesized cross-level relationships revealed 3 salient findings. First, experienced HPWS and empowerment climate partially mediate the influence of branch-level HPWS on psychological empowerment. Second, psychological empowerment partially mediates the influence of empowerment climate and experienced HPWS on service performance. Third, service orientation moderates the psychological empowerment-service performance relationship such that the relationship is stronger for those high rather than low in service orientation. Last, ordinary least squares regression results revealed that branch-level HPWS influences branch-level market performance through cross-level and individual-level influences on service performance that emerges at the branch level as aggregated service performance.

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…

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…

Multilevel Modeling in Psychosomatic Medicine Research

PubMed Central

Myers, Nicholas D.; Brincks, Ahnalee M.; Ames, Allison J.; Prado, Guillermo J.; Penedo, Frank J.; Benedict, Catherine

2012-01-01

The primary purpose of this manuscript is to provide an overview of multilevel modeling for Psychosomatic Medicine readers and contributors. The manuscript begins with a general introduction to multilevel modeling. Multilevel regression modeling at two-levels is emphasized because of its prevalence in psychosomatic medicine research. Simulated datasets based on some core ideas from the Familias Unidas effectiveness study are used to illustrate key concepts including: communication of model specification, parameter interpretation, sample size and power, and missing data. Input and key output files from Mplus and SAS are provided. A cluster randomized trial with repeated measures (i.e., three-level regression model) is then briefly presented with simulated data based on some core ideas from a cognitive behavioral stress management intervention in prostate cancer. PMID:23107843

Estimating multilevel logistic regression models when the number of clusters is low: a comparison of different statistical software procedures.

PubMed

Austin, Peter C

2010-04-22

Multilevel logistic regression models are increasingly being used to analyze clustered data in medical, public health, epidemiological, and educational research. Procedures for estimating the parameters of such models are available in many statistical software packages. There is currently little evidence on the minimum number of clusters necessary to reliably fit multilevel regression models. We conducted a Monte Carlo study to compare the performance of different statistical software procedures for estimating multilevel logistic regression models when the number of clusters was low. We examined procedures available in BUGS, HLM, R, SAS, and Stata. We found that there were qualitative differences in the performance of different software procedures for estimating multilevel logistic models when the number of clusters was low. Among the likelihood-based procedures, estimation methods based on adaptive Gauss-Hermite approximations to the likelihood (glmer in R and xtlogit in Stata) or adaptive Gaussian quadrature (Proc NLMIXED in SAS) tended to have superior performance for estimating variance components when the number of clusters was small, compared to software procedures based on penalized quasi-likelihood. However, only Bayesian estimation with BUGS allowed for accurate estimation of variance components when there were fewer than 10 clusters. For all statistical software procedures, estimation of variance components tended to be poor when there were only five subjects per cluster, regardless of the number of clusters.

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…

An Original Stepwise Multilevel Logistic Regression Analysis of Discriminatory Accuracy: The Case of Neighbourhoods and Health

PubMed Central

Wagner, Philippe; Ghith, Nermin; Leckie, George

2016-01-01

Background and Aim Many multilevel logistic regression analyses of “neighbourhood and health” focus on interpreting measures of associations (e.g., odds ratio, OR). In contrast, multilevel analysis of variance is rarely considered. We propose an original stepwise analytical approach that distinguishes between “specific” (measures of association) and “general” (measures of variance) contextual effects. Performing two empirical examples we illustrate the methodology, interpret the results and discuss the implications of this kind of analysis in public health. Methods We analyse 43,291 individuals residing in 218 neighbourhoods in the city of Malmö, Sweden in 2006. We study two individual outcomes (psychotropic drug use and choice of private vs. public general practitioner, GP) for which the relative importance of neighbourhood as a source of individual variation differs substantially. In Step 1 of the analysis, we evaluate the OR and the area under the receiver operating characteristic (AUC) curve for individual-level covariates (i.e., age, sex and individual low income). In Step 2, we assess general contextual effects using the AUC. Finally, in Step 3 the OR for a specific neighbourhood characteristic (i.e., neighbourhood income) is interpreted jointly with the proportional change in variance (i.e., PCV) and the proportion of ORs in the opposite direction (POOR) statistics. Results For both outcomes, information on individual characteristics (Step 1) provide a low discriminatory accuracy (AUC = 0.616 for psychotropic drugs; = 0.600 for choosing a private GP). Accounting for neighbourhood of residence (Step 2) only improved the AUC for choosing a private GP (+0.295 units). High neighbourhood income (Step 3) was strongly associated to choosing a private GP (OR = 3.50) but the PCV was only 11% and the POOR 33%. Conclusion Applying an innovative stepwise multilevel analysis, we observed that, in Malmö, the neighbourhood context per se had a negligible influence on individual use of psychotropic drugs, but appears to strongly condition individual choice of a private GP. However, the latter was only modestly explained by the socioeconomic circumstances of the neighbourhoods. Our analyses are based on real data and provide useful information for understanding neighbourhood level influences in general and on individual use of psychotropic drugs and choice of GP in particular. However, our primary aim is to illustrate how to perform and interpret a multilevel analysis of individual heterogeneity in social epidemiology and public health. Our study shows that neighbourhood “effects” are not properly quantified by reporting differences between neighbourhood averages but rather by measuring the share of the individual heterogeneity that exists at the neighbourhood level. PMID:27120054

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

Three frameworks to predict physical activity behavior in middle school inclusive physical education: a multilevel analysis.

PubMed

Jin, Jooyeon; Yun, Joonkoo

2013-07-01

The purpose of this study was to examine three frameworks, (a) process-product, (b) student mediation, and (c) classroom ecology, to understand physical activity (PA) behavior of adolescents with and without disabilities in middle school inclusive physical education (PE). A total of 13 physical educators teaching inclusive PE and their 503 students, including 22 students with different disabilities, participated in this study. A series of multilevel regression analyses indicated that physical educators' teaching behavior and students' implementation intentions play important roles in promoting the students' PA in middle school inclusive PE settings when gender, disability, lesson content, instructional model, and class location are considered simultaneously. The findings suggest that the ecological framework should be considered to effectively promote PA of adolescents with and without disabilities in middle school PE classes.

Application of Hierarchical Linear Models/Linear Mixed-Effects Models in School Effectiveness Research

ERIC Educational Resources Information Center

Ker, H. W.

2014-01-01

Multilevel data are very common in educational research. Hierarchical linear models/linear mixed-effects models (HLMs/LMEs) are often utilized to analyze multilevel data nowadays. This paper discusses the problems of utilizing ordinary regressions for modeling multilevel educational data, compare the data analytic results from three regression…

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."…

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.

Covariate Selection for Multilevel Models with Missing Data

PubMed Central

Marino, Miguel; Buxton, Orfeu M.; Li, Yi

2017-01-01

Missing covariate data hampers variable selection in multilevel regression settings. Current variable selection techniques for multiply-imputed data commonly address missingness in the predictors through list-wise deletion and stepwise-selection methods which are problematic. Moreover, most variable selection methods are developed for independent linear regression models and do not accommodate multilevel mixed effects regression models with incomplete covariate data. We develop a novel methodology that is able to perform covariate selection across multiply-imputed data for multilevel random effects models when missing data is present. Specifically, we propose to stack the multiply-imputed data sets from a multiple imputation procedure and to apply a group variable selection procedure through group lasso regularization to assess the overall impact of each predictor on the outcome across the imputed data sets. Simulations confirm the advantageous performance of the proposed method compared with the competing methods. We applied the method to reanalyze the Healthy Directions-Small Business cancer prevention study, which evaluated a behavioral intervention program targeting multiple risk-related behaviors in a working-class, multi-ethnic population. PMID:28239457

Crush Analyses of Multi-Level Equipment

DOT National Transportation Integrated Search

2006-11-06

Non-linear large deformation crush analyses were conducted on a multi-level cab car typical of those in operation by the Southern California Regional Rail Authority (SCRRA) in California. The motivation for these analyses was a collision, which occur...

Is religiosity positively associated with school connectedness: evidence from high school students in Atlantic Canada?

PubMed

Azagba, Sunday; Asbridge, Mark; Langille, Donald B

2014-12-01

School connectedness (SC) is associated with decreased student risk behavior and better health and social outcomes. While a considerable body of research has examined the factors associated with SC, there is limited evidence about the particular role of religiosity in shaping levels of SC. Employing data reported by junior and senior high school students from Atlantic Canada, this study examines whether religiosity is positively associated with SC and whether such associations differ by gender. We tested the association between SC and religiosity using a random intercept multilevel logistic regression. The between-school variability in SC was first determined by our estimating a null or empty model; three different model specifications that included covariates were estimated: in Model 1 we adjusted for gender, age, academic performance, parental education, and living arrangement; in Model 2 for sensation seeking and subjective social status in addition to Model 1 variables; and in Model 3 we added substance use to the analysis. Our multilevel regression analyses showed that religiosity was protectively associated with lower SC across the three model specifications when both genders were examined together. In gender-stratified analyses we found similar protective associations of religiosity, with lower SC for both males and females in all three models. Given the overwhelming positive impact of SC on a range of health, social and school outcomes, it is important to understand the role of religiosity, among other factors, that may be modified to enhance student's connectedness to school.

Neighborhood Predictors of Dating Violence Victimization and Perpetration in Young Adulthood: A Multilevel Study

PubMed Central

Buka, Stephen L.; Subramanian, S. V.; Molnar, Beth E.

2010-01-01

Objectives. We examined whether social processes of neighborhoods, such as collective efficacy, during individual's adolescent years affect the likelihood of being involved in physical dating violence during young adulthood. Methods. Using longitudinal data on 633 urban youths aged 13 to 19 years at baseline and data from their neighborhoods (collected by the Project on Human Development in Chicago Neighborhoods), we ran multilevel linear regression models separately by gender to assess the association between collective efficacy and physical dating violence victimization and perpetration, controlling for individual covariates, neighborhood poverty, and perceived neighborhood violence. Results. Females were significantly more likely than were males to be perpetrators of dating violence during young adulthood (38% vs 19%). Multilevel analyses revealed some variation in dating violence at the neighborhood level, partly accounted for by collective efficacy. Collective efficacy was predictive of victimization for males but not females after control for confounders; it was marginally associated with perpetration (P = .07). The effects of collective efficacy varied by neighborhood poverty. Finally, a significant proportion (intraclass correlation = 14%–21%) of the neighborhood-level variation in male perpetration remained unexplained after modeling. Conclusions. Community-level strategies may be useful in preventing dating violence. PMID:20634470

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.

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.

Multilevel modelling: Beyond the basic applications.

PubMed

Wright, Daniel B; London, Kamala

2009-05-01

Over the last 30 years statistical algorithms have been developed to analyse datasets that have a hierarchical/multilevel structure. Particularly within developmental and educational psychology these techniques have become common where the sample has an obvious hierarchical structure, like pupils nested within a classroom. We describe two areas beyond the basic applications of multilevel modelling that are important to psychology: modelling the covariance structure in longitudinal designs and using generalized linear multilevel modelling as an alternative to methods from signal detection theory (SDT). Detailed code for all analyses is described using packages for the freeware R.

A Regression Framework for Effect Size Assessments in Longitudinal Modeling of Group Differences

PubMed Central

Feingold, Alan

2013-01-01

The use of growth modeling analysis (GMA)--particularly multilevel analysis and latent growth modeling--to test the significance of intervention effects has increased exponentially in prevention science, clinical psychology, and psychiatry over the past 15 years. Model-based effect sizes for differences in means between two independent groups in GMA can be expressed in the same metric (Cohen’s d) commonly used in classical analysis and meta-analysis. This article first reviews conceptual issues regarding calculation of d for findings from GMA and then introduces an integrative framework for effect size assessments that subsumes GMA. The new approach uses the structure of the linear regression model, from which effect sizes for findings from diverse cross-sectional and longitudinal analyses can be calculated with familiar statistics, such as the regression coefficient, the standard deviation of the dependent measure, and study duration. PMID:23956615

Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis.

PubMed

Daru, Jahnavi; Zamora, Javier; Fernández-Félix, Borja M; Vogel, Joshua; Oladapo, Olufemi T; Morisaki, Naho; Tunçalp, Özge; Torloni, Maria Regina; Mittal, Suneeta; Jayaratne, Kapila; Lumbiganon, Pisake; Togoobaatar, Ganchimeg; Thangaratinam, Shakila; Khan, Khalid S

2018-05-01

Anaemia affects as many as half of all pregnant women in low-income and middle-income countries, but the burden of disease and associated maternal mortality are not robustly quantified. We aimed to assess the association between severe anaemia and maternal death with data from the WHO Multicountry Survey on maternal and newborn health. We used multilevel and propensity score regression analyses to establish the relation between severe anaemia and maternal death in 359 health facilities in 29 countries across Latin America, Africa, the Western Pacific, eastern Mediterranean, and southeast Asia. Severe anaemia was defined as antenatal or postnatal haemoglobin concentrations of less than 70 g/L in a blood sample obtained before death. Maternal death was defined as death any time after admission until the seventh day post partum or discharge. In regression analyses, we adjusted for post-partum haemorrhage, general anaesthesia, admission to intensive care, sepsis, pre-eclampsia or eclampsia, thrombocytopenia, shock, massive transfusion, severe oliguria, failure to form clots, and severe acidosis as confounding variables. These variables were used to develop the propensity score. 312 281 women admitted in labour or with ectopic pregnancies were included in the adjusted multilevel logistic analysis, and 12 470 were included in the propensity score regression analysis. The adjusted odds ratio for maternal death in women with severe anaemia compared with those without severe anaemia was 2·36 (95% CI 1·60-3·48). In the propensity score analysis, severe anaemia was also associated with maternal death (adjusted odds ratio 1·86 [95% CI 1·39-2·49]). Prevention and treatment of anaemia during pregnancy and post partum should remain a global public health and research priority. Barts and the London Charity. Copyright This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

Does the density of the health workforce predict adolescent health? A cross-sectional, multilevel study of 38 countries.

PubMed

Riehm, Kira E; Latimer, Eric; Quesnel-Vallée, Amélie; Stevens, Gonneke W J M; Gariépy, Geneviève; Elgar, Frank J

2018-06-11

Scant evidence exists on the relation between the availability of health professionals and adolescent health, and whether the size of the health workforce equally benefits adolescents across socioeconomic strata. We conducted a cross-sectional analysis of adolescent health in 38 countries. Data from 218 790 adolescents were drawn from the 2013/2014 Health Behavior in School-aged Children survey. We used multilevel regression analyses to examine the association between the density of the health workforce and psychosomatic and mental health symptoms with differences in country wealth and income inequality controlled. A higher density of psychologists was associated with better self-reported mental health in adolescents (P = 0.047); however, this finding was not robust to sensitivity analyses. The densities of physicians and psychiatrists were not significantly associated with better adolescent psychosomatic or mental health. Cross-level interactions between the health workforce and socioeconomic status did not relate to health, indicating that larger health workforces did not reduce socioeconomic differences in adolescent health. This study found that adolescents in countries with a higher density of health providers do not report better psychosomatic or mental health. Other social or structural factors may play larger roles in adolescent health.

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.

Predicting multi-level drug response with gene expression profile in multiple myeloma using hierarchical ordinal regression.

PubMed

Zhang, Xinyan; Li, Bingzong; Han, Huiying; Song, Sha; Xu, Hongxia; Hong, Yating; Yi, Nengjun; Zhuang, Wenzhuo

2018-05-10

Multiple myeloma (MM), like other cancers, is caused by the accumulation of genetic abnormalities. Heterogeneity exists in the patients' response to treatments, for example, bortezomib. This urges efforts to identify biomarkers from numerous molecular features and build predictive models for identifying patients that can benefit from a certain treatment scheme. However, previous studies treated the multi-level ordinal drug response as a binary response where only responsive and non-responsive groups are considered. It is desirable to directly analyze the multi-level drug response, rather than combining the response to two groups. In this study, we present a novel method to identify significantly associated biomarkers and then develop ordinal genomic classifier using the hierarchical ordinal logistic model. The proposed hierarchical ordinal logistic model employs the heavy-tailed Cauchy prior on the coefficients and is fitted by an efficient quasi-Newton algorithm. We apply our hierarchical ordinal regression approach to analyze two publicly available datasets for MM with five-level drug response and numerous gene expression measures. Our results show that our method is able to identify genes associated with the multi-level drug response and to generate powerful predictive models for predicting the multi-level response. The proposed method allows us to jointly fit numerous correlated predictors and thus build efficient models for predicting the multi-level drug response. The predictive model for the multi-level drug response can be more informative than the previous approaches. Thus, the proposed approach provides a powerful tool for predicting multi-level drug response and has important impact on cancer studies.

Cross-national differences in the gender gap in subjective health in Europe: does country-level gender equality matter?

PubMed

Dahlin, Johanna; Härkönen, Juho

2013-12-01

Multiple studies have found that women report being in worse health despite living longer. Gender gaps vary cross-nationally, but relatively little is known about the causes of comparative differences. Existing literature is inconclusive as to whether gender gaps in health are smaller in more gender equal societies. We analyze gender gaps in self-rated health (SRH) and limiting longstanding illness (LLI) with five waves of European Social Survey data for 191,104 respondents from 28 countries. We use means, odds ratios, logistic regressions, and multilevel random slopes logistic regressions. Gender gaps in subjective health vary visibly across Europe. In many countries (especially in Eastern and Southern Europe), women report distinctly worse health, while in others (such as Estonia, Finland, and Great Britain) there are small or no differences. Logistic regressions ran separately for each country revealed that individual-level socioeconomic and demographic variables explain a majority of these gaps in some countries, but contribute little to their understanding in most countries. In yet other countries, men had worse health when these variables were controlled for. Cross-national variation in the gender gaps exists after accounting for individual-level factors. Against expectations, the remaining gaps are not systematically related to societal-level gender inequality in the multilevel analyses. Our findings stress persistent cross-national variability in gender gaps in health and call for further analysis. Copyright © 2013 Elsevier Ltd. All rights reserved.

Are tuition-free primary education policies associated with lower infant and neonatal mortality in low- and middle-income countries?

PubMed

Quamruzzaman, Amm; Mendoza Rodríguez, José M; Heymann, Jody; Kaufman, Jay S; Nandi, Arijit

2014-11-01

Robust evidence from low- and middle-income countries (LMICs) suggests that maternal education is associated with better child health outcomes. However, whether or not policies aimed at increasing access to education, including tuition-free education policies, contribute to lower infant and neonatal mortality has not been empirically tested. We joined country-level data on national education policies for 37 LMICs to information on live births to young mothers aged 15-21 years, who were surveyed as part of the population-based Demographic and Health Surveys. We used propensity scores to match births to mothers who were exposed to a tuition-free primary education policy with births to mothers who were not, based on individual-level, household, and country-level characteristics, including GDP per capita, urbanization, and health expenditures per capita. Multilevel logistic regression models, fitted using generalized estimating equations, were used to estimate the effect of exposure to tuition-free primary education policies on the risk of infant and neonatal mortality. We also tested whether this effect was modified by household socioeconomic status. The propensity score matched samples for analyses of infant and neonatal mortality comprised 24,396 and 36,030 births, respectively, from 23 countries. Multilevel regression analyses showed that, on average, exposure to a tuition-free education policy was associated with 15 (95% CI=-32, 1) fewer infant and 5 (95% CI=-13, 4) fewer neonatal deaths per 1000 live births. We found no strong evidence of heterogeneity of this effect by socioeconomic level. Copyright © 2014. Published by Elsevier Ltd.

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.

Transgenerational effect of neighborhood poverty on low birth weight among African Americans in Cook County, Illinois.

PubMed

Collins, James W; David, Richard J; Rankin, Kristin M; Desireddi, Jennifer R

2009-03-15

In perinatal epidemiology, transgenerational risk factors are defined as conditions experienced by one generation that affect the pregnancy outcomes of the next generation. The authors investigated the transgenerational effect of neighborhood poverty on infant birth weight among African Americans. Stratified and multilevel logistic regression analyses were performed on an Illinois transgenerational data set with appended US Census income information. Singleton African-American infants (n = 40,648) born in 1989-1991 were considered index births. The mothers of index infants had been born in 1956-1976. The maternal grandmothers of index infants were identified. Rates of infant low birth weight (<2,500 g) rose as maternal grandmother's residential environment during her pregnancy deteriorated, independently of mother's residential environment during her pregnancy. In a multilevel logistic regression model that accounted for clustering by maternal grandmother's residential environment, the adjusted odds ratio (controlling for mother's age, education, prenatal care, cigarette smoking status, and residential environment) for infant low birth weight for maternal grandmother's residence in a poor neighborhood (compared with an affluent neighborhood) equaled 1.3 (95% confidence interval: 1.1, 1.4). This study suggests that maternal grandmother's exposure to neighborhood poverty during her pregnancy is a risk factor for infant low birth weight among African Americans.

Depressive Symptoms among Young Breast Cancer Survivors: The Importance of Reproductive Concerns

PubMed Central

Gorman, Jessica R; Malcarne, Vanessa L; Roesch, Scott C; Madlensky, Lisa; Pierce, John P

2010-01-01

Purpose Breast cancer diagnosis and treatment can negatively impact fertility in premenopausal women and influence reproductive planning. This study investigates whether concerns about reproduction after breast cancer treatment were associated with long-term depressive symptoms. Patients and Methods Participants include 131 women diagnosed with early-stage breast cancer at age 40 or younger participating in the Women's Healthy Eating and Living (WHEL) Survivorship Study. Participants were enrolled an average of 1.5 years post-diagnosis and depressive symptoms were monitored 6 times throughout the average additional 10 year follow-up period. Detailed recall of reproductive concerns after treatment was collected an average of 12 years post-diagnosis. Multilevel regression was used to evaluate whether mean long-term depressive symptoms differed as a function of reproductive concerns and significant covariates. Results Multilevel regression identified greater recalled reproductive concerns as an independent predictor of consistent depressive symptoms after controlling for both social support and physical health (B= 0.02, SE= 0.01, p=0.04). In bivariate analyses, being nulliparous at diagnosis and reporting treatment-related ovarian damage were both strongly associated with higher reproductive concerns and with depressive symptoms. Conclusion Reported reproductive concerns after breast cancer treatment were a significant contributor to consistent depressive symptoms. Younger survivors would benefit from additional information and support related to reproductive issues. PMID:20130979

Subjective Well-being in Rural India: The Curse of Conspicuous Consumption

PubMed Central

van Kempen, Luuk; Kraaykamp, Gerbert

2010-01-01

Using data on 697 individuals from 375 rural low income households in India, we test expectations on the effects of relative income and conspicuous consumption on subjective well-being. The results of the multi-level regression analyses show that individuals who spent more on conspicuous consumption report lower levels of subjective well-being. Surprisingly an individual’s relative income position does not affect feelings of well-being. Motivated by positional concerns, people do not passively accept their relative rank but instead consume conspicuous goods to keep up with the Joneses. Conspicuous consumption always comes at the account of the consumption of basic needs. Our analyses point at a positional treadmill effect of the consumption of status goods. PMID:21423323

Individual-Level Influences on Perceptions of Neighborhood Disorder: A Multilevel Analysis

ERIC Educational Resources Information Center

Latkin, Carl A.; German, Danielle; Hua, Wei; Curry, Aaron D.

2009-01-01

Health outcomes are associated with aggregate neighborhood measures and individual neighborhood perceptions. In this study, the authors sought to delineate individual, social network, and spatial factors that may influence perceptions of neighborhood disorder. Multilevel regression analysis showed that neighborhood perceptions were more negative…

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…

Anthropometry and blood pressure changes in a Caribbean adolescent population of African ancestry: an evaluation of longitudinal data using a multilevel mixed regression approach.

PubMed

Nichols, S; Cadogan, F

2012-10-01

The aim of this study was to determine the effect of growth pattern on blood pressure changes in an adolescent population of African ancestry based on longitudinal data and to compare this with estimates derived from cross-sectional data. Participants had measurements of weight, height, blood pressure and percentage body fat taken annually using standardized procedures. Annual blood pressure and anthropometry velocities as well as one- and three-year interval gender specific tracking coefficients were computed. We investigated whether changes in blood pressure could be explained by measures of growth using a multilevel mixed regression approach. The results showed that systolic blood pressure (SBP) increased by 1.27 and 3.09 mmHg per year among females and males, respectively. Similarly, diastolic blood pressure (DBP) increased by 1.16 and 1.92 mmHg per year among females and males, respectively. Multilevel analyses suggested that weight, body mass index, percentage body fat and height were the strongest anthropometric determinants of blood pressure change in this population. The results also suggest that there are gender differences in the relative importance of these anthropometric measures with height playing a minor role in predicting blood pressure changes among adolescent females. With the exception of DBP at 18 years among females, there were no significant differences between mean blood pressure generated from cross-sectional and longitudinal data by age in both males and females. Anthropometric measures are important covariates of age-related blood pressure changes and cross-sectional data may provide a more cost-effective and useful proxy for generating age-related blood pressure estimates in this population.

[Nursing Workforce Characteristics and Control of Diabetes Mellitus in Primary Care: a Multilevel Analysis].

PubMed

Parro Moreno, Ana; Santiago Pérez, M Isolina; Abraira Santos, Victor; Aréjula Torres, José Luis Aréjula Torres; Díaz Holgado, Antonio; Gandarillas Grande, Ana; Morales Asencio, José Miguel; Serrano Gallardo, Pilar

2016-03-04

Nurse activity is determined by the characteristics of nursing staff. The objective was to determine the impact of Primary Health Care (PHC) nursing workforce characteristics on the control of Diabetes Mellitus (DM) in adults. Cross-sectional analytical study. Administrative and clinical registries and questionnaire PES-Nursing Work Index from PHC nurses. Participants 44.214 diabetic patients in two health zones within the Community of Madrid, North-West Zone (NWZ) with higher socioeconomic situation and South-West Zone (SWZ) with lower socioeconomic situation, and their 507 reference nurses. Analyses were performed to multivariate multilevel logistic regression models. Poor DM control (figures equal or higher than 7% HbA1c). The prevalence of poor DM control was 40.1% [CI95%: 38.2-42.1]. There was a risk of 25% more of poor control if the patient changed centre and of 27% if changed of doctor-nurse pair. In the multilevel multivariate regression models: in SWZ increasing the ratio of patients over 65 years per nurse increased the poor control (OR=1.00008 [CI95%:1.00006-1.001]); and higher proportion of patients whose Hb1Ac was not measured at the centre contributed to poor DM control (OR=5.1 [CI95%:1.6-15.6]). In two models for health zone, the economic immigration condition increased poor control, in SWZ (OR=1.3 [CI95%:1.03-1.7]); and in NWZ (OR=1.29 [CI95%:1.03-1.6]). Higher 65 years old patients ratio per nurse, economic immigration condition and a higher proportion of patients whose Hb1Ac was not measured contribute to worse DM control.

An investigation of emotion dynamics in major depressive disorder patients and healthy persons using sparse longitudinal networks.

PubMed

de Vos, Stijn; Wardenaar, Klaas J; Bos, Elisabeth H; Wit, Ernst C; Bouwmans, Mara E J; de Jonge, Peter

2017-01-01

Differences in within-person emotion dynamics may be an important source of heterogeneity in depression. To investigate these dynamics, researchers have previously combined multilevel regression analyses with network representations. However, sparse network methods, specifically developed for longitudinal network analyses, have not been applied. Therefore, this study used this approach to investigate population-level and individual-level emotion dynamics in healthy and depressed persons and compared this method with the multilevel approach. Time-series data were collected in pair-matched healthy persons and major depressive disorder (MDD) patients (n = 54). Seven positive affect (PA) and seven negative affect (NA) items were administered electronically at 90 times (30 days; thrice per day). The population-level (healthy vs. MDD) and individual-level time series were analyzed using a sparse longitudinal network model based on vector autoregression. The population-level model was also estimated with a multilevel approach. Effects of different preprocessing steps were evaluated as well. The characteristics of the longitudinal networks were investigated to gain insight into the emotion dynamics. In the population-level networks, longitudinal network connectivity was strongest in the healthy group, with nodes showing more and stronger longitudinal associations with each other. Individually estimated networks varied strongly across individuals. Individual variations in network connectivity were unrelated to baseline characteristics (depression status, neuroticism, severity). A multilevel approach applied to the same data showed higher connectivity in the MDD group, which seemed partly related to the preprocessing approach. The sparse network approach can be useful for the estimation of networks with multiple nodes, where overparameterization is an issue, and for individual-level networks. However, its current inability to model random effects makes it less useful as a population-level approach in case of large heterogeneity. Different preprocessing strategies appeared to strongly influence the results, complicating inferences about network density.

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,…

Lean production tools and decision latitude enable conditions for innovative learning in organizations: a multilevel analysis.

PubMed

Fagerlind Ståhl, Anna-Carin; Gustavsson, Maria; Karlsson, Nadine; Johansson, Gun; Ekberg, Kerstin

2015-03-01

The effect of lean production on conditions for learning is debated. This study aimed to investigate how tools inspired by lean production (standardization, resource reduction, visual monitoring, housekeeping, value flow analysis) were associated with an innovative learning climate and with collective dispersion of ideas in organizations, and whether decision latitude contributed to these associations. A questionnaire was sent out to employees in public, private, production and service organizations (n = 4442). Multilevel linear regression analyses were used. Use of lean tools and decision latitude were positively associated with an innovative learning climate and collective dispersion of ideas. A low degree of decision latitude was a modifier in the association to collective dispersion of ideas. Lean tools can enable shared understanding and collective spreading of ideas, needed for the development of work processes, especially when decision latitude is low. Value flow analysis played a pivotal role in the associations. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

A cross-sectional study of workplace social capital and blood pressure: a multilevel analysis at Japanese manufacturing companies.

PubMed

Fujino, Yoshihisa; Kubo, Tatsuhiko; Kunimoto, Masamizu; Tabata, Hidetoshi; Tsuchiya, Takuto; Kadowaki, Koji; Nakamura, Takehiro; Oyama, Ichiro

2013-01-01

We examined the contextual effect of workplace social capital on systolic blood pressure (SBP). Cross-sectional. A conglomerate from 58 workplaces in Japan. Of the 5844 workers at a Japanese conglomerate from 58 workplaces, 5368 were recruited. Individuals who received drugs for hypertension (n=531) and who lacked information on any variable (n=167) were excluded from the analyses, leaving 4735 individuals (3281 men and 1454 women) for inclusion. Systolic blood pressure. The contextual effect of workplace social capital on SBP was examined using a multilevel regression analysis with a random intercept. Coworker support had a contextual effect at the workplace level (coefficient=-1.97, p=0.043), while a lack of trust for coworkers (coefficient=0.27, p=0.039) and lack of helpfulness from coworkers were associated with SBP (coefficient=0.28, p=0.002). The present study suggested that social capital at the workplace level has beneficial effects on SBP.

Seeing the forest and the trees: multilevel models reveal both species and community patterns

Treesearch

Michelle M. Jackson; Monica G. Turner; Scott M. Pearson; Anthony R. Ives

2012-01-01

Studies designed to understand species distributions and community assemblages typically use separate analytical approaches (e.g., logistic regression and ordination) to model the distribution of individual species and to relate community composition to environmental variation. Multilevel models (MLMs) offer a promising strategy for integrating species and community-...

Developing an Adequately Specified Model of State Level Student Achievement with Multilevel Data.

ERIC Educational Resources Information Center

Bernstein, Lawrence

Limitations of using linear, unilevel regression procedures in modeling student achievement are discussed. This study is a part of a broader study that is developing an empirically-based predictive model of variables associated with academic achievement from a multilevel perspective and examining the differences by which parameters are estimated…

The Economic Cost of Homosexuality: Multilevel Analyses

ERIC Educational Resources Information Center

Baumle, Amanda K.; Poston, Dudley, Jr.

2011-01-01

This article builds on earlier studies that have examined "the economic cost of homosexuality," by using data from the 2000 U.S. Census and by employing multilevel analyses. Our findings indicate that partnered gay men experience a 12.5 percent earnings penalty compared to married heterosexual men, and a statistically insignificant earnings…

An empirical study of statistical properties of variance partition coefficients for multi-level logistic regression models

USGS Publications Warehouse

Li, Ji; Gray, B.R.; Bates, D.M.

2008-01-01

Partitioning the variance of a response by design levels is challenging for binomial and other discrete outcomes. Goldstein (2003) proposed four definitions for variance partitioning coefficients (VPC) under a two-level logistic regression model. In this study, we explicitly derived formulae for multi-level logistic regression model and subsequently studied the distributional properties of the calculated VPCs. Using simulations and a vegetation dataset, we demonstrated associations between different VPC definitions, the importance of methods for estimating VPCs (by comparing VPC obtained using Laplace and penalized quasilikehood methods), and bivariate dependence between VPCs calculated at different levels. Such an empirical study lends an immediate support to wider applications of VPC in scientific data analysis.

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…

Is an index of co-occurring unhealthy lifestyles suitable for understanding migrant health?

PubMed

Feng, Xiaoqi; Astell-Burt, Thomas; Kolt, Gregory S

2014-12-01

This study investigated variation in unhealthy lifestyles within Australia according to where people were born. Multilevel linear regression models were used to explore variation in co-occurring unhealthy lifestyles (from 0 to 8) constructed from responses to tobacco smoking, alcohol consumption, moderate-to-vigorous physical activity and a range of dietary indicators for 217,498 adults born in 22 different countries now living in Australia. Models were adjusted for socio-economic variables. Data was from the 45 and Up Study (2006-2009). Further analyses involved multilevel logistic regression to examine country-of-birth patterning of each individual unhealthy lifestyle. Small differences in the co-occurrence of unhealthy lifestyles were observed by country of birth, ranging from 3.1 (Philippines) to 3.8 (Russia). More substantial variation was observed for each individual unhealthy lifestyle. Smoking and alcohol ranged from 7.3% and 4.2% (both China) to 28.5% (Lebanon) and 30.8% (Ireland) respectively. Non-adherence to physical activity guidelines was joint-highest among participants born in Japan and China (both 74.5%), but lowest among those born in Scandinavian countries (52.5%). Substantial variation in meeting national dietary guidelines was also evident between participants born in different countries. The growing trend for constructing unhealthy lifestyle indices can hide important variation in individual unhealthy lifestyles by country of birth. Copyright © 2014. Published by Elsevier Inc.

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.

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…

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…

Mapping Regional Impervious Surface Distribution from Night Time Light: The Variability across Global Cities

NASA Astrophysics Data System (ADS)

Lin, M.; Yang, Z.; Park, H.; Qian, S.; Chen, J.; Fan, P.

2017-12-01

Impervious surface area (ISA) has become an important indicator for studying urban environments, but mapping ISA at the regional or global scale is still challenging due to the complexity of impervious surface features. The Defense Meteorological Satellite Program's Operational Linescan System (DMSP-OLS) nighttime light data is (NTL) and Resolution Imaging Spectroradiometer (MODIS) are the major remote sensing data source for regional ISA mapping. A single regression relationship between fractional ISA and NTL or various index derived based on NTL and MODIS vegetation index (NDVI) data was established in many previous studies for regional ISA mapping. However, due to the varying geographical, climatic, and socio-economic characteristics of different cities, the same regression relationship may vary significantly across different cities in the same region in terms of both fitting performance (i.e. R2) and the rate of change (Slope). In this study, we examined the regression relationship between fractional ISA and Vegetation Adjusted Nighttime light Urban Index (VANUI) for 120 randomly selected cities around the world with a multilevel regression model. We found that indeed there is substantial variability of both the R2 (0.68±0.29) and slopes (0.64±0.40) among individual regressions, which suggests that multilevel/hierarchical models are needed for accuracy improvement of future regional ISA mapping .Further analysis also let us find the this substantial variability are affected by climate conditions, socio-economic status, and urban spatial structures. However, all these effects are nonlinear rather than linear, thus could not modeled explicitly in multilevel linear regression models.

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…

Predicting Depression among Patients with Diabetes Using Longitudinal Data. A Multilevel Regression Model.

PubMed

Jin, H; Wu, S; Vidyanti, I; Di Capua, P; Wu, B

2015-01-01

This article is part of the Focus Theme of Methods of Information in Medicine on "Big Data and Analytics in Healthcare". Depression is a common and often undiagnosed condition for patients with diabetes. It is also a condition that significantly impacts healthcare outcomes, use, and cost as well as elevating suicide risk. Therefore, a model to predict depression among diabetes patients is a promising and valuable tool for providers to proactively assess depressive symptoms and identify those with depression. This study seeks to develop a generalized multilevel regression model, using a longitudinal data set from a recent large-scale clinical trial, to predict depression severity and presence of major depression among patients with diabetes. Severity of depression was measured by the Patient Health Questionnaire PHQ-9 score. Predictors were selected from 29 candidate factors to develop a 2-level Poisson regression model that can make population-average predictions for all patients and subject-specific predictions for individual patients with historical records. Newly obtained patient records can be incorporated with historical records to update the prediction model. Root-mean-square errors (RMSE) were used to evaluate predictive accuracy of PHQ-9 scores. The study also evaluated the classification ability of using the predicted PHQ-9 scores to classify patients as having major depression. Two time-invariant and 10 time-varying predictors were selected for the model. Incorporating historical records and using them to update the model may improve both predictive accuracy of PHQ-9 scores and classification ability of the predicted scores. Subject-specific predictions (for individual patients with historical records) achieved RMSE about 4 and areas under the receiver operating characteristic (ROC) curve about 0.9 and are better than population-average predictions. The study developed a generalized multilevel regression model to predict depression and demonstrated that using generalized multilevel regression based on longitudinal patient records can achieve high predictive ability.

Exploring the impact of different multi-level measures of physician communities in patient-centric care networks on healthcare outcomes: A multi-level regression approach.

PubMed

Uddin, Shahadat

2016-02-04

A patient-centric care network can be defined as a network among a group of healthcare professionals who provide treatments to common patients. Various multi-level attributes of the members of this network have substantial influence to its perceived level of performance. In order to assess the impact different multi-level attributes of patient-centric care networks on healthcare outcomes, this study first captured patient-centric care networks for 85 hospitals using health insurance claim dataset. From these networks, this study then constructed physician collaboration networks based on the concept of patient-sharing network among physicians. A multi-level regression model was then developed to explore the impact of different attributes that are organised at two levels on hospitalisation cost and hospital length of stay. For Level-1 model, the average visit per physician significantly predicted both hospitalisation cost and hospital length of stay. The number of different physicians significantly predicted only the hospitalisation cost, which has significantly been moderated by age, gender and Comorbidity score of patients. All Level-1 findings showed significance variance across physician collaboration networks having different community structure and density. These findings could be utilised as a reflective measure by healthcare decision makers. Moreover, healthcare managers could consider them in developing effective healthcare environments.

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…

What happens at work stays at work? Workplace supervisory social interactions and blood pressure outcomes.

PubMed

Wong, Jennifer H K; Kelloway, E Kevin

2016-04-01

We investigated the relationship between workplace supervisory social interactions and blood pressure outcomes using hourly diary entries and ambulatory blood pressure data from an experience sampling study of 55 long-term care employees. After accounting for relevant cardiovascular controls, significant effects of supervisory interactions on cardiovascular reactivity and recovery were found. Multilevel analyses revealed that negatively perceived supervisory interactions predicted higher systolic blood pressure at work (B = -1.59, p < .05, N observations = 422). Using time-lagged hierarchical regression analyses, the average perceived valence of supervisory interactions at work predicted average systolic blood pressure recovery after work (B = -14.52, p < .05, N = 33). Specifically, negatively perceived supervisory interactions at work predicted poorer cardiovascular recovery after work. Suggestions for improving practices in organizations and in experience sampling research are discussed. (c) 2016 APA, all rights reserved).

A cross-sectional study of workplace social capital and blood pressure: a multilevel analysis at Japanese manufacturing companies

PubMed Central

Fujino, Yoshihisa; Kubo, Tatsuhiko; Kunimoto, Masamizu; Tabata, Hidetoshi; Tsuchiya, Takuto; Kadowaki, Koji; Nakamura, Takehiro; Oyama, Ichiro

2013-01-01

Objectives We examined the contextual effect of workplace social capital on systolic blood pressure (SBP). Design Cross-sectional. Setting A conglomerate from 58 workplaces in Japan. Participants Of the 5844 workers at a Japanese conglomerate from 58 workplaces, 5368 were recruited. Individuals who received drugs for hypertension (n=531) and who lacked information on any variable (n=167) were excluded from the analyses, leaving 4735 individuals (3281 men and 1454 women) for inclusion. Primary and secondary outcome measures Systolic blood pressure. Results The contextual effect of workplace social capital on SBP was examined using a multilevel regression analysis with a random intercept. Coworker support had a contextual effect at the workplace level (coefficient=−1.97, p=0.043), while a lack of trust for coworkers (coefficient=0.27, p=0.039) and lack of helpfulness from coworkers were associated with SBP (coefficient=0.28, p=0.002). Conclusions The present study suggested that social capital at the workplace level has beneficial effects on SBP. PMID:23386581

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.

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.

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.

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.

Analyzing Multilevel Data: Comparing Findings from Hierarchical Linear Modeling and Ordinary Least Squares Regression

ERIC Educational Resources Information Center

Rocconi, Louis M.

2013-01-01

This study examined the differing conclusions one may come to depending upon the type of analysis chosen, hierarchical linear modeling or ordinary least squares (OLS) regression. To illustrate this point, this study examined the influences of seniors' self-reported critical thinking abilities three ways: (1) an OLS regression with the student…

The role of perceived social support in loneliness and self-esteem among children affected by HIV/AIDS: a longitudinal multilevel analysis in rural China.

PubMed

Qiao, Shan; Li, Xiaoming; Zhao, Guoxiang; Zhao, Junfeng; Stanton, Bonita

2014-07-01

To delineate the trajectories of loneliness and self-esteem over time among children affected by parental HIV and AIDS, and to examine how their perceived social support (PSS) influenced initial scores and change rates of these two psychological outcomes. We collected longitudinal data from children affected by parental HIV/AIDS in rural central China. Children 6-18 years of age at baseline were eligible to participate in the study and were assessed annually for 3 years. Multilevel regression models for change were used to assess the effect of baseline PSS on the trajectories of loneliness and self-esteem over time. We employed maximum likelihood estimates to fit multilevel models and specified the between-individual covariance matrix as 'unstructured' to allow correlation among the different sources of variance. Statistics including -2 Log Likelihood, Akaike Information Criterion and Bayesian Information Criterion were used in evaluating the model fit. The results of multilevel analyses indicated that loneliness scores significantly declined over time. Controlling for demographic characteristics, children with higher PSS reported significantly lower baseline loneliness score and experienced a slower rate of decline in loneliness over time. Children with higher PSS were more likely to report higher self-esteem scores at baseline. However, the self-esteem scores remained stable over time controlling for baseline PSS and all the other variables. The positive effect of PSS on psychological adjustment may imply a promising approach for future intervention among children affected by HIV/AIDS, in which efforts to promote psychosocial well being could focus on children and families with lower social support. We also call for a greater understanding of children's psychological adjustment process in various contexts of social support and appropriate adaptations of evidence-based interventions to meet their diverse needs.

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.

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…

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…

Health related social exclusion in Europe: a multilevel study of the role of welfare generosity

PubMed Central

2013-01-01

Introduction The aim of this paper was to investigate the association between health, social position, social participation and the welfare state. Extending recent research on the social consequences of poor health, we asked whether and how welfare generosity is related to the risk of social exclusion associated with combinations of poor health, low education and economic inactivity. Methods Our analyses are based on data from the European Social Survey, round 3 (2006/7), comprising between 21,205 and 21,397 individuals, aged 25–59 years, within 21 European welfare states. The analyses were conducted by means of multilevel logistic regression analysis in STATA 12. Results The results demonstrated that the risk of non-participation in social networks decreased as welfare generosity increased. The risk of social exclusion, i.e. non-participation in social networks among disadvantaged groups, seldom differed from the overall association, and in absolute terms it was invariably smaller in more generous welfare state contexts. Conclusions The results showed that there were no indications of higher levels of non-participation among disadvantaged groups in more generous welfare states. On the contrary, resources made available by the welfare state seemed to matter to all individuals in terms of overall lower levels of non-participation. As such, these results demonstrate the importance of linking health related social exclusion to the social policy context. PMID:24073744

Health related social exclusion in Europe: a multilevel study of the role of welfare generosity.

PubMed

Saltkjel, Therese; Dahl, Espen; van der Wel, Kjetil A

2013-09-28

The aim of this paper was to investigate the association between health, social position, social participation and the welfare state. Extending recent research on the social consequences of poor health, we asked whether and how welfare generosity is related to the risk of social exclusion associated with combinations of poor health, low education and economic inactivity. Our analyses are based on data from the European Social Survey, round 3 (2006/7), comprising between 21,205 and 21,397 individuals, aged 25-59 years, within 21 European welfare states. The analyses were conducted by means of multilevel logistic regression analysis in STATA 12. The results demonstrated that the risk of non-participation in social networks decreased as welfare generosity increased. The risk of social exclusion, i.e. non-participation in social networks among disadvantaged groups, seldom differed from the overall association, and in absolute terms it was invariably smaller in more generous welfare state contexts. The results showed that there were no indications of higher levels of non-participation among disadvantaged groups in more generous welfare states. On the contrary, resources made available by the welfare state seemed to matter to all individuals in terms of overall lower levels of non-participation. As such, these results demonstrate the importance of linking health related social exclusion to the social policy context.

An Approximate Approach to Automatic Kernel Selection.

PubMed

Ding, Lizhong; Liao, Shizhong

2016-02-02

Kernel selection is a fundamental problem of kernel-based learning algorithms. In this paper, we propose an approximate approach to automatic kernel selection for regression from the perspective of kernel matrix approximation. We first introduce multilevel circulant matrices into automatic kernel selection, and develop two approximate kernel selection algorithms by exploiting the computational virtues of multilevel circulant matrices. The complexity of the proposed algorithms is quasi-linear in the number of data points. Then, we prove an approximation error bound to measure the effect of the approximation in kernel matrices by multilevel circulant matrices on the hypothesis and further show that the approximate hypothesis produced with multilevel circulant matrices converges to the accurate hypothesis produced with kernel matrices. Experimental evaluations on benchmark datasets demonstrate the effectiveness of approximate kernel selection.

Burned Out at the Bedside: Patient Perceptions of Physician Burnout in an Internal Medicine Resident Continuity Clinic.

PubMed

Lafreniere, Justin P; Rios, Rebeca; Packer, Hillary; Ghazarian, Sharon; Wright, Scott M; Levine, Rachel B

2016-02-01

Burnout is high among resident physicians and may be associated with suboptimal patient care and reduced empathy. To investigate the relationship between patient perceptions of empathy and enablement and physician burnout in internal medicine residents. Cross-sectional, survey-based observational study between December 2012 and March 2013 in a resident continuity clinic located within a large urban academic primary care practice in Baltimore, Maryland. Study participants were 44 PGY1-3 residents and a convenience sample of their English-speaking adult primary care patients (N = 244). Patients rated their resident physicians using the Consultation and Relational Empathy Measure (CARE) and the Patient Enablement Instrument (PEI). Residents completed the Maslach Burnout Inventory (MBI). We tested for associations between resident burnout and patients' perceptions of resident empathy (CARE) and enablement (PEI) using multilevel regression analysis. Multilevel regression analyses indicated significant positive associations between physician depersonalization scores on the MBI and patient ratings of empathy (B = 0.28, SE = 0.17, p < 0.001) and enablement (B = 0.11, SE = 0.11, p = 0.02). Emotional exhaustion scores on the MBI were not significantly related to either patient outcome. Patients perceived residents who reported higher levels of depersonalization as more empathic and enabling during their patient care encounters. The relationship between physician distress and patient perceptions of care has important implications for medical education and requires further study.

Multi-level modeling of social factors and preterm delivery in Santiago de Chile

PubMed Central

Kaufman, Jay S; Alonso, Faustino T; Pino, Paulina

2008-01-01

Background Birth before the 37th week of gestation (preterm birth) is an important cause of infant and neonatal mortality, but has been little studied outside of wealthy nations. Chile is an urbanized Latin American nation classified as "middle-income" based on its annual income per capita of about $6000. Methods We studied the relations between maternal social status and neighborhood social status on risk of preterm delivery in this setting using multilevel regression analyses of vital statistics data linked to geocoded decennial census data. The analytic data set included 56,970 births from 2004 in the metropolitan region of Santiago, which constitutes about 70% of all births in the study area and about 25% of all births in Chile that year. Dimensionality of census data was reduced using principal components analysis, with regression scoring to create a single index of community socioeconomic advantage. This was modeled along with years of maternal education in order to predict preterm birth and preterm low birthweight. Results Births in Santiago displayed an advantaged pattern of preterm risk, with only 6.4% of births delivering before 37 weeks. Associations were observed between risk of outcomes and individual and neighborhood factors, but the magnitudes of these associations were much more modest than reported in North America. Conclusion While several potential explanations for this relatively flat social gradient might be considered, one possibility is that Chile's egalitarian approach to universal prenatal care may have reduced social inequalities in these reproductive outcomes. PMID:18842145

State variations in women's socioeconomic status and use of modern contraceptives in Nigeria.

PubMed

Lamidi, Esther O

2015-01-01

According to the 2014 World Population Data Sheet, Nigeria has one of the highest fertility and lowest contraceptive prevalence rates around the world. However, research suggests that national contraceptive prevalence rate overshadows enormous spatial variations in reproductive behavior in the country. I examined the variations in women's socioeconomic status and modern contraceptive use across states in Nigeria. Using the 2013 Nigeria Demographic and Health Survey data (n = 18,910), I estimated the odds of modern contraceptive use among sexually active married and cohabiting women in a series of multilevel logistic regression models. The share of sexually active, married and cohabiting women using modern contraceptives widely varied, from less than one percent in Kano, Yobe, and Jigawa states, to 40 percent in Osun state. Most of the states with low contraceptive prevalence rates also ranked low on women's socioeconomic attributes. Results of multilevel logistic regression analyses showed that women residing in states with greater shares of women with secondary or higher education, higher female labor force participation rates, and more women with health care decision-making power, had significantly higher odds of using modern contraceptives. Differences in women's participation in health care decisions across states remained significantly associated with modern contraceptive use, net of individual-level socioeconomic status and other covariates of modern contraceptive use. Understanding of state variations in contraceptive use is crucial to the design and implementation of family planning programs. The findings reinforce the need for state-specific family planning programs in Nigeria.

Multilevel Hierarchical Modeling of Benthic Macroinvertebrate Responses to Urbanization in Nine Metropolitan Regions across the Conterminous United States

USGS Publications Warehouse

Kashuba, Roxolana; Cha, YoonKyung; Alameddine, Ibrahim; Lee, Boknam; Cuffney, Thomas F.

2010-01-01

Multilevel hierarchical modeling methodology has been developed for use in ecological data analysis. The effect of urbanization on stream macroinvertebrate communities was measured across a gradient of basins in each of nine metropolitan regions across the conterminous United States. The hierarchical nature of this dataset was harnessed in a multi-tiered model structure, predicting both invertebrate response at the basin scale and differences in invertebrate response at the region scale. Ordination site scores, total taxa richness, Ephemeroptera, Plecoptera, Trichoptera (EPT) taxa richness, and richness-weighted mean tolerance of organisms at a site were used to describe invertebrate responses. Percentage of urban land cover was used as a basin-level predictor variable. Regional mean precipitation, air temperature, and antecedent agriculture were used as region-level predictor variables. Multilevel hierarchical models were fit to both levels of data simultaneously, borrowing statistical strength from the complete dataset to reduce uncertainty in regional coefficient estimates. Additionally, whereas non-hierarchical regressions were only able to show differing relations between invertebrate responses and urban intensity separately for each region, the multilevel hierarchical regressions were able to explain and quantify those differences within a single model. In this way, this modeling approach directly establishes the importance of antecedent agricultural conditions in masking the response of invertebrates to urbanization in metropolitan regions such as Milwaukee-Green Bay, Wisconsin; Denver, Colorado; and Dallas-Fort Worth, Texas. Also, these models show that regions with high precipitation, such as Atlanta, Georgia; Birmingham, Alabama; and Portland, Oregon, start out with better regional background conditions of invertebrates prior to urbanization but experience faster negative rates of change with urbanization. Ultimately, this urbanization-invertebrate response example is used to detail the multilevel hierarchical construction methodology, showing how the result is a set of models that are both statistically more rigorous and ecologically more interpretable than simple linear regression models.

Perceived parental monitoring and health risk behavior among public secondary school students in El Salvador.

PubMed

Springer, Andrew E; Sharma, Shreela; de Guardado, Alba Margarita; Nava, Francisco Vázquez; Kelder, Steven H

2006-12-28

Although parental monitoring has received considerable attention in studies of U.S. adolescents, few published studies have examined how parents' knowledge of their children's whereabouts may influence health risk behaviors in adolescents living in Latin America. We investigated the association between perceived parental monitoring and substance use, fighting, and sexual behaviors in rural and urban Salvadoran adolescents (n = 982). After adjusting for several sociodemographic covariates, multilevel regression analyses indicated that students reporting low parental monitoring were between 2 to 3.5 times more likely to report risk behaviors examined. The promotion of specific parenting practices such as parental monitoring may hold promise for reducing adolescent risk behaviors in El Salvador.

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.,…

Multilevel corporate environmental responsibility.

PubMed

Karassin, Orr; Bar-Haim, Aviad

2016-12-01

The multilevel empirical study of the antecedents of corporate social responsibility (CSR) has been identified as "the first knowledge gap" in CSR research. Based on an extensive literature review, the present study outlines a conceptual multilevel model of CSR, then designs and empirically validates an operational multilevel model of the principal driving factors affecting corporate environmental responsibility (CER), as a measure of CSR. Both conceptual and operational models incorporate three levels of analysis: institutional, organizational, and individual. The multilevel nature of the design allows for the assessment of the relative importance of the levels and of their components in the achievement of CER. Unweighted least squares (ULS) regression analysis reveals that the institutional-level variables have medium relationships with CER, some variables having a negative effect. The organizational level is revealed as having strong and positive significant relationships with CER, with organizational culture and managers' attitudes and behaviors as significant driving forces. The study demonstrates the importance of multilevel analysis in improving the understanding of CSR drivers, relative to single level models, even if the significance of specific drivers and levels may vary by context. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Reciprocity between adult generations: family transfers over the life course].

PubMed

Brandt, Martina; Deindl, Christian; Haberkern, Klaus; Szydlik, Marc

2008-10-01

Intergenerational relations are characterised by reciprocal transfers and solidarity over the shared life span. Children care for their elderly parents, and parents support their adult children financially, for example, during their education or when they start their own household and family. From a life course-perspective, we analysed mutual transfers between parents and their adult children: Are transfers balanced over the life course and family-stages? Do we find patterns of direct or indirect reciprocity? Which factors facilitate exchange, and which do not? Using multinomial multilevel regression analyses based on the Survey of Health, Ageing and Retirement in Europe (SHARE) we trace transfers of time and money between parents and adult children back to opportunity, need and family structures. Remaining differences between European countries are explained by cultural contextual structures, here: family expenditures. The exchange between generations is reciprocal, but not necessarily balanced in various phases of family life.

Multilevel Models for Binary Data

ERIC Educational Resources Information Center

Powers, Daniel A.

2012-01-01

The methods and models for categorical data analysis cover considerable ground, ranging from regression-type models for binary and binomial data, count data, to ordered and unordered polytomous variables, as well as regression models that mix qualitative and continuous data. This article focuses on methods for binary or binomial data, which are…

Simulator for multilevel optimization research

NASA Technical Reports Server (NTRS)

Padula, S. L.; Young, K. C.

