General Structural Equation Model Research Articles

Political trust and economic development in European regions

AbstractThis paper examines the complex relationship between political and social trust, government quality, and economic development across 208 regions in the European Union (EU). We use a pooled data generalized structural equation model (GSEM) to show that political trust serves as a fundamental driver of regional economic development in the EU. Political trust is, in turn, influenced by both social trust and government quality. Social trust and government quality have quadratic effects on political trust, showing diminishing returns, while the effect of political trust on economic development is linear. Political trust mediates the relationship between social trust and economic development entirely, while government quality retains a direct relationship with economic development. These findings underscore the fundamental role that political trust plays as a mechanism through which both formal and informal institutions shape regional development.

Association between Internet use and depression among older adults in China: the chain-mediating role of volunteer activity participation and friend network.

Depression is a significant burden on individuals and society, which requires our attention and action. As the aging wave collides with digitalization, further research is needed to understand how internet use relates to depression in older adults. This study aimed to investigate whether volunteer activity participation and friend networks played a chain mediating role in this relationship from the perspective of the socioemotional selectivity theory. This study's data was derived from the 2018 China Longitudinal Aging Social Survey (CLASS), comprising 5,558 samples. The study employed the OLS model for benchmark regression and multiple robust check methods, including altering variable settings and utilizing the instrumental variable model. In addition, the generalized structural equation model (GSEM) was used to analyze the mechanism. Using the internet was significantly associated with reduced depression in older adults (coefficient = -0.9321, p < 0.001). The instrumental variable model confirmed this reduction (coefficient = -0.9200, p < 0.001). Moreover, we found that there were three indirect pathways of Internet use on depression among older adults: the mediating role of volunteer activity participation (all p-values <0.001), the mediating role of friend network (all p-values <0.001), and the chain mediating role of both factors (all p-values <0.001). Based on the research findings, we suggest mobilizing tech-savvy older adults to assist others in adopting digital technology and using the internet. We also suggest that the government could assist in creating older adult-friendly communities. Social workers could collaborate with tech-savvy older adults to organize various voluntary activities, encouraging more senior citizens to participate. In addition, we recommend that the community should consider the form of activities to help older adults make friends first rather than solely focusing on voluntary activities.

Longitudinal examination of marijuana use and physical teen dating violence: Antisocial peers and impulsivity as mediators

BackgroundPrior studies have shown that marijuana use is often associated with physical teen dating violence. However, few studies have examined the longitudinal mediating effects of associating with antisocial peers and impulsivity on this relationship. Also, few studies have estimated the cascading developmental impact of marijuana use and antisocial peer association, predicting the continued marijuana use and antisocial peer associations while considering the risk of impulsivity in physical teen dating violence. Thus, the current study utilized the problem behavior theory and an alternative path to physical dating violence to address these limitations. ObjectiveThe current study tested the longitudinal effects of marijuana use on physical teen dating violence and the indirect effects of antisocial peer association and impulsivity on this relationship (M = 12.29); 52.1 % of males and 47.9 % of females participated. MethodsAdolescents completed questionnaires at baseline and were assessed six months later (n = 836). Generalized structural equation modeling (GSEM) and cross-lagged mediation models were used first to analyze the direct effect of lifetime marijuana use on physical dating violence and antisocial peer association and impulsivity as potential mediators of this relationship. Then, the cross-lagged mediation models were used to estimate the alternative path to physical teen dating violence using lifetime marijuana use and antisocial peer association as predictors at baseline and continued antisocial peer association, marijuana use, and impulsivity at the subsequent wave as mediators. ResultsResults suggested that marijuana use at baseline was not positively associated with physical teen dating violence over time. The association with antisocial peers but not impulsivity mediated the relationship between marijuana use and physical dating violence. Cross-lagged mediation results suggested that marijuana use at baseline positively predicted antisocial peer association in the subsequent wave, which led to an increase in physical teen dating violence. Further, antisocial peer association at baseline is positively associated with continued antisocial peer association at the subsequent wave; thus, antisocial peer association is positively related to physical teen dating violence when controlling for depressive symptoms, family support, number of dates, and parental monitoring. ConclusionThese results suggest though marijuana use alone is not statistically associated with physical teen dating violence, it does increase the risk of antisocial social peer associations that could increase adolescents' likelihood to engage in physical teen dating violence. Further, the onset of antisocial peer association could persist over time, thus serving as a risk factor for physical teen dating violence over time.

