Hierarchical Regression Research Articles

Predictors of consistent condom use among male construction workers who have engaged in concurrent sex with regular sex partners, casual sex partners, and sex workers over a 3-month period

ABSTRACT This study investigates the predictors of consistent condom use among male construction workers in South Africa who reported concurrent sexual relationships with regular partners, casual partners, and sex workers over a 3-month period. A cross-sectional survey was used to collect data from a convenience sample of 450 male workers across 18 construction work sites in the Western Cape province. Of these, 245 (54%) indicated that they had engaged in sex with all three partner types during the 3-month study period. Hierarchical multiple linear regression was then used to assess consistent condom use as a function of demographic, experiential, behavioural and cognitive characteristics. Three statistically significant predictors of consistent condom use were identified: perceived control over condom use (β = 0.252, p < 0.001), positive attitude toward condom use (β = 0.154, p < 0.05) and fear of HIV infection (β = 0.121, p < 0.05). These findings highlight the high prevalence of sexual concurrency among study participants. It also suggests that amid declining condom use, interventions which focus on enhancing an individuals’ condom application skills and efficacy, that foster positive attitudes toward condom use and that strategically incorporate fear-based messaging within a multilevel framework may potentially increase condom use among individuals in concurrent sexual relationships.

Influence of Health Literacy on Physical Activity and Sedentary Behaviors in Older Patients with Coronary Artery Disease.

Coronary artery disease is a chronic condition that requires continuous adherence to healthy behaviors. Adhering to physical activity and reducing prolonged sedentary behavior are important for the physical health of older patients with coronary artery disease (CAD). Health literacy is increasingly recognized as a key factor in secondary prevention for these patients. However, evidence regarding the associations among health literacy, physical activity, and sedentary behaviors for secondary prevention in older patients with coronary artery disease remains limited. This study aimed to identify the prevalence of limited health literacy and the influence of health literacy on physical activity and sedentary behaviors in older patients with CAD. This study was a descriptive cross-sectional study conducted from May to December 2022 in South Korea. A total of 186 patients aged 65 and older diagnosed with coronary artery disease participated. Data on health literacy, physical activity, and sedentary behaviors were collected through self-reported questionnaires and electronic medical records. The prevalence of limited health literacy in older patients was 66.7%. Hierarchical linear regression revealed that health literacy was a significant determinant of physical activity (β = -0.50, P < .001) and sedentary behaviors (β = 0.58, P < .001) after adjusting for confounding variables. Our main findings showed that health literacy can facilitate improvements in physical activity and sedentary behaviors. Health literacy can facilitate health decisions for secondary prevention in older patients with CAD. Thus, healthcare professionals should assess patient health literacy and illness severity when designing secondary prevention programs.

Healthcare administrators and hypertension at small-to-medium worksites in Okinawa, Japan.

This longitudinal study investigated whether the presence of a person in charge of healthcare at a worksite, termed a healthcare administrator (HA), and not limited to licensed staff, facilitated visits to medical facilities for treatment of newly-identified hypertension after a health checkup. The study included employees at small-to-medium companies in Okinawa, Japan who had systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, no history of hypertension in the last year, and not taking antihypertensive medication. Pre-existing data on worksite characteristics, employees' health checkups, and health insurance claims were collected. The odds ratio (OR) and 95% confidence interval (CI) were calculated for visits in the HA group using a multi-level logistic regression model, with the non-HA group serving as the reference. The cumulative incidence of visits during the 1st month after the health checkup in 2906 participants with newly-identified hypertension employed at 1366 worksites was 2.00% for the non-HA group and 2.97% for the HA group. The OR for visits in the HA group was 1.74 (95% CI, 0.94-3.22) after adjusting for potential confounding factors. When the hypertensive population was stratified using the cut-off values of 150 mmHg for systolic and 95 mmHg for diastolic blood pressure, more hypertensive stratum showed a cumulative incidence of 2.29% in the non-HA group and 4.97% in the HA group, with an adjusted OR of 3.05 (1.12-8.29). The presence of a HA at a worksite was associated with increased early visits to medical facilities by employees for treatment of hypertension.

Relations among the trifurcated narcissism domains at trait and state level: Two of a kind?

