Hierarchical Regression Research Articles

Impoverishing effects of out-of-pocket health payments in Malawi: a methodological comparison of spatial multilevel models, standard multilevel and logistic regression models using survey data

ABSTRACT Out-of-pocket health payments are payments made by households at a point of use of health services. Researchers often use single-level logistic models to examine factors associated with impoverishment due to health payments. However, single-level models fail to account for neighborhood correlation which exist in complex survey data. The paper compares spatial multilevel to standard multilevel and single-level logistic models in terms of performance of model estimates and fit. It uses data from Malawi integrated household survey collected from 12,447 households and simulated data. Mean squared error and percentage bias were used to compare performance. Deviance Information Criterion was used to assess model fit. The results show that spatial multilevel and standard multilevel models provide similar fixed parameter estimates when both within and between neighborhood correlation exist in data while single-level model provides biased estimates and poor fit. Households with at least one chronically ill member, at least one hospitalized member or located in rural areas were significantly more likely to face impoverishment. Researchers using complex survey data should be cautious as both within and between neighborhood correlation may exist in data and failure to account for spatial correlation may lead to biased estimates consequently wrong conclusions.

An Embodied Intelligence System for Coal Mine Safety Assessment Based on Multi-Level Large Language Models

Artificial intelligence (AI), particularly through advanced large language model (LLM) technologies, is reshaping coal mine safety assessment methods with its powerful cognitive capabilities. Given the dynamic, multi-source, and heterogeneous characteristics of data in typical mining scenarios, traditional manual assessment methods are limited in their information processing capacity and cost-effectiveness. This study addresses these challenges by proposing an embodied intelligent system for mine safety assessment based on multi-level large language models (LLMs) for multi-source sensor data. The system employs a multi-layer architecture implemented through multiple LLMs, enabling not only rapid and effective processing of multi-source sensor data but also enhanced environmental perception through physical interactions. By leveraging the tool invocation and reasoning capabilities of LLM in conjunction with a coal mine safety knowledge base, the system achieves logical inference, anomalous data detection, and potential safety risk prediction. Furthermore, its memory functionality ensures the learning and utilization of historical experiences, providing a solid foundation for continuous assessment processes. This study established a comprehensive experimental framework integrating numerical simulation, scenario simulation, and real-world testing to evaluate the system through embodied intelligence. Experimental results demonstrate that the system effectively processes sensor data and exhibits rapid, efficient safety assessment capabilities during embodied interactions, offering an innovative solution for coal mine safety.

Trajectories of Justice Involved Youth: Changing Risk and Protective Factors for Violence

Forensic interventions aim to mitigate risk, yet research on change measured through repeated risk assessment is scarce, particularly regarding protective factors. This study examined changes in risk and protective factors during intervention and the impact of change on violent recidivism. Trajectories of 175 male justice involved youth with a history of violence were modeled using multilevel mixture modelling. Findings reveal that youths abstaining from violence displayed fewer risk factors and more protective factors at discharge. Assessments at discharge predicted recidivism. Change scores on several SAVRY/SAPROF-YV subscales over time demonstrated incremental predictive validity above and beyond assessments at discharge, emphasizing the necessity of personalized interventions and considering individual change alongside one’s overall risk level to inform more effective interventions. These insights advocate for balanced approaches informed by repeated assessments encompassing both risk and protective factors.

Analyzing Predictive Factors for the Media’s Impact on the Nursing Profession

Introduction: Mass media play a crucial role not only in informing the public but also in shaping public perception, educating, and enhancing the visibility of various professions, including nursing. Despite being the most populous healthcare profession, nursing remains underrepresented in media coverage. This imbalance affects the social status of the nursing profession and its public perception. Methods: This cross-sectional study utilized a validated questionnaire with high internal reliability (Cronbach’s alpha coefficients) to assess nurses’ perceptions of the media’s role in society and the nursing profession. Data were collected from 203 participants using an online survey employing the snowball sampling method. Statistical analyses included Welch ANOVA, t-tests, and hierarchical regression to predict the importance of media education. Results: Participants demonstrated positive perceptions of the media’s societal influence but identified a lack of adequate representation of nurses. Younger nurses and those with higher education levels emphasized the need for media education. Regression analysis revealed that perceptions of the media’s power and self-assessed media competencies were significant predictors of valuing media education. Conclusions: The findings highlight the need for integrating media literacy training into nursing education to enhance professional visibility and public engagement. This can empower nurses to actively contribute to shaping their professional image and addressing public misconceptions. Future research should expand the sample size and explore diverse healthcare settings to validate these findings.

