Hierarchical Multiple Logistic Regression Research Articles

Clarifying the importance and moderating roles of temporal self-regulation theory across behaviour types

Objectives The aim of this study was to explore the utility of temporal self-regulation theory across four behaviours differing in complexity and approach or avoidance nature. Specifically, we explored if intention, habit, cues, self-regulation (disorganisation, coping planning, task switching, present orientation, sensation seeking, automaticity, planning and distractibility) and interactions between constructs could account for variance in fruit consumption, unhealthy snacking, walking and recycling. Methods and Measures Two hundred and fifty-four participants completed a two-part online survey measuring theory constructs at time one and behaviours at time two. Data was analysed using hierarchical multiple regression and binary logistic regression analyses. Results Findings partially support the theory with differential importance of constructs across behaviours. Intention, habit, sensation seeking and automaticity significantly predicted fruit consumption. Intention and cues significantly predicted unhealthy snacking. There were no significant predictors of walking. Habit, present orientation, sensation seeking, and interactions between intention and sensation seeking, and intention and planning significantly predicted recycling. Conclusion Findings may help develop future frameworks to guide research and tailored interventions using the theory according to behaviour type. Behavioural pathways suggested in the theory may be reconsidered, or other constructs could be included as extensions of the model to improve the theory’s utility.

Engaging healthcare teams to increase access to medications for opioid use disorder.

To assess the effectiveness of evidence-based quality improvement (EBQI) as an implementation strategy to expand the use of medications for opioid use disorder (MOUD) within nonspecialty settings. We studied eight facilities in one Veteran Health Administration (VHA) region from October 2015 to September 2022 using administrative data. Initially a pilot, we sequentially engaged seven of eight facilities from April 2018 to September 2022 using EBQI, consisting of multilevel stakeholder engagement, technical support, practice facilitation, and data feedback. We established facility-level interdisciplinary quality improvement (QI) teams and a regional-level cross-facility collaborative. We used a nonrandomized stepped wedge design with repeated cross sections to accommodate the phased implementation. Using aggregate facility-level data from October 2015 to September 2022, we analyzed changes in patients receiving MOUD using hierarchical multiple logistic regression. Eligible patients had an opioid use disorder (OUD) diagnosis from an outpatient or inpatient visit in the previous year. Receiving MOUD was defined as having been prescribed an opioid agonist or antagonist treatment or a visit to an opioid substitution clinic. The probability of patients with OUD receiving MOUD improved significantly over time for all eight facilities (average marginal effect [AME]: 0.0057, 95% CI: 0.0044, 0.0070) due to ongoing VHA initiatives, with the probability of receiving MOUD increasing by 0.577 percentage points, on average, each quarter, totaling 16 percentage points during the evaluation period. The seven facilities engaging in EBQI experienced, on average, an additional 5.25 percentage point increase in the probability of receiving MOUD (AME: 0.0525, 95%CI: 0.0280, 0.0769). EBQI duration was not associated with changes. EBQI was effective for expanding access to MOUD in nonspecialty settings, resulting in increases in patients receiving MOUD exceeding those associated with temporal trends. Additional research is needed due to recent MOUD expansion legislation.

Assessing COVID-19 Vulnerability Among HIV-positive Men Who Have Sex With Men in Korea: The Role of Vaccination and Sexual Behaviors.

Comorbidities increase susceptibility to severe coronavirus disease 2019 (COVID-19) infections, but limited information has been published regarding human immunodeficiency virus (HIV) and COVID-19 co-infections. This study explored the relationships among socioeconomic characteristics, sexual behaviors, and COVID-19 infection rates among Korean men who have sex with men (MSM) who are also living with HIV. Data were collected through a web survey aimed at members of the largest gay portal site in Korea, supported by the National Research Foundation of Korea (n=1005). The primary independent variables included COVID-19-related vaccinations and sexual behaviors. The dependent variable was the incidence of COVID-19 infection among respondents during the pandemic. For statistical analysis, hierarchical multiple logistic regression was performed, controlling for potential confounding variables. Model I indicated that older MSM were less likely to contract COVID-19 (adjusted odds ratio [aOR], 0.98; 95% confidence interval [CI], 0.96 to 0.99). Model II demonstrated that HIV-positive MSM were nearly twice as likely to be infected with COVID-19 compared to their HIV-negative counterparts (aOR, 1.97; 95% CI, 1.14 to 3.41). Furthermore, even after accounting for COVID-19 vaccination status in model III, HIV-positive MSM continued to show a higher risk of infection (aOR, 1.93; 95% CI, 1.12 to 3.35). The findings of this study indicate that HIV-positive MSM are at an increased risk of contracting COVID-19, even when their vaccination status is considered. Therefore, it is essential to prioritize the prevention of COVID-19 infections in HIV-positive individuals by administering appropriate antiretroviral therapy and ensuring adherence to public health guidelines.