This study explored narcissistic states using a hierarchical, trifurcated structure, examining state variability and trait-state associations of agentic extraversion, self-centered antagonism, and narcissistic neuroticism. The primary objective was to investigate whether the structural composition of narcissism, well-established in trait data, could be replicated in state data. We examined this structure at both between- and within-person levels in state data, including situation-specific structures of narcissism. The study used data from an experimental study where participants ( N = 189) met in groups of up to four people weekly over six weeks. Multilevel confirmatory factor analyses revealed that the narcissism structure was largely the same at both levels. However, within-person compositions of narcissism differed across affiliative versus controversial situations. In affiliative contexts, grandiosity manifested exclusively through agentic extraversion, with no expression through self-centered antagonism. In controversial settings, agentic extraversion and narcissistic neuroticism exhibited a slight negative association, contrasting the positive association observed across all group meetings. Our results show that narcissistic states exhibited less variability compared to the Big Five and rarely varied above their corresponding trait levels. This research contributes to a refined understanding of narcissism, highlighting the interplay between trait tendencies and situational factors in shaping narcissistic state expressions.

The Role of Spiritual Well-Being in Spanish Cancer Patients: Exploring the Relationship Between Health, Religiosity and Spirituality, and the Underlying Psychosocial and Behavioral Pathways

ABSTRACT This study aims to examine the interactions of spiritual well-being with different psychosocial and behavioral aspects that have been proposed in the literature as pathways underlying the relationship of religiosity and spirituality (R/S) with physical health, specifically in cancer patients (N = 351). Using a cross-sectional research design, a series of hierarchical regression analyses show the predictive power of different elements of R/S (attachment to God, religious practice, commitment and coping, and spiritual experiences) on spiritual well-being. In turn, spiritual well-being (meaning/peace and faith) predicts gratitude and compassion (as psychological pathways). Thus, finally, spiritual well-being, together with gratitude and compassion, correlates to the rest of the psychological (positive and negative emotions), social (social support) and behavioral (healthy behaviors) pathways to different extents. Spiritual well-being may play an important role in understanding the relationships between R/S and health, so considering it along with its associated factors may be key to improving the health and quality of life of people affected by cancer in Spain.

Effects of subject-specific professional knowledge and skills of physical education teachers on students’ learning progress

AbstractAlthough the subject-specific professional knowledge of teachers is considered to be of central importance with regard to the learning performance of their students, there is only sparse empirical evidence on this issue. Moreover, current studies are primarily limited to the subject of mathematics. The aim of this article is to investigate the significance of subject-specific professional knowledge and skills of physical education (PE) teachers on the practical learning gains of their students based on a panel study. In order to measure both non-contextual knowledge and contextual skills on the teachers’ side, paper–pencil tests as well as video and text vignettes were used as test instruments. On the students’ side, practical sport skills were assessed in a pretest–posttest design to evaluate competence growth with regard to complex sports performance. An effect chain with mediation processes was postulated. Multilevel modeling analyzing 1669 students who were taught by 74 teachers could prove significant performance improvements for the students, but none of the four differentiated knowledge dimensions (content knowledge, non-contextual; pedagogical content knowledge, non-contextual; content knowledge, contextual; pedagogical content knowledge, contextual) of the teachers could explain these learning gains. Thus, the results are in line with various studies in mathematics and suggest that direct effects of teachers’ professional knowledge on students’ learning gains seem to be lost. The results therefore suggest that while basic and broad professional knowledge is required for instructional success, specific expertise in certain competence areas does not lead to additional learning success among students. Further research within the EPiC-PE study is needed to provide a more comprehensive picture of the relationships between professional knowledge and skills, classroom behavior, instructional processes, and learning outcomes.

Size scaling of large landslides from incomplete inventories

Abstract. Landslide inventories have become cornerstones for estimating the relationship between the frequency and size of slope failures, thus informing appraisals of hillslope stability, erosion, and commensurate hazard. Numerous studies have reported how larger landslides are systematically rarer than smaller ones, drawing on probability distributions fitted to mapped landslide areas or volumes. In these models, much uncertainty concerns the larger landslides (defined here as affecting areas ≥ 0.1 km2) that are rarely sampled and often projected by extrapolating beyond the observed size range in a given study area. Relying instead on size-scaling estimates from other inventories is problematic because landslide detection and mapping, data quality, resolution, sample size, model choice, and fitting method can vary. To overcome these constraints, we use a Bayesian multi-level model with a generalised Pareto likelihood to provide a single, objective, and consistent comparison grounded in extreme value theory. We explore whether and how scaling parameters vary between 37 inventories that, although incomplete, bring together 8627 large landslides. Despite the broad range of mapping protocols and lengths of record, as well as differing topographic, geological, and climatic settings, the posterior power-law exponents remain indistinguishable between most inventories. Likewise, the size statistics fail to separate known earthquakes from rainfall triggers and event-based triggers from multi-temporal catalogues. Instead, our model identifies several inventories with outlier scaling statistics that reflect intentional censoring during mapping. Our results thus caution against a universal or solely mechanistic interpretation of the scaling parameters, at least in the context of large landslides.

