Hierarchical Regression Research Articles

Mining diamonds: validation of the vibrant school scale

PurposeThe Vibrant School Scale (VSS) is an exciting new measure of school climate grounded in positive psychology designed to assess aspirational aspects of climate through three subscales—enlivened minds, emboldened voices and playful learning. This study demonstrates its validity and reliability.Design/methodology/approachData were collected via online surveys from teachers (n = 446) and school leaders (n = 49) across 31 schools. A Multilevel Exploratory Factor Analysis (MEFA) was conducted to examine the factor structure and reliability of the measure.FindingsMEFA confirmed distinct factor structures for the VSS at both the individual and school levels. At the organizational level, Vibrant School Climate (VSC) emerged as a cohesive, unified construct, while the three subscales were distinct at the individual level. Results also demonstrated high reliability coefficients.Practical implicationsVSS offers school leaders a forward-looking tool for assessing and fostering a climate aligned with aspirations for deeper learning. Subscales pinpoint specific areas for intervention for fostering enlivened minds, emboldened voices and playful learning, while the school-level factor supports cohesive, school-wide initiatives. Used alongside strengths-based approaches like appreciative inquiry, VSS can empower school communities to thrive.Originality/valueThis study offers educational researchers a new validated tool to capture emerging ideas for the kinds of school environments that foster deeper learning. It provides leaders with actionable insights for achieving their aspirations for their schools. It addresses the call for assessing school climate through multilevel analysis.

Understanding College Students' Help-Seeking Intentions for Alcohol Use: A Theoretical and Network-Based Approach.

This study investigated the association between college students' social network characteristics, the RAA, and intentions to seek help for alcohol use if they thought or knew they had a problem. Cross-sectional survey data from 1,447 college students were extracted from a larger, nationally representative college student quota sample. Inclusion criteria were between 18 to 24 years of age, enrolled full time in a college or university, reported past-year alcohol consumption, and passed data quality checks. Participants reported demographics, RAA constructs, and egocentric network data. Network composition variables were calculated via E-Net. Descriptive statistics and hierarchical linear regression analyses were conducted to examine intentions to seek help. A regression model consisting of RAA constructs was statistically significant at the p < .001 level, accounting for nearly 40% of the variance in help-seeking intentions. The addition of network composition variables increased the explained variance by an additional 2.8%, which was statistically significant at the p < .001 level. Integrating RAA constructs with social network characteristics can help identify specific individual beliefs and social influences that can be targeted to strengthen help-seeking intentions and behaviors among college students who engage in high-risk drinking.

Waist circumference and waist-to-height ratio are better predictors of body mass index changes in adolescents in Ho Chi Minh City.

This study was conducted to assess the correlation between baseline waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), triceps skinfold thickness (TSFT) and subscapular skinfold thickness (SSFT) with body mass index (BMI) at follow-up and to identify the anthropometric parameters accounting for the highest proportion of the BMI variation among junior high school students in Ho Chi Minh City. This was a 5-y prospective cohort study; 761 students were followed annually. Data collected included height, weight, WC, TSFT and SSFT. Pearson correlation coefficients were calculated to investigate the correlations between baseline anthropometric parameters with BMI at follow-up. Multilevel mixed-effect models with linear regression analyses and Poisson regression were used to assess the relationship between all listed variables with BMI changes as well as the risk of being overweight/obesity. BMI, WC, TSFT, SSFT, WHtR, the sum of four skinfold thicknesses and % body fat at baseline were all strongly correlated with BMI at follow-up (p<0.001). Among multiple linear regression models, the models with WC or WHtR accounted for the highest variation in BMI changes (approximately 74.5%) (p<0.001), while the model with WHR explained only 22.7% of the variation in BMI changes. WC is a simple anthropometric indicator, which can be easily used to assess adiposity and is significantly associated with BMI changes over time.

Alcohol Use Disparities Among Transgender and Nonbinary Adults: An Intersectional Investigation.

