Fixed-effects Logistic Regression Research Articles

Dividend payout and corporate transparency: Do CSR governance mechanisms matter?

In this paper, we investigate whether dividend payout is associated with corporate transparency (i.e., CSR reporting and assurance) and whether CSR mechanisms (i.e., CSR committee and executive CSR compensation) moderate this relationship. The data covering the period between 2002 and 2019 was retrieved from the Thomson Reuters Eikon and country, industry, and year fixed-effects logistic regression analysis was used to analyze the relationships. The results underline that CSR reporting and assurance are positively associated with dividend payout and CSR committee and executive CSR compensation moderate this relationship significantly. Further analyses indicate that the dividend payout and CSR reporting and assurance relationship is robust to endogeneity concerns, regional samples, and economic downturn periods. In addition, we find that different CSR mechanisms have differential moderating roles in Anglo-Saxon and non-Anglo-Saxon countries; while CSR committee functions a better-moderating role in non-Anglo-Saxon countries, executive CSR compensation performs a better-moderating role in Anglo-Saxon countries.

Factors associated with differential seropositivity to Leptospira interrogans and Leptospira kirschneri in a high transmission urban setting for leptospirosis in Brazil.

Leptospirosis is a zoonosis caused by pathogenic species of bacteria belonging to the genus Leptospira. Most studies infer the epidemiological patterns of a single serogroup or aggregate all serogroups to estimate overall seropositivity, thus not exploring the risks of exposure to distinct serogroups. The present study aims to delineate the demographic, socioeconomic and environmental factors associated with seropositivity of Leptospira serogroup Icterohaemorraghiae and serogroup Cynopteri in an urban high transmission setting for leptospirosis in Brazil. We performed a cross-sectional serological study in five informal urban communities in the city of Salvador, Brazil. During the years 2018, 2020 2021, we recruited 2.808 residents and collected blood samples for serological analysis using microagglutination assays. We used a fixed-effect multinomial logistic regression model to identify risk factors associated with seropositivity for each serogroup. Seropositivity to Cynopteri increased with each year of age (OR 1.03; 95% CI 1.01-1.06) and was higher in those living in houses with unplastered walls (exposed brick) (OR 1.68; 95% CI 1.09-2.59) and where cats were present near the household (OR 2.00; 95% CI 1.03-3.88). Seropositivity to Icterohaemorrhagiae also increased with each year of age (OR 1.02; 95% CI 1.01-1.03) and was higher in males (OR 1.51; 95% CI 1.09-2.10), in those with work-related exposures (OR 1.71; 95% CI 1.10-2.66) or who had contact with sewage (OR 1.42; 95% CI 1.00-2.03). Spatial analysis showed differences in distribution of seropositivity to serogroups Icterohaemorrhagiae and Cynopteri within the five districts where study communities were situated. Our data suggest distinct epidemiological patterns associated with the Icterohaemorrhagiae and Cynopteri serogroups in the urban environment at high risk for leptospirosis and with differences in spatial niches. We emphasize the need for studies that accurately identify the different pathogenic serogroups that circulate and infect residents of low-income areas.

Support on the way to the top? The effects of family-friendly flexible working arrangements in organisations on the promotion of women to management positions—the case of Germany

Women are still significantly underrepresented in management positions, even though they have been able to increase their share to a small extent in recent years. Using arguments derived from signalling theory, this study examines whether organisational family-friendly flexible working arrangements (FFWAs) help to increase internal promotions of women to supervisory or managerial positions and thus reduce the existing gender leadership gap. This effect is investigated using longitudinal data for German workplaces and employees covering 1631 firms and 314,201 employees and fixed effects logistic regression models. The results demonstrate that the implementation of FFWAs improves the chances of internal promotions to supervisory or managerial positions for employees, with women and men benefiting equally. However, if I use a broader definition that also includes highly qualified specialist roles, implementing FFWAs can provide better promotion opportunities for women. Second, FFWAs increase the likelihood of being promoted to managerial positions with reduced working hours, and this effect is slightly stronger for men. Third, surprisingly, no significant positive effects of FFWAs were found on mothers’ promotion of managerial positions. These results show that, even with organisational support, it remains difficult for women to reach management positions and combine family and career at the same time.

