Regression Mediation Analyses Research Articles

Effects of physical activity on anxiety levels in college students: mediating role of emotion regulation.

To explore the effects of physical activity on anxiety levels in college students, as well as to examine the mediating role of emotion regulation. A convenience sample of 1,721 college students from Shanghai, Jiangsu, Shandong, Guangxi, and Hunan was used to conduct an evaluation and a survey through the Physical Activity Rating Scale (PARS-3), the Anxiety Self-Rating Scale (SAS), and the Emotion Regulation Scale (ERQ). College students' anxiety level, cognitive reappraisal, and expression inhibition scores were (44.72±10.37), (30.16±6.51), and (16.96±4.99), respectively. There were significant grade and physical activity level differences in anxiety levels and cognitive reappraisal, and significant gender and physical activity level differences in expression inhibition among college students. Process model 4 mediated effect regression analysis showed that physical activity had a significant positive effect on cognitive reappraisal (R 2 = 0.14, β = 0.04, P<0.001), and physical activity did not have a significant expression inhibition effect (R 2 = 0.17, β = 0.01, P = 0.27). Physical activity (β = -0.03, P = 0.012), cognitive reappraisal (β = -0.59, P<0.001), and expression inhibition had a significant effect on (β = 0.57, P<0.001) anxiety levels (R 2 = 0.37). In the model effect relationship, the direct and indirect effects of physical activity on anxiety levels were -0.028 and -0.019, respectively. Physical activity has a significant negative effect on college students' anxiety levels. Cognitive reappraisal is a mediating variable for the effect of physical activity on anxiety levels. The higher the level of physical activity and the higher the intensity of the activity, the lower the level of anxiety.

플립러닝 수업이 지식공유태도와 학습성과에 미치는 영향: 학습참여의 조절효과 중심으로

Objectives The purpose of this study is to apply flipped learning to general chemistry subjects and to examine the effect of knowledge sharing attitude and learning participation on the effect of flipped learning class on learning outcomes. Methods For this purpose, 110 students in the first to fourth grade who participated in the flipped learning class of applied chemistry major at K University in Busan were randomly sampled and selected. Using the final 98 copies, mediated regression analysis and hierarchical regression analysis were conducted using SPSS 29.0 program to analyze the mediating effect and the moderating effect. Results Flipped learning class had a positive effect on learning outcomes, and knowledge sharing attitude proved to have a partial mediating effect between flipped learning class and learning outcomes. The hierarchical regression analysis confirmed the moderating effect of learning participation between knowledge sharing attitude and learning outcome. Conclusions In the process of improving learning outcomes in the flipped learning class, students' attitudes of sharing knowledge and cooperating with each other are important, and students' active participation in learning strengthens learning outcomes by raising positive awareness of knowledge sharing. However, when learning participation was high, the negative effect on knowledge sharing weakened the effect of knowledge sharing attitude on learning outcomes. In order to maximize the effect of flipped learning, when learners have positive emotions through interaction between professors and colleagues, they can lead to active behavior in learning participation and promote knowledge sharing attitude.

간호대학생의 영어학습동기가 영어학습지속에 미치는 영향: 교양영어 수업만족도의 매개효과

Objectives This study is to examine the mediating effect of class satisfaction in the effect of nursing students' English learning motivation on English learning continuity and the effect of nursing students' English learning motivation and English learning continuity. Methods 274 university students in J area were surveyed to measure their English learning motivation, class satisfaction, and level of English learning continuity, and descriptive statistical analysis was conducted. The correlation between the variables was calculated by the Pearson correlation coefficient, and the mediating effect of class satisfaction in the relationship between the subject's English learning motivation and English learning continuity was analyzed using Hayes (2013)'s PROCESS macro Model 4. Results The effect of English learning motivation on the mediating variable, class satisfaction, was statistically significant (β=.591, p&lt;.001), and the effect of the independent variable, English learning motivation, on the dependent variable, English learning continuity was also statistically significant (β=.484, p&lt;.001). In addition, as a result of conducting a mediated regression analysis by using English learning motivation, an independent variable, and class satisfaction, a parameter, as an independent variable, and English learning continuity as a dependent variable, the effect of English learning motivation on English learning continuity decreased compared to the previous one, but a positive relationship was still analyzed to be significant, indicating that class satisfaction had a partial mediating effect on the relationship between English learning motivation and English learning continuity of college students (β=.379, p&lt;.001). Conclusions It was confirmed that nursing students' English learning motivation had a significant positive effect on liberal arts English class satisfaction and English learning continuity, and it was verified that liberal arts English class satisfaction positively mediated the relationship between English learning motivation and English learning continuity.