1986-01-01

A computer program designed to simulate and improve multilevel optimization techniques is described. By using simple analytic functions to represent complex engineering analyses, the simulator can generate and test a large variety of multilevel decomposition strategies in a relatively short time. This type of research is an essential step toward routine optimization of large aerospace systems. The paper discusses the types of optimization problems handled by the simulator and gives input and output listings and plots for a sample problem. It also describes multilevel implementation techniques which have value beyond the present computer program. Thus, this document serves as a user's manual for the simulator and as a guide for building future multilevel optimization applications.

A 2 x 2 Taxonomy of Multilevel Latent Contextual Models: Accuracy-Bias Trade-Offs in Full and Partial Error Correction Models

ERIC Educational Resources Information Center

Ludtke, Oliver; Marsh, Herbert W.; Robitzsch, Alexander; Trautwein, Ulrich

2011-01-01

In multilevel modeling, group-level variables (L2) for assessing contextual effects are frequently generated by aggregating variables from a lower level (L1). A major problem of contextual analyses in the social sciences is that there is no error-free measurement of constructs. In the present article, 2 types of error occurring in multilevel data…

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.

Inner-city green space and its association with body mass index and prevalent type 2 diabetes: a cross-sectional study in an urban German city

PubMed Central

Müller, Grit; Harhoff, Roland; Rahe, Corinna; Berger, Klaus

2018-01-01

Objective The accessibility of green space is an important aspect of the urban residential environment and has been found to be beneficial for health and well-being. This study investigates the association between different indicators of green space and the outcomes body mass index (BMI) and prevalent type 2 diabetes in an urban population. Design Population-based cross-sectional study. Setting Dortmund, a city located in the industrial Ruhr area in Western Germany. Participants 1312 participants aged 25–74 years from the Dortmund Health Study. Methods The participants’ addresses were geocoded and shapefiles of statistical districts, road network and land use, as well as data on neighbourhood characteristics were obtained at baseline. Three indicators of green space were constructed using geographical information systems: proportion of green space, recreation location quotient (RLQ) weighted by population and distance to the next park or forest. Multilevel linear and logistic regression analyses on the association of green space with BMI and type 2 diabetes were performed, adjusted by individual-level characteristics and neighbourhood unemployment rate. Results The multilevel regression analyses showed no association between green space and BMI. In contrast, the three indicators of green space were significantly associated with type 2 diabetes. Residents of neighbourhoods with a low RLQ had a 2.44 (95% CI 1.01 to 5.93) times higher odds to have type 2 diabetes compared with residents of high RLQ neighbourhoods. Likewise, residing more than 0.8 km away from the nearest park or forest increased the odds of type 2 diabetes (OR 1.71, 95% CI 1.05 to 2.77). Conclusions This study indicates that green space and its spatial accessibility might play a role in the development of type 2 diabetes. Further research is needed to clarify this association. PMID:29358439

Inner-city green space and its association with body mass index and prevalent type 2 diabetes: a cross-sectional study in an urban German city.

PubMed

Müller, Grit; Harhoff, Roland; Rahe, Corinna; Berger, Klaus

2018-01-21

The accessibility of green space is an important aspect of the urban residential environment and has been found to be beneficial for health and well-being. This study investigates the association between different indicators of green space and the outcomes body mass index (BMI) and prevalent type 2 diabetes in an urban population. Population-based cross-sectional study. Dortmund, a city located in the industrial Ruhr area in Western Germany. 1312 participants aged 25-74 years from the Dortmund Health Study. The participants' addresses were geocoded and shapefiles of statistical districts, road network and land use, as well as data on neighbourhood characteristics were obtained at baseline. Three indicators of green space were constructed using geographical information systems: proportion of green space, recreation location quotient (RLQ) weighted by population and distance to the next park or forest. Multilevel linear and logistic regression analyses on the association of green space with BMI and type 2 diabetes were performed, adjusted by individual-level characteristics and neighbourhood unemployment rate. The multilevel regression analyses showed no association between green space and BMI. In contrast, the three indicators of green space were significantly associated with type 2 diabetes. Residents of neighbourhoods with a low RLQ had a 2.44 (95% CI 1.01 to 5.93) times higher odds to have type 2 diabetes compared with residents of high RLQ neighbourhoods. Likewise, residing more than 0.8 km away from the nearest park or forest increased the odds of type 2 diabetes (OR 1.71, 95% CI 1.05 to 2.77). This study indicates that green space and its spatial accessibility might play a role in the development of type 2 diabetes. Further research is needed to clarify this association. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Adolescent Substance Use Following Participation in a Universal Drug Prevention Program: Examining Relationships with Program Recall and Baseline Use Status

PubMed Central

Bavarian, Niloofar; Duncan, Robert; Lewis, Kendra M.; Miao, Alicia; Washburn, Isaac J.

2014-01-01

Background We examined whether adolescents receiving a universal, school-based, drug-prevention program in grade 7 varied, by student profile, in substance use behaviors post-program implementation. Profiles were a function of recall of program receipt and substance use at baseline. Methods We analyzed data from the Adolescent Substance Abuse Prevention Study, a large, geographically diverse, longitudinal school-based cluster-randomized controlled trial of the Take Charge of Your Life drug-prevention program. Profiles were created using self-reported substance use (pre-intervention) and program recall (post-intervention) at Grade 7. We first examined characteristics of each of the four profiles of treatment students who varied by program recall and baseline substance use. Using multilevel logistic regression analyses, we examined differences in the odds of substance use (alcohol, tobacco, and marijuana) among student profiles at the six additional study waves (Time 2 (Grade 7) through Time 7 (Grade 11)). Results Pearson’s chi-square tests showed sample characteristics varied by student profile. Multilevel logistic regression results were consistent across all examined substance use behaviors at all time points. Namely, as compared to students who had no baseline substance use and had program recall (No Use, Recall), each of the remaining three profiles (No Use, No Recall; Use, Recall; Use, No Recall) were more likely to engage in substance use. Post-hoc analyses showed that for the two sub-profiles of baseline substance users, there were only two observed, and inconsistent, differences in the odds of subsequent substance use by recall status. Conclusions Findings suggest that for students who were not baseline substance users, program recall significantly decreased the likelihood of subsequent substance use. For students who were baseline substance users, program recall did not generally influence subsequent substance use. Implications for school-based drug prevention programs are discussed. PMID:25148566

Adolescent Substance Use Following Participation in a Universal Drug Prevention Program: Examining Relationships With Program Recall and Baseline Use Status.

PubMed

Bavarian, Niloofar; Duncan, Robert; Lewis, Kendra M; Miao, Alicia; Washburn, Isaac J

2015-01-01

The study examined whether adolescents receiving a universal, school based, drug prevention program in Grade 7 varied, by student profile, in substance use behaviors post program implementation. Profiles were a function of recall of program receipt and substance use at baseline. A secondary analysis was conducted on data from the Adolescent Substance Abuse Prevention Study, a large, geographically diverse, longitudinal school-based cluster-randomized controlled trial of the Take Charge of Your Life drug prevention program. Profiles were created using self-reported substance use (preintervention) and program recall (postintervention) at Grade 7. First, characteristics of each of the 4 profiles of treatment students who varied by program recall and baseline substance use were explored. Then, multilevel logistic regression analyses were used to examine differences in the odds of substance use (alcohol, tobacco, and marijuana) among student profiles at the 6 additional study waves (Time 2 [Grade 7] through Time 7 [Grade 11]). Pearson's chi-square tests showed sample characteristics varied by student profile. Multilevel logistic regression results were consistent across all examined substance use behaviors at all time points. Namely, as compared with students who had no baseline substance use and had program recall (No Use, Recall), each of the remaining 3 profiles (No Use, No Recall; Use, Recall; Use, No Recall) were more likely to engage in substance use. Post hoc analyses showed that for the 2 subprofiles of baseline substance users, there were only 2 observed, and inconsistent, differences in the odds of subsequent substance use by recall status. Findings suggest that for students who were not baseline substance users, program recall significantly decreased the likelihood of subsequent substance use. For students who were baseline substance users, program recall did not generally influence subsequent substance use. Implications for school-based drug prevention programs are discussed.

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.

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.

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

School Collective Efficacy and Bullying Behaviour: A Multilevel Study.

PubMed

Olsson, Gabriella; Låftman, Sara Brolin; Modin, Bitte

2017-12-20

As with other forms of violent behaviour, bullying is the result of multiple influences acting on different societal levels. Yet the majority of studies on bullying focus primarily on the characteristics of individual bullies and bullied. Fewer studies have explored how the characteristics of central contexts in young people's lives are related to bullying behaviour over and above the influence of individual-level characteristics. This study explores how teacher-rated school collective efficacy is related to student-reported bullying behaviour (traditional and cyberbullying victimization and perpetration). A central focus is to explore if school collective efficacy is related similarly to both traditional bullying and cyberbullying. Analyses are based on combined information from two independent data collections conducted in 2016 among 11th grade students ( n = 6067) and teachers ( n = 1251) in 58 upper secondary schools in Stockholm. The statistical method used is multilevel modelling, estimating two-level binary logistic regression models. The results demonstrate statistically significant between-school differences in all outcomes, except traditional bullying perpetration. Strong school collective efficacy is related to less traditional bullying perpetration and less cyberbullying victimization and perpetration, indicating that collective norm regulation and school social cohesion may contribute to reducing the occurrence of bullying.

School Collective Efficacy and Bullying Behaviour: A Multilevel Study

PubMed Central

Olsson, Gabriella; Låftman, Sara Brolin; Modin, Bitte

2017-01-01

As with other forms of violent behaviour, bullying is the result of multiple influences acting on different societal levels. Yet the majority of studies on bullying focus primarily on the characteristics of individual bullies and bullied. Fewer studies have explored how the characteristics of central contexts in young people’s lives are related to bullying behaviour over and above the influence of individual-level characteristics. This study explores how teacher-rated school collective efficacy is related to student-reported bullying behaviour (traditional and cyberbullying victimization and perpetration). A central focus is to explore if school collective efficacy is related similarly to both traditional bullying and cyberbullying. Analyses are based on combined information from two independent data collections conducted in 2016 among 11th grade students (n = 6067) and teachers (n = 1251) in 58 upper secondary schools in Stockholm. The statistical method used is multilevel modelling, estimating two-level binary logistic regression models. The results demonstrate statistically significant between-school differences in all outcomes, except traditional bullying perpetration. Strong school collective efficacy is related to less traditional bullying perpetration and less cyberbullying victimization and perpetration, indicating that collective norm regulation and school social cohesion may contribute to reducing the occurrence of bullying. PMID:29261114

Effects of friendship closeness in an adolescent group HIV prevention intervention.

PubMed

Morrison, Diane M; Casey, Erin A; Beadnell, Blair A; Hoppe, Marilyn J; Gillmore, Mary Rogers; Wilsdon, Anthony; Higa, Darrel; Carlisle, Shauna; Wells, Elizabeth A

2007-12-01

Although many interventions for youth rely, explicitly or implicitly, on group effects, sparse theoretical or empirical attention has been paid to the rationale for choosing a small-group design. The present study assesses the role of friendship closeness among youth in prevention intervention groups in shaping their HIV risk-related attitudes, intentions, perceived self-efficacy and perceived norms. Data from an experimental test of a group HIV prevention intervention are used to assess the relationship of friendship on cognitive outcomes at posttest and 6-month follow-up, in a multilevel regression design. Friendship among group members was assessed at baseline and post-intervention, for youth in the experimental intervention and in a control, career exploration, condition. Level of friendship within the group was positively related to attendance and enjoyment of the intervention in the control group only. Most cognitive outcomes were unaffected by individual or group levels of friendship closeness, but those effects observed were opposite to those desired. Friendly groups were no more likely to converge in their cognitions over time than were less-friendly groups. The need for more research on the effects of friendship on intervention outcomes, and for multilevel analyses of group effects, are discussed.

Psychological distress in the workforce: a multilevel and longitudinal analysis of the case of regulated occupations in Canada.

PubMed

Cadieux, Nathalie; Marchand, Alain

2014-08-07

This study uses a multidimensional theoretical model to evaluate the role of regulated occupations and working conditions in explaining psychological distress. Various multilevel regression analyses were conducted on longitudinal data for which measures repeated over time (n1 = 36,166) were nested in individuals (n2 = 7007). Results showed that when we controlled for working conditions, family situation, the social network outside the workplace, and personal characteristics, the level of psychological distress was significantly lower among professional workers in regulated occupations than among professionals not in regulated occupations. Among the working conditions studied, skill utilisation, psychological demands, and job insecurity were positively associated with psychological distress levels, whereas social support in the workplace was inversely related to distress. Finally, our results suggest that self-esteem reduced the effect of social support in the workplace on psychological distress levels in the workforce. These results support our hypothesis that working in regulated occupations exerts a direct effect on mental health. These results also make clear the importance of developing new tools for measuring psychological distress among upper-level professional workers. Such tools will be much better suited to the realities characterising today's knowledge-based economies.

Longitudinal cognitive biomarkers predicting symptom onset in presymptomatic frontotemporal dementia.

PubMed

Jiskoot, Lize C; Panman, Jessica L; van Asseldonk, Lauren; Franzen, Sanne; Meeter, Lieke H H; Donker Kaat, Laura; van der Ende, Emma L; Dopper, Elise G P; Timman, Reinier; van Minkelen, Rick; van Swieten, John C; van den Berg, Esther; Papma, Janne M

2018-06-01

We performed 4-year follow-up neuropsychological assessment to investigate cognitive decline and the prognostic abilities from presymptomatic to symptomatic familial frontotemporal dementia (FTD). Presymptomatic MAPT (n = 15) and GRN mutation carriers (n = 31), and healthy controls (n = 39) underwent neuropsychological assessment every 2 years. Eight mutation carriers (5 MAPT, 3 GRN) became symptomatic. We investigated cognitive decline with multilevel regression modeling; the prognostic performance was assessed with ROC analyses and stepwise logistic regression. MAPT converters declined on language, attention, executive function, social cognition, and memory, and GRN converters declined on attention and executive function (p < 0.05). Cognitive decline in ScreeLing phonology (p = 0.046) and letter fluency (p = 0.046) were predictive for conversion to non-fluent variant PPA, and decline on categorical fluency (p = 0.025) for an underlying MAPT mutation. Using longitudinal neuropsychological assessment, we detected a mutation-specific pattern of cognitive decline, potentially suggesting prognostic value of neuropsychological trajectories in conversion to symptomatic FTD.

Measurement Development and Validation of the Family Supportive Supervisor Behavior Short-Form (FSSB-SF)

PubMed Central

Hammer, Leslie B.; Kossek, Ellen Ernst; Bodner, Todd; Crain, Tori

2013-01-01

Recently, scholars have demonstrated the importance of Family Supportive Supervisor Behaviors (FSSB), defined as behaviors exhibited by supervisors that are supportive of employees’ family roles, in relation to health, well-being, and organizational outcomes. FSSB was originally conceptualized as a multidimensional, superordinate construct with four subordinate dimensions assessed with 14 items: emotional support, instrumental support, role modeling behaviors, and creative work-family management. Retaining one item from each dimension, two studies were conducted to support the development and use of a new FSSB-Short Form (FSSB-SF). Study 1 draws on the original data from the FSSB validation study of retail employees to determine if the results using the 14-item measure replicate with the shorter 4-item measure. Using data from a sample of 823 information technology professionals and their 219 supervisors, Study 2 extends the validation of the FSSB-SF to a new sample of professional workers and new outcome variables. Results from multilevel confirmatory factor analyses and multilevel regression analyses provide evidence of construct and criterion-related validity of the FSSB-SF, as it was significantly related to work-family conflict, job satisfaction, turnover intentions, control over work hours, obligation to work when sick, perceived stress, and reports of family time adequacy. We argue that it is important to develop parsimonious measures of work-family specific support to ensure supervisor support for work and family is mainstreamed into organizational research and practice. PMID:23730803

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 gender gap in self-rated health and education in Spain. A multilevel analysis.

PubMed

Pinillos-Franco, Sara; García-Prieto, Carmen

2017-01-01

Women tend to report poorer self-rated health than men. It is also well established that education has a positive effect on health. However, the issue of how the benefits of education on health differ between men and women has not received enough attention and the few existing studies which do focus on the subject do not draw a clear conclusion. Therefore, this study aims to analyse whether the positive influence of educational attainment on health is higher for women and whether education helps to overcome the gender gap in self-rated health. We analyse cross-sectional data from the 2012 European Union statistics on income and living conditions. We use a logit regression model with odds ratios and a multilevel perspective to carry out a study which includes several individual and contextual control variables. We focused our study on the working population in Spain aged between 25 and 65. The final sample considered is composed of 14,120 subjects: 7,653 men and 6,467 women. There is a gender gap in self-rated health only for the less educated. This gap is not statistically significant among more highly educated individuals. Attaining a high level of education has the same positive effect on both women's and men's self-rated health. Although we did not find gender disparities when considering the effect of education on health, we show that women's health is poorer among the less educated, mainly due to labour precariousness and household conditions.

Measurement development and validation of the Family Supportive Supervisor Behavior Short-Form (FSSB-SF).

PubMed

Hammer, Leslie B; Ernst Kossek, Ellen; Bodner, Todd; Crain, Tori

2013-07-01

Recently, scholars have demonstrated the importance of Family Supportive Supervisor Behaviors (FSSB), defined as behaviors exhibited by supervisors that are supportive of employees' family roles, in relation to health, well-being, and organizational outcomes. FSSB was originally conceptualized as a multidimensional, superordinate construct with four subordinate dimensions assessed with 14 items: emotional support, instrumental support, role modeling behaviors, and creative work-family management. Retaining one item from each dimension, two studies were conducted to support the development and use of a new FSSB-Short Form (FSSB-SF). Study 1 draws on the original data from the FSSB validation study of retail employees to determine whether the results using the 14-item measure replicate with the shorter 4-item measure. Using data from a sample of 823 information technology professionals and their 219 supervisors, Study 2 extends the validation of the FSSB-SF to a new sample of professional workers and new outcome variables. Results from multilevel confirmatory factor analyses and multilevel regression analyses provide evidence of construct and criterion-related validity of the FSSB-SF, as it was significantly related to work-family conflict, job satisfaction, turnover intentions, control over work hours, obligation to work when sick, perceived stress, and reports of family time adequacy. We argue that it is important to develop parsimonious measures of work-family specific support to ensure supervisor support for work and family is mainstreamed into organizational research and practice. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Socioeconomic inequalities in the impact of tobacco control policies on adolescent smoking. A multilevel study in 29 European countries.

PubMed

Pförtner, Timo-Kolja; Hublet, Anne; Schnohr, Christina Warrer; Rathmann, Katharina; Moor, Irene; de Looze, Margaretha; Baška, Tibor; Molcho, Michal; Kannas, Lasse; Kunst, Anton E; Richter, Matthias

2016-02-01

There are concerns that tobacco control policies may be less effective in reducing smoking among disadvantaged socioeconomic groups and thus may contribute to inequalities in adolescent smoking. This study examines how the association between tobacco control policies and smoking of 15-year-old boys and girls among 29 European countries varies according to socioeconomic group. Data were used from the Health Behaviour in School-aged Children (HBSC) study conducted in 2005/2006 comprising 50,338 adolescents aged 15 years from 29 European countries. Multilevel logistic regression analyses were conducted to assess the association of weekly smoking with components of the Tobacco Control Scale (TCS), and to assess whether this association varied according to family affluence (FAS). Analyses were carried out per gender and adjusted for national wealth and general smoking rate. For boys, tobacco price was negatively associated with weekly smoking rates. This association did not significantly differ between low and high FAS. Levels of tobacco-dependence treatment were significantly associated with weekly smoking. This association varied between low and high FAS, with higher treatment levels associated with higher probability of smoking only for low FAS boys. For girls, no tobacco policy was significantly associated with weekly smoking, irrespective of the FAS. Results indicated that most tobacco control policies are not clearly related to adolescent weekly smoking across European countries. Only tobacco price seemed to be adequate decreasing smoking prevalence among boys, irrespective of their socioeconomic status.

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.

Risk Factors for Child Malnutrition in Bangladesh: A Multilevel Analysis of a Nationwide Population-Based Survey.

PubMed

Chowdhury, Mohammad Rocky Khan; Rahman, Mohammad Shafiur; Khan, Mohammad Mubarak Hossain; Mondal, Mohammad Nazrul Islam; Rahman, Mohammad Mosiur; Billah, Baki

2016-05-01

To identify the prevalence and risk factors of child malnutrition in Bangladesh. Data was extracted from the Bangladesh Demographic Health Survey (2011). The outcome measures were stunting, wasting, and underweight. χ(2) analysis was performed to find the association of outcome variables with selected factors. Multilevel logistic regression models with a random intercept at each of the household and community levels were used to identify the risk factors of stunting, wasting, and underweight. From the 2011 survey, 7568 children less than 5 years of age were included in the current analysis. The overall prevalence of stunting, wasting, and underweight was 41.3% (95% CI 39.0-42.9). The χ(2) test and multilevel logistic regression analysis showed that the variables age, sex, mother's body mass index, mother's educational status, father's educational status, place of residence, socioeconomic status, community status, religion, region of residence, and food security are significant factors of child malnutrition. Children with poor socioeconomic and community status were at higher risk of malnutrition. Children from food insecure families were more likely to be malnourished. Significant community- and household-level variations were found. The prevalence of child malnutrition is still high in Bangladesh, and the risk was assessed at several multilevel factors. Therefore, prevention of malnutrition should be given top priority as a major public health intervention. Copyright © 2016 Elsevier Inc. All rights reserved.

Influence of health providers on pediatrics' immunization rate.

PubMed

Al-lela, Omer Q B; Baidi Bahari, Mohd; Al-abbassi, Mustafa G; Salih, Muhannad R M; Basher, Amena Y

2012-12-01

To identify the immunization providers' characteristics associated with immunization rate in children younger than 2 years. A cohort and a cluster sampling design were implemented; 528 children between 18 and 70 months of age were sampled in five public health clinics in Mosul-Iraq. Providers' characterizations were obtained. Immunization rate for the children was assessed. Risk factors for partial immunization were explored using both bivariate analyses and multi-level logistic regression models. Less than half of the children had one or more than one missed dose, considered as partial immunization cases. The study found significant association of immunization rate with provider's type. Two factors were found that strongly impacted on immunization rate in the presence of other factors: birthplace and immunization providers' type.

Neighborhood deprivation is strongly associated with participation in a population-based health check.

PubMed

Bender, Anne Mette; Kawachi, Ichiro; Jørgensen, Torben; Pisinger, Charlotta

2015-01-01

We sought to examine whether neighborhood deprivation is associated with participation in a large population-based health check. Such analyses will help answer the question whether health checks, which are designed to meet the needs of residents in deprived neighborhoods, may increase participation and prove to be more effective in preventing disease. In Europe, no study has previously looked at the association between neighborhood deprivation and participation in a population-based health check. The study population comprised 12,768 persons invited for a health check including screening for ischemic heart disease and lifestyle counseling. The study population was randomly drawn from a population of 179,097 persons living in 73 neighborhoods in Denmark. Data on neighborhood deprivation (percentage with basic education, with low income and not in work) and individual socioeconomic position were retrieved from national administrative registers. Multilevel regression analyses with log links and binary distributions were conducted to obtain relative risks, intraclass correlation coefficients and proportional change in variance. Large differences between neighborhoods existed in both deprivation levels and neighborhood health check participation rate (mean 53%; range 35-84%). In multilevel analyses adjusted for age and sex, higher levels of all three indicators of neighborhood deprivation and a deprivation score were associated with lower participation in a dose-response fashion. Persons living in the most deprived neighborhoods had up to 37% decreased probability of participating compared to those living in the least deprived neighborhoods. Inclusion of individual socioeconomic position in the model attenuated the neighborhood deprivation coefficients, but all except for income deprivation remained statistically significant. Neighborhood deprivation was associated with participation in a population-based health check in a dose-response manner, in which increasing neighborhood deprivation was associated with decreasing participation. This suggests the need to develop preventive health checks tailored to deprived neighborhoods.

Parent involvement in beginning primary school: Correlates and changes in involvement across the first two years of school in a New Zealand sample.

PubMed

McDowall, Philippa S; Taumoepeau, Mele; Schaughency, Elizabeth

2017-06-01

This study described the relations of parents' and teachers' beliefs and attitudes to forms of parents' involvement in children's first two years of primary school. Parents of children in their first year of primary school (age 5) were recruited from 12 classrooms within four schools in New Zealand; 196 families participated in their child's first year, and 124 families continued to participate in their child's second school year. Parents completed the Family-Involvement Questionnaire, New Zealand, and we archivally collected parent-documented children's oral reading homework. Teachers' rated helpfulness of parents' involvement at school (level 2) and parents' rated teacher invitations to be involved and their perceived time and energy (level 1) contributed to school-based involvement in Year 1 in multilevel models, with parents' rated teacher invitations for involvement also found to predict Year 1 home-school communication in regression analyses. Contributors to Year 1 child-parent reading in multilevel models included level 1 predictors of two or more adults in the home and parents' perceived time and energy. Longitudinal analyses suggested both consistency and change in each form of involvement from Year 1 to Year 2, with increases in each form of involvement found to be associated with increases in parents' and/or teachers' views about involvement in Year 2 in cross-sectional time-series analyses. Implications for schools wanting to engage families are that parents' involvement in children's schooling may be influenced by parents' perceptions of their capacity, teachers' engagement efforts, and the school's climate for involvement. This is a special issue paper "Family Engagement in Education and Intervention". Copyright © 2017 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

Changes in health care utilisation following a reform involving choice and privatisation in Swedish primary care: a five-year follow-up of GP-visits

PubMed Central

2013-01-01

Background The organisation of Swedish primary health care has changed following introduction of free choice of provider for the population in combination with freedom of establishment for private primary care providers. Our aim was to investigate changes in individual health care utilisation following choice and privatisation in Swedish primary care from an equity perspective, in subgroups defined by age, gender and family income. Methods The study is based on register data years 2007 – 2011 from the Skåne Regional Council (population 1.2 million) regarding individual health care utilisation in the form of visits to general practitioner (GP). Health utilisation data was matched with data about individual’s age, gender and family income provided by Statistics Sweden. Multilevel, logistic regression models were constructed to analyse changes in health utilisation in different subgroups and the probability of a GP-visit before and after reform. Results Health care utilisation in terms of both number of individuals that had visited a GP and number of GP-visits per capita increased in all defined subgroups, but to a varying degree. Multilevel logistic regression showed that individuals of both genders aged above 64 and belonging to a family with an income above median had more advantage of the reform, OR 1.25-1.29. Conclusions Reforms involving choice and privatisation in Swedish primary health care improved access to GP-visits generally, but more so for individuals belonging to a family with income above the median. PMID:24171894

Cancer patients use hospital-based care until death: a further analysis of the Dutch Bone Metastasis Study.

PubMed

Meeuse, Jan J; van der Linden, Yvette M; Post, Wendy J; Wanders, Rinus; Gans, Rijk O B; Leer, Jan Willem H; Reyners, Anna K L

2011-10-01

To describe health care utilization (HCU) at the end of life in cancer patients. These data are relevant to plan palliative care services, and to develop training programs for involved health care professionals. The Dutch Bone Metastasis Study (DBMS) was a nationwide study proving equal effectiveness of single fraction palliative radiotherapy compared with multiple fractions for painful bone metastases in 1157 patients. The 860 (74%) patients who died during follow-up were included in the current analysis. The main outcome was the frequency of hospital-based (outpatient contact or admission) and/or general practitioner (GP) contact during the last 12 weeks of life. Changes in HCU towards death were related to data on quality of life and pain intensity using a multilevel regression model. Hospital-based HCU was reported in 1801 (63%) returned questionnaires, whereas GP contact was stated in 1246 (43%). In 573 (20%) questionnaires, both types of HCU were reported. In multilevel regression analyses, the frequency of outpatient contacts remained constant during the weeks towards death, whereas the frequency of GP contacts increased. Lower valuation of quality of life was related to both GP- and hospital-based HCU. There was a high consumption of hospital-based HCU in the last 12 weeks of life of cancer patients with bone metastases. Hospital-based HCU did not decrease during the weeks towards death, despite an increase in GP contacts. Future planning of palliative care and training programs should encompass close collaboration between medical specialists and GPs to optimize end-of-life care.

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.

The importance of proximal fusion level selection for outcomes of multi-level lumbar posterolateral fusion.

PubMed

Nam, Woo Dong; Cho, Jae Hwan

2015-03-01

There are few studies about risk factors for poor outcomes from multi-level lumbar posterolateral fusion limited to three or four level lumbar posterolateral fusions. The purpose of this study was to analyze the outcomes of multi-level lumbar posterolateral fusion and to search for possible risk factors for poor surgical outcomes. We retrospectively analyzed 37 consecutive patients who underwent multi-level lumbar or lumbosacral posterolateral fusion with posterior instrumentation. The outcomes were deemed either 'good' or 'bad' based on clinical and radiological results. Many demographic and radiological factors were analyzed to examine potential risk factors for poor outcomes. Student t-test, Fisher exact test, and the chi-square test were used based on the nature of the variables. Multiple logistic regression analysis was used to exclude confounding factors. Twenty cases showed a good outcome (group A, 54.1%) and 17 cases showed a bad outcome (group B, 45.9%). The overall fusion rate was 70.3%. The revision procedures (group A: 1/20, 5.0%; group B: 4/17, 23.5%), proximal fusion to L2 (group A: 5/20, 25.0%; group B: 10/17, 58.8%), and severity of stenosis (group A: 12/19, 63.3%; group B: 3/11, 27.3%) were adopted as possible related factors to the outcome in univariate analysis. Multiple logistic regression analysis revealed that only the proximal fusion level (superior instrumented vertebra, SIV) was a significant risk factor. The cases in which SIV was L2 showed inferior outcomes than those in which SIV was L3. The odds ratio was 6.562 (95% confidence interval, 1.259 to 34.203). The overall outcome of multi-level lumbar or lumbosacral posterolateral fusion was not as high as we had hoped it would be. Whether the SIV was L2 or L3 was the only significant risk factor identified for poor outcomes in multi-level lumbar or lumbosacral posterolateral fusion in the current study. Thus, the authors recommend that proximal fusion levels be carefully determined when multi-level lumbar fusions are considered.

The Importance of Proximal Fusion Level Selection for Outcomes of Multi-Level Lumbar Posterolateral Fusion

PubMed Central

Nam, Woo Dong

2015-01-01

Background There are few studies about risk factors for poor outcomes from multi-level lumbar posterolateral fusion limited to three or four level lumbar posterolateral fusions. The purpose of this study was to analyze the outcomes of multi-level lumbar posterolateral fusion and to search for possible risk factors for poor surgical outcomes. Methods We retrospectively analyzed 37 consecutive patients who underwent multi-level lumbar or lumbosacral posterolateral fusion with posterior instrumentation. The outcomes were deemed either 'good' or 'bad' based on clinical and radiological results. Many demographic and radiological factors were analyzed to examine potential risk factors for poor outcomes. Student t-test, Fisher exact test, and the chi-square test were used based on the nature of the variables. Multiple logistic regression analysis was used to exclude confounding factors. Results Twenty cases showed a good outcome (group A, 54.1%) and 17 cases showed a bad outcome (group B, 45.9%). The overall fusion rate was 70.3%. The revision procedures (group A: 1/20, 5.0%; group B: 4/17, 23.5%), proximal fusion to L2 (group A: 5/20, 25.0%; group B: 10/17, 58.8%), and severity of stenosis (group A: 12/19, 63.3%; group B: 3/11, 27.3%) were adopted as possible related factors to the outcome in univariate analysis. Multiple logistic regression analysis revealed that only the proximal fusion level (superior instrumented vertebra, SIV) was a significant risk factor. The cases in which SIV was L2 showed inferior outcomes than those in which SIV was L3. The odds ratio was 6.562 (95% confidence interval, 1.259 to 34.203). Conclusions The overall outcome of multi-level lumbar or lumbosacral posterolateral fusion was not as high as we had hoped it would be. Whether the SIV was L2 or L3 was the only significant risk factor identified for poor outcomes in multi-level lumbar or lumbosacral posterolateral fusion in the current study. Thus, the authors recommend that proximal fusion levels be carefully determined when multi-level lumbar fusions are considered. PMID:25729522

Analyzing Multilevel Data: An Empirical Comparison of Parameter Estimates of Hierarchical Linear Modeling and Ordinary Least Squares Regression

ERIC Educational Resources Information Center

Rocconi, Louis M.

2011-01-01

Hierarchical linear models (HLM) solve the problems associated with the unit of analysis problem such as misestimated standard errors, heterogeneity of regression and aggregation bias by modeling all levels of interest simultaneously. Hierarchical linear modeling resolves the problem of misestimated standard errors by incorporating a unique random…

Similarities and differences regarding changes in attachment preferences and attachment styles in relation to romantic relationship length: longitudinal and concurrent analyses.

PubMed

Umemura, Tomotaka; Lacinová, Lenka; Kotrčová, Kristína; Fraley, R Chris

2018-04-01

This study examines whether attachment preferences and attachment styles with different figures (mother, father, romantic partner, and friends) change over the course of a romantic relationship. Study 1 employed a three-wave longitudinal sample of Czech young adults who were currently in a romantic relationship (N = 870; mean age = 21.57; SD = 1.51; 81% females). Multilevel modeling analyses revealed that, as romantic relationships progressed, attachment preferences for romantic partners increased and preferences for friends decreased. However, preferences for the mother or for the father did not change over time. The parallel pattern was found for attachment avoidance; as romantic relationships progressed, attachment avoidance with romantic partners decreased and avoidance with the best friend increased. Avoidance with mother or with father, however, did not change over time. Study 2 employed a cross-sectional international sample (n = 2,593; mean age = 31.99; SD = 12.13; 79% females). Multiple regression analyses replicated the findings of attachment avoidance in the longitudinal data.

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…

Predicting Homework Effort: Support for a Domain-Specific, Multilevel Homework Model

ERIC Educational Resources Information Center

Trautwein, Ulrich; Ludtke, Oliver; Schnyder, Inge; Niggli, Alois

2006-01-01

According to the domain-specific, multilevel homework model proposed in the present study, students' homework effort is influenced by expectancy and value beliefs, homework characteristics, parental homework behavior, and conscientiousness. The authors used structural equation modeling and hierarchical linear modeling analyses to test the model in…

The Influence of Distributed Leadership on Teachers' Organizational Commitment: A Multilevel Approach

ERIC Educational Resources Information Center

Hulpia, Hester; Devos, Geert; Van Keer, Hilde

2009-01-01

In the present study the effects of a cooperative leadership team, distributed leadership, participative decision-making, and context variables on teachers' organizational commitment are investigated. Multilevel analyses on data from 1522 teachers indicated that 9% of the variance in teachers' organizational commitment is attributable to…

The Norwegian Healthier Goats program--modeling lactation curves using a multilevel cubic spline regression model.

PubMed

Nagel-Alne, G E; Krontveit, R; Bohlin, J; Valle, P S; Skjerve, E; Sølverød, L S

2014-07-01

In 2001, the Norwegian Goat Health Service initiated the Healthier Goats program (HG), with the aim of eradicating caprine arthritis encephalitis, caseous lymphadenitis, and Johne's disease (caprine paratuberculosis) in Norwegian goat herds. The aim of the present study was to explore how control and eradication of the above-mentioned diseases by enrolling in HG affected milk yield by comparison with herds not enrolled in HG. Lactation curves were modeled using a multilevel cubic spline regression model where farm, goat, and lactation were included as random effect parameters. The data material contained 135,446 registrations of daily milk yield from 28,829 lactations in 43 herds. The multilevel cubic spline regression model was applied to 4 categories of data: enrolled early, control early, enrolled late, and control late. For enrolled herds, the early and late notations refer to the situation before and after enrolling in HG; for nonenrolled herds (controls), they refer to development over time, independent of HG. Total milk yield increased in the enrolled herds after eradication: the total milk yields in the fourth lactation were 634.2 and 873.3 kg in enrolled early and enrolled late herds, respectively, and 613.2 and 701.4 kg in the control early and control late herds, respectively. Day of peak yield differed between enrolled and control herds. The day of peak yield came on d 6 of lactation for the control early category for parities 2, 3, and 4, indicating an inability of the goats to further increase their milk yield from the initial level. For enrolled herds, on the other hand, peak yield came between d 49 and 56, indicating a gradual increase in milk yield after kidding. Our results indicate that enrollment in the HG disease eradication program improved the milk yield of dairy goats considerably, and that the multilevel cubic spline regression was a suitable model for exploring effects of disease control and eradication on milk yield. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Power, effects, confidence, and significance: an investigation of statistical practices in nursing research.

PubMed

Gaskin, Cadeyrn J; Happell, Brenda

2014-05-01

To (a) assess the statistical power of nursing research to detect small, medium, and large effect sizes; (b) estimate the experiment-wise Type I error rate in these studies; and (c) assess the extent to which (i) a priori power analyses, (ii) effect sizes (and interpretations thereof), and (iii) confidence intervals were reported. Statistical review. Papers published in the 2011 volumes of the 10 highest ranked nursing journals, based on their 5-year impact factors. Papers were assessed for statistical power, control of experiment-wise Type I error, reporting of a priori power analyses, reporting and interpretation of effect sizes, and reporting of confidence intervals. The analyses were based on 333 papers, from which 10,337 inferential statistics were identified. The median power to detect small, medium, and large effect sizes was .40 (interquartile range [IQR]=.24-.71), .98 (IQR=.85-1.00), and 1.00 (IQR=1.00-1.00), respectively. The median experiment-wise Type I error rate was .54 (IQR=.26-.80). A priori power analyses were reported in 28% of papers. Effect sizes were routinely reported for Spearman's rank correlations (100% of papers in which this test was used), Poisson regressions (100%), odds ratios (100%), Kendall's tau correlations (100%), Pearson's correlations (99%), logistic regressions (98%), structural equation modelling/confirmatory factor analyses/path analyses (97%), and linear regressions (83%), but were reported less often for two-proportion z tests (50%), analyses of variance/analyses of covariance/multivariate analyses of variance (18%), t tests (8%), Wilcoxon's tests (8%), Chi-squared tests (8%), and Fisher's exact tests (7%), and not reported for sign tests, Friedman's tests, McNemar's tests, multi-level models, and Kruskal-Wallis tests. Effect sizes were infrequently interpreted. Confidence intervals were reported in 28% of papers. The use, reporting, and interpretation of inferential statistics in nursing research need substantial improvement. Most importantly, researchers should abandon the misleading practice of interpreting the results from inferential tests based solely on whether they are statistically significant (or not) and, instead, focus on reporting and interpreting effect sizes, confidence intervals, and significance levels. Nursing researchers also need to conduct and report a priori power analyses, and to address the issue of Type I experiment-wise error inflation in their studies. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

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.

Use of multilevel logistic regression to identify the causes of differential item functioning.

PubMed

Balluerka, Nekane; Gorostiaga, Arantxa; Gómez-Benito, Juana; Hidalgo, María Dolores

2010-11-01

Given that a key function of tests is to serve as evaluation instruments and for decision making in the fields of psychology and education, the possibility that some of their items may show differential behaviour is a major concern for psychometricians. In recent decades, important progress has been made as regards the efficacy of techniques designed to detect this differential item functioning (DIF). However, the findings are scant when it comes to explaining its causes. The present study addresses this problem from the perspective of multilevel analysis. Starting from a case study in the area of transcultural comparisons, multilevel logistic regression is used: 1) to identify the item characteristics associated with the presence of DIF; 2) to estimate the proportion of variation in the DIF coefficients that is explained by these characteristics; and 3) to evaluate alternative explanations of the DIF by comparing the explanatory power or fit of different sequential models. The comparison of these models confirmed one of the two alternatives (familiarity with the stimulus) and rejected the other (the topic area) as being a cause of differential functioning with respect to the compared groups.

Multilevel regression models describing regional patterns of invertebrate and algal responses to urbanization across the USA

USGS Publications Warehouse

Cuffney, T.F.; Kashuba, R.; Qian, S.S.; Alameddine, I.; Cha, Y.K.; Lee, B.; Coles, J.F.; McMahon, G.

2011-01-01

Multilevel hierarchical regression was used to examine regional patterns in the responses of benthic macroinvertebrates and algae to urbanization across 9 metropolitan areas of the conterminous USA. Linear regressions established that responses (intercepts and slopes) to urbanization of invertebrates and algae varied among metropolitan areas. Multilevel hierarchical regression models were able to explain these differences on the basis of region-scale predictors. Regional differences in the type of land cover (agriculture or forest) being converted to urban and climatic factors (precipitation and air temperature) accounted for the differences in the response of macroinvertebrates to urbanization based on ordination scores, total richness, Ephemeroptera, Plecoptera, Trichoptera richness, and average tolerance. Regional differences in climate and antecedent agriculture also accounted for differences in the responses of salt-tolerant diatoms, but differences in the responses of other diatom metrics (% eutraphenic, % sensitive, and % silt tolerant) were best explained by regional differences in soils (mean % clay soils). The effects of urbanization were most readily detected in regions where forest lands were being converted to urban land because agricultural development significantly degraded assemblages before urbanization and made detection of urban effects difficult. The effects of climatic factors (temperature, precipitation) on background conditions (biogeographic differences) and rates of response to urbanization were most apparent after accounting for the effects of agricultural development. The effects of climate and land cover on responses to urbanization provide strong evidence that monitoring, mitigation, and restoration efforts must be tailored for specific regions and that attainment goals (background conditions) may not be possible in regions with high levels of prior disturbance (e.g., agricultural development). ?? 2011 by The North American Benthological Society.

Examining the Association between School Context, Educational Capacity, and Student Achievement: A Regression Discontinuity Approach

ERIC Educational Resources Information Center

Moriyama, Karen Ito

2009-01-01

In this era of accountability, there is a need to fairly and accurately document the ways that educational systems contribute to student achievement. This study used the regression discontinuity design within a multilevel framework as an alternative approach to estimate school effectiveness by examining the effect of the value added to students'…

Nutritional status of under-five children in Bangladesh: a multilevel analysis.

PubMed

Alom, Jahangir; Quddus, Md Abdul; Islam, Mohammad Amirul

2012-09-01

The nutritional status of under-five children is a sensitive sign of a country's health status as well as economic condition. This study investigated the differential impact of some demographic, socioeconomic, environmental and health-related factors on the nutritional status among under-five children in Bangladesh using Bangladesh Demographic and Health Survey 2007 data. Two-level random intercept binary logistic regression models were used to identify the determinants of under-five malnutrition. The analyses revealed that 16% of the children were severely stunted and 25% were moderately stunted. Among the children under five years of age 3% were severely wasted and 14% were moderately wasted. Furthermore, 11% of the children were severely underweight and 28% were moderately underweight. The main contributing factors for under-five malnutrition were found to be child's age, mother's education, father's education, father's occupation, family wealth index, currently breast-feeding, place of delivery and division. Significant community-level variations were found in the analyses.

Does time of day influence cancer detection and recall rates in mammography?

NASA Astrophysics Data System (ADS)

Stinton, Chris; Jenkinson, David; Adekanmbi, Victor; Clarke, Aileen; Taylor-Phillips, Sian

2017-03-01

Background: The interpretation of screening mammograms is influenced by factors such as reader experience and their annual interpretative volume. There is some evidence that time of day can also have an effect, with better diagnostic accuracy for readings conducted early in the day. This is not a consistent finding, however. The aim of our study is to provide further evidence on whether there is an effect of time of day on recall- and breast cancer detection rates. Method: We analysed breast screening data from 222,577 women from the Midlands of England. Data were split into three eight hour periods: 0900-1700, 1700-0100, 0100-0900. Differences in recall- and cancer detection rates were analysed using multilevel logistic regression models. Results: Recall rates were lowest for mammograms read between the 1700-0100 time period. Cancer detection rates were lowest during the 0100-0900 time period. Conclusions: Our findings suggest that there are fluctuations in recall- and cancer detection rates over the course of the day.

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…

Multilevel Modeling: Overview and Applications to Research in Counseling Psychology

ERIC Educational Resources Information Center

Kahn, Jeffrey H.

2011-01-01

Multilevel modeling (MLM) is rapidly becoming the standard method of analyzing nested data, for example, data from students within multiple schools, data on multiple clients seen by a smaller number of therapists, and even longitudinal data. Although MLM analyses are likely to increase in frequency in counseling psychology research, many readers…

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.

Within-person variation in security of attachment: a self-determination theory perspective on attachment, need fulfillment, and well-being.

PubMed

La Guardia, J G; Ryan, R M; Couchman, C E; Deci, E L

2000-09-01

Attachment research has traditionally focused on individual differences in global patterns of attachment to important others. The current research instead focuses primarily on within-person variability in attachments across relational partners. It was predicted that within-person variability would be substantial, even among primary attachment figures of mother, father, romantic partner, and best friend. The prediction was supported in three studies. Furthermore, in line with self-determination theory, multilevel modeling and regression analyses showed that, at the relationship level, individuals' experience of fulfillment of the basic needs for autonomy, competence, and relatedness positively predicted overall attachment security, model of self, and model of other. Relations of both attachment and need satisfaction to well-being were also explored.

Organizational Culture and Climate and Mental Health Provider Attitudes Toward Evidence-Based Practice

PubMed Central

Aarons, Gregory A.; Sawitzky, Angelina C.

2006-01-01

Mental health provider attitudes toward adopting evidence-based practice (EBP) are associated with organizational context and provider individual differences. Organizational culture and climate are contextual factors that can affect staff acceptance of innovation. This study examined the association of organizational culture and climate with attitudes toward adopting EBP. Participants were 301 public sector mental health service providers from 49 programs providing mental health services for youths and families. Correlation analyses and multilevel hierarchical regressions, controlling for effects of provider characteristics, showed that constructive culture was associated with more positive attitudes toward adoption of EBP and poor organizational climates with perceived divergence of usual practice and EBP. Behavioral health organizations may benefit from consideration of how culture and climate affect staff attitudes toward change in practice. PMID:17183411

Physical Discipline and Children's Adjustment: Cultural Normativeness as a Moderator

PubMed Central

Lansford, Jennifer E.; Chang, Lei; Dodge, Kenneth A.; Malone, Patrick S.; Oburu, Paul; Palmérus, Kerstin; Bacchini, Dario; Pastorelli, Concetta; Bombi, Anna Silvia; Zelli, Arnaldo; Tapanya, Sombat; Chaudhary, Nandita; Deater-Deckard, Kirby; Manke, Beth; Quinn, Naomi

2009-01-01

Interviews were conducted with 336 mother – child dyads (children's ages ranged from 6 to 17 years; mothers' ages ranged from 20 to 59 years) in China, India, Italy, Kenya, the Philippines, and Thailand to examine whether normativeness of physical discipline moderates the link between mothers' use of physical discipline and children's adjustment. Multilevel regression analyses revealed that physical discipline was less strongly associated with adverse child outcomes in conditions of greater perceived normativeness, but physical discipline was also associated with more adverse outcomes regardless of its perceived normativeness. Countries with the lowest use of physical discipline showed the strongest association between mothers' use and children's behavior problems, but in all countries higher use of physical discipline was associated with more aggression and anxiety. PMID:16274437

Remediation for Students With Mathematics Difficulties: An Intervention Study in Middle Schools.

PubMed

Moser Opitz, Elisabeth; Freesemann, Okka; Prediger, Susanne; Grob, Urs; Matull, Ina; Hußmann, Stephan

As empirical studies have consistently shown, low achievement in mathematics at the secondary level can often be traced to deficits in the understanding of certain basic arithmetic concepts taught in primary school. The present intervention study in middle schools evaluated whether such learning deficits can be reduced effectively and whether the type of instruction influences students' progress. The sample consisted of 123 students in 34 classes, split among one control group and two intervention groups: (a) small group instruction and (b) independent work partially integrated into regular classrooms. Over a period of 14 weeks, students were taught basic concepts, such as place value and basic operations. In addition, they practiced fact retrieval and counting (in groups). Multilevel regression analyses demonstrated that the interventions can be used to reduce given deficits.

Organizational Culture and Climate and Mental Health Provider Attitudes Toward Evidence-Based Practice.

PubMed

Aarons, Gregory A; Sawitzky, Angelina C

2006-02-01

Mental health provider attitudes toward adopting evidence-based practice (EBP) are associated with organizational context and provider individual differences. Organizational culture and climate are contextual factors that can affect staff acceptance of innovation. This study examined the association of organizational culture and climate with attitudes toward adopting EBP. Participants were 301 public sector mental health service providers from 49 programs providing mental health services for youths and families. Correlation analyses and multilevel hierarchical regressions, controlling for effects of provider characteristics, showed that constructive culture was associated with more positive attitudes toward adoption of EBP and poor organizational climates with perceived divergence of usual practice and EBP. Behavioral health organizations may benefit from consideration of how culture and climate affect staff attitudes toward change in practice.

Developing soft skill training for salespersons to increase total sales

NASA Astrophysics Data System (ADS)

Mardatillah, A.; Budiman, I.; Tarigan, U. P. P.; Sembiring, A. C.; Hendi

2018-04-01

This research was conducted in the multilevel marketing industry. Unprofessional salespersons behavior and responsibility can ruin the image of the multilevel marketing industry and distrust to the multilevel marketing industry. This leads to decreased company revenue due to lack of public interest in multilevel marketing products. Seeing these conditions, researcher develop training programs to improve the competence of salespersons in making sales. It was done by looking at factors that affect the level of salespersons sales. The research analyzes several factors that influence the salesperson’s sales level: presentation skills, questioning ability, adaptability, technical knowledge, self-control, interaction involvement, sales environment, and intrapersonal skills. Through the analysis of these factors with One Sample T-Test and Multiple Linear Regression methods, researchers design a training program for salespersons to increase their sales. The developed training for salespersons is basic training and special training and before training was given, salespersons need to be assessed for the effectivity and efficiency reasons.

Multilevel poisson regression modelling for determining factors of dengue fever cases in bandung

NASA Astrophysics Data System (ADS)

Arundina, Davila Rubianti; Tantular, Bertho; Pontoh, Resa Septiani

2017-03-01

Scralatina or Dengue Fever is a kind of fever caused by serotype virus which Flavivirus genus and be known as Dengue Virus. Dengue Fever caused by Aedes Aegipty Mosquito bites who infected by a dengue virus. The study was conducted in 151 villages in Bandung. Health Analysts believes that there are two factors that affect the dengue cases, Internal factor (individual) and external factor (environment). The data who used in this research is hierarchical data. The method is used for hierarchical data modelling is multilevel method. Which is, the level 1 is village and level 2 is sub-district. According exploration data analysis, the suitable Multilevel Method is Random Intercept Model. Penalized Quasi Likelihood (PQL) approach on multilevel Poisson is a proper analysis to determine factors that affecting dengue cases in the city of Bandung. Clean and Healthy Behavior factor from the village level have an effect on the number of cases of dengue fever in the city of Bandung. Factor from the sub-district level has no effect.

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.

Individual characteristics, area social participation, and primary non-concordance with medication: a multilevel analysis.

PubMed

Johnell, Kristina; Lindström, Martin; Sundquist, Jan; Eriksson, Charli; Merlo, Juan

2006-03-02

Non-concordance with medication remains a major public health problem that imposes a considerable financial burden on the health care system, and there is still a need for studies on correlates of non-concordance. Our first aim is to analyse whether any of the individual characteristics age, educational level, financial strain, self-rated health, social participation, and trust in the health care system are associated with primary non-concordance with medication. Our second aim is to investigate whether people living in the same area have similar probability of primary non-concordance with medication, that relates to area social participation. We analysed cross sectional data from 9,070 women and 6,795 men aged 18 to 79 years, living in 78 areas in central Sweden, who participated in the Life & Health year 2000 survey, with multilevel logistic regression (individuals at the first level and areas at the second level). Younger age, financial strain, low self-rated health, and low trust in the health care system were associated with primary non-concordance with medication. However, area social participation was not related to primary non-concordance, and the variation in primary non-concordance between the areas was small. Our results indicate that people in central Sweden with younger age, financial difficulties, low self-rated health, and low trust in the health care system may have a higher probability of primary non-concordance with medication. However, the area of residence--as defined by administrative boundaries--seems to play a minor role for primary non-concordance.

Individual characteristics, area social participation, and primary non-concordance with medication: a multilevel analysis

PubMed Central

Johnell, Kristina; Lindström, Martin; Sundquist, Jan; Eriksson, Charli; Merlo, Juan

2006-01-01

Background Non-concordance with medication remains a major public health problem that imposes a considerable financial burden on the health care system, and there is still a need for studies on correlates of non-concordance. Our first aim is to analyse whether any of the individual characteristics age, educational level, financial strain, self-rated health, social participation, and trust in the health care system are associated with primary non-concordance with medication. Our second aim is to investigate whether people living in the same area have similar probability of primary non-concordance with medication, that relates to area social participation. Methods We analysed cross sectional data from 9 070 women and 6 795 men aged 18 to 79 years, living in 78 areas in central Sweden, who participated in the Life & Health year 2000 survey, with multilevel logistic regression (individuals at the first level and areas at the second level). Results Younger age, financial strain, low self-rated health, and low trust in the health care system were associated with primary non-concordance with medication. However, area social participation was not related to primary non-concordance, and the variation in primary non-concordance between the areas was small. Conclusion Our results indicate that people in central Sweden with younger age, financial difficulties, low self-rated health, and low trust in the health care system may have a higher probability of primary non-concordance with medication. However, the area of residence – as defined by administrative boundaries – seems to play a minor role for primary non-concordance. PMID:16512907

Trends and correlates of the public’s perception of healthcare systems in the European Union: a multilevel analysis of Eurobarometer survey data from 2009 to 2013

PubMed Central

AlSaud, AlJohara M; Taddese, Henock B; Filippidis, Filippos T

2018-01-01

Objective The aim of the study is to assess trends in public perceptions of health systems in 27 European Union (EU) member states following the financial crisis (2009–2013), in order to discuss observed changes in the context of the financial crisis. Design Repeated cross-sectional studies. Setting 27 EU countries. Participants EU citizens aged 15 years and older. Methods The study mainly uses the Eurobarometer Social Climate Survey, conducted annually between 2009 and 2013, thereby analysing 116 706 observations. A multilevel logistic regression was carried out to analyse trends over time and the factors associated with citizens’ perceptions of their healthcare systems. Results Europeans generally exhibit positive perceptions of their national healthcare systems, 64.0% (95% CI 63.6% to 64.4%). However, we observed a significant drop in positive perceptions in the years following the crisis, especially within countries most affected by the crisis. Concerning fiscal characteristics, wealthier countries and those dedicating higher proportion of their national income to health were more likely to maintain positive perceptions. At the individual level, perceptions of healthcare systems were significantly associated with respondents’ self-perceptions of their social status, financial capacity and overall satisfaction in life. Conclusions Our finding confirms previous observations that citizens’ perceptions of their healthcare systems may reflect their overall prospects within the broader socioeconomic systems they live in; which have in turn been affected by the financial crisis and the policy measures instituted in response. PMID:29317413

Work-related threats and violence in human service sectors: The importance of the psycho-social work environment examined in a multilevel prospective study.