This study examined an intersectional perspective on alcohol use disparities within transgender and nonbinary (TGNB) adults. We examined the data from the 2015 U.S. Transgender Survey (N = 27,715), a cross-sectional, nationwide survey of TGNB adults. The number of drinking days and the number of binge-drinking days were primary outcomes. Analyses followed a multilevel analysis of individual heterogeneity and discriminatory accuracy approach to examine alcohol disparities across gender identities (transgender, nonbinary and crossdresser) and intersections with race/ethnicity, age, sex assigned at birth and dis/ability status. Significant identity-related differences existed within TGNB communities across all facets of identity. Relative to the sample average, individuals at the intersection of White and crossdressers reported elevated levels of alcohol use. Further, effects were most pronounced across combinations of transgender, nonbinary, White and Black participants to accurately describe alcohol risk in subpopulations relative to examining risk associated with each one of these identities independently. Disparities in alcohol use among TGNB adults are best understood from an intersectional perspective. Affirming public health initiatives for alcohol use should consider identity-related differences across TGNB communities. Results provide the first evidence that alcohol use disparities exist across gender and intersecting identities in a large sample of TGNB adults. Findings lay the groundwork for future research examining mechanisms responsible for these disparities.

Is there a beauty is beastly effect in electoral success? An empirical analysis of the German federal elections 2005 to 2021.

Research shows that attractive women may face disadvantages in male-dominated contexts or those stereotypically associated with masculinity, because they tend to be ascribed more stereotypically feminine character traits and capabilities. This is known as the "beauty is beastly effect." However, its impact on political elections remains largely unexamined. This study investigates whether such an effect exists for female candidates in Germany, where political competition is male-dominated and rewards stereotypically masculine traits. Using a comprehensive data set from the 2005 to 2021 federal elections, we empirically test for interactions between gender and physical attractiveness. Despite extensive multilevel analyses, no evidence was found for the "beauty is beastly effect" in this context. Nevertheless, positive main effects suggest female candidates may still face disadvantages. Possible explanations for these findings are discussed.

Rehabilitation engagement is associated with lower level of care needs on discharge from postacute care in older adults with cognitive impairment.

Older adults with cognitive impairment (CI) in postacute care (PAC) are at risk for an increased level of care (LOC) postdischarge. Rehabilitation engagement may impact the relationship between CI and increased LOC. Ninety-two older veterans (> 50 years) were assessed by physical therapists or assistants with the Hopkins Rehabilitation Engagement Rating Scale (HRERS) while participating in Veterans Affairs PAC. Hierarchical logistic regression examined whether rehabilitation engagement predicted LOC while controlling for cognition as assessed with the Montreal Cognitive Assessment (MoCA). We then examined whether rehabilitation engagement moderated the effect of cognition on LOC. Hierarchical logistic regression modeling revealed that the HRERS total score predicted LOC after controlling for MoCA scores. The interaction between MoCA and HRERS total score was nonsignificant. Item-level HRERS analyses revealed a significant interaction for CI (MoCA score < 22) and active participation (HRERS Item 5). Examination of the interaction indicated that among low scorers on active participation, CI increased the odds of requiring higher LOC, while the main effect of CI on LOC was nonsignificant among those who scored high on active participation. Higher rehabilitation engagement reduced the risk of requiring higher LOC at PAC discharge after controlling for cognitive functioning. Additionally, active participation may buffer against adverse outcomes for older adults with CI. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Calmness and excitement intensity and variability in old age: Linking stressful circumstances to well-being and health.