Unmasking the Risk Factors Associated with Undiagnosed Diabetes and Prediabetes in Ghana: Insights from Cardiometabolic Risk (CarMeR) Study-APTI Project.

Undiagnosed diabetes poses significant public health challenges in Ghana. Numerous factors may influence the prevalence of undiagnosed diabetes among adults, and therefore, using a model that takes into account the intricate network of these relationships should be considered. Our goal was to evaluate fasting plasma levels, a critical indicator of diabetes, and the associated direct and indirect associated or protective factors. This research employed a cross-sectional survey to sample 1200 adults aged 25-70 years who perceived themselves as healthy and had not been previously diagnosed with diabetes from 13 indigenous communities within the Cape Coast Metropolis, Ghana. Diabetes was diagnosed based on the American Diabetes Association (ADA) criteria for fasting plasma glucose, and lipid profiles were determined using Mindray equipment (August 2022, China). A stepwise WHO questionnaire was used to collect data on sociodemographic and lifestyle variables. We analyzed the associations among the exogenous, mediating, and endogenous variables using a generalized structural equation model (GSEM). Overall, the prevalence of prediabetes and diabetes in the Cape Coast Metropolis was found to be 14.2% and 3.84%, respectively. In the sex domain, females had a higher prevalence of prediabetes (15.33%) and diabetes (5.15%) than males (12.62% and 1.24%, respectively). Rural areas had the highest prevalence, followed by peri-urban areas, whereas urban areas had the lowest prevalence. In the GSEM results, we found that body mass index (BMI), triglycerides (TG), systolic blood pressure (SBP), gamma-glutamyl transferase (GGT), and female sex were direct predictive factors for prediabetes and diabetes, based on fasting plasma glucose (FPG) levels. Indirect factors influencing diabetes and prediabetes through waist circumference (WC) included childhood overweight status, family history, age 35-55 and 56-70, and moderate and high socioeconomic status. High density lipoprotein (HDL) cholesterol, childhood overweight, low physical activity, female sex, moderate and high socioeconomic status, and market trading were also associated with high BMI, indirectly influencing prediabetes and diabetes. Total cholesterol, increased TG levels, WC, age, low physical activity, and rural dwellers were identified as indirectly associated factors with prediabetes and diabetes through SBP. Religion, male sex, and alcohol consumption were identified as predictive factors for GGT, indirectly influencing prediabetes and diabetes. Diabetes in indigenous communities is directly influenced by blood lipid, BMI, SBP, and alcohol levels. Childhood obesity, physical inactivity, sex, socioeconomic status, and family history could indirectly influence diabetes development. These findings offer valuable insights for policymakers and health-sector stakeholders, enabling them to understand the factors associated with diabetes development and implement necessary public health interventions and personalized care strategies for prevention and management in Ghana.

INVITED PAPER — THE ATTITUDE–BEHAVIOR DICHOTOMY IN THE TIME OF COVID-19: AN EXPLORATION USING GENERALIZED STRUCTURAL EQUATION MODELING

The COVID-19 pandemic brought the need to quickly deploy non-pharmaceutical measures like facemasks to reduce transmission rates into sharp focus. Factors influencing this behavior are examined through the classic attitude–behavior lens of Fishbein and Ajzen [Belief, Attitude, Intention, and Behavior: An Introduction to Theory and Research. Reading, MA: Addison-Wesley] cast in the language of property rights and social norms. Behavior is operationalized as wearing a facemask (or not) and attitude in terms of supporting a mandatory mask mandate. This yields targetable segments of the population as they are referred to in a marketing context: wearing/supporting, wearing/not supporting, not wearing/supporting, not wearing/not supporting [Kim, D, RT Carson, D Whittington and WM Hanemann (2022). Support for regulation versus compliance: Face masks during COVID-19. Public Health in Practice, 5, 100324]. Membership in each segment is predicted using a generalized structural equation modelling (GSEM) approach focused on three broad factors. The first includes political and demographic variables, which represent exogenous taste parameters. The second is a set of knowledge variables characterizing the COVID-19 information a person possesses. These are potentially influenceable by health officials. The third relates to risk cast in the form of knowing someone who had tested positive for COVID-19, been hospitalized or died from it. The GSEM results paint a rich picture of how our factor sets interact with the four targetable segments of the population in a critical situation where high but not perfect compliance is needed.