PubMed

Andersen, Lars Peter; Hogh, Annie; Biering, Karin; Gadegaard, Charlotte Ann

2018-01-01

Threats and violence at work are major concerns for employees in many human service sectors. The prevention of work-related violence is a major challenge for employees and management. The purpose of this study was to identify prospective associations between psycho-social work environment and work-related threats and violence in four high risk human service sectors. Questionnaire data was collected from 3011 employees working at psychiatric wards, in the elder sector, in the Prison and Probation Service and at Special Schools. Associations between psycho-social work environment and work-related violence and threats were then studied using a one-year follow-up design and multilevel logistic regression analyses. The analyses showed that quantitative demands, high emotional demands, low level of influence over own work-situation, low predictability, low rewards at work, low role clarity, many role conflicts, many work-family conflicts and low organizational justice had statistically significant associations with high levels of work-related threats. Furthermore, high emotional demands, low predictability, low role clarity, many role conflicts, many work-family conflicts, low supervisor quality and low support from nearest supervisor had statistically significant associations with high levels of work-related violence. Finally, across the four sectors both similar and different associations between psycho-social work environment and work-related violence and threats were found. The results of the study underline the importance of including the psycho-social work environment as a supplement to existing violence prevention methods and interventions aimed at reducing work-related violence and threats.

Obesity and the Built Environment: Does the Density of Neighborhood Fast-Food Outlets Matter?

PubMed Central

Li, Fuzhong; Harmer, Peter; Cardinal, Bradley J.; Bosworth, Mark; Johnson-Shelton, Deb

2009-01-01

Purpose To examine variation in obesity among older adults relative to the joint influences of density of neighborhood fast-food outlets and residents' behavioral, psychosocial, and sociodemographic characteristics. Design Cross-sectional and multilevel design. Setting Census block groups, used as a proxy for neighborhoods, within the metropolitan region's Urban Growth Boundary in Portland, Oregon. Subjects A total of 1,221 residents (mean age=65 years old) recruited randomly from 120 neighborhoods (48% response rate). Measures A Geographic Information System-based measure of fast-food restaurant density across 120 neighborhoods was created. Residents within the sampled neighborhoods were assessed with respect to their body mass index (BMI), frequency of visits to local fast-food restaurants, fried food consumption, levels of physical activity, self-efficacy of eating fruits and vegetables, household income, and race/ethnicity. Analyses Multilevel logistic regression analyses. Results Significant associations were found between resident-level individual characteristics and the likelihood of being obese (BMI≥30) for neighborhoods with a high-density of fast-food restaurants in comparison to those with a low density: odds ratios [OR] for obesity, 95% confidence interval [CI] were: 1.878 (CI=1.006-3.496) for weekly visits to local fast-food restaurants; 1.792 (CI=1.006-3.190) for not meeting physical activity recommendations; 1.212 (CI=1.057-1.391) for low confidence in eating healthy food; and 8.057 (CI=1.705-38.086) for non-Hispanic black residents. Conclusion Increased density of neighborhood fast-food outlets was associated with unhealthy lifestyles, poorer psychosocial profiles, and increased risk of obesity among older adults. PMID:19149426

Classroom relationship qualities and social-cognitive correlates of defending and passive bystanding in school bullying in Sweden: A multilevel analysis.

PubMed

Thornberg, Robert; Wänström, Linda; Hong, Jun Sung; Espelage, Dorothy L

2017-08-01

Using the social-ecological and social cognitive theories as integrated guiding frameworks, the present study examined whether moral disengagement and defender self-efficacy at the individual level, and moral disengagement, quality of teacher-student relationships and quality of student-student relationships at the classroom level were associated with passive bystanding and defending in bullying situations. Participants were 900 Swedish students from 43 classrooms, ranging in age from 9 to 13years. Multilevel regression analyses revealed that passive reactions by bystanders were associated with greater moral disengagement and less defender self-efficacy. Defending, in turn, was associated with less moral disengagement and greater defender self-efficacy and classroom student-student relationship quality. Furthermore, students who scored high in moral disengagement were even less prone to defend victims when the classroom student-student relationship quality was low, but more prone to act as defenders when the classroom student-student relationship quality was high. In addition, the negative association between defender self-efficacy and passive bystanding was stronger both in classrooms with higher student-student relationship quality and in those with lower class moral disengagement. Implications for prevention are discussed. Copyright © 2017 Society for the Study of School Psychology. All rights reserved.

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.

Inequalities in mortality by socioeconomic factors and Roma ethnicity in the two biggest cities in Slovakia: a multilevel analysis.

PubMed

Rosicova, Katarina; Reijneveld, Sijmen A; Madarasova Geckova, Andrea; Stewart, Roy E; Rosic, Martin; Groothoff, Johan W; van Dijk, Jitse P

2015-11-05

The socioeconomic and ethnic composition of urban neighbourhoods may affect mortality, but evidence on Central European cities is lacking. The aim of this study was to assess the associations between socioeconomic and ethnic neighbourhood indicators and the mortality of individuals aged 20-64 years old in the two biggest cities of the Slovak Republic. We obtained data on the characteristics of neighbourhoods and districts (educational level, unemployment, income and share of Roma) and on individual mortality of residents aged 20-64 years old, for the two largest cities in the Slovak Republic (Bratislava and Kosice) in the period 2003-2005. We performed multilevel Poisson regression analyses adjusted for age and gender on the individual (mortality), neighbourhood (education level and share of Roma in population) and district levels (unemployment and income). The proportions of Roma and of low-educated residents were associated with mortality at the neighbourhood level in both cities. Mutually adjusted, only the association with the proportion of Roma remained in the model (risk ratio 1.02; 95 % confidence interval 1.01-1.04). The area indicators - high education, income and unemployment - were not associated with mortality. The proportion of Roma is associated with early mortality in the two biggest cities in the Slovak Republic.

Insular pathways to health care in the city: a multilevel analysis of access to hospital care in urban Kerala, India.

PubMed

Levesque, Jean-Frédéric; Haddad, Slim; Narayana, Delampady; Fournier, Pierre

2007-07-01

To identify individual and urban unit characteristics associated with access to inpatient care in public and private sectors in urban Kerala, and to discuss policy implications of inequalities in access. We analysed the NSSO survey (1995-1996) for urban Kerala with regard to source and trajectories of hospitalization. Multinomial multilevel regression models were built for 695 cases nested in 24 urban units. Private sector accounts for 62% of hospitalizations. Only 31% of hospitalizations are in free wards and 20% of public hospitalizations involve payment. Hospitalization pathways suggest a segmentation of public and private health markets. Members of poor and casual worker households have lower propensity of hospitalization in paying public wards or private hospitals. There were important variations between cities, with higher odds of private hospitalization in towns with fewer hospital beds overall and in districts with high private-public bed ratios. Cities from districts with better economic indicators and dominance of private services have higher proportion of private hospitalizations. The private sector is the predominant source of inpatient care in urban Kerala. The public sector has an important role in providing access to care for the poor. Investing in the quality of public services is essential to ensure equity in access.

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.

Neighborhood Racial Diversity and Metabolic Syndrome: 2003-2008 National Health and Nutrition Examination Survey.

PubMed

Li, Kelin; Wen, Ming; Fan, Jessie X

2018-03-30

This study investigated the independent association between neighborhood racial/ethnic diversity and metabolic syndrome among US adults, and focused on how this association differed across individual and neighborhood characteristics (i.e., race/ethnicity, sex, age, urbanity, neighborhood poverty). Objectively-measured biomarker data from 2003 to 2008 National Health and Nutrition Examination Survey were linked to census-tract profiles from 2000 decennial census (N = 10,122). Multilevel random intercept logistic regression models were estimated to examine the contextual effects of tract-level racial/ethnic diversity on individual risks of metabolic syndrome. Overall, more than 20% of the study population were identified as having metabolic syndrome, although the prevalence also varied across demographic subgroups and specific biomarkers. Multilevel analyses showed that increased racial/ethnic diversity within a census tract was associated with decreased likelihood of having metabolic syndrome (OR 0.71, 95% CI 0.52-0.96), particularly among female (OR 0.64; 95% CI 0.43-0.96), young adults (OR 0.60; 95% CI 0.39-0.93), and residents living in urban (OR 0.67; 95% CI 0.48-0.93) or poverty neighborhoods (OR 0.54; 95% CI 0.31-0.95). The findings point to the potential benefits of neighborhood racial/ethnic diversity on individual health risks.

Has decentralisation affected child immunisation status in Indonesia?

PubMed

Maharani, Asri; Tampubolon, Gindo

2014-01-01

The past two decades have seen many countries, including a number in Southeast Asia, decentralising their health system with the expectation that this reform will improve their citizens' health. However, the consequences of this reform remain largely unknown. This study analyses the effects of fiscal decentralisation on child immunisation status in Indonesia. We used multilevel logistic regression analysis to estimate these effects, and multilevel multiple imputation to manage missing data. The 2011 publication of Indonesia's national socio-economic survey (Susenas) is the source of household data, while the Podes village census survey from the same year provides village-level data. We supplement these with local government fiscal data from the Ministry of Finance. The findings show that decentralising the fiscal allocation of responsibilities to local governments has a lack of association with child immunisation status and the results are robust. The results also suggest that increasing the number of village health centres (posyandu) per 1,000 population improves probability of children to receive full immunisation significantly, while increasing that of hospitals and health centres (puskesmas) has no significant effect. These findings suggest that merely decentralising the health system does not guarantee improvement in a country's immunisation coverage. Any successful decentralisation demands good capacity and capability of local governments.

Has decentralisation affected child immunisation status in Indonesia?

PubMed Central

Maharani, Asri; Tampubolon, Gindo

2014-01-01

Background The past two decades have seen many countries, including a number in Southeast Asia, decentralising their health system with the expectation that this reform will improve their citizens’ health. However, the consequences of this reform remain largely unknown. Objective This study analyses the effects of fiscal decentralisation on child immunisation status in Indonesia. Design We used multilevel logistic regression analysis to estimate these effects, and multilevel multiple imputation to manage missing data. The 2011 publication of Indonesia's national socio-economic survey (Susenas) is the source of household data, while the Podes village census survey from the same year provides village-level data. We supplement these with local government fiscal data from the Ministry of Finance. Results The findings show that decentralising the fiscal allocation of responsibilities to local governments has a lack of association with child immunisation status and the results are robust. The results also suggest that increasing the number of village health centres (posyandu) per 1,000 population improves probability of children to receive full immunisation significantly, while increasing that of hospitals and health centres (puskesmas) has no significant effect. Conclusion These findings suggest that merely decentralising the health system does not guarantee improvement in a country's immunisation coverage. Any successful decentralisation demands good capacity and capability of local governments. PMID:25160515

African-American women's Upward Economic Mobility and Small for Gestational Age Births: A Population-Based Study.

PubMed

Collins, James W; Mariani, Allison; Rankin, Kristin

2018-03-01

Background The relationship between African-American women's upward economic mobility and small for gestational age (weight for gestational < 10th percentile, SGA) rates is incompletely understood. Objective To ascertain the extent to which African-American women's upward economic mobility from early-life impoverishment is coupled with reduced SGA rates. Methods Stratified and multilevel logistic regression analyses were completed on the Illinois transgenerational dataset of African-American infants (1989-1991) and their Chicago-born mothers (1956-1976) with linked U.S. census income information. Results Impoverished-born (defined as lowest quartile of neighborhood income distribution) African-American women (n = 4891) who remained impoverished by the time of delivery had a SGA rate of 19.7%. Individuals who achieved low (n = 5827), modest (n = 2254), or high (n = 732) upward economic mobility by adulthood had lower SGA rates of 17.2, 14.8, and 13.7%, respectively; RR = 0.9 (0.8-0.9), 0.8 (0.7-0.8), and 0.7 (0.6-0.8), respectively. In adjusted (controlling for traditional individual-level risk factors) multilevel regression models, there was a decreasing linear trend in SGA rates with increasing levels of upward economic mobility; the adjusted RR of SGA birth for impoverished-born African-American women who experienced low, modest, of high (compared to no) upward mobility equaled 0.95 (0.91, 0.99), 0.90 (0.83, 0.98), and 0.86 (0.75, 0.98), respectively, p < 0.05. Conclusions African-American women's upward economic mobility from early-life residence in poor urban communities is associated with lower SGA rates independent of adulthood risk status.

Suburban migration and the birth outcome of Chicago-born white and African-American women: the merit of the healthy migrant theory?

PubMed

Collins, James W; Rankin, Kristin M; Janowiak, Christine M

2013-11-01

The healthy migrant theory posits that women who migrate before pregnancy are intrinsically healthier and therefore have better birth outcomes than those who don't move. Objective. To determine whether migration to the suburbs is associated with lower rates of preterm (<37 weeks) birth among Chicago-born White and African-American mothers. We performed stratified and multilevel logistic regression analyses on an Illinois transgenerational dataset of non-Latino White and African-American infants (1989-1991) and their mothers (1956-1976) with appended US census income information. Forty percent of Chicago-born White mothers (N = 45,135) migrated to Suburban Cook County and 30 % migrated to the more geographically distant collar counties. In contrast, 10 % of Chicago-born African-American mothers (N = 41,221) migrated to Suburban Cook and only two percent migrated to the collar counties. Chicago-born White and African-American migrant mothers to Suburban Cook County had lower preterm birth rates than their non-migrant counterparts; RR = 0.8 (0.8-0.9) and 0.8 (0.7-0.8), respectively. When neighborhood income was singularly taken into account, the protective association of suburban migration and preterm birth disappeared among Chicago-born Whites. In race-specific multilevel multivariate regression models which included neighborhood income, the adjusted odds ratio of preterm birth, low birth weight, and small for gestational-age for Chicago-born White and African-American migrant (compared to non-migrant) mothers approximated unity. Neighborhood income underlies the protective association of suburban migration and birth outcome among Chicago-born White and African-American mothers. These findings do not support the healthy migrant hypothesis of reproductive outcome.

Are environmental influences on physical activity distinct for urban, suburban, and rural schools? A multilevel study among secondary school students in Ontario, Canada.

PubMed

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

2013-05-01

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. Multilevel linear regression analyses were used to examine the environment- and student-level characteristics associated with time spent in PA among grades 9 to 12 students attending 76 secondary schools in Ontario, Canada, as part of the SHAPES-Ontario study. This approach was first conducted with the full data set testing for interactions between environment-level factors and school location. Then, school-location specific regression models were run separately. Statistically significant between-school variation was identified among students attending urban (σ(2) μ0  = 8959.63 [372.46]), suburban (σ(2) μ0  = 8918.75 [186.20]), and rural (σ(2) μ0  = 9403.17 [203.69]) schools, where school-level differences accounted for 4.0%, 2.0%, and 2.1% of the variability in students' time spent in PA, respectively. Students attending an urban or suburban school that provided another room for PA or was located within close proximity to a shopping mall or fast food outlet spent more time in PA. Students' time spent in PA varies by school location and some features of the school environment have a different impact on students' time spent in PA by school location. Developing a better understanding of the environment-level characteristics associated with students' time spent in PA by school location may help public health and planning experts to tailor school programs and policies to the needs of students in different locations. © 2013, American School Health Association.

Institutional delivery in India, 2004-14: unravelling the equity-enhancing contributions of the public sector.

PubMed

Joe, William; Perkins, Jessica M; Kumar, Saroj; Rajpal, Sunil; Subramanian, S V

2018-06-01

To achieve faster and equitable improvements in maternal and child health outcomes, the government of India launched the National Rural Health Mission in 2005. This paper describes the equity-enhancing role of the public sector in increasing use of institutional delivery care services in India between 2004 and 2014. Information on 24 661 births from nationally representative survey data for 2004 and 2014 is analysed. Concentration index is computed to describe socioeconomic-rank-related relative inequalities in institutional delivery and decomposition is used to assess the contributions of public and private sectors in overall socioeconomic inequality. Multilevel logistic regression is applied to examine the changes in socioeconomic gradient between 2004 and 2014. The analysis finds that utilization of institutional delivery care in India increased from 43% in 2004 to 83% in 2014. The bulk of the increase was in public sector use (21% in 2004 to 53% in 2014) with a modest increase in private sector use (22% in 2004 to 30% in 2014). The shift from a pro-rich to pro-poor distribution of public sector use is confirmed. Decomposition analysis indicates that 51% of these reductions in socioeconomic inequality are associated with improved pro-poor distribution of public sector births. Multilevel logistic regressions confirm the disappearance of a wealth-based gradient in public sector births between 2004 and 2014. We conclude that public health investments in India have significantly contributed towards an equitable increase in the coverage of institutional delivery care. Sustained policy efforts are necessary, however, with an emphasis on education, sociocultural and geographical factors to ensure universal coverage of institutional delivery care services in India.

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…

Multilevel Analyses of School and Children's Characteristics Associated with Physical Activity

ERIC Educational Resources Information Center

Gomes, Thayse Natacha; dos Santos, Fernanda K.; Zhu, Weimo; Eisenmann, Joey; Maia, José A. R.

2014-01-01

Background: Children spend most of their awake time at school, and it is important to identify individual and school-level correlates of their physical activity (PA) levels. This study aimed to identify the between-school variability in Portuguese children PA and to investigate student and school PA correlates using multilevel modeling. Methods:…

Multilevel modeling: overview and applications to research in counseling psychology.

PubMed

Kahn, Jeffrey H

2011-04-01

Multilevel modeling (MLM) is rapidly becoming the standard method of analyzing nested data, for example, data from students within multiple schools, data on multiple clients seen by a smaller number of therapists, and even longitudinal data. Although MLM analyses are likely to increase in frequency in counseling psychology research, many readers of counseling psychology journals have had only limited exposure to MLM concepts. This paper provides an overview of MLM that blends mathematical concepts with examples drawn from counseling psychology. This tutorial is intended to be a first step in learning about MLM; readers are referred to other sources for more advanced explorations of MLM. In addition to being a tutorial for understanding and perhaps even conducting MLM analyses, this paper reviews recent research in counseling psychology that has adopted a multilevel framework, and it provides ideas for MLM approaches to future research in counseling psychology. 2011 APA, all rights reserved

Multi-level structure in the large scale distribution of optically luminous galaxies

NASA Astrophysics Data System (ADS)

Deng, Xin-fa; Deng, Zu-gan; Liu, Yong-zhen

1992-04-01

Fractal dimensions in the large scale distribution of galaxies have been calculated with the method given by Wen et al. [1] Samples are taken from CfA redshift survey in northern and southern galactic [2] hemisphere in our analysis respectively. Results from these two regions are compared with each other. There are significant differences between the distributions in these two regions. However, our analyses do show some common features of the distributions in these two regions. All subsamples show multi-level fractal character distinctly. Combining it with the results from analyses of samples given by IRAS galaxies and results from samples given by redshift survey in pencil-beam fields, [3,4] we suggest that multi-level fractal structure is most likely to be a general and important character in the large scale distribution of galaxies. The possible implications of this character are discussed.

Child maltreatment and educational attainment in young adulthood: results from the Ontario Child Health Study.

PubMed

Tanaka, Masako; Georgiades, Katholiki; Boyle, Michael H; MacMillan, Harriet L

2015-01-01

There is increasing evidence for the adverse effects of child maltreatment on academic performance; however, most of these studies used selective samples and did not account for potential confounding or mediating factors. We examined the relationship between child physical abuse (PA; severe and non-severe) and sexual abuse (SA) and educational attainment (years of education, failure to graduate from high school) with a Canadian community sample. We used data from the Ontario Child Health Study (N = 1,893), a province-wide longitudinal survey. Potential confounding variables (family socio-demographic and parental capacity) and child-level characteristics were assessed in 1983, and child abuse was determined in 2000-2001 based on retrospective self-report. Results showed that PA and SA were associated with several factors indicative of social disadvantage in childhood. Multilevel regression analyses for years of education revealed a significant estimate for severe PA based on the unadjusted model (-0.60 years, 95% CI = [-0.45, -0.76]); estimates for non-severe PA (0.05 years, CI = [-0.15, 0.26]) and SA (-0.25 years, CI = [-0.09, -0.42]) were not significant. In the adjusted full model, the only association to reach significance was between severe PA and reduced years of education (-0.31 years, CI = [-0.18, -0.44]). Multilevel regression analyses for failure to graduate from high school showed significant unadjusted estimates for severe PA (OR = 1.77, 95% CI = [1.21, 2.58]) and non-severe PA (OR = 1.61, CI = [1.01, 2.57]); SA was not associated with this outcome (OR = 1.40, CI = [0.94, 2.07]). In the adjusted full models, there were no significant associations between child abuse variables and failure to graduate. The magnitude of effect of PA on both outcomes was reduced largely by child individual characteristics. These findings generally support earlier research, indicating the adverse effects of child maltreatment on educational attainment. Of particular note, severe PA was associated with reduced years of education after accounting for a comprehensive set of potential confounding variables and child characteristics. © The Author(s) 2014.

Country of residence, gender equality and victim blaming attitudes about partner violence: a multilevel analysis in EU.

PubMed

Ivert, Anna-Karin; Merlo, Juan; Gracia, Enrique

2017-09-27

Intimate partner violence against women (IPVAW) is a global and preventable public health problem. Public attitudes, such as victim-blaming, are important for our understanding of differences in the occurrence of IPVAW, as they contribute to its justification. In this paper, we focus on victim-blaming attitudes regarding IPVAW within the EU and we apply multilevel analyses to identify contextual determinants of victim-blaming attitudes. We investigate both the general contextual effect of the country and the specific association between country level of gender equality and individual victim-blaming attitudes, as well as to what extend a possible general contextual effect was explained by county level gender equality. We analyzed data from 26 800 respondents from 27 member states of the European Union who responded to a survey on public perceptions of domestic violence. We applied multilevel logistic regression analysis and measures of variance (intra-class correlation (ICC)) were calculated, as well as the discriminatory accuracy by calculating the area under the receiver operator characteristic curve. Over and above individual characteristics, about 15% of the individual variance in the propensity for having victim-blaming attitudes was found at the country level, and country level of gender equality did not affect the general contextual effect (i.e. ICC) of the country on individual victim-blaming attitudes. The present study shows that there are important between-country differences in victim-blaming attitudes that cannot be explained by differences in individual-level demographics or in gender equality at the country level. More research on attitudes towards IPVAW is needed. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Area-level socioeconomic inequalities in the use of mammography screening: A multilevel analysis of the Health of Houston Survey

PubMed Central

Calo, William A.; Vernon, Sally W.; Lairson, David R.; Linder, Stephen H.

2015-01-01

Background An emerging literature reports that women who reside in socioeconomically deprived communities are less likely to adhere to mammography screening. This study explored associations between area-level socioeconomic measures and mammography screening among a racially and ethnically diverse sample of women in Texas. Methods We conducted a cross-sectional multilevel study linking individual-level data from the 2010 Health of Houston Survey and contextual data from the U.S. Census. Women ages 40–74 years (N=1,541) were included in the analyses. We examined tract-level poverty, unemployment, education, Hispanic and Black composition, female-headed householder families, and crowding as contextual measures. Using multilevel logistic regression modeling, we compared most disadvantaged tracts (quartiles 2–4) to the most advantaged tract (quartile 1). Results Overall, 64% of the sample was adherent to mammography screening. Screening rates were lower (P<.05) among Hispanics, those foreign born, women aged 40–49 years, and those with low educational attainment, unemployed, and without health insurance coverage. Women living in areas with high levels of poverty (quartile 2 vs. quartile 1: OR=0.50; 95% CI: 0.30–0.85), Hispanic composition (quartile 3 vs. quartile 1: OR=0.54; 95% CI: 0.32–0.90), and crowding (quartile 4 vs. quartile 1: OR=0.53; 95% CI: 0.29–0.96) were less likely to have up-to-date mammography screening, net of individual-level factors. Conclusion Our findings highlight the importance of examining area-level socioeconomic inequalities in mammography screening. The study represents an advance on previous research because we examined multiple area measures, controlled for key individual-level covariates, used data aggregated at the tract level, and accounted for the nested structure of the data. PMID:26809487

Parental supply of alcohol and adolescent drinking: a multilevel analysis of nationally representative data.

PubMed

Chan, Gary C K; Leung, Janni; Connor, Jason; Hall, Wayne; Kelly, Adrian B

2017-06-09

Existing research on parental supply of alcohol analyses the effects of self-reported parental supply on adolescent drinking using individual level data. This study examined the contextual effect of parental supply of alcohol on adolescent alcohol use by examining the association between the prevalence of parental supply in each Australian state and adolescent alcohol use using a multilevel analytic framework. Adolescent samples (Age: 12-17) were drawn from the four National Drug Strategy Household Surveys (2004, 2007, 2010 and 2013; N = 6803). The prevalence of parental supply of alcohol, defined as the weighted percentage of sample who reported obtaining alcohol from their parents, was estimated in each state and territory across the four surveys. Three multilevel logistic regressions were used to examine the contextual effects of parental supply prevalence on adolescents' alcohol use in the past 12 months, weekly drinking and heavy drinking. Overall, adolescents' rates of past 12 months alcohol use, heavy drinking and weekly drinking between 2004 and 2013 were 40.1, 14.4 and 6.4% respectively. The prevalence of parental supply was significantly associated with past 12 months alcohol use (OR = 1.06, p < .001) and heavy drinking (OR = 1.04, p < .001) but not with weekly drinking (OR = 1.03, p = .189). The results were adjusted for gender, age, socio-economic index for area, place of birth, survey year and prevalence of peer supply. A high prevalence of parental supply in a region was associated with heavier adolescent drinking, regardless of whether adolescents primarily obtained their alcohol from their own parents.

Bacterial Adherence and Dwelling Probability: Two Drivers of Early Alveolar Infection by Streptococcus pneumoniae Identified in Multi-Level Mathematical Modeling.

PubMed

Santos, Guido; Lai, Xin; Eberhardt, Martin; Vera, Julio

2018-01-01

Pneumococcal infection is the most frequent cause of pneumonia, and one of the most prevalent diseases worldwide. The population groups at high risk of death from bacterial pneumonia are infants, elderly and immunosuppressed people. These groups are more vulnerable because they have immature or impaired immune systems, the efficacy of their response to vaccines is lower, and antibiotic treatment often does not take place until the inflammatory response triggered is already overwhelming. The immune response to bacterial lung infections involves dynamic interactions between several types of cells whose activation is driven by intracellular molecular networks. A feasible approach to the integration of knowledge and data linking tissue, cellular and intracellular events and the construction of hypotheses in this area is the use of mathematical modeling. For this paper, we used a multi-level computational model to analyse the role of cellular and molecular interactions during the first 10 h after alveolar invasion of Streptococcus pneumoniae bacteria. By "multi-level" we mean that we simulated the interplay between different temporal and spatial scales in a single computational model. In this instance, we included the intracellular scale of processes driving lung epithelial cell activation together with the scale of cell-to-cell interactions at the alveolar tissue. In our analysis, we combined systematic model simulations with logistic regression analysis and decision trees to find genotypic-phenotypic signatures that explain differences in bacteria strain infectivity. According to our simulations, pneumococci benefit from a high dwelling probability and a high proliferation rate during the first stages of infection. In addition to this, the model predicts that during the very early phases of infection the bacterial capsule could be an impediment to the establishment of the alveolar infection because it impairs bacterial colonization.

Trimethoprim and ciprofloxacin resistance and prescribing in urinary tract infection associated with Escherichia coli: a multilevel model.

PubMed

Vellinga, Akke; Tansey, Sana; Hanahoe, Belinda; Bennett, Kathleen; Murphy, Andrew W; Cormican, Martin

2012-10-01

Individual and group level factors associated with the probability of antimicrobial resistance of uropathogenic Escherichia coli were analysed in a multilevel model. Adult patients consulting with a suspected urinary tract infection (UTI) in 22 general practices over a 9 month period supplied a urine sample for laboratory analysis. Cases were patients with a UTI associated with a resistant E. coli. Previous antimicrobial exposure and other patient characteristics were recorded from the medical files. Six hundred and thirty-three patients with an E. coli UTI and a full record for all variables were included. Of the E. coli isolates, 36% were resistant to trimethoprim and 12% to ciprofloxacin. A multilevel logistic regression model was fitted. The odds that E. coli was resistant increased with increasing number of prescriptions over the previous year for trimethoprim from 1.4 (0.8-2.2) for one previous prescription to 4.7 (1.9-12.4) for two and 6.4 (2.0-25.4) for three or more. For ciprofloxacin the ORs were 2.7 (1.2-5.6) for one and 6.5 (2.9-14.8) for two or more. The probability that uropathogenic E. coli was resistant showed important variation between practices and a difference of 17% for trimethoprim and 33% for ciprofloxacin was observed for an imaginary patient moving from a practice with low to a practice with high probability. This difference could not be explained by practice prescribing or practice resistance levels. Previous antimicrobial use and the practice visited affect the risk that a patient with a UTI will be diagnosed with an E. coli resistant to this agent, which was particularly important for ciprofloxacin.

Many-level multilevel structural equation modeling: An efficient evaluation strategy.

PubMed

Pritikin, Joshua N; Hunter, Michael D; von Oertzen, Timo; Brick, Timothy R; Boker, Steven M

2017-01-01

Structural equation models are increasingly used for clustered or multilevel data in cases where mixed regression is too inflexible. However, when there are many levels of nesting, these models can become difficult to estimate. We introduce a novel evaluation strategy, Rampart, that applies an orthogonal rotation to the parts of a model that conform to commonly met requirements. This rotation dramatically simplifies fit evaluation in a way that becomes more potent as the size of the data set increases. We validate and evaluate the implementation using a 3-level latent regression simulation study. Then we analyze data from a state-wide child behavioral health measure administered by the Oklahoma Department of Human Services. We demonstrate the efficiency of Rampart compared to other similar software using a latent factor model with a 5-level decomposition of latent variance. Rampart is implemented in OpenMx, a free and open source software.

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

Multilevel Effects of Wealth on Women's Contraceptive Use in Mozambique

PubMed Central

Dias, José G.; de Oliveira, Isabel Tiago

2015-01-01

Objective This paper analyzes the impact of wealth on the use of contraception in Mozambique unmixing the contextual effects due to community wealth from the individual effects associated with the women's situation within the community of residence. Methods Data from the 2011 Mozambican Demographic and Health Survey on women who are married or living together are analyzed for the entire country and also for the rural and urban areas separately. We used single level and multilevel probit regression models. Findings A single level probit regression reveals that region, religion, age, previous fertility, education, and wealth impact contraceptive behavior. The multilevel analysis shows that average community wealth and the women’s relative socioeconomic position within the community have significant positive effects on the use of modern contraceptives. The multilevel framework proved to be necessary in rural settings but not relevant in urban areas. Moreover, the contextual effects due to community wealth are greater in rural than in urban areas and this feature is associated with the higher socioeconomic heterogeneity within the richest communities. Conclusion This analysis highlights the need for the studies on contraceptive behavior to specifically address the individual and contextual effects arising from the poverty-wealth dimension in rural and urban areas separately. The inclusion in a particular community of residence is not relevant in urban areas, but it is an important feature in rural areas. Although the women's individual position within the community of residence has a similar effect on contraceptive adoption in rural and urban settings, the impact of community wealth is greater in rural areas and smaller in urban areas. PMID:25786228

Effects of Individual Nurse and Hospital Characteristics on Patient Adverse Events and Quality of Care: A Multilevel Analysis.

PubMed

Lee, Seung Eun; Vincent, Catherine; Dahinten, V Susan; Scott, Linda D; Park, Chang Gi; Dunn Lopez, Karen

2018-06-14

This study aimed to investigate effects of individual nurse and hospital characteristics on patient adverse events and quality of care using a multilevel approach. This is a secondary analysis of a combination of nurse survey data (N = 1,053 nurses) and facility data (N = 63 hospitals) in Canada. Multilevel ordinal logistic regression was employed to examine effects of individual nurse and hospital characteristics on patient adverse events. Multilevel linear regressions were used to investigate effects of individual nurse and hospital characteristics on quality of care. Organizational safety culture was associated with patient adverse events and quality of care. Controlling for effects of nurse and hospital characteristics, nurses in hospitals with a stronger safety culture were 64% less likely to report administration of wrong medication, time, or dose; 58% less likely to report patient falls with injury; and 60% less likely to report urinary tract infections; and were more likely to report higher levels of quality of care. Additionally, the effects of individual-level baccalaureate education and years of experience on quality of care differed across hospitals, and hospital-level nurse education interacted with individual-level baccalaureate education. This study makes significant contributions to existing knowledge regarding the positive effect of organizational safety culture on patient adverse events and quality of care. Healthcare organizations should strive to improve their safety culture by creating environments where healthcare providers trust each other, work collaboratively, and share accountability for patient safety and care quality. © 2018 Sigma Theta Tau International.

Elder abuse and socioeconomic inequalities: a multilevel study in 7 European countries.

PubMed

Fraga, Sílvia; Lindert, Jutta; Barros, Henrique; Torres-González, Francisco; Ioannidi-Kapolou, Elisabeth; Melchiorre, Maria Gabriella; Stankunas, Mindaugas; Soares, Joaquim F

2014-04-01

To compare the prevalence of elder abuse using a multilevel approach that takes into account the characteristics of participants as well as socioeconomic indicators at city and country level. In 2009, the project on abuse of elderly in Europe (ABUEL) was conducted in seven cities (Stuttgart, Germany; Ancona, Italy; Kaunas, Lithuania, Stockholm, Sweden; Porto, Portugal; Granada, Spain; Athens, Greece) comprising 4467 individuals aged 60-84 years. We used a 3-level hierarchical structure of data: 1) characteristics of participants; 2) mean of tertiary education of each city; and 3) country inequality indicator (Gini coefficient). Multilevel logistic regression was used and proportional changes in Intraclass Correlation Coefficient (ICC) were inspected to assert explained variance between models. The prevalence of elder abuse showed large variations across sites. Adding tertiary education to the regression model reduced the country level variance for psychological abuse (ICC=3.4%), with no significant decrease in the explained variance for the other types of abuse. When the Gini coefficient was considered, the highest drop in ICC was observed for financial abuse (from 9.5% to 4.3%). There is a societal and community level dimension that adds information to individual variability in explaining country differences in elder abuse, highlighting underlying socioeconomic inequalities leading to such behavior. Copyright © 2014 Elsevier Inc. All rights reserved.

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.

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 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.

Prioritization of Evidence-Based Preventive Health Services During Periodic Health Examinations

PubMed Central

Shires, Deirdre A.; Stange, Kurt C.; Divine, George; Ratliff, Scott; Vashi, Ronak; Tai-Seale, Ming; Lafata, Jennifer Elston

2011-01-01

Background Delivery of preventive services sometimes falls short of guideline recommendations. Purpose To evaluate the multilevel factors associated with evidence-based preventive service delivery during periodic health examinations (PHE). Methods Primary care physicians were recruited from an integrated delivery system in southeast Michigan. Office visit audio-recordings of PHE visits conducted from 2007–2009 were used to ascertain physician recommendation for or delivery of 19 guideline-recommended preventive services. Alternating logistic regression was used to evaluate factors associated with service delivery. Data analyses were completed in 2011. Results Among 484 PHE visits to 64 general internal medicine and family physicians by insured patients aged 50–80 years, there were 2662 services for which patients were due; 54% were recommended or delivered. Regression analyses indicated that the likelihood of service delivery decreased with patient age and with each concern the patient raised, and increased with increasing BMI and with each additional minute after scheduled appointment time the physician first presented. The likelihood was greater with patient/physician gender concordance and less if the physician used the electronic medical record in the exam room and had seen the patient in the past 12 months. Conclusions A combination of patient, physician, visit and contextual factors are associated with preventive service delivery. Additional studies are warranted to understand the complex interplay of factors that support and compromise preventive service delivery. PMID:22261213

Growth in Reading Performance during the First Four Years in School. Research Report. ETS RR-07-39

ERIC Educational Resources Information Center

Rock, Donald A.

2007-01-01

This study addressed concerns about the potential for differential gains in reading during the first 2 years of formal schooling (K-1) versus the next 2 years of schooling (1st-3rd grade). A multilevel piecewise regression with a node at spring 1st grade was used in order to define separate regressions for the two time periods. Empirical Bayes…

The interplay between neighbourhood characteristics: The health impact of changes in social cohesion, disorder and unsafety feelings.

PubMed

Ruijsbroek, Annemarie; Droomers, Mariël; Hardyns, Wim; Groenewegen, Peter P; Stronks, Karien

2016-05-01

This study examined how the health of Dutch residents in 2012 was influenced by changes in neighbourhood social cohesion, disorder, and unsafety feelings between 2009 and 2011. Multilevel regression analyses on repeated cross-sectional survey data included 43,635 respondents living in 2100 areas. Deteriorating social cohesion and unsafety feelings were negatively associated with general health, while improvement in social cohesion was associated with better general health of the population. When the interplay of neighbourhood features was considered, deteriorating neighbourhood safety appeared decisive for health, i.e. improving social cohesion did not mitigate the health effect of deteriorating neighbourhood safety. Our results show it is important to take concurrent interactions between neighbourhood features into account when examining their health impact. Copyright © 2016 Elsevier Ltd. All rights reserved.

Parents' work patterns and adolescent mental health.

PubMed

Dockery, Alfred; Li, Jianghong; Kendall, Garth

2009-02-01

Previous research demonstrates that non-standard work schedules undermine the stability of marriage and reduce family cohesiveness. Limited research has investigated the effects of parents working non-standard schedules on children's health and wellbeing and no published Australian studies have addressed this important issue. This paper contributes to bridging this knowledge gap by focusing on adolescents aged 15-20 years and by including sole parent families which have been omitted in previous research, using panel data from the Household, Income and Labour Dynamics in Australia Survey. Multilevel linear regression models are estimated to analyse the association between parental work schedules and hours of work and measures of adolescents' mental health derived from the SF-36 Health Survey. Evidence of negative impacts of parents working non-standard hours upon adolescent wellbeing is found to exist primarily within sole parent families.

Sexual objectification in women's daily lives: A smartphone ecological momentary assessment study.

PubMed

Holland, Elise; Koval, Peter; Stratemeyer, Michelle; Thomson, Fiona; Haslam, Nick

2017-06-01

Sexual objectification, particularly of young women, is highly prevalent in modern industrialized societies. Although there is plenty of experimental and cross-sectional research on objectification, prospective studies investigating the prevalence and psychological impact of objectifying events in daily life are scarce. We used ecological momentary assessment to track the occurrence of objectifying events over 1 week in the daily lives of young women (N = 81). Participants reported being targeted by a sexually objectifying event - most often the objectifying gaze - approximately once every 2 days and reported witnessing sexual objectification of others approximately 1.35 times per day. Further, multilevel linear regression analyses showed that being targeted by sexual objectification was associated with a substantial increase in state self-objectification. Overall, individual differences had little impact in moderating these effects. © 2016 The British Psychological Society.

Do observed or perceived characteristics of the neighborhood environment mediate associations between neighborhood poverty and cumulative biological risk?

PubMed Central

Schulz, Amy J.; Mentz, Graciela; Lachance, Laurie; Zenk, Shannon N.; Johnson, Jonetta; Stokes, Carmen; Mandell, Rebecca

2013-01-01

Objective To examine contributions of observed and perceived neighborhood characteristics in explaining associations between neighborhood poverty and cumulative biological risk (CBR) in an urban community. Methods Multilevel regression analyses were conducted using cross-sectional data from a probability sample survey (n=919), and observational and census data. Dependent variable: CBR. Independent variables: Neighborhood disorder, deterioration and characteristics; perceived neighborhood social environment, physical environment, and neighborhood environment. Covariates: Neighborhood and individual demographics, health-related behaviors. Results Observed and perceived indicators of neighborhood conditions were significantly associated with CBR, after accounting for both neighborhood and individual level socioeconomic indicators. Observed and perceived neighborhood environmental conditions mediated associations between neighborhood poverty and CBR. Conclusions Findings were consistent with the hypothesis that neighborhood conditions associated with economic divestment mediate associations between neighborhood poverty and CBR. PMID:24100238

A large-scale evaluation of the KiVa antibullying program: grades 4-6.

PubMed

Kärnä, Antti; Voeten, Marinus; Little, Todd D; Poskiparta, Elisa; Kaljonen, Anne; Salmivalli, Christina

2011-01-01

This study demonstrates the effectiveness of the KiVa antibullying program using a large sample of 8,237 youth from Grades 4-6 (10-12 years). Altogether, 78 schools were randomly assigned to intervention (39 schools, 4,207 students) and control conditions (39 schools, 4,030 students). Multilevel regression analyses revealed that after 9 months of implementation, the intervention had consistent beneficial effects on 7 of the 11 dependent variables, including self- and peer-reported victimization and self-reported bullying. The results indicate that the KiVa program is effective in reducing school bullying and victimization in Grades 4-6. Despite some evidence against school-based interventions, the results suggest that well-conceived school-based programs can reduce victimization. © 2011 The Authors. Child Development © 2011 Society for Research in Child Development, Inc.

Effects of AlcoholEdu for College on Alcohol-Related Problems Among Freshmen: A Randomized Multicampus Trial*

PubMed Central

Paschall, Mallie J.; Antin, Tamar; Ringwalt, Christopher L.; Saltz, Robert F.

2011-01-01

Objective: AlcoholEdu for College is a 2- to 3-hour online course for incoming college freshmen. This study was the first multicampus trial to examine effects of AlcoholEdu for College on alcohol-related problems among freshmen. Method: Thirty universi participated in the study. Fifteen were randomly assigned to receive AlcoholEdu, and the other 15 were assigned to the control condition. AlcoholEdu was implemented by intervention schools during the summer and/or fall semester. Cross-sectional surveys of freshmen were conducted at each university beginning before the intervention in spring 2008/2009; post-intervention surveys were administered in fall 2008/2009 and spring 2009/2010. The surveys included questions about the past-30-day frequency of 28 alcohol-related problems, from which we created indices for the total number of problems and problems in seven domains: physiological, academic, social, driving under the influence/riding with drinking drivers, aggression, sexual risk taking, and victimization. Multilevel Poisson regression analyses were conducted to examine intent-to-treat and dosage effects of AlcoholEdu for College on these outcomes. Results: Multilevel intent-to-treat analyses indicated significant reductions in the risk for past-30-day alcohol problems in general and problems in the physiological, social, and victimization domains during the fall semester immediately after completion of the course. However, these effects did not persist in the spring semester. Additional analyses suggested stronger AlcoholEdu effects on these outcomes at colleges with higher rates of student course completion. No AlcoholEdu effects were observed for alcohol-related problems in the other four domains. Conclusions: AlcoholEdu for College appears to have beneficial short-term effects on victimization and the most common types of alcohol-related problems among freshmen. Universities may benefit the most by mandating AlcoholEdu for College for all incoming freshmen and by implementing this online course along with environmental prevention strategies. PMID:21683046

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.

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…

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,…

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.…

Trends and correlates of the public's perception of healthcare systems in the European Union: a multilevel analysis of Eurobarometer survey data from 2009 to 2013.

PubMed

AlSaud, AlJohara M; Taddese, Henock B; Filippidis, Filippos T

2018-01-08

The aim of the study is to assess trends in public perceptions of health systems in 27 European Union (EU) member states following the financial crisis (2009-2013), in order to discuss observed changes in the context of the financial crisis. Repeated cross-sectional studies. 27 EU countries. EU citizens aged 15 years and older. The study mainly uses the Eurobarometer Social Climate Survey, conducted annually between 2009 and 2013, thereby analysing 116 706 observations. A multilevel logistic regression was carried out to analyse trends over time and the factors associated with citizens' perceptions of their healthcare systems. Europeans generally exhibit positive perceptions of their national healthcare systems, 64.0% (95% CI 63.6% to 64.4%). However, we observed a significant drop in positive perceptions in the years following the crisis, especially within countries most affected by the crisis. Concerning fiscal characteristics, wealthier countries and those dedicating higher proportion of their national income to health were more likely to maintain positive perceptions. At the individual level, perceptions of healthcare systems were significantly associated with respondents' self-perceptions of their social status, financial capacity and overall satisfaction in life. Our finding confirms previous observations that citizens' perceptions of their healthcare systems may reflect their overall prospects within the broader socioeconomic systems they live in; which have in turn been affected by the financial crisis and the policy measures instituted in response. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Role Stress and Emotional Exhaustion Among Health Care Workers: The Buffering Effect of Supportive Coworker Climate in a Multilevel Perspective.

PubMed

Portoghese, Igor; Galletta, Maura; Burdorf, Alex; Cocco, Pierluigi; D'Aloja, Ernesto; Campagna, Marcello

2017-10-01

The aim of the study was to examine the relationship between role stress, emotional exhaustion, and a supportive coworker climate among health care workers, by adopting a multilevel perspective. Aggregated data of 738 health care workers nested within 67 teams of three Italian hospitals were collected. Multilevel regression analysis with a random intercept model was used. Hierarchical linear modeling showed that a lack of role clarity was significantly linked to emotional exhaustion at the individual level. At the unit level, the cross-level interaction revealed that a supportive coworker climate moderated the relationship between lack of role clarity and emotional exhaustion. This study supports previous results of single-level burnout studies, extending the existing literature with evidence on the multidimensional and cross-level interaction associations of a supportive coworker climate as a key aspect of job resources on burnout.

[Are new forms of primary health care organization (PHLU) associated with a better health care experience for patients with chronic diseases in Quebec?].

PubMed

Pineault, Raynald; Da Silva, Roxane Borgés; Provost, Sylvie; Fournier, Michel; Prud'homme, Alexandre

2015-01-01

To assess the extent to which new forms of PHC organization - Family medicine groups (FMG) and Network clinics (NC) - established in Quebec since 2003, are associated with a better experience of care than other forms of PHC organization, for patients with chronic diseases. Two surveys were conducted in 2010 in two regions of Quebec: the first among 9,180 residents and the second among 606 PHC organizations. Indices of experience of care were constructed concerning accessibility, continuity, comprehensiveness and perceived outcomes. Five categories of chronic diseases were selected. Descriptive analyses and multilevel regression analyses were conducted to compare the different forms of PHC organization. Individuals with chronic diseases tend to report a better experience of care than those without chronic diseases for all dimensions except for accessibility. FMGs compare to group practices on all dimensions and NCs are associated with a poorer experience of care on most dimensions. Experience of care associated with FMGs and NCs is not superior to that associated with group practices.

Cell-phone vs microphone recordings: Judging emotion in the voice.

PubMed

Green, Joshua J; Eigsti, Inge-Marie

2017-09-01

Emotional states can be conveyed by vocal cues such as pitch and intensity. Despite the ubiquity of cellular telephones, there is limited information on how vocal emotional states are perceived during cell-phone transmissions. Emotional utterances (neutral, happy, angry) were elicited from two female talkers and simultaneously recorded via microphone and cell-phone. Ten-step continua (neutral to happy, neutral to angry) were generated using the straight algorithm. Analyses compared reaction time (RT) and emotion judgment as a function of recording type (microphone vs cell-phone). Logistic regression revealed no judgment differences between recording types, though there were interactions with emotion type. Multi-level model analyses indicated that RT data were best fit by a quadratic model, with slower RT at the middle of each continuum, suggesting greater ambiguity, and slower RT for cell-phone stimuli across blocks. While preliminary, results suggest that critical acoustic cues to emotion are largely retained in cell-phone transmissions, though with effects of recording source on RT, and support the methodological utility of collecting speech samples by phone.

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.

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.

School demands and subjective health complaints among Swedish schoolchildren: a multilevel study.

PubMed

Eriksson, Ulrika; Sellström, Eva

2010-06-01

As children spend a great deal of their time in school, the climate in the classroom can constitute a resource, but also a risk factor in the development of the pupils' health. The aim of the present study was to determine the extent to which demands in the classroom are associated with subjective health complaints in Swedish schoolchildren. Data from the 2001/2002 and 2005/2006 Swedish cross-national Health Behaviour in School-aged Children (HBSC) survey were analysed using a multilevel logistic regression technique. The study demonstrated a substantial variation between school classes in pupils' subjective health complaints. In school classes with high demands, the odds of having subjective health complaints was about 50% higher than in school classes with low demands. Further, the results indicated that these effects were mediated by sex so as to girls being more affected by high levels of demands in the school class. The findings are important since they point at the crucial role that teachers play in creating a favourable school climate. Therefore interventions aiming at supporting teachers to set realistic demands and expectations are one way to improve the school climate. Such interventions should also make clear the need to take into consideration the fact that the school class effect was mediated by sex, i.e. girls being more vulnerable to high level of school class demands.

The effects of sports participation on the development of left ventricular mass in adolescent boys.

PubMed

Valente-Dos-Santos, João; Coelho-E-Silva, Manuel J; Castanheira, Joaquim; Machado-Rodrigues, Aristides M; Cyrino, Edilson S; Sherar, Lauren B; Esliger, Dale W; Elferink-Gemser, Marije T; Malina, Robert M

2015-01-01

To examine the contribution of body size, biological maturation, and nonelite sports participation to longitudinal changes of left ventricular mass (LVM) in healthy boys. One hundred and ten boys (11.0-14.5 years at baseline) were assessed biannually for 2 years. Stature, body mass, and four skinfolds were measured. Lean body mass (LBM) was estimated. Biological maturation was assessed as years from age at peak height velocity (APHV). Sports participation was assessed by questionnaire. LVM was obtained from M-mode echocardiograms using two-dimensional images. To account for the repeated measures within individual nature of longitudinal data, multilevel random effects regression analyses were used in the analysis. LVM increased on average 42 ± 18 g from 11 to 15 years (P < 0.05) and 76 ± 14 g from 3.5 years pre-APHV to 1.5 years post-APHV (P < 0.05). The multilevel model with the best statistical fit (Model B) showed that changes of 1 cm in stature, 1 year post-APHV, and 1 kg of LBM predicts 4.7, 0.5, and 1 g of LVM (P < 0.05), respectively. Among healthy, male adolescents aged 11-15 years individual differences in growth and biological maturation influence growth of LVM. Subcutaneous adiposity and sports participation were not associated with greater LVM. © 2015 Wiley Periodicals, Inc.

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.

Governance Dynamics and the Application of the Multilevel Governance Approach in Vocational Education and Training (VET) in the European Neighbourhood Countries: The Case of the ENPI South Region

ERIC Educational Resources Information Center

Galvin Arribas, J. Manuel

2016-01-01

This article analyses moves towards good multilevel governance approaches in Vocational Education and Training (VET) as an effective way to improve VET policy making in transition and developing countries, focusing on the Southern Neighbourhood of the EU (ENPI South). The centralised approaches in public administration and to VET governance still…

Multilevel models for cost-effectiveness analyses that use cluster randomised trial data: An approach to model choice.

PubMed

Ng, Edmond S-W; Diaz-Ordaz, Karla; Grieve, Richard; Nixon, Richard M; Thompson, Simon G; Carpenter, James R

2016-10-01

Multilevel models provide a flexible modelling framework for cost-effectiveness analyses that use cluster randomised trial data. However, there is a lack of guidance on how to choose the most appropriate multilevel models. This paper illustrates an approach for deciding what level of model complexity is warranted; in particular how best to accommodate complex variance-covariance structures, right-skewed costs and missing data. Our proposed models differ according to whether or not they allow individual-level variances and correlations to differ across treatment arms or clusters and by the assumed cost distribution (Normal, Gamma, Inverse Gaussian). The models are fitted by Markov chain Monte Carlo methods. Our approach to model choice is based on four main criteria: the characteristics of the data, model pre-specification informed by the previous literature, diagnostic plots and assessment of model appropriateness. This is illustrated by re-analysing a previous cost-effectiveness analysis that uses data from a cluster randomised trial. We find that the most useful criterion for model choice was the deviance information criterion, which distinguishes amongst models with alternative variance-covariance structures, as well as between those with different cost distributions. This strategy for model choice can help cost-effectiveness analyses provide reliable inferences for policy-making when using cluster trials, including those with missing data. © The Author(s) 2013.

Exposure to a multi-level multi-component childhood obesity prevention community-randomized controlled trial: patterns, determinants, and implications.

PubMed

Trude, Angela Cristina Bizzotto; Kharmats, Anna Yevgenyevna; Jones-Smith, Jessica C; Gittelsohn, Joel

2018-05-22

For community interventions to be effective in real-world conditions, participants need to have sufficient exposure to the intervention. It is unclear how the dose and intensity of the intervention differ among study participants in low-income areas. We aimed to understand patterns of exposure to different components of a multi-level multi-component obesity prevention program to inform our future impact analyses. B'more Healthy Communities for Kids (BHCK) was a community-randomized controlled trial implemented in 28 low-income zones in Baltimore in two rounds (waves). Exposure to three different intervention components (corner store/carryout restaurants, social media/text messaging, and youth-led nutrition education) was assessed via post-intervention interviews with 385 low-income urban youths and their caregivers. Exposure scores were generated based on self-reported viewing of BHCK materials (posters, handouts, educational displays, and social media posts) and participating in activities, including taste tests during the intervention. For each intervention component, points were assigned for exposure to study materials and activities, then scaled (0-1 range), yielding an overall BHCK exposure score [youths: mean 1.1 (range 0-7.6 points); caregivers: 1.1 (0-6.7), possible highest score: 13]. Ordered logit regression analyses were used to investigate correlates of youths' and caregivers' exposure level (quartile of exposure). Mean intervention exposure scores were significantly higher for intervention than comparison youths (mean 1.6 vs 0.5, p < 0.001) and caregivers (mean 1.6 vs 0.6, p < 0.001). However, exposure scores were low in both groups and 10% of the comparison group was moderately exposed to the intervention. For each 1-year increase in age, there was a 33% lower odds of being highly exposed to the intervention (odds ratio 0.77, 95% confidence interval 0.69; 0.88) in the unadjusted and adjusted model controlling for youths' sex and household income. Treatment effects may be attenuated in community-based trials, as participants may be differentially exposed to intervention components and the comparison group may also be exposed. Exposure should be measured to provide context to impact evaluations in multi-level trials. Future analyses linking exposure scores to the outcome should control for potential confounders in the treatment-on-the-treated approach, while recognizing that confounding and selection bias may exist affecting causal inference. ClinicalTrials.gov, NCT02181010 . Retrospectively registered on 2 July 2014.

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.

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.

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.

A tutorial on count regression and zero-altered count models for longitudinal substance use data

PubMed Central

Atkins, David C.; Baldwin, Scott A.; Zheng, Cheng; Gallop, Robert J.; Neighbors, Clayton

2012-01-01

Critical research questions in the study of addictive behaviors concern how these behaviors change over time - either as the result of intervention or in naturalistic settings. The combination of count outcomes that are often strongly skewed with many zeroes (e.g., days using, number of total drinks, number of drinking consequences) with repeated assessments (e.g., longitudinal follow-up after intervention or daily diary data) present challenges for data analyses. The current article provides a tutorial on methods for analyzing longitudinal substance use data, focusing on Poisson, zero-inflated, and hurdle mixed models, which are types of hierarchical or multilevel models. Two example datasets are used throughout, focusing on drinking-related consequences following an intervention and daily drinking over the past 30 days, respectively. Both datasets as well as R, SAS, Mplus, Stata, and SPSS code showing how to fit the models are available on a supplemental website. PMID:22905895

The Relation Between Aggression and the Living Group Climate in a Forensic Treatment Unit for Adolescents: A Pilot Study.