The association between potential predictors and death of patients during the COVID-19 pandemic in Shiraz: a hierarchical multiple regression analysis

IntroductionIdentifying clinical factors that increase the risk of mortality in COVID-19 patients is crucial. This enables targeted screening, optimizing treatment, and prevention of severe complications, ultimately reducing death rates. This study aimed to develop prediction models for the death of patients (i.e., survival or death) during the COVID-19 pandemic in Shiraz, exploring the main influencing factors.MethodWe conducted a retrospective cohort study using hospital-based records of 1030 individuals diagnosed with COVID-19, who were hospitalized for treatment between March 21, 2021, and March 21, 2022, in Shiraz, Iran. Variables related to the final outcome were selected based on criteria and univariate logistic regression. Hierarchical multiple logistic regression and classification and regression tree (CART) models were utilized to explore the relationships between potential influencing factors and the final outcome. Additionally, methods were employed to identify the high-risk population for increased mortality rates during COVID-19. Finally, accuracy was evaluated the performance of the models, with the area under the receiver operator characteristic curve(AUC), sensitivity, and specificity metrics.ResultsIn this study, 558 (54.2%) individuals infected with COVID-19 died. The final model showed that the type of medicine antiviral (OR: 11.10, p = 0.038) than reference (antiviral and corticosteroid), and discharge oxygen saturation(O2) (OR: 1.10, p < 0.001) had a positive association with the chance of survival, but other variables were not considered as predictive variables. Predictive models for the final outcome(death) achieved accuracies ranging from 81 to 87% for hierarchical multiple logistic regression and from 87 to 94% for the CART model. Therefore, the CART model performed better than the hirerical multiple logistic regression model.ConclusionThese findings firstly elucidate the incidence and associated factors of the outcome (death) among patients in Shiraz, Iran. Furthermore, we demonstrated that antiviral medication alone (without corticosteroids) and high O2 increase the survival chances of COVID patients.

Association between Levels of Loneliness, Laboratory Measurements, and Behavioral Aspects in a Primary Care Setting in Crete, Greece.

This paper examines potential associations of loneliness with laboratory data and specific psychosocial and behavioral attitudes. The sample collection took place in an urban Primary Health Care unit between May and July 2023, consecutively, and once exclusion criteria were implemented. Participants were aged between 40 and 75 years. Routine laboratory test results upon study initiation and six months before were used. The University of California, Los Angeles (UCLA), Loneliness Scale (Version 3), blood glucose, serum lipids, Fibrosis-4 index, and Creatinine Clearance (CrCl) were assessed through hierarchical multiple logistic regression analysis. Based on full model (3rd) analysis, those who were engaged in an individual sport or activity or had contacts with more friends presented significantly lower odds for increased loneliness levels (odds ratio (OR): 0.28 [95% confidence interval (CI) 0.09-0.91], p = 0.034 and OR: 0.76 [95%CI 0.66-0.88], p < 0.001, respectively). The consumption of alcohol was associated with increased loneliness (OR: 5.55 [95%CI 1.42-21.63], p = 0.014). Elevated triglyceride levels were linked with moderate or no loneliness (OR: 0.20 [95%CI 0.05-0.83], p = 0.026), while an increased LDL/HDL atherosclerotic index was related to increased subjective loneliness (OR: 4.50 [95%CI 1.12-18.13], p = 0.035). The need for holistic approaches-involving primary care personnel-in understanding and addressing loneliness, recognizing its multifaceted nature as well as the diverse factors that contribute to this issue, is considered challenging.