Pre-Gestational Obesity and Gestational Weight Gain as Predictors of Childhood Obesity

To evaluate the associations of pre-gestational body mass index (BMI) and gestational weight gain (GWG) with the risks of overweight, obesity, and adiposity in the first seven years of life in the offspring of a cohort of pregnant women. Analysis of 751 mothers and their children participating in the PROGRESS cohort. These women were recruited in Mexico City between 2007 and 2010. Pre-gestational BMI was classified as normal, overweight, and obesity according to the WHO. GWG was calculated as the difference between the last reported pre-pregnancy weight and the pre-gestational weight and categorized as inadequate, adequate, or excessive, according to US IOM recommendations. Children's anthropometry was evaluated at 4-5 and 6-7 years of age. Adiposity was classified into three groups: normal (BMI z-score and waist circumference), overweight (BMI z-score>1), and overweight plus abdominal obesity (OW+AO). A generalized structural equation model (GSEM) was constructed to account for the temporal relationship between variables and to assess direct and indirect effects. A total of 49.3% of the women had excessive (13.8 ± 4.2 kg) and 19.8% inadequate (3.15 ± 3.4 kg) GWG. Women with pre-gestational overweight or obesity were more likely to have excessive GWG (OR 1.9 [95% CI: 1.32, 2.74] and 3.50 [95% CI: 1.83, 6.69], respectively). In the GSEM, excessive GWG was directly associated with OW+AO at 4-5 years. At 6-7 years, pre-gestational obesity was associated with OW+AO. Pre-gestational obesity and excessive GWG were independent predictors of childhood obesity.

Neurodevelopmental outcomes following possible serious bacterial infection in early infancy in Karachi, Pakistan: a prospective cohort study

BackgroundPakistan reports a significant burden of neonatal mortality, with infections as one of the major causes. We aim to assess the long-term impact of early infancy infections on neurodevelopmental outcomes during later childhood.MethodsWe conducted a prospective follow-up study of the cohort enrolled at the Karachi site of the Aetiology of Neonatal Infection in South Asia (ANISA) during 2019–2020. Children with a possible serious bacterial infection (based on the WHO IMCI algorithm) at early infancy were assessed for neurodevelopment at 6–9 years of age and compared with healthy controls. The Ten Questions (TQS) questionnaire, Strengths and Difficulties Questionnaire (SDQ), and Parent’s Evaluation of Developmental Stage Assessment Level (PEDS: DM-AL) neurodevelopmental assessment tools, were administered and scored by the research staff who were blinded to the child’s exposure status. Generalized Structural Equation Modelling (GSEM) was employed to verify relationships and associations among developmental milestones, anthropometry, and sociodemographic variables.ResultsA total of 398 children (241 cases and 157 controls) completed neurodevelopmental and growth assessments. Cases had a significantly higher rate of abnormal TQS scores (54.5% vs. 35.0%, p-value 0.001), greater delays in motor milestones (21.2% vs. 12.1%, p-value 0.02), lower fine motor skills (78.4 ± 1.4 vs. 83.2 ± 1.5, p-value 0.02). The receptive language skills were well-developed in both groups. According to the logistic regression model, exposure to infection during the first 59 days of life was associated with delayed TQS milestones (β = -0.6, 95% CI -1.2,-0.04), TQS hearing domain (β = -0.3, 95% CI: -1.2 to 0.7), PEDS: DM-AL fine motor domain (β = -1.3, 95% CI: -4.4 to 1.7), PEDS: DM-AL receptive language development (β = -1.1, 95% CI: -3.7 to 1.4) and child anthropometric measurements such as weight and height (β = -0.2, 95% CI: -0.4 to 0.01 and β = -0.2, 95% CI: -0.4 to -0.01, respectively). Early pSBI exposure was positively associated with PEDS: DM-AL self-help domain (β = 0.6, 95% CI: -1.2 to 2.4) and SDQ-P overall score (β = 0.02, 95% CI: -0.3 to 0.3).ConclusionChildren exposed to PSBI during early infancy have higher rates of abnormal development, motor delays, and lower fine motor skills during later childhood in Pakistan. Socioeconomic challenges and limited healthcare access contribute to these challenges, highlighting the need for long-term follow-ups with integrated neurodevelopment assessments.