PubMed

de Decker, An; Lemmens, Lisa; van der Helm, Peer; Bruckers, Liesbeth; Molenberghs, Geert; Tremmery, Sabine

2018-05-01

In the current study, the associations between inpatient aggression and the living group climate as perceived by the adolescents admitted to a forensic psychiatric treatment unit, are investigated based on carefully registered longitudinal data. Multilevel regression analyses revealed a significant inverse relation between the number and severity of aggressive incidents and the amount of support, as well as with the possibilities of growth perceived by the adolescents. No significant associations of aggression and the perception of repression or atmosphere are found. Our study reveals preliminary evidence for the relation between the prevalence of aggressive incidents and how the adolescents perceive social contextual factors in daily forensic treatment practices. Moreover, preliminary evidence that evidence-based treatment programs and psychiatric care have an important influence on experienced possibilities for growth and support and as such prevent institutional aggression, is found.

Delinquency in context; neighbourhood and gender interactions among adolescents.

PubMed

Drukker, Marjan; Kaplan, Charles D; Feron, Frans J M; Van Os, Jim; Korebrits, Andries

2010-01-01

Delinquency among adolescents and antecedent conduct disorder among children has been recognized as a growing public mental health problem in contemporary societies. The contribution of the neighbourhood environment to delinquent behaviour was examined in a cohort of Dutch adolescents (aged approximately 11 years at baseline; n = 394). Multilevel regression analyses estimated associations between baseline neighbourhood socioeconomic status and social capital, and delinquent behaviour two years later controlling for individual-level variables. A significant interaction effect was found between neighbourhood environment variables and gender in models of delinquency, indicating that associations between neighbourhood environment variables and delinquency were apparent, for the most part, in girls only. However, higher level of neighbourhood informal social control was associated with increased delinquency rates in boys. In girls there is a longitudinal association between neighbourhood characteristics and delinquency, suggesting complex gender differences in the way the wider social environment impacts on behavioural outcomes.

Human maternal behaviour is associated with arginine vasopressin receptor 1A gene.

PubMed

Avinun, Reut; Ebstein, Richard P; Knafo, Ariel

2012-10-23

Parenting is one of the main influences on children's early development, and yet its underlying genetic mechanisms have only recently begun to be explored, with many studies neglecting to control for possible child effects. This study focuses on maternal behaviour and on an allele at the RS3 promoter region of the arginine vasopressin receptor 1A (AVPR1A) gene, previously associated with autism and with higher amygdala activation in a face-matching task. Mothers were observed during a free-play session with each of their 3.5-year-old twins. Multilevel regression analyses revealed that mothers who are carriers of the AVPR1A RS3 allele tend to show less structuring and support throughout the interaction independent of the child's sex and RS3 genotype. This finding advances our understanding of the genetic influences on human maternal behaviour.

Composition, concentration and deprivation: exploring their association with social cohesion among different ethnic groups in the UK.

PubMed

Bécares, Laia; Stafford, Mai; Laurence, James; Nazroo, James

2011-01-01

Although studies in the US have shown an association between the ethnic residential composition of an area and reports of decreased social cohesion among its residents, this association is not clear in the UK, and particularly for ethnic minority groups. The current study analyses a merged dataset from the 2005 and 2007 Citizenship Survey to assess the evidence for an association between social cohesion and ethnic residential concentration, composition and area deprivation across different ethnic groups in the UK. Results of the multilevel regression models show that, after adjusting for area deprivation, increased levels of social cohesion are found in areas of greater ethnic residential heterogeneity. Although different patterns emerge across ethnic groups and the measure of social cohesion used, findings consistently show that it is area deprivation, and not ethnic residential heterogeneity, which erodes social cohesion in the UK.

Cultivating Conformists or Raising Rebels? Connecting Parental Control and Autonomy Support to Adolescent Delinquency.

PubMed

Brauer, Jonathan R

2017-06-01

This study investigates short-term and long-term associations between parenting in early adolescence and delinquency throughout adolescence using data from the National Longitudinal Surveys. Multilevel longitudinal Poisson regressions show that behavioral control, psychological control, and decision-making autonomy in early adolescence (ages 10-11) are associated with delinquency trajectories throughout adolescence (ages 10-17). Path analyses reveal support for three mediation hypotheses. Parental monitoring (behavioral control) is negatively associated with delinquency in the short term and operates partly through changes in self-control. Parental pressure (psychological control) shows immediate and long-lasting associations with delinquency through changes in self-control and delinquent peer pressures. Decision-making autonomy is negatively associated with delinquency in the long term, yet may exacerbate delinquency in early adolescence by increasing exposure to delinquent peers. © 2016 The Author. Journal of Research on Adolescence © 2016 Society for Research on Adolescence.

Hospitalization Risk Before and After Employment Among Adults With Schizophrenia, Bipolar Disorder, or Major Depression.

PubMed

Luciano, Alison; Metcalfe, Justin D; Bond, Gary R; Xie, Haiyi; Miller, Alexander L; Riley, Jarnee; O'Malley, A James; Drake, Robert E

2016-10-01

The influence of employment on subsequent psychiatric hospitalization for people with serious mental illness is unclear. This study examined whether unemployed people with serious mental illness were more or less likely to experience psychiatric hospitalization after gaining employment. A secondary analysis was conducted of data from the Mental Health Treatment Study. Two years of prospective employment and psychiatric hospital outcomes were examined for 2,055 adults with schizophrenia, bipolar disorder, or major depression. The analyses examined associations between employment and psychiatric hospitalization via multilevel regression by using time-lagged modeling. Employment was associated with a lower subsequent three-month risk of psychiatric hospitalization (odds ratio=.65, 95% confidence interval=.50-.84) after the analysis adjusted for baseline characteristics, including previous psychiatric hospitalizations and self-reported physical health. Unemployed outpatients with serious mental illness were less likely to experience psychiatric hospitalization after gaining employment.

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.

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.

Job characteristics in nursing and cognitive failure at work.

PubMed

Elfering, Achim; Grebner, Simone; Dudan, Anna

2011-06-01

Stressors in nursing put high demands on cognitive control and, therefore, may increase the risk of cognitive failures that put patients at risk. Task-related stressors were expected to be positively associated with cognitive failure at work and job control was expected to be negatively associated with cognitive failure at work. Ninety-six registered nurses from 11 Swiss hospitals were investigated (89 women, 7 men, mean age = 36 years, standard deviation = 12 years, 80% supervisors, response rate 48%). A new German version of the Workplace Cognitive Failure Scale (WCFS) was employed to assess failure in memory function, failure in attention regulation, and failure in action exertion. In linear regression analyses, WCFS was related to work characteristics, neuroticism, and conscientiousness. The German WCFS was valid and reliable. The factorial structure of the original WCF could be replicated. Multilevel regression task-related stressors and conscientiousness were significantly related to attention control and action exertion. The study sheds light on the association between job characteristics and work-related cognitive failure. These associations were unique, i.e. associations were shown even when individual differences in conscientiousness and neuroticism were controlled for. A job redesign in nursing should address task stressors.

Who will volunteer? Analysing individual and structural factors of volunteering in Swiss sports clubs.

PubMed

Schlesinger, Torsten; Nagel, Siegfried

2013-01-01

This article analyses the conditions influencing volunteering in sports clubs. It focuses not only on individual characteristics of volunteers but also on the corresponding structural conditions of sports clubs. It proposes a model of voluntary work in sports clubs based on economic behaviour theory. The influences of both the individual and context levels on the decision to engage in voluntary work are estimated in different multilevel models. Results of these multilevel analyses indicate that volunteering is not just an outcome of individual characteristics such as lower workloads, higher income, children belonging to the sports club, longer club memberships, or a strong commitment to the club. It is also influenced by club-specific structural conditions; volunteering is more probable in rural sports clubs whereas growth-oriented goals in clubs have a destabilising effect.

Sample size estimation for alternating logistic regressions analysis of multilevel randomized community trials of under-age drinking.

PubMed

Reboussin, Beth A; Preisser, John S; Song, Eun-Young; Wolfson, Mark

2012-07-01

Under-age drinking is an enormous public health issue in the USA. Evidence that community level structures may impact on under-age drinking has led to a proliferation of efforts to change the environment surrounding the use of alcohol. Although the focus of these efforts is to reduce drinking by individual youths, environmental interventions are typically implemented at the community level with entire communities randomized to the same intervention condition. A distinct feature of these trials is the tendency of the behaviours of individuals residing in the same community to be more alike than that of others residing in different communities, which is herein called 'clustering'. Statistical analyses and sample size calculations must account for this clustering to avoid type I errors and to ensure an appropriately powered trial. Clustering itself may also be of scientific interest. We consider the alternating logistic regressions procedure within the population-averaged modelling framework to estimate the effect of a law enforcement intervention on the prevalence of under-age drinking behaviours while modelling the clustering at multiple levels, e.g. within communities and within neighbourhoods nested within communities, by using pairwise odds ratios. We then derive sample size formulae for estimating intervention effects when planning a post-test-only or repeated cross-sectional community-randomized trial using the alternating logistic regressions procedure.

The Health Hazards of Marriage. A cohort study of work related disability within 12,500 Norwegian couples - the HUNT Study.

PubMed

Vie, Gunnhild Åberge; Krokstad, Steinar; Johnsen, Roar; Bjørngaard, Johan Håkon

2013-07-01

Work disability and sickness absence increase following partner's retirement, which similarities in spouses' health could explain. We therefore studied the risk of work disability within couples, taking account of baseline health, lifestyle and socioeconomic factors. A cohort of 12,511 couples from the HUNT Study (aged 20-67 years in HUNT2, 1995-1997) was linked to national registries, identifying all new cases of disability pension up until December 2007. Data were analysed with discrete time multilevel logistic regression and Cox regression models. Partners' disability pension was included as a time-varying covariate. Follow-up time was split to examine the association dependent of time. Analyses were adjusted for age only, adjusted for health, and for lifestyle and education along with health. About 15% of an individual's propensity to receive a disability pension could be attributed couple similarity. There was an increased risk of work disability following the spouse's disability retirement [HR (hazard ratio) 1.43 (95% confidence interval 1.20-1.71) for men, HR 1.49 (95% confidence interval 1.28-1.74) for women]. The association was somewhat attenuated after adjustments for health, lifestyle and education. There was a substantial clustering of disability pensions within couples, which cannot be explained by similarities in health, lifestyle and education. This suggests partners influence each other's work ability. From a clinical perspective, the family situation needs to be taken into account when addressing health promotion and work participation.

Safety organizing, emotional exhaustion, and turnover in hospital nursing units.

PubMed

Vogus, Timothy J; Cooil, Bruce; Sitterding, Mary; Everett, Linda Q

2014-10-01

Prior research has found that safety organizing behaviors of registered nurses (RNs) positively impact patient safety. However, little research exists on how engaging in safety organizing affects caregivers. While we know that organizational processes can have divergent effects on organizational and employee outcomes, little research exists on the effects of pursuing highly reliable performance through safety organizing on caregivers. Specifically, we examined whether, and the conditions under which, safety organizing affects RN emotional exhaustion and nursing unit turnover rates. Subjects included 1352 RNs in 50 intensive care, internal medicine, labor, and surgery nursing units in 3 Midwestern acute-care hospitals who completed questionnaires between August and December 2011 and 50 Nurse Managers from the units who completed questionnaires in December 2012. Cross-sectional analyses of RN emotional exhaustion linked to survey data on safety organizing and hospital incident reporting system data on adverse event rates for the year before survey administration. Cross-sectional analysis of unit-level RN turnover rates for the year following the administration of the survey linked to survey data on safety organizing. Multilevel regression analysis indicated that safety organizing was negatively associated with RN emotional exhaustion on units with higher rates of adverse events and positively associated with RN emotional exhaustion with lower rates of adverse events. Tobit regression analyses indicated that safety organizing was associated with lower unit level of turnover rates over time. Safety organizing is beneficial to caregivers in multiple ways, especially on nursing units with high levels of adverse events and over time.

Variation in formulary adherence in general practice over time (2003-2007).

PubMed

van Dijk, Liset; de Jong, Judith D; Westert, Gert P; de Bakker, Dinny H

2011-12-01

To study trends and variation in adherence to the main national formulary for the 20 most prevalent health problems in Dutch general practice over a 5-year period (2003-07). Routine electronic medical records from a pool of 115 representative general practices were linked to the main national formulary. Analyses included over 2 million prescriptions for 246 391 patients. The outcome variable was whether or not the prescribed medication was congruent with recommendations in the national formulary. Trends and variation were analysed using three-level multilevel logistic regression analyses (general practice, patient, and prescription). The percentage of formulary adherent prescriptions for the 20 most prevalent health problems was 73-76% between 2003 and 2007. The percentage varied considerably between guidelines. Lowest adherence rates were found for acute bronchitis and acute upper respiratory infection. Interpractice variation was constant over time. General practice information networks are useful for monitoring general patterns of formulary on a year-to-year basis. Formulary adherence is stable over time but varies across diagnoses, patients and general practices. In the past decade, efforts have been made to increase the level of formulary adherent prescribing. These general efforts managed to stabilize (variation in) adherence in a field where many other initiatives (e.g. by pharmaceutical companies) are undertaken to influence prescribing behaviour.

Multidisciplinary design and analytic approaches to advance prospective research on the multilevel determinants of child health.

PubMed

Johnson, Sara B; Little, Todd D; Masyn, Katherine; Mehta, Paras D; Ghazarian, Sharon R

2017-06-01

Characterizing the determinants of child health and development over time, and identifying the mechanisms by which these determinants operate, is a research priority. The growth of precision medicine has increased awareness and refinement of conceptual frameworks, data management systems, and analytic methods for multilevel data. This article reviews key methodological challenges in cohort studies designed to investigate multilevel influences on child health and strategies to address them. We review and summarize methodological challenges that could undermine prospective studies of the multilevel determinants of child health and ways to address them, borrowing approaches from the social and behavioral sciences. Nested data, variation in intervals of data collection and assessment, missing data, construct measurement across development and reporters, and unobserved population heterogeneity pose challenges in prospective multilevel cohort studies with children. We discuss innovations in missing data, innovations in person-oriented analyses, and innovations in multilevel modeling to address these challenges. Study design and analytic approaches that facilitate the integration across multiple levels, and that account for changes in people and the multiple, dynamic, nested systems in which they participate over time, are crucial to fully realize the promise of precision medicine for children and adolescents. Copyright © 2017 Elsevier Inc. All rights reserved.

Towards people-centred health systems: a multi-level framework for analysing primary health care governance in low- and middle-income countries.

PubMed

Abimbola, Seye; Negin, Joel; Jan, Stephen; Martiniuk, Alexandra

2014-09-01

Although there is evidence that non-government health system actors can individually or collectively develop practical strategies to address primary health care (PHC) challenges in the community, existing frameworks for analysing health system governance largely focus on the role of governments, and do not sufficiently account for the broad range of contribution to PHC governance. This is important because of the tendency for weak governments in low- and middle-income countries (LMICs). We present a multi-level governance framework for use as a thinking guide in analysing PHC governance in LMICs. This framework has previously been used to analyse the governance of common-pool resources such as community fisheries and irrigation systems. We apply the framework to PHC because, like common-pool resources, PHC facilities in LMICs tend to be commonly owned by the community such that individual and collective action is often required to avoid the 'tragedy of the commons'-destruction and degradation of the resource resulting from lack of concern for its continuous supply. In the multi-level framework, PHC governance is conceptualized at three levels, depending on who influences the supply and demand of PHC services in a community and how: operational governance (individuals and providers within the local health market), collective governance (community coalitions) and constitutional governance (governments at different levels and other distant but influential actors). Using the example of PHC governance in Nigeria, we illustrate how the multi-level governance framework offers a people-centred lens on the governance of PHC in LMICs, with a focus on relations among health system actors within and between levels of governance. We demonstrate the potential impact of health system actors functioning at different levels of governance on PHC delivery, and how governance failure at one level can be assuaged by governance at another level. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Towards people-centred health systems: a multi-level framework for analysing primary health care governance in low- and middle-income countries

PubMed Central

Abimbola, Seye; Negin, Joel; Jan, Stephen; Martiniuk, Alexandra

2014-01-01

Although there is evidence that non-government health system actors can individually or collectively develop practical strategies to address primary health care (PHC) challenges in the community, existing frameworks for analysing health system governance largely focus on the role of governments, and do not sufficiently account for the broad range of contribution to PHC governance. This is important because of the tendency for weak governments in low- and middle-income countries (LMICs). We present a multi-level governance framework for use as a thinking guide in analysing PHC governance in LMICs. This framework has previously been used to analyse the governance of common-pool resources such as community fisheries and irrigation systems. We apply the framework to PHC because, like common-pool resources, PHC facilities in LMICs tend to be commonly owned by the community such that individual and collective action is often required to avoid the ‘tragedy of the commons’—destruction and degradation of the resource resulting from lack of concern for its continuous supply. In the multi-level framework, PHC governance is conceptualized at three levels, depending on who influences the supply and demand of PHC services in a community and how: operational governance (individuals and providers within the local health market), collective governance (community coalitions) and constitutional governance (governments at different levels and other distant but influential actors). Using the example of PHC governance in Nigeria, we illustrate how the multi-level governance framework offers a people-centred lens on the governance of PHC in LMICs, with a focus on relations among health system actors within and between levels of governance. We demonstrate the potential impact of health system actors functioning at different levels of governance on PHC delivery, and how governance failure at one level can be assuaged by governance at another level. PMID:25274638

Studying Individual Differences in Predictability with Gamma Regression and Nonlinear Multilevel Models

ERIC Educational Resources Information Center

Culpepper, Steven Andrew

2010-01-01

Statistical prediction remains an important tool for decisions in a variety of disciplines. An equally important issue is identifying factors that contribute to more or less accurate predictions. The time series literature includes well developed methods for studying predictability and volatility over time. This article develops…

Administrative Climate and Novices' Intent to Remain Teaching

ERIC Educational Resources Information Center

Pogodzinski, Ben; Youngs, Peter; Frank, Kenneth A.; Belman, Dale

2012-01-01

Using survey data from novice teachers at the elementary and middle school level across 11 districts, multilevel logistic regressions were estimated to examine the association between novices' perceptions of the administrative climate and their desire to remain teaching within their schools. We find that the probability that a novice teacher…

Foreign-Born Concentration and Acculturation to Volunteering among Immigrant Youth

ERIC Educational Resources Information Center

Tong, Yuying

2010-01-01

Using children of immigrants sample from National Longitudinal Study of Adolescent Health, this study investigates how immigrant youth acculturating to the American social norm of volunteering and how the acculturation is modified by living in immigrant neighborhoods. Multilevel logistic regression produces distinct patterns for children living in…

A Noncentral "t" Regression Model for Meta-Analysis

ERIC Educational Resources Information Center

Camilli, Gregory; de la Torre, Jimmy; Chiu, Chia-Yi

2010-01-01

In this article, three multilevel models for meta-analysis are examined. Hedges and Olkin suggested that effect sizes follow a noncentral "t" distribution and proposed several approximate methods. Raudenbush and Bryk further refined this model; however, this procedure is based on a normal approximation. In the current research literature, this…

Student and School SES, Gender, Strategy Use, and Achievement

ERIC Educational Resources Information Center

Callan, Gregory L.; Marchant, Gregory J.; Finch, W. Holmes; Flegge, Lindsay

2017-01-01

A multilevel mediated regression model was fit to Programme for International Student Assessment achievement, strategy use, gender, and family- and school-level socioeconomic status (SES). Two metacognitive strategies (i.e., understanding and summarizing) and one learning strategy (i.e., control strategies) were found to relate significantly and…

Collegial Climate and Novice Teachers' Intent to Remain Teaching

ERIC Educational Resources Information Center

Pogodzinski, Ben; Youngs, Peter; Frank, Kenneth A.

2013-01-01

Using survey data from novice teachers across 99 schools, we estimated multilevel regressions to identify the association between novices' intent to remain teaching within their schools and their perceptions of the collegial climate. The results suggest that novice teachers who perceive a more positive collegial climate marked by higher degrees…

Optimal Design for Regression Discontinuity Studies with Clustering

ERIC Educational Resources Information Center

Rhoads, Christopher; Dye, Charles

2014-01-01

Recent years have seen an increased interest in quantitative educational research studies that use random assignment (RA) to evaluate the causal impacts of educational interventions (Angrist, 2004). The multi-level structure of the public education system in the United States often leads to experimental designs where naturally occurring clusters…

Optimal Design for Two-Level Random Assignment and Regression Discontinuity Studies

ERIC Educational Resources Information Center

Rhoads, Christopher H.; Dye, Charles

2016-01-01

An important concern when planning research studies is to obtain maximum precision of an estimate of a treatment effect given a budget constraint. When research designs have a "multilevel" or "hierarchical" structure changes in sample size at different levels of the design will impact precision differently. Furthermore, there…

Downward economic mobility and preterm birth: an exploratory study of Chicago-born upper class White mothers.

PubMed

Collins, James W; Rankin, Kristin M; David, Richard J

2015-07-01

A paucity of published data exists on the factors underlying the relatively poor birth outcome of non-Hispanic White women in the United States. To determine whether downward economic mobility is a risk factor for preterm birth (<37 weeks, PTB) among upper class-born White women. Stratified and multilevel logistic regression analyses were performed on an Illinois transgenerational dataset of non-Hispanic White infants (1989-1991) and their women (1956-1976) with appended US census income information. The study sample was restricted to singleton births of Chicago-born upper-class (defined by early-life residence in affluent neighborhoods) non-Hispanic White women. Upper class-born White women (n = 4,891) who did not experience downward economic mobility by the time of delivery had a PTB rate of 5.4 %. Those women who experienced slight (n = 5,112), moderate (n = 2,158), or extreme (n = 339) downward economic mobility had PTB rates of 6.5, 8.5, and 10.1 %, respectively; RR (95 % CI) = 1.2 (1.0-4.0), 1.6 (1.3-1.9), and 1.9 (1.3-2.6), respectively. Maternal downward economic mobility was also associated with an increased prevalence of biologic, medical, and behavioral risk factors. Interestingly, the relationship between moderate to extreme downward mobility and preterm birth was stronger among former low birth weight (<2500 g, LBW) than non-LBW women: 2.8 (1.4-5.8) versus 1.6 (1.3-1.9), respectively. In multilevel logistic regression models, the adjusted odds ratio of preterm birth for former LBW and non-LBW women who experienced any downward mobility (compared to those women with lifelong upper class status) equaled 2.4 (1.1-5.3) and 1.1 (1.0-1.1), respectively. Downward economic mobility is associated with an increased risk of preterm birth among upper class-born White urban women; this phenomenon is strongest among former low birth weight women.

Minimal improvement of nurses' motivational interviewing skills in routine diabetes care one year after training: a cluster randomized trial.

PubMed

Jansink, Renate; Braspenning, Jozé; Laurant, Miranda; Keizer, Ellen; Elwyn, Glyn; Weijden, Trudy van der; Grol, Richard

2013-03-28

The effectiveness of nurse-led motivational interviewing (MI) in routine diabetes care in general practice is inconclusive. Knowledge about the extent to which nurses apply MI skills and the factors that affect the usage can help to understand the black box of this intervention. The current study compared MI skills of trained versus non-trained general practice nurses in diabetes consultations. The nurses participated in a cluster randomized trial in which a comprehensive program (including MI training) was tested on improving clinical parameters, lifestyle, patients' readiness to change lifestyle, and quality of life. Fifty-eight general practices were randomly assigned to usual care (35 nurses) or the intervention (30 nurses). The ratings of applying 24 MI skills (primary outcome) were based on five consultation recordings per nurse at baseline and 14 months later. Two judges evaluated independently the MI skills and the consultation characteristics time, amount of nurse communication, amount of lifestyle discussion and patients' readiness to change. The effect of the training on the MI skills was analysed with a multilevel linear regression by comparing baseline and the one-year follow-up between the interventions with usual care group. The overall effect of the consultation characteristics on the MI skills was studied in a multilevel regression analyses. At one year follow up, it was demonstrated that the nurses improved on 2 of the 24 MI skills, namely, "inviting the patient to talk about behaviour change" (mean difference=0.39, p=0.009), and "assessing patient's confidence in changing their lifestyle" (mean difference=0.28, p=0.037). Consultation time and the amount of lifestyle discussion as well as the patients' readiness to change health behaviour was associated positively with applying MI skills. The maintenance of the MI skills one year after the training program was minimal. The question is whether the success of MI to change unhealthy behaviour must be doubted, whether the technique is less suitable for patients with a complex chronic disease, such as diabetes mellitus, or that nurses have problems with the acquisition and maintenance of MI skills in daily practice. Overall, performing MI skills during consultation increases, if there is more time, more lifestyle discussion, and the patients show more readiness to change. Current Controlled Trials ISRCTN68707773.

Minimal improvement of nurses’ motivational interviewing skills in routine diabetes care one year after training: a cluster randomized trial

PubMed Central

2013-01-01

Background The effectiveness of nurse-led motivational interviewing (MI) in routine diabetes care in general practice is inconclusive. Knowledge about the extent to which nurses apply MI skills and the factors that affect the usage can help to understand the black box of this intervention. The current study compared MI skills of trained versus non-trained general practice nurses in diabetes consultations. The nurses participated in a cluster randomized trial in which a comprehensive program (including MI training) was tested on improving clinical parameters, lifestyle, patients’ readiness to change lifestyle, and quality of life. Methods Fifty-eight general practices were randomly assigned to usual care (35 nurses) or the intervention (30 nurses). The ratings of applying 24 MI skills (primary outcome) were based on five consultation recordings per nurse at baseline and 14 months later. Two judges evaluated independently the MI skills and the consultation characteristics time, amount of nurse communication, amount of lifestyle discussion and patients’ readiness to change. The effect of the training on the MI skills was analysed with a multilevel linear regression by comparing baseline and the one-year follow-up between the interventions with usual care group. The overall effect of the consultation characteristics on the MI skills was studied in a multilevel regression analyses. Results At one year follow up, it was demonstrated that the nurses improved on 2 of the 24 MI skills, namely, “inviting the patient to talk about behaviour change” (mean difference=0.39, p=0.009), and “assessing patient’s confidence in changing their lifestyle” (mean difference=0.28, p=0.037). Consultation time and the amount of lifestyle discussion as well as the patients’ readiness to change health behaviour was associated positively with applying MI skills. Conclusions The maintenance of the MI skills one year after the training program was minimal. The question is whether the success of MI to change unhealthy behaviour must be doubted, whether the technique is less suitable for patients with a complex chronic disease, such as diabetes mellitus, or that nurses have problems with the acquisition and maintenance of MI skills in daily practice. Overall, performing MI skills during consultation increases, if there is more time, more lifestyle discussion, and the patients show more readiness to change. Trial registration Current Controlled Trials ISRCTN68707773 PMID:23537327

Modeling Joint Exposures and Health Outcomes for Cumulative Risk Assessment: The Case of Radon and Smoking

PubMed Central

Chahine, Teresa; Schultz, Bradley D.; Zartarian, Valerie G.; Xue, Jianping; Subramanian, SV; Levy, Jonathan I.

2011-01-01

Community-based cumulative risk assessment requires characterization of exposures to multiple chemical and non-chemical stressors, with consideration of how the non-chemical stressors may influence risks from chemical stressors. Residential radon provides an interesting case example, given its large attributable risk, effect modification due to smoking, and significant variability in radon concentrations and smoking patterns. In spite of this fact, no study to date has estimated geographic and sociodemographic patterns of both radon and smoking in a manner that would allow for inclusion of radon in community-based cumulative risk assessment. In this study, we apply multi-level regression models to explain variability in radon based on housing characteristics and geological variables, and construct a regression model predicting housing characteristics using U.S. Census data. Multi-level regression models of smoking based on predictors common to the housing model allow us to link the exposures. We estimate county-average lifetime lung cancer risks from radon ranging from 0.15 to 1.8 in 100, with high-risk clusters in areas and for subpopulations with high predicted radon and smoking rates. Our findings demonstrate the viability of screening-level assessment to characterize patterns of lung cancer risk from radon, with an approach that can be generalized to multiple chemical and non-chemical stressors. PMID:22016710

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.

Integrative eQTL analysis of tumor and host omics data in individuals with bladder cancer.

PubMed

Pineda, Silvia; Van Steen, Kristel; Malats, Núria

2017-09-01

Integrative analyses of several omics data are emerging. The data are usually generated from the same source material (i.e., tumor sample) representing one level of regulation. However, integrating different regulatory levels (i.e., blood) with those from tumor may also reveal important knowledge about the human genetic architecture. To model this multilevel structure, an integrative-expression quantitative trait loci (eQTL) analysis applying two-stage regression (2SR) was proposed. This approach first regressed tumor gene expression levels with tumor markers and the adjusted residuals from the previous model were then regressed with the germline genotypes measured in blood. Previously, we demonstrated that penalized regression methods in combination with a permutation-based MaxT method (Global-LASSO) is a promising tool to fix some of the challenges that high-throughput omics data analysis imposes. Here, we assessed whether Global-LASSO can also be applied when tumor and blood omics data are integrated. We further compared our strategy with two 2SR-approaches, one using multiple linear regression (2SR-MLR) and other using LASSO (2SR-LASSO). We applied the three models to integrate genomic, epigenomic, and transcriptomic data from tumor tissue with blood germline genotypes from 181 individuals with bladder cancer included in the TCGA Consortium. Global-LASSO provided a larger list of eQTLs than the 2SR methods, identified a previously reported eQTLs in prostate stem cell antigen (PSCA), and provided further clues on the complexity of APBEC3B loci, with a minimal false-positive rate not achieved by 2SR-MLR. It also represents an important contribution for omics integrative analysis because it is easy to apply and adaptable to any type of data. © 2017 WILEY PERIODICALS, INC.

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

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.

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.

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

Regional contextual influences on short sleep duration: a 50 universities population-based multilevel study in China.

PubMed

Yang, Tingzhong; Peng, Sihui; Barnett, Ross; Zhang, Chichen

2018-01-01

Ecological models have emphasized that short sleep duration (SSD) is influenced by both individual and environmental variables. However, few studies have considered the latter. The present study explores the influence of urban and regional contextual factors, net of individual characteristics, on the prevalence of SSD among university students in China. Participants were 11,954 students, who were identified through a multistage survey sampling process conducted in 50 universities. Individual data were obtained through a self-administered questionnaire, and contextual variables were retrieved from a national database. Multilevel logistic regression models were used to examine urban and regional variations in high and moderate levels of SSD. Overall the prevalence of high SSD (<6 hours sleep duration) was 2.8% (95% CI: 1.7%,3.9%) and moderate SSD (<7 hours) 24.7% (95% CI: 19.5%, 29.8%). Multilevel logistic regressions confirmed that home region gross domestic product (GDP) and the university regional unemployment rate were associated with SSD, net of other individual- and city-level covariates. Students attending high-level universities also recorded the highest levels of SSD. Of the individual characteristcs, only mother's occupation and student mental health status were related to SSD. The results of this study add important insights about the role of contextual factors affecting SSD among young adults and indicate the need to take into account both past, as well as present, environmental influences to control SSD.

A multilevel approach to the relationship between birth order and intelligence.

PubMed

Wichman, Aaron L; Rodgers, Joseph Lee; MacCallum, Robert C

2006-01-01

Many studies show relationships between birth order and intelligence but use cross-sectional designs or manifest other threats to internal validity. Multilevel analyses with a control variable show that when these threats are removed, two major results emerge: (a) birth order has no significant influence on children's intelligence and (b) earlier reported birth order effects on intelligence are attributable to factors that vary between, not within, families. Analyses on 7- to 8 - and 13- to 14-year-old children from the National Longitudinal Survey of Youth support these conclusions. When hierarchical data structures, age variance of children, and within-family versus between-family variance sources are taken into account, previous research is seen in a new light.

A menu-driven software package of Bayesian nonparametric (and parametric) mixed models for regression analysis and density estimation.

PubMed

Karabatsos, George

2017-02-01

Most of applied statistics involves regression analysis of data. In practice, it is important to specify a regression model that has minimal assumptions which are not violated by data, to ensure that statistical inferences from the model are informative and not misleading. This paper presents a stand-alone and menu-driven software package, Bayesian Regression: Nonparametric and Parametric Models, constructed from MATLAB Compiler. Currently, this package gives the user a choice from 83 Bayesian models for data analysis. They include 47 Bayesian nonparametric (BNP) infinite-mixture regression models; 5 BNP infinite-mixture models for density estimation; and 31 normal random effects models (HLMs), including normal linear models. Each of the 78 regression models handles either a continuous, binary, or ordinal dependent variable, and can handle multi-level (grouped) data. All 83 Bayesian models can handle the analysis of weighted observations (e.g., for meta-analysis), and the analysis of left-censored, right-censored, and/or interval-censored data. Each BNP infinite-mixture model has a mixture distribution assigned one of various BNP prior distributions, including priors defined by either the Dirichlet process, Pitman-Yor process (including the normalized stable process), beta (two-parameter) process, normalized inverse-Gaussian process, geometric weights prior, dependent Dirichlet process, or the dependent infinite-probits prior. The software user can mouse-click to select a Bayesian model and perform data analysis via Markov chain Monte Carlo (MCMC) sampling. After the sampling completes, the software automatically opens text output that reports MCMC-based estimates of the model's posterior distribution and model predictive fit to the data. Additional text and/or graphical output can be generated by mouse-clicking other menu options. This includes output of MCMC convergence analyses, and estimates of the model's posterior predictive distribution, for selected functionals and values of covariates. The software is illustrated through the BNP regression analysis of real data.

Multilevel lumbar fusion and postoperative physiotherapy rehabilitation in a patient with persistent pain.

PubMed

Pons, Tracey; Shipton, Edward A

2011-04-01

There are no comparative randomised controlled trials of physiotherapy modalities for chronic low back and radicular pain associated with multilevel fusion. Physiotherapy-based rehabilitation to control pain and improve activation levels for persistent pain following multilevel fusion can be challenging. This is a case report of a 68-year-old man who was referred for physiotherapy intervention 10 months after a multilevel spinal fusion for spinal stenosis. He reported high levels of persistent postoperative pain with minimal activity as a consequence of his pain following the surgery. The physiotherapy interventions consisted of three phases of rehabilitation starting with pool exercise that progressed to land-based walking. These were all combined with transcutaneous electrical nerve stimulation (TENS) that was used consistently for up to 8 hours per day. As outcome measures, daily pain levels and walking distances were charted once the pool programme was completed (in the third phase). Phase progression was determined by shuttle test results. The pain level was correlated with the distance walked using linear regression over a 5-day average. Over a 5-day moving average, the pain level reduced and walking distance increased. The chart of recorded pain level and walking distance showed a trend toward decreased pain with the increased distance walked. In a patient undergoing multilevel lumbar fusion, the combined use of TENS and a progressive walking programme (from pool to land) reduced pain and increased walking distance. This improvement was despite poor medication compliance and a reported high level of postsurgical pain.

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

Managing fever in children: a national survey of parents' knowledge and practices in France.

PubMed

Bertille, Nathalie; Fournier-Charrière, Elisabeth; Pons, Gérard; Chalumeau, Martin

2013-01-01

Identifying targets to improve parental practices for managing fever in children is the first step to reducing the overloaded healthcare system related to this common symptom. We aimed to study parents' knowledge and practices and their determinants in managing fever symptoms in children in France as compared with current recommendations. We conducted an observational national study between 2007 and 2008 of French general practitioners, primary care pediatricians and pharmacists. These healthcare professionals (HPs) were asked to include 5 consecutive patients from 1 month to 12 years old with fever for up to 48 hr who were accompanied by a family member. Parents completed a questionnaire about their knowledge of fever in children and their attitudes about the current fever episode. We used a multilevel logistic regression model to assess the joint effects of patient- and HP-level variables. In all, 1,534 HPs (participation rate 13%) included 6,596 children. Parental concordance with current recommendations for temperature measurement methods, the threshold for defining fever, and physical (oral hydration, undressing, room temperature) and drug treatment was 89%, 61%, 15%, and 23%, respectively. Multivariate multi-level analyses revealed a significant HP effect. In general, high concordance with recommendations was associated with high educational level of parents and the HP consulted being a pediatrician. In France, parents' knowledge and practices related to managing fever symptoms in children frequently differ from recommendations. Targeted health education interventions are needed to effectively manage fever symptoms in children.

Managing Fever in Children: A National Survey of Parents' Knowledge and Practices in France

PubMed Central

Bertille, Nathalie; Fournier-Charrière, Elisabeth; Pons, Gérard; Chalumeau, Martin

2013-01-01

Introduction Identifying targets to improve parental practices for managing fever in children is the first step to reducing the overloaded healthcare system related to this common symptom. We aimed to study parents' knowledge and practices and their determinants in managing fever symptoms in children in France as compared with current recommendations. Methods We conducted an observational national study between 2007 and 2008 of French general practitioners, primary care pediatricians and pharmacists. These healthcare professionals (HPs) were asked to include 5 consecutive patients from 1 month to 12 years old with fever for up to 48 hr who were accompanied by a family member. Parents completed a questionnaire about their knowledge of fever in children and their attitudes about the current fever episode. We used a multilevel logistic regression model to assess the joint effects of patient- and HP-level variables. Results In all, 1,534 HPs (participation rate 13%) included 6,596 children. Parental concordance with current recommendations for temperature measurement methods, the threshold for defining fever, and physical (oral hydration, undressing, room temperature) and drug treatment was 89%, 61%, 15%, and 23%, respectively. Multivariate multi-level analyses revealed a significant HP effect. In general, high concordance with recommendations was associated with high educational level of parents and the HP consulted being a pediatrician. Conclusions In France, parents' knowledge and practices related to managing fever symptoms in children frequently differ from recommendations. Targeted health education interventions are needed to effectively manage fever symptoms in children. PMID:24391772

Substance Use among Adolescents Involved in Bullying: A Cross-Sectional Multilevel Study.

PubMed

Gaete, Jorge; Tornero, Bernardita; Valenzuela, Daniela; Rojas-Barahona, Cristian A; Salmivalli, Christina; Valenzuela, Eduardo; Araya, Ricardo

2017-01-01

Being involved in bullying as a victim or perpetrator could have deleterious health consequences. Even though there is some evidence that bullies and victims of bullying have a higher risk for drug use, less is known about bystanders. The aim of this research was to study the association between bullying experience (as victims, bullies, or bystanders) and substance use. We gathered complete information from a nationally representative sample of 36,687 students (51.4% female) attending 756 schools in Chile. We used a self-reported questionnaire which was developed based on similar instruments used elsewhere. This questionnaire was piloted and presented to an expert panel for approval. We used multilevel multivariate logistic regression analyses, controlling for several variables at the individual (e.g., school membership, parental monitoring) and school levels (e.g., school type, school denomination). This study shows that bullies and bully-victims have a high risk for cigarette, alcohol, and cannabis use than bystanders. This is one of the few studies exploring the association between witnessing bullying and substance use. These findings add new insights to the study of the co-occurrence of bullying and substance use. Other factors, such as higher academic performance, stronger school membership, and better parental monitoring reduced the risk of any substance use, while the experience of domestic violence and the perception of social disorganization in the neighborhood, increased the risk. These findings may help the design of preventive interventions.

Substance Use among Adolescents Involved in Bullying: A Cross-Sectional Multilevel Study

PubMed Central

Gaete, Jorge; Tornero, Bernardita; Valenzuela, Daniela; Rojas-Barahona, Cristian A.; Salmivalli, Christina; Valenzuela, Eduardo; Araya, Ricardo

2017-01-01

Being involved in bullying as a victim or perpetrator could have deleterious health consequences. Even though there is some evidence that bullies and victims of bullying have a higher risk for drug use, less is known about bystanders. The aim of this research was to study the association between bullying experience (as victims, bullies, or bystanders) and substance use. We gathered complete information from a nationally representative sample of 36,687 students (51.4% female) attending 756 schools in Chile. We used a self-reported questionnaire which was developed based on similar instruments used elsewhere. This questionnaire was piloted and presented to an expert panel for approval. We used multilevel multivariate logistic regression analyses, controlling for several variables at the individual (e.g., school membership, parental monitoring) and school levels (e.g., school type, school denomination). This study shows that bullies and bully-victims have a high risk for cigarette, alcohol, and cannabis use than bystanders. This is one of the few studies exploring the association between witnessing bullying and substance use. These findings add new insights to the study of the co-occurrence of bullying and substance use. Other factors, such as higher academic performance, stronger school membership, and better parental monitoring reduced the risk of any substance use, while the experience of domestic violence and the perception of social disorganization in the neighborhood, increased the risk. These findings may help the design of preventive interventions. PMID:28701974

Socioeconomic status, environmental and individual factors, and sports participation.

PubMed

Kamphuis, Carlijn Barbara Maria; Van Lenthe, Frank J; Giskes, Katrina; Huisman, Martijn; Brug, Johannes; Mackenbach, Johan P

2008-01-01

To examine the contribution of neighborhood, household, and individual factors to socioeconomic inequalities in sports participation in a multilevel design. Data were obtained by a large-scale postal survey among a stratified sample of the adult population (age 25-75 yr) of Eindhoven (the fifth-largest city of the Netherlands) and surrounding areas, residing in 213 neighborhoods (N = 4785; response rate 64.4%). Multilevel logistic regression analyses were performed with sports participation as a binary outcome (no vs yes); that is, respondents not doing any moderate- or high-intensity sports at least once a week were classified as nonparticipants. Unfavorable perceived neighborhood factors (e.g., feeling unsafe, small social network), household factors (material and social deprivation), and individual physical activity cognitions (e.g., negative outcome expectancies, low self-efficacy) were significantly associated with doing no sports and were reported more frequently among lower socioeconomic groups. Taking these factors into account reduced the odds ratios of doing no sports among the lowest educational group by 57%, from 3.99 (95% CI, 2.99-5.31) to 2.29 (95% CI, 1.70-3.07), and among the lowest income group by 67%, from 3.02 (95% CI, 2.36-3.86) to 1.66 (95% CI, 1.22-2.27). A combination of neighborhood, household, and individual factors can explain socioeconomic inequalities in sports participation to a large extent. Interventions and policies should focus on all three groups of factors simultaneously to yield a maximal reduction of socioeconomic inequalities in sports participation.

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

Family and School Influences on Adolescent Smoking Behaviour

ERIC Educational Resources Information Center

Wiium, Nora; Wold, Bente

2006-01-01

Purpose: This paper aims to examine how influences at home and school interact to predict smoking among adolescents. Design/methodology/approach: Data were collected from 15-year-old pupils from Norway (n=1,404 in 73 Grade 10 school classes). Multilevel logistic regression analysis was used to determine how family and school influences interact to…

Does the "Pupil Enterprise Programme" Influence Grades among Pupils with Special Needs?

ERIC Educational Resources Information Center

Johansen, Vegard; Somby, Hege M.

2016-01-01

This paper asks whether the Pupil Enterprise Programme (PEP) is a suitable working method for improving academic performance among pupils with special needs. Overall, 20% of pupils participate in PEP at some point during lower secondary school. Results from multilevel regression modelling indicate that pupils with special needs who have…

Freshman Year Dropouts: Interactions between Student and School Characteristics and Student Dropout Status

ERIC Educational Resources Information Center

Zvoch, Keith

2006-01-01

Data from a large school district in the southwestern United States were analyzed to investigate relations between student and school characteristics and high school freshman dropout patterns. Application of a multilevel logistic regression model to student dropout data revealed evidence of school-to-school differences in student dropout rates and…

Examining Relations between Mathematics Teachers' Instructional Vision and Knowledge and Change in Practice

ERIC Educational Resources Information Center

Munter, Charles; Correnti, Richard

2017-01-01

This article provides a longitudinal examination of how changes in more than 200 middle-grades mathematics teachers' instructional practices related to their (a) mathematical knowledge for teaching (MKT) and (b) instructional vision. Results of this multilevel regression analysis suggest that MKT and instructional vision are related to instruction…

Using Cluster Bootstrapping to Analyze Nested Data With a Few Clusters.

PubMed

Huang, Francis L

2018-04-01

Cluster randomized trials involving participants nested within intact treatment and control groups are commonly performed in various educational, psychological, and biomedical studies. However, recruiting and retaining intact groups present various practical, financial, and logistical challenges to evaluators and often, cluster randomized trials are performed with a low number of clusters (~20 groups). Although multilevel models are often used to analyze nested data, researchers may be concerned of potentially biased results due to having only a few groups under study. Cluster bootstrapping has been suggested as an alternative procedure when analyzing clustered data though it has seen very little use in educational and psychological studies. Using a Monte Carlo simulation that varied the number of clusters, average cluster size, and intraclass correlations, we compared standard errors using cluster bootstrapping with those derived using ordinary least squares regression and multilevel models. Results indicate that cluster bootstrapping, though more computationally demanding, can be used as an alternative procedure for the analysis of clustered data when treatment effects at the group level are of primary interest. Supplementary material showing how to perform cluster bootstrapped regressions using R is also provided.

Addictive internet use among Korean adolescents: a national survey.

PubMed

Heo, Jongho; Oh, Juhwan; Subramanian, S V; Kim, Yoon; Kawachi, Ichiro

2014-01-01

A psychological disorder called 'Internet addiction' has newly emerged along with a dramatic increase of worldwide Internet use. However, few studies have used population-level samples nor taken into account contextual factors on Internet addiction. We identified 57,857 middle and high school students (13-18 year olds) from a Korean nationally representative survey, which was surveyed in 2009. To identify associated factors with addictive Internet use, two-level multilevel regression models were fitted with individual-level responses (1st level) nested within schools (2nd level) to estimate associations of individual and school characteristics simultaneously. Gender differences of addictive Internet use were estimated with the regression model stratified by gender. Significant associations were found between addictive Internet use and school grade, parental education, alcohol use, tobacco use, and substance use. Female students in girls' schools were more likely to use Internet addictively than those in coeducational schools. Our results also revealed significant gender differences of addictive Internet use in its associated individual- and school-level factors. Our results suggest that multilevel risk factors along with gender differences should be considered to protect adolescents from addictive Internet use.

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

Patterns and Predictors of Late-Life Drinking Trajectories: A 10-Year Longitudinal Study

PubMed Central

Brennan, Penny L.; Schutte, Kathleen K.; Moos, Rudolf H.

2010-01-01

This study examines the extent of group-level and intra-individual decline in alcohol consumption among adults as they traverse a 10-year interval spanning late-middle to early-old age. Further, it identifies key baseline predictors of these adults' 10-year drinking trajectories. Community residents (n=1,291; age 55 to 65 at baseline) were assessed at 4 points over a 10-year interval on demographic and health characteristics, coping responses, social context, and alcohol consumption. Descriptive cross-wave statistics, and multilevel regression analyses, indicated that in the sample overall, participants' 10-year patterns of alcohol consumption were relatively stable. However, men's patterns, and those of individuals drinking beyond recommended alcohol consumption guidelines at baseline, were more variable and showed steeper rates of decline, than did those of women and individuals drinking within recommended levels. Contrary to expectation, baseline use of substances to reduce tension and heavier reliance on avoidance coping predicted faster rate of decline in alcohol consumption. Post-hoc prospective mediation analyses suggested that this may have occurred because these and other baseline predictors heighten risk of developing new health problems which, in turn, motivate reduced alcohol consumption. PMID:20565151

Explaining Differences in Subjective Well-Being Across 33 Nations Using Multilevel Models: Universal Personality, Cultural Relativity, and National Income.

PubMed

Cheng, Cecilia; Cheung, Mike W-L; Montasem, Alex

2016-02-01

This multinational study simultaneously tested three prominent hypotheses--universal disposition, cultural relativity, and livability--that explained differences in subjective well-being across nations. We performed multilevel structural equation modeling to examine the hypothesized relationships at both individual and cultural levels in 33 nations. Participants were 6,753 university students (2,215 men; 4,403 women; 135 did not specify), and the average age of the entire sample was 20.97 years (SD = 2.39). Both individual- and cultural-level analyses supported the universal disposition and cultural relativity hypotheses by revealing significant associations of subjective well-being with Extraversion, Neuroticism, and independent self-construal. In addition, interdependent self-construal was positively related to life satisfaction at the individual level only, whereas aggregated negative affect was positively linked with aggregate levels of Extraversion and interdependent self-construal at the cultural level only. Consistent with the livability hypothesis, gross national income (GNI) was related to aggregate levels of negative affect and life satisfaction. There was also a quadratic relationship between GNI and aggregated positive affect. Our findings reveal that universal disposition, cultural self-construal, and national income can elucidate differences in subjective well-being, but the multilevel analyses advance the literature by yielding new findings that cannot be identified in studies using individual-level analyses alone. © 2014 Wiley Periodicals, Inc.

Antenatal counselling for congenital anomaly tests: an exploratory video-observational study about client-midwife communication.

PubMed

Martin, Linda; Hutton, Eileen K; Gitsels-van der Wal, Janneke T; Spelten, Evelien R; Kuiper, Fleur; Pereboom, Monique T R; van Dulmen, Sandra

2015-01-01

antenatal counselling for congenital anomaly tests is conceptualised as having both Health Education (HE) and Decision-Making Support (DMS) functions. Building and maintaining a client-midwife relation (CMR) is seen as a necessary condition for enabling these two counselling functions. However, little is known about how these functions are fulfilled in daily practice. This study aims to describe the relative expression of the antenatal counselling functions; to describe the ratio of client versus midwife conversational contribution and to get insight into clients' characteristics, which are associated with midwives' expressions of the functions of antenatal counselling. exploratory video-observational study. 269 videotaped antenatal counselling sessions for congenital anomaly tests provided by 20 midwives within six Dutch practices. we used an adapted version of the Roter Interaction Analysis System to code the client-midwife communication. Multilevel linear regression analyses were used to analyse associations between clients' characteristics and midwives' expressions of antenatal counselling in practice. most utterances made during counselling were coded as HE (41%); a quarter as DMS (23%) and 36% as CMR. Midwives contributed the most to the HE compared to clients or their partners (91% versus 9%) and less to the DMS function of counselling (61% versus 39%). Multilevel analyses showed an independent association between parity and shorter duration of antenatal counselling; (β=-3.01; p<0.001). The amount of utterances concerning HE and DMS during counselling of multipara was less compared to nulliparous. antenatal counselling for congenital anomaly tests by midwives is focused on giving HE compared to DMS. The relatively low contribution of clients during DMS might indicate poor DMS given by midwives. Counselling of multipara was significantly shorter than counselling of nulliparous; multiparae received less HE as well as DMS compared to nulliparous women. our findings should encourage midwives to reflect on the process of antenatal counselling they offer with regards to the way they address the three antenatal counselling functions during counselling of nulliparous women compared to multiparae. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Objectively measured sedentary time and academic achievement in schoolchildren.

PubMed

Lopes, Luís; Santos, Rute; Mota, Jorge; Pereira, Beatriz; Lopes, Vítor

2017-03-01

This study aimed to evaluate the relationship between objectively measured total sedentary time and academic achievement (AA) in Portuguese children. The sample comprised of 213 children (51.6% girls) aged 9.46 ± 0.43 years, from the north of Portugal. Sedentary time was measured with accelerometry, and AA was assessed using the Portuguese Language and Mathematics National Exams results. Multilevel linear regression models were fitted to assess regression coefficients predicting AA. The results showed that objectively measured total sedentary time was not associated with AA, after adjusting for potential confounders.

Extended opening hours and patient experience of general practice in England: multilevel regression analysis of a national patient survey

PubMed Central

Cowling, Thomas E; Harris, Matthew; Majeed, Azeem

2017-01-01

Background The UK government plans to extend the opening hours of general practices in England. The ‘extended hours access scheme’ pays practices for providing appointments outside core times (08:00 to 18.30, Monday to Friday) for at least 30 min per 1000 registered patients each week. Objective To determine the association between extended hours access scheme participation and patient experience. Methods Retrospective analysis of a national cross-sectional survey completed by questionnaire (General Practice Patient Survey 2013–2014); 903 357 survey respondents aged ≥18 years old and registered to 8005 general practices formed the study population. Outcome measures were satisfaction with opening hours, experience of making an appointment and overall experience (on five-level interval scales from 0 to 100). Mean differences between scheme participation groups were estimated using multilevel random-effects regression, propensity score matching and instrumental variable analysis. Results Most patients were very (37.2%) or fairly satisfied (42.7%) with the opening hours of their general practices; results were similar for experience of making an appointment and overall experience. Most general practices participated in the extended hours access scheme (73.9%). Mean differences in outcome measures between scheme participants and non-participants were positive but small across estimation methods (mean differences ≤1.79). For example, scheme participation was associated with a 1.25 (95% CI 0.96 to 1.55) increase in satisfaction with opening hours using multilevel regression; this association was slightly greater when patients could not take time off work to see a general practitioner (2.08, 95% CI 1.53 to 2.63). Conclusions Participation in the extended hours access scheme has a limited association with three patient experience measures. This questions expected impacts of current plans to extend opening hours on patient experience. PMID:27343274

Extended opening hours and patient experience of general practice in England: multilevel regression analysis of a national patient survey.

PubMed

Cowling, Thomas E; Harris, Matthew; Majeed, Azeem

2017-05-01

The UK government plans to extend the opening hours of general practices in England. The 'extended hours access scheme' pays practices for providing appointments outside core times (08:00 to 18.30, Monday to Friday) for at least 30 min per 1000 registered patients each week. To determine the association between extended hours access scheme participation and patient experience. Retrospective analysis of a national cross-sectional survey completed by questionnaire (General Practice Patient Survey 2013-2014); 903 357 survey respondents aged ≥18 years old and registered to 8005 general practices formed the study population. Outcome measures were satisfaction with opening hours, experience of making an appointment and overall experience (on five-level interval scales from 0 to 100). Mean differences between scheme participation groups were estimated using multilevel random-effects regression, propensity score matching and instrumental variable analysis. Most patients were very (37.2%) or fairly satisfied (42.7%) with the opening hours of their general practices; results were similar for experience of making an appointment and overall experience. Most general practices participated in the extended hours access scheme (73.9%). Mean differences in outcome measures between scheme participants and non-participants were positive but small across estimation methods (mean differences ≤1.79). For example, scheme participation was associated with a 1.25 (95% CI 0.96 to 1.55) increase in satisfaction with opening hours using multilevel regression; this association was slightly greater when patients could not take time off work to see a general practitioner (2.08, 95% CI 1.53 to 2.63). Participation in the extended hours access scheme has a limited association with three patient experience measures. This questions expected impacts of current plans to extend opening hours on patient experience. 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/.

Availability and quality of coronary heart disease family history in primary care medical records: implications for cardiovascular risk assessment.

PubMed

Dhiman, Paula; Kai, Joe; Horsfall, Laura; Walters, Kate; Qureshi, Nadeem

2014-01-01

The potential to use data on family history of premature disease to assess disease risk is increasingly recognised, particularly in scoring risk for coronary heart disease (CHD). However the quality of family health information in primary care records is unclear. To assess the availability and quality of family history of CHD documented in electronic primary care records. Cross-sectional study. 537 UK family practices contributing to The Health Improvement Network database. Data were obtained from patients aged 20 years or more, registered with their current practice between 1(st) January 1998 and 31(st) December 2008, for at least one year. The availability and quality of recorded CHD family history was assessed using multilevel logistic and ordinal logistic regression respectively. In a cross-section of 1,504,535 patients, 19% had a positive or negative family history of CHD recorded. Multilevel logistic regression showed patients aged 50-59 had higher odds of having their family history recorded compared to those aged 20-29 (OR:1.23 (1.21 to 1.25)), however most deprived patients had lower odds compared to those least deprived (OR: 0.86 (0.85 to 0.88)). Of the 140,058 patients with a positive family history recorded (9% of total cohort), age of onset was available in 45%; with data specifying both age of onset and relative affected available in only 11% of records. Multilevel ordinal logistic regression confirmed no statistical association between the quality of family history recording and age, gender, deprivation and year of registration. Family history of CHD is documented in a small proportion of primary care records; and where positive family history is documented the details are insufficient to assess familial risk or populate cardiovascular risk assessment tools. Data capture needs to be improved particularly for more disadvantaged patients who may be most likely to benefit from CHD risk assessment.