Addressing the role of eHealth literacy in shaping popular attitudes towards post-COVID-19 vaccination among Chinese adults

This study examined the influence of eHealth literacy on Chinese individuals’ attitudes towards post-COVID-19 vaccination and explored methods to address obstacles related to eHealth literacy that could affect their comprehension and willingness to get vaccinated. In 2022, a web-based cross-sectional survey was conducted to assess the vaccination-related knowledge, attitudes and intentions of 950 participants. Vaccination knowledge was established by employing validated measures and conducting a Mokken scale analysis. Causal-directed acyclic graphs were used to illustrate the current comprehension of the correlation between eHealth literacy and the desire to receive vaccinations. This study utilised causal mediation and multiple linear regression analysis to determine the relationships between eHealth literacy, vaccination knowledge, vaccination willingness and subjective health status. The primary finding of this study was that an individual’s comprehension of vaccination was a robust indicator of their inclination to receive vaccination. Moreover, eHealth literacy has an indirect effect on the propensity to get vaccinated by enhancing one’s understanding of vaccines. This study emphasises the significant role of eHealth literacy in enhancing vaccination awareness and willingness, particularly among Chinese adults with poorer health in the post-COVID-19 period. The results affirm the efficacy of employing eHealth technologies to bolster immunisation initiatives, amplify vaccine consciousness, and promote compliance. Moreover, this study emphasises the significance of additional research to assess and record the function of eHealth literacy in immunisation practices.

Firm Size on IDX BUMN 20 Stock Prices: The Role of Mediating Activity and Profitability

This study investigates if firm size increases stock prices using activity and profitability as mediating variables. It employs a quantitative causality method using secondary data from financial reports on firm websites and the IDX. The sample includes companies listed in the IDX BUMN 20 index from 2018-2021, using non-probability sampling and unbalanced panel data estimated with a random effects model. Data analysis involves descriptive statistics, mediation regression, and path analysis with Eviews 12 software. Results indicate firm size and profitability positively impact stock price, firm size positively impacts profitability, activity does not impact stock price, and activity and profitability do not mediate the firm size-stock price relationship

Nonprofit Chief Executive Compensation: Implications of Board Governance Activities

Using secondary data collected as part of a national survey of nonprofit organizations, this research examines compensation outcomes of 704 nonprofit Chief Executives (CEO), integrating and social and performative aspects of governing/governance to explain compensation (in)equity. Theorizing governance as a socially complex and functionally consequential arena, we examine the impact of social categorization and identity fit between CEO Ethno-Racial Demography and Board Ethno-Racial Variety prior to overlaying the influence of three forms of governance activity: Fiduciary Oversight, Internal Awareness, and External Engagement. We employ serial multiple mediation regression analysis to test direct and indirect effects of demographic diversity and governance activity for nonprofit CEO compensation outcomes. We found compensation of ethno-racialized CEOs is higher when their organizations have diverse boards. Therefore, boards of directors must be cognizant of board composition, the potential for subjectivity and bias, and the impact these factors can have on CEO compensation and compensation equity.