Drinking to Cope With the COVID-19 Pandemic Mediates Pathways From COVID-19 Anxiety to Alcohol Use and Alcohol Myopia Consequences

Objective People may consume alcohol to cope with the stressors and anxieties of the COVID-19 pandemic. The present study applied the self-medication hypothesis, tension reduction hypothesis, and alcohol myopia theory to understand COVID-19 alcohol coping as a mediator of the pathways from COVID-19 anxiety to alcohol use and alcohol consequences. Methods Participants (N = 477) were undergraduate college students. The mean age was 22.14 (SD = 5.66) years. Gender distribution included 73% females, 26% males, and 1% transgender. Racial categories included 70% White, 11% Latino, 5% Black, 5% Asian, and 9% multiracial. They completed the Coronavirus Anxiety Scale, the COVID-19 Alcohol Coping Scale developed and validated in the present study, measures of drinking frequency and drinking quantity, and the Alcohol Myopia Scale to assess alcohol consequences. Results First, confirmatory factor analysis supported the measurement structure of the COVID-19 Alcohol Coping Scale. Second, a general structural equation model containing only latent factors provided evidence for the following pathways: COVID-19 anxiety to COVID-19 alcohol coping to overall alcohol use to alcohol myopia consequences. Third, a specific structural equation model separated the overall alcohol use factor into two measures of drinking frequency and drinking quantity. Results found that COVID-19 alcohol coping uniquely explained drinking frequency (but not drinking quantity), indicating that the pursuit of alcohol to cope with the pandemic was related to more frequent days of alcohol use but not more concentrated use on drinking days. Tests of indirect effects corroborated the mediational pathways in the explanatory models. Conclusions The research offers insights into understanding that the risk connections from COVID-19 anxiety to alcohol behavioral outcomes are mediated by alcohol use to cope with the pandemic.

Hypertension and diabetes, but not leptin and adiponectin, mediate the relationship between body fat and chronic kidney disease

PurposeObesity may promote kidney damage through hemodynamic and hormonal effects. We investigated the association between body mass index (BMI), total body fat (TBF) and chronic kidney disease (CKD) and whether hypertension, diabetes, leptin and adiponectin mediated these associations.MethodsIn this cross-sectional analysis of the Netherlands Epidemiology of Obesity study, 6671 participants (45–65 y) were included. We defined CKD as eGFR <60 ml/min/1.73 m2 and/or moderately increased albuminuria. The percentage of mediation was calculated using general structural equation modeling, adjusted for potential confounding factors age, sex, smoking, ethnicity, physical activity and Dutch healthy diet index.ResultsAt baseline mean (SD) age was 56 (6), BMI 26.3 (4.4), 44% men, and 4% had CKD. Higher BMI and TBF were associated with 1.08 (95%CI 1.05; 1.11) and 1.05-fold (95%CI 1.02; 1.08) increased odds of CKD, respectively. As adiponectin was not associated with any of the outcomes, it was not studied further as a mediating factor. The association between BMI and CKD was 8.5% (95%CI 0.5; 16.5) mediated by diabetes and 22.3% (95%CI 7.5; 37.2) by hypertension. In addition, the association between TBF and CKD was 9.6% (95%CI −0.4; 19.6) mediated by diabetes and 22.4% (95%CI 4.2; 40.6) by hypertension. We could not confirm mediation by leptin in the association between BMI and CKD (35.6% [95%CI −18.8; 90.3]), nor between TBF and CKD (59.7% [95%CI −7.1; 126.6]).ConclusionOur results suggest that the relations between BMI, TBF and CKD are in part mediated by diabetes and hypertension.