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.

Provincial income inequality and self‐reported health status in China during 1991–7

PubMed Central

Pei, X; Rodriguez, E

2006-01-01

Background The relationship between income inequality and health has been widely explored. Today there is some evidence suggesting that good health is inversely related to income inequality. After the economic reforms initiated in the early 1980s, China experienced one of the fastest‐growing income inequalities in the world. The state of China in the 1990s is focussed on and possible effects of provincial income inequality on individual health status are explored. Methods A multilevel regression model is used to analyse the data collected in 1991, 1993 and 1997 from nine provinces included in the China Health and Nutrition Survey. The effects of provincial Gini coefficients on self‐rated health in each year are evaluated by two logistic regressions estimating the odds ratios of reporting poor or fair health. The patterns of this effect are compared among the survey years and also among different demographic groups. Results The analyses show an independent effect of income inequality on self‐reported health after adjusting for individual and household variables. Furthermore, the effect of income distribution is not attenuated when household income and provincial gross domestic product per capita are included in the model. The results show that there is an increased risk of about 10–15% on average for fair or poor health for people living in provinces with greater income inequalities compared with provinces with modest income inequalities. Conclusions In China, societal income inequality appears to be an important determinant of population health during 1991–7. PMID:17108303

Trends and risk factors of stillbirths and neonatal deaths in Eastern Uganda (1982-2011): a cross-sectional, population-based study.

PubMed

Kujala, Sanni; Waiswa, Peter; Kadobera, Daniel; Akuze, Joseph; Pariyo, George; Hanson, Claudia

2017-01-01

To identify mortality trends and risk factors associated with stillbirths and neonatal deaths 1982-2011. Population-based cross-sectional study based on reported pregnancy history in Iganga-Mayuge Health and Demographic Surveillance Site (HDSS) in Uganda. A pregnancy history survey was conducted among women aged 15-49 years living in the HDSS during May-July 2011 (n = 10 540). Time trends were analysed with cubic splines and linear regression. Potential risk factors were examined with multilevel logistic regression with adjusted odds ratios (AOR) and 95% confidence intervals (CI). 34 073 births from 1982 to 2011 were analysed. The annual rate of decrease was 0.9% for stillbirths and 1.8% for neonatal mortality. Stillbirths were associated with several risk factors: multiple births (AOR 2.57, CI 1.66-3.99), previous adverse outcome (AOR 6.16, CI 4.26-8.88) and grand multiparity among 35- to 49-year-olds (AOR 1.97, CI 1.32-2.89). Neonatal deaths were associated with multiple births (AOR 6.16, CI 4.80-7.92) and advanced maternal age linked with parity of 1-4 (AOR 2.34, CI 1.28-4.25) and grand multiparity (AOR 1.44, CI 1.09-1.90). Education, marital status and household wealth were not associated with the outcomes. The slow decline in mortality rates and easily identifiable risk factors calls for improving quality of care at birth and a rethinking of how to address obstetric risks, potentially a revival of the risk approach in antenatal care. © 2016 John Wiley & Sons Ltd.

For whom is income inequality most harmful? A multi-level analysis of income inequality and mortality in Norway.

PubMed

Dahl, Espen; Ivar Elstad, Jon; Hofoss, Dag; Martin-Mollard, Melissa

2006-11-01

This study investigates the degree to which contextual income inequality in economic regions in Norway affected mortality during the 1990s, above the effects of mean regional income and individual-level confounders. A further objective is to explore whether income inequality effects on mortality differed between socioeconomic groups. Data were constructed by linkages of administrative registers encompassing all Norwegian inhabitants. The outcome variable was all-cause mortality during 6 years (i.e., died 1994-1999 or alive end of 1999). Men and women aged 25-66 in 1993 were analysed. Regions' mean income and income inequality (in terms of gini coefficients) were calculated from consumption-units-adjusted family disposable income. Individual-level variables included sex, age, marital status, individual income, education, and being a recipient of health-related welfare benefits. Multilevel logistic regression models were fitted for 2,197,231 individuals nested within 88 regions. After adjusting for regional mean income and individual-level variables, the odds ratio (OR) for mortality 1994-1999 was 1.028 (95% CI 1.023-1.033) on the gini variable multiplied by 100. Analyses of cross-level interactions indicated some, albeit modest, income inequality effects on mortality in the upper income and educational categories. Among those with low individual income, low education, and among recipients of health-related welfare benefits, mortality effects of higher regional income inequality were significantly stronger than among those more advantageously placed in the social structure. The results of this study differ from previous studies which have suggested that contextual income inequality has a minor impact on population health in egalitarian countries. The results indicate that in Norway, neither a comparatively egalitarian income distribution nor generous and comprehensive welfare institutions hindered the emergence of regional-level income inequality effects on mortality, and these effects were particularly marked among socioeconomically disadvantaged groups. Explanations for the results are discussed.

Trade liberalization and tuberculosis incidence: a longitudinal multi-level analysis in 22 high burden countries between 1990 and 2010

PubMed Central

Bozorgmehr, Kayvan; San Sebastian, Miguel

2014-01-01

Background Trade liberalization is promoted by the World Trade Organization (WTO) through a complex architecture of binding trade agreements. This type of trade, however, has the potential to modify the upstream and proximate determinants of tuberculosis (TB) infection. We aimed to analyse the association between trade liberalization and TB incidence in 22 high-burden TB countries between 1990 and 2010. Methods and findings A longitudinal multi-level linear regression analysis was performed using five different measures of trade liberalization as exposure [WTO membership, duration of membership, trade as % of gross domestic product, and components of both the Economic Freedom of the World Index (EFI4) and the KOF Index of Globalization (KOF1)]. We adjusted for a wide range of factors, including differences in human development index (HDI), income inequality, debts, polity patterns, conflict, overcrowding, population stage transition, health system financing, case detection rates and HIV prevalence. None of the five trade indicators was significantly associated with TB incidence in the crude analysis. Any positive effect of EFI4 on (Log-) TB incidence over time was confounded by differences in socio-economic development (HDI), HIV prevalence and health financing indicators. The adjusted TB incidence rate ratio of WTO member countries was significantly higher [RR: 1.60; 95% confidence interval (CI): 1.12–2.29] when compared with non-member countries. Conclusion We found no association between specific aggregate indicators of trade liberalization and TB incidence. Our analyses provide evidence of a significant association between WTO membership and higher TB incidence, which suggests a possible conflict between the architecture of WTO agreements and TB-related Millennium Development Goals. Further research is needed, particularly on the relation between the aggregate trade indices used in this study and the hypothesized mediators and also on sector-specific indices, specific trade agreements and other (non-TB) health outcomes. PMID:23595571

The role of team climate in improving the quality of chronic care delivery: a longitudinal study among professionals working with chronically ill adolescents in transitional care programmes.

PubMed

Cramm, Jane M; Strating, Mathilde M H; Nieboer, Anna P

2014-05-22

This study aimed to (1) evaluate the effectiveness of implementing transition programmes in improving the quality of chronic care delivery and (2) identify the predictive role of (changes in) team climate on the quality of chronic care delivery over time. This longitudinal study was undertaken with professionals working in hospitals and rehabilitation units that participated in the transition programme 'On Your Own Feet Ahead!' in the Netherlands. A total of 145/180 respondents (80.6%) filled in the questionnaire at the beginning of the programme (T1), and 101/173 respondents (58.4%) did so 1 year later at the end of the programme (T2). A total of 90 (52%) respondents filled in the questionnaire at both time points. Two-tailed, paired t tests were used to investigate improvements over time and multilevel analyses to investigate the predictive role of (changes in) team climate on the quality of chronic care delivery. Transition programme. Quality of chronic care delivery measured with the Assessment of Chronic Illness Care Short version (ACIC-S). The overall ACIC-S score at T1 was 5.90, indicating basic or intermediate support for chronic care delivery. The mean ACIC-S score at T2 significantly improved to 6.70, indicating advanced support for chronic care. After adjusting for the quality of chronic care delivery at T1 and significant respondents' characteristics, multilevel regression analyses showed that team climate at T1 (p<0.01) and changes in team climate (p<0.001) predicted the quality of chronic care delivery at T2. The implementation of transition programmes requires a supportive and stimulating team climate to enhance the quality of chronic care delivery to chronically ill adolescents. 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.

Income inequality and foregone medical care in Europe during The Great Recession: multilevel analyses of EU-SILC surveys 2008-2013.

PubMed

Elstad, Jon Ivar

2016-07-07

The association between income inequality and societal performance has been intensely debated in recent decades. This paper reports how unmet need for medical care has changed in Europe during The Great Recession, and investigates whether countries with smaller income differences have been more successful than inegalitarian countries in protecting access to medical care during an economic crisis. Six waves of EU-SILC surveys (2008-2013) from 30 European countries were analyzed. Foregone medical care, defined as self-reported unmet need for medical care due to costs, waiting lists, or travel difficulties, was examined among respondents aged 30-59 years (N = 1.24 million). Countries' macro-economic situation was measured by Real Gross Domestic Product (GDP) per capita. The S80/S20 ratio indicated the country's level of income inequality. Equity issues were highlighted by separate analyses of disadvantaged respondents with limited economic resources and relatively poor health. Cross-tabulations and multilevel linear probability regression models were utilized. Foregone medical care increased 2008-2013 in the majority of the 30 countries, especially among the disadvantaged parts of the population. For the disadvantaged, unmet need for medical care tended to be higher in countries with larger income inequalities, regardless of the average economic standard in terms of GDP per capita. Both for disadvantaged and for other parts of the samples, a decline in GDP had more severe effects on access in inegalitarian countries than in countries with less income inequality. During The Great Recession, unmet need for medical care increased in Europe, and social inequalities in foregone medical care widened. Overall, countries with a more egalitarian income distribution have been more able to protect their populations, and especially disadvantaged groups, against deteriorated access to medical care when the country is confronted with an economic crisis.

Sick regimes and sick people: a multilevel investigation of the population health consequences of perceived national corruption.

PubMed

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

2013-10-01

There is a paucity of empirical work on the potential population health impact of living under a regime marred by corruption. African countries differ in the extent of national corruption, and we explore whether perceived national corruption is associated with population health across all rungs of society. World Health Survey data were analysed on 72 524 adults from 20 African countries. The main outcome was self-reported poor general health. Multilevel logistic regression was used to assess the association between poor health and perceived corruption, while jointly accounting for individual- and country-level human development factors. In this research, we use Transparency International's corruption perception index (CPI), which measures 'both administrative and political corruption' on a 0-10 scale. A higher score pertains to a higher rate of perceived corruption within society. We also examined effect modification by gender, age and socio-economic status. Higher national corruption perception was consistently associated with an increase in poor health prevalence, also after multivariable adjustments, with odds ratio (OR) of 1.62 (95% CI: 1.01-2.60). Stratified analyses by age and gender suggested this same pattern in all subgroups. Positive associations between poor health and perceived corruption were evident in all socio-economic groups, with the association being somewhat more positive among less educated people (OR = 1.61, 95% CI: 1.01-2.58) than among more educated people (OR = 1.40, 95% CI: 0.83-2.37). This study is a cautious first step in empirically testing the general health consequences of corruption. Our results suggest that higher perceived national corruption is associated with general health of both men and women within all socio-economic groups across the lifespan. Further research is needed using more countries to assess the magnitude of the health consequences of corruption. © 2013 John Wiley & Sons Ltd.

Trade liberalization and tuberculosis incidence: a longitudinal multi-level analysis in 22 high burden countries between 1990 and 2010.

PubMed

Bozorgmehr, Kayvan; San Sebastian, Miguel

2014-05-01

Trade liberalization is promoted by the World Trade Organization (WTO) through a complex architecture of binding trade agreements. This type of trade, however, has the potential to modify the upstream and proximate determinants of tuberculosis (TB) infection. We aimed to analyse the association between trade liberalization and TB incidence in 22 high-burden TB countries between 1990 and 2010. and findings A longitudinal multi-level linear regression analysis was performed using five different measures of trade liberalization as exposure [WTO membership, duration of membership, trade as % of gross domestic product, and components of both the Economic Freedom of the World Index (EFI4) and the KOF Index of Globalization (KOF1)]. We adjusted for a wide range of factors, including differences in human development index (HDI), income inequality, debts, polity patterns, conflict, overcrowding, population stage transition, health system financing, case detection rates and HIV prevalence. None of the five trade indicators was significantly associated with TB incidence in the crude analysis. Any positive effect of EFI4 on (Log-) TB incidence over time was confounded by differences in socio-economic development (HDI), HIV prevalence and health financing indicators. The adjusted TB incidence rate ratio of WTO member countries was significantly higher [RR: 1.60; 95% confidence interval (CI): 1.12-2.29] when compared with non-member countries. We found no association between specific aggregate indicators of trade liberalization and TB incidence. Our analyses provide evidence of a significant association between WTO membership and higher TB incidence, which suggests a possible conflict between the architecture of WTO agreements and TB-related Millennium Development Goals. Further research is needed, particularly on the relation between the aggregate trade indices used in this study and the hypothesized mediators and also on sector-specific indices, specific trade agreements and other (non-TB) health outcomes.

Television viewing and forms of bullying among adolescents from eight countries.

PubMed

Kuntsche, Emmanuel; Pickett, William; Overpeck, Mary; Craig, Wendy; Boyce, William; de Matos, Margarida Gaspar

2006-12-01

Based on theories suggesting that frequent television viewers act and react in hostile, malicious, malevolent, or verbally aggressive ways rather than being physically violent, the present study investigates relationships between television viewing and different forms of bullying. Multilevel regression models were estimated based on cross-sectional data from 31,177 adolescents aged 11, 13, and 15 years from Canada, Estonia, Israel, Latvia, Macedonia, Poland, Portugal, and the United States who participated in the 2001-2002 Health Behavior in School-aged Children Survey. Although all different forms of bullying were associated with television viewing in bivariate analyses, only the verbal forms (i.e. "calling mean names" and "spreading rumors") remained significant in multiple regression models. These relationships were observed consistently in all eight participating countries. However, the association between television viewing and physical forms of bullying such as kicking, pushing, or shoving around, varied across countries. In most weekend TV viewing cultures, frequent television viewers were prone to kick or push another student in addition to verbal forms of bullying, which was not the case in weekday viewing cultures. These results demonstrate the importance of limiting adolescents' time engaged in unsupervised television watching, and the need to motivate adolescents to engage in joint family activities or organized after-school activities.

Assessing the Associations Between Types of Green Space, Physical Activity, and Health Indicators Using GIS and Participatory Survey

NASA Astrophysics Data System (ADS)

Akpinar, A.

2017-11-01

This study explores whether specific types of green spaces (i.e. urban green spaces, forests, agricultural lands, rangelands, and wetlands) are associated with physical activity, quality of life, and cardiovascular disease prevalence. A sample of 8,976 respondents from the Behavioral Risk Factor Surveillance System, conducted in 2006 in Washington State across 291 zip-codes, was analyzed. Measures included physical activity status, quality of life, and cardiovascular disease prevalence (i.e. heart attack, angina, and stroke). Percentage of green spaces was derived from the National Land Cover Dataset and measured with Geographical Information System. Multilevel regression analyses were conducted to analyze the data while controlling for age, sex, race, weight, marital status, occupation, income, education level, and zip-code population and socio-economic situation. Regression results reveal that no green space types were associated with physical activity, quality of life, and cardiovascular disease prevalence. On the other hand, the analysis shows that physical activity was associated with general health, quality of life, and cardiovascular disease prevalence. The findings suggest that other factors such as size, structure and distribution (sprawled or concentrated, large or small), quality, and characteristics of green space might be important in general health, quality of life, and cardiovascular disease prevalence rather than green space types. Therefore, further investigations are needed.

Family and Motivation Effects on Mathematics Achievement: Analyses of Students in 41 Countries

ERIC Educational Resources Information Center

Chiu, Ming Ming; Xihua, Zeng

2008-01-01

This study examines family and motivation effects on student mathematics achievement across 41 countries. The Rasch estimates of PISA mathematics test scores and questionnaire responses of 107,975 15-year-old students were analyzed via multilevel analyses. Students scored higher in richer or more egalitarian countries; when living with two…

English Phonological Awareness in Bilinguals: A Cross-Linguistic Study of Tamil, Malay and Chinese English-Language Learners

ERIC Educational Resources Information Center

Dixon, L. Quentin; Chuang, Hui-Kai; Quiroz, Blanca

2012-01-01

To test the lexical restructuring hypothesis among bilingual English-language learners, English phonological awareness (PA), English vocabulary and ethnic language vocabulary (Mandarin Chinese, Malay or Tamil) were assessed among 284 kindergarteners (168 Chinese, 71 Malays and 45 Tamils) in Singapore. A multi-level regression analysis showed that…

A Multilevel Study of Students' Motivations of Studying Accounting: Implications for Employers

ERIC Educational Resources Information Center

Law, Philip; Yuen, Desmond

2012-01-01

Purpose: The purpose of this study is to examine the influence of factors affecting students' choice of accounting as a study major in Hong Kong. Design/methodology/approach: Multinomial logistic regression and Hierarchical Generalized Linear Modeling (HGLM) are used to analyze the survey data for the level one and level two data, which is the…

Educational Investment, Family Context, and Children's Math and Reading Growth from Kindergarten through the Third Grade

ERIC Educational Resources Information Center

Cheadle, Jacob E.

2008-01-01

Drawing on longitudinal data from the Early Childhood Longitudinal Study, Kindergarten Class of 1998-1999, this study used IRT modeling to operationalize a measure of parental educational investments based on Lareau's notion of concerted cultivation. It used multilevel piece-wise growth models regressing children's math and reading achievement…

Family Structure and Child Mortality in Sub-Saharan Africa: Cross-National Effects of Polygyny

ERIC Educational Resources Information Center

Omariba, D. Walter Rasugu; Boyle, Michael H.

2007-01-01

This study applies multilevel logistic regression to Demographic and Health Survey data from 22 sub-Saharan African countries to examine whether the relationship between child mortality and family structure, with a specific emphasis on polygyny, varies cross-nationally and over time. Hypotheses were developed on the basis of competing theories on…

Evaluating the Effect of a Television Public Service Announcement about Epilepsy

ERIC Educational Resources Information Center

Martiniuk, Alexandra L. C.; Secco, Mary; Yake, Laura; Speechley, Kathy N.

2010-01-01

Public service announcements (PSAs) are non-commercial advertisements aiming to improve knowledge, attitudes and/or behavior. No evaluations of epilepsy PSAs exist. This study sought to evaluate a televised PSA showing first aid for a seizure. A multilevel regression analysis was used to determine the effect of the PSA on epilepsy knowledge and…

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.

The relationship between session frequency and psychotherapy outcome in a naturalistic setting.

PubMed

Erekson, David M; Lambert, Michael J; Eggett, Dennis L

2015-12-01

The dose-response relationship in psychotherapy has been examined extensively, but few studies have included session frequency as a component of psychotherapy "dose." Studies that have examined session frequency have indicated that it may affect both the speed and the amount of recovery. No studies were found examining the clinical significance of this construct in a naturalistic setting, which is the aim of the current study. Using an archival database of session-by-session Outcome Questionnaire 45 (OQ-45) measures over 17 years, change trajectories of 21,488 university counseling center clients (54.9% female, 85.0% White, mean age = 22.5) were examined using multilevel modeling, including session frequency at the occasion level. Of these clients, subgroups that attended therapy approximately weekly or fortnightly were compared to each other for differences in speed of recovery (using multilevel Cox regression) and clinically significant change (using multilevel logistic regression). Results indicated that more frequent therapy was associated with steeper recovery curves (Cohen's f2 = 0.07; an effect size between small and medium). When comparing weekly and fortnightly groups, clinically significant gains were achieved faster for those attending weekly sessions; however, few significant differences were found between groups in total amount of change in therapy. Findings replicated previous session frequency literature and supported a clinically significant effect, where higher session frequency resulted in faster recovery. Session frequency appears to be an impactful component in delivering more efficient psychotherapy, and it is important to consider in individual treatment planning, institutional policy, and future research. (c) 2015 APA, all rights reserved).

Determinants of Exclusive Breast Feeding in sub-Saharan Africa: A Multilevel Approach.

PubMed

Yalçin, Siddika Songül; Berde, Anselm S; Yalçin, Suzan

2016-09-01

The study aimed to provide an overall picture of the general pattern of exclusive breast feeding (EBF) in sub-Saharan Africa (SSA) by examining maternal sociodemographic, antenatal and postnatal factors associated with EBF in the region, as well as explore countries variations in EBF rates. We utilised cross-sectional data from the Demographic Health Surveys in 27 SSA countries. Our study sample included 25 084 infants under 6 months of age. The key outcome variable was EBF in the last 24 h. Due to the hierarchical structure of the data, a multilevel logistic regression model was used to explore factors associated with EBF. The overall prevalence of EBF in SSA was 36.0%, the prevalence was highest in Rwanda and lowest in Gabon. In the multilevel regression model, factors that were associated with increased likelihood of EBF included secondary and above maternal education, mothers within the ages of 25-34 years, rural residence, richer household wealth quantile, 4+ antenatal care visit, delivering in a health facility, singleton births, female infants, early initiation of breast feeding (EIBF), and younger infants. However, countries with higher gross national income per capita had lower EBF rates. To achieve a substantial increase in EBF rates in SSA, breast-feeding interventions and policies should target all women but with more emphasis to mothers with younger age, low educational status, urban residence, poor status, multiple births, and male infants. In addition, there is a need to promote antenatal care utilisation, hospital deliveries, and EIBF. © 2016 John Wiley & Sons Ltd.

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)

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 value of urban open space: meta-analyses of contingent valuation and hedonic pricing results.

PubMed

Brander, Luke M; Koetse, Mark J

2011-10-01

Urban open space provides a number of valuable services to urban populations, including recreational opportunities, aesthetic enjoyment, environmental functions, and may also be associated with existence values. In separate meta-analyses of the contingent valuation (CV) and hedonic pricing (HP) literature we examine which physical, socio-economic, and study characteristics determine the value of open space. The dependent variable in the CV meta-regression is defined as the value of open space per hectare per year in 2003 US$, and in the HP model as the percentage change in house price for a 10 m decrease in distance to open space. Using a multi-level modelling approach we find in both the CV and HP analyses that there is a positive and significant relationship between the value of urban open space and population density, indicating that scarcity and crowdedness matter, and that the value of open space does not vary significantly with income. Further, urban parks are more highly valued than other types of urban open space (forests, agricultural and undeveloped land) and methodological differences in study design have a large influence on estimated values from both CV and HP. We also find important regional differences in preferences for urban open space, which suggests that the potential for transferring estimated values between regions is likely to be limited. Copyright © 2011 Elsevier Ltd. All rights reserved.

Intergroup contact, attitudes toward homosexuality, and the role of acceptance of gender non-conformity in young adolescents.

PubMed

Collier, Kate L; Bos, Henny M W; Sandfort, Theo G M

2012-08-01

This study explored how contact with gay and lesbian persons affects adolescents' attitudes toward them, and whether this association is mediated or moderated by one's acceptance of gender non-conformity. We analyzed survey responses from 456 Dutch adolescents aged 12-15 who reported having no same-sex attractions. Data were collected in 2008 at 8 schools in Amsterdam, the Netherlands. Preliminary analyses showed that contact with lesbian/gay persons outside of school was positively associated with attitudes toward lesbians and gay men. Multilevel analyses showed that acceptance of gender non-conformity mediated rather than moderated the relationship between intergroup contact and sexual prejudice in males. The effect of intergroup contact on females' attitudes toward lesbian women was no longer significant in multilevel analyses. The findings suggest that attention to both intergroup contact and acceptance of gender non-conformity would enhance our understanding of attitudes toward homosexuality in adolescents. Copyright © 2011 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Changes in the Associations of Heavy Drinking and Drug Use with Intimate Partner Violence in Early Adulthood

PubMed Central

Feingold, Alan; Washburn, Isaac J.; Tiberio, Stacey S.; Capaldi, Deborah M.

2013-01-01

The hypothesis that the disinhibitory effects induced by alcohol consumption contribute to domestic violence has gained support from meta-analyses of mainly cross-sectional studies that examined the association between alcohol abuse and perpetration of intimate partner violence (IPV). However, findings from multilevel analyses of longitudinal data investigating the time-varying effects of heavy episodic drinking (HED) on physical IPV have been equivocal. This 12-year prospective study used multilevel analysis to examine the effects of HED and illicit drug use on perpetration of both physical and psychological IPV during early adulthood. Participants were 157 romantic couples who were assessed biennially 2 to 6 times for substance misuse and IPV. The analyses found no significant main effect of either HED or drug use on perpetration of IPV but there were significant interactions of both HED and drug use with age. Moreover, the developmental trends in substance use effects on IPV typically varied by gender and type of IPV. PMID:25678737

Intergroup contact, attitudes toward homosexuality, and the role of acceptance of gender non-conformity in young adolescents

PubMed Central

Collier, Kate L.; Bos, Henny M.W.; Sandfort, Theo G.M.

2012-01-01

This study explored how contact with gay and lesbian persons affects adolescents' attitudes toward them, and whether this association is mediated or moderated by one's acceptance of gender non-conformity. We analyzed survey responses from 456 Dutch adolescents aged 12 to 15 who reported having no same-sex attractions. Data were collected in 2008 at 8 schools in Amsterdam, the Netherlands. Preliminary analyses showed that contact with lesbian/gay persons outside of school was positively associated with attitudes toward lesbians and gay men. Multilevel analyses showed that acceptance of gender non-conformity mediated rather than moderated the relationship between intergroup contact and sexual prejudice in males. The effect of intergroup contact on females' attitudes toward lesbian women was no longer significant in multilevel analyses. The findings suggest that attention to both intergroup contact and acceptance of gender non-conformity would enhance our understanding of attitudes toward homosexuality in adolescents. PMID:22243627

Sex segregation in undergraduate engineering majors

NASA Astrophysics Data System (ADS)

Litzler, Elizabeth

Gender inequality in engineering persists in spite of women reaching parity in college enrollments and degrees granted. To date, no analyses of educational sex segregation have comprehensively examined segregation within one discipline. To move beyond traditional methods of studying the long-standing stratification by field of study in higher education, I explore gender stratification within one field: engineering. This dissertation investigates why some engineering disciplines have a greater representation of women than other engineering disciplines. I assess the individual and institutional factors and conditions associated with women's representation in certain engineering departments and compare the mechanisms affecting women's and men's choice of majors. I use national data from the Engineering Workforce Commission, survey data from 21 schools in the Project to Assess Climate in Engineering study, and Carnegie Foundation classification information to study sex segregation in engineering majors from multiple perspectives: the individual, major, institution, and country. I utilize correlations, t-tests, cross-tabulations, log-linear modeling, multilevel logistic regression and weighted least squares regression to test the relative utility of alternative explanations for women's disproportionate representation across engineering majors. As a whole, the analyses illustrate the importance of context and environment for women's representation in engineering majors. Hypotheses regarding hostile climate and discrimination find wide support across different analyses, suggesting that women's under-representation in certain engineering majors is not a question of choice or ability. However, individual level factors such as having engineering coursework prior to college show an especially strong association with student choice of major. Overall, the analyses indicate that institutions matter, albeit less for women, and women's under-representation in engineering is not reducible to individual choice. This dissertation provides a broad, descriptive view of the state of sex segregation in engineering as well as a careful analysis of how individual and institutional factors inhibit or encourage sex segregation. This study contributes to the research literature through the use of novel data, testing of occupational segregation theories, and the use of multiple levels of analysis. The analyses provide new insight into an enduring phenomenon, and suggest new avenues for understanding sex segregation in higher education.

Gender inequalities in mental wellbeing in 26 European countries: do welfare regimes matter?

PubMed

Dreger, Stefanie; Gerlinger, Thomas; Bolte, Gabriele

2016-10-01

Nature and extent of welfare regimes and social policies are important determinants of health and health inequalities. This study examines the association of gender and mental wellbeing in European countries and investigates whether type of welfare regime plays a role in this association. Data of 19 366 women and 14 338 men of the third round of the European Quality of Life Survey (2011-12) was used to analyse mental wellbeing, assessed by the World Health Organization 5-Mental Wellbeing Index. Multilevel logistic regression analyses were performed to analyse the association between gender and good mental wellbeing first at country-level, and secondly the between country variation was analysed and welfare regimes were included as explanatory variables. We observed cross-national variation in good mental wellbeing. At country levels gender inequalities in good mental wellbeing were observed in 7 out of 26 countries. In analyses considering all countries together gender inequalities in good mental wellbeing were identified independent of further individual socio-demographic variables and independent of the welfare regimes that people lived in [women vs. men: OR = 0.76; (95% CI = 0.71-0.81)]. Gender inequalities in good mental wellbeing were not modified by welfare regimes. There are cross-national differences in good mental wellbeing between European countries. Gender inequalities with a lower prevalence of good mental wellbeing among women are common in European countries. This study suggests that welfare regimes do not modify these gender inequalities in mental wellbeing. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Redefining Racial Residential Segregation and its Association With Physical Activity Among African Americans 50 years and Older: A Mixed Methods Approach

PubMed Central

Armstrong-Brown, Janelle; Eng, Eugenia; Hammond, Wizdom Powell; Zimmer, Catherine; Bowling, J. Michael

2016-01-01

Physical inactivity is one of the factors contributing to disproportionate disease rates among older African Americans. Previous literature indicates that older African Americans are more likely to live in racially segregated neighborhoods and that racial residential segregation is associated with limited opportunities for physical activity. A cross-sectional mixed methods study was conducted guided by the concept of therapeutic landscapes. Multilevel regression analyses demonstrated that racial residential segregation was associated with more minutes of physical activity and greater odds of meeting physical activity recommendations. Qualitative interviews revealed the following physical activity related themes: aging of the neighborhood, knowing your neighbors, feeling of safety, and neighborhood racial identity. Perceptions of social cohesion enhanced participants’ physical activity, offering a plausible explanation to the higher rates of physical activity found in this population. Understanding how social cohesion operates within racially segregated neighborhoods can help to inform the design of effective interventions for this population. PMID:24812201

Effects of work stress on work-related rumination, restful sleep, and nocturnal heart rate variability experienced on workdays and weekends.

PubMed

Vahle-Hinz, Tim; Bamberg, Eva; Dettmers, Jan; Friedrich, Niklas; Keller, Monika

2014-04-01

The present study reports the lagged effects of work stress on work-related rumination, restful sleep, and nocturnal heart rate variability experienced during both workdays and weekends. Fifty employees participated in a diary study. Multilevel and regression analyses revealed a significant relationship between work stress measured at the end of a workday, work-related rumination measured during the evening, and restful sleep measured the following morning. Work stress, measured as the mean of 2 consecutive workdays, was substantially but not significantly related to restful sleep on weekends. Work stress was unrelated to nocturnal heart rate variability. Work-related rumination was related to restful sleep on weekends but not on workdays. Additionally, work-related rumination on weekends was positively related to nocturnal heart rate variability during the night between Saturday and Sunday. No mediation effects of work stress on restful sleep or nocturnal heart rate variability via work-related rumination were confirmed.

The relationship between clinician turnover and adolescent treatment outcomes: An examination from the client perspective

PubMed Central

Garner, Bryan R.; Funk, Rodney R.; Hunter, Brooke D.

2012-01-01

The turnover of substance use disorder (SUD) treatment staff has been assumed to adversely impact treatment effectiveness, yet only limited research has empirically examined this assumption. Representing an extension of prior organizational-level analyses of the impact of staff turnover on client outcomes, this study examined the impact of SUD clinician turnover on adolescent treatment outcomes using a client perspective. Multilevel regression analysis did reveal that relative to those adolescents who did not experience clinician turnover, adolescents who experienced both direct and indirect clinician turnover reported a significantly higher percentage of days using alcohol or drugs at 6-month follow-up. However, clinician turnover was not found to have significant associations (negative or positive) with the other five treatment outcomes examined (e.g., substance-related problems, involvement in illegal activity). Thus, consistent with our prior findings, the current study provides additional evidence that turnover of SUD clinicians is not necessarily associated with adverse treatment outcomes. PMID:23083980

Alcohol and risky sexual behavior among heavy drinking college students.

PubMed

Scott-Sheldon, Lori A J; Carey, Michael P; Carey, Kate B

2010-08-01

Multiple event-level methodology was used to examine the relation between risky sexual behavior and alcohol use among sexually active, heavy drinking college students (N = 221). Using a structured timeline follow-back interview, participants reported their sexual, alcohol, and drug use behaviors over a 3-month period. Over 2,700 vaginal or anal sexual events were reported from 177 participants. Overall, condom use was not associated with heavy or non-heavy alcohol consumption among those reporting both sexual events concurrent with heavy drinking and when no alcohol was consumed. Results from multilevel regression analyses revealed a more complex pattern. Among women, but not men, less condom use was associated with steady versus casual sexual partners, but partner type interacted with alcohol consumption such that less condom use occurred when heavy drinking preceded sex with steady partners. At the event-level, alcohol consumption among heavy drinking college students leads to risky sexual behavior but the relation differs by gender and partner type.

Capability for change at community health centers serving Asian Pacific Islanders: an exploratory study of a cancer screening evidence-based intervention.

PubMed

Sohng, Hee Yon; Kuniyuki, Alan; Edelson, Jane; Weir, Rosy Chang; Song, Hui; Tu, Shin-Ping

2013-01-01

Understanding and enhancing change capabilities, including Practice Adaptive Reserve (PAR), of Community Health Centers (CHCs) may mitigate cancer-related health disparities. Using stratified random sampling, we recruited 232 staff from seven CHCs serving Asian Pacific Islander communities to complete a self-administered survey. We performed multilevel regression analyses to examine PAR composite scores by CHC, position type, and number of years worked at their clinic. The mean PAR score was 0.7 (s.d. 0.14). Higher scores were associated with a greater perceived likelihood that clinic staff would participate in an evidence-based intervention (EBI). Constructs such as communication, clinic flow, sensemaking, change valence, and resource availability were positively associated with EBI implementation or trended toward significance. PAR scores are positively associated with perceived likelihood of clinic staff participation in cancer screening EBI. Future research is needed to determine PAR levels most conducive to implementing change and to developing interventions that enhance Adaptive Reserve.

Metacognitive Influences on Study Time Allocation in an Associative Recognition Task: An Analysis of Adult Age Differences

PubMed Central

Hines, Jarrod C.; Touron, Dayna R.; Hertzog, Christopher

2009-01-01

The current study evaluated a metacognitive account of study time allocation, which argues that metacognitive monitoring of recognition test accuracy and latency influences subsequent strategic control and regulation. We examined judgments of learning (JOLs), recognition test confidence judgments (CJs), and subjective response time (RT) judgments by younger and older adults in an associative recognition task involving two study-test phases, with self-paced study in phase 2. Multilevel regression analyses assessed the degree to which age and metacognitive variables predicted phase 2 study time independent of actual test accuracy and RT. Outcomes supported the metacognitive account – JOLs and CJs predicted study time independent of recognition accuracy. For older adults with errant RT judgments, subjective retrieval fluency influenced response confidence as well as (mediated through confidence) subsequent study time allocation. Older adults studied items longer which had been assigned lower CJs, suggesting no age deficit in using memory monitoring to control learning. PMID:19485662

Accessibility of fast food outlets is associated with fast food intake. A study in the Capital Region of Denmark.

PubMed

Bernsdorf, Kamille Almer; Lau, Cathrine Juel; Andreasen, Anne Helms; Toft, Ulla; Lykke, Maja; Glümer, Charlotte

2017-11-01

Literature suggests that people living in areas with a wealth of unhealthy fast food options may show higher levels of fast food intake. Multilevel logistic regression analyses were applied to examine the association between GIS-located fast food outlets (FFOs) and self-reported fast food intake among adults (+ 16 years) in the Capital Region of Denmark (N = 48,305). Accessibility of FFOs was measured both as proximity (distance to nearest FFO) and density (number of FFOs within a 1km network buffer around home). Odds of fast food intake ≥ 1/week increased significantly with increasing FFO density and decreased significantly with increasing distance to the nearest FFO for distances ≤ 4km. For long distances (>4km), odds increased with increasing distance, although this applied only for car owners. Results suggest that Danish health promotion strategies need to consider the contribution of the built environment to unhealthy eating. Copyright © 2017 Elsevier Ltd. All rights reserved.

Understanding Racial and Ethnic Disparities in Arrest: The Role of Individual, Home, School, and Community Characteristics

PubMed Central

Gase, Lauren Nichol; Glenn, Beth A.; Gomez, Louis M.; Kuo, Tony; Inkelas, Moira; Ponce, Ninez A.

2016-01-01

Contact with the justice system can lead to a range of poor health and social outcomes. While persons of color are disproportionately represented in both the juvenile and criminal justice systems, reasons for these patters remain unclear. This study sought to examine the extent and sources of differences in arrests during adolescence and young adulthood among blacks, whites, and Hispanics in the USA. Multilevel cross-sectional logistic regression analyses were conducted using data from waves I and IV of the National Longitudinal Study of Adolescent to Adult Health (n = 12,752 respondents). Results showed significantly higher likelihood of having ever been arrested among blacks, when compared to whites, even after controlling for a range of delinquent behaviors (odds ratio = 1.58, 95 % confidence interval = 1.27, 1.95). These black–white disparities were no longer present after accounting for racial composition of the neighborhood, supporting the growing body of research demonstrating the importance of contextual variables in driving disproportionate minority contact with the justice system. PMID:28713449

Predictors of Shared Decision Making and Level of Agreement between Consumers and Providers in Psychiatric Care

PubMed Central

Fukui, Sadaaki; Salyers, Michelle P.; Matthias, Marianne S.; Collins, Linda; Thompson, John; Coffman, Melinda; Torrey, William C.

2014-01-01

The purpose of this study was to quantitatively examine elements of shared decision making (SDM), and to establish empirical evidence for factors correlated with SDM and the level of agreement between consumer and provider in psychiatric care. Transcripts containing 128 audio-recorded medication check-up visits with eight providers at three community mental health centers were rated using the Shared Decision Making scale, adapted from Braddock’s Informed Decision Making Scale (Braddock et al., 1997; 1999; 2008). Multilevel regression analyses revealed that greater consumer activity in the session and greater decision complexity significantly predicted the SDM score. The best predictor of agreement between consumer and provider was “exploration of consumer preference,” with a four-fold increase in full agreement when consumer preferences were discussed more completely. Enhancing active consumer participation, particularly by incorporating consumer preferences in the decision making process appears to be an important factor in SDM. PMID:23299226

Understanding Racial and Ethnic Disparities in Arrest: The Role of Individual, Home, School, and Community Characteristics.

PubMed

Gase, Lauren Nichol; Glenn, Beth A; Gomez, Louis M; Kuo, Tony; Inkelas, Moira; Ponce, Ninez A

2016-12-01

Contact with the justice system can lead to a range of poor health and social outcomes. While persons of color are disproportionately represented in both the juvenile and criminal justice systems, reasons for these patters remain unclear. This study sought to examine the extent and sources of differences in arrests during adolescence and young adulthood among blacks, whites, and Hispanics in the USA. Multilevel cross-sectional logistic regression analyses were conducted using data from waves I and IV of the National Longitudinal Study of Adolescent to Adult Health ( n = 12,752 respondents). Results showed significantly higher likelihood of having ever been arrested among blacks, when compared to whites, even after controlling for a range of delinquent behaviors (odds ratio = 1.58, 95 % confidence interval = 1.27, 1.95). These black-white disparities were no longer present after accounting for racial composition of the neighborhood, supporting the growing body of research demonstrating the importance of contextual variables in driving disproportionate minority contact with the justice system.

Examining correlates of different cigarette access behaviours among Canadian youth: data from the Canadian Youth Smoking Survey (2006).

PubMed

Vu, Mary; Leatherdale, Scott T; Ahmed, Rashid

2011-12-01

Understanding factors associated with youth cigarette access behaviours can provide insight into the development of more effective means of preventing youth from accessing cigarettes. This cross-sectional study used self-reported data collected from 41,886 students in grades 9 to 12 who participated in the 2006-07 Youth Smoking Survey to examine the student- and school-level characteristics that differentiate youth smokers who usually access cigarettes from a social source versus buying their own from retailers. Multi-level regression analyses revealed significant between-school variability in the odds of a smoking student reporting that they usually buy their own cigarettes. Important student-level characteristics associated with how youth usually access their cigarettes included binge drinking and being asked for age or photo identification when purchasing cigarettes from a retailer. Future studies should further explore the school- and student-level characteristics associated with youth cigarette access behaviour. Copyright © 2011 Elsevier Ltd. All rights reserved.

Classroom climate indicators and attitudes towards foreigners.

PubMed

Gniewosz, Burkhard; Noack, Peter

2008-10-01

The school has been described as an important socialization agent in the process of political development. But the mechanism concerning how school contributes to political development has rarely been investigated. In this study we focus on contextual variables, i.e., classroom climate indicators that are seen as important aspects of the context in which adolescent development takes place. The study was based on the total of 1312 German students. In multilevel analyses, we regressed students' reports on intolerant attitudes towards foreigners on background characteristics as well as on the perceived classroom climate. Fairness in the classroom as perceived by the individual student was found to be negatively related to intolerance and achievement pressure was positively related. Students attending the high college-bound track reported less antiforeigner attitudes as did students where parents had a more sophisticated educational background. The results are discussed proposing schools to provide an open climate as a contextual framework for the development of tolerant attitudes among adolescents.

The big-fish-little-pond effect on mathematics self-concept: Evidence from the United Arab Emirates.

PubMed

Areepattamannil, Shaljan; Khine, Myint Swe; Al Nuaimi, Samira

2017-08-01

This study examined the big-fish-little-pond effect (BFLPE; Marsh, 1987) on mathematics self-concept of 7404 adolescents (female = 3767 [51%], male = 3637 [49%]; M age  = 15.85 years, SD = 0.28) from 456 schools in the United Arab Emirates, one of the Arab states of the Persian Gulf. The results of multilevel regression analyses indicated good support for the BFLPE's theoretical predictions: the effect of individual student mathematics achievement on individual student mathematics self-concept was positive and statistically significant, whereas the effect of school-average mathematics achievement on individual student mathematics self-concept was negative and statistically significant. Moreover, the interaction between school-average mathematics achievement and individual student mathematics achievement was small and non-significant. Implications of the findings for policy and practice are briefly discussed. Copyright © 2017 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

The Institutional Foundations of Medicalization: A Cross-national Analysis of Mental Health and Unemployment.

PubMed

Buffel, Veerle; Beckfield, Jason; Bracke, Piet

2017-09-01

In this study, we question (1) whether the relationship between unemployment and mental healthcare use, controlling for mental health status, varies across European countries and (2) whether these differences are patterned by a combination of unemployment and healthcare generosity. We hypothesize that medicalization of unemployment is stronger in countries where a low level of unemployment generosity is combined with a high level of healthcare generosity. A subsample of 36,306 working-age respondents from rounds 64.4 (2005-2006) and 73.2 (2010) of the cross-national survey Eurobarometer was used. Country-specific logistic regression and multilevel analyses, controlling for public disability spending, changes in government spending, economic capacity, and unemployment rate, were performed. We find that unemployment is medicalized, at least to some degree, in the majority of the 24 nations surveyed. Moreover, the medicalization of unemployment varies substantially across countries, corresponding to the combination of the level of unemployment and of healthcare generosity.

Siblings of Children With a Complex Chronic Health Condition: Maternal Posttraumatic Growth as a Predictor of Changes in Child Behavior Problems.

PubMed

Stephenson, Ellen; DeLongis, Anita; Steele, Rose; Cadell, Susan; Andrews, Gail S; Siden, Harold

2017-01-01

The present study examined the role of maternal posttraumatic growth in changes in behavioral problems among the siblings of children with complex chronic health conditions. Data were collected from a sample of 70 siblings from 58 families with at least one child diagnosed with a life-threatening genetic, metabolic, or neurological condition. Every 6 months for up to 4 years, sibling behavior problems were assessed through both parent-reports and youth self-reports. At each visit, mothers also completed self-reports of posttraumatic growth. Time-lagged multilevel regression analyses revealed that higher levels of maternal posttraumatic growth predicted subsequent declines in parent-reported internalizing, externalizing, and total behavior problems among healthy siblings. These findings were partially replicated using youth self-reports of their own behavior problems. The findings suggest that the benefits of posttraumatic growth may extend beyond the self to other family members, particularly to children in the family.

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.

Neck/upper back and low back pain in parents and their adult offspring: Family linkage data from the Norwegian HUNT Study.

PubMed

Lier, R; Nilsen, T I L; Vasseljen, O; Mork, P J

2015-07-01

Chronic pain in the neck and low back is highly prevalent. Although heritable components have been identified, knowledge about generational transmission of spinal pain between parents and their adult offspring is sparse. This study examined the intergenerational association of spinal pain using data from 11,081 parent-offspring trios participating in the population-based HUNT Study in Norway. Logistic regression was used to calculate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for offspring spinal pain associated with parental spinal pain. In total, 3654 (33%) offspring reported spinal pain at participation. Maternal and paternal spinal pain was consistently associated with higher ORs for offspring spinal pain. The results suggest a slightly stronger association for parental multilevel spinal pain (i.e., both neck/upper back pain and low back pain) than for pain localized to the neck/upper back or low back. Multilevel spinal pain in both parents was associated with ORs of 2.6 (95% CI, 2.1-3.3), 2.4 (95% CI, 1.9-3.1) and 3.1 (95% CI, 2.2-4.4) for offspring neck/upper back, low back and multilevel spinal pain, respectively. Parental chronic spinal pain was consistently associated with increased occurrence of chronic spinal pain in their adult offspring, and this association was particularly strong for multilevel spinal pain. © 2014 European Pain Federation - EFIC®

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.

A dynamic multi-level optimal design method with embedded finite-element modeling for power transformers

NASA Astrophysics Data System (ADS)

Zhang, Yunpeng; Ho, Siu-lau; Fu, Weinong

2018-05-01

This paper proposes a dynamic multi-level optimal design method for power transformer design optimization (TDO) problems. A response surface generated by second-order polynomial regression analysis is updated dynamically by adding more design points, which are selected by Shifted Hammersley Method (SHM) and calculated by finite-element method (FEM). The updating stops when the accuracy requirement is satisfied, and optimized solutions of the preliminary design are derived simultaneously. The optimal design level is modulated through changing the level of error tolerance. Based on the response surface of the preliminary design, a refined optimal design is added using multi-objective genetic algorithm (MOGA). The effectiveness of the proposed optimal design method is validated through a classic three-phase power TDO problem.

Financial and Emotional Support in Close Personal Ties among Central Asian Migrant Women in Russia.

PubMed

Kornienko, Olga; Agadjanian, Victor; Menjívar, Cecilia; Zotova, Natalia

2018-05-01

This study advances research on the role of personal networks as sources of financial and emotional support in immigrants' close personal ties beyond the immediate family. Because resource scarcity experienced by members of immigrant communities is likely to disrupt normatively expected reciprocal support, we explored multi-level predictors of exchange processes with personal network members that involve (1) only receiving support, (2) only providing support, and (3) reciprocal support exchanges. We focus on an understudied case of Central Asian migrant women in the Russian Federation using a sample of 607 women from three ethnic groups-Kyrgyz, Tajik, Uzbek-who were surveyed in two large Russian cities-Nizhny Novgorod and Kazan. The survey collected information on respondents' demographic, socioeconomic, and migration-related characteristics, as well as characteristics of up to five individuals with whom they had a close relationship. Multi-level multinomial regression analyses were used to account for the nested nature of the data. Our results revealed that closer social relationships (siblings and friends) and greater levels of resources (income and regularized legal status) at both ego and alter levels were positively related to providing, receiving, and reciprocally exchanging financial and emotional support. Egos were more likely to provide financial assistance to transnational alters, whereas they were more likely to engage in mutual exchanges of emotional support with their network members from other countries. Personal network size and density showed no relationship with support exchanges. These findings provide a nuanced picture of close personal ties as conduits for financial and emotional support in migrant communities in a major, yet understudied, migrant-receiving context.

Childhood Malnutrition and Its Determinants among Under-Five Children in Ghana.

PubMed

Aheto, Justice Moses K; Keegan, Thomas J; Taylor, Benjamin M; Diggle, Peter J

2015-11-01

Childhood malnutrition adversely affects short- and long-term health and economic well-being of children. Malnutrition is a global challenge and accounts for around 40% of under-five mortality in Ghana. Limited studies are available indicating determinants of malnutrition among children. This study investigates prevalence and determinants of malnutrition among children under-five with the aim of providing advice to policymakers and other stakeholders responsible for the health and nutrition of children. The study used data from the 2008 Ghana Demographic and Health Survey (GDHS). Analyses were conducted on 2083 children under 5 years old nested within 1641 households with eligible anthropometric measurements, using multilevel regression analysis. Results from the multilevel models were used to compute probabilities of malnutrition. This study observed that 588 (28%), 276 (13%), and 176 (8%) of the children were moderately 'stunted', moderately 'underweight', and moderately 'wasted' respectively. Older ages are associated with increased risk of stunting and underweight. Longer breast-feeding duration, multiple births, experience of diarrhoeal episodes, small size at birth, absence of toilet facilities in households, poor households, and mothers who are not covered by national health insurance are associated with increased risk of malnutrition. Increase in mother's years of education and body mass index are associated with decreased malnutrition. Strong residual household-level variations in childhood nutritional outcomes were found. Policies and intervention strategies aimed at improving childhood nutrition and health should address the risk factors identified and the need to search for additional risk factors that might account for the unexplained household-level variations. © 2015 John Wiley & Sons Ltd.

We do not smoke but some of us are more susceptible than others: a multilevel analysis of a sample of Canadian youth in grades 9 to 12.

PubMed

Kaai, Susan C; Brown, K Stephen; Leatherdale, Scott T; Manske, Stephen R; Murnaghan, Donna

2014-09-01

Smoking susceptibility has been found to be a strong predictor of experimental smoking. This paper examined which student- and school-level factors differentiated susceptible never smokers from non-susceptible never smokers among a nationally representative sample of Canadian students in grades 9 to 12. Student-level data from the 2008-2009 Canadian Youth Smoking Survey were linked with school-level data from the 2006 Census, and one built environment characteristic (the density of tobacco retailers surrounding schools). These data were examined using multilevel logistic regression analyses. The likelihood of a never smoker being susceptible to smoking significantly varied across schools (p=0.0002). Students in this study were more likely to be susceptible never smokers if they reported low self-esteem, held positive attitudes towards smoking, used alcohol or marijuana, had close friends who smoked, and came from homes without a total ban on smoking. The school location (rural versus urban), the socioeconomic status of the neighbourhood surrounding a school, and the density of tobacco retailers that were located within 1-km radius of each school were not associated with students' smoking susceptibility. These findings underscore the continued need to develop school-based tobacco use prevention policies and/or programs that enhance students' self-esteem, address tobacco use misinformation and substance use, and include strategies targeting friends who smoke, and students who come from homes without a total ban on smoking. Copyright © 2014 Elsevier Ltd. All rights reserved.

Using GPS and activity tracking to reveal the influence of adolescents' food environment exposure on junk food purchasing.

PubMed

Sadler, Richard C; Clark, Andrew F; Wilk, Piotr; O'Connor, Colleen; Gilliland, Jason A

2016-06-09

This study examines the influence of adolescents' exposure to unhealthy food outlets on junk food purchasing during trips between home and school, with particular attention to how exposure and purchasing differ according to child's biological sex, mode of transportation, and direction to or from school. Between 2010 and 2013, students (n = 654) aged 9-13 years from 25 schools in London and Middlesex County, ON, completed a socio-demographic survey and an activity diary (to identify food purchases), and were observed via a global positioning system for 2 weeks (to track routes for trips to/from school). Spatial data on routes and purchase data were integrated with a validated food outlet database in a geographic information system, and exposure was measured as the minutes a child spent within 50 m of an unhealthy food outlet (i.e., fast food restaurants, variety stores). For trips involving junk food exposure (n = 4588), multilevel logistic regression was used to assess the relationship between exposure and purchasing. Multilevel analyses indicated that adolescents' duration of exposure to unhealthy food outlets between home and school had a significant effect on the likelihood of junk food purchasing. This relationship remained significant when the data were stratified by sex (female/male), trip direction (to/from school) and travel mode (active/car), with the exception of adolescents who travelled by bus. Policies and programs that mitigate the concentration of unhealthy food outlets close to schools are critical for encouraging healthy eating behaviours among children and reducing diet-related health issues such as obesity.

A multi-level examination of school programs, policies and resources associated with physical activity among elementary school youth in the PLAY-ON study

PubMed Central

2010-01-01

Background Given the decline in physical activity (PA) levels among youth populations it is vital to understand the factors that are associated with PA in order to inform the development of new prevention programs. Many studies have examined individual characteristics associated with PA among youth yet few have studied the relationship between the school environment and PA despite knowing that there is variability in student PA levels across schools. Methods Using multi-level logistic regression analyses we explored the school- and student-level characteristics associated with PA using data from 2,379 grade 5 to 8 students attending 30 elementary schools in Ontario, Canada as part of the PLAY-Ontario study. Results Findings indicate that there was significant between-school random variation for being moderately and highly active; school-level differences accounted for 4.8% of the variability in the odds of being moderately active and 7.3% of the variability in the odds of being highly active. Students were more likely to be moderately active if they attended a school that used PA as a reward and not as discipline, and students were more likely to be highly active if they attended a school with established community partnerships. Important student characteristics included screen time sedentary behaviour, participating in team sports, and having active friends. Conclusion Future research should evaluate if the optimal population level impact for school-based PA promotion programming might be achieved most economically if intervention selectively targeted the schools that are putting students at the greatest risk for inactivity. PMID:20181010

Obesity and the built environment: does the density of neighborhood fast-food outlets matter?

PubMed

Li, Fuzhong; Harmer, Peter; Cardinal, Bradley J; Bosworth, Mark; Johnson-Shelton, Deb

2009-01-01

Examine variation in obesity among older adults relative to the joint influences of density of neighborhood fast food outlets and residents' behavioral, psychosocial, and sociodemographic characteristics. Cross-sectional and multilevel design. Census block groups, used as a proxy for neighborhoods, within the metropolitan region's Urban Growth Boundary in Portland, Oregon. A total of 1221 residents (mean age, 65 years) recruited randomly from 120 neighborhoods (48% response rate). A geographic information system-based measure of fast food restaurant density across 120 neighborhoods was created. Residents within the sampled neighborhoods were assessed with respect to their body mass indices (BMI), frequency of visits to local fast food restaurants, fried food consumption, levels of physical activity, self-efficacy of eating fruits and vegetables, household income, and race/ethnicity. Multilevel logistic regression analyses. Significant associations were found between resident-level individual characteristics and the likelihood of being obese (BMI > or = 30) for neighborhoods with a high-density of fast food restaurants in comparison with those with a low density: odds ratios for obesity, 95% confidence intervals (CI), were 1.878 (CI, 1.006-3.496) for weekly visits to local fast food restaurants; 1.792 (CI, 1.006-3.190) for not meeting physical activity recommendations; 1.212 (CI, 1.057-1.391) for low confidence in eating healthy food; and 8.057 (CI, 1.705-38.086) for non-Hispanic black residents. Increased density of neighborhood fast food outlets was associated with unhealthy lifestyles, poorer psychosocial profiles, and increased risk of obesity among older adults.