The discrete emotion theory of affective aging posits that the adaptive effects of emotions vary depending on their ability to facilitate effective responses to developmental constraints and opportunities. Research suggests that calmness and excitement are two positive emotions with distinct functions and that calmness, but not excitement, supports effective adjustment to developmental constraints in old age, particularly when control perceptions are low. In the present research, we conducted a 1-week daily diary study with 169 community-dwelling older adults (Mage = 76.6, SD = 7.2). Data were collected in 2018. We examined the effects of calmness and excitement intensity (between- and within-person differences) and variability within the context of stressful experiences on older adults' well-being and health. We expected that levels, increases, and consistency (i.e., low variability) of calmness, but not excitement, may be adaptive, particularly among older adults with low control perceptions. Results from hierarchical and linear regression models showed that calmness intensity was associated with better well-being and health, on both the between- and within-person levels. Between-person levels of excitement intensity, by contrast, predicted poorer health and depressive symptoms among individuals with low perceived control. Compared to variable calmness, consistent calmness was associated with adaptive outcomes, particularly for older adults with low perceived control. By contrast, excitement variability was largely unrelated to well-being and health, except for a positive association with depressive symptoms among adults with low control. Findings inform functional theories of emotion by suggesting that positive emotions with disparate motivational functions can exert diverging effects in older adulthood. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Leadership dynamics in health care crises: The impact of initiating structure and consideration behaviors on safety climate in public hospitals.

Health care crises underscore the critical need to maintain a robust safety climate to prevent medical errors and improve patient outcomes. Leadership behaviors, particularly initiating structure and consideration, are vital in shaping safety climate. However, inconsistent findings have raised questions regarding the effectiveness of these behaviors in crisis contexts. This study examines how the initiating structure and consideration behaviors of clinical leaders influence safety climate during crises and explores the moderating role of leaders' affectivity in these relationships. Empirical data were collected from 108 dyads of clinical leaders and their direct reports across 21 public hospitals in Thailand at three intervals over one year. The study employed growth modeling using random coefficient models to analyze the impact of leadership behaviors on safety climate, accounting for the nonindependence of observations over time and variations in leader affectivity. The results show that the positive impact of consideration behaviors on safety climate diminishes during crises, whereas initiating structure plays a crucial role in enhancing safety climate by providing clarity and stability. Additionally, leaders' positive affectivity enhances the impact of consideration behaviors on safety climate, although this effect weakens as the crisis intensifies. These findings highlight the need for clinical leaders to balance initiating structure with consideration to enhance safety climate during crises, while leveraging positive affectivity to integrate new information to stabilize safety practices and develop effective contingency responses to immediate needs.

Understanding racial/ethnic differences in e-cigarette outcome expectancies among early adolescents: findings from the Adolescent Brain Cognitive Development Study

IntroductionE-cigarette expectancies, which may differ by race/ethnicity, play a crucial role in shaping youth e-cigarette use. Observed differences by race/ethnicity, however, may reflect racial/ethnic variations in social determinants of health, such as socioeconomic status (SES). This study examined the extent to which race/ethnicity was uniquely associated with youths’ positive and negative e-cigarette expectancies, after adjusting for SES and neighborhood disadvantage, and individual, family, and peer risk factors.MethodsAnalyses included 8,814 Black (15.0%), Latinx (22.8%), and White (62.2%) 12 to 14-year-old participants in the Adolescent Brain Cognitive Development Study. Applying a three-stage analytic approach, hierarchical regression analyses examined associations of positive and negative e-cigarette expectancies with race/ethnicity in three blocks, with age and gender in block 1, adding SES and neighborhood disadvantage in block 2, and individual, family, and peer risk factors in block 3.ResultsBlack and Latinx (relative to White) race/ethnicity and Latinx (relative to Black) race/ethnicity were associated with positive expectancies (p &amp;lt; 0.001) in blocks 1 and 2 but were non-significant in block 3. Black and Latinx (relative to White) race/ethnicity and Latinx (relative to Black) race/ethnicity were associated with lower negative expectancies (p &amp;lt; 0.001) in block 1, but were no longer significant after adding SES and neighborhood indicators in block 2. Perceived risk, perceived peer disapproval, and curiosity about e-cigarettes were associated with positive and negative expectancies.DiscussionThe results highlight the importance of considering associations of race/ethnicity with e-cigarette expectancies in the context of social determinants and individual and interpersonal factors in e-cigarette prevention.

Smartphone use, wellbeing, and their association in children.