Ethnic differences in metabolic syndrome in high-income countries: A systematic review and meta-analysis.

This review aimed to systematically quantify the differences in Metabolic Syndrome (MetS) prevalence across various ethnic groups in high-income countries by sex, and to evaluate the overall prevalence trends from 1996 to 2022. We conducted a systematic literature review using MEDLINE, Web of Science Core Collection, CINAHL, and the Cochrane Library, focusing on studies about MetS prevalence among ethnic groups in high-income countries. We pooled 23 studies that used NCEP-ATP III criteria and included 147,756 healthy participants aged 18 and above. We calculated pooled prevalence estimates and 95% confidence intervals (CI) using both fixed-effect and random-effect intercept logistic regression models. Data were analysed for 3 periods: 1996-2005, 2006-2009, and 2010-2021. The pooled prevalence of MetS in high-income countries, based on the NCEP-ATP III criteria, was 27.4% over the studied period, showing an increase from 24.2% in 1996-2005 to 31.9% in 2010-2021, with men and women having similar rates. When stratified by ethnicity and sex, ethnic minority women experienced the highest prevalence at 31.7%, while ethnic majority women had the lowest at 22.7%. Notably, MetS was more prevalent in ethnic minority women than men. Among ethnic minorities, women had a higher prevalence of MetS than men, and the difference was highest in Asians (about 15 percentage points). Among women, the prevalence of MetS was highest in Asians (41.2%) and lowest in Blacks/Africans (26.7%). Among men, it was highest in indigenous minority groups (34.3%) and lowest among in Blacks/Africans (19.8%). MetS is increasing at an alarming rate in high-income countries, particularly among ethnic minority women. The burden of MetS could be effectively reduced by tailoring interventions according to ethnic variations and risk profiles.

Changes in family situation and concurrent changes in working life: a 15-year longitudinal analysis

ObjectiveCurrently, little is known regarding changes in family situation with concurrent changes in working life. This study aimed to examine whether changes in family situation (based on living with children...

How does empowering men affect intimate partner violence? Evidence from Bangladesh

This paper investigates the relationship between women's and men's empowerment and intimate partner violence (IPV). To do so, it uses a sample of 4548 households with a husband and a wife who are present in two or three rounds of the Bangladesh Integrated Household Survey (BIHS). Measures of empowerment are constructed separately and symmetrically for husbands and wives. Conditional fixed-effects logistic regressions are employed to examine the statistical association between measures of empowerment and intimate partner violence. Findings indicate that IPV is widespread in rural Bangladesh, as 67.6% and 22.4% of households report experiencing verbal and physical IPV, respectively, in at least one round. Husbands tend to be more empowered than their wives in most, but not all, dimensions. Yet, even in dimensions of empowerment dominated by men on average, the percentage of households in which individual wives are more empowered than their husbands is notable. In regressions, some measures of men's empowerment (e.g., ownership of assets) are negatively associated with verbal and any IPV. Some measures of women's empowerment (e.g., community influence) are associated with verbal, physical, and any IPV, but the signs are mixed. All in all, the findings suggest that men's empowerment may be a determinant of intimate partner violence in rural Bangladesh, and they also underscore the need to extend theories of empowerment.

Readmission After Neonatal Intensive Care Unit Discharge: The Importance of Social Drivers of Health