A multilevel analysis of green organizational support among hotel employees in Türkiye

This study tests the cross-level association between green organizational support (GOS) among team members, green team resilience (GTR), green work engagement (GWE), and pro-environmental behaviour (PEB). Data for this study came from 59 work groups and 372 individuals working in 14 hotels in Antalya, Türkiye. To account for the nested data structure, hierarchical linear modeling was employed using R programming language. The present research reveals that GOS directly and indirectly correlates with GTR, GWE, and PEB. In addition, GOS promotes GTR and fosters GWE and PEB. The authors infer that eco-friendly support provided by the organization to the hotel employees can facilitate the green resilience of teams and boost employees' GWE, consequently increasing individual-level PEB. Practitioners can utilize these insights to implement effective strategies that support environmental initiatives, improve team dynamics, and engage employees in sustainability efforts, thereby contributing to the overall environmental performance of hotels.

The impact of side and top arm techniques during the backstroke breakout phase on 15-meter swimming performance

Background Research on the swimming starts and turns in professional swimming has become increasingly refined. The breakout phase is a crucial transition from point between underwater and above-water movements. The side arm technique is commonly used during the backstroke breakout phase. However, some swimmers have also achieved good performance using the top arm technique. The impact of the two techniques during the backstroke breakout phase is yet to be explored. Purpose To compare the velocity and key angles differences between the side arm and top arm techniques and analyze their effect on the first 15-m performance after push-off. Methods The subjects were 16 high-level swimmers: eight males (20.4 ± 1.6 yr) and eight females (20.9 ± 1.7 yr). Of these, 14 were backstrokers or had individual medley as their primary event. The best performances in the history of the sport’s level World Aquatics Points are 682.1 ± 59.0 and 729.3 ± 41.5 for males and females, respectively. A within-subject design was used to test both the side arm and top arm techniques. Four underwater cameras were used to capture two-dimensional data from two perspectives, focusing on the breakout phase. A two-way ANOVA used to compare segment velocity, angles, and 15-m performance between the two genders and breakout techniques. Pearson’s correlation analysis was used to explore the relationship between segment velocity and 15-m performance, and hierarchical regression was employed to investigate the impact of breakout velocity on the 15-m performance. Results Both male and female swimmers exhibited a significantly faster top arm velocities of (1.72 ± 0.20 and 1.47 ± 0.16 m/s, respectively) compared to the side arm velocities (1.51 ± 0.23 and 1.29 ± 0.19 m/s, respectively) during the breakout phase. Additionally, significant differences were found between the two genders (F = 11.189, p = 0.002, η2 = 0.286) and breakout techniques (F = 8.014, p = 0.008, η2 = 0.223), with no interaction effect (F = 0.037, p = 0.849, η2 = 0.001). Furthermore, both male (R = −0.447, p = 0.109) and female (R = −0.555, p = 0.017) swimmers showed a moderate positive correlation between breakout velocity and 15-m performance, and the regression model indicated a significant impact on the 15-m performance. Conclusion The top arm technique during backstroke may offer a velocity advantage over the traditional side arm technique during the breakout phase, influencing 15-m performance. However, considering the short duration of the breakout phase, this advantage and its impact may need to be considered in conjunction with the smoothness of the transition to the subsequent phases.