Questionnaire-assessed atypical sensory sensitivity is prospectively related to higher ARFID psychopathology, higher food neophobia, and lower satisfaction with food-related life in an online sample of Chinese older adults

Altered sensory processing is common in older adults, and avoidant/restrictive food intake disorder (ARFID) psychopathology and food neophobia contribute to adverse health outcomes in older adults. Yet, the relationships, particularly longitudinal relationships, between sensory processing, ARFID psychopathology, and food neophobia, as well as their associations with satisfaction with food-related life (SWFL), remain unexplored in older adults. A sample of Chinese older adults (N = 202; 45 % men; Mage = 59.35 years) completed an online survey at baseline (T1) and 12 months later (T2); atypical sensory sensitivity, ARFID psychopathology, food neophobia, and SWFL were measured with self-report questionnaires. Cross-lagged and mediation regression analyses were conducted to examine the prospective associations between T1 atypical sensory sensitivity and T2 ARFID psychopathology, food neophobia, and SWFL. The results revealed that higher T1 atypical sensory sensitivity predicted higher T2 ARFID psychopathology and food neophobia and lower SWFL. The results also showed that the relationship between T1 atypical sensory sensitivity and T2 SWFL was mediated by T2 picky eating and food neophobia. These findings suggest that atypical sensory sensitivity may be a risk factor for ARFID psychopathology, food neophobia, and poor SWFL in older adults. Future studies with larger samples and experimental designs are needed to further explore the mechanisms linking atypical sensory sensitivity and ARFID psychopathology, food neophobia, and SWFL in older adults.

Utilization of the Lentera DESA Website in Blended Learning-Based Soil Fertility and Health Management Training in Yogyakarta

Knowledge of soil fertility and soil health management is essential, especially in Yogyakarta, where the soil fertility and health of rice fields are low. This study employed an experimental research design involving 715 farmers, with data collected in August 2022 and June 2023. The research explored the effectiveness of a blended learning training scheme, especially in the use of The Lentera DESA website. The primary objectives were to identify factors that are related to the use of the Lentera DESA website and to examine the correlation between the duration of watching training videos and farmers’ knowledge. Factor analysis was carried out using multiple linear and mediated regression analyses. Multiple linear regression analysis was conducted to examine whether there is a relationship between video viewing duration and increased knowledge. As a result, four factors directly relate to the use of the Lentera DESA website, namely re-login activity (P = 0.001), farmer age (P = 0.047), presence of info-session (P = 0.054), and smartphone ownership (P = 0.023). Mediated regression analysis revealed that re-login activity plays an essential role in increasing the utilization of the Lentera DESA website through both partial mediation and complete mediation. However, using the Lentera DESA website as an online training medium showed no significant correlation with increasing farmers knowledge of soil fertility and soil health management.

Trauma, Critical Incidents, Organizational and Operational Stressors: The Relationship Between Harms and Psychological Outcomes for Police

Early psychological health studies in policing often focused on trauma and critical incidents (CIs). More recent research builds a compelling argument that significant causes of psychological harm stems from other operational and organizational factors. The current study uses survey data from a large sample of Australian police ( N = 1763), producing strength metrics derived from mediated regression analyses. The relationships between stressors (trauma and CIs, operational and organizational) and psychological health (psychological distress and burnout) were studied. For the relationship between stress and psychological distress, compared to trauma stress, the relationship with organizational stress was three times stronger and the relationship with operational stress was two and half times stronger. No direct relationship between trauma stress and burnout was found. It was fully explained by organizational and operational stress. The findings suggest police leaders must consider the direct and combined impacts of different stressors on the psychological health of their staff.

Adverse childhood experiences and psychological maladjustment in adolescence: The protective role of epistemic trust, mentalized affectivity, and reflective functioning.