ObjectiveTo determine associations between sociodemographic and medical factors and odds of readmission after discharge from the neonatal intensive care unit (NICU) for infants with very low birth weight (VLBW, <1500g). Study DesignCohort study using linked data from the California Perinatal Quality Care Collaborative, California Vital Statistics, and the Child Opportunity Index 2.0 (COI). Infants with VLBW born from 2009 through 2018 in California were considered. Odds ratios of readmission within 30 days of discharge adjusting for infant medical factors, maternal sociodemographic factors, and birth hospital were calculated via multivariable logistic regression and fixed effect logistic regression models. Results42,411 infants met inclusion criteria. 8.5% of all infants were readmitted within 30 days of discharge. In addition to traditional medical risk factors, two sociodemographic factors were significantly associated with increased odds of readmission in adjusted models: payor other than private insurance for delivery [aOR =1.25 (95% CI 1.14-1.36)] and maternal education of less than high school degree [aOR = 1.19 (95% CI 1.06-1.33)]. Neighborhood COI was not associated with odds of readmission. ConclusionsSociodemographic factors, including lack of private insurance and lower maternal educational attainment, are significantly and independently associated with increased odds of readmission after NICU discharge, in addition to traditional medical risk factors. Socioeconomic deprivation and health literacy may contribute to risk of readmission. Targeted discharge interventions focused on addressing social drivers of health warrant exploration.

Temperature anomalies undermine the health of reproductive-age women in low- and middle-income countries

Climate change is expected to undermine population health and well-being in low- and middle-income countries, but relatively few analyses have directly examined these effects using individual-level data at global scales, particularly for reproductive-age women. To address this lacuna, we harmonize nationally representative data from the Demographic and Health Surveys on reproductive health, body mass index (BMI), and temporary migration from 2.5 million adult women (ages 15 to 49) in approximately 109,000 sites across 59 low- and middle-income countries, which we link to high-resolution climate data. We use this linked dataset to estimate fixed-effect logistic regression models of demographic and health outcomes as a function of climate exposures, woman-level and site-level characteristics, seasonality, and regional time trends, allowing us to plausibly isolate climate effects from other influences on health and migration. Specifically, we measure the effects of recent exposures to temperature and precipitation anomalies on the likelihood of having a live birth in the past year, desire for another child, use of modern contraception, underweight (BMI < 18.5), and temporary migration, and subsequently allow for nonlinearity as well as heterogeneity across education, rural/urban residence, and baseline climate. This analysis reveals that exposures to high temperatures increase live births, reduce desire for another child, increase underweight, and increase temporary migration, particularly in rural areas. The findings represent clear evidence that anthropogenic temperature increases contribute to temporary migration and are a significant threat to women's health and reproductive autonomy in low- and middle-income countries.

Community-based intervention for managing hypertension and diabetes in rural Bangladesh

BackgroundApproximately 80% of non-communicable diseases (NCDs) have been reported in low- and middle-income countries (LMICs). However, studies on the usefulness of educational interventions run by non-healthcare workers in combating NCDs in resource-limited areas in rural parts of LMICs are limited. This study aimed to identify the effectiveness of a community-based simple educational program run by non-healthcare trained staff for several outcomes associated with NCDs in a resource-limited area.MethodsSix villages in the Narail district in Bangladesh were selected, two each in the first and second intervention and the control groups, in the Narail district in Bangladesh were selected. Pre- and post-intervention survey data were collected. The first intervention group received the “strong” educational intervention that included a checklist poster on the wall, phone call messages, personalized advice papers, seminar videos, and face-to-face seminars. The second intervention group received a “weak” intervention that included only a checklist poster on the wall in their house. The outcome was the proportion of NCDs and changes in systolic blood pressure and blood sugar level. Confidential fixed-effects logistic regression and multiple linear regression were performed to identify the effectiveness of the intervention.ResultsOverall, 600 participants completed the baseline survey and the follow-up survey. The mean systolic blood pressure reduced by 7.3 mm Hg (95% confidence interval [CI] 4.6–9.9) in the first intervention group, 1.9 mm Hg (95% CI − 0.5–4.2) in the second intervention group, and 4.7 mm Hg (95% CI 2.4–7.0) in the control group. Multiple linear regression analysis showed that the between-group differences in the decline in systolic blood pressure were significant for the first intervention versus control (p = 0.001), but not for the second intervention versus control (p = 0.21). The between-group differences in the reduction in blood glucose after the intervention, were not significant on multiple linear regression analysis.ConclusionsCommunity-based educational interventions for NCDs provided by non-healthcare staff improved the outcomes of hypertension and risk behaviors. Well-designed community-based educational interventions should be frequently implemented to reduce NCDs in rural areas of low- and middle-income countries.Trial registration UMIN Clinical Trials Registry (UMIN-CTR; UMIN000050171) retrospectively registered on January 29, 2023.