A Retrospective Analysis Evaluating the Impact of Neighborhood Deprivation on Birth Weight in Phoenix, Arizona

Background: Health inequities begin before birth and are influenced by pregnancy conditions, race/ethnicity, social class, and environment. Research indicates that, in the United States, Black women are significantly more likely to have low-birth-weight babies compared to White women. Interestingly, Hispanic women in the United States do not experience this birth weight inequity. The reasons for this disparity remain unclear. Both Hispanic and Black women face discrimination, and this is often cited as a primary reason for the higher prevalence of low-birth-weight babies among Black women. One type of discrimination that is less examined is neighborhood deprivation. Method: This study systematically examined the impact of various sociodemographic and pregnancy predictors among 9607 women in Phoenix, Arizona. Using multilevel modeling, we analyzed whether neighborhood deprivation (using the Area Deprivation Index) influenced the association between demographic and pregnancy risk and protective factors on birth weight outcomes. Results: Consistent with prior research, we found that Black and Asian women had lower-birth-weight babies than White women, while Hispanic women did not show a significant difference from non-Hispanic women. Additionally, multilevel modeling suggested that increased neighborhood deprivation tends to exacerbate the impact of some risk factors (e.g., race) and reduce the impact of specific protective factors (e.g., gestational age) on birth weight. Conclusion: These findings suggest that both place and individual factors synergistically influence birth weight outcomes. Moreover, the results underscore the importance of targeting interventions to enhance resources among those who live in the most deprived neighborhoods.

Characteristics of vocal cues, facial action units, and emotions that distinguish high from low self-protection participants engaged in self-protective response to self-criticizing

IntroductionSelf-protection, also called protective anger or assertive anger, is a key factor in mental health. Thus, far, researchers have focused mainly on the qualitative analysis of self-protection.MethodsTherefore, we investigated facial action units, emotions, and vocal cues in low and high self-protective groups of participants in order to detect any differences. The total sample consisted of 239 participants. Using the Performance factor in the Short version of the Scale for Interpersonal Behavior (lower 15th percentile and upper 15th percentile) we selected 33 high self-protective participants (11 men, 22 women) and 25 low self-protective participants (eight men, 17 women). The self-protective dialogue was recorded using the two-chair technique script from Emotion Focused Therapy. The subsequent analysis was performed using iMotions software (for action units and emotions) and Praat software (for vocal cues of pitch and intensity). We used multilevel models in program R for the statistical analysis.ResultsCompared to low self-protective participants, high self-protective participants exhibited more contempt and fear and less surprise and joy. Compared to low self-protective participants, high self-protective participants expressed the action units the following action units less often: Mouth Open (AU25), Smile (AU12), Brow Raise (AU2), Cheek Raise (AU6), Inner Brow Raise (AU1), and more often Brow Furrow (AU4), Chin Raise (AU17), Smirk (AU12), Upper Lip Raise (AU10), and Nose Wrinkle (AU9). We found no differences between the two groups in the use of vocal cues.DiscussionThese findings bring us closer to understanding and diagnosing self-protection.

Multilevel Analysis Applied in High-Impact Environments: Causes and Effects of Firm and Political Activities During the Pandemic in the Restaurant Sector

The COVID-19 pandemic has meant a serious risk to the economic viability of companies and the sustainability of employment in the restaurant sector, a high-impact activity for the economy and employment in Mexico and Spain. This paper analyzes the causes of the prolonged and intense damage to companies and employees via multilevel analysis techniques and a qualitative, inductive methodology drawing on multiple sources. Research propositions posit that the sectoral structure, management practices, and institutional actions during and after the pandemic are predictors of recovery or continued losses. The balanced result of these three levels of analysis, in a severe crisis situation, such as the global pandemic, reveals that the combination of low institutional protection at the macro level, a hostile industry structure at the meso level, and a focus solely on economic sustainability as the primary business objective resulted in widespread resignation and put survival at risk, particularly for smaller companies and entrepreneurs. Analysis of the firms’ and stakeholders’ actions also shed light on the inter-relations, such as the negative effect of macro general policies on a fragmented, asymmetric meso level. Inter-relations among customers and firms’ behavior gave insights that could increase resilience before general critical events. Finally, the balanced results recommend a simultaneous effort from firms and policy makers to make possible a profound change while addressing the sector’s shortcomings. Firms’ effort in managing key assets, such as human capital, to acquire the capacity for the flexibility, adaptability, and innovation essential for change and renewal, must be endorsed by institutional support and customer recognition of the contributions of this singular service and cultural industry.