Association between early spontaneous abortion and homocysteine metabolism.

The purpose of this study is to explore the effects of homocysteine (HCY) metabolism and related factors on early spontaneous abortion. We conducted a hospital-based case-control study and included a total of 500 cases and 1,000 controls in Shaanxi China. Pregnant women waiting for delivery in the hospital were interviewed to report their characteristics and other relevant information during pregnancy. The unconditional Logisitic regression model was applied to assess the association between early spontaneous abortion and HCY metabolism and related factors. The multiplicative model was applied to assess the effects of interaction of HCY metabolism and related factors on early spontaneous abortion. The logit test method of generalized structural equation model (GSEM) was used to construct the pathway diagram of HCY metabolism and related factors affecting early spontaneous abortion. Folic acid supplementation and adequate folic acid supplementation during periconception were the protective factors of early spontaneous abortion (OR = 0.50, 95% CI: 0.38-0.65; OR = 0.44, 95% CI: 0.35-0.54). The serum folate deficiency, higher plasma HCY in early pregnancy, the women who carried the MTHFR 677TT genotype were the risk factors of early spontaneous abortion (OR = 5.87, 95% CI: 1.53-22.50; OR = 2.94, 95% CI: 1.14-7.57; OR = 2.32, 95% CI: 1.20-4.50). The women's educational level and maternal and child health care utilization affected the occurrence of early spontaneous abortion by influencing the folic acid supplementation during periconception. The folic acid supplementation during periconception affected the occurrence of early spontaneous abortion by influencing the level of serum folate or plasma HCY in early pregnancy. The maternal MTHFR 677 gene polymorphism affected the occurrence of early spontaneous abortion by influencing the level of serum folate in early pregnancy. In terms of the risks for early spontaneous abortion, there was multiplicative interaction between higher plasma HCY in early pregnancy, serum folate deficiency in early pregnancy and maternal MTHFR 677TT genotype (OR = 1.76, 95% CI: 1.17-4.03), and there was multiplicative interaction between higher plasma HCY and serum folate deficiency in early pregnancy (OR = 3.46, 95% CI: 2.49-4.81), and there was multiplicative interaction between serum folate deficiency in early pregnancy and maternal MTHFR 677TT genotype (OR = 3.50, 95% CI: 2.78-5.18). The above interactions are all synergistic. The occurrence risk of early spontaneous abortion was significantly increased if multiple factors existed at the same time. Our study is the first time to construct the pathway of HCY metabolism and related factors affecting early spontaneous abortion, and provides a comprehensively new idea to prevent and reduce the occurrence of spontaneous abortion.

A Technique for Efficient Estimation of Dynamic Structural Equation Models: A Case Study

Dynamic structural equation models (DSEM) are designed for time series analysis of latent structures. Inherent to the application of DSEM is model parameter estimation, which has to be addressed in many applications by a single time series. In this context, however, the methods currently available either lack estimation quality or are computationally inefficient. Given the era of big data, the necessity for a trade-off between these properties may be detrimental to the applicability of DSEM. The paper is aimed at tackling this trade-off by proposing a novel estimator recursioning technique (ER technique) that facilitates the development of computationally efficient raw-data maximum likelihood estimation algorithms through data transformation, covariance matrix block decomposition, likelihood function reduction, and estimator recursioning steps. The ER technique is introduced by applying it to a special case of the general dynamic structural equation model that encompasses a noisy Wiener-process-type structure with input from the factor-analytic model. The resulting algorithm has been verified through a number of numerical experiments as well as implemented in a brand new R package EMLI, which is available on CRAN.