Physician selection for hospital integration: Theoretical considerations and empirical findings.

The U.S. health care system has seen an increase in hospital-physician integration, with hospitals acquiring increasing numbers of physician practices. This shift has been linked to higher costs without significant improvements in quality. This study sought to identify the characteristics of physicians who transitioned from independent practice to hospital integration. We used physician variables, including quality scores, medical school rankings, years of experience, experience treating socially or medically complex patients, practice style, and location, as well as health care market and county-level variables to understand these determinants using a fixed-effects logistic regression model. A total of 101,746 physicians representing 66 clinical specialties satisfied our inclusion criteria, of which 3,656 became hospital-integrated between 2018 and 2020. The integrating physicians were generally less experienced, had lower quality scores, and generated less revenue per Medicare patient. Their patients, on average, had higher comorbidity scores, were more likely to be dually eligible, and resided in counties with higher poverty rates. Our findings indicate that the physicians most likely to become hospital integrated are those facing reimbursement pressures due to a complex case mix and the associated challenges of performing well on the quality metrics. We also found some support for the anticompetitive aspects of hospital-physician integration. Our results suggest that hospitals are integrating with a relatively less experienced physician workforce but one that is perhaps more capable of treating clinically and socioeconomically complex patients. Hospitals interested in using physician integration strategically to improve care quality should put more emphasis on physician quality. Such an approach has the potential to increase efficiency without sacrificing quality of care.

Effect of nutrition education on improving dietary diversity of children aged 6–23 months in Horo district, Oromia region, Ethiopia

BackgroundUnmet minimum dietary diversity (MDD) feeding practices in poor nations place children at high risk of undernutrition and its related effects, which are far-reaching and difficult to correct later in life. ObjectiveThis study aimed to assess the effect of maternal nutrition education and another determinant on the dietary diversity of children aged 6–23 months. MethodsA community-based cluster randomized trial study design was conducted from July 2019 to January 2020 in the Horo district. Twenty-three kebeles were assigned to two clusters. From two clusters, two kebeles were selected by simple random sampling. Two kebeles were assigned as intervention (150) and control (150) groups by the lottery method, at the end of the line as intervention (139) and control (137) groups. Simple random sampling techniques were used to select the study subjects. The nutrition education intervention, which lasted three months and consisted of eight sessions, was given to the intervention group, which was made up of mothers and other caregivers of children aged 6–23 months.Data entry into Epi-data and analysis were done using IBM SPSS version 26 computer software. At a 95% confidence level, values with P ≤ 0.05 were considered statistically significant. B-ivariable and multivariable conditional fixed-effect logistic regression analyses were done to identify the determinants of the dietary diversity score. Variables with a p-value of less than 0.05 were considered statistically significant. The crude odds ratio (COR) and adjusted odds ratio (AOR) were used to describe the strength and direction of the association. ResultThe result was that the proportion of children with a good dietary diversity score was 52 (34.7%) and 40 (26.7%) in the control group and intervention groups at baseline, respectively. Household food security [AOR = 4.06, 95% CI: (2.45, 6.73] and being in the intervention group [AOR = 1.90, 95% CI: (1.10, 3.29] were both positive predictors of the dietary diversity score, while maternal age (35–45 years) was a negative predictor. ConclusionAt baseline, a high proportion of children aged 6–23 months did not receive the World Health Organization's minimum dietary diversity recommendation for both groups. The consumption of animal sources and vitamin-A-rich fruits and vegetables was poor among both groups. At the end of the day, after nutrition education, the dietary diversity score improved in the intervention groups but not in the control groups. New strategies and programs should be made at all levels to improve childhood nutritional status. This includes providing nutrition education for mothers aged between 35 and 45 years old.

Corporate social responsibility performance and social reputation via corporate social responsibility awarding: is there a threshold effect?