The role of spatial processing in verbal serial order working memory

Abstract In a sequence, at least two aspects of information—the identity of items and their serial order—are maintained and supported by distinct working memory (WM) capacities. Verbal serial order WM is modulated by spatial processing, reflected in the Spatial Position Association of Response Codes (SPoARC) effect—the left-beginning, right-end positional association between space and serial position of verbal WM memoranda. We investigated the individual differences in this modulation with both behavioral and neurobiological approaches. We administered a battery of seven behavioral tasks with 160 healthy adults and collected resting-state fMRI data from a subset of 25 participants. With a multilevel mixed-effects modeling approach, we found that the SPoARC effect’s magnitude predicts individual differences in verbal serial order WM capacity and is related to spatial item WM capacity. With a graph-theory-based analytic approach, this interaction between verbal serial order WM and spatial WM was corroborated in that the level of interaction between corresponding cortical regions (indexed by modularity) was predictive of the magnitude of the SPoARC effect. Additionally, the modularity of cortical regions associated with verbal serial order WM and spatial attention predicted the SPoARC effect’s magnitude, indicating the involvement of spatial attention in this modulation. Together, our findings highlight multiple sources of the interplay between verbal serial order WM and spatial processing.

Bullying in adolescents across three years in the context of the COVID-19 pandemic: a repeated cross-sectional and prospective analysis

BackgroundBullying has been identified as a risk factor for many issues among adolescents. Although it was already considered a public health issue in Brazil before the COVID-19 pandemic, little is known about how the pandemic and associated public health measures have affected bullying behavior.ObjectiveTo explore changes in bullying victimization and perpetration among Brazilian high school students from 2019 to 2022.MethodsThis study utilizes data from the Longitudinal Study of Adolescent Lifestyle (ELEVA), employing a repeated cross-sectional with a nested cohort design. Adolescents (n = 1.987, 50.2% female, mean age 16.4 years) answered a questionnaire and bullying-related information were extracted from two different questions for victims and perpetrators. Multilevel logistic regression models were used.ResultsBullying victimization decreased from 46% (95% CI: 40-52%) in 2019 to 30% (95% CI: 24-36%) in 2022 (OR: 0.46, 95% CI: 0.30–0.69, p < 0.05) in the longitudinal sample. Stable prevalences of bullying victimization (44% in 2019, 40% in 2022, p = 0.090) and perpetration (9.7% in 2019. 8.7% in 2022, p = 0.5) were observed within the repeated cross-sectional sample.ConclusionThis study found a significant decrease in bullying victimization among Brazilian high school students from 2019 to 2022 in the longitudinal sample, which coincides with the decrease in bullying behavior associated with getting older. However, the prevalence of bullying victimization and perpetration remained relatively stable and high in the repeated cross-sectional sample. These findings highlight the need for effective policies and interventions to prevent bullying among high school students. Additionally, providing resources and support for students experiencing bullying could be beneficial.

Five-Year Outcomes of a School-Based Personality-Focused Prevention Program on Adolescent Substance Use Disorder: A Cluster Randomized Trial.

Rates of substance use disorders (SUDs) remain significantly above national targets for health promotion and disease prevention in Canada and the United States. This study investigated the 5-year SUD outcomes following a selective drug and alcohol prevention program targeting personality risk factors for adolescent substance misuse. The Co-Venture trial is a cluster randomized trial involving 31 high schools in the greater Montreal area that agreed to conduct annual health behavior surveys for 5 years on the entire 7th grade cohort of assenting students enrolled at the school in 2012 or 2013. Half of all schools were randomly assigned to be trained and assisted in the delivery of the personality-targeted PreVenture Program to all eligible 7th grade participants. The intervention consisted of a brief (two-session) group cognitive-behavioral intervention that is delivered in a personality-matched fashion to students who have elevated scores on one of four personality traits linked to early-onset substance misuse: impulsivity, sensation seeking, anxiety sensitivity, or hopelessness. Mixed-effects multilevel Bayesian models were used to estimate the effect of the intervention on the year-by-year change in probability of SUD. When baseline differences were controlled for, a time-by-intervention interaction revealed positive growth in SUD rate for the control group (b=1.380, SE=0.143, odds ratio=3.97) and reduced growth for the intervention group (b=-0.423, SE=0.173, 95% CI=-0.771, -0.084, odds ratio=0.655), indicating a 35% reduction in the annual increase in SUD rate in the intervention condition relative to the control condition. Group differences in SUD rates were reliably nonzero (95% confidence) at the fourth and fifth year of assessment. Secondary analyses revealed no significant intervention effects on growth of anxiety, depression, or total mental health difficulties over the four follow-up periods. This study showed for the first time that personality-targeted interventions might protect against longer-term development of SUD.