Enhancing science achievement through inquiry activities: the critical role of perceived teacher support

ABSTRACT In science education, scientific inquiry is crucial for developing inquiry skills and constructing scientific knowledge. However, the impact of scientific inquiry activities on student achievement continues to be debated. A number of counterintuitive findings highlight the need to explore the underlying factors influencing the effectiveness of inquiry-based learning. This study employed hierarchical linear models (HLM) to investigate the role of students’ perceived school teacher support in moderating the relationship between inquiry-based science activities and science achievement. The sample used in this study was drawn from Beijing, Shanghai, Jiangsu, and Guangdong in mainland China (B-S-J-G-China). These four provinces participated in the 2015 Programme for International Student Assessment (PISA) as a collective group. The dataset comprised 9,592 students (4,543 females and 5,049 males) from 261 schools. Results revealed a negative correlation between inquiry-based activities and science achievement, indicating that a higher frequency of inquiry-based activities was associated with lower science achievement. However, this association was positively and significantly moderated by the extent of school teacher support. These findings highlight the pivotal role of students’ perceived school teacher support in enhancing the effectiveness of inquiry-based practices and shed light on optimising inquiry-based educational strategies. This suggests that the effective implementation of inquiry-based activities requires the backing of supportive teachers, with broader implications for curriculum design and teacher development in science education.

A multilevel modeling analysis of community-based mental health and psychosocial support group intervention for refugee newcomers in the United States.

A growing number of resettlement agencies adopt and implement interventions and programs to promote community-based mental health and psychosocial support (CB-MHPSS) among refugees and asylum seekers in the United States. However, few studies examine how multilevel factors either facilitate or interfere with mental health and other associated outcomes. Adopting a realist evaluation approach, this study examines the effects of multilevel (i.e., community, group and individual) factors on mental health coping and emotional well-being (EW) among asylum seekers and refugee newcomers in CB-MHPSS group interventions. A total of 235 adult refugees and asylum seekers participated in 31 CB-MHPSS intervention groups implemented by 11 HIAS affiliate agencies in 2021. A series of bi-/multivariate and multilevel modeling analyses were conducted to investigate the impacts of individual, group or agency, and community-level factors on competency for coping and EW among intervention participants. Mental health and psychosocial support (MHPSS) interventions grounded to the local community help facilitate individual-level improvement in competencies for mental health care and EW. Multilevel modeling analyses attested to multilevel effects of individual, group, and community settings on MHPSS outcomes, highlighting the impacts of intervention facilitator types and group composition, as well as community's unemployment rates. This study sheds light on the value of community-based, participatory approaches to psychosocial interventions; focusing on the role of refugee community leaders and bicultural staff who deliver MHPSS activities, which was a key feature that enhanced the well-being and coping of refugee newcomers across various settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Nested multilevel modelling study of smoking and smokeless tobacco consumption among middle aged and elderly Indian adults: distribution, determinants and socioeconomic disparities