Purpose This study aims to examine the potential threshold effect in the association between corporate social responsibility (CSR) performance and social reputation. Design/methodology/approach This study includes an international and cross-sector sample covering 41 countries, nine sectors and 45,395 firm-year observations. It applies a parabolic relationship, rather than linear regressions, between CSR engagement and social reputation via CSR awarding. This implies that CSR performance should increase until a certain point to gain a social reputation but then should decrease after reaching that threshold point considering limited financial resources. Findings The findings of country-industry-year fixed-effects logistic regressions confirm the threshold effect with an inverted U-shaped relationship between CSR and CSR awarding. More specifically, firms increase their environmental and social engagement until a certain point, and then they reduce it after reaching a social reputation. This finding is confirmed by three dimensions of the environmental pillar (i.e. resource use, emissions and eco-innovation) as well as four dimensions of the social pillar (i.e. workforce, human rights, community and product responsibility). The findings are robust to alternative samples, alternative methodology and endogeneity concerns. Practical implications The findings of this study have implications for firms about the better allocation of available funds between CSR and operations. The findings could be particularly useful for CSR teams/committees of the firms who formulate CSR policies and how to mobilize firm resources for better social enhancement via environmental and social reputation. Originality/value This study examines deeper the nature of the association between CSR engagement and social reputation and considers the possibility of an inverted U-shaped relationship between them. The determination of a threshold effect suggests that CSR engagement increases social reputation, but once it reaches a certain point, social reputation will decrease owing to financial resource constraints.

Habitat selection by lake trout at reefs near Drummond Island, Lake Huron: An evaluation of physical characteristics used for spawning

Continued dependence on stocking of hatchery-reared lake trout, Salvelinus namaycush, in the Laurentian Great Lakes indicates recruitment bottlenecks still exist between spawning and the juvenile life stage (age-1). Possible impediments include poor habitat quality and an inability of hatchery-origin adults to select substrates that support successful incubation. Understanding of characteristics of suitable lake trout spawning habitat is limited but has centered on the cobble-contour framework, which identifies sloped reefs with cobble substrate and deep interstices to entrain eggs as spawning habitat. A novel sampling design based on acoustic-telemetry detections was used to evaluate relative importance of cobble-contour habitat characteristics (substrate size, homogeneity, interstitial depth, and slope) for predicting egg presence on two spawning reefs in northern Lake Huron. Fixed effect logistic regression models were used to relate egg presence to all possible combinations of measured physical characteristics. Physical characteristics of sites with naturally spawned eggs present varied, and no single best model predicted egg presence. Model selection and multi-model inference revealed slope to be the only informative predictor. Substrate size, homogeneity, and interstitial depth were not important. Embryo survival-to-hatch was also compared among sampling sites using in situ habitat bioassays seeded with hatchery fertilized embryos. No difference in embryo survival was observed between sites where naturally spawned eggs were present vs. absent. Over half of sites evaluated exceeded 75% survival. Naturally spawned eggs were observed at 25 of 57 sites. We suspect other characteristics such as interstitial flow could be helpful for predicting selection of lake trout spawning habitats.

Tracking global English changes through local data: Intensifiers in German Learner English

Aims and objectives/purpose/research questions: The empirical goal of the paper is to document the linguistic distribution and patterning as well as the sociolinguistic conditioning of intensifiers in English spoken by educated young adults from Germany. Here, I also seek to understand how the empirical data presented here informs our understanding of the mechanisms underlying language change in those forms of English that emerge through the combined impact of naturalistic L2 acquisition and instructed foreign language learning (henceforth, EFL or Learner English). Design/methodology/approach: The study reports intensification data from 53 advanced learners of English from Germany and compares it with that reported for L1 English vernaculars. The data were elicited with the help of sociolinguistic interviews tapping into learners’ natural linguistic behaviour. The processes of language change are explored against the backdrop of grammaticalisation theory, as espoused by variationist sociolinguists. Data and analysis: The study employs two methods of analysis: distributional percentages and fixed-effects logistic regression analyses. These allow pinpoint rates and patterns of intensification as well as its language-internal and language-external conditioning. Findings/conclusions: Systematic comparisons of language-internal conditioning underlying the occurrence of linguistic variants pinpoint ‘functional specialisation’ (also ‘entrenchment’) as a driving mechanism of and a potent constraint on language change. Originality: While demonstrating how functional specialisation is operative in the system of German Learner English intensification, the present study highlights the relevance of EFL data to empirical testing and advancement of (socio-)linguistic theory. The study also highlights the relevance of learners’ linguistic identity and the sociopsychological construct of ‘relatedness’ in the adoption of the globally available features of the English language. Significance/implications: The study pleads for more research at the intersection of historical/general linguistics and SLA as such an approach adds to knowledge about language acquisition, language variation and, ultimately, language change.