Prevalence and determinants of unhealthy feeding practices among young children aged 6–23 months in five sub-Saharan African countries

Introduction Despite the World Health Organization’s advice against unhealthy feeding, many low- and middle-income countries, including sub-Saharan Africa (SSA) countries, are experiencing a nutritional transition to high in sugar, unhealthy fats, salts, and processed carbohydrates for younger children. However, there is a scarcity of recently updated multicounty information on unhealthy feeding practices and determinants in SSA countries. Therefore, this study aimed to assess the pooled prevalence of unhealthy feeding practices and determinants among children aged 6–23 months in five SSA countries. Method A cross-sectional study design was employed with the most recent demographic and health survey secondary data (DHS) from five SSA countries. This secondary data was accessed from the DHS portal through an online request. The DHS is the global data collection initiative that provides detailed and high-quality data on population demographics, health, and nutrition in low- and middle-income countries. We used a weighted sample of 14,064 children aged 6–23 months. A multilevel mixed-effect binary logistic regression model was fitted to identify significant factors associated with unhealthy feeding practices. The level of statistical significance was declared with p-value &lt; 0.05. Result This study found that overall, 62.4% (95% CI: 61.62–63.17) of children aged 6–23 months in five SSA countries had unhealthy feeding practices. Rural residents, lower-middle-income SSA countries, and children aged above 12 months had lower odds of unhealthy feeding practices. On the other hand, richer households and women who had not had an optimal antenatal care visit had higher odds of unhealthy feeding practices. Conclusion According to this study, nearly two out of three young children in five SSA countries had unhealthy feeding practices. Both individual and community-level factors are significantly associated with unhealthy feeding practices. As a result, responsible bodies shall make all efforts to reduce unhealthy feeding practices among young children in SSA countries.

Longitudinal Associations Between Neighborhood Environments and Functional Disabilities among Community-Dwelling Older Adults in China.

This study aims to investigate the longitudinal associations between neighborhood environments and functional disabilities over time among older adults in China. Urban-rural disparities in these associations were examined in this study. Data from four waves of the China Health and Retirement Longitudinal Study (2011-2018) were analyzed, including a sample of 5,379 older adults aged 60 and over. Multilevel linear probability modeling was fitted to estimate the effects of neighborhood environments on functional disabilities, encompassing both incidence and rate of change over a 7-year period. Older adults residing in neighborhoods with superior infrastructure experienced a lower incidence of functional disabilities in both rural and urban areas. In urban communities, increased handicapped access was associated with a reduced risk of IADL disability onset among older adults (B = -0.013, SE = 0.006, p < 0.05). In rural villages, the presence of two or more bus lines was associated with a slower rate of IADL disablement over the 7-year period (B = -0.019, SE = 0.009, p < 0.05). This research reveals the prominent roles of neighborhood environments in protecting functional abilities among older adults. The findings highlight the importance of incorporating community policies and infrastructure development into public health considerations. Empirical evidence is provided for policymakers and urban planners aimed at enhancing functional abilities in older adults and mitigating urban-rural disparities in health outcomes.

Supportive teachers, active students: Is teacher support a promising key to engaging students with and without migration backgrounds?