IntroductionThe Global Adult Tobacco Survey (GATS) shows a drop in tobacco use worldwide. Despite the drop, there still continues to be a significant number of tobacco users in India. Research on tobacco use among young persons is commonly prioritised in India, while studies on tobacco use among middle-aged (45–59 years) and elderly (≥ 60 years) adults are noticeably lacking. We have conducted this study with objective to estimate the distribution, determinants and socioeconomic inequalities of smoking (SM) and smokeless tobacco (SLT) consumption across Indian states and union territories.MethodsThis study was based on 66,606 participants aged ≥ 45 years using Longitudinal Aging Study in India (LASI)-1 (2017–2018) data. Distribution of tobacco consumption (any form, smoking (SM), smokeless (SLT) and both) was documented as per Indian states and union territories with spatial distribution by Indian map. Demographic, socioeconomic, health related and behavioural determinants were established using nested multilevel regression modelling. Socioeconomic disparities were documented using concentration curve. P-value < 0.05 was considered as statistically significant.ResultsOverall, 36.78% participants documented using any form of tobacco; with higher consumption of SLT (19.88%) than smoking/SM (13.92%). Only 2.98% consumed both. Mizoram had highest consumption of tobacco in any form (78.21%) and smoking (35.18%). Elderly participants had higher odds of consuming tobacco (any 1.23 (1.18–1.28), SM 1.99 (1.14–1.27), SLT 1.08 (1.03–1.14) and both 1.27 (1.14–1.40 times) than middle aged participants. Females, OBC (other backward castes), urban residence had lower odds in all the categories, while being widow/ separated/ divorced, belonging to Muslim community, having clerical and skilled occupation, poor self-rated health, comorbidity and multimorbidity had higher odds. With decrease in the wealth index, educational status and frequency of physical activity the odds of tobacco consumption increased. The odds of higher tobacco consumption were documented from northeast region (2.56 (2.37–2.76) higher than north). Alcohol consumption had the highest odds (4.94 (4.69–5.21)). Participants exposed to media had lower odds (11% lower) of consuming tobacco. The socioeconomic inequalities in tobacco consumption were significantly distributed more among the poorest (any -0.064 (-0.072 to -0.056) and SLT -0.069 (-0.072 to -0.056)).ConclusionPrioritising tobacco prevention and increasing availability and accessibility of cessation programmes that are suited with unique requirements and circumstances, even for elderly population, are essential focusing on the higher determinants across poorest section in the country.

The 'ideal' dancer: An investigation into predictors of body image dissatisfaction among male dancers, female dancers and their non-dancing counterparts.

Body image dissatisfaction is consistently highlighted as a precursor for eating disorders, arising from several factors. One factor surrounds social expectations of being thin, which can be emphasised in certain physical activities, like dance. Whilst research is available for body image dissatisfaction among female dancers, literature has neglected the male demographic. The present study investigated seven predictors of body image dissatisfaction within male and female dancers, from a variety of genres. The study employed a non-experimental quantitative method, utilising an independent groups correlational design. The role of clothing practices, body ideal internalisation and sociocultural influences were investigated as predictors for body image dissatisfaction. Data from 180 participants (mean age = 23.7, SD = 7.51) was analysed from an online survey. Hierarchical multiple regression revealed that the model consisting of all predictors significantly accounted for over 60% of variance in body image dissatisfaction scores within all independent groups. The individual contribution of predictors differed between groups, with clothing practice being the only significant predictor in all four groups. Media pressure was a significant predictor within non-dancer groups only. This research highlights the importance of clothing practices, specifically tight-fitting garments within the dance environment and general population. Future research should investigate potential differences in the predictors between each level of dance.

Association of neighborhood-level disadvantage beyond individual sociodemographic factors in patients with or at risk of knee osteoarthritis

ObjectiveLower socioeconomic status (SES) is a risk factor for poorer pain-related outcomes. Further, the neighborhood environments of disadvantaged communities can create a milieu of increased stress and deprivation that adversely affects pain-related and other health outcomes. Socioenvironmental variables such as the Area Deprivation Index, which ranks neighborhoods based on socioeconomic factors could be used to capture environmental aspects associated with poor pain outcomes. However, it is unclear whether the ADI could be used as a risk assessment tool in addition to individual-level SES.MethodsThe current study investigated whether neighborhood-level disadvantage impacts knee pain-related outcomes above sociodemographic measures. Participants were 188 community-dwelling adults who self-identified as non-Hispanic Black or non-Hispanic White and reported knee pain. Area Deprivation Index (ADI; measure of neighborhood-level disadvantage) state deciles were derived for each participant. Participants reported educational attainment and annual household income as measures of SES, and completed several measures of pain and function: Short-form McGill Pain Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, and Graded Chronic Pain Scale were completed, and movement-evoked pain was assessed following the Short Physical Performance Battery. Hierarchical linear regression analyses were used to assess whether environmental and sociodemographic measures (i.e., ADI 80/20 [80% least disadvantaged and 20% most disadvantaged]; education/income, race) were associated with pain-related clinical outcomes.ResultsLiving in the most deprived neighborhood was associated with poorer clinical knee pain-related outcomes compared to living in less deprived neighborhoods (ps < 0.05). Study site, age, BMI, education, and income explained 11.3–28.5% of the variance across all of the individual pain-related outcomes. However, the ADI accounted for 2.5–4.2% additional variance across multiple pain-related outcomes.ConclusionThe ADI accounted for a significant amount of variance in pain-related outcomes beyond the control variables including education and income. Further, the effect of ADI was similar to or higher than the effect of age and BMI. While the effect of neighborhood environment was modest, a neighborhood-level socioenvironmental variable like ADI might be used by clinicians and researchers to improve the characterization of patients’ risk profile for chronic pain outcomes.