Adverse childhood experiences (ACEs) are psychosocial factors acknowledged as significant contributors to health consequences later in adolescence, including psychological maladjustment. The research suggests that, at a transdiagnostic and transtheoretical level, working on restoring epistemic trust (ET), mentalized affectivity (MA), and reflective functioning (RF) in adolescents with ACEs assumes a central role in the therapeutic process. However, there are still few studies that attempted to investigate the specific role of these sociocognitive factors in the detrimental positive association between levels of experienced ACEs during childhood and psychological maladjustment in nonclinical adolescents. A community sample of 306 Italian cisgender adolescents (61.4% assigned females at birth; age range 13-19 years old; Mage = 16.1, SD = 1.64) self-reported ACEs (Childhood Trauma Questionnaire-Short Form), psychological maladjustment (Strengths and Difficulties Questionnaire), ET (Epistemic Trust, Mistrust and Credulity Questionnaire), MA (Brief-Mentalized Affectivity Scale for Adolescence), and RF (Reflective Functioning Questionnaire). A multiple mediation regression analysis has been performed to explore the association between ACEs and psychological maladjustment through the interaction with socio-cognitive factors. ACEs are positive predictors of psychological maladjustment later in adolescence. Regardless of gender differences, epistemic mistrust and credulity, processing and expressing emotions, and uncertainty about mental states mediated this association, while epistemic trust, identifying emotions, and certainty about mental states did not configure as significant mediators. Findings suggest that ET disruptions and deficits in RF are risk factors, while MA is a protective factor within the link between ACEs and psychological maladjustment in adolescence. These links help to specify the role of sociocognitive factors in the development of mental problems in adolescents who have been exposed to adverse experiences in childhood.

Towards a Healthy Diet in an Adolescent Population: The Mediating Role of Motivation and Perceived Barriers between Self-Efficacy and Weight Regulation.

(1) Background: Adolescence is a critical period when dietary choices are a major concern. It is therefore important to understand the psychological factors that explain these choices. The objective of this study was to assess the predictive role of perceived self-efficacy for healthy eating and weight regulation on healthy and unhealthy eating behavior through the mediation of autonomous motivation, controlled motivation, amotivation, and perceived barriers to daily mechanisms affecting healthy consumption. (2) Methods: A total of 994 adolescents between 15 and 19 years old from Mexico and Spain participated in the study. The Spanish versions of the healthy eating and weight self-efficacy questionnaire, the behavioral regulation in exercise questionnaire, the barriers to healthy eating scale, and the weight-related behaviors scale questionnaire were used to measure the variables of interest. (3) Results: Mediated serial regression analysis showed that barriers to healthy eating (the daily mechanism of food consumption) reduced healthy eating choices. Healthy eating and weight self-efficacy also showed a positive significant relationship with autonomous motivation and a negative relationship with controlled motivation and amotivation. All the types of motivation showed a positive relationship with barriers to healthy eating. (4) Conclusions: The results point out the need to enhance self-efficacy, promote autonomous motivation, and reduce perceived barriers in young people with respect to healthy eating.

THE INFLUENCE OF ENVIRONMENTAL SOCIAL GOVERNANCE (ESG) ON COMPANY VALUE WITH FINANCIAL PERFORMANCE AS A MEDIATION VARIABLE

This research was conducted to analyze the relationship between ESG and company value and the role of financial performance variables as mediation between the two. The sample in this research is the energy company sector listed on the Indonesia Stock Exchange (BEI). By implementing good ESG, a company can improve quality, credibility and public trust. Increasing a company's attractiveness also attracts more investors to invest, so that a company can also improve its financial performance. Thus, good financial performance indicates effective ESG practices, so this can increase the company's value for investors. The sample for this research is companies listed on the Indonesian stock exchange in the energy sector consisting of 42 companies with a 2 year period from 2021 to 2022. The statistical tool used is the e-views 12 program with a quantitative approach through the method used for mediation regression analysis multiple. It is known that research shows that ESG influences company value and company financial performance. However, financial performance is not able to directly increase company value, this is proven by the financial performance variable which is proxied by ROA showing less than optimal figures so that it is unable to mediate the relationship between ESG and company value. This research supports the development of the application of ESG practices in energy companies in order to improve the company's credibility and attract more investors in the future.