This study assessed changes in the duration of smartphone use, problematic smartphone use (PSU), quality of life, and their association from 2018 to 2024 in children and adolescents. Data were collected between 2018 and 2024 within the LIFE Child cohort study (Germany). We used a repeated cross-sectional dataset containing 2576 data points of 1113 10- to 17-year-old children and adolescents (51% male) who had reported on their quality of life, PSU, and their smartphone use duration. Hierarchical regression analyses were applied to assess associations of PSU, smartphone use duration, and quality of life with the year of assessment and associations of PSU and smartphone use duration with quality of life. From 2021 onwards, symptoms of PSU and smartphone use durations >3 h/day were significantly more frequent than in 2018. For PSU, these changes were significantly stronger in girls and younger children. Concurrently, quality of life was significantly poorer than in 2018. Both PSU and long smartphone usage durations were significantly associated with lower quality of life. This study shows the increasingly problematic use of smartphones and its negative association with the overall declining quality of life of children over the last seven years. Problematic smartphone use in children and adolescents has increased in the last seven years, while quality of life has decreased. Problematic smartphone use is associated with decreased quality of life, and this association was especially strong in 2022 and 2023. In contrast to previous studies, the present time trend analysis covers time periods before and within the Covid-19 pandemic and suggests that the pandemic has reinforced the observed changes in smartphone use and quality of life. Restricting children's smartphone use might help to improve or maintain a higher quality of life.

When do parents use positive behavior support? Day-to-day fluctuations in parental moods and coparenting support.

Parent's use of positive behavior support-including praise, encouragement, and consistency-is beneficial for adolescent development, yet there is limited research exploring how within-person differences in individual and family factors contribute to why parents use it more or less on a day-to-day basis. This study aimed to examine whether daily parental mood and coparenting support would explain day-to-day changes in parents' use of positive behavior support with their adolescents. This study included a sample of 150 parents (Mage = 43.4, SDage = 6.9) from two-parent families, who completed a 21-day daily diary protocol. Multilevel model results revealed within-person relations linking daily variation in parents' mood and coparenting support with positive behavior support. On days when parents' positive mood was higher (or negative mood was lower) than usual and when coparenting support was higher than usual, parents used more positive behavior support with their adolescents. When all parental moods were considered simultaneously, daily positive moods remained significant. In addition, daily variation in coparenting support moderated the relation between parents' daily anxious mood and their positive behavior support (but not for daily angry, depressed, or positive moods). In this interaction, the daily anxious mood was only associated with positive behavior support if coparenting support was also high; positive behavior support was consistently low in the context of low coparenting support. These findings have implications for understanding daily parenting processes and interventions aimed at supporting parent's positive behavior support. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Humorous peer play and social understanding in childhood

Humour plays a crucial role in children’s early interactions, likely promoting the development of social understanding and fostering positive social relationships. To date, the connection between humour production in peer play and the development of social understanding skills in middle childhood has received limited attention. In a community sample of 130 children residing in the UK (M = 6.16 years old, range 5–7; 67 [51.5%] girls, 62 [47.7%] boys, and 1 [0.8%] non-binary child; 95 [73.1%] mothers and 85 [65.4%] fathers identified as Welsh, English, Scottish, or Irish), we tested our prediction that children’s use of humour in play with peers would be positively associated with children’s ability to understand the minds of others. We conducted detailed observational coding of children’s humour production during peer play and examined associations with children’s performance on a battery of social understanding assessments. Multilevel models showed that 42.8% of the variance in children’s humour production was explained by play partner effects. When controlling for the effect of play partner and other individual child characteristics (age, gender, receptive vocabulary) children’s spontaneous attributions of mental states were associated with humour production. Results are discussed considering how these playful exchanges reflect and influence the development of children’s socio-cognitive competencies.