The effect of perceived social support and health literacy on parental COVID-19 vaccine hesitation in preschool children: a cross-sectional study

Children are generally susceptible to COVID-19, and infection with COVID-19 may cause serious harm to children. COVID-19 vaccination is an effective way to prevent infection at present, and many factors affect children's COVID-19 vaccination. This study aimed to explore the effects of perceived social support and health literacy on hesitancy towards first and second vaccine dose. This cross-sectional study was conducted in the Minhang District of Shanghai, China, in October 2022. A total of 1150 parents of preschool children from 10 kindergartens participated. The survey encompassed four sections, capturing data on sociodemographic attributes, health literacy, perceived social support, and parental COVID-19 vaccine hesitancy. Health literacy was measured using a self-designed questionnaire consisting of four dimensions. Perceived social support was assessed using the MSPSS questionnaire. Hierarchical multiple logistic regression was used to examine the relationship between the independent variables and parental hesitancy towards the first and second doses of COVID-19 vaccine. Parental hesitancy rate for the first dose of the COVID-19 vaccine was 69.6%, and for the second dose, it was 33.1%. The final integrated model showed that parental hesitancy towards the first and the second dose of COVID-19 vaccine was associated with parental educational level, allergy in children, information decision-making and information comprehension ability, perceived social support from family and friends. Health literacy and perceived social support are influence factors for parental hesitancy towards COVID-19 vaccine for preschool children. The findings will provide insights for future intervention studies on COVID-19 vaccine hesitancy and inform the development of vaccination policies.

Childhood trauma and major depression in Chinese college students: mediating role of Internet addiction and victimization of domestic violence

Aim: Major depression disorder in adolescents has received much attention around the world. While the factors correlated with major depression in adolescents have been extensively described, the mechanisms underlying the complexity of the relationship between childhood traumatic experiences and major depression have been less studied. This study investigated both the direct influence of childhood trauma on major depression and whether the mediation of domestic violence victimization and Internet addiction played a role in connecting childhood trauma to major depression. Method: The school-based mental health survey was conducted in April 2023 in northeast Chinas Heilongjiang Province. We collected sociodemographic information and targeted mental health outcomes with standardized questionnaires. Hierarchical multiple logistic regression and structural equation modeling were used to analyze the data. Results: The study included 596 college students. The prevalence of major depression and Internet addiction was 31.2% and 21.6%, respectively. 16.4% of participants reported experiences of childhood trauma and 12.8% reported being victims of domestic violence. Childhood trauma, domestic violence victimization and Internet addiction have direct effects on major depression. The total effect of childhood trauma on suicidal ideation was 0.201 (p &amp;lt; 0.001). Domestic violence victimization and Internet addiction play mediating roles between childhood trauma and depression. Internet addiction plays a mediating role between domestic violence and major depression. Childhood trauma has direct and indirect effects on major depression of college students. Domestic violence victimization and Internet addiction play mediating roles in major depression of college students. Understanding these relationships will help develop and implement more targeted interventions and strategies to improve the mental health of Chinese college students.

LGBTQ+ related curricular activities in Brazilian Dental Schools: Do institutional and/or deans' profiles matter?

The aim of this cross-sectional study was to investigate whether the characteristics of dental schools and the profiles of their deans were associated with curricular activities related to LGBTQ+ in Brazilian dental schools. A survey was mailed to the deans of all Brazilian dental schools for the purpose of assessing the development of pedagogical activities focused on the topic of oral health of the LGBTQ+ population, and the characteristics of the institutions and profiles of their deans. The data collected were analyzed with hierarchical multiple logistic regression models in order to analyze associations between variables of interest. Of the deans approached, 156 (response rate of approximately 32.4%) completed and returned the survey. The majority of dental schools (67.3%) of the sample were private institutions and 39% of them developed pedagogical activities directed toward the LGBTQ+. This percentage was much lower in public institutions (18%). The results of the hierarchical multiple logistic regression demonstrated that deans who attributed high relevance to the theme "oral health of the LGBTQ+ population" were more likely to develop pedagogical activities directed toward the LGBTQ+ population (odds ratio=4.74; 95% confidence interval: 1.65-13.48), than those who attributed low or little importance to this topic (p<0.05). A low percentage of activities aimed at the LGBTQ+ population was observed in the sample of Brazilian dental schools. Deans must be aware of the importance of the topic and be motivated to implement pedagogical activities for this population.