Social infrastructure, social cohesion and subjective wellbeing

Neighborhood physical places that bring people together, referred to as social infrastructure, form the foundation of communities. Studies suggest that by facilitating social encounters, social infrastructure can enhance sense of social cohesion and belonging and may also improve subjective wellbeing. Yet the extent to which wellbeing benefits are mediated through increased social cohesion and belonging is less understood. Drawing on data collected in March 2022 from a nationally representative sample of 1000 Australian adults aged over 18 years, we use mediated regression analysis to examine the extent to which the link between social infrastructure and subjective wellbeing is mediated by perceived social cohesion and belonging. Our findings reveal that social cohesion and belonging partially mediate the relationship between proximate social infrastructure and wellbeing. Our findings go beyond previous studies that note the importance of walking or greenspaces for social interaction and cohesion to demonstrate that social and wellbeing benefits can be accrued across a suite of ordinary neighborhood places when the social context is perceived as cohesive. The results highlight the capacity for ordinary places such as shops and cafes to contribute to social cohesion during everyday activities and facilitate subjective wellbeing by satisfying the basic human need to belong.

A Study on Advertising Effectiveness Depending on Information Source Type (Real Human vs. Virtual Human)

Purpose: This study was conducted to investigate the differences in information source properties according to the type of information source (real human vs. virtual human) and to empirically analyze the impact of the information source type on advertising attitude and product attitude. In addition, this study examined the moderating effect of consumer gender on the effect of information source type on advertising attitude, and the mediating effect of advertising attitude on the effect of type of information source on product attitude. Theoretical framework: The Source effect refers to the degree to which consumers' message acceptance varies depending on the information source, that is, the properties of the advertising model. In general, representative properties that affect information source effectiveness include expertise, trustworthiness, and attractiveness. The Uncanny Valley theory is the theory that when humans see a non-human being, the more it resembles a human being, the more they feel favorable towards it, but when it reaches a certain level, they feel displeased with it. Methodology: To test hypotheses, this study conducted an online and offline mixed survey, and a total of 410 questionnaires were used in the final analysis. To test validity and reliability of measurement tools, this study did factor analysis and reliability analysis. Hypotheses were tested with t-test and ANOVA analysis. To test mediating effects, it did mediating regression analysis. Findings: The findings of data analysis were as follows. First, when the information source type was a virtual human, the level of information source properties was lower than when the information source type was a real human. When the information source type was a virtual human, expertise and trustworthiness were low, and there was no difference in attractiveness. Second, when the information source type was a virtual human, the attitude toward advertising was low. Third, the information source properties of the virtual human advertising model were confirmed to have a positive (+) effect on consumer advertising attitudes. Fourth, the information source properties of the virtual human advertising model were confirmed to have a positive effect on consumer product attitudes. Fifth, the impact of the type of information source on advertising attitude was found to be higher for male consumers than for female consumers, confirming that there is a moderating effect of consumer gender. Sixth, it was confirmed that advertising attitude has a positive effect on product attitude. Seventh, it was confirmed that the effect of information source type on product attitude was mediated by advertising attitude. Research, Practical &amp; Social implications: The results of this study suggest the following implications. First, this is the first level of research to theoretically verify the effectiveness of advertisements featuring virtual humans and examine whether the theoretical foundation of the information source effect can be extended to virtual humans. Second, this study empirically verified the moderating effects of consumers' psychological mechanisms and demographic factors on the effect of information source types on advertising attitudes. Originality/value: This study empirically analyzed the source effect of a virtual human advertising model based on the information source effect and the uncanny valley effect.