The effect of possible mediators on the association between chewing khat during pregnancy and fetal growth and newborn size at birth in Eastern Ethiopia

IntroductionRestriction in the growth of the fetus is a leading cause of stillbirth, neonatal mortality, and short- and long-term morbidity. Documented existing scientific evidence have shown the effects of maternal drugs use, alcohol drinking, tobacco smoking, cocaine use and heroin use on fetal growth restriction. However, data is lacking on the effects of khat chewing during pregnancy on fetal growth status and newborn size at birth. Therefore, the aim of the present study was to measure the effect of chewing khat during pregnancy on fetal growth and size at birth in eastern Ethiopia.MethodA cohort study was conducted in selected health institutions in eastern Ethiopia. All pregnant women fulfilled the eligibility criteria in the selected health institutions was the source population. The calculated sample size of exposed and unexposed groups included in the study, in total, was 344. Data collection was performed prospectively by interviewers administered questionnaires, and anthropometric, clinical and ultrasound measurements. Data was analyzed using SPSS version 27 and STATA version 16 software. The survival analysis (cox proportional hazards model) and generalized linear model (GLM) for the binomial family analysis were performed to estimate the crude and adjusted relative risk and attributable risk (AR) with corresponding 95% CI of chewing khat on fetal growth restriction. The mediation effect has been examined through Generalized Structural Equation Modeling (GSEM) analysis using the Stata ‘gsem’ command. Statistically significant association was declared at p-value less than 5%.ResultsIn the present study, the incidence of fetal growth restriction (FGR) among the study cohorts was 95 (29.7%); of this, 81 (85.3%) were among khat chewer cohorts. The relative risk of fetal growth restriction among khat chewer cohort mothers was significantly higher (aRR = 4.32; 95%CI 2.62–7.12). Moreover, the incidence of small for gestational age at birth among the present study cohorts was 100 (31.3%); 84 (84%) were from khat chewer cohorts’ deliveries. More importantly, in the present study, 98.95% of the ultrasound-identified fetuses with FGR were found to be SGA at birth. Hence, in the current study, FGR was highly associated with SGA at birth. In additional analysis, the regression coefficient of khat chewing during pregnancy on fetal growth restriction has been decreased in size from path o, β = 0.43, p < 0.001 to path o’, β = 0.32, p < 0.001, after adjusting for gestational hypertension and maternal anemia.ConclusionIn sum, the present study showed khat chewing during pregnancy is not simply affected the mothers, but it also affected the unborn fetuses. Therefore, the health workers as well as the local community and religious leaders should give high emphasis on provision of health education regarding the damage of chewing khat by pregnant mothers, with especial focus of the effects on their fetuses.

Trumpism, climate and COVID: Social bases of the new science rejection.

Although the hazards posed by greenhouse warming and COVID-19 are quite different, diagnosis and mitigation prospects for both depend heavily on science. Unfortunately, the reality of both threats has been subject to politicized science rejection in the US, making these deadly problems less tractable. There are substantial parallels between the two cases of science rejection, including common rhetoric and conservative political leadership. Survey research has reached widely-replicated conclusions regarding the social bases of climate-change perceptions. Corresponding studies of COVID-19 perceptions have found some political commonalities, but less agreement on other details. Here, we address this gap using generalized structural equation modeling (GSEM) and 2021 US survey data to make direct comparisons between the social bases of rejecting the reality of anthropogenic climate change (ACC) and rejecting COVID-19 vaccination. Trumpism, operationalized from approval of ex-president Trump, is viewed as an intervening variable that influences both types of science rejection. Trumpism itself is predicted by age, race, evangelical religion, ideology, and receptivity to seemingly non-political conspiracy beliefs. Considering direct as well as indirect effects (through Trumpism), climate change and vaccine rejection are similarly predicted by white and evangelical identity, conspiracism, and by education×ideology and friends×party interactions. The finding that Trumpism exacerbates science rejection could also apply to other science- and expertise-related topics unrelated to climate and COVID. These results invite broader comparisons across topics, with analogous movements in other countries, and continued tracking as US Trumpism evolves beyond Trump.

The impact of chewing khat during pregnancy on selected pregnancy outcomes in eastern Ethiopia: A cohort study with a generalized structural equation modeling analysis approach.