Does a geographical context of deprivation affect differences in injury mortality? A multilevel analysis in South Korean adults residing in metropolitan cities.

PubMed

Lee, JeSuk; Lee, Weon-Young; Noh, Maengseok; Khang, Young-Ho

2014-05-01

This study aimed to examine whether the socioeconomic context of urban areas affects differences in adult mortality from injuries in the districts of all seven South Korean metropolitan cities, after adjusting for individual demographic and socioeconomic indicators. Two different sets of data were used in this study: (1) the National Death Registration data from 2003 to 2008; and (2) the National Census in 2005. Variables for individual characteristics were gender, age, residential area and educational level. A geographic deprivation index was calculated based on the Carstairs Index. Multilevel Poisson regression models were used to analyse the relationship between area deprivation levels and injury mortality. Greater mortality risks of traffic accidents, falls, suicide and all injuries were found in the elderly, the less educated and men, compared with their counterparts. The most deprived districts were at greater risks of death due to traffic accidents (risk ratio (RR)=1.34; 95% CI 1.05 to 1.73), falls (RR=1.63; 95% CI 1.20 to 2.20), suicide (RR=1.09; 95% CI 1.01 to 1.17) and all injuries (RR=1.14; 95% CI 1.07 to 1.22) compared with the least deprived districts, even after individual level socioeconomic variables were controlled for. However, area level deprivation did not show cross level interactions with the individual level education in estimating fatal injury risks. Both contextual and compositional effects of socioeconomic status on injury mortality among urban areas in South Korea should be considered in allocating resources for injury prevention.

Associations between physical activity and the neighbourhood social environment: baseline results from the HABITAT multilevel study.

PubMed

Rachele, Jerome N; Ghani, Fatima; Loh, Venurs H Y; Brown, Wendy J; Turrell, Gavin

2016-12-01

Limitations have arisen when measuring associations between the neighbourhood social environment and physical activity, including same-source bias, and the reliability of aggregated neighbourhood-level social environment measures. This study examines cross-sectional associations between the neighbourhood social environment (perceptions of incivilities, crime, and social cohesion) and self-reported physical activity, while accounting for same-source bias and reliability of neighbourhood-level exposure measures, using data from a large population-based clustered sample. This investigation included 11,035 residents aged 40-65years from 200 neighbourhoods in Brisbane, Australia, in 2007. Respondents self-reported their physical activity and perceptions of the social environment (neighbourhood incivilities, crime and safety, and social cohesion). Models were adjusted for individual-level education, occupation, and household income, and neighbourhood disadvantage. Exposure measures were generated via split clusters and an empirical Bayes estimation procedure. Data were analysed in 2016 using multilevel multinomial logistic regression. Residents of neighbourhoods with the highest incivilities and crime, and lowest social cohesion were reference categories. Individuals were more likely to be in the higher physical activity categories if they were in neighbourhoods with the lowest incivilities and the lowest crime. No associations were found between social cohesion and physical activity. This study provides a basis from which to gain a clearer understanding of the relationship between the neighbourhood social environment and individual physical activity. Further work is required to explore the pathways between perceptions of the neighbourhood social environment and physical activity. Copyright © 2016 Elsevier Inc. All rights reserved.

An Exploration of Teacher Attrition and Mobility in High Poverty Racially Segregated Schools

ERIC Educational Resources Information Center

Djonko-Moore, Cara M.

2016-01-01

The purpose of this study was to examine the mobility (movement to a new school) and attrition (quitting teaching) patterns of teachers in high poverty, racially segregated (HPRS) schools in the US. Using 2007-9 survey data from the National Center for Education Statistics, a multi-level multinomial logistic regression was performed to examine the…

Hospitalization of Nursing Home Residents with Cognitive Impairments: The Influence of Organizational Features and State Policies

ERIC Educational Resources Information Center

Gruneir, Andrea; Miller, Susan C.; Intrator, Orna; Mor, Vincent

2007-01-01

Purpose: The purpose of this study was to quantify the effect of specific nursing home features and state Medicaid policies on the risk of hospitalization among cognitively impaired nursing home residents. Design and Methods: We used multilevel logistic regression to estimate the odds of hospitalization among long-stay (greater than 90 days)…

Exploring the Ups and Downs of Mathematics Engagement in the Middle Years of School

ERIC Educational Resources Information Center

Martin, Andrew J.; Way, Jennifer; Bobis, Janette; Anderson, Judy

2015-01-01

This study of 1,601 students in the middle years of schooling (Grades 5-8, each student measured twice, 1 year apart) from 200 classrooms in 44 schools sought to identify factors explaining gains and declines in mathematics engagement at key transition points. In multilevel regression modeling, findings showed that compared with Grade 6 students…

The Contribution of Organized Youth Sport to Antisocial and Prosocial Behavior in Adolescent Athletes

ERIC Educational Resources Information Center

Rutten, Esther A.; Stams, Geert Jan J. M.; Biesta, Gert J. J.; Schuengel, Carlo; Dirks, Evelien; Hoeksma, Jan B.

2007-01-01

In this study, we investigated the contribution of organized youth sport to antisocial and prosocial behavior in adolescent athletes. The sample consisted of N = 260 male and female soccer players and competitive swimmers, 12 to 18 years of age. Multilevel regression analysis revealed that 8% of the variance in antisocial behavior and 7% of the…

A Comparison of Individual-Level and Community-Level Predictors of Marijuana and Cocaine Use among a Sample of Newly Arrested Juvenile Offenders

ERIC Educational Resources Information Center

Childs, Kristina; Dembo, Richard; Belenko, Steven; Wareham, Jennifer; Schmeidler, James

2011-01-01

Variations in drug use have been found across individual-level factors and community characteristics, and by type of drug used. Relatively little research, however, has examined this variation among juvenile offenders. Based on a sample of 924 newly arrested juvenile offenders, two multilevel logistic regression models predicting marijuana test…

Examining the relationships between life satisfaction and alcohol, tobacco and marijuana use among school-aged children.

PubMed

Lew, D; Xian, H; Qian, Z; Vaughn, M G

2018-05-03

There are many known risk factors associated with youth substance use. Nonetheless, the impact of life satisfaction (LS) on the use of alcohol, tobacco and marijuana by adolescents still remains largely unknown. The present analysis utilized data from the Health Behavior in School-Aged Children 2009-10 US study. Multilevel logistic regression models were used to assess the relationship between LS and individual substance use. Multilevel multinomial regression models examined the relationship with total number of substances used. After controlling for numerous variables associated with substance use, individuals reporting low LS were significantly more likely to ever use tobacco (OR = 1.34, 95% CI = [1.01, 1.78]), alcohol (OR = 1.45, 95% CI = [1.10, 1.92]) and marijuana (OR = 1.98, 95% CI = [1.39, 2.82]). Additionally, students with low LS were significantly more likely to use two substances (OR = 1.90, 95% CI = [1.15, 3.14]) and three substances concurrently (OR = 2.00, 95% CI = [1.27, 3.16]). The present study identified strong associations between LS and individual, as well as concurrent, substance use among adolescents. Interventions aiming to reduce adolescent substance use may benefit from incorporating components to improve LS.

Approximate l-fold cross-validation with Least Squares SVM and Kernel Ridge Regression

DOE Office of Scientific and Technical Information (OSTI.GOV)

Edwards, Richard E; Zhang, Hao; Parker, Lynne Edwards

2013-01-01

Kernel methods have difficulties scaling to large modern data sets. The scalability issues are based on computational and memory requirements for working with a large matrix. These requirements have been addressed over the years by using low-rank kernel approximations or by improving the solvers scalability. However, Least Squares Support VectorMachines (LS-SVM), a popular SVM variant, and Kernel Ridge Regression still have several scalability issues. In particular, the O(n^3) computational complexity for solving a single model, and the overall computational complexity associated with tuning hyperparameters are still major problems. We address these problems by introducing an O(n log n) approximate l-foldmore » cross-validation method that uses a multi-level circulant matrix to approximate the kernel. In addition, we prove our algorithm s computational complexity and present empirical runtimes on data sets with approximately 1 million data points. We also validate our approximate method s effectiveness at selecting hyperparameters on real world and standard benchmark data sets. Lastly, we provide experimental results on using a multi-level circulant kernel approximation to solve LS-SVM problems with hyperparameters selected using our method.« less

Addictive Internet Use among Korean Adolescents: A National Survey

PubMed Central

Heo, Jongho; Oh, Juhwan; Subramanian, S. V.; Kim, Yoon; Kawachi, Ichiro

2014-01-01

Background A psychological disorder called ‘Internet addiction’ has newly emerged along with a dramatic increase of worldwide Internet use. However, few studies have used population-level samples nor taken into account contextual factors on Internet addiction. Methods and Findings We identified 57,857 middle and high school students (13–18 year olds) from a Korean nationally representative survey, which was surveyed in 2009. To identify associated factors with addictive Internet use, two-level multilevel regression models were fitted with individual-level responses (1st level) nested within schools (2nd level) to estimate associations of individual and school characteristics simultaneously. Gender differences of addictive Internet use were estimated with the regression model stratified by gender. Significant associations were found between addictive Internet use and school grade, parental education, alcohol use, tobacco use, and substance use. Female students in girls' schools were more likely to use Internet addictively than those in coeducational schools. Our results also revealed significant gender differences of addictive Internet use in its associated individual- and school-level factors. Conclusions Our results suggest that multilevel risk factors along with gender differences should be considered to protect adolescents from addictive Internet use. PMID:24505318

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.

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 Combined Pathway and Regional Heritability Analysis Indicates NETRIN1 Pathway Is Associated With Major Depressive Disorder.

PubMed

Zeng, Yanni; Navarro, Pau; Fernandez-Pujals, Ana M; Hall, Lynsey S; Clarke, Toni-Kim; Thomson, Pippa A; Smith, Blair H; Hocking, Lynne J; Padmanabhan, Sandosh; Hayward, Caroline; MacIntyre, Donald J; Wray, Naomi R; Deary, Ian J; Porteous, David J; Haley, Chris S; McIntosh, Andrew M

2017-02-15

Genome-wide association studies (GWASs) of major depressive disorder (MDD) have identified few significant associations. Testing the aggregation of genetic variants, in particular biological pathways, may be more powerful. Regional heritability analysis can be used to detect genomic regions that contribute to disease risk. We integrated pathway analysis and multilevel regional heritability analyses in a pipeline designed to identify MDD-associated pathways. The pipeline was applied to two independent GWAS samples [Generation Scotland: The Scottish Family Health Study (GS:SFHS, N = 6455) and Psychiatric Genomics Consortium (PGC:MDD) (N = 18,759)]. A polygenic risk score (PRS) composed of single nucleotide polymorphisms from the pathway most consistently associated with MDD was created, and its accuracy to predict MDD, using area under the curve, logistic regression, and linear mixed model analyses, was tested. In GS:SFHS, four pathways were significantly associated with MDD, and two of these explained a significant amount of pathway-level regional heritability. In PGC:MDD, one pathway was significantly associated with MDD. Pathway-level regional heritability was significant in this pathway in one subset of PGC:MDD. For both samples the regional heritabilities were further localized to the gene and subregion levels. The NETRIN1 signaling pathway showed the most consistent association with MDD across the two samples. PRSs from this pathway showed competitive predictive accuracy compared with the whole-genome PRSs when using area under the curve statistics, logistic regression, and linear mixed model. These post-GWAS analyses highlight the value of combining multiple methods on multiple GWAS data for the identification of risk pathways for MDD. The NETRIN1 signaling pathway is identified as a candidate pathway for MDD and should be explored in further large population studies. Copyright © 2016 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Cross-National Differences in the Association Between Parental Work Hours and Time with Children in Europe: A Multilevel Analysis.

PubMed

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 and by considering the possibility of selection effects. The presumption was that parents employ strategies to protect family life from work encroachments and that these strategies are enhanced by reconciliation policies, stronger parenthood ideologies, access to part-time work and higher income levels. Multilevel analyses were based on a subset of 5.183 parents in 23 countries from the 2005 European Working Conditions Survey that was complemented with country-level data. The negative association between parental work hours and parent-child time indeed varied significantly across countries and was weaker in countries where formal child care coverage was higher, part-time work was less prevalent, and earnings were lower. The effects of part-time work and earnings mainly applied to mothers. These findings suggest that child care coverage limits the availability of children and that differences in parent-child time between parents who work short and long hours are more pronounced when part-time work is more accessible and affordable.

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.

Ideal cardiovascular health and inflammation in European adolescents: The HELENA study.

PubMed

González-Gil, E M; Santabárbara, J; Ruiz, J R; Bel-Serrat, S; Huybrechts, I; Pedrero-Chamizo, R; de la O, A; Gottrand, F; Kafatos, A; Widhalm, K; Manios, Y; Molnar, D; De Henauw, S; Plada, M; Ferrari, M; Palacios Le Blé, G; Siani, A; González-Gross, M; Gómez-Martínez, S; Marcos, A; Moreno Aznar, L A

2017-05-01

Inflammation plays a key role in atherosclerosis and this process seems to appear in childhood. The ideal cardiovascular health index (ICHI) has been inversely related to atherosclerotic plaque in adults. However, evidence regarding inflammation and ICHI in adolescents is scarce. The aim is to assess the association between ICHI and inflammation in European adolescents. As many as 543 adolescents (251 boys and 292 girls) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional multi-center study including 9 European countries, were measured. C-reactive protein (CRP), complement factors C3 and C4, leptin and white blood cell counts were used to compute an inflammatory score. Multilevel linear models and multilevel logistic regression were used to assess the association between ICHI and inflammation controlling by covariates. Higher ICHI was associated with a lower inflammatory score, as well as with several individual components, both in boys and girls (p < 0.01). In addition, adolescents with at least 4 ideal components of the ICHI had significantly lower inflammatory score and lower levels of the study biomarkers, except CRP. Finally, the multilevel logistic regression showed that for every unit increase in the ICHI, the probability of having an inflammatory profile decreased by 28.1% in girls. Results from this study suggest that a better ICHI is associated with a lower inflammatory profile already in adolescence. Improving these health behaviors, and health factors included in the ICHI, could play an important role in CVD prevention. Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

High Maternal Body Mass Index Is Associated with an Early-Onset of Overweight/Obesity in Pre-School-Aged Children in Malawi. A Multilevel Analysis of the 2015-16 Malawi Demographic and Health Survey.

PubMed

Ntenda, Peter Austin Morton; Mhone, Thomas Gabriel; Nkoka, Owen

2018-05-25

Overweight/obesity in young children is one of the most serious public health issues globally. We examined whether individual- and community-level maternal nutritional status is associated with an early onset of overweight/obesity in pre-school-aged children in Malawi. Data were obtained from the 2015-16 Malawi Demographic and Health Survey (MDHS). The maternal nutritional status as body mass index and childhood overweight/obesity status was assessed by using the World Health Organization (WHO) recommendations. To examine whether the maternal nutritional status is associated with overweight/obesity in pre-school-aged children, two-level multilevel logistic regression models were constructed on 4023 children of age less than five years dwelling in 850 different communities. The multilevel regression analysis showed that children born to overweight/obese mothers had increased odds of being overweight/obese [adjusted odds ratio (aOR) = 3.11; 95% confidence interval (CI): 1.13-8.54]. At the community level, children born to mothers from the middle (aOR: 1.68; 95% CI: 1.02-2.78) and high (aOR: 1.69; 95% CI: 1.00-2.90) percentage of overweight/obese women had increased odds of being overweight/obese. In addition, there were significant variations in the odds of childhood overweight/obesity in the communities. Strategies aimed at reducing childhood overweight/obesity in Malawi should address not only women and their children but also their communities. Appropriate choices of nutrition, diet and physical activity patterns should be emphasized upon in overweight/obese women of childbearing age throughout pregnancy and beyond.

Adolescents' psychological health complaints and the economic recession in late 2007: a multilevel study in 31 countries.

PubMed

Pfoertner, Timo-Kolja; Rathmann, Katharina; Elgar, Frank J; de Looze, Margaretha; Hofmann, Felix; Ottova-Jordan, Veronika; Ravens-Sieberer, Ulrike; Bosakova, Lucia; Currie, Candace; Richter, Matthias

2014-12-01

The recent economic recession, which began in 2007, has had a detrimental effect on the health of the adult population, but no study yet has investigated the impact of this downturn on adolescent health. This article uniquely examines the effect of the crisis on adolescents' psychological health complaints in a cross-national comparison. Data came from the World Health Organization collaborative 'Health Behaviour in School-aged Children' study in 2005-06 and 2009-10. We measured change in psychological health complaints from before to during the recession in the context of changing adult and adolescent unemployment rates. Furthermore, we used logistic multilevel regression to model the impact of absolute unemployment in 2010 and its change rate between 2005-06 and 2009-10 on adolescents' psychological health complaints in 2010. Descriptive results showed that although youth and adult unemployment has increased during the economic crisis, rates of psychological health complaints among adolescents were unaffected in some countries and even decreased in others. Multilevel regression models support this finding and reveal that only youth unemployment in 2010 increased the likelihood of psychological health complaints, whereas its change rate in light of the recession as well as adult unemployment did not relate to levels of psychological health complaints. In contrast to recent findings, our study indicates that the negative shift of the recent recession on the employment market in several countries has not affected adolescents' psychological health complaints. Adolescents' well-being instead seems to be influenced by the current situation on the labour market that shapes their occupational outlook. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Gender Difference Added? Institutional Variations in the Gender Gap in First Class Degree Awards in Mathematical Sciences

ERIC Educational Resources Information Center

Simonite, Vanessa

2005-01-01

This article shows how multilevel modelling can be used to study institutional variations in the gender differences in achievement. The results presented are from analyses of the degree classifications of 22,433 individuals who graduated in mathematical sciences, from universities in the UK, between 1994/95 and 1999/2000. The analyses were…

Understanding Statistical Power in Cluster Randomized Trials: Challenges Posed by Differences in Notation and Terminology

ERIC Educational Resources Information Center

Spybrook, Jessaca; Hedges, Larry; Borenstein, Michael

2014-01-01

Research designs in which clusters are the unit of randomization are quite common in the social sciences. Given the multilevel nature of these studies, the power analyses for these studies are more complex than in a simple individually randomized trial. Tools are now available to help researchers conduct power analyses for cluster randomized…

Integrating the Analysis of Mental Operations into Multilevel Models to Validate an Assessment of Higher Education Students' Competency in Business and Economics

ERIC Educational Resources Information Center

Brückner, Sebastian; Pellegrino, James W.

2016-01-01

The Standards for Educational and Psychological Testing indicate that validation of assessments should include analyses of participants' response processes. However, such analyses typically are conducted only to supplement quantitative field studies with qualitative data, and seldom are such data connected to quantitative data on student or item…

Dynamics and complexity of body temperature in preterm infants nursed in incubators

PubMed Central

Jost, Kerstin; Pramana, Isabelle; Delgado-Eckert, Edgar; Kumar, Nitin; Datta, Alexandre N.; Frey, Urs; Schulzke, Sven M.

2017-01-01

Background Poor control of body temperature is associated with mortality and major morbidity in preterm infants. We aimed to quantify its dynamics and complexity to evaluate whether indices from fluctuation analyses of temperature time series obtained within the first five days of life are associated with gestational age (GA) and body size at birth, and presence and severity of typical comorbidities of preterm birth. Methods We recorded 3h-time series of body temperature using a skin electrode in incubator-nursed preterm infants. We calculated mean and coefficient of variation of body temperature, scaling exponent alpha (Talpha) derived from detrended fluctuation analysis, and sample entropy (TSampEn) of temperature fluctuations. Data were analysed by multilevel multivariable linear regression. Results Data of satisfactory technical quality were obtained from 285/357 measurements (80%) in 73/90 infants (81%) with a mean (range) GA of 30.1 (24.0–34.0) weeks. We found a positive association of Talpha with increasing levels of respiratory support after adjusting for GA and birth weight z-score (p<0.001; R2 = 0.38). Conclusion Dynamics and complexity of body temperature in incubator-nursed preterm infants show considerable associations with GA and respiratory morbidity. Talpha may be a useful marker of autonomic maturity and severity of disease in preterm infants. PMID:28448569

Physical activity after myocardial infarction: is it related to mental health?

PubMed

Rius-Ottenheim, Nathaly; Geleijnse, Johanna M; Kromhout, Daan; van der Mast, Roos C; Zitman, Frans G; Giltay, Erik J

2013-06-01

Physical inactivity and poor mental wellbeing are associated with poorer prognoses in patients with cardiovascular disease. We aimed to analyse the cross-sectional and prospective associations between physical activity and mental wellbeing in patients with a history of myocardial infarction. Longitudinal, observational study. We investigated 600 older subjects with a history of myocardial infarction (age range 60-80 years) who participated in the Alpha Omega Trial (AOT). They were tested twice at baseline and at 40 months follow-up for physical activity - with the Physical Activity Scale for the Elderly (PASE); depressive symptoms - with the Geriatric Depression Scale (GDS-15); and dispositional optimism - with the Life Orientation Test (LOT-R). Linear (multilevel) and logistic regression analyses were used to examine cross-sectional and longitudinal associations. Physical activity was cross-sectionally associated with depressive symptoms (adjusted beta = -0.143; p = 0.001), but not with dispositional optimism (adjusted beta = 0.074; p = 0.07). We found a synchrony of change between physical activity and depressive symptoms (adjusted beta = -0.155; p < 0.001), but not with dispositional optimism (adjusted beta = 0.049; p = 0.24). Baseline physical activity did not predict depressive symptoms at 40 months follow-up. Concordant inverse associations were observed for (changes) in physical activity and depressive symptoms. Physical activity did not predict depressive symptoms or low optimism.

Are there differences in birth weight between neighbourhoods in a Nordic welfare state?

PubMed

Sellström, Eva; Arnoldsson, Göran; Bremberg, Sven; Hjern, Anders

2007-09-26

The objective of this cohort study was to examine the effect on birth weight of living in a disadvantaged neighbourhood in a Nordic welfare state. Birth weight is a health indicator known to be sensitive to political and welfare state conditions. No former studies on urban neighbourhood differences regarding mean birth weight have been carried out in a Nordic country. A register based on individual data on children's birth weight and maternal risk factors was used. A neighbourhood characteristic, i.e. an aggregated measure on income was also included. Connections between individual- and neighbourhood-level determinants and the outcome were analysed using multi-level regression technique. The study covered six hundred and ninety-six neighbourhoods in the three major cities of Sweden, Stockholm, Göteborg and Malmö, during 1992-2001. The majority of neighbourhoods had a population of 4 000-10 000 inhabitants. An average of 500 births per neighbourhood were analysed in this study. Differences in mean birth weight in Swedish urban neighbourhoods were minor. However, gestational length, parity and maternal smoking acted as modifiers of the neighbourhood effects. Most of the observed variation in mean birth weight was explained by individual risk factors. Welfare institutions and benefits in Sweden might buffer against negative infant outcomes due to adverse structural organisation of urban neighbourhoods.

[Quality of clinical studies published in the RBGO over one decade (1999-2009): methodological and ethical aspects and statistical procedures].

PubMed

de Sá, Joceline Cássia Ferezini; Marini, Gabriela; Gelaleti, Rafael Bottaro; da Silva, João Batista; de Azevedo, George Gantas; Rudge, Marilza Vieira Cunha

2013-11-01

To evaluate the methodological and statistical design evolution of the publications in the Brazilian Journal of Gynecology and Obstetrics (RBGO) from resolution 196/96. A review of 133 articles published in 1999 (65) and 2009 (68) was performed by two independent reviewers with training in clinical epidemiology and methodology of scientific research. We included all original clinical articles, case and series reports and excluded editorials, letters to the editor, systematic reviews, experimental studies, opinion articles, besides abstracts of theses and dissertations. Characteristics related to the methodological quality of the studies were analyzed in each article using a checklist that evaluated two criteria: methodological aspects and statistical procedures. We used descriptive statistics and the χ2 test for comparison of the two years. There was a difference between 1999 and 2009 regarding the study and statistical design, with more accuracy in the procedures and the use of more robust tests between 1999 and 2009. In RBGO, we observed an evolution in the methods of published articles and a more in-depth use of the statistical analyses, with more sophisticated tests such as regression and multilevel analyses, which are essential techniques for the knowledge and planning of health interventions, leading to fewer interpretation errors.

Practical Application of Linear Growth Measurements in Clinical Research in Low- and Middle-Income Countries

PubMed Central

Wit, Jan M.; Himes, John H.; van Buuren, Stef; Denno, Donna M.; Suchdev, Parminder S.

2017-01-01

Background/Aims Childhood stunting is a prevalent problem in low- and middle-income countries and is associated with long-term adverse neurodevelopment and health outcomes. In this review, we define indicators of growth, discuss key challenges in their analysis and application, and offer suggestions for indicator selection in clinical research contexts. Methods Critical review of the literature. Results Linear growth is commonly expressed as length-for-age or height-for-age z-score (HAZ) in comparison to normative growth standards. Conditional HAZ corrects for regression to the mean where growth changes relate to previous status. In longitudinal studies, growth can be expressed as ΔHAZ at 2 time points. Multilevel modeling is preferable when more measurements per individual child are available over time. Height velocity z-score reference standards are available for children under the age of 2 years. Adjusting for covariates or confounders (e.g., birth weight, gestational age, sex, parental height, maternal education, socioeconomic status) is recommended in growth analyses. Conclusion The most suitable indicator(s) for linear growth can be selected based on the number of available measurements per child and the child's age. By following a step-by-step algorithm, growth analyses can be precisely and accurately performed to allow for improved comparability within and between studies. PMID:28196362

Do age and gender contribute to workers' burnout symptoms?

PubMed

Marchand, A; Blanc, M-E; Beauregard, N

2018-06-15

Despite mounting evidence on the association between work stress and burnout, there is limited knowledge about the extent to which workers' age and gender are associated with burnout. To evaluate the relationship between age, gender and their interaction with burnout in a sample of Canadian workers. Data were collected in 2009-12 from a sample of 2073 Canadian workers from 63 workplaces in the province of Quebec. Data were analysed with multilevel regression models to test for linear and non-linear relationships between age and burnout. Analyses adjusted for marital status, parental status, educational level and number of working hours were conducted on the total sample and stratified by gender. Data were collected from a sample of 2073 Canadian workers (response rate 73%). Age followed a non-linear relationship with emotional exhaustion and total burnout, while it was linearly related to cynicism and reduced professional efficacy. Burnout level reduced with increasing age in men, but the association was bimodal in women, with women aged between 20-35 and over 55 years showing the highest burnout level. These results suggest that burnout symptoms varied greatly according to different life stages of working men and women. Younger men, and women aged between 20-35 and 55 years and over are particularly susceptible and should be targeted for programmes to reduce risk of burnout.

The influence of anthropometry and body composition on children's bone health: the childhood health, activity and motor performance school (the CHAMPS) study, Denmark.

PubMed

Heidemann, Malene; Holst, René; Schou, Anders J; Klakk, Heidi; Husby, Steffen; Wedderkopp, Niels; Mølgaard, Christian

2015-02-01

Overweight, physical inactivity and sedentary behaviour have become increasing problems during the past decade. Increased sedentary behaviour may change the body composition (BC) by increasing the fat mass relative to the lean mass (LM). These changes may influence bone health to describe how anthropometry and BC predict the development of the bone accruement. The longitudinal study is a part of The CHAMPS study-DK. Children were DXA scanned at baseline and at 2-year follow-up. BC (LM, BF %) and BMC, BMD and BA were measured. The relationship between bone traits, anthropometry and BC was analysed by multilevel regression analyses. Of the invited children, 742/800 (93%) accepted to participate. Of these, 682/742 (92%) participated at follow-up. Mean (range) of age at baseline was 9.5 years (7.7-12.1). Height, BMI, LM and BF % predicted bone mineral accrual and bone size positively and independently. Height and BMI are both positive predictors of bone accruement. LM is a more precise predictor of bone traits than BF % in both genders. The effects of height and BMI and LM on bone accruement are nearly identical in the two genders, while changes in BF % have different but positive effects on bone accretion in both boys and girls.

Dynamics and complexity of body temperature in preterm infants nursed in incubators.

PubMed

Jost, Kerstin; Pramana, Isabelle; Delgado-Eckert, Edgar; Kumar, Nitin; Datta, Alexandre N; Frey, Urs; Schulzke, Sven M

2017-01-01

Poor control of body temperature is associated with mortality and major morbidity in preterm infants. We aimed to quantify its dynamics and complexity to evaluate whether indices from fluctuation analyses of temperature time series obtained within the first five days of life are associated with gestational age (GA) and body size at birth, and presence and severity of typical comorbidities of preterm birth. We recorded 3h-time series of body temperature using a skin electrode in incubator-nursed preterm infants. We calculated mean and coefficient of variation of body temperature, scaling exponent alpha (Talpha) derived from detrended fluctuation analysis, and sample entropy (TSampEn) of temperature fluctuations. Data were analysed by multilevel multivariable linear regression. Data of satisfactory technical quality were obtained from 285/357 measurements (80%) in 73/90 infants (81%) with a mean (range) GA of 30.1 (24.0-34.0) weeks. We found a positive association of Talpha with increasing levels of respiratory support after adjusting for GA and birth weight z-score (p<0.001; R2 = 0.38). Dynamics and complexity of body temperature in incubator-nursed preterm infants show considerable associations with GA and respiratory morbidity. Talpha may be a useful marker of autonomic maturity and severity of disease in preterm infants.

I spy with my little eye - the detection of intentional contingency in early psychosis.

PubMed

Fett, Anne-Kathrin J; González Berdugo, Clara Isabel; Hanssen, Esther; Lemmers-Jansen, Imke; Shergill, Sukhi S; Krabbendam, Lydia

2015-01-01

Paranoid delusions have been associated with a tendency to over-attribute intentionality and contingency to others' actions and incidental events in individuals with chronic psychosis. However, this hyper-associative perception bias has not been investigated in the early illness stages of psychosis, during which it may play a particularly crucial role in the formation of symptoms. We used an experimental paradigm with 20 short film clips of simple animate and inanimate shapes that either moved in a contingent or non-contingent manner to investigate the perception of contingency in 38 adolescents with early psychosis and 93 healthy control adolescents. Participants rated the contingency between the shapes' movements on a scale from 0 to 10. The data were analysed with multilevel regression analyses to account for repeated measures within subjects. There were no significant differences between patients and controls; both perceived the contingency of the shapes' movements similarly across all conditions and patients' contingency perception was unrelated to their levels of paranoid delusions. Contingency perception was unimpaired in patients with early psychosis, suggesting that it might still be intact in the early illness stages. Future studies should set out to determine whether the early illness stages could offer a window for interventions that counteract the development of hyper-associative perceptions of contingency.

Socioeconomic Differences in Parenting Strategies to Prevent Adolescent Smoking: A Case Study from the Netherlands.

PubMed

Kuipers, Mirte A G; Haal, Sylke; Kunst, Anton E

2016-06-01

This study aimed to identify possible socioeconomic differences in the use of anti-smoking parenting strategies. In 2012, survey data of adolescents (N = 225) aged 13 to 17 years and their mothers (N = 122) and fathers (N = 105) were collected in Haarlem, the Netherlands. Questions on smoking behaviour and eleven anti-smoking parenting strategies were answered by adolescents, mothers and fathers. School tracks of adolescents and educational level of parents were measured as indicators of socioeconomic position. Linear multilevel regression analyses were applied to study the association between socioeconomic position (SEP) and standardised scores of anti-smoking strategies. Analyses were controlled for age, sex and smoking by parents and adolescents. We found no consistent socioeconomic differences in the use of anti-smoking parenting strategies. There were no statistically significant differences in relation to parental educational level or when using adolescent reports on parenting practices. However, when using parental reports, a few strategies varied significantly according to adolescent educational track. Adolescents in higher educational tracks were more likely to have no-smoking rules in the home (standardised regression coefficient (β) = 0.20, 95 % confidence interval (CI): 0.03; 0.37, p = 0.022) and more likely to have a no-smoking agreement (β = 0.17, 95 % CI: 0.00; 0.34, p = 0.048). However, they were less likely to frequently communicate about smoking with their parents (β = -0.25, 95 % CI: -0.41; -0.08, p = 0.004). In this specific population, there was no consistent support for the hypothesis that anti-smoking parenting strategies contribute to socioeconomic inequalities in adolescent smoking. Parental factors that are more likely to contribute to these inequalities include parental smoking and parenting styles.

The contributing role of physical education in youth's daily physical activity and sedentary behavior.

PubMed

Chen, Senlin; Kim, Youngwon; Gao, Zan

2014-02-04

School physical education (PE) is considered as an effective channel for youth to accumulate moderate-to-vigorous physical activity (MVPA) and reduce sedentary time. The purpose of this study was to determine the contributing role of PE in daily MVPA and sedentary time among youth. The study recruited 67 sixth grade children (29 boys; Mean age = 11.75) from two suburban schools at a U.S. Midwest state, 48 of whom contributed ≥10 hours of physical activity (PA) data per day were included for analysis. An objective monitoring tool (i.e., Sensewear armband monitor) was used to capture the participants' MVPA and sedentary time for 7-14 days. Pearson product-moment correlation analysis (r), multi-level regression analyses, and analysis of variance were conducted for data analysis. MVPA and sedentary time in PE showed significant positive associations with daily MVPA and sedentary time, respectively (r = 0.35, p < 0.01; r = 0.55, p < 0.01). Regression analyses revealed that one minute increase in MVPA and sedentary behavior in PE was associated with 2.04 minutes and 5.30 minutes increases in daily MVPA and sedentary behavior, respectively, after controlling for sex and BMI. The participants demonstrated a significantly higher level of MVPA (p = .05) but similar sedentary time (p = 0.61) on PE days than on non-PE days. Boys had significantly more daily MVPA (p < .01) and less sedentary time (p < .01) than girls; while higher BMI was associated with more sedentary time (p < .01). PE displayed a positive contribution to increasing daily MVPA and decreasing daily sedentary time among youth. Active participation in PE classes increases the chance to be more active and less sedentary beyond PE among youth.

The influence of gender equality policies on gender inequalities in health in Europe.

PubMed

Palència, Laia; Malmusi, Davide; De Moortel, Deborah; Artazcoz, Lucía; Backhans, Mona; Vanroelen, Christophe; Borrell, Carme

2014-09-01

Few studies have addressed the effect of gender policies on women's health and gender inequalities in health. This study aims to analyse the relationship between the orientation of public gender equality policies and gender inequalities in health in European countries, and whether this relationship is mediated by gender equality at country level or by other individual social determinants of health. A multilevel cross-sectional study was performed using individual-level data extracted from the European Social Survey 2010. The study sample consisted of 23,782 men and 28,655 women from 26 European countries. The dependent variable was self-perceived health. Individual independent variables were gender, age, immigrant status, educational level, partner status and employment status. The main contextual independent variable was a modification of Korpi's typology of family policy models (Dual-earner, Traditional-Central, Traditional-Southern, Market-oriented and Contradictory). Other contextual variables were the Gender Empowerment Measure (GEM), to measure country-level gender equality, and the Gross Domestic Product (GDP). For each country and country typology the prevalence of fair/poor health by gender was calculated and prevalence ratios (PR, women compared to men) and 95% confidence intervals (CI) were computed. Multilevel robust Poisson regression models were fitted. Women had poorer self-perceived health than men in countries with traditional family policies (PR = 1.13, 95%CI: 1.07-1.21 in Traditional-Central and PR = 1.27, 95%CI: 1.19-1.35 in Traditional-Southern) and in Contradictory countries (PR = 1.08, 95%CI: 1.05-1.11). In multilevel models, only gender inequalities in Traditional-Southern countries were significantly higher than those in Dual-earner countries. Gender inequalities in self-perceived health were higher, women reporting worse self-perceived health than men, in countries with family policies that were less oriented to gender equality (especially in the Traditional-Southern country-group). This was partially explained by gender inequalities in the individual social determinants of health but not by GEM or GDP. Copyright © 2014 Elsevier Ltd. All rights reserved.

Impact of primary care nursing workforce characteristics on the control of high-blood pressure: a multilevel analysis

PubMed Central

Parro-Moreno, Ana; Serrano-Gallardo, Pilar; Díaz-Holgado, Antonio; Aréjula-Torres, Jose L; Abraira, Victor; Santiago-Pérez, Isolina M; Morales-Asencio, Jose M

2015-01-01

Objective To determine the impact of Primary Health Care (PHC) nursing workforce characteristics and of the clinical practice environment (CPE) perceived by nurses on the control of high-blood pressure (HBP). Design Cross-sectional analytical study. Setting Administrative and clinical registries of hypertensive patients from PHC information systems and questionnaire from PHC nurses. Participants 76 797 hypertensive patients in two health zones within the Community of Madrid, North-West Zone (NWZ) with a higher socioeconomic situation and South-West Zone (SWZ) with a lower socioeconomic situation, and 442 reference nurses. Segmented analyses by area were made due to their different socioeconomic characteristics. Primary outcome measure: Poor HBP control (adequate figures below the value 140/90 mm Hg) associated with the characteristics of the nursing workforce and self-perceived CPE. Results The prevalence of poor HBP control, estimated by an empty multilevel model, was 33.5% (95% CI 31.5% to 35.6%). In the multilevel multivariate regression models, the perception of a more favourable CPE was associated with a reduction in poor control in NWZ men and SWZ women (OR=0.99 (95% CI 0.98 to 0.99)); the economic immigration conditions increased poor control in NWZ women (OR=1.53 (95% CI 1.24 to 1.89)) and in SWZ, both men (OR=1.89 (95% CI 1.43 to 2.51)) and women (OR=1.39 (95% CI 1.09 to 1.76)). In all four models, increasing the annual number of patient consultations was associated with a reduction in poor control (NWZ women: OR=0.98 (95% CI0.98 to 0.99); NWZ men: OR=0.98 (95% CI 0.97 to 0.99); SWZ women: OR=0.98 (95% CI 0.97 to 0.99); SWZ men: OR=0.99 (95% CI 0.97 to 0.99). Conclusions A CPE, perceived by PHC nurses as more favourable, and more patient–nurse consultations, contribute to better HBP control. Economic immigration condition is a risk factor for poor HBP control. Health policies oriented towards promoting positive environments for nursing practice are needed. PMID:26644122

Multi-level stressor analysis from the DNA/biochemical level to community levels in an urban stream and integrative health response (IHR) assessments.

PubMed

Lee, Jae Hoon; Kim, Joon Ha; Oh, Hee-Mock; An, Kwang-Guk

2013-01-01

The objectives of this study were to identify multi-level stressors at the DNA/biochemical level to the community level in fish in an urban stream and to develop an integrative health response (IHR) model for ecological health diagnosis. A pristine control site (S (c) ) and an impacted site (S (i) ) were selected from among seven pre-screened sites studied over seven years. Various chemical analyses indicated that nutrient enrichment (Nitrogen, Phosphorus) and organic pollution were significantly greater (t > 8.783, p < 0.01) at the S (i) site compared to the S (c) site. Single-cell gel electrophoresis (comet assays) of DNA-level impairment indicated significantly (t = 5.678, p < 0.01) greater tail intensity, expressed as % tail-DNA, at the S (i) site and genotoxic responses were detected in the downstream reach. Ethoxyresorufin-O-deethylase (EROD) assays, as a physiological bioindicator, were 2.8-fold higher (p < 0.05, NK-test after ANOVA) at the S (i) site. Tissue analysis using a necropsy-based health assessment index (NHAI) showed distinct internal organ disorders in three tissues, i.e., liver, kidney, and gill, at the S (i) site. Population-level analysis using the sentinel species Zacco platypus showed that the regression coefficient (b) was 3.012 for the S (i) site and 2.915 for the S (c) site, indicating population skewness in the downstream reach. Community-level health was impaired at the S (i) site based on an index of biological integrity (IBI), and physical habitat modifications were identified by a qualitative habitat evaluation index (QHEI). Overall, the model values for the integrative health response (IHR), developed using the star plot approach, were 3.22 (80.5%) at the S (c) site and 0.74 (18.5%) at the S (i) site, indicating that, overall, ecological health impairments were evident in the urban reach. Our study was based on multi-level approaches using biological organization and the results suggest that there is a pivotal point of linkage between mechanistic understanding and real ecological consequences of environmental stressors.

Advanced development of atmospheric models. [SEASAT Program support

NASA Technical Reports Server (NTRS)

Kesel, P. G.; Langland, R. A.; Stephens, P. L.; Welleck, R. E.; Wolff, P. M.

1979-01-01

A set of atmospheric analysis and prediction models was developed in support of the SEASAT Program existing objective analysis models which utilize a 125x125 polar stereographic grid of the Northern Hemisphere, which were modified in order to incorporate and assess the impact of (real or simulated) satellite data in the analysis of a two-day meteorological scenario in January 1979. Program/procedural changes included: (1) a provision to utilize winds in the sea level pressure and multi-level height analyses (1000-100 MBS); (2) The capability to perform a pre-analysis at two control levels (1000 MBS and 250 MBS); (3) a greater degree of wind- and mass-field coupling, especially at these controls levels; (4) an improved facility to bogus the analyses based on results of the preanalysis; and (5) a provision to utilize (SIRS) satellite thickness values and cloud motion vectors in the multi-level height analysis.

[Multilevel analyses of labour market and return to work after vocational retraining].

PubMed

Hetzel, C

2015-02-01

is to test individual level and regional labour market hypotheses about return to work (RTW) after vocational retraining derived from matching theory. In multilevel analyses individual data of graduates in 2006 (n=3620) by the association of German "Berufsförderungswerke" and for contextual level the regional unemployment rates in 2007 (n=159 Federal Employment Agency of Germany districts) are used. Probability of RTW rises with decreasing regional unemployment. There's an age effect only in context of high unemployment. In context of low unemployment partnership promotes RTW - but in context of high unemployment only for men and not for women. It's compatible with matching theory because family obligations lead to high individual reservation wages and entry wages are to low. Direct and indirect effects of labour market should be taken into account in research on effectiveness and in comparative evaluation on intervention quality. © Georg Thieme Verlag KG Stuttgart · New York.

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

Validation of the INCEPT: A Multisource Feedback Tool for Capturing Different Perspectives on Physicians' Professional Performance.

PubMed

van der Meulen, Mirja W; Boerebach, Benjamin C M; Smirnova, Alina; Heeneman, Sylvia; Oude Egbrink, Mirjam G A; van der Vleuten, Cees P M; Arah, Onyebuchi A; Lombarts, Kiki M J M H

2017-01-01

Multisource feedback (MSF) instruments are used to and must feasibly provide reliable and valid data on physicians' performance from multiple perspectives. The "INviting Co-workers to Evaluate Physicians Tool" (INCEPT) is a multisource feedback instrument used to evaluate physicians' professional performance as perceived by peers, residents, and coworkers. In this study, we report on the validity, reliability, and feasibility of the INCEPT. The performance of 218 physicians was assessed by 597 peers, 344 residents, and 822 coworkers. Using explorative and confirmatory factor analyses, multilevel regression analyses between narrative and numerical feedback, item-total correlations, interscale correlations, Cronbach's α and generalizability analyses, the psychometric qualities, and feasibility of the INCEPT were investigated. For all respondent groups, three factors were identified, although constructed slightly different: "professional attitude," "patient-centeredness," and "organization and (self)-management." Internal consistency was high for all constructs (Cronbach's α ≥ 0.84 and item-total correlations ≥ 0.52). Confirmatory factor analyses indicated acceptable to good fit. Further validity evidence was given by the associations between narrative and numerical feedback. For reliable total INCEPT scores, three peer, two resident and three coworker evaluations were needed; for subscale scores, evaluations of three peers, three residents and three to four coworkers were sufficient. The INCEPT instrument provides physicians performance feedback in a valid and reliable way. The number of evaluations to establish reliable scores is achievable in a regular clinical department. When interpreting feedback, physicians should consider that respondent groups' perceptions differ as indicated by the different item clustering per performance factor.

Neighbourhood social capital as a moderator between individual cognitions and sports behaviour among Dutch adolescents.

PubMed

Prins, R G; Beenackers, M A; Boog, M C; Van Lenthe, F J; Brug, J; Oenema, A

2014-03-01

This study aimed to explore whether individual cognitions and neighbourhood social capital strengthen each other in their relation with engaging in sports at least three times per week. Cross-sectional analyses on data from the last wave of the YouRAction trial (2009-2010, Rotterdam, the Netherlands; baseline response: 98%) were conducted. In total 1129 had data on the last wave questionnaire (93%) and 832 of them had complete data on a self-administered questionnaire on frequency of sports participation, perceived neighbourhood social capital, cognitions (attitude, subjective norm, perceived behavioural control and intention toward sport participation) and demographics. Ecometric methods were used to aggregate perceived neighbourhood social capital to the neighbourhood level. Multilevel logistic regression analyses (neighbourhood and individual as levels) were conducted to examine associations of cognitions, neighbourhood social capital and the social capital by individual cognition interaction with fit norm compliance. If the interaction was significant, simple slopes analyses were conducted to decompose interaction effects. It was found that neighbourhood social capital was significantly associated with fit norm compliance (OR: 5.40; 95% CI: 1.13-25.74). Moreover, neighbourhood social capital moderated the association of attitude, perceived behavioural control and intention with fit norm compliance. The simple slope analyses visualized that the associations of cognitions with fit norm compliance were stronger in case of more neighbourhood social capital. Hence, higher levels of neighbourhood social capital strengthen the associations of attitude, perceived behavioural control and intention in their association with fit norm compliance. Copyright © 2014 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

[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.

Immigrant maternal depression and social networks. A multilevel Bayesian spatial logistic regression in South Western Sydney, Australia.

PubMed

Eastwood, John G; Jalaludin, Bin B; Kemp, Lynn A; Phung, Hai N; Barnett, Bryanne E W

2013-09-01

The purpose is to explore the multilevel spatial distribution of depressive symptoms among migrant mothers in South Western Sydney and to identify any group level associations that could inform subsequent theory building and local public health interventions. Migrant mothers (n=7256) delivering in 2002 and 2003 were assessed at 2-3 weeks after delivery for risk factors for depressive symptoms. The binary outcome variables were Edinburgh Postnatal Depression Scale scores (EPDS) of >9 and >12. Individual level variables included were: financial income, self-reported maternal health, social support network, emotional support, practical support, baby trouble sleeping, baby demanding and baby not content. The group level variable reported here is aggregated social support networks. We used Bayesian hierarchical multilevel spatial modelling with conditional autoregression. Migrant mothers were at higher risk of having depressive symptoms if they lived in a community with predominantly Australian-born mothers and strong social capital as measured by aggregated social networks. These findings suggest that migrant mothers are socially isolated and current home visiting services should be strengthened for migrant mothers living in communities where they may have poor social networks. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Effects of the X:IT smoking intervention: a school-based cluster randomized trial.

PubMed

Andersen, Anette; Krølner, Rikker; Bast, Lotus Sofie; Thygesen, Lau Caspar; Due, Pernille

2015-12-01

Uptake of smoking in adolescence is still of major public health concern. Evaluations of school-based programmes for smoking prevention show mixed results. The aim of this study was to examine the effect of X:IT, a multi-component school-based programme to prevent adolescent smoking. Data from a Danish cluster randomized trial included 4041 year-7 students (mean age: 12.5) from 51 intervention and 43 control schools. Outcome measure 'current smoking' was dichotomized into smoking daily, weekly, monthly or more seldom vs do not smoke. Analyses were adjusted for baseline covariates: sex, family socioeconomic position (SEP), best friend's smoking and parental smoking. We performed multilevel, logistic regression analyses of available cases and intention-to-treat (ITT) analyses, replacing missing outcome values by multiple imputation. At baseline, 4.7% and 6.8% of the students at the intervention and the control schools smoked, respectively. After 1 year of the intervention, the prevalence was 7.9% and 10.7%, respectively. At follow-up, 553 students (13.7%) did not answer the question on smoking. Available case analyses: crude odds ratios (OR) for smoking at intervention schools compared with control schools: 0.65 (0.48-0.88) and adjusted: 0.70 (0.47-1.04). ITT analyses: crude OR for smoking at intervention schools compared with control schools: 0.67 (0.50-0.89) and adjusted: 0.61 (0.45-0.82). Students at intervention schools had a lower risk of smoking after a year of intervention in year 7. This multi-component intervention involving educational, parental and context-related intervention components seems to be efficient in lowering or postponing smoking uptake in Danish adolescents. © The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

Follow-up after telephone consultations at out-of-hours primary care.

PubMed

Huibers, Linda; Koetsenruijter, Jan; Grol, Richard; Giesen, Paul; Wensing, Michel

2013-01-01

After a contact with a primary care physician (PCP) cooperative for out-of-hours care, many patients have subsequent contact with health care. Little is known about the factors associated with these follow-up contacts. The objective of this study was to examine whether patient experiences with nurse telephone consultations and the cooperative's organizational characteristics were associated with the probability of follow-up contact. We conducted a cross-sectional study of patients attending 16 Dutch PCP cooperatives (2009 to 2011) using a validated questionnaire to measure patient experiences with nurse telephone consultations and patient-reported follow-up. Participating cooperatives provided information on 12 organizational characteristics. Multilevel regression modeling was used to identify associations. A total of 7039 patients returned a questionnaire (50.4%), of which 5678 were complete. About half of patients reported a follow-up contact (47%). Regression analyses showed increasing probability of follow-up contact in patients with higher age (≥65 years; odds ratio [OR], 2.39), patients receiving a home visit (OR, 1.32), and cooperatives with a higher percentage of telephone consultations (OR, 1.02) and a decreased probability among patients with more positive experiences with a nurse via telephone contact (OR, 0.68). Although follow-up contacts can be medically required, a substantial number of contacts seem to be not required and thus are potentially avoidable (eg, by changes in work routine and communication).

Does Insight Affect the Efficacy of Antipsychotics in Acute Mania?: An Individual Patient Data Regression Meta-Analysis.

PubMed

Welten, Carlijn C M; Koeter, Maarten W J; Wohlfarth, Tamar D; Storosum, Jitschak G; van den Brink, Wim; Gispen-de Wied, Christine C; Leufkens, Hubert G M; Denys, Damiaan A J P

2016-02-01

Patients having an acute manic episode of bipolar disorder often lack insight into their condition. Because little is known about the possible effect of insight on treatment efficacy, we examined whether insight at the start of treatment affects the efficacy of antipsychotic treatment in patients with acute mania. We used individual patient data from 7 randomized, double-blind, placebo-controlled registration studies of 4 antipsychotics in patients with acute mania (N = 1904). Insight was measured with item 11 of the Young Mania Rating Scale (YMRS) at baseline and study endpoint 3 weeks later. Treatment outcome was defined by (a) mean change score, (b) response defined as 50% or more improvement on YMRS, and (c) remission defined as YMRS score less than 8 at study endpoint. We used multilevel mixed effect linear (or logistic) regression analyses of individual patient data to assess the interaction between baseline insight and treatment outcomes. At treatment initiation, 1207 (63.5%) patients had impaired or no insight into their condition. Level of insight significantly modified the efficacy of treatment by mean change score (P = 0.039), response rate (P = 0.033), and remission rate (P = 0.043), with greater improvement in patients with more impaired insight. We therefore recommend that patients experiencing acute mania should be treated immediately and not be delayed until patients regain insight.

The long-term impact of community mobilisation through participatory women's groups on women's agency in the household: A follow-up study to the Makwanpur trial

PubMed Central

Skordis-Worrall, Jolene; Manandhar, Dharma S.; Strachan, Daniel; Morrison, Joanna; Saville, Naomi; Osrin, David; Tumbahangphe, Kirti M.; Costello, Anthony; Heys, Michelle

2018-01-01

Women’s groups practicing participatory learning and action (PLA) in rural areas have been shown to improve maternal and newborn survival in low-income countries, but the pathways from intervention to impact remain unclear. We assessed the long-term impact of a PLA intervention in rural Nepal on women’s agency in the household. In 2014, we conducted a follow-up study to a cluster randomised controlled trial on the impact of PLA women’s groups from 2001–2003. Agency was measured using the Relative Autonomy Index (RAI) and its subdomains. Multi-level regression analyses were performed adjusting for baseline socio-demographic characteristics. We additionally adjusted for potential exposure to subsequent PLA groups based on women’s pregnancy status and conduct of PLA groups in areas of residence. Sensitivity analyses were performed using two alternative measures of agency. We analysed outcomes for 4030 mothers (66% of the cohort) who survived and were recruited to follow-up at mean age 39.6 years. Across a wide range of model specifications, we found no association between exposure to the original PLA intervention with women’s agency in the household approximately 11.5 years later. Subsequent exposure to PLA groups was not associated with greater agency in the household at follow-up, but some specifications found evidence for reduced agency. Household agency may be a prerequisite for actualising the benefits of PLA groups rather than a consequence. PMID:29758071

Gender difference in cycling speed and age of winning performers in ultra-cycling - the 508-mile "Furnace Creek" from 1983 to 2012.

PubMed

Rüst, Christoph Alexander; Rosemann, Thomas; Lepers, Romuald; Knechtle, Beat

2015-01-01

We analysed (i) the gender difference in cycling speed and (ii) the age of winning performers in the 508-mile "Furnace Creek 508". Changes in cycling speeds and gender differences from 1983 to 2012 were analysed using linear, non-linear and hierarchical multi-level regression analyses for the annual three fastest women and men. Cycling speed increased non-linearly in men from 14.6 (s = 0.3) km · h(-1) (1983) to 27.1 (s = 0.7) km · h(-1) (2012) and non-linearly in women from 11.0 (s = 0.3) km · h(-1) (1984) to 24.2 (s = 0.2) km · h(-1) (2012). The gender difference in cycling speed decreased linearly from 26.2 (s = 0.5)% (1984) to 10.7 (s = 1.9)% (2012). The age of winning performers increased from 26 (s = 2) years (1984) to 43 (s = 11) years (2012) in women and from 33 (s = 6) years (1983) to 50 (s = 5) years (2012) in men. To summarise, these results suggest that (i) women will be able to narrow the gender gap in cycling speed in the near future in an ultra-endurance cycling race such as the "Furnace Creek 508" due to the linear decrease in gender difference and (ii) the maturity of these athletes has changed during the last three decades where winning performers become older and faster across years.

Exploring the relationships between drivers' familiarity and two-lane rural road accidents. A multi-level study.

PubMed

Intini, Paolo; Berloco, Nicola; Colonna, Pasquale; Ranieri, Vittorio; Ryeng, Eirin

2018-02-01

Previous research has suggested that drivers' route familiarity/unfamiliarity (using different definitions of familiarity), and the interactions between familiar and unfamiliar drivers, may affect both the driving performances and the likelihood of road crashes. The purpose of this study is to provide a contribution in the search for relationships between familiarity and crashes by: 1) introducing a measure of familiarity based on the distance from residence; 2) analyzing a traffic and accident dataset referred to rural two-lane sections of the Norwegian highways E6 and E39; 3) using a multi-level approach, based on different perspectives, from a macro analysis to more detailed levels. In the macro analyses, the accident rates computed for different seasons and for different summer traffic variation rates (used as indicators of the share of familiar drivers in the flow) were performed. At the second level, a logistic regression model was used to explain the familiarity/unfamiliarity of drivers (based on their distance from residence), through variables retrieved from the database. In the last step, an in-depth analysis considering also accident types and dynamics was conducted. In the macro analysis, no differences were found between accident rates in the different conditions. Whereas, as emerged from the detailed analyses, the factors: high traffic volume, low summer traffic variation, autumn/winter, minor intersections/driveways, speed limits <80 km/h, travel purposes (commuting/not working) are associated to higher odds of having familiar drivers involved in crashes; while the factors: high traffic volume, high summer traffic variation, summer, head on/rear end-angle crashes, heavy vehicles involved, travel purposes (not commuting), young drivers involved are associated to higher odds of finding unfamiliar drivers involved. To a minor extent, some indications arise from the in-depth analyses about crash types and dynamics, especially for familiar drivers. With regard to the definitions used in this article, the familiarity was confirmed as an influential factor on the accident risk, possibly due to distraction and dangerous behaviors, while the influence of being unfamiliar on the accident proneness has some unclarified aspects. However, crashes to unfamiliar drivers may cluster at sites showing high summer traffic variation and in summer months. Copyright © 2017 Elsevier Ltd. All rights reserved.