Association Between Workplace Violence and Post-Traumatic Stress Disorder Among Healthcare Workers in China, 2020 to 2023.

This is the first study in China to investigate the prevalence of workplace violence (WPV) and its long-term association with post-traumatic stress disorder (PTSD) among healthcare workers. Conducted across various time points from March 27, 2020, to April 10, 2023, the research employed a four-wave repeated cross-sectional design involving 14,993 healthcare workers from 32 provincial administrative regions across the country. Nurses accounted for 34.3% of the sample, while doctors accounted for 65.7% of the sample, with a higher concentration in western China. Multivariate logistic regression analysis was employed to identify the risk factors for WPV, and hierarchical logistic regression models were used to examine the association between PTSD and WPV. The findings revealed that 71.4% of healthcare workers reported experiencing or witnessing WPV, with nearly half (47.5%) indicating exposure to violent incidents within the past year. Further analysis revealed significant associations between WPV incidence and various factors, including age, gender, work experience, work setting, and a history of contact with Coronavirus Disease 2019 (COVID-19) patients (the odds ratio [OR] of these influencing factors ranged from 1.10 to 2.03. All the p-values were less than .05). 28.5% of healthcare workers displayed symptoms of PTSD, with WPV identified as a major risk factor contributing to these symptoms (lifetime WPV: OR = 1.61, 95% CI [1.47-1.76]; 1-year WPV: OR = 1.75 [1.61-1.90]). Therefore, it is imperative to prioritize the mental health of healthcare workers and implement effective measures to prevent and mitigate WPV, ensuring their physical and psychological well-being as well as occupational safety.

Associations Between Callous-Unemotional (CU) Traits and EmotionRecognition Abilities in School Children: The Influence of ConductProblems and Age.

Callous-unemotional (CU) traits are associated with severe conduct problems (CP) in youth. Causal theories for CU traits focus on emotion processing deficits that interfere with empathy development. However, though CU traits are consistently associated with deficits in affective empathy (i.e., emotional reactivity), the association between CU traits and cognitive empathy, which requires accurate emotion recognition, is less clear. We hypothesize that past inconsistencies in the associations between CU traits and emotion recognition may be due to interactions with conduct problems (CP) and age. To test this, a sample (N = 258) of school children in the 3rd, 6th, and 8th grades completed a computer task that assessed facial expression recognition, while caregivers and teachers reported on CU traits and CP. Results from hierarchical linear regression analyses indicated significant interactions between CU traits and CP in their associations with overall emotion recognition and with recognition of fearful and sad faces. In each case, CP showed a non-significant negative association with emotion recognition at high levels of CU traits. However, for fear and sadness recognition, CP was positively associated with accuracy at low levels of CU traits. Significant interactions between CU traits and age also emerged for recognition of fear and sadness, such that there were non-significant negative associations between CU traits and recognition accuracy in younger children, but significant positive associations in 8th grade students. These results have multiple implications as they help to clarify past inconsistencies on the association between CU traits and emotion recognition and can aid in the development of more effective interventions to prevent or treat conduct problems in young children.

Gender differences in reported potentially morally injurious events among post-9/11 U.S. combat veterans, using two measures.