Little is known about the fetal and pregnancy effects of khat chewing during pregnancy. The aim of the current study was to determine the impact of chewing khat during pregnancy on selected pregnancy outcomes in Ethiopia, 2022: A Cohort Study with a Generalized Structural Equation Modeling Analysis Approach. An institution-based prospective cohort study was employed in selected hospitals in eastern Ethiopia. Pregnant women who visited the selected hospitals in the study area during the study period that fulfilled the eligibility criteria were included until a sample size (344) was fulfilled. The main outcomes studied in the present study were preterm birth and low birth weight. Data were collected through anthropometric and clinical measurements, and interviewers administered questionnaires. The survival analysis and generalized linear model analysis were performed to estimate the crude and adjusted relative risk and attributable risk. The Generalized Structural Equation Modeling (GSEM) analysis was performed using the Statistical software for data science (Stata) 'GSEM' command to examine the mediation effect. The risk of occurrence of preterm birth was significantly higher among khat chewers [adjusted relative risk (aRR) = 2.19; 95%CI 1.21-3.96]. In further analysis after adjusting for gestational hypertension and cesarean delivery, the regression coefficient of khat chewing during pregnancy on preterm birth has been decreased in size from path n, β = 0.37, p<0.001 to path n', β = 0.15, p<0.005. The risk of occurrence of low birth weight among khat chewers was significantly higher (aRR = 4.17; 95%CI 2.11-8.25). In further analysis after adjusting for gestational hypertension, cesarean delivery, preterm birth and maternal anemia, the regression coefficient of khat chewing during pregnancy on low birth weight has been decreased in size from path q, β = 0.4, p<0.001 to path q', β = 0.2, p<0.001. Overall, the present study revealed that khat chewing is not only a worry of the current population but also a public health concern of the generation affecting unborn fetuses.

The Impact of Biological and Social Factors on Mortality in Older Adults Living in Rural Communities.

Information on factors that increase mortality in remote settings is limited. This study aims to estimate the independent and joint role of several factors on mortality risk among older adults living in rural Ecuador. Participants were selected from community-dwelling older adults who were included in previous studies targeting mortality risk factors in the study population. Generalized structural equation modeling (GSEM) was utilized to evaluate prior causal assumptions, to redraw causal links, and to introduce latent variables that may help to explain how the independently significant variables are associated with mortality. The study included 590 individuals (mean age: 67.9 ± 7.3 years; 57% women), followed for a median of 8.2 years. Mortality rate was 3.4 per 100 person-years. Prior work on separate multivariate Poisson and Cox models was used to build a tentative causal construct. A GSEM containing all variables showed that age, symptoms of depression, high social risk, high fasting glucose, a history of overt stroke, and neck circumference were directly associated with mortality. Two latent variables were introduced, 1 representing the impact of biological factors and another, the impact of social factors on mortality. The social variable significantly influenced the biological variable which carried most of the direct effect on mortality. Several factors contributed to mortality risk in the study population, the most significant being biological factors which are highly influenced by social factors. High social risk interact with biological variables and play an important role in mortality risk.

Impact of Limited English Proficiency on Medication-Related Problems and Emergency Room Visits Among Community-Dwelling Older People.

Background Older people have higher risk of experiencing medication-related problems (MRPs), leading to increased morbidity, health care use, and mortality. Few studies have examined the pathway between limited English proficiency (LEP) among older people and health service use through MRPs. Objective This study aimed to explore the association of LEP among Latino older people with MRPs and their relationship to emergency room (ER) visits. Methods Researchers used secondary enrollment data from a community medication program for older people (N = 180). Researchers conducted linear regression to examine the relationship between ethnicity/English proficiency and MRPs, and logistic regression to explore the association between MRPs and ER visits. Generalized structural equation modeling (GSEM) with bootstrapping was used to test the indirect effect between LEP Latino through MRPs to ER visits. Results The sample included 70% non-Latino participants, 12% English-speaking Latinos, and 18% LEP Latinos. Analysis LEP Latinos were associated with having 3.4 more MRPs than non-Latino participants, after controlling for covariates. Additionally, each additional MRP was associated with a 10% increased probability of having an ER visit. The GSEM results illustrated there was a significant indirect effect between LEP through MRPs to ER visits (β = 0.27, 95% CI 0.07-0.61). Conclusion Though LEP was not directly related to increased ER visits, it may have inhibited the ability of Latinos to read and understand medication instructions, contributing to their elevated risk of experiencing MRPs, thus indirectly increasing potential risks of having ER visits.

Association between residential environment and emotional wellbeing among older adults in China: the mediating effect of health lifestyle.