A computer simulator for development of engineering system design methodologies

NASA Technical Reports Server (NTRS)

Padula, S. L.; Sobieszczanski-Sobieski, J.

1987-01-01

A computer program designed to simulate and improve engineering system design methodology is described. The simulator mimics the qualitative behavior and data couplings occurring among the subsystems of a complex engineering system. It eliminates the engineering analyses in the subsystems by replacing them with judiciously chosen analytical functions. With the cost of analysis eliminated, the simulator is used for experimentation with a large variety of candidate algorithms for multilevel design optimization to choose the best ones for the actual application. Thus, the simulator serves as a development tool for multilevel design optimization strategy. The simulator concept, implementation, and status are described and illustrated with examples.

Design and Fabrication of Orthotropic Deck Details

DOT National Transportation Integrated Search

2016-02-01

The objectives of the research were to verify the design and fabrication of the orthotropic deck details proposed for the lift bridge, for infinite fatigue life. Multi-level 3D finite element analyses (FEA) of the proposed deck were performed to dete...

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…

Bacterial Adherence and Dwelling Probability: Two Drivers of Early Alveolar Infection by Streptococcus pneumoniae Identified in Multi-Level Mathematical Modeling

PubMed Central

Santos, Guido; Lai, Xin; Eberhardt, Martin; Vera, Julio

2018-01-01

Pneumococcal infection is the most frequent cause of pneumonia, and one of the most prevalent diseases worldwide. The population groups at high risk of death from bacterial pneumonia are infants, elderly and immunosuppressed people. These groups are more vulnerable because they have immature or impaired immune systems, the efficacy of their response to vaccines is lower, and antibiotic treatment often does not take place until the inflammatory response triggered is already overwhelming. The immune response to bacterial lung infections involves dynamic interactions between several types of cells whose activation is driven by intracellular molecular networks. A feasible approach to the integration of knowledge and data linking tissue, cellular and intracellular events and the construction of hypotheses in this area is the use of mathematical modeling. For this paper, we used a multi-level computational model to analyse the role of cellular and molecular interactions during the first 10 h after alveolar invasion of Streptococcus pneumoniae bacteria. By “multi-level” we mean that we simulated the interplay between different temporal and spatial scales in a single computational model. In this instance, we included the intracellular scale of processes driving lung epithelial cell activation together with the scale of cell-to-cell interactions at the alveolar tissue. In our analysis, we combined systematic model simulations with logistic regression analysis and decision trees to find genotypic-phenotypic signatures that explain differences in bacteria strain infectivity. According to our simulations, pneumococci benefit from a high dwelling probability and a high proliferation rate during the first stages of infection. In addition to this, the model predicts that during the very early phases of infection the bacterial capsule could be an impediment to the establishment of the alveolar infection because it impairs bacterial colonization. PMID:29868515

Undertreatment of acute pain (oligoanalgesia) and medical practice variation in prehospital analgesia of adult trauma patients: a 10 yr retrospective study.

PubMed

Albrecht, E; Taffe, P; Yersin, B; Schoettker, P; Decosterd, I; Hugli, O

2013-01-01

Prehospital oligoanalgesia is prevalent among trauma victims, even when the emergency medical services team includes a physician. We investigated if not only patients' characteristics but physicians' practice variations contributed to prehospital oligoanalgesia. Patient records of conscious adult trauma victims transported by our air rescue helicopter service over 10 yr were reviewed retrospectively. Oligoanalgesia was defined as a numeric rating scale (NRS) >3 at hospital admission. Multilevel logistic regression analysis was used to predict oligoanalgesia, accounting first for patient case-mix, and then physician-level clustering. The intraclass correlation was expressed as the median odds ratio (MOR). A total of 1202 patients and 77 physicians were included in the study. NRS at the scene was 6.9 (1.9). The prevalence of oligoanalgesia was 43%. Physicians had a median of 5.7 yr (inter-quartile range: 4.2-7.5) of post-graduate training and 27% were female. In our multilevel analysis, significant predictors of oligoanalgesia were: no analgesia [odds ratio (OR) 8.8], National Advisory Committee for Aeronautics V on site (OR 4.4), NRS on site (OR 1.5 per additional NRS unit >4), female physician (OR 2.0), and years of post-graduate experience [>4.0 to ≤5.0 (OR 1.3), >3.0 to ≤4.0 (OR 1.6), >2.0 to ≤3.0 (OR 2.6), and ≤2.0 yr (OR 16.7)]. The MOR was 2.6, and was statistically significant. Physicians' practice variations contributed to oligoanalgesia, a factor often overlooked in analyses of prehospital pain management. Further exploration of the sources of these variations may provide innovative targets for quality improvement programmes to achieve consistent pain relief for trauma victims.

Socio-economic factors linked with mental health during the recession: a multilevel analysis.

PubMed

Ruiz-Pérez, Isabel; Bermúdez-Tamayo, Clara; Rodríguez-Barranco, Miguel

2017-03-06

Periods of financial crisis are associated with higher psychological stress among the population and greater use of mental health services. The objective is to analyse contextual factors associated with mental health among the Spanish population during the recession. Cross-sectional, descriptive study of two periods: before the recession (2006) and after therecession (2011-2012). The study population comprised individuals aged 16+ years old, polled for the National Health Survey. There were 25,234 subjects (2006) and 20,754 subjects (2012). The dependent variable was psychic morbidity. 1) socio-demographic (age, socio-professional class, level of education, nationality, employment situation, marital status), 2) psycho-social (social support) and 3) financial (GDP per capita, risk of poverty, income per capita per household), public welfare services (health spending per capita), labour market (employment and unemployment rates, percentage of temporary workers). Multilevel logistic regression models with mixed effects were constructed to determine change in psychic morbidity according to the variables studied. The macroeconomic variables associated with worse mental health for both males and females were lower health spending per capita and percentage of temporary workers. Among women, the risk of poor mental health increased 6% for each 100€ decrease in healthcare spending per capita. Among men, the risk of poor mental health decreased 8% for each 5-percentage point increase in temporary workers. Higher rates of precarious employment in a region have a negative effect on people's mental health; likewise lower health spending per capita. Policies during periods of recession should focus on support and improved conditions for vulnerable groups such as temporary workers. Healthcare cutbacks should be avoided in order to prevent increased prevalence of poor mental health.

Community-level influences on women's experience of intimate partner violence and terminated pregnancy in Nigeria: a multilevel analysis

PubMed Central

2012-01-01

Background Intimate partner violence (IPV) is a major public health problem with serious consequences for women’s physical, mental, sexual and reproductive health. Reproductive health outcomes such as unwanted and terminated pregnancies, fetal loss or child loss during infancy, non-use of family planning methods, and high fertility are increasingly recognized. However, little is known about the role of community influences on women's experience of IPV and its effect on terminated pregnancy, given the increased awareness of IPV being a product of social context. This study sought to examine the role of community-level norms and characteristics in the association between IPV and terminated pregnancy in Nigeria. Methods Multilevel logistic regression analyses were performed on nationally-representative cross-sectional data including 19,226 women aged 15–49 years in Nigeria. Data were collected by a stratified two-stage sampling technique, with 888 primary sampling units (PSUs) selected in the first sampling stage, and 7,864 households selected through probability sampling in the second sampling stage. Results Women who had experienced physical IPV, sexual IPV, and any IPV were more likely to have terminated a pregnancy compared to women who had not experienced these IPV types. IPV types were significantly associated with factors reflecting relationship control, relationship inequalities, and socio-demographic characteristics. Characteristics of the women aggregated at the community level (mean education, justifying wife beating, mean age at first marriage, and contraceptive use) were significantly associated with IPV types and terminated pregnancy. Conclusion Findings indicate the role of community influence in the association between IPV-exposure and terminated pregnancy, and stress the need for screening women seeking abortions for a history of abuse. PMID:23150987

Neighbourhood deprivation, individual-level familial and socio-demographic factors and diagnosed childhood obesity: a nationwide multilevel study from Sweden.

PubMed

Li, Xinjun; Memarian, Ensieh; Sundquist, Jan; Zöller, Bengt; Sundquist, Kristina

2014-01-01

To examine whether there is an association between neighbourhood deprivation and diagnosed childhood obesity, after accounting for family- and individual-level socio-demographic characteristics. An open cohort of all children aged 0-14 years was followed between January 1, 2000 and December 31, 2010. Childhood residential locations were geocoded and classified according to neighbourhood deprivation. Data were analysed by multilevel logistic regression, with family- and individual-level characteristics at the first level and level of neighbourhood deprivation at the second level. During the study period, among a total of 948,062 children, 10,799 were diagnosed with childhood obesity. Age-adjusted cumulative incidence for diagnosed childhood obesity increased with increasing level of neighbourhood deprivation. Incidence of diagnosed childhood obesity increased with increasing neighbourhood-level deprivation across all family and individual-level socio-demographic categories. The odds ratio (OR) for diagnosed childhood obesity for those living in high-deprivation neighbourhoods versus those living in low-deprivation neighbourhoods was 2.44 (95% confidence interval (CI) = 2.22-2.68). High neighbourhood deprivation remained significantly associated with higher odds of diagnosed childhood obesity after adjustment for family- and individual-level socio-demographic characteristics (OR = 1.70, 95% CI = 1.55-1.89). Age, middle level family income, maternal marital status, low level education, living in large cities, advanced paternal and maternal age, family history of obesity, parental history of diabetes, chronic obstructive pulmonary disease, alcoholism and personal history of diabetes were all associated with higher odds of diagnosed childhood obesity. Our results suggest that neighbourhood characteristics affect the odds of diagnosed childhood obesity independently of family- and individual-level socio-demographic characteristics. © 2014 S. Karger GmbH, Freiburg.

Understanding the effects of a decentralized budget on physicians' compliance with guidelines for statin prescription – a multilevel methodological approach

PubMed Central

Ohlsson, Henrik; Merlo, Juan

2007-01-01

Background Official guidelines that promote evidence-based and cost-effective prescribing are of main relevance for obvious reasons. However, to what extent these guidelines are followed and their conditioning factors at different levels of the health care system are still insufficiently known. In January 2004, a decentralized drug budget was implemented in the county of Scania, Sweden. Focusing on lipid-lowering drugs (i.e., statins), we evaluated the effect of this intervention across a 25-month period. We expected that increased local economic responsibility would promote prescribing of recommended statins. Methods We performed two separate multilevel regression analyses; on 110 827 individual prescriptions issued at 136 publicly-administered health care centres (HCCs) nested within 14 administrative areas (HCAs), and on 72 012 individual prescriptions issued by 115 privately-administered HCCs. Temporal trends in the prevalence of prescription of recommended statins were investigated by random slope analysis. Differences (i.e., variance) between HCCs and between HCAs were expressed by median odds ratio (MOR). Results After the implementation of the decentralized drug budget, adherence to guidelines increased continuously. At the end of the observation period, however, practice variation remained high. Prescription of recommended statins presented a high degree of clustering within both publicly (i.e., MORHCC = 2.18 and MORHCA = 1.31 respectively) and privately administered facilities (MORHCC = 3.47). Conclusion A decentralized drug budget seems to promote adherence to guidelines for statin prescription. However, the high practice differences at the end of the observation period may reflect inefficient therapeutic traditions, and indicates that rational statin prescription could be further improved. PMID:17488496

Psychological and Social Work Factors as Predictors of Mental Distress and Positive Affect: A Prospective, Multilevel Study.

PubMed

Finne, Live Bakke; Christensen, Jan Olav; Knardahl, Stein

2016-01-01

Occupational health research has mainly addressed determinants of negative health effects, typically employing individual-level self-report data. The present study investigated individual- and department-level (means of each work unit) effects of psychological/social work factors on mental distress and positive affect. Employees were recruited from 63 Norwegian organizations, representing a wide variety of job types. A total of 4158 employees, in 918 departments, responded at baseline and at follow-up two years later. Multilevel linear regressions estimated individual- and department-level effects simultaneously, and accounted for clustering of data. Baseline exposures and average exposures over time ([T1+T2]/2) were tested. All work factors; decision control, role conflict, positive challenge, support from immediate superior, fair leadership, predictability during the next month, commitment to organization, rumors of change, human resource primacy, and social climate, were related to mental distress and positive affect at the individual and department level. However, analyses of baseline exposures adjusted for baseline outcome, demonstrated significant associations at the individual level only. Baseline "rumors of change" was related to mental distress only and baseline "predictability during the next month" was not a statistical significant predictor of either outcome when adjusted for outcome at baseline. Psychological and social work factors were generally related to mental distress and positive affect in a mirrored way. Impact of exposures seemed most pervasive at the individual level. However, department-level relations were also discovered. Supplementing individual-level measures with aggregated measures may increase understanding of working conditions influence on employees`health and well-being. Organizational improvements focusing on the work factors in the current study should be able to reduce distress and enhance positive affect. Furthermore, both targeting individual employees and redesigning working conditions at the work unit level seems important.

Factors associated with sexual and reproductive health stigma among adolescent girls in Ghana.

PubMed

Hall, Kelli Stidham; Morhe, Emmanuel; Manu, Abubakar; Harris, Lisa H; Ela, Elizabeth; Loll, Dana; Kolenic, Giselle; Dozier, Jessica L; Challa, Sneha; Zochowski, Melissa K; Boakye, Andrew; Adanu, Richard; Dalton, Vanessa K

2018-01-01

Using our previously developed and tested Adolescent Sexual and Reproductive Health (SRH) Stigma Scale, we investigated factors associated with perceived SRH stigma among adolescent girls in Ghana. We drew upon data from our survey study of 1,063 females 15-24yrs recruited from community- and clinic-based sites in two Ghanaian cities. Our Adolescent SRH Stigma Scale comprised 20 items and 3 sub-scales (Internalized, Enacted, Lay Attitudes) to measure stigma occurring with sexual activity, contraceptive use, pregnancy, abortion and family planning service use. We assessed relationships between a comprehensive set of demographic, health and social factors and SRH Stigma with multi-level multivariable linear regression models. In unadjusted bivariate analyses, compared to their counterparts, SRH stigma scores were higher among girls who were younger, Accra residents, Muslim, still in/dropped out of secondary school, unemployed, reporting excellent/very good health, not in a relationship, not sexually experienced, never received family planning services, never used contraception, but had been pregnant (all p-values <0.05). In multivariable models, higher SRH stigma scores were associated with history of pregnancy (β = 1.53, CI = 0.51,2.56) and excellent/very good self-rated health (β = 0.89, CI = 0.20,1.58), while lower stigma scores were associated with older age (β = -0.17, 95%CI = -0.24,-0.09), higher educational attainment (β = -1.22, CI = -1.82,-0.63), and sexual intercourse experience (β = -1.32, CI = -2.10,-0.55). Findings provide insight into factors contributing to SRH stigma among this young Ghanaian female sample. Further research disentangling the complex interrelationships between SRH stigma, health, and social context is needed to guide multi-level interventions to address SRH stigma and its causes and consequences for adolescents worldwide.

Factors associated with sexual and reproductive health stigma among adolescent girls in Ghana

PubMed Central

Morhe, Emmanuel; Manu, Abubakar; Harris, Lisa H.; Ela, Elizabeth; Loll, Dana; Kolenic, Giselle; Dozier, Jessica L.; Challa, Sneha; Zochowski, Melissa K.; Boakye, Andrew; Adanu, Richard; Dalton, Vanessa K.

2018-01-01

Objective Using our previously developed and tested Adolescent Sexual and Reproductive Health (SRH) Stigma Scale, we investigated factors associated with perceived SRH stigma among adolescent girls in Ghana. Methods We drew upon data from our survey study of 1,063 females 15-24yrs recruited from community- and clinic-based sites in two Ghanaian cities. Our Adolescent SRH Stigma Scale comprised 20 items and 3 sub-scales (Internalized, Enacted, Lay Attitudes) to measure stigma occurring with sexual activity, contraceptive use, pregnancy, abortion and family planning service use. We assessed relationships between a comprehensive set of demographic, health and social factors and SRH Stigma with multi-level multivariable linear regression models. Results In unadjusted bivariate analyses, compared to their counterparts, SRH stigma scores were higher among girls who were younger, Accra residents, Muslim, still in/dropped out of secondary school, unemployed, reporting excellent/very good health, not in a relationship, not sexually experienced, never received family planning services, never used contraception, but had been pregnant (all p-values <0.05). In multivariable models, higher SRH stigma scores were associated with history of pregnancy (β = 1.53, CI = 0.51,2.56) and excellent/very good self-rated health (β = 0.89, CI = 0.20,1.58), while lower stigma scores were associated with older age (β = -0.17, 95%CI = -0.24,-0.09), higher educational attainment (β = -1.22, CI = -1.82,-0.63), and sexual intercourse experience (β = -1.32, CI = -2.10,-0.55). Conclusions Findings provide insight into factors contributing to SRH stigma among this young Ghanaian female sample. Further research disentangling the complex interrelationships between SRH stigma, health, and social context is needed to guide multi-level interventions to address SRH stigma and its causes and consequences for adolescents worldwide. PMID:29608595

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.

Do welfare regimes influence the association between disability and self-perceived health? A multilevel analysis of 57 countries.

PubMed

Foubert, Josephine; Levecque, Katia; Van Rossem, Ronan; Romagnoli, Alessia

2014-09-01

Disability is usually associated with poorer self-rated health. However, as many people with disabilities do not consider themselves unhealthy, the association may not be as straightforward as it appears. This study examines whether the relationship between disability and self-rated health is dependent on a country's welfare regime. Welfare regimes can play a significant role in securing the needs of disabled people and lessening their social exclusion. However, welfare regimes also label disabled people accordingly, before they become entitled to specific provisions and services. Being given a low status label and being dependent on welfare provisions might trigger a negative self-evaluation of health. Using data from 57 countries of the World Health Survey of 2002-2004, the multilevel regression analyses show that people with a disability tend to rate their health worse than people without any disability. Moreover, the strength of this negative association varies significantly across countries and is affected by a country's welfare regime. The association is the strongest in the various Welfare State regimes (mostly European countries) and the weakest in Informal-Security regimes (Latin-American and Asian countries) and in Insecurity regimes (African countries). Disabled people living in Welfare States regimes tend to rate their health worse than people in other regimes. These findings confirm that welfare regimes play a role in shaping the health perception of disabled people and that processes of labeling may result in unintended and negative consequences of welfare programs. Research on the nexus between disability and self-rated health that neglects this macro-social context of welfare regimes may lead to undifferentiated and even incorrect conclusions. Copyright © 2014 Elsevier Ltd. All rights reserved.

Community-level influences on women's experience of intimate partner violence and terminated pregnancy in Nigeria: a multilevel analysis.

PubMed

Antai, Diddy; Adaji, Sunday

2012-11-14

Intimate partner violence (IPV) is a major public health problem with serious consequences for women's physical, mental, sexual and reproductive health. Reproductive health outcomes such as unwanted and terminated pregnancies, fetal loss or child loss during infancy, non-use of family planning methods, and high fertility are increasingly recognized. However, little is known about the role of community influences on women's experience of IPV and its effect on terminated pregnancy, given the increased awareness of IPV being a product of social context. This study sought to examine the role of community-level norms and characteristics in the association between IPV and terminated pregnancy in Nigeria. Multilevel logistic regression analyses were performed on nationally-representative cross-sectional data including 19,226 women aged 15-49 years in Nigeria. Data were collected by a stratified two-stage sampling technique, with 888 primary sampling units (PSUs) selected in the first sampling stage, and 7,864 households selected through probability sampling in the second sampling stage. Women who had experienced physical IPV, sexual IPV, and any IPV were more likely to have terminated a pregnancy compared to women who had not experienced these IPV types.IPV types were significantly associated with factors reflecting relationship control, relationship inequalities, and socio-demographic characteristics. Characteristics of the women aggregated at the community level (mean education, justifying wife beating, mean age at first marriage, and contraceptive use) were significantly associated with IPV types and terminated pregnancy. Findings indicate the role of community influence in the association between IPV-exposure and terminated pregnancy, and stress the need for screening women seeking abortions for a history of abuse.

Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases.

PubMed

2016-11-01

The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals. Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2). Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m 2 , who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals. Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care. © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

The role of municipal public policies in oral health socioeconomic inequalities in Brazil: A multilevel study.

PubMed

Aguiar, Violeta Rodrigues; Pattussi, Marcos Pascoal; Celeste, Roger Keller

2018-06-01

It is known that fluoridation has a contextual effect on oral health socioeconomic inequalities, but broad public policies have not been investigated. Thus, the aim of this study was to determine the effects of municipal public policies on oral health across different social strata. This was a cross-sectional study with 7328 12-year-old children and 5445 15-19-year-old adolescents from 177 Brazilian municipalities. Information at municipal level was collated for dental services, educational services, sanitation and water fluoridation. The main individual-level exposure was the disposable equivalent household income. The dichotomous outcomes were as follows: untreated dental caries (≥1 tooth), missing teeth (≥1 tooth) and filled teeth (≥1 tooth). Analyses were carried out using multilevel logistic regression. Interaction terms were tested between individual-level income and policy variables. The prevalence of untreated dental caries, missing and filled teeth was 47.0%, 15.1% and 47.5%, respectively. There was no significant interaction between income and policy indicators. Individuals living in municipalities with no water fluoridation had 1.42 (95% CI: 1.08-1.86) higher odds of having untreated dental caries; the odds ratio (OR) for those in municipalities with less education policies was 1.36 (95% CI: 1.07-1.73); those in municipalities with less sanitation had OR = 1.05 (95% CI: 0.78-1.40); and those in municipalities with less dental care had OR = 1.36 (95% CI: 1.02-1.80). Fluoridation and policies about sanitation, education and dental care were similarly associated with oral health in different social strata. Other policies on social and economic fields may be further explored. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A multilevel examination of school and student characteristics associated with moderate and high levels of physical activity among elementary school students (Ontario, Canada).

PubMed

Hobin, Erin P; Leatherdale, Scott T; Manske, Steve R; Robertson-Wilson, Jennifer

2010-01-01

Schools represent an important environment for physical activity (PA) promotion among youth. Schools can promote PA through policies and programs but our understanding of how these school characteristics associate with student PA levels is largely unknown. Developing this understanding is critical for implementing new prevention interventions. The aim of this study was to identify the school- and student-related characteristics associated with moderate and high levels of PA in a sample of Ontario elementary schools. Using multi-level logistic regression analyses, we explored the school- and student-level characteristics associated with being moderately and highly active using data collected from administrators and from students in grades 5 to 8 at 30 elementary schools in Ontario. Students' PA levels, sex, grade, and the number of physical education classes per week were linked to school environment data--specifically, a school's chosen implementation model for daily physical activity and whether it offers intramural and interschool PA programming. Findings indicate that there was significant between-school variation for being moderately and highly active. Students were less likely to be moderately or highly active if they attended a school offering interschool PA programming. An important student characteristic positively associated with student PA levels included participating in at least two physical education classes per week. The residual differences in PA by school suggest that school-level characteristics facilitate higher levels of student PA beyond individual-level factors. Although most variation in student PA lies between students within schools, there is sufficient between-school variation to be of interest to practitioners and policy-makers.

Family structure and posttraumatic stress reactions: a longitudinal study using multilevel analyses

PubMed Central

2011-01-01

Background There is limited research on the relevance of family structures to the development and maintenance of posttraumatic stress following disasters. We longitudinally studied the effects of marital and parental statuses on posttraumatic stress reactions after the 2004 Southeast Asian tsunami and whether persons in the same households had more shared stress reactions than others. Method The study included a tourist population of 641 Norwegian adult citizens, many of them from families with children. We measured posttraumatic stress symptoms with the Impact of Event Scale-Revised at 6 months and 2 years post-disaster. Analyses included multilevel methods with mixed effects models. Results Results showed that neither marital nor parental status was significantly related to posttraumatic stress. At both assessments, adults living in the same household reported levels of posttraumatic stress that were more similar to one another than adults who were not living together. Between households, disaster experiences were closely related to the variance in posttraumatic stress symptom levels at both assessments. Within households, however, disaster experiences were less related to the variance in symptom level at 2 years than at 6 months. Conclusions These results indicate that adult household members may influence one another's posttraumatic stress reactions as well as their interpretations of the disaster experiences over time. Our findings suggest that multilevel methods may provide important information about family processes after disasters. PMID:22171549

Return to Work and Multilevel Versus Single-Level Cervical Fusion for Radiculopathy in a Workers' Compensation Setting.

PubMed

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

2017-01-15

Retrospective comparative cohort study. Examine the impact of multilevel fusion on return to work (RTW) status and compare RTW status after multi- versus single-level cervical fusion for patients with work-related injury. Patients with work-related injuries in the workers' compensation systems have less favorable surgical outcomes. Cervical fusion provides a greater than 90% likelihood of relieving radiculopathy and stabilizing or improving myelopathy. However, more levels fused at index surgery are reportedly associated with poorer surgical outcomes than single-level fusion. Data was collected from the Ohio Bureau of Workers' Compensation (BWC) between 1993 and 2011. The study population included patients who underwent cervical fusion for radiculopathy. Two groups were constructed (multilevel fusion [MLF] vs. single-level fusion [SLF]). Outcomes measures evaluated were: RTW criteria, RTW <1year, reoperation, surgical complication, disability, and legal litigation after surgery. After accounting for a number of independent variables in the regression model, multilevel fusion was a negative predictor of successful RTW status within 3-year follow-up after surgery (OR = 0.82, 95% CI: 0.70-0.95, P <0.05).RTW criteria were met 62.9% of SLF group compared with 54.8% of MLF group. The odds of having a stable RTW for MLF patients were 0.71% compared with the SLF patients (95% CI: 0.61-0.83; P: 0.0001).At 1 year after surgery, RTW rate was 53.1% for the SLF group compared with 43.7% for the MLF group. The odds of RTW within 1 year after surgery for the MLF group were 0.69% compared with SLF patients (95% CI: 0.59-0.80; P: 0.0001).Higher rate of disability after surgery was observed in the MLF group compared with the SLF group (P: 0.0001) CONCLUSION.: Multilevel cervical fusion for radiculopathy was associated with poor return to work profile after surgery. Multilevel cervical fusion was associated with lower RTW rates, less likelihood of achieving stable return to work, and higher rate of disability after surgery. 3.

Tobacco advertising, environmental smoking bans, and smoking in Chinese urban areas.

PubMed

Yang, Tingzhong; Rockett, Ian R H; Li, Mu; Xu, Xiaochao; Gu, Yaming

2012-07-01

To evaluate whether cigarette smoking in Chinese urban areas was respectively associated with exposure to tobacco advertising and smoking bans in households, workplaces, and public places. Participants were 4735 urban residents aged 15 years and older, who were identified through multi-stage quota-sampling conducted in six Chinese cities. Data were collected on individual sociodemographics and smoking status, and regional tobacco control measures. The sample was characterized in terms of smoking prevalence, and multilevel logistic models were employed to analyze the association between smoking and tobacco advertising and environmental smoking restrictions, respectively. Smoking prevalence was 30%. Multilevel logistic regression analysis showed that smoking was positively associated with exposure to tobacco advertising, and negatively associated with workplace and household smoking bans. The association of smoking with both tobacco advertising and environmental smoking bans further justifies implementation of comprehensive smoking interventions and tobacco control programs in China. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Effects of Youth Participation in Extra-Curricular Sport Programs on Perceived Self-Efficacy: A Multilevel Analysis.

PubMed

Reverdito, Riller S; Carvalho, Humberto M; Galatti, Larissa R; Scaglia, Alcides J; Gonçalves, Carlos E; Paes, Roberto R

2017-06-01

The present study examined extracurricular sport participation variables and developmental context in relationship to perceived self-efficacy among underserved adolescents. Participants ( n = 821, 13.6 ± 1.5 years) completed the Youth Experience in Sport questionnaire and General Self-Efficacy Scale. We used the Human Development Index (HDI) to characterize developmental contexts. Multilevel regression models were used to explore the relative contributions of age, sex, years of participation in extracurricular sport, HDI, and perceived positive experience in sport. Our results highlight that positive experience alone and in interaction with length of participation in the program fostered perceived self-efficacy. Participants from higher HDI contexts remained longer in the program. An implication of our research is that variables linked to positive sport experiences and perceived self-efficacy can be used as markers to evaluate the outcomes and impact of sport participation programs aimed at promoting positive youth development.

Placing Families in Context: Challenges for Cross-National Family Research

PubMed Central

Yu, Wei-hsin

2015-01-01

Cross-national comparisons constitute a valuable strategy to assess how broader cultural, political, and institutional contexts shape family outcomes. One typical approach of cross-national family research is to use comparable data from a limited number of countries, fit similar regression models for each country, and compare results across country-specific models. Increasingly, researchers are adopting a second approach, which requires merging data from many more societies and testing multilevel models using the pooled sample. Although the second approach has the advantage of allowing direct estimates of the effects of nation-level characteristics, it is more likely to suffer from the problems of omitted-variable bias, influential cases, and measurement and construct nonequivalence. I discuss ways to improve the first approach's ability to infer macrolevel influences, as well as how to deal with challenges associated with the second one. I also suggest choosing analytical strategies according to whether the data meet multilevel models’ assumptions. PMID:25999603

Giant multilevel thoracic hemangioma with spinal cord compression in a patient with Klippel-Weber-Trenaunay syndrome: case report.

PubMed

Grau, Stefan J; Holtmannspoetter, Markus; Seelos, Klaus; Tonn, Joerg-Christian; Siefert, Axel

2009-06-15

Case report and clinical discussion. We intend to report a very rare case of a giant spinal hemangioma causing myelopathy. Multilevel symptomatic spinal hemangiomas causing acute neurologic symptoms are rare disorders. We found only sporadic reports in English literature. We describe a very rare case in which Klippel-Trenaunay-Weber syndrome is associated with a multisegmental vertebral hemangioma causing a rapidly progressing thoracic myelopathy. Because of the extension of the disease, surgical intervention was not feasible, the patient was treated by radiotherapy. The patient showed a complete regression of symptoms with stable condition after 3 months. In extensive spinal hemangiomas, radiotherapy may represent a safe treatment modality with rapid clinical improvement even in cases with spinal cord compression. This report contributes to a wide range of known vascular abnormalities in Klippel-Trenaunay-Weber syndrome and supports the need for a careful multisystemic evaluation of these patients.

[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.

A multilevel analysis of social ties and social cohesion among Latinos and their neighborhoods: results from Chicago.

PubMed

Almeida, Joanna; Kawachi, Ichiro; Molnar, Beth E; Subramanian, S V

2009-09-01

Research suggests that, among Latinos, there are health benefits associated with living in a neighborhood populated with coethnics. While social networks and social cohesion are the proposed explanation for the salubrious effect and are assumed to be characteristics of Latino immigrant enclaves, evidence for this is limited. We used multilevel regression to test the relative contribution of individual race/ethnicity and neighborhood concentration of Mexican Americans as predictors of social networks and social cohesion. After accounting for personal characteristics, we found a negative association between neighborhood concentration of Mexican Americans and social cohesion. Among Latinos, living in a neighborhood with increased coethnics was associated with increased social ties. Compared to non-Latino whites, Mexican Americans reported more social ties but lower social cohesion. Contrary to the assumption that Mexican immigrant enclaves beget social cohesion, we did not find this to be true in Chicago neighborhoods.

Occupational injury among hospital patient-care workers: what is the association with workplace verbal abuse?

PubMed

Sabbath, Erika L; Hurtado, David A; Okechukwu, Cassandra A; Tamers, Sara L; Nelson, Candace; Kim, Seung-Sup; Wagner, Gregory; Sorenson, Glorian

2014-02-01

To test the association between workplace abuse exposure and injury risk among hospital workers. We hypothesized that exposed workers would have higher injury rates than unexposed workers. Survey of direct-care workers (n = 1,497) in two hospitals. Exposure to workplace abuse was assessed through self-report; occupational injury reports were extracted from employee records. We tested associations between non-physical workplace violence and injury using log-binomial regression and multilevel modeling. Adjusted prevalence ratio (PR) for injury associated with being yelled at was 1.52 (95% CI 1.19, 1.95); for experiencing hostile/offensive gestures 1.43 (1.11, 1.82); and for being sworn at 1.41 (1.09, 1.81). In analyses by injury subtypes, musculoskeletal injuries were more strongly associated with abuse than were acute traumatic injuries. Associations operated on group and individual levels and were most consistently associated with abuse perpetrated by patients. Exposure to workplace abuse may be a risk factor for injuries among hospital workers. © 2013 Wiley Periodicals, Inc.

Correlates of school dropout and absenteeism among adolescent girls from marginalized community in north Karnataka, south India.

PubMed

Prakash, Ravi; Beattie, Tara; Javalkar, Prakash; Bhattacharjee, Parinita; Ramanaik, Satyanarayana; Thalinja, Raghavendra; Murthy, Srikanta; Davey, Calum; Blanchard, James; Watts, Charlotte; Collumbien, Martine; Moses, Stephen; Heise, Lori; Isac, Shajy

2017-12-01

Secondary education among lower caste adolescent girls living in rural Karnataka, South India, is characterized by high rates of school drop-out and absenteeism. A cross-sectional baseline survey (N=2275) was conducted in 2014 as part of a cluster-randomized control trial among adolescent girls (13-14 year) and their families from marginalized communities in two districts of north Karnataka. Bivariate and multivariate logistic regression models were used. Overall, 8.7% girls reported secondary school dropout and 8.1% reported frequent absenteeism (past month). In adjusted analyses, economic factors (household poverty; girls' work-related migration), social norms and practices (child marriage; value of girls' education), and school-related factors (poor learning environment and bullying/harassment at school) were associated with an increased odds of school dropout and absenteeism. Interventions aiming to increase secondary school retention among marginalized girls may require a multi-level approach, with synergistic components that address social, structural and economic determinants of school absenteeism and dropout. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Do therapist cultural characteristics influence the outcome of substance abuse treatment for Spanish-speaking adults?

PubMed Central

Suarez-Morales, Lourdes; McCabe, Brian E.; Feaster, Daniel J.; Martino, Steve; Cuzmar, Ivette Y.; Carroll, Kathleen M.; Bedregal, Luis; Paris, Manuel; Szapocznik, José

2010-01-01

This secondary data analysis of the Clinical Trials Network’s Motivational Enhancement Therapy effectiveness trial with Spanish-speaking substance users examined whether the degree of birthplace and acculturation similarities between clients and therapists, as well as the therapists’ own level of acculturation and birthplace were related to the clients’ participation in treatment and level of substance use during outpatient substance use treatment. Sixteen therapists and their 235 clients from the larger effectiveness trial were included in the analyses for this study. Results of the multilevel regression models for client participation in substance use treatment and client days of substance use taking into account within and between therapist cultural characteristics revealed that birthplace match and acculturation similarity between each therapist and his/her clients did not predict client outcomes. Instead, therapists’ birthplace and level of acculturation independently predicted days of substance use, but not treatment participation for monolingual Spanish-speaking clients. These findings are discussed in the context of the results of the main effectiveness trial and of psychotherapy research with ethnic minority populations, in particular Hispanic minorities. PMID:20438158

Friends' drinking norms and male adolescents' alcohol consumption: The moderating role of performance-based peer influence susceptibility.

PubMed

Teunissen, Hanneke A; Kuntsche, Emmanuel; Scholte, Ron H J; Spijkerman, Renske; Prinstein, Mitchell J; Engels, Rutger C M E

2016-12-01

This study examined whether the relationship between friends' drinking norms and male adolescents' alcohol use is moderated by performance-based peer influence susceptibility. Seventy-three male adolescents (M = 17 years) from three schools in the Netherlands were exposed to the drinking norms of "peers" (electronic confederates) in a chat room experiment. These peers were either popular or unpopular, and conveyed pro- or anti-alcohol norms. Peer influence susceptibility was defined as the change in adolescents' answers before and after exposure to the peer norms. Multilevel regression analyses indicated that the relationship between friends' drinking norms and adolescents' alcohol use (assessed during eight weekends) was moderated by susceptibility to the pro-alcohol norms of popular peers. This relationship was stronger for adolescents who were highly susceptible. These findings suggest that a behavioral measure of peer influence susceptibility could be useful in alcohol prevention programs to select adolescents at risk for negative peer socialization. Copyright © 2016 The Foundation for Professionals in Services for Adolescents. All rights reserved.

Skewed sex ratios and criminal victimization in India.

PubMed

South, Scott J; Trent, Katherine; Bose, Sunita

2014-06-01

Although substantial research has explored the causes of India's excessively masculine population sex ratio, few studies have examined the consequences of this surplus of males. We merge individual-level data from the 2004-2005 India Human Development Survey with data from the 2001 India population census to examine the association between the district-level male-to-female sex ratio at ages 15 to 39 and self-reports of victimization by theft, breaking and entering, and assault. Multilevel logistic regression analyses reveal positive and statistically significant albeit substantively modest effects of the district-level sex ratio on all three victimization risks. We also find that higher male-to-female sex ratios are associated with the perception that young unmarried women in the local community are frequently harassed. Household-level indicators of family structure, socioeconomic status, and caste, as well as areal indicators of women's empowerment and collective efficacy, also emerge as significant predictors of self-reported criminal victimization and the perceived harassment of young women. The implications of these findings for India's growing sex ratio imbalance are discussed.

Proximal and distal determinants of stressful work: framework and analysis of retrospective European data.

PubMed

Wahrendorf, Morten; Siegrist, Johannes

2014-08-15

While robust evidence on associations of stressful work with health exists, less research is available on determinants of stressful work in terms of respondents' characteristics (proximal factors) and in terms of national labour market policies (distal factors). In this article we analyse proximal (childhood circumstances and labour market disadvantage) and distal determinants (national compensation and integration policies) of stressful work in a comprehensive framework. We use data from the third wave of the Survey of Health, Ageing and Retirement in Europe (SHARE), with retrospective information on individual life courses collected among 11181 retired men and women in 13 European countries (2008-2009). To test our hypotheses we estimate multilevel regression models. Results show that stressful work is related to disadvantaged circumstances during childhood. To some extent this association is explained by labour market disadvantage during adulthood. Additionally, well developed labour market integration policies are related to lower overall levels of stressful work at national level. This analysis provides first evidence of important determinants of stressful work, both in terms of pre-employment conditions (childhood circumstances) and in terms of contextual macro-social policies.

Neighbourhood crime and adolescent cannabis use in Canadian adolescents.

PubMed

de Looze, Margaretha; Janssen, Ian; Elgar, Frank J; Craig, Wendy; Pickett, William

2015-01-01

Although neighbourhood factors have been proposed as determinants of adolescent behaviour, few studies document their relative etiological importance. We investigated the relationship between neighbourhood crime and cannabis use in a nationally representative sample of Canadian adolescents. Data from the 2009/10 Canadian Health Behaviour in School-aged Children (HBSC) survey (n=9134 14- and 15-year-olds) were combined with area-level data on crime and socioeconomic status of the neighbourhood surrounding the schools (n=218). Multilevel logistic regression analyses showed that after individual and contextual differences were held constant, neighbourhood crime related to cannabis use (OR 1.29, CI 1.12-1.47 per 1.0 SD increase in crime). This association was not moderated by parental support nor having cannabis-using friends. The amount of explained variance at the neighbourhood level was 19%. Neighbourhood crime is an important factor to consider when designing interventions aimed at reducing adolescent cannabis use. Interventional research should examine the effectiveness of community-based interventions that target adolescents through parents and peers. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The relationship between immigration and depression in South Africa: Evidence from the first South African National Income Dynamics Study

PubMed Central

Tomita, Andrew; Labys, Charlotte A.; Burns, Jonathan K.

2014-01-01

Few studies have examined depression among immigrants in post-apartheid South Africa, and factors that strengthen the relationship between immigration and depression. The first wave of the National Income Dynamics Study was used to investigate links between immigration and depression (n=15,205). Depression symptoms were assessed using a 10-item version of the Center for Epidemiologic Studies Depression (CES-D) Scale. Immigrants in South Africa had fewer depressive symptoms (CES-D ≥ 10) than locally-born participants (17.1% vs. 32.4%, F = 13.5, p<0.01). Multilevel mixed-effects logistic regression analyses found that among immigrant populations, younger age (adjusted OR=1.03, 95% CI = 1.01-1.05) and black African ethnicity (adjusted OR=3.72, 95% CI = 1.29-10.7) were associated with higher depression. Younger age was associated with lower depression among locally-born study participants (adjusted OR=0.98, 95% CI = 0.97-0.98). The varying relationship between certain demographic factors, depression and the different mental health challenges among these groups requires closer attention. PMID:24526432

The relationship between immigration and depression in South Africa: evidence from the first South African National Income Dynamics Study.

PubMed

Tomita, Andrew; Labys, Charlotte A; Burns, Jonathan K

2014-12-01

Few studies have examined depression among immigrants in post-apartheid South Africa, and factors that strengthen the relationship between immigration and depression. The first wave of the National Income Dynamics Study was used to investigate links between immigration and depression (n = 15,205). Depression symptoms were assessed using a 10-item version of the Center for Epidemiologic Studies Depression (CES-D) Scale. Immigrants in South Africa had fewer depressive symptoms (CES-D ≥ 10) than locally-born participants (17.1 vs. 32.4%, F = 13.5, p < 0.01). Multilevel mixed-effects logistic regression analyses found that among immigrant populations, younger age (adjusted OR 1.03, 95% CI 1.01-1.05) and black African ethnicity (adjusted OR 3.72, 95% CI 1.29-10.7) were associated with higher depression. Younger age was associated with lower depression among locally-born study participants (adjusted OR 0.98, 95% CI 0.97-0.98). The varying relationship between certain demographic factors, depression and the different mental health challenges among these groups requires closer attention.

Individual and community levels of maternal autonomy and child undernutrition in India.

PubMed

Rajaram, Ramaprasad; Perkins, Jessica M; Joe, William; Subramanian, S V

2017-03-01

Investigate the relationship between maternal autonomy at multiple levels and the risk of child stunting, underweight, and wasting in India. Data were from a 2005-2006 nationally representative, cross-sectional sample of 51,555 children under 5 years from 29 states in India. Multilevel, multivariable, logistic regression analyses were used to estimate the odds of child stunting, underweight, and wasting in relation to maternal autonomy in healthcare, movement, and money at the individual level and community level, while adjusting for several child, maternal, and household factors. When only adjusting for child age and sex, children in communities with a high proportion of women with autonomy in healthcare, or movement, or money, separately, had a lower risk of being stunted, underweight, or wasted, separately. However, adjusting for other explanatory factors attenuated these relationships and made them statistically insignificant. Individual maternal autonomy in any of the three domains was not associated with any of the outcomes. The results suggest that caution should be taken when interpreting the direct relevance of maternal autonomy at both individual and community levels to measures of child undernutrition.

Predictability of a favorable outcome in anorexia nervosa.

PubMed

Deter, H C; Schellberg, D; Köpp, W; Friederich, H C; Herzog, W

2005-03-01

In a long-term follow-up of anorexia nervosa (AN) patients, somatic, psychological and social variables at clinical presentation should be investigated using a multilevel approach. This study isolated predictors known from the literature over longer time periods and carried out a separate investigation of predictors in a sample of 81 AN patients of the Heidelberg-Mannheim study over a mean period of 12 years (range 9-19 years). Separate hierarchic regression analyses on the basis of the course of the Morgan-Russell categories were calculated for four individually recorded areas: anamnestic, psychological, somatic and social data sets. Age at the onset of the disease, purging behavior, low serum albumin, high glutamic-oxalo acetic transaminase (GOT) psychopathology (ANSS) and social pathology had the highest predictive value qualities. In survival analysis overall assessment of all six main predictors at clinical presentation could differentiate all patients who recovered from those who remained ill (log-rank test P = 0.019). A small number of variables were important for detecting a good or poor long-term course of AN. At onset of the disease, it seems necessary to evaluate these psychological, somatic and social predictors.

Girls' and boys' experience with teen sexting in early and late adolescence.

PubMed

Ševčíková, Anna

2016-08-01

This study explored the extent to which sexting represents a problematic behavior in early and late adolescence. Using data from the EU Kids Online II project (17,016 participants aged 11-16 from 25 European countries, 49.7% boys), multilevel logistic regression analyses were conducted separately for four groups: younger girls, older girls, younger boys, and older boys. Irrespective of age and gender, sexting was associated with emotional problems and alcohol use. Its effect decreased in older adolescents, except for emotional difficulties, which remained relatively high in older boys. Vaginal sex was associated with sexting in both younger and older boys while, in girls, the association was observed only in the older group. Younger boys with higher self-efficacy were more likely to send sexts than those with lower self-efficacy. Although sexting is associated with psychological challenges and other types of risk behavior, sexting in some younger boys may not necessarily represent problematic behavior. Copyright © 2016 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Gender and racial differences in risk factors for sexually transmitted diseases among justice-involved youth

PubMed Central

Dembo, Richard; Childs, Kristina; Belenko, Steven; Schmeidler, James; Wareham, Jennifer

2010-01-01

Gender and racial differences in infection rates for chlamydia and gonorrhea have been reported within community-based populations, but little is known of such differences within juvenile offending populations. Moreover, while research has demonstrated that certain individual-level and community-level factors affect risky behaviors associated with sexually transmitted disease (STD), less is known about how multi-level factors affect STD infection, particularly among delinquent populations. The present study investigated gender and racial differences in STD infection among a sample of 924 juvenile offenders. Generalized linear model regression analyses were conducted to examine the influence of individual-level factors such as age, offense history, and substance use and community-level factors such as concentrated disadvantage, ethnic heterogeneity, and family disruption on STD status. Results revealed significant racial and STD status differences across gender, as well as interaction effects for race and STD status for males only. Gender differences in individual-level and community-level predictors were also found. Implications of these findings for future research and public health policy are discussed. PMID:20700475

Neighbourhood green space, social environment and mental health: an examination in four European cities.

PubMed

Ruijsbroek, Annemarie; Mohnen, Sigrid M; Droomers, Mariël; Kruize, Hanneke; Gidlow, Christopher; Gražulevičiene, Regina; Andrusaityte, Sandra; Maas, Jolanda; Nieuwenhuijsen, Mark J; Triguero-Mas, Margarita; Masterson, Daniel; Ellis, Naomi; van Kempen, Elise; Hardyns, Wim; Stronks, Karien; Groenewegen, Peter P

2017-07-01

This study examines the relationship between neighbourhood green space, the neighbourhood social environment (social cohesion, neighbourhood attachment, social contacts), and mental health in four European cities. The PHENOTYPE study was carried out in 2013 in Barcelona (Spain), Stoke-on-Trent (United Kingdom), Doetinchem (The Netherlands), and Kaunas (Lithuania). 3771 adults living in 124 neighbourhoods answered questions on mental health, neighbourhood social environment, and amount and quality of green space. Additionally, audit data on neighbourhood green space were collected. Multilevel regression analyses examined the relation between neighbourhood green space and individual mental health and the influence of neighbourhood social environment. Mental health was only related to green (audit) in Barcelona. The amount and quality of neighbourhood green space (audit and perceived) were related to social cohesion in Doetinchem and Stoke-on-Trent and to neighbourhood attachment in Doetinchem. In all four cities, mental health was associated with social contacts. Neighbourhood green was related to mental health only in Barcelona. Though neighbourhood green was related to social cohesion and attachment, the neighbourhood social environment seems not the underlying mechanism for this relationship.

Skewed Sex Ratios and Criminal Victimization in India

PubMed Central

South, Scott J.; Trent, Katherine; Bose, Sunita

2014-01-01

Although substantial research has explored the causes of India’s excessively masculine population sex ratio, few studies have examined the consequences of this surplus of males. We merge individual-level data from the 2004–2005 India Human Development Survey with data from the 2001 India population census to examine the association between the district-level male-to-female sex ratio at ages 15 to 39 and self-reports of victimization by theft, breaking and entering, and assault. Multilevel logistic regression analyses reveal positive and statistically significant albeit substantively modest effects of the district-level sex ratio on all three victimization risks. We also find that higher male-to-female sex ratios are associated with the perception that young unmarried women in the local community are frequently harassed. Household-level indicators of family structure, socioeconomic status, and caste, as well as areal indicators of women’s empowerment and collective efficacy, also emerge as significant predictors of self-reported criminal victimization and the perceived harassment of young women. The implications of these findings for India’s growing sex ratio imbalance are discussed. PMID:24682921

Prediction of Mental Health Services Use One Year After Regular Referral to Specialized Care Versus Referral to Stepped Collaborative Care.

PubMed

van Orden, Mirjam; Leone, Stephanie; Haffmans, Judith; Spinhoven, Philip; Hoencamp, Erik

2017-04-01

Referral to collaborative mental health care within the primary care setting is a service concept that has shown to be as effective as direct referral to specialized mental health care for patients with common mental disorders. Additionally it is more efficient in terms of lower mental health services use. This post-hoc analysis examines if treatment intensity during 1-year of follow-up can be predicted prospectively by baseline characteristics. With multilevel multivariate regression analyses baseline characteristics were examined as potential predictors of visit counts. Results showed that only the enabling factors service concept and referral delay for treatment had a significant association with mental health visit counts, when outcome was dichotomized in five or more visits. Inclusion of the outcome variable as a count variable confirmed the predictive value of service concept and referral delay, but added marital status as a significant predictor. Overall, enabling factors (service concept and referral delay) seem to be important and dominant predictors of mental health services use.

Is gentrification all bad? Positive association between gentrification and individual's perceived neighborhood collective efficacy in Montreal, Canada.

PubMed

Steinmetz-Wood, Madeleine; Wasfi, Rania; Parker, George; Bornstein, Lisa; Caron, Jean; Kestens, Yan

2017-07-14

Collective efficacy has been associated with many health benefits at the neighborhood level. Therefore, understanding why some communities have greater collective efficacy than others is important from a public health perspective. This study examined the relationship between gentrification and collective efficacy, in Montreal Canada. A gentrification index was created using tract level median household income, proportion of the population with a bachelor's degree, average rent, proportion of the population with low income, and proportion of the population aged 30-44. Multilevel linear regression analyses were conducted to measure the association between gentrification and individual level collective efficacy. Gentrification was positively associated with collective efficacy. Gentrifiers (individuals moving into gentrifying neighborhoods) had higher collective efficacy than individuals that lived in a neighborhood that did not gentrify. Perceptions of collective efficacy of the original residents of gentrifying neighborhoods were not significantly different from the perceptions of neighborhood collective efficacy of gentrifiers. Our results indicate that gentrification was positively associated with perceived collective efficacy. This implies that gentrification could have beneficial health effects for individuals living in gentrifying neighborhoods.

Social disparities in Disease Management Programmes for coronary heart disease in Germany: a cross-classified multilevel analysis

PubMed Central

Bozorgmehr, Kayvan; Maier, Werner; Brenner, Hermann; Saum, Kai-Uwe; Stock, Christian; Miksch, Antje; Holleczek, Bernd; Szecsenyi, Joachim; Razum, Oliver

2015-01-01

Background Disease Management Programmes (DMPs) aim to improve effectiveness and equity of care but may suffer from selective enrolment. We analysed social disparities in DMP enrolment among elderly patients with coronary heart disease (CHD) in Germany, taking into account contextual effects at municipality and primary care practice levels. Methods Cross-sectional analysis of effects of educational attainment and regional deprivation on physician-reported DMP enrolment in a subsample of a large population-based cohort study in Germany, adjusting for individual-level, practice-level and area-level variables. We calculated OR and their 95% CIs (95% CI) in cross-classified, multilevel logistic regression models. Results Among N=1280 individuals with CHD (37.3% women), DMP enrolment rates were 22.2% (women) and 35% (men). The odds of DMP enrolment were significantly higher for male patients (OR=1.98 (1.50 to 2.62)), even after adjustment for potential confounding by individual-level, practice-level and area-level variables (range: OR=1.60 (1.08 to 2.36) to 2.16 (1.57 to 2.98)). Educational attainment was not significantly associated with DMP enrolment. Compared to patients living in least-deprived municipalities, the adjusted propensity of DMP enrolment was statistically significantly lower for patients living in medium-deprived municipalities (OR=0.41 (0.24 to 0.71)), and it also tended to be lower for patients living in the most-deprived municipalities (OR=0.70 (0.40 to 1.21)). Models controlling for the social situation (instead of health-related behaviour) yielded comparable effect estimates (medium-deprived/most-deprived vs least-deprived areas: OR=0.45 (0.26 to 0.78)/OR=0.68 (0.33 to 1.19)). Controlling for differences in comorbidity attenuated the deprivation effect estimates. Conclusions We found evidence for marked gender, but not educational disparities in DMP enrolment among patients with CHD. Small-area deprivation was associated with DMP enrolment, but the effects were partly explained by differences in comorbidity. Future studies on DMPs should consider contextual effects when analysing programme effectiveness or impacts on equity and efficiency. PMID:26082518

Trends in adolescent mental health during economic upturns and downturns: a multilevel analysis of Swedish data 1988-2008

PubMed Central

Kim, Yunhwan; Hagquist, Curt

2018-01-01

Background A long-term trend of increasing mental health problems among adolescents in many Western countries indicates a great need to investigate if and how societal changes have contributed to the reported increase. Using seven waves of repeated cross-sectional data collected between 1988 and 2008 in Sweden, the current study examined if economic factors at the societal level (municipality unemployment rate) and at the individual level (worry about family finances), and their interaction could explain a secular trend in mental health problems. Methods Participants were 17 533 students of age 15–16 years (49.3% girls), from 14 municipalities in a county of Sweden. Data on adolescents’ mental health (psychosomatic problems) and worry about family finances were obtained using a self-report questionnaire. A series of multilevel regression analyses were conducted in order to explain the trends in adolescents’ mental health. Results The results indicated that the individual-level predictor (worry about family finances) significantly explained the increasing rates of adolescents’ psychosomatic problems. This was particularly the case during the mid-1990s, which was characterised by a severe recession in Sweden with high unemployment rates. For example, after accounting for adolescents’ worry, a significant increase in psychosomatic symptoms between 1988 and 1998 among girls (b=0.112, P<0.05) disappeared (b=0.018, P>0.05) and a non-significant decrease between 1988 and 1995 among boys (b=−0.017, P>0.05) became significant (b=−0.142, P<0.05). Neither municipality unemployment rate nor its interaction with adolescents’ worry explained psychosomatic problems. Conclusions The findings demonstrate the effects of adolescents’ worry about family finances on a secular trend in mental health problems during an economically bleak period of time. The study highlights the need for repeated measurements including a large number of time points over a long time period in order to analyse time-specific putative explanatory factors for trends in adolescent mental health problems. PMID:29203524

Socio-Demographic, Social-Cognitive, Health-Related and Physical Environmental Variables Associated with Context-Specific Sitting Time in Belgian Adolescents: A One-Year Follow-Up Study.