Military experiences that violate one's sense of right and wrong (i.e., potentially morally injurious events [PMIEs]) may result in moral injury, characterized by shame, guilt, demoralization, self-condemnation, and social withdrawal. The objective of this study was to examine gender-related differences in the rate of reporting PMIEs. Secondary analyses were conducted on a previously collected longitudinal cohort study of postdeployment functioning among U.S. post-9/11 combat veterans in Central Texas (N = 406). As part of the parent study, participants completed two measures of PMIEs-the Moral Injury Events Scale (MIES; Nash et al., 2013) and the Moral Injury Questionnaire-Military Version (MIQ-M; Currier et al., 2015). Gender differences at the item response level were analyzed in a series of Bayesian multilevel item response theory models. The most frequently endorsed responses on both the MIES and MIQ-M for both men and women were never or strongly disagree. On the MIQ-M, more veteran men endorsed experiencing PMIEs to some degree. On the MIES, more veteran women endorsed strongly agree to betrayal items. Veteran men and women reported any PMIE occurring at relatively high rates. Gender differences at the item response level were found for most items on both the MIES and MIQ-M, albeit of small magnitude. Awareness of gender differences in the likelihood of experiencing a given PMIE may help inform clinical assessments and case conceptualizations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Viral hepatitis knowledge and vaccination awareness among men who have sex with men (MSM) in 43 countries of the WHO European Region: results from the European MSM Internet Survey, EMIS-2017.

BackgroundRecent hepatitis A virus outbreaks in Europe affecting men who have sex with men (MSM) and ongoing hepatitis B virus transmission among MSM underscore the ongoing need for viral hepatitis prevention in this population.AimTo describe viral hepatitis knowledge and associated factors among MSM in the WHO European Region to inform targeted prevention.MethodsIn the European MSM Internet Survey (EMIS-2017), basic knowledge was defined as correctly identifying at least 4 of 5 statements about viral hepatitis and vaccination. We described basic knowledge by country. In a multilevel logistic regression model, we estimated adjusted odds ratios (aOR) with 95% confidence intervals (CI) for having basic knowledge and explanatory variables: sociodemographic characteristics, history of hepatitis C and/or HIV diagnosis, sexual orientation disclosure at last sexually transmitted infections (STI) test and outness.ResultsOf 113,884 participants across 43 WHO European Region countries, 68% demonstrated basic knowledge, ranging from 50% in Israel to 80% in the Netherlands. Basic knowledge was significantly associated with older age (≥ 40 years vs < 25 years, aOR: 2.9, 95% CI: 2.7-3.0), a history of hepatitis C and/or HIV diagnosis (aOR: 1.8, 95% CI: 1.7-1.9) and sexual orientation disclosure at last STI test (aOR: 1.3, 95% CI: 1.2-1.3), among other factors.ConclusionsWe found a knowledge disparity regarding viral hepatitis and hepatitis vaccination awareness among MSM across Europe, highlighting a need to address these gaps. A non-judgemental, accepting climate that allows individuals attending medical services to safely disclose their sexual orientation is fundamental to enable healthcare professionals to target information and preventative measures more effectively.

Society's educational debts due to racism, sexism, and classism in introductory biology student learning

AbstractWe investigated the intersectional relationships between racism, sexism, and classism in inequities in student conceptual knowledge in introductory biology courses using a quantitative critical framework. Using Bayesian hierarchical linear models, we examined students' conceptual knowledge as measured by the Introductory Molecular and Cell Biology Assessment. The data came from the LASSO Platform database and included 6547 students from 87 introductory courses at 11 institutions. The model indicated that students with marginalized identities by race, gender, and class tended to start with lower scores than continuing‐generation, White men. We conceptualized these differences as educational debts society owed these students due to racism, sexism, and classism. Instruction added to these educational debts for most marginalized groups, with the largest increases for students with multiple marginalized identities. After instruction, society owed Black and Hispanic, first‐generation women an educational debt equal to 60–80% of the average learning in the courses. These courses almost all (85/87) used collaborative learning and half (45/87) supported instruction with near‐peer learning assistants. While research shows collaborative learning better serves students than lecture‐based instruction, these results indicate it adds to educational debts due to racism, sexism, and classism in introductory college biology courses.

Preschoolers' home music environment relates to their home literacy environment and parental self-efficacy.

Positive relationships between the home literacy environment and children's language and literacy development are well-established. However, existing literature has overlooked the potential contributions of the home music environment. Initial evidence indicates positive relationships between the home music environment and children's emerging language and literacy skills, yet it remains unclear whether and how children's home music and literacy environments may be related. Furthermore, parents' sense of self-efficacy is known to impact the home environment provided for their children. Despite being linked with the home literacy environment, parental self-efficacy has not been directly investigated in relation to the home music environment. In the present study, 124 caregivers of preschoolers completed a one-time online survey about their children's home music environment, home literacy environment, and parental self-efficacy. Partial correlations and hierarchical regressions reveal that children's amount of music exposure is associated with qualitative (not quantitative) aspects of the home literacy environment, specifically parents' use of interactive techniques during shared reading. Moreover, parental self-efficacy is associated with children's amount of exposure to music. Overall, these findings support the need to further examine how the home music environment may meaningfully contribute to an enriching learning environment, especially to support language and literacy development.