Interstate Resource Conflicts: A Network-Centric Resource Access Security Perspective

This paper introduces the theoretical concept of perceived resource access security in order to assess the link between natural resource scarcity and interstate conflict. It develops the hypothesis that resource access through international trade is an important determinant for conflict behaviour of states arising from resource concerns, implying a shift in focus away from endowments and towards competition for access. The main analysis is conducted in the form of a unit fixed effects logistic regression covering country-dyads of the period 1962–2010 with military interstate dispute (MID) initiation as dependent variable. The empirical findings consistently demonstrate that a diversified position in resource supply networks mitigates the conflict propensity of states characterized by outside dependence for access to natural resources, and thereby help to determine conditions under which trade reduces conflict.

Longitudinal Associations Between Body-Related Self-Conscious Emotions and Weight Control Status During Adolescence

PurposeHalf of adolescents are trying to change their weight and body-related self-conscious emotions may influence these intentions. We estimated associations between body-related shame, guilt, embarrassment, envy, authentic pride, and hubristic pride and weight control status (trying to maintain, lose, or gain weight) throughout adolescence in girls and boys. MethodsSix annual cycles of self-administered questionnaires were collected from age 12–17 in the Monitoring Activities of Teenagers to Comprehend their Habits (MATCH) study (n = 776). Average associations over all cycles were estimated with generalized estimating equations to describe the relationship between emotions (predictors) and weight control status (outcome). To explore the impact of changes in emotions on weight control status, fixed effects logistic regressions were used. Separate models were conducted for each emotion and for boys and girls. ResultsOn average, boys and girls with higher scores for negative emotions (shame, guilt, embarrassment and, exclusively among girls, envy) had higher odds of trying to lose weight. Higher scores for positive emotions (authentic and hubristic pride) were associated with lower odds of trying to lose weight among girls. Higher scores for authentic pride were associated with trying to gain weight among boys. Girls with increases in any of the negative emotions presented higher odds of trying to lose weight. Girls with increases in hubristic pride had increased odds of trying to maintain weight. DiscussionBody-related self-conscious emotions may be promising healthy-weight intervention targets as they represent important predictors of weight control status, particularly in girls.

Wishing for an end? Longitudinal analysis of suicidal ideation among informal caregivers inside and outside their household in different welfare systems of Europe.

This study examines whether transition to caregiving within or outside the household is associated with changes in suicidal ideation and whether this depends on the type of caregiver relationship, the age or gender of the caregiver, or the welfare system. Longitudinal study. Ten European countries. Data from the Survey of Health, Ageing, and Retirement in Europe were used (waves 1, 2, 4, 5, and 6) including participants aged ≥40 years (pooled Observations = 171,848). Suicidal ideation was measured using the Euro-D scale. Caregiving was measured as care inside and outside the household, and for different recipients. Fixed effects logistic regression analyses, adjusted for health and sociodemographic factors, were used. Transitioning into caregiving inside the household was associated with higher odds of suicidal ideation, in particular if they transitioned into care for partners or parents and within Southern and Bismarckian welfare systems. Transitioning into caregiving outside the household was not associated with suicidal ideation, except among those transitioning into caregiving for non-relatives (higher odds of suicidal ideation), and among male and older caregivers (lower odds of suicidal ideation). Suicide ideation was higher among caregivers in Southern compared to Bismarckian or Scandinavian welfare systems. Informal caregiving is associated with suicidal ideation among caregivers inside but not among all caregivers outside the household. The caregiver's characteristics, the care relationship, and the welfare system play an important role. Preventing suicidal ideation requires interventions that focus on informal caregivers and consider their individual and contextual factors.