Students with and without migration backgrounds differ in terms of their achievement. One approach to reducing the gap between the two groups may be through equal participation in classroom discourse. Here, supportive teaching behavior can be particularly important for promoting student participation. Especially teacher support after a student has made a mistake, the so-called error culture in the classroom, could pave the way for students to become active participants. In this study, we analyzed whether error culture as a facet of teacher support could be a promising key to engaging students with and without migration backgrounds. To investigate the generalizability of the process across different subjects, we examined video data from 20 eighth-grade classrooms of academic-track secondary schools in both German Language Arts and Mathematics (N = 387 students). The results from nested hierarchical linear models indicate that error culture is related to student participation in German Language Arts but not in Mathematics. Interestingly, students with and without migration backgrounds did not differ in terms of their participation in classroom discourse. Furthermore, teachers’ positive error culture supported students’ participation irrespective of their migration background. Therefore, we encourage teachers to continue to pay attention to their error culture as this seems relevant for all students in the classroom.

Examining the relationship between emotion dysregulation and gender identity among adolescents in residential or partial hospital DBT treatment

ABSTRACT Past research exploring gender differences in relation to emotion dysregulation has shown mixed results. This study explores the extent to which gender differences in emotion dysregulation exist among adolescents in residential or partial hospital treatment settings after controlling for known variables that have demonstrated significant gender differences and have been linked to emotion dysregulation. Participants were 412 adolescents at admission to residential or partial hospitalisation DBT treatment. Participants self-identified their gender as: 28% (n = 116) cisgender male, 50% (n = 206) cisgender female, and 22% (n = 90) transgender and gender diverse (TGD). One-way ANOVA indicated TGD individuals and cisgender females scored significantly higher on emotion dysregulation than cisgender males. Hierarchical regression results indicated that gender overall explained only an additional 1.6% of the variance in emotion dysregulation after controlling for interpersonal competence, psychological distress, and interpersonal needs. Present findings underscore the importance of considering a range of psychosocial factors and pathways that may contribute to emotion dysregulation, and how gender groups may be differentially impacted.

Impact of seasonal malaria chemoprevention timing on clinical malaria incidence dynamics in the Kedougou region, Senegal

Seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine and amodiaquine is recommended by the World Health Organization since 2012 for clinical malaria prevention in children in the Sahelian region of Africa. In Senegal, SMC implementation began in 2013 and is given to children under 10 years old. This study aimed to describe clinical malaria incidence in the general population during routine SMC implementation and to analyse how SMC timing impacted clinical malaria dynamics in eligible children. We conducted an ecological study in the Kedougou region of Senegal in 27 villages included in the Bandafassi Health and Demographic Surveillance System (HDSS). We calculated weekly Plasmodium falciparum malaria incidence by age group using malaria case data recorded by community health workers and health-posts, and population denominators obtained from Bandafassi Health and Demographic Surveillance System. We used negative binomial generalized additive multilevel models to analyse the incidence of clinical episodes in children under 10 years during the expected SMC prophylactic period and at the end of the transmission period. Malaria incidence was strongly seasonal with a high transmission period starting in June. Children under SMC presented an overall lower incidence compared to older children and young adults. Among children eligible for SMC, the incidence was lowest for approximately 3 weeks after treatment administration and increased subsequently, suggesting a gradual loss of protection. At the end of the high transmission period, a higher malaria incidence was recorded from the 3rd to 6th week after the week of administration of the fourth (final) SMC round. While protecting children under 10 years, SMC warrants adjustment to reduce exposure before the next round, to increase protection of 5–9 years, and to cover the high transmission period completely. The addition of a 5th round of SMC in 2023 was necessary to cover the end of the transmission season, but individual-level studies are required to ensure that drug efficacy and adequate dosing are maintained.

Using ecological momentary assessment to quantify Δ-9-tetrahydrocannabinol and cannabidiol use across different forms of cannabis: Feasibility in a sample of Canadian young adults reporting frequent cannabis use.