Factors associated with concurrent alcohol, tobacco and illicit drug use: 2019 National School-Based Health Survey.

The aim of this study was to analyze the factors associated with concurrent alcohol, tobacco and illicit drug use among Brazilian schoolchildren aged 13-17. We conducted a cross-sectional study using data from the 2019 National School-Based Health Survey. The outcome was use of the three substances during the last 30 days. Hierarchical multiple logistic regression was carried out with independent variables grouped into four blocks: sociodemographic characteristics; family context; behavioral aspects; and stressors. Variables with p<0.05 were retained in the final model. The prevalence of concurrent substance use was 3.3%. Being male, living in the Midwest, South and Southeast, skipping school without parent permission, parents not knowing what their children do in their free time, having parents who smoke, having experienced physical aggression from parents, feeling that life is not worth living, trying drinking and illicit drugs before the age of 13, and having friends who drink alcohol, smoke and use drugs in their presence remained associated with the outcome in the final model. The findings reveal high prevalence of concurrent alcohol, cigarette and illicit drug use among adolescents and that poly use is associated with sociodemographic, family, and behavioral factors and stressors.

Fatores associados ao policonsumo de álcool, tabaco e drogas ilícitas: Pesquisa Nacional de Saúde do Escolar 2019

Abstract The aim of this study was to analyze the factors associated with concurrent alcohol, tobacco and illicit drug use among Brazilian schoolchildren aged 13-17. We conducted a cross-sectional study using data from the 2019 National School-Based Health Survey. The outcome was use of the three substances during the last 30 days. Hierarchical multiple logistic regression was carried out with independent variables grouped into four blocks: sociodemographic characteristics; family context; behavioral aspects; and stressors. Variables with p&lt;0.05 were retained in the final model. The prevalence of concurrent substance use was 3.3%. Being male, living in the Midwest, South and Southeast, skipping school without parent permission, parents not knowing what their children do in their free time, having parents who smoke, having experienced physical aggression from parents, feeling that life is not worth living, trying drinking and illicit drugs before the age of 13, and having friends who drink alcohol, smoke and use drugs in their presence remained associated with the outcome in the final model. The findings reveal high prevalence of concurrent alcohol, cigarette and illicit drug use among adolescents and that poly use is associated with sociodemographic, family, and behavioral factors and stressors.

Oral health-related quality of life in the LGBTIQ+ population: a cross-sectional study.

The aim of this cross-sectional study was to investigate the associations between oral health-related quality of life (OHRQoL) and socioeconomic and demographic variables, suicidal ideation, self-perception of oral health, and experiences of dental care in the Brazilian adult LGBTIQ+ population. A sample of 464 participants completed self-administered online questionnaires and provided information for OHRQoL assessment, using the OHIP-14 instrument at three hierarchical levels of explanatory variables: LGBTIQ+ identities; socioeconomic and demographic data and existential suffering; and self-perception of oral health and experience of dental care. The collected data were fitted to hierarchical multiple logistic regression models, in which the associations between each independent variable with the OHIP-14 prevalence outcome were analyzed. The OHIP-14-prevalence index showed that 33.2% of the participants answered 'frequently' or 'always', and the highest frequencies were obtained for the psychological discomfort (27.8%), psychological disability (18.3%), and physical pain (17.5%) domains. According to the adjusted final model, LGBTIQ+ individuals who were more likely to have their OHRQoL affected were those who were indifferent (OR=3.21; 95% CI: 1.26-8.20), dissatisfied (OR=10.45; 95% CI: 3.86-28.26), or very dissatisfied (OR=53.93; 95% CI: 12.12-239.93) with their oral health status, and also those who had or have difficulty accessing dental treatment (OR=2.06; 95% CI: 1.24-3.41) (p<0.05). It may be concluded that the OHRQoL of the investigated Brazilian LGBTIQ+ population showed associations with individual aspects and with access to dental services.