An exploratory analysis on city characteristics likely to affect autonomous vehicle legislation enactment across the United States

As Autonomous Vehicle (AV) technology enters developmental maturity, the need for real-life testing is crucial. AV testing and deployment in a city or State must be preceded by favorable legislation in that jurisdiction. However, research on which city characteristics affect the likelihood of adopting AV legislation remains in question. In this paper, we investigate city characteristics of different urbanized areas (UZAs) in States across the US. Panel data was collected from 29 UZAs and 23 States over the span of eight years (2011–2018) on variables such as existing AV legislations, electric vehicle score, congestion, and vehicle miles traveled (VMT). A method of fixed effects logistic regression is implemented to overcome omitted variable bias and the limitation of datasets available. Features are selected through the leaps and bounds algorithm, and time and State fixed-effects logistic regression models are tested to predict a binary variable for AV legislation enactment in UZAs. Our results yield a five-predictor State fixed effects model as the most robust by variable statistical significance and concordance. The findings reveal that an increase in electric vehicle use, GDP per capita, freeway VMT, and land use score of a UZA increase likelihood of AV testing adoption, while an increase in fatality cases negatively impact the likelihood of adoption (Ceteris paribus).

Parametric and nonparametric propensity score estimation in multilevel observational studies.

There has been growing interest in using nonparametric machine learning approaches for propensity score estimation in order to foster robustness against misspecification of the propensity score model. However, the vast majority of studies focused on single-level data settings, and research on nonparametric propensity score estimation in clustered data settings is scarce. In this article, we extend existing research by describing a general algorithm for incorporating random effects into a machine learning model, which we implemented for generalized boosted modeling (GBM). In a simulation study, we investigated the performance of logistic regression, GBM, and Bayesian additive regression trees for inverse probability of treatment weighting (IPW) when the data are clustered, the treatment exposure mechanism is nonlinear, and unmeasured cluster-level confounding is present. For each approach, we compared fixed and random effects propensity score models to single-level models and evaluated their use in both marginal and clustered IPW. We additionally investigated the performance of the standard Super Learner and the balance Super Learner. The results showed that when there was no unmeasured confounding, logistic regression resulted in moderate bias in both marginal and clustered IPW, whereas the nonparametric approaches were unbiased. In presence of cluster-level confounding, fixed and random effects models greatly reduced bias compared to single-level models in marginal IPW, with fixed effects GBM and fixed effects logistic regression performing best. Finally, clustered IPW was overall preferable to marginal IPW and the balance Super Learner outperformed the standard Super Learner, though neither worked as well as their best candidate model.

Parent Ratings of Health Insurance Adequacy for Children with Emotional, Behavioral, or Developmental Problems.

Parents of children with special health care needs (CSHCN) report that private insurance is less adequate than public health coverage. Parents of CSHCN with emotional, behavioral, or developmental problems (EBDPs) may perceive private insurance to be especially inadequate due to higher need for a wider array of non-medical services and supports. This study's objective is to assess differences in parent ratings of insurance adequacy for public versus private health coverage between non-CSHCN, CSHCN, and CSHCN with EBDPs. This study pooled publicly available data from the 2016 through 2019 National Survey of Children's Health. Multivariable fixed effects logistic regression models estimated the association between insurance type, CSCHN and EBDP status, and parent ratings of their child's insurance adequacy. Marginal effects were calculated for insurance type, CSHCN and EBDP status, and their interactions to estimate the size of the association. Among all subgroups, consistently more parents with publicly insured children rated their insurance as adequate compared to those with private insurance. Parents of privately insured CSHCN with EBDPs rated their insurance as adequate at significantly lower rates than any other group of parents (55%)-including those with privately insured children without EBDPs (non-CSHCN= 67%; CSHCN=63%) and all other parents with publicly insured children (non-CSHCN=87%; CSHCN=83%; CSHCN with EBDPs=84%). Future research should investigate if perceptions of insurance adequacy among families whose CSHCN has an EBDP aligns with reports of service access and unmet health care needs.