The association between the residential environment and emotional wellbeing (EWB) in older adults has received extensive attention from gerontologists, especially during the COVID-19 pandemic; however, the mediating mechanism of how residential environment affects emotional wellbeing has not been fully explored. This study examined the effects of the residential environment on EWB and the mediating role of health lifestyle. This study analyzed the survey data of 493 rural and 515 urban older adults from 2021 Chinese General Social Survey. General linear regression and structural equation models were used to examine the effects of residential environment and health lifestyle. Urban participants exhibited clear advantages in EWB, residential environment, and physical activity. Residential environment significantly affected the EWB of older adults, and health lifestyle played a mediating role in this relationship. The residential environment and health lifestyle did not significantly affect EWB in rural participants. This study revealed differences in the effects of health lifestyles and residential environments on EWB among older adults in rural and urban settings in China. This study provided empirical evidence of mental health disparities between older rural and urban Chinese residents.

Green signals: The impact of environmental protection support policies on firms' green innovation

AbstractThe importance of government environmental financial incentives in stimulating firms' green innovation has long been recognized. However, researchers have yet to fully determine how a small amount of financial incentives can be used to promote expensive green innovation. Unlike prior studies based on the investigation of direct effects, this study provides a new perspective by employing signaling theory. Focusing on environmental protection support policy (EPSP) in China, it employs ordinary least squares (OLS) regression and generalized structural equation modeling (GSEM) to analyze a sample of panel data from China's A‐share listed companies from 2003 to 2020. The results suggest that EPSP funding can serve as a green signal that helps firms acquire external resources for green innovation. The results of this study enhance our understanding of the role that government financial incentives play in firms' green innovation and inform policymakers on how to formulate effective environmental policies.

Spousal religious difference, marital satisfaction, and psychological well‐being of Chinese older adults

AbstractObjectivesThis study aims to explore the associations between spousal religious difference (one religious and one nonreligious), marital satisfaction, and the psychological well‐being of middle‐aged and older Chinese adults.BackgroundBoth religion and marital relationships are critical in coping with aging‐related challenges.MethodWe adopted the China Health and Retirement Longitudinal Study (CHARLS) data, which collected a nationally representative sample of Chinese people over 45 years old. The sample included 1,285 adults (714 men and 571 women). Descriptive statistics, multiple regression models, and a path analysis based on generalized structural equation modeling (GSEM) were adopted.ResultsWives' marital satisfaction mediated spousal religious difference and psychological well‐being, including depression and life satisfaction. Marital satisfaction was associated with depression and life satisfaction for both genders, and wives' marital satisfaction had a stronger association with life satisfaction than husbands'.ConclusionsSpousal religious difference has significant negative associations with marital satisfaction and psychological well‐being among middle‐aged and older people in China, especially among women.ImplicationBased on the results of this study, further research is needed to focus on the individual and interpersonal outcomes of religiosity in middle‐aged and older adults. In family therapy involving couples with different religious affiliations, counselors should pay attention to gender differences and prioritize addressing wives' marital satisfaction. Additionally, policies and services should also recognize the significant role of wives' marital satisfaction in the well‐being of such couples.

Can Knowledge, Responsibility and Environmentalism Explain Preference Heterogeneity? A Latent-Class Probit Model Analysis for Plastic Pollution Abatement

This study explores the impact of prior experiences, environmental concern and awareness levels on pro-environmental behavior in the context of mitigation of plastic pollution. Using survey and geo-location data after a tsunami and a monsoon season, this survey employs a latent class analysis through a Generalized Structural Equation Model (GSEM) to identify similarities between groups’ willingness to pay (WTP) to mitigate macroplastic pollution in riverbeds and beaches in Indonesia. Results show that more environmentally-conscious respondents were also more sensitive to the issue of pollution while having observed more plastic pollution also increases support for pollution mitigation. Proximity to polluted waterways also increased WTP, especially to urban participants. Overall, accounting for prior experiences, environmental concern and awareness levels does lead to statistical differences between classes, with those scoring higher in these categories being also more willing to monetarily contribute to mitigate that issue. The use of such an integrated latent class model (LCM) can help with disentangling drivers of preferences, especially in the context of determining levels of support for pollution abatement in a developing country.