P2Y12 Inhibitor Pretreatment in Non-ST-Segment Elevation AcuteCoronary Syndrome: The NCDR Chest Pain-MI Registry.

Although high rates of P2Y12 inhibitor pretreatment (defined as the administration before coronary angiography) for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) have been reported, contemporary U.S. practice patterns are not well studied. The goal of this study was to investigate the temporal U.S. trends, variability, and clinical outcomes of P2Y12 inhibitor pretreatment in NSTE-ACS. Consecutive patients who underwent early invasive strategy for NSTE-ACS (coronary angiography≤24 hours of arrival) in the National Cardiovascular Data Registry Chest Pain-Myocardial Infarction (MI) Registry were analyzed. A time-trend analysis was conducted on a complete cohort between January 1, 2013, and March 31, 2023. Subsequently, a more recent cohort (January 1, 2019, to March 31, 2023) with a complete set of variables was used to construct hierarchical regression models to quantify the variability in the use of pretreatment among operators and institutions. For this contemporary cohort, instrumental variable analysis, with operator preference as the instrument, was performed to compare the in-hospital outcomes between patients who received pretreatment and those who did not. Use of P2Y12 inhibitor pretreatment decreased from 24.8% in 2013Q1 to 12.4% in 2023Q1. Among the contemporary cohort of 110,148 patients (2019-2023; mean age 63.9 ± 12.5 years; 33.0% female), 17,509 (15.9%) received pretreatment. Significant variability in P2Y12 inhibitor pretreatment was observed (range: 0%-100%): hierarchical regression model demonstrated that 2 similar patients would have a >3-fold difference in the odds of pretreatment from 1 random operator or institution as compared with another (median OR: 3.74 [95%CI: 3.57-3.91] and 3.63 [95%CI: 3.51-3.74], respectively). Instrumental variable analysis demonstrated no significant differences in in-hospital all-cause death (1.5% vs 1.7%; P=0.07), recurrent MI (0.6% vs 0.6%; P=0.98), or major bleeding (2.7% vs 2.8%; P=0.98) with pretreatment. However, in patients who underwent coronary artery bypass surgery, pretreatment was associated with a longer length of stay (11.2 ± 5.1days vs 9.8 ± 5.0days; P< 0.01). In a national U.S. registry, we observed significant variability in the use of P2Y12 inhibitor pretreatment among NSTE-ACS patients. Given the lack of clear advantages and the potential for prolonged hospital stays, our findings highlight the importance of efforts to improve standardization.

Reliability of the Cleveland Clinic Behavioral Rating System (CCBRS) Among Diverse Patients Seeking Bariatric Surgery.

The CCBRS is a multidimensional assessment tool developed to aid in the psychosocial evaluation of patients seeking bariatric surgery. To date, three studies support the interrater reliability, internal consistency, and predictive validity of the CCBRS for a number of postoperative outcomes. However, research has predominantly been with White females. This study examines the reliability of the CCBRS with diverse individuals from three surgery clinics. The relative contribution of demographic and psychosocial variables to overall CCBRS ratings and differences in overall CCBRS ratings based on these factors are also explored. Patients seeking bariatric surgery (n = 407; 86.2% female; 49.6% Black; mean BMI 48.3kg/m2, SD = 8.5) were evaluated with a standardized multimodal assessment. CCBRS domain and overall ratings were made based on the integration of assessment data. Patient weight, BMI, and weight loss surgery procedure were obtained from the initial bariatric surgery consult. Internal consistency of the CCBRS was good (Cronbach's alpha = .80) for this sample though lower than previously found. Most patients (75.6%) were cleared for surgery. Statistically significant differences in overall CCBRS ratings were found only based on employment status and referring clinic. Hierarchical regression analysis demonstrated a small effect for demographic and psychosocial factors, with only past alcohol abuse, current substance abuse, and referring clinic explaining statistically significant variance in overall CCBRS ratings. Results support the reliability of the CCBRS; however, additional research is needed with diverse populations.