Diabetes knowledge predicts HbA1c levels of people with type 2 diabetes mellitus in rural China: a ten-month follow-up study

Improving diabetes self-management (DSM) is facing real-world challenges among people with type 2 diabetes mellitus (T2DM) who have a low education level in resource-limited areas. This study aimed to investigate whether diabetes knowledge could predict glycemic levels in people with T2DM in rural China. This analytical cross-sectional study recruited 321 people with T2DM from eight villages by purposive sampling at baseline. After 10 months, 206 patients completed the follow-up survey and HbA1c tests, with a response rate of 64.17% (206/321). Multiple regression analysis was employed to explore the correlation between diabetes knowledge and HbA1c levels. The patient's diabetes knowledge was significantly negatively correlated with HbA1c levels before and after controlling for covariates in both hierarchical multiple regression and multiple logistic regression (p < 0.01). In addition, other influencing factors, including sex, age, marital status, employment status, income, and HbA1c levels at baseline, were also identified. Diabetes knowledge could predict HbA1c levels significantly among patients with low education levels in rural China. Therefore, interventions on improving diabetes knowledge need to be strengthened for patients in rural China so that they can improve their health outcomes and reduce the disease burden.

Contestation but not Euroscepticism: economic and security concerns and the fear of losing national traditions in Georgia

ABSTRACT This paper examines the role of utilitarian, political, and cultural/identity-based factors of Euroscepticism on a nationwide representative sample of ethnic Georgians. Hierarchical multiple logistic regression showed that for ethnic Georgians, utilitarian factors are the strongest predictors of support for the EU integration, followed by cultural/identity and political variables, supporting the rational choice theory. These predictors are, in turn, anteceded by popular perceptions of the EU in Georgia. Mediation analysis revealed that the perception of the EU as a source of peace and security precedes the hope for an increase in national security with its support (political predictor). Likewise, the perception of the EU as a champion of economic development antecedes the hope for reduced poverty in Georgia (utilitarian predictor). On the other hand, the perception of the EU as a threat to national traditions does not predict Euroscepticism. We elaborate on this result through an examination of the current political atmosphere of Georgia, where we determine that fears of losing national traditions are outweighed by fears of economic and political insecurity.

Parents’ intention to vaccinate their preschool children against COVID-19: Combining the health belief model and the theory of planned behavior

ABSTRACT The vaccination rate of COVID-19 in preschool children is low, and parents’ intention to vaccinate their children is also low due to multiple factors. This study aimed to establish an integrated model based on the Health Belief Model (HBM)and Theory of Planned Behavior (TPB), to explore the factors influencing parents’ intention to vaccinate their preschool children with the first and second doses of COVID-19 vaccines. A total of 1264 parents of preschool children from 10 kindergartens participated in this study. Hierarchical multiple logistic regression was used to analyze the intention separately. For the integrated model with the first dose of vaccine of COVID-19, introducing the HBM variable in model 1 explained 33.98% of the variance (F = 398.71, p < .001), then upon adding the TPB variable in model 2, the explanation of variance increased to 41.93% (F = 491.94, p < .001) and parents’ intention were associated with their perceived barriers, cues to action, and subjective norms. For the integrated model with the second dose of vaccine of COVID-19, introducing the HBM variable in Model 1 explained 23.76% of the variance (F = 68.82, p < .001), then upon adding the TPB variable in model 2, the explanation of variance increased to 26.67% (F = 77.24, p < .001), and parents’ intention was associated with cues to action and subjective norms. The combination of the two theories improves the explanatory power of parents’ intention to vaccinate their preschool children against COVID-19, and provides a basis for the development of effective interventions for vaccination of COVID-19 for preschool children.

Behavioral predictors associated with HIV screening needs in gay Korean men during the COVID-19 pandemic.