To establish the feasibility of using ecological momentary assessment (EMA) to estimate total quantities of Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) used across different forms of cannabis, and to assess the predictive validity of THC estimates for predicting acute cannabis-related consequences. 14-day EMA using a smartphone application to assess cannabis use in real time. Canada. Targeted sample of n = 42 young adults (59.52% women, mean age 25 years) reporting frequent cannabis use. Surveys completed immediately prior to cannabis use assessed the quantities, THC content and CBD content of various forms of cannabis to be used in the current session; participants also uploaded photos of the cannabis product labels when available. Surveys administered at fixed times throughout the day (84.81% completion rate) assessed acute cannabis-related consequences. Participants completed a total of 786 pre-cannabis surveys, of which 79.39% and 77.35% contained sufficient information to calculate total THC and CBD (in milligrams), respectively. High agreement was observed between participant-entered THC and CBD contents and those shown in corresponding photos of cannabis product labels. Aggregating across all products used, participants reported using an average of 141.41 [standard deviation (SD)=224.62, range = 0.00-2000.00] milligrams of THC (i.e. 28.28 standard five-milligram units) and 7.53 (SD = 34.87, range = 0.00-484.22) milligrams of CBD per day. Multilevel models revealed that participants were more likely to report acute negative consequences following sessions when their estimated THC use was higher than their typical THC use. At the between-person level, participants reporting more THC use on average across sessions were less likely to report negative consequences overall. Using ecological momentary assessment to estimate total quantities of Δ-9-tetrahydrocannabinol and cannabidiol used across different forms of cannabis appears to be feasible, with preliminary predictive validity for acute negative cannabis-related consequences.

Mental Health and the Intersection of Perceived Discrimination and Social Inequalities Among Students in Germany – a Quantitative Intersectional Study

ObjectivesDiscrimination poses a threat to the mental health of university students, especially those affected by social inequality, yet understanding its intersectional impact remains limited. This study examines the intersection of social inequalities with perceived discrimination to explore differences in mental health among students in Germany.MethodsData from the cross-sectional project “Survey on study conditions and mental health of university students” (n = 14,592) were analysed using Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA). Depressive symptoms, cognitive stress symptoms, and exhaustion were examined across 48 intersectional strata based on gender, first academic generation, family care tasks, and perceived discrimination.ResultsThe MAIHDA analysis revealed substantial between strata variance, with most of it explained by additive rather than intersectional interaction effects. Perceived discrimination, diverse or female gender, first academic generation, and family care tasks (for exhaustion only) were associated with worse mental health outcomes.ConclusionThe profound associations between perceived discrimination and the mental health among university students call for urgent attention and intervention within university settings. Adopting an intersectional lens is key to identifying and addressing inequalities.

Experiences at recovery community centers predict holistic recovery outcomes: a daily diary assessment of RCC helpfulness, meaningfulness, and recovery identity

IntroductionRecovery community centers (RCCs) offer various support services to people in addiction recovery, such as hosting mutual help meetings and sober social activities and providing employment support and recovery coaching. To date, very little is known about RCCs and their relationship with recovery outcomes, as well as how RCCs may vary in helpfulness from visit to visit. This study used a daily diary approach to assess the intraindividual variation of daily RCC helpfulness, and whether RCC helpfulness predicted the holistic recovery indices of daily meaningfulness and recovery identity.Methods and materialsRCC attendees (analytical N = 88) from RCCs in Pennsylvania completed daily diary assessments using a smartphone application, for 10 consecutive days. If participants reported that they had spent time at the RCC that day, they then reported the perceived helpfulness of the RCC visit using 7 items. Participants also reported their daily meaningfulness and recovery identity. Ultimately, participants visited their RCC on 247/799 (30.9%) of all reported study days. Multilevel models were used to assess the hypotheses.ResultsParticipants generally reported that their RCC visits were very helpful (M = 87.13 [scale of 0–100], SD = 13.26). Nearly half of the variation in RCC helpfulness was attributable to intraindividual variation (ICC = 0.51). Multilevel models revealed that both interindividual and intraindividual RCC experiences predicted increased holistic recovery outcomes, over the prior day. Individuals’ mean levels of perceived RCC helpfulness, as well as person-mean-centered RCC daily helpfulness, positively predicted daily meaningfulness and recovery identity.ConclusionRCCs predict the holistic recovery outcomes of meaningfulness and recovery identity outcomes on the particular days that the RCCs are visited, and for the individuals who find RCCs more helpful overall. This study offers preliminary evidence to suggest that RCCs are appropriate recipients of public funding intended to support recovery in US communities.