INFLUENCE OF REGIONAL GOVERNMENT (PEMDA) CHARACTERISTICS ON AUDIT OPINION WITH REGIONAL GOVERNMENT (PEMDA) FINANCIAL PERFORMANCE AS A MEDIATION VARIABLE

Purpose - With local government financial performance serving as a mediating variable, this study intends to investigate the impact of local government characteristics, whose indicators are the degree of reliance and audit results on audit opinions Design/methodology/approach - The Regency/City Government in Banten Province from 2018 to 2021 serves as the study's population. In this investigation, 8 samples were evaluated using the saturation sampling technique. The financial reports of each PEMDA, whose information was collected from the Banten Province Representative Office of the Financial Audit Board (BPK), served as the source of the data for this study. Logistic regression analysis and mediation regression analysis were the analytical techniques employed in this investigation Finding - The outcomes of this study suggest that the amount of reliance and audit findings have a favorable effect on audit opinion, but that this effect is stronger when measured using financial performance as a mediating variable. Originality - Paper Type – Research Paper Keywords: Dependency Level, Audit Findings, Audit Opinion, Local Government Financial Performance

Is Owner Satisfaction a Mediator between Service Quality and Behavioral Intentions in Low-cost Housing?

The Malaysian government has favorable policies to improve the affordability for the Malaysians particularly the low-income groups to own a house. The agendas of low-cost housing have been focusing on quality, adequacy, and affordability. However, there are failed housing projects particularly due to the lack of owners’ intentions to stay and other reasons. Therefore, this study aims to investigate the owner satisfaction's mediating role in the relationship between service quality and behavioral intentions (to stay or to move) for low-cost housing. The structured questionnaires were sent to low-cost house owners in southern (administration and business), northern (agriculture) and central (agriculture and industry) regions of Sarawak, and 403 responses were received. Mediated regression analysis and bootstrapping indirect effect were employed in the analysis. The results indicate that service quality has a significant positive relationship with behavioral intentions, and it also significantly contributes to owner satisfaction. However, the relationship between the owner satisfaction and behavioral intentions is not significant. Also, owner satisfaction has no mediating role in the relationship between service quality and behavioral intentions in Sarawak low-cost housing.

Digital Dilemma of Cyberbullying Victimization among High School Students: Prevalence, Risk Factors, and Associations with Stress and Mental Well-Being.

Cyberbullying has emerged as a pervasive problem among high school students, with potentially severe consequences for their mental well-being. This study aimed to investigate the prevalence, risk factors, and associations of cyberbullying with stress and mental well-being among high school students in Zagazig, Egypt. A cross-sectional study was conducted among 562 high school students using a random sampling technique. The data were collected using a self-administered questionnaire that included the Cyberbullying Scale, Perceived Stress Scale (PSS-10), and General Health Questionnaire (GHQ-12). Descriptive statistics, independent samples t-tests, multiple regression, mediation, and logistic regression analyses were employed for data analysis. The prevalence of cyberbullying victimization was 38.3%, with 20.6% exposed to two or three cyberbullying behaviors and 4.1% exposed to four or more. Female students, those under 18 years old, those with lower educational achievement, and those with higher daily internet use were more likely to experience cyberbullying. Cyberbullied students reported significantly higher levels of perceived stress and poorer mental well-being compared to non-cyberbullied students. Perceived stress likely mediated the relationship between cyberbullying victimization and general psychological health. Cyberbullying is a significant problem among high school students in Zagazig, Egypt, with detrimental effects on their stress levels and mental well-being. Targeted interventions and prevention strategies are needed to address cyberbullying and promote the well-being of adolescents in the digital age.

The mediating role of risk tolerance in the relationship between behavioural factors of small investors and investment decisions in the saudi stock market

The aim of this study was to examine the mediating role of risk tolerance in the relationship between behavioural factors of small investors and investment decisions in the Saudi stock market. A random sample of small investors in the Saudi stock market was selected, with a sample size of 384 investors. Descriptive statistical methods such as mean, standard deviation, and frequencies were used to describe the study variables, and the mediation regression analysis was employed to test the study hypotheses. The main findings of the study revealed that individual investors' risk tolerance acts as a partial mediator in the relationship between behavioural factors and investment decision-making in the stock market. There is a significant relationship between the behavioural factors of small investors and their ability to make investment decisions in the Saudi stock market. Additionally, there is a significant relationship between risk tolerance of small investors and their investment decisions in the Saudi stock market. Based on the study findings, several recommendations were proposed, including the consideration of behavioural factors and risk tolerance of small investors by brokers and financial advisors in the Saudi stock market when providing advice and guidance on financial investments. They should also provide information based on accurate securities analysis to facilitate sound investment decisions in the Saudi stock market.