During the pandemic, the capacity of medical resources focused on testing, diagnosing and treating COVID-19 has severely limited public access to health care. In particular, HIV screening, for which homosexual males in Korea received free and anonymous testing at public health centers, was completely halted. This study investigated behavioral predictors related to the HIV screening needs of Korean male homosexuals during the pandemic. Data were collected by conducting a web survey targeting members of the largest homosexual portal site in Korea with support from the National Research Foundation of Korea (n = 1,005). The key independent variables are COVID-19-related characteristics and sexual risk behavior. The moderating variable is health information search behavior, and the dependent variable is the need for HIV screening. For a statistical analysis, a hierarchical multiple logistic regression analysis was conducted while controlling for potential confounding variables. According to the results of this study, the need for HIV screening was 0.928 times lower for older people (p<0.05, 95% CI = 0.966-0.998). However, if the respondent had a primary partner, the need for HIV screening was 1.459 times higher (p<0.01, 95% CI = 1.071-1.989). In addition, the need for screening was 1.773 times higher for those who preferred anal intercourse (p<0.01, 95% CI = 1.261-2.494) and 2.034 times higher (p<0.01, 95% CI = 1.337-3.095) if there was a history of being diagnosed with an STD. Finally, health information-seeking behavior was marginally significant. This study revealed that male Korean homosexuals who were young, preferred anal sex with a primary partner, and who had a history of a sexually transmitted disease had a high need for HIV screening at public health centers. They are more likely to be susceptible to HIV infection because they are usually consistent with gay men, characterized by risky behavior. Therefore, an intervention strategy that provides health information using a communication campaign is needed.

An assessment of self-rated life satisfaction and its correlates with physical, mental and social health status among older adults in India

Life satisfaction refers to the assessment of one’s own life in terms of self-perceived favourable qualities. It is an integral part of healthy and successful course of ageing. It is widely associated with the health status and social well-being. The present study attempted to determine the constructing factors of self-rated life satisfaction, such as socio-demographic, physical, social, and mental well-being of older adults. We analysed information from the Longitudinal Ageing Study in India (LASI-1), the initial phase conducted during 2017–18 for the population of older adults in India. We applied descriptive statistics for prevalence assessment and association was checked using chi-square test. Further, to determine the adjusted outcome of predictor covariates on the likelihood of an individual being satisfied from life estimated by applying hierarchical multiple logistic regression models. Several noteworthy affirmations on the relationship between the socio-demographic variables and health risk behaviours with life satisfaction were observed. The results were consistent with studies showing change in life satisfaction subject to the state of physical and mental health, presence of chronic diseases, friends and family relations, dependency, and events of trauma or abuse. While comparing respondents, we found varying degrees of life satisfaction by gender, education, marital status, expenditure and other socio-economic features. We also found that besides physical and mental health, social support and well-being play a pivotal role in achieving higher life satisfaction among older adults. Overall, this work contributes to the study of the subjective well-being of older adults in India based on self-reported levels of life satisfaction and further narrows the gap in knowledge about associated behaviour. Hence, with on-going ageing scenario, there is need for multi-sectorial policy-oriented approaches at individual, family, and community level, which helps to take care of older-adults’ physical, social, and mental health for the betterment of healthy ageing.

Associations between Patient Experience and Addiction Treatment Facility Services: Results of the Addiction Treatment Locator, Assessment, and Standards Surveys.

Patient experience and presence of evidence-based facility services are 2 dimensions of assessing quality of addiction treatment facilities. However, the relationship between these two is not well described. The objective of this study was to explore associations between patient experience measures and service offerings at addiction treatment facilities. We used data from cross-sectional surveys of addiction treatment facilities and persons involved in treatment at corresponding facilities to identify facility services (eg, availability of medications for alcohol use disorder, assistance with obtaining social services, etc) and patient experience measures (overall facility rating, extent helped by treatment, ability to deal with daily problems after treatment), respectively. We used hierarchical multiple logistic regression to test for associations between top-box scores for each patient experience outcome and facility services. We analyzed 9191 patient experience surveys from 149 facilities. Assistance with obtaining social services (adjusted odds ratio [95% confidence interval], 0.43 [0.28-0.66]) was associated with lower overall treatment facility ratings. Childcare (2.00 [1.04-3.84]) was associated with top-box scores for extent helped. Availability of cognitive behavioral therapy (2.67 [1.25-5.73]) and childcare (1.77 [1.08-2.92]) were associated with top-box scores for ability to deal with daily problems after treatment. Assistance with obtaining social services (0.61 [0.41-0.90]) was associated with lower scores for ability to deal with problems after treatment. Few addiction treatment facility services were associated with patient experience measures. Future work should explore bridging the gap between evidence-based services and positive patient experiences.