PubMed

Busschaert, Cedric; Ridgers, Nicola D; De Bourdeaudhuij, Ilse; Cardon, Greet; Van Cauwenberg, Jelle; De Cocker, Katrien

2016-01-01

More knowledge is warranted about multilevel ecological variables associated with context-specific sitting time among adolescents. The present study explored cross-sectional and longitudinal associations of ecological domains of sedentary behaviour, including socio-demographic, social-cognitive, health-related and physical-environmental variables with sitting during TV viewing, computer use, electronic gaming and motorized transport among adolescents. For this longitudinal study, a sample of Belgian adolescents completed questionnaires at school on context-specific sitting time and associated ecological variables. At baseline, complete data were gathered from 513 adolescents (15.0±1.7 years). At one-year follow-up, complete data of 340 participants were available (retention rate: 66.3%). Multilevel linear regression analyses were conducted to explore cross-sectional correlates (baseline variables) and longitudinal predictors (change scores variables) of context-specific sitting time. Social-cognitive correlates/predictors were most frequently associated with context-specific sitting time. Longitudinal analyses revealed that increases over time in considering it pleasant to watch TV (p < .001), in perceiving TV watching as a way to relax (p < .05), in TV time of parents/care givers (p < .01) and in TV time of siblings (p < .001) were associated with more sitting during TV viewing at follow-up. Increases over time in considering it pleasant to use a computer in leisure time (p < .01) and in the computer time of siblings (p < .001) were associated with more sitting during computer use at follow-up. None of the changes in potential predictors were significantly related to changes in sitting during motorized transport or during electronic gaming. Future intervention studies aiming to decrease TV viewing and computer use should acknowledge the importance of the behaviour of siblings and the pleasure adolescents experience during these screen-related behaviours. In addition, more time parents or care givers spent sitting may lead to more sitting during TV viewing of the adolescents, so that a family-based approach may be preferable for interventions. Experimental study designs are warranted to confirm the present findings.

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

Nurse forecasting in Europe (RN4CAST): Rationale, design and methodology

PubMed Central

2011-01-01

Background Current human resources planning models in nursing are unreliable and ineffective as they consider volumes, but ignore effects on quality in patient care. The project RN4CAST aims innovative forecasting methods by addressing not only volumes, but quality of nursing staff as well as quality of patient care. Methods/Design A multi-country, multilevel cross-sectional design is used to obtain important unmeasured factors in forecasting models including how features of hospital work environments impact on nurse recruitment, retention and patient outcomes. In each of the 12 participating European countries, at least 30 general acute hospitals were sampled. Data are gathered via four data sources (nurse, patient and organizational surveys and via routinely collected hospital discharge data). All staff nurses of a random selection of medical and surgical units (at least 2 per hospital) were surveyed. The nurse survey has the purpose to measure the experiences of nurses on their job (e.g. job satisfaction, burnout) as well as to allow the creation of aggregated hospital level measures of staffing and working conditions. The patient survey is organized in a sub-sample of countries and hospitals using a one-day census approach to measure the patient experiences with medical and nursing care. In addition to conducting a patient survey, hospital discharge abstract datasets will be used to calculate additional patient outcomes like in-hospital mortality and failure-to-rescue. Via the organizational survey, information about the organizational profile (e.g. bed size, types of technology available, teaching status) is collected to control the analyses for institutional differences. This information will be linked via common identifiers and the relationships between different aspects of the nursing work environment and patient and nurse outcomes will be studied by using multilevel regression type analyses. These results will be used to simulate the impact of changing different aspects of the nursing work environment on quality of care and satisfaction of the nursing workforce. Discussion RN4CAST is one of the largest nurse workforce studies ever conducted in Europe, will add to accuracy of forecasting models and generate new approaches to more effective management of nursing resources in Europe. PMID:21501487

Socio-Demographic, Social-Cognitive, Health-Related and Physical Environmental Variables Associated with Context-Specific Sitting Time in Belgian Adolescents: A One-Year Follow-Up Study

PubMed Central

Busschaert, Cedric; Ridgers, Nicola D.; De Bourdeaudhuij, Ilse; Cardon, Greet; Van Cauwenberg, Jelle; De Cocker, Katrien

2016-01-01

Introduction More knowledge is warranted about multilevel ecological variables associated with context-specific sitting time among adolescents. The present study explored cross-sectional and longitudinal associations of ecological domains of sedentary behaviour, including socio-demographic, social-cognitive, health-related and physical-environmental variables with sitting during TV viewing, computer use, electronic gaming and motorized transport among adolescents. Methods For this longitudinal study, a sample of Belgian adolescents completed questionnaires at school on context-specific sitting time and associated ecological variables. At baseline, complete data were gathered from 513 adolescents (15.0±1.7 years). At one-year follow-up, complete data of 340 participants were available (retention rate: 66.3%). Multilevel linear regression analyses were conducted to explore cross-sectional correlates (baseline variables) and longitudinal predictors (change scores variables) of context-specific sitting time. Results Social-cognitive correlates/predictors were most frequently associated with context-specific sitting time. Longitudinal analyses revealed that increases over time in considering it pleasant to watch TV (p < .001), in perceiving TV watching as a way to relax (p < .05), in TV time of parents/care givers (p < .01) and in TV time of siblings (p < .001) were associated with more sitting during TV viewing at follow-up. Increases over time in considering it pleasant to use a computer in leisure time (p < .01) and in the computer time of siblings (p < .001) were associated with more sitting during computer use at follow-up. None of the changes in potential predictors were significantly related to changes in sitting during motorized transport or during electronic gaming. Conclusions Future intervention studies aiming to decrease TV viewing and computer use should acknowledge the importance of the behaviour of siblings and the pleasure adolescents experience during these screen-related behaviours. In addition, more time parents or care givers spent sitting may lead to more sitting during TV viewing of the adolescents, so that a family-based approach may be preferable for interventions. Experimental study designs are warranted to confirm the present findings. PMID:27936073

Nurse forecasting in Europe (RN4CAST): Rationale, design and methodology.

PubMed

Sermeus, Walter; Aiken, Linda H; Van den Heede, Koen; Rafferty, Anne Marie; Griffiths, Peter; Moreno-Casbas, Maria Teresa; Busse, Reinhard; Lindqvist, Rikard; Scott, Anne P; Bruyneel, Luk; Brzostek, Tomasz; Kinnunen, Juha; Schubert, Maria; Schoonhoven, Lisette; Zikos, Dimitrios

2011-04-18

Current human resources planning models in nursing are unreliable and ineffective as they consider volumes, but ignore effects on quality in patient care. The project RN4CAST aims innovative forecasting methods by addressing not only volumes, but quality of nursing staff as well as quality of patient care. A multi-country, multilevel cross-sectional design is used to obtain important unmeasured factors in forecasting models including how features of hospital work environments impact on nurse recruitment, retention and patient outcomes. In each of the 12 participating European countries, at least 30 general acute hospitals were sampled. Data are gathered via four data sources (nurse, patient and organizational surveys and via routinely collected hospital discharge data). All staff nurses of a random selection of medical and surgical units (at least 2 per hospital) were surveyed. The nurse survey has the purpose to measure the experiences of nurses on their job (e.g. job satisfaction, burnout) as well as to allow the creation of aggregated hospital level measures of staffing and working conditions. The patient survey is organized in a sub-sample of countries and hospitals using a one-day census approach to measure the patient experiences with medical and nursing care. In addition to conducting a patient survey, hospital discharge abstract datasets will be used to calculate additional patient outcomes like in-hospital mortality and failure-to-rescue. Via the organizational survey, information about the organizational profile (e.g. bed size, types of technology available, teaching status) is collected to control the analyses for institutional differences.This information will be linked via common identifiers and the relationships between different aspects of the nursing work environment and patient and nurse outcomes will be studied by using multilevel regression type analyses. These results will be used to simulate the impact of changing different aspects of the nursing work environment on quality of care and satisfaction of the nursing workforce. RN4CAST is one of the largest nurse workforce studies ever conducted in Europe, will add to accuracy of forecasting models and generate new approaches to more effective management of nursing resources in Europe.

A multilevel reuse system with source separation process for printing and dyeing wastewater treatment: A case study.

PubMed

Wang, Rui; Jin, Xin; Wang, Ziyuan; Gu, Wantao; Wei, Zhechao; Huang, Yuanjie; Qiu, Zhuang; Jin, Pengkang

2018-01-01

This paper proposes a new system of multilevel reuse with source separation in printing and dyeing wastewater (PDWW) treatment in order to dramatically improve the water reuse rate to 35%. By analysing the characteristics of the sources and concentrations of pollutants produced in different printing and dyeing processes, special, highly, and less contaminated wastewaters (SCW, HCW, and LCW, respectively) were collected and treated separately. Specially, a large quantity of LCW was sequentially reused at multiple levels to meet the water quality requirements for different production processes. Based on this concept, a multilevel reuse system with a source separation process was established in a typical printing and dyeing enterprise. The water reuse rate increased dramatically to 62%, and the reclaimed water was reused in different printing and dyeing processes based on the water quality. This study provides promising leads in water management for wastewater reclamation. Copyright © 2017 Elsevier Ltd. All rights reserved.

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.

From deindustrialization to individual health-related quality of life: multilevel evidence of contextual predictors, mediators and modulators across French regions, 2003.

PubMed

Audureau, Etienne; Rican, Stéphane; Coste, Joël

2013-07-01

Although small area effects on health-related quality of life (HRQoL) have been extensively studied, less is known at the regional level, particularly in France where no multilevel evidence is available. Using data from a large representative cross-sectional survey conducted in 2003 (N=16 732), this study explores individual and regional determinants of the SF-36 Physical Functioning and Mental Health subscales. We considered a causal pathway leading from deindustrialization to HRQoL and assessed the roles of net migratory flows, deprivation, and the social and physical environments. Worse HRQoL results were found in regions most affected by deindustrialization, with evidence for mediating effects of migration, voter abstention rate and individual health-related behaviors. Cross-level interactions and intraregional heterogeneity were also found, confirming the complexity of individual-area relationships and the need for carefully conceptualized multilevel analyses to guide health policies effectively. Copyright © 2013 Elsevier Ltd. All rights reserved.

Multi-level functionality of social media in the aftermath of the Great East Japan Earthquake.

PubMed

Jung, Joo-Young; Moro, Munehito

2014-07-01

This study examines the multi-level functionalities of social media in the aftermath of the Great East Japan Earthquake of 11 March 2011. Based on a conceptual model of multi-level story flows of social media (Jung and Moro, 2012), the study analyses the multiple functionalities that were ascribed to social media by individuals, organisations, and macro-level social systems (government and the mass media) after the earthquake. Based on survey data, a review of Twitter timelines and secondary sources, the authors derive five functionalities of social media: interpersonal communications with others (micro level); channels for local governments; organisations and local media (meso level); channels for mass media (macro level); information sharing and gathering (cross level); and direct channels between micro-/meso- and macro-level agents. The study sheds light on the future potential of social media in disaster situations and suggests how to design an effective communication network to prepare for emergency situations. © 2014 The Author(s). Disasters © Overseas Development Institute, 2014.

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.

Introducing the Event Related Fixed Interval Area (ERFIA) Multilevel Technique: a Method to Analyze the Complete Epoch of Event-Related Potentials at Single Trial Level

PubMed Central

Vossen, Catherine J.; Vossen, Helen G. M.; Marcus, Marco A. E.; van Os, Jim; Lousberg, Richel

2013-01-01

In analyzing time-locked event-related potentials (ERPs), many studies have focused on specific peaks and their differences between experimental conditions. In theory, each latency point after a stimulus contains potentially meaningful information, regardless of whether it is peak-related. Based on this assumption, we introduce a new concept which allows for flexible investigation of the whole epoch and does not primarily focus on peaks and their corresponding latencies. For each trial, the entire epoch is partitioned into event-related fixed-interval areas under the curve (ERFIAs). These ERFIAs, obtained at single trial level, act as dependent variables in a multilevel random regression analysis. The ERFIA multilevel method was tested in an existing ERP dataset of 85 healthy subjects, who underwent a rating paradigm of 150 painful and non-painful somatosensory electrical stimuli. We modeled the variability of each consecutive ERFIA with a set of predictor variables among which were stimulus intensity and stimulus number. Furthermore, we corrected for latency variations of the P2 (260 ms). With respect to known relationships between stimulus intensity, habituation, and pain-related somatosensory ERP, the ERFIA method generated highly comparable results to those of commonly used methods. Notably, effects on stimulus intensity and habituation were also observed in non-peak-related latency ranges. Further, cortical processing of actual stimulus intensity depended on the intensity of the previous stimulus, which may reflect pain-memory processing. In conclusion, the ERFIA multilevel method is a promising tool that can be used to study event-related cortical processing. PMID:24224018

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.

Promoting and Protecting Against Stigma in Assisted Living and Nursing Homes

PubMed Central

Zimmerman, Sheryl; Dobbs, Debra; Roth, Erin G.; Goldman, Susan; Peeples, Amanda D.; Wallace, Brandy

2016-01-01

Purpose of the Study: To determine the extent to which structures and processes of care in multilevel settings (independent living, assisted living, and nursing homes) result in stigma in assisted living and nursing homes. Design and Methods: Ethnographic in-depth interviews were conducted in 5 multilevel settings with 256 residents, families, and staff members. Qualitative analyses identified the themes that resulted when examining text describing either structures of care or processes of care in relation to 7 codes associated with stigma. Results: Four themes related to structures of care and stigma were identified, including the physical environment, case mix, staff training, and multilevel settings; five themes related to processes of care and stigma, including dining, independence, respect, privacy, and care provision. For each theme, examples were identified illustrating how structures and processes of care can potentially promote or protect against stigma. Implications: In no instance were examples or themes identified that suggested the staff intentionally promoted stigma; on the other hand, there was indication that some structures and processes were intentionally in place to protect against stigma. Perhaps the most important theme is the stigma related to multilevel settings, as it has the potential to reduce individuals’ likelihood to seek and accept necessary care. Results suggest specific recommendations to modify care and reduce stigma. PMID:24928555

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.

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

Race/Ethnicity, Education, and Treatment Parameters as Moderators and Predictors of Outcome in Binge Eating Disorder

PubMed Central

Thompson-Brenner, Heather; Franko, Debra L.; Thompson, Douglas R.; Grilo, Carlos M.; Boisseau, Christina L.; Roehrig, James P.; Richards, Lauren K.; Bryson, Susan W.; Bulik, Cynthia M.; Crow, Scott J.; Devlin, Michael J.; Gorin, Amy A.; Kristeller, Jean L.; Masheb, Robin; Mitchell, James E.; Peterson, Carol B.; Safer, Debra L.; Striegel, Ruth H.; Wilfley, Denise E.; Wilson, G. Terence

2014-01-01

Objective Binge eating disorder (BED) is prevalent among individuals from minority racial/ethnic groups and among individuals with lower levels of education, yet the efficacy of psychosocial treatments for these groups has not been examined in adequately powered analyses. This study investigated the relative variance in treatment retention and post-treatment symptom levels accounted for by demographic, clinical, and treatment variables as moderators and predictors of outcome. Method Data were aggregated from eleven randomized, controlled trials of psychosocial treatments for BED conducted at treatment sites across the United States. Participants were N = 1,073 individuals meeting criteria for BED including n = 946 Caucasian, n = 79 African American, and n = 48 Hispanic/Latino participants. Approximately 86% had some higher education; 85% were female. Multi-level regression analyses examined moderators and predictors of treatment retention, Eating Disorder Examination (EDE) global score, frequency of objective bulimic episodes (OBEs), and OBE remission. Results Moderator analyses of race/ethnicity and education were non-significant. Predictor analyses revealed African Americans were more likely to drop out of treatment than Caucasians, and lower level of education predicted greater post-treatment OBEs. African Americans showed a small but significantly greater reduction in EDE global score relative to Caucasians. Self-help treatment administered in a group showed negative outcomes relative to other treatment types, and longer treatment was associated with better outcome. Conclusions Observed lower treatment retention among African Americans and lesser treatment effects for individuals with lower levels of educational attainment are serious issues requiring attention. Reduced benefit was observed for shorter treatment length and self-help administered in groups. PMID:23647283

Prospective analysis of time out-of-home and objectively measured walking duration during a week in a large cohort of older adults.

PubMed

Rapp, Kilian; Mikolaizak, Stefanie; Rothenbacher, Dietrich; Denkinger, Michael D; Klenk, Jochen

2018-01-01

Physical activity is considered an effective measure to promote health in older people. There is evidence that the number of outdoor trips increases physical activity by increasing walking duration. The objective of this study was to analyse the relationship between daily time out-of-home and walking duration. Furthermore, predictors for walking duration and time out-of-home were evaluated. Walking duration was measured prospectively over a 1 week period by a body-fixed sensor and the time out-of-home was assessed by a questionnaire at the same days. Seven thousand, two hundred and forty-three days from 1289 older people (mean age 75.4 years) with both sensor-based measures and completed questionnaires were included in the analyses. To account for several observation days per participant multilevel regression analyses were applied. Analyses were stratified according to the time out-of-home (more or less than 100 min/day). In the group with less than 100 min out-of-home, each additional minute out-of-home added 20 s to overall walking duration. If the time exceeded 100 min the additional increase of walking duration was only moderate or weak. Leaving the home once added 40 min of walking, the following trips 15 to 20 min. Increasing age, lower gait speed, comorbidities, low temperature, rain and specific week days (Sunday) decreased both the time out-of-home and walking duration. Other variables like gender (female), isolation or living with a spouse reduced the time out-of-home without affecting walking duration. Being out-of-home increases daily walking duration. The association is strongest if the time out-of-home is 100 min or less.

A multilevel modelling approach to analysis of patient costs under managed care.

PubMed

Carey, K

2000-07-01

The growth of the managed care model of health care delivery in the USA has led to broadened interest in the performance of health care providers. This paper uses multilevel modelling to analyse the effects of managed care penetration on patient level costs for a sample of 24 medical centres operated by the Veterans Health Administration (VHA). The appropriateness of a two level approach to this problem over ordinary least squares (OLS) is demonstrated. Results indicate a modicum of difference in institutions' performance after controlling for patient effects. Facilities more heavily penetrated by the managed care model may be more effective at controlling costs of their sicker patients. Copyright 2000 John Wiley & Sons, Ltd.

Differences in beliefs and home environments regarding energy balance behaviors according to parental education and ethnicity among schoolchildren in Europe: the ENERGY cross sectional study.

PubMed

Brug, Johannes; Uijtdewilligen, Léonie; van Stralen, Maartje M; Singh, Amika S; ChinAPaw, Mai J M; De Bourdeaudhuij, Ilse; Lien, Nanna; Bere, Elling; Maes, Lea; Fernández-Alvira, Juan M; Jan, Nataša; Kovacs, Eva; Dössegger, Alain; Manios, Yannis; te Velde, Saskia J

2014-06-17

To explore differences in personal and home environmental factors that are regarded as determinants of energy balance-related behaviors (EBRBs) according to parental education and ethnic background among 10-12 year old schoolchildren across Europe. A school-based survey among 10-12 year olds was conducted in eight countries across Europe. A range of personal and home environment variables relevant for soft drink consumption, daily breakfast, sport participation and TV time was assessed by means of child report. Personal factors included attitude, health beliefs, and preference/liking. Home environment factors included parental subjective norm, modeling, support, practices and home availability. Children were classified based on parental education (i.e., low vs. high) and ethnic background (i.e., native vs. non-native). Data from 6018 children originating from 83 schools were included in the analyses. Multilevel logistic regression analyses showed that the majority of the factors tested -and especially home environment variables- were more favorable among children from higher educated parents and from native ethnicity. None of the personal and home environment factors was found to be more favorable among children from lower educated parents or non-native ethnicity. The present study indicates that schoolchildren from lower educated and non-native parents across Europe have EBRB-related beliefs and are exposed to home environments that are less favorable for engagement in healthy EBRBs.

Economic incentives and diagnostic coding in a public health care system.

PubMed

Anthun, Kjartan Sarheim; Bjørngaard, Johan Håkon; Magnussen, Jon

2017-03-01

We analysed the association between economic incentives and diagnostic coding practice in the Norwegian public health care system. Data included 3,180,578 hospital discharges in Norway covering the period 1999-2008. For reimbursement purposes, all discharges are grouped in diagnosis-related groups (DRGs). We examined pairs of DRGs where the addition of one or more specific diagnoses places the patient in a complicated rather than an uncomplicated group, yielding higher reimbursement. The economic incentive was measured as the potential gain in income by coding a patient as complicated, and we analysed the association between this gain and the share of complicated discharges within the DRG pairs. Using multilevel linear regression modelling, we estimated both differences between hospitals for each DRG pair and changes within hospitals for each DRG pair over time. Over the whole period, a one-DRG-point difference in price was associated with an increased share of complicated discharges of 14.2 (95 % confidence interval [CI] 11.2-17.2) percentage points. However, a one-DRG-point change in prices between years was only associated with a 0.4 (95 % CI [Formula: see text] to 1.8) percentage point change of discharges into the most complicated diagnostic category. Although there was a strong increase in complicated discharges over time, this was not as closely related to price changes as expected.

All part of the job? The contribution of the psychosocial and physical work environment to health inequalities in Europe and the European health divide.

PubMed

Toch, Marlen; Bambra, Clare; Lunau, Thorsten; van der Wel, Kjetil A; Witvliet, Margot I; Dragano, Nico; Eikemo, Terje A

2014-01-01

This study is the first to examine the contribution of both psychosocial and physical risk factors to occupational inequalities in self-assessed health in Europe. Data from 27 countries were obtained from the 2010 European Working Conditions Survey for men and women aged 16 to 60 (n = 21,803). Multilevel logistic regression analyses (random intercept) were applied, estimating odds ratios of reporting less than good health. Analyses indicate that physical working conditions account for a substantial proportion of occupational inequalities in health in both Central/Eastern and Western Europe. Physical, rather than psychosocial, working conditions seem to have the largest effect on self-assessed health in manual classes. For example, controlling for physical working conditions reduced the inequalities in the prevalence of"less than good health" between the lowest (semi- and unskilled manual workers) and highest (higher controllers) occupational groups in Europe by almost 50 percent (Odds Ratio 1.87, 95% Confidence Interval 1.62-2.16 to 1.42, 1.23-1.65). Physical working conditions contribute substantially to health inequalities across "post-industrial" Europe, with women in manual occupations being particularly vulnerable, especially those living in Central/Eastern Europe. An increased political and academic focus on physical working conditions is needed to explain and potentially reduce occupational inequalities in health.

Are there differences in birth weight between neighbourhoods in a Nordic welfare state?

PubMed Central

Sellström, Eva; Arnoldsson, Göran; Bremberg, Sven; Hjern, Anders

2007-01-01

Background The objective of this cohort study was to examine the effect on birth weight of living in a disadvantaged neighbourhood in a Nordic welfare state. Birth weight is a health indicator known to be sensitive to political and welfare state conditions. No former studies on urban neighbourhood differences regarding mean birth weight have been carried out in a Nordic country. Methods A register based on individual data on children's birth weight and maternal risk factors was used. A neighbourhood characteristic, i.e. an aggregated measure on income was also included. Connections between individual- and neighbourhood-level determinants and the outcome were analysed using multi-level regression technique. The study covered six hundred and ninety-six neighbourhoods in the three major cities of Sweden, Stockholm, Göteborg and Malmö, during 1992–2001. The majority of neighbourhoods had a population of 4 000–10 000 inhabitants. An average of 500 births per neighbourhood were analysed in this study. Results Differences in mean birth weight in Swedish urban neighbourhoods were minor. However, gestational length, parity and maternal smoking acted as modifiers of the neighbourhood effects. Most of the observed variation in mean birth weight was explained by individual risk factors. Conclusion Welfare institutions and benefits in Sweden might buffer against negative infant outcomes due to adverse structural organisation of urban neighbourhoods. PMID:17897453

'Fish out of water': a cross-sectional study on the interaction between social and neighbourhood effects on weight management behaviours.

PubMed

Green, M A; Subramanian, S V; Strong, M; Cooper, C L; Loban, A; Bissell, P

2015-03-01

To analyse whether an individual's neighbourhood influences the uptake of weight management strategies and whether there is an interaction between individual socio-economic status and neighbourhood deprivation. Data were collected from the Yorkshire Health Study (2010-2012) for 27 806 individuals on the use of the following weight management strategies: 'slimming clubs', 'healthy eating', 'increasing exercise' and 'controlling portion size'. A multi-level logistic regression was fit to analyse the use of these strategies, controlling for age, sex, body mass index, education, neighbourhood deprivation and neighbourhood population turnover (a proxy for neighbourhood social capital). A cross-level interaction term was included for education and neighbourhood deprivation. Lower Super Output Area was used as the geographical scale for the areal unit of analysis. Significant neighbourhood effects were observed for use of 'slimming clubs', 'healthy eating' and 'increasing exercise' as weight management strategies, independent of individual- and area-level covariates. A significant interaction between education and neighbourhood deprivation was observed across all strategies, suggesting that as an area becomes more deprived, individuals of the lowest education are more likely not to use any strategy compared with those of the highest education. Neighbourhoods modify/amplify individual disadvantage and social inequalities, with individuals of low education disproportionally affected by deprivation. It is important to include neighbourhood-based explanations in the development of community-based policy interventions to help tackle obesity.

Quality of Care and Job Satisfaction in the European Home Care Setting: Research Protocol

PubMed Central

van der Roest, Henriëtte; van Hout, Hein; Declercq, Anja

2016-01-01

Introduction: Since the European population is ageing, a growing number of elderly will need home care. Consequently, high quality home care for the elderly remains an important challenge. Job satisfaction among care professionals is regarded as an important aspect of the quality of home care. Aim: This paper describes a research protocol to identify elements that have an impact on job satisfaction among care professionals and on quality of care for older people in the home care setting of six European countries. Methods: Data on elements at the macro-level (policy), meso-level (care organisations) and micro-level (clients) are of importance in determining job satisfaction and quality of care. Macro-level indicators will be identified in a previously published literature review. At meso- and micro-level, data will be collected by means of two questionnaires utilsed with both care organisations and care professionals, and by means of interRAI Home Care assessments of clients. The client assessments will be used to calculate quality of care indicators. Subsequently, data will be analysed by means of linear and stepwise multiple regression analyses, correlations and multilevel techniques. Conclusions and Discussion: These results can guide health care policy makers in their decision making process in order to increase the quality of home care in their organisation, in their country or in Europe. PMID:28435423

Impact of primary healthcare providers' initial role security and therapeutic commitment on implementing brief interventions in managing risky alcohol consumption: a cluster randomised factorial trial.

PubMed

Keurhorst, M; Anderson, P; Heinen, M; Bendtsen, Preben; Baena, Begoña; Brzózka, Krzysztof; Colom, Joan; Deluca, Paolo; Drummond, Colin; Kaner, Eileen; Kłoda, Karolina; Mierzecki, Artur; Newbury-Birch, Dorothy; Okulicz-Kozaryn, Katarzyna; Palacio-Vieira, Jorge; Parkinson, Kathryn; Reynolds, Jillian; Ronda, Gaby; Segura, Lidia; Słodownik, Luiza; Spak, Fredrik; van Steenkiste, Ben; Wallace, Paul; Wolstenholme, Amy; Wojnar, Marcin; Gual, Antoni; Laurant, M; Wensing, M

2016-07-16

Brief interventions in primary healthcare are cost-effective in reducing drinking problems but poorly implemented in routine practice. Although evidence about implementing brief interventions is growing, knowledge is limited with regard to impact of initial role security and therapeutic commitment on brief intervention implementation. In a cluster randomised factorial trial, 120 primary healthcare units (PHCUs) were randomised to eight groups: care as usual, training and support, financial reimbursement, and the opportunity to refer patients to an internet-based brief intervention (e-BI); paired combinations of these three strategies, and all three strategies combined. To explore the impact of initial role security and therapeutic commitment on implementing brief interventions, we performed multilevel linear regression analyses adapted to the factorial design. Data from 746 providers from 120 PHCUs were included in the analyses. Baseline role security and therapeutic commitment were found not to influence implementation of brief interventions. Furthermore, there were no significant interactions between these characteristics and allocated implementation groups. The extent to which providers changed their brief intervention delivery following experience of different implementation strategies was not determined by their initial attitudes towards alcohol problems. In future research, more attention is needed to unravel the causal relation between practitioners' attitudes, their actual behaviour and care improvement strategies to enhance implementation science. ClinicalTrials.gov: NCT01501552.

Introduction--Understanding Education, Fragility and Conflict

ERIC Educational Resources Information Center

Buchert, Lene

2013-01-01

This Introduction discusses approaches to and perspectives on analyzing the complex relationship between education, fragility, and conflict and its underlying causes and dynamics. It argues for the need for contextual and time-bound multi-level analyses of interlinked societal dimensions in order to address the ultimate purposes of education…

Practical Effects of Classwide Mathematics Intervention

ERIC Educational Resources Information Center

VanDerHeyden, Amanda M.; Codding, Robin S.

2015-01-01

The current article presents additional analyses of a classwide mathematics intervention, from a previously reported randomized controlled trial, to offer new information about the treatment and to demonstrate the utility of different types of effect sizes. Multilevel modeling was used to examine treatment effects by race, sex, socioeconomic…

Bullying Victims' Perceptions of Classroom Interaction

ERIC Educational Resources Information Center

Havik, Trude

2017-01-01

This study investigated bullying victims' perceptions of their teachers' support and monitoring when controlling for level of mental health problems, peer relationships, gender, and grade level. Given the nested structure of the data, multilevel analyses were employed to examine these associations. The quality of classroom interaction is highly…

Modeling Students' Interest in Mathematics Homework

ERIC Educational Resources Information Center

Xu, Jianzhong; Yuan, Ruiping; Xu, Brian; Xu, Melinda

2016-01-01

The authors examine the factors influencing mathematics homework interest for Chinese students and compare the findings with a recent study involving U.S. students. The findings from multilevel analyses revealed that some predictors for homework interest functioned similarly (e.g., affective attitude toward homework, learning-oriented reasons,…

Neighborhood social capital and crime victimization: comparison of spatial regression analysis and hierarchical regression analysis.

PubMed

Takagi, Daisuke; Ikeda, Ken'ichi; Kawachi, Ichiro

2012-11-01

Crime is an important determinant of public health outcomes, including quality of life, mental well-being, and health behavior. A body of research has documented the association between community social capital and crime victimization. The association between social capital and crime victimization has been examined at multiple levels of spatial aggregation, ranging from entire countries, to states, metropolitan areas, counties, and neighborhoods. In multilevel analysis, the spatial boundaries at level 2 are most often drawn from administrative boundaries (e.g., Census tracts in the U.S.). One problem with adopting administrative definitions of neighborhoods is that it ignores spatial spillover. We conducted a study of social capital and crime victimization in one ward of Tokyo city, using a spatial Durbin model with an inverse-distance weighting matrix that assigned each respondent a unique level of "exposure" to social capital based on all other residents' perceptions. The study is based on a postal questionnaire sent to 20-69 years old residents of Arakawa Ward, Tokyo. The response rate was 43.7%. We examined the contextual influence of generalized trust, perceptions of reciprocity, two types of social network variables, as well as two principal components of social capital (constructed from the above four variables). Our outcome measure was self-reported crime victimization in the last five years. In the spatial Durbin model, we found that neighborhood generalized trust, reciprocity, supportive networks and two principal components of social capital were each inversely associated with crime victimization. By contrast, a multilevel regression performed with the same data (using administrative neighborhood boundaries) found generally null associations between neighborhood social capital and crime. Spatial regression methods may be more appropriate for investigating the contextual influence of social capital in homogeneous cultural settings such as Japan. Copyright © 2012 Elsevier Ltd. All rights reserved.

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.

The effect of a school-based intervention on sunbed use in Danish pupils at continuation schools: a cluster-randomized controlled trial.

PubMed

Aarestrup, Cecilie; Bonnesen, Camilla T; Thygesen, Lau C; Krarup, Anne F; Waagstein, Anne B; Jensen, Poul D; Bentzen, Joan

2014-02-01

To examine the effect of an educational intervention on sunbed use and intentions and attitudes toward sunbed use in 14- to 18-year-olds at continuation schools. We randomized 33 continuation schools either to receive the educational intervention (n = 16) or to be controls (n = 17). Intervention schools received an e-magazine addressing the health risks of sunbed use. Information on behavior and intentions and attitudes toward sunbed use was gathered through self-administrated questionnaires before the intervention and at 6 months as a follow-up. The effect of the intervention was examined by multilevel linear regression and logistic regression. Sunbed use was significantly lower at follow-up among pupils at intervention schools versus pupils at control schools (girls: odds ratio .60, 95% confidence interval .42-.86; Boys: odds ratio .58, 95% confidence interval .35-.96). The intervention had no effect on intention to use sunbeds or attitudes toward sunbed use. The analyses revealed a significant impact of school on attitudes toward sunbed; the intraclass correlation coefficient was estimated to be 6.0% and 7.8% for girls and boys, respectively. The findings from the present study provide new evidence of a positive effect of an educational intervention on sunbed use among pupils aged 14-18 years at continuation schools. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

The association between green space and mental health varies across the lifecourse. A longitudinal study.

PubMed

Astell-Burt, Thomas; Mitchell, Richard; Hartig, Terry

2014-06-01

Epidemiological studies on green space and health have relied almost exclusively on cross-sectional designs, restricting understanding on how this relationship could vary across the lifecourse. We used multilevel linear regression to analyse variation in minor psychiatric morbidity over nine annual waves of the British Household Panel Survey (1996-2004). The sample was restricted to residents of urban areas who remained within their neighbourhoods for at least 12 months. The 12-item General Health Questionnaire and confounders were reported for 29 626 male and 35 781 female observations (person-years). This individual-level dataset was linked to a measure of green space availability within each ward of residence. Regression models included age, gender, employment status, household tenure, marital status, education, smoking status and household income. When not considering age, green space was associated with better mental health among men, but not women. Interaction terms fitted between age and green space revealed variation in the association between green space and mental health across the lifecourse and by gender. For men, the benefit of more green space emerged in early to mid-adulthood. Among older women, a curvilinear association materialised wherein those with a moderate availability of green space had better mental health. These findings illustrate how the relationship between urban green space and health can vary across the lifecourse, and they highlight the need for longitudinal studies to answer why green space may be better for health at some points in the lifecourse than others.

Quality of life of nursing-home residents with dementia subject to surveillance technology versus physical restraints: an explorative study.

PubMed

Te Boekhorst, S; Depla, M F I A; Francke, A L; Twisk, J W R; Zwijsen, S A; Hertogh, C M P M

2013-04-01

As physical restraints should only be used in exceptional cases, there is an urgent need for alternatives to restraint use. Surveillance technology could be such an alternative. This study explored whether nursing-home residents with dementia subjected to surveillance technology had better quality of life scores for mood, behavioral and societal dimensions than residents with physical restraints. Quality of life was assessed longitudinally, with three measurements in six psychogeriatric nursing homes of residents with surveillance technology (n = 170) and residents with physical restraints (n = 22). QUALIDEM subscales were used to measure five dimensions of quality of life. Multilevel longitudinal univariate and multivariate regression techniques were used to analyze the data. Because physical restraints were almost exclusively used in residents with low activities of daily living (ADL) independency (18 of the 22), we restricted the regression analyses to residents with a Barthel Index score ≤ 5 (overall n = 53). Univariate results showed that highly ADL-dependent residents with surveillance technology had significantly more positive affect than highly ADL-dependent residents with physical restraints. However, this difference proved to be no longer significant after adjustment for the confounders: age, sex and stage of dementia. Quality of life of highly ADL-dependent nursing-home residents with dementia seems to be unrelated to the use of surveillance technology as opposed to physical restraints. Copyright © 2012 John Wiley & Sons, Ltd.

Association of objectively measured arm inclination with shoulder pain: A 6-month follow-up prospective study of construction and health care workers.

PubMed

Koch, Markus; Lunde, Lars-Kristian; Veiersted, Kaj Bo; Knardahl, Stein

2017-01-01

The aim was to determine the association of occupational arm inclination with shoulder pain in construction and health care workers. Arm inclination relative to the vertical was measured with an accelerometer placed on the dominant upper arm for up to four full days at baseline in 62 construction workers and 63 health care workers. The pain intensity in the shoulder and mechanical and psychosocial work factors were measured by self-reports at baseline and prospectively after 6 months. The associations between exposures and shoulder pain were analyzed with multilevel mixed-effects linear regressions. For the total study population working with the dominant arm at inclinations > 30° and >120° was associated with lower levels of shoulder pain both cross-sectionally and after 6 months. Associations were attenuated when adjusting for individual and social factors, psychological state, and exposure during leisure time, especially for the high inclination levels. Analyses, only including subjects with no pain at baseline revealed no significant associations. While stratified analysis showed negative associations in the construction worker group, there were no significant association in health care workers. Compared to the number of hypotheses tested, the number of significant findings was low. Adjustment by Bonferroni-correction made almost all findings insignificant. All analyses reflected a negative association between arm inclination and shoulder pain, but few analyses showed these associations to be statistically significant. If there is a relationship between arm inclination and shoulder pain, these findings could indicate that pain-avoidance may modify how workers perform their tasks.

Are women deciding against home births in low and middle income countries?

PubMed

Amoako Johnson, Fiifi; Padmadas, Sabu S; Matthews, Zoë

2013-01-01

Although there is evidence to tracking progress towards facility births within the UN Millennium Development Goals framework, we do not know whether women are deciding against home birth over their reproductive lives. Using Demographic and Health Surveys (DHS) data from 44 countries, this study aims to investigate the patterns and shifts in childbirth locations and to determine whether these shifts are in favour of home or health settings. The analyses considered 108,777 women who had at least two births in the five years preceding the most recent DHS over the period 2000-2010. The vast majority of women opted for the same place of childbirth for their successive births. However, about 14% did switch their place and not all these decisions favoured health facility over home setting. In 24 of the 44 countries analysed, a higher proportion of women switched from a health facility to home. Multilevel regression analyses show significantly higher odds of switching from home to a facility for high parity women, those with frequent antenatal visits and more wealth. However, in countries with high infant mortality rates, low parity women had an increased probability of switching from home to a health facility. There is clear evidence that women do change their childbirth locations over successive births in low and middle income countries. After two decades of efforts to improve maternal health, it might be expected that a higher proportion of women will be deciding against home births in favour of facility births. The results from this analysis show that is not the case.

Association of objectively measured arm inclination with shoulder pain: A 6-month follow-up prospective study of construction and health care workers

PubMed Central

Koch, Markus; Lunde, Lars-Kristian; Veiersted, Kaj Bo; Knardahl, Stein

2017-01-01

Objectives The aim was to determine the association of occupational arm inclination with shoulder pain in construction and health care workers. Methods Arm inclination relative to the vertical was measured with an accelerometer placed on the dominant upper arm for up to four full days at baseline in 62 construction workers and 63 health care workers. The pain intensity in the shoulder and mechanical and psychosocial work factors were measured by self-reports at baseline and prospectively after 6 months. The associations between exposures and shoulder pain were analyzed with multilevel mixed-effects linear regressions. Results For the total study population working with the dominant arm at inclinations > 30° and >120° was associated with lower levels of shoulder pain both cross-sectionally and after 6 months. Associations were attenuated when adjusting for individual and social factors, psychological state, and exposure during leisure time, especially for the high inclination levels. Analyses, only including subjects with no pain at baseline revealed no significant associations. While stratified analysis showed negative associations in the construction worker group, there were no significant association in health care workers. Compared to the number of hypotheses tested, the number of significant findings was low. Adjustment by Bonferroni-correction made almost all findings insignificant. Conclusions All analyses reflected a negative association between arm inclination and shoulder pain, but few analyses showed these associations to be statistically significant. If there is a relationship between arm inclination and shoulder pain, these findings could indicate that pain-avoidance may modify how workers perform their tasks. PMID:29176761

Intimate partner violence among women in Spain: the impact of regional-level male unemployment and income inequality.

PubMed

Sanz-Barbero, Belén; Vives-Cases, Carmen; Otero-García, Laura; Muntaner, Carles; Torrubiano-Domínguez, Jordi; O'Campo, Patricia

2015-12-01

Intimate partner violence (IPV) against women is a complex worldwide public health problem. There is scarce research on the independent effect on IPV exerted by structural factors such as labour and economic policies, economic inequalities and gender inequality. To analyse the association, in Spain, between contextual variables of regional unemployment and income inequality and individual women's likelihood of IPV, independently of the women's characteristics. We conducted multilevel logistic regression to analyse cross-sectional data from the 2011 Spanish Macrosurvey of Gender-based Violence which included 7898 adult women. The first level of analyses was the individual women' characteristics and the second level was the region of residence. Of the survey participants, 12.2% reported lifetime IPV. The region of residence accounted for 3.5% of the total variability in IPV prevalence. We determined a direct association between regional male long-term unemployment and IPV likelihood (P = 0.007) and between the Gini Index for the regional income inequality and IPV likelihood (P < 0.001). Women residing in a region with higher gender-based income discrimination are at a lower likelihood of IPV than those residing in a region with low gender-based income discrimination (odds ratio = 0.64, 95% confidence intervals: 0.55-0.75). Growing regional unemployment rates and income inequalities increase women's likelihood of IPV. In times of economic downturn, like the current one in Spain, this association may translate into an increase in women's vulnerability to IPV. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

The relationship between self-management abilities, quality of chronic care delivery, and wellbeing among patients with chronic obstructive pulmonary disease in The Netherlands

PubMed Central

Cramm, Jane Murray; Nieboer, Anna Petra

2013-01-01

Background This cross-sectional study aimed to identify the relationship between quality of chronic care delivery, self-management abilities, and wellbeing among patients with chronic obstructive pulmonary disease (COPD). Methods The study was conducted in 2012 and included 548 (out of 1303; 42% response rate) patients with COPD enrolled in a COPD care program in the region of Noord-Kennemerland in The Netherlands. We employed a multilevel random-effects model (548 patients nested in 47 healthcare practices) to investigate the relationship between quality of chronic care delivery, self-management abilities, and patients’ wellbeing. In the multilevel analyses we controlled for patients’ background characteristics and health behaviors. Results Multilevel analyses clearly showed a significant relationship between quality of chronic care delivery and wellbeing of patients with COPD (P ≤ 0.001). When self-management abilities were included in the equation while controlling for background characteristics, health behaviors, and quality of chronic care delivery, these abilities were found to have a strong positive relationship with patients’ wellbeing (P ≤ 0.001). Low educational level, single marital status, and physical exercise were not significantly associated with wellbeing when self-management abilities were included in the equation. Conclusion Self-management abilities and the quality of chronic care delivery are important for the wellbeing of patients with COPD. Furthermore, self-management abilities acted as mediators between wellbeing and low educational level, single status, and physical exercise among these patients. PMID:23641152

Clarifying the Use of Aggregated Exposures in Multilevel Models: Self-Included vs. Self-Excluded Measures

PubMed Central

Suzuki, Etsuji; Yamamoto, Eiji; Takao, Soshi; Kawachi, Ichiro; Subramanian, S. V.

2012-01-01

Background Multilevel analyses are ideally suited to assess the effects of ecological (higher level) and individual (lower level) exposure variables simultaneously. In applying such analyses to measures of ecologies in epidemiological studies, individual variables are usually aggregated into the higher level unit. Typically, the aggregated measure includes responses of every individual belonging to that group (i.e. it constitutes a self-included measure). More recently, researchers have developed an aggregate measure which excludes the response of the individual to whom the aggregate measure is linked (i.e. a self-excluded measure). In this study, we clarify the substantive and technical properties of these two measures when they are used as exposures in multilevel models. Methods Although the differences between the two aggregated measures are mathematically subtle, distinguishing between them is important in terms of the specific scientific questions to be addressed. We then show how these measures can be used in two distinct types of multilevel models—self-included model and self-excluded model—and interpret the parameters in each model by imposing hypothetical interventions. The concept is tested on empirical data of workplace social capital and employees' systolic blood pressure. Results Researchers assume group-level interventions when using a self-included model, and individual-level interventions when using a self-excluded model. Analytical re-parameterizations of these two models highlight their differences in parameter interpretation. Cluster-mean centered self-included models enable researchers to decompose the collective effect into its within- and between-group components. The benefit of cluster-mean centering procedure is further discussed in terms of hypothetical interventions. Conclusions When investigating the potential roles of aggregated variables, researchers should carefully explore which type of model—self-included or self-excluded—is suitable for a given situation, particularly when group sizes are relatively small. PMID:23251609

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

Sex, price and preferences: accounting for unsafe sexual practices in prostitution markets.

PubMed

Adriaenssens, Stef; Hendrickx, Jef

2012-06-01

Unsafe sexual practices are persistent in prostitution interactions: one in four contacts can be called unsafe. The determinants of this are still matter for debate. We account for the roles played by clients' preferences and the hypothetical price premium of unsafe sexual practices with the help of a large dataset of clients' self-reported commercial sexual transactions in Belgium and The Netherlands. Almost 25,000 reports were collected, representing the whole gamut of prostitution market segments. The first set of explanations consists of an analysis of the price-fixing elements of paid sex. With the help of the so-called hedonic pricing method we test for the existence of a price incentive for unsafe sex. In accordance with the results from studies in some prostitution markets in the developing world, the study replicates a significant wage penalty for condom use of an estimated 7.2 per cent, confirmed in both multilevel and fixed-effects regressions. The second part of the analysis reconstructs the demand side basis of this wage penalty: the consistent preference of clients of prostitution for unsafe sex. This study is the first to document empirically clients' preference for intercourse without a condom, with the help of a multilevel ordinal regression. © 2011 The Authors. Sociology of Health & Illness © 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

Multilevel regularized regression for simultaneous taxa selection and network construction with metagenomic count data.

PubMed

Liu, Zhenqiu; Sun, Fengzhu; Braun, Jonathan; McGovern, Dermot P B; Piantadosi, Steven

2015-04-01

Identifying disease associated taxa and constructing networks for bacteria interactions are two important tasks usually studied separately. In reality, differentiation of disease associated taxa and correlation among taxa may affect each other. One genus can be differentiated because it is highly correlated with another highly differentiated one. In addition, network structures may vary under different clinical conditions. Permutation tests are commonly used to detect differences between networks in distinct phenotypes, and they are time-consuming. In this manuscript, we propose a multilevel regularized regression method to simultaneously identify taxa and construct networks. We also extend the framework to allow construction of a common network and differentiated network together. An efficient algorithm with dual formulation is developed to deal with the large-scale n ≪ m problem with a large number of taxa (m) and a small number of samples (n) efficiently. The proposed method is regularized with a general Lp (p ∈ [0, 2]) penalty and models the effects of taxa abundance differentiation and correlation jointly. We demonstrate that it can identify both true and biologically significant genera and network structures. Software MLRR in MATLAB is available at http://biostatistics.csmc.edu/mlrr/. Supplementary data are available at Bioinformatics online. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Individual and Area Level Socioeconomic Status and Its Association with Cognitive Function and Cognitive Impairment (Low MMSE) among Community-Dwelling Elderly in Singapore.

PubMed

Wee, Liang En; Yeo, Wei Xin; Yang, Gui Rong; Hannan, Nazirul; Lim, Kenny; Chua, Christopher; Tan, Mae Yue; Fong, Nikki; Yeap, Amelia; Chen, Lionel; Koh, Gerald Choon-Huat; Shen, Han Ming

2012-01-01

Neighborhood socioeconomic status (SES) can affect cognitive function. We assessed cognitive function and cognitive impairment among community-dwelling elderly in a multi-ethnic urban low-SES Asian neighborhood and compared them with a higher-SES neighborhood. The study population involved all residents aged ≥60 years in two housing estates comprising owner-occupied housing (higher SES) and rental flats (low SES) in Singapore in 2012. Cognitive impairment was defined as <24 on the Mini Mental State Examination. Demographic/clinical details were collected via questionnaire. Multilevel linear regression was used to evaluate factors associated with cognitive function, while multilevel logistic regression determined predictors of cognitive impairment. Participation was 61.4% (558/909). Cognitive impairment was found in 26.2% (104/397) of residents in the low-SES community and in 16.1% (26/161) of residents in the higher-SES community. After adjusting for other sociodemographic variables, living in a low-SES community was independently associated with poorer cognitive function (β = -1.41, SD = 0.58, p < 0.01) and cognitive impairment (adjusted odds ratio 5.13, 95% CI 1.98-13.34). Among cognitively impaired elderly in the low-SES community, 96.2% (100/104) were newly detected. Living in a low-SES community is independently associated with cognitive impairment in an urban Asian society.

Prediction models for solitary pulmonary nodules based on curvelet textural features and clinical parameters.

PubMed

Wang, Jing-Jing; Wu, Hai-Feng; Sun, Tao; Li, Xia; Wang, Wei; Tao, Li-Xin; Huo, Da; Lv, Ping-Xin; He, Wen; Guo, Xiu-Hua

2013-01-01

Lung cancer, one of the leading causes of cancer-related deaths, usually appears as solitary pulmonary nodules (SPNs) which are hard to diagnose using the naked eye. In this paper, curvelet-based textural features and clinical parameters are used with three prediction models [a multilevel model, a least absolute shrinkage and selection operator (LASSO) regression method, and a support vector machine (SVM)] to improve the diagnosis of benign and malignant SPNs. Dimensionality reduction of the original curvelet-based textural features was achieved using principal component analysis. In addition, non-conditional logistical regression was used to find clinical predictors among demographic parameters and morphological features. The results showed that, combined with 11 clinical predictors, the accuracy rates using 12 principal components were higher than those using the original curvelet-based textural features. To evaluate the models, 10-fold cross validation and back substitution were applied. The results obtained, respectively, were 0.8549 and 0.9221 for the LASSO method, 0.9443 and 0.9831 for SVM, and 0.8722 and 0.9722 for the multilevel model. All in all, it was found that using curvelet-based textural features after dimensionality reduction and using clinical predictors, the highest accuracy rate was achieved with SVM. The method may be used as an auxiliary tool to differentiate between benign and malignant SPNs in CT images.

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.

Examination of the Gender-Student Engagement Relationship at One University

ERIC Educational Resources Information Center

Tison, Emilee B.; Bateman, Tanner; Culver, Steven M.

2011-01-01

Research examining the relationship between gender and student engagement at the post secondary level has provided mixed results. The current study explores two possible reasons for lack of clarity regarding this relationship: improper parameter estimation resulting from a lack of multi-level analyses and inconsistent conceptions/measures of…

Revised Models and Conceptualisation of Successful School Principalship for Improved Student Outcomes

ERIC Educational Resources Information Center

Mulford, Bill; Silins, Halia

2011-01-01

Purpose: This study aims to present revised models and a reconceptualisation of successful school principalship for improved student outcomes. Design/methodology/approach: The study's approach is qualitative and quantitative, culminating in model building and multi-level statistical analyses. Findings: Principals who promote both capacity building…

Community Influence on Adolescent Obesity: Race/Ethnic Differences

ERIC Educational Resources Information Center

Wickrama, K. A. Thulitha; Wickrama, K. A. S.; Bryant, Chalandra M.

2006-01-01

Using a sample of 20,000 adolescents (Add Health data), this study examined the influences of community poverty and race/ethnicity on adolescent obesity. Multilevel analyses revealed strong evidence for the unique influences of community poverty and race/ethnicity on adolescent obesity net of family characteristics. The prevalence of obesity is…

Disparities in Overweight and Obesity among US College Students

ERIC Educational Resources Information Center

Nelson, Toben F.; Gortmaker, Steven L.; Subramanian, S. V.; Cheung, Lilian; Wechsler, Henry

2007-01-01

Objectives: To examine social disparities and behavioral correlates of overweight and obesity over time among college students. Methods: Multilevel analyses of BMI, physical activity, and television viewing from 2 representative surveys of US college students (n=24,613). Results: Overweight and obesity increased over time and were higher among…

Mediation of Changes in Anxiety and Depression During Treatment of Social Phobia

ERIC Educational Resources Information Center

Moscovitch, David A.; Stefan G. Hofmann, Michael K.; Suvak, Michael K.; In-Albon, Tina

2005-01-01

To investigate the interactive process of changes in social anxiety and depression during treatment, the authors assessed weekly symptoms in 66 adult outpatients with social phobia (social anxiety disorder) who participated in cognitive- behavioral group therapy. Multilevel mediational analyses revealed that improvements in social anxiety mediated…

Intolerance of Uncertainty, Fear of Anxiety, and Adolescent Worry

ERIC Educational Resources Information Center

Dugas, Michel J.; Laugesen, Nina; Bukowski, William M.

2012-01-01

A 5 year, ten wave longitudinal study of 338 adolescents assessed the association between two forms of cognitive vulnerability (intolerance of uncertainty and fear of anxiety) and worry. Multilevel mediational analyses revealed a bidirectional and reciprocal relation between intolerance of uncertainty and worry in which change in one variable…

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…

Cultural Differences in the Relationship between Parenting and Children's Behavior

ERIC Educational Resources Information Center

Ho, Caroline; Bluestein, Deborah N.; Jenkins, Jennifer M.

2008-01-01

Parent and teacher data for 14,990 children from the National Longitudinal Survey of Children and Youth were used in multilevel analyses to examine the relationship between ethnicity, children's aggression and emotional problems, and parenting. Using parent and teacher report, relationships between ethnicity and child behavior were present but…

Impact of primary care nursing workforce characteristics on the control of high-blood pressure: a multilevel analysis.

PubMed

Parro-Moreno, Ana; Serrano-Gallardo, Pilar; Díaz-Holgado, Antonio; Aréjula-Torres, Jose L; Abraira, Victor; Santiago-Pérez, Isolina M; Morales-Asencio, Jose M

2015-12-07

To determine the impact of Primary Health Care (PHC) nursing workforce characteristics and of the clinical practice environment (CPE) perceived by nurses on the control of high-blood pressure (HBP). Cross-sectional analytical study. Administrative and clinical registries of hypertensive patients from PHC information systems and questionnaire from PHC nurses. 76,797 hypertensive patients in two health zones within the Community of Madrid, North-West Zone (NWZ) with a higher socioeconomic situation and South-West Zone (SWZ) with a lower socioeconomic situation, and 442 reference nurses. Segmented analyses by area were made due to their different socioeconomic characteristics. Poor HBP control (adequate figures below the value 140/90 mm Hg) associated with the characteristics of the nursing workforce and self-perceived CPE. The prevalence of poor HBP control, estimated by an empty multilevel model, was 33.5% (95% CI 31.5% to 35.6%). In the multilevel multivariate regression models, the perception of a more favourable CPE was associated with a reduction in poor control in NWZ men and SWZ women (OR=0.99 (95% CI 0.98 to 0.99)); the economic immigration conditions increased poor control in NWZ women (OR=1.53 (95% CI 1.24 to 1.89)) and in SWZ, both men (OR=1.89 (95% CI 1.43 to 2.51)) and women (OR=1.39 (95% CI 1.09 to 1.76)). In all four models, increasing the annual number of patient consultations was associated with a reduction in poor control (NWZ women: OR=0.98 (95% CI0.98 to 0.99); NWZ men: OR=0.98 (95% CI 0.97 to 0.99); SWZ women: OR=0.98 (95% CI 0.97 to 0.99); SWZ men: OR=0.99 (95% CI 0.97 to 0.99). A CPE, perceived by PHC nurses as more favourable, and more patient-nurse consultations, contribute to better HBP control. Economic immigration condition is a risk factor for poor HBP control. Health policies oriented towards promoting positive environments for nursing practice are needed. 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/