Autistic traits and eating behaviors in Chinese preschoolers: Role of sensory profiles and home environment

ObjectiveThis study aims to 1) explore the association between autistic traits and eating behaviors in Chinese preschoolers; 2) explore the mediating role of sensory processing patterns on the relation of autistic traits and eating-related behaviors; and 3) examine home nurturing environment as a moderator between autistic traits and eating-related behaviors. We hypothesize that there is a significant association between autistic traits and eating behaviors, which is mediated by sensory processing patterns and moderated by the home nurturing environment. Method509 children aged 3–4 years participated in this cross-sectional research. They were assessed using the Social Responsiveness Scale-Second Edition (SRS-2) for autistic traits, the Chinese Preschoolers' Eating Behavior Questionnaire (CPEBQ) for eating-related behaviors, the Short Sensory Profile-Second Edition (SSP-2) for sensory processing patterns, and the Children Home Nurture Environment Questionnaire (CHNEQ) for home nurturing environment. Mediation regression analyses were used to examine the role of sensory processing patterns, while moderation analyses to examine the role of home nurturing environment. ResultsWe observed a positive association between autistic traits and eating behavior problems among typically developed children. Sensory processing patterns significantly mediated the impact of autistic traits on children's eating-related behaviors and home nurturing environment also moderated this relationship. DiscussionOur research suggests that Chinese preschoolers with higher autistic traits may face more eating challenges when they possess more heightened sensory processing patterns, while living in supportive home environments helps to improve their eating behaviors. These findings contribute to the understanding of how and to what extent eating problems are influenced by autistic traits, and they offer insight into the alleviation of eating problems from the perspectives of sensory patterns and family nurturing environments.

The Association Between Unintended Pregnancy and Perinatal Outcomes in Low-Risk Pregnancies: A Retrospective Registry Study in the Netherlands.

People with unintended pregnancies might be at increased risk of adverse perinatal outcomes due to structural factors, distress, or delayed prenatal care. Existing studies addressing this association yielded inconsistent findings. Using contemporary data from a large Dutch midwifery care registry, we investigated the association between unintended pregnancy ending in birth and neonatal outcomes, parental morbidity, and obstetric interventions. We extend previous research by exploring whether delayed initiation of prenatal care mediates these associations. This study used data (N = 9803) from a Dutch nationally representative registry of people with low-risk pregnancies receiving primary midwife-led care in the Netherlands between 2012 and 2020. Using logistic (mediation) regression analyses adjusted for potential confounders we investigated associations between unintended pregnancy and neonatal outcomes (low Apgar score, small for gestational age, and prematurity), parental morbidity (hypertension and gestational diabetes mellitus), and obstetric interventions (induction of labor, pain medication, assisted vaginal birth, and cesarean birth) and whether delayed initiation of prenatal care mediated these associations. Unintended pregnancies were associated with increased odds of low Apgar scores (odds ratio [OR], 1.68; 95% CI, 1.09 -2.59), preterm birth (OR, 1.27; 95% CI, 1.02-1.58), small for gestational age (OR, 1.19; 95% CI, 1.00-1.41), and induction of labor (OR, 1.14; 95% CI, 1.01-1.28). Conversely, unintended pregnancy was associated with a decreased odds of cesarean birth (OR, 0.83; 95% CI, 0.71-0.97). The timing of prenatal care initiation did not mediate any of these associations. Our findings suggest that people in primary midwifery-led care with unintended pregnancies ending in birth are at increased risk for adverse perinatal health outcomes and that structural factors might underlie this link. Health care professionals and policy makers should attend to their own biases and offer nonjudgmental, tailored preventive preconception care and antenatal care strategies for people with higher vulnerabilities.