Ecological Factors of Telemental Healthcare Utilization Among Adolescents with Increased Substance Use During the COVID-19 Pandemic: The Moderating Effect of Gender.

Adolescent substance use is often associated with concurrent mental health problems (e.g., depression, suicide attempts, parental emotional and physical abuse, not feeling close to people at school, and lower virtual connectedness) at multiple ecological levels. This study examined whether such risk factors among adolescents were associated with the use of telemental healthcare (TMHC) and whether gender moderated these associations. Data were drawn from the Adolescent Behaviors and Experiences Survey, collected by the U.S. Centers for Disease Control and Prevention from January to June 2021. A hierarchical multiple logistic regression analysis was conducted using a national sample of 1,460 students in Grades 9-12 in the United States who reported having used more alcohol and/or drugs during the pandemic than before it started. The results showed that only 15.3% of students sought TMHC. Students reporting increased substance use during the pandemic were more likely to use TMHC if they experienced more severe mental health problems (e.g., suicide attempts) compared to other ecological factors, such as issues with their family, school, or community. Analysis of the moderating effect showed that the closer male students felt to people at school, the more likely they were to seek TMHC, whereas the opposite was true for female students. The findings highlighted that feeling close to people at school is an important aspect of understanding the help-seeking behavior of female and male adolescent substance users.

A moderated mediation analysis of the association between smoking and suicide attempts among adolescents in 28 countries

Globally, evidence has shown that many adolescents are victims of substance use, mainly cigarette smoking, and it has been associated with suicidal ideation. However, the mechanisms underlying this association are poorly understood. This study examines whether truancy mediates and gender moderates the association of cigarette smoking with suicide attempts among adolescents in 28 countries. Data from the Global School-Based Student Health Survey were used. Hierarchical multiple logistic regression analyses were used to estimate the effect-modification of gender on cigarette smoking and suicide attempt. The mediating effect of truancy on the association between cigarette smoking and suicidal attempt was assessed using the generalized decomposition method. Cigarette smoking was associated with suicide attempts after adjusting for several confounding variables (aOR = 1.21; 95% CI = 1.09–1.33). The bootstrap results from the generalized decomposition analysis indicated that truancy partially mediated the association of cigarette smoking with a suicide attempt, contributing 21% of the total effect among in-school adolescents. Hierarchical regression analyses suggested that gender moderated the effect of cigarette smoking on suicidal attempts: female adolescents who smoked had 36% higher odds of suicidal attempts compared to male adolescents. The findings suggest possible pathways for designing and implementing interventions to address adolescents' cigarette smoking and truancy to prevent suicidal attempts.

Risk factors for perinatal death in high-risk pregnant women at a tertiary hospital in Curitiba-PR, Brazil: a case-control study

A case-control study was carried out to estimate risk factors for perinatal mortality in a referral hospital for high-risk pregnancies in Curitiba-PR. Sociodemographic, maternal, pregnancy and concept characteristics data were obtained from the hospital records of 316 cases and 316 controls from 2013 to 2017. A hierarchical multiple logistic regression analysis was performed, remaining in the final model variables with p < 0.05. The results show an increased risk of perinatal death in mothers with blood type B (OR = 2.82; 95%CI: 1.07-7.43), who did not undergo prenatal care (OR = 30.78; 95%CI: 4.23-224.29), fetuses with congenital malformations (OR = 63.90; 95%CI: 27.32-149.48), born under 28 (OR = 24.21; 95%CI: 1, 10-531.81) and between 28-31 weeks of gestation (OR = 6.03; 95%CI: 1.34-27.17) and birth weight below 1,000g (OR = 51.94; 95%CI: 4.31-626.46), between 1,000-1,499g (OR = 11.17; 95%CI: 2.29-54.41) and between 1,500-2,499g (OR = 2.75; 25-6.06). Concepts of pregnancies with premature outcome, low birth weight and the presence of congenital malformations are the main risk factors for perinatal death. On the other hand, adequate prenatal care is an important protective factor.