A Grounded Theory Study of the Rules Governing Chinese Teachers’ Emotional Labor from a Cultural Perspective

This study employs grounded theory to systematically review and analyze the content related to the emotional labor of Chinese teachers in policy texts and authoritative journals. A multi-level attribution model, referred to as the “Onion Model,” is developed to examine the influencing factors of teachers’ emotional labor rules. This model comprises five levels: the environmental level, the behavioral level, the ability level, the belief level, and the mission level. The study reveals the dynamic process of teachers’ emotional labor within specific cultural and policy contexts. Driven by traditional cultural values and professional missions, teachers internalize beliefs and utilize emotional regulation skills, which are ultimately externalized as specific emotional behaviors. This research challenges previous perceptions that regarded emotional labor merely as organizational discipline. It highlights the central role of cultural factors in shaping teachers’ emotional labor, enriches the theory of cross-cultural emotional labor, and offers theoretical support and practical insights for the formulation of educational policies and the professional development of teachers.

Environmental Knowledge Influences Pro‐Environmental Behavior to Mitigating Air Pollution Toward Sustainable Development in Indonesia: A Logistic Multilevel Analysis

ABSTRACTThis investigation seeks to uncover both internal and external influences that contribute to fostering pro‐environmental behavior, particularly in the realm of mitigating air pollution. This study also seeks to examine the relationship between environmental knowledge and individual attitudes toward the reduction of air pollution. This study employed multilevel binary logistic regression to achieve its objectives and address the multilevel characteristics of the data. The study utilized two types of data: the nationwide household survey for level one and the regional aggregate data for level two. The findings indicate that environmental knowledge influences the reduction of motor vehicle usage. Furthermore, public knowledge regarding air pollution and its origins, along with the quantity of motor vehicles at the provincial level, markedly affects motor vehicle usage at the 10% significance level. Individuals' propensity to decrease motor vehicle usage significantly correlates with various strategies to mitigate air pollution, such as using bicycles and public transportation. Consequently, the government can formulate policies about environmental education that consider both internal and external factors for individuals with the aim of promoting pro‐environmental behavior (PEB) and mitigating air pollution in Indonesia.

Estimating mechanisms linking relative income to self-rated health by multilevel modeling: the moderating role of healthcare access and quality index

Income-health gradients vary in societies with diverse cultures and healthcare access levels, and generalized trust in unknown resources of health services may play a crucial role in these gradients. Multilevel models using a sample of 152,501 respondents from 89 societies are conducted to investigate the mediation effect of generalized trust in the correlation between relative income and self-rated health globally, and the moderating role of healthcare access in the association between relative income and self-rated health. Results show that individuals’ relative income significantly and positively predicts their generalized trust, which in turn significantly and positively predicts their self-rated health. In countries and regions with higher levels of healthcare access and quality, a higher level of relative income is positively correlated with increased self-rated health. This study theoretically contributes to the literature on income-health relationships by capturing medical resource access and individual characteristics. Specific policy recommendations include fostering generalized trust, improving healthcare education, and expanding telemedicine.

Responsive early childhood parenting, preschool enrollment, and eventual student learning outcomes: a cross-country analysis using hierarchical linear modeling with TIMSS 2019 data

This paper examines whether parental engagement in early childhood and preschooling act as substitutes, or whether their joint effect enhances students’ learning outcomes. We utilize the TIMSS 2019 dataset and employ a hierarchical linear modeling (HLM) approach to analyze data from 52 countries, ensuring a robust examination of cross-national variations. Although extant literature proposes that parental engagement and preschooling are likely to function as substitutes, our analysis reveals that they can also serve as complements. For instance, a one-unit increase in the TIMSS ECEC parental engagement index is associated with an estimated increase of 0.58 and 0.85 units in math test scores for students with up to one and two years of preschooling, respectively. In the case of science, for students with three or more years of preschooling, our findings suggest a substitutive relationship between parental engagement and preschool participation. In addition, we find that home literacy and numeracy activities undertaken by parents influence both math and science scores, albeit differently. Furthermore, we observe that a higher degree of parental engagement, combined with preschooling, yields the largest test score gains in countries with a greater proportion of children already enrolled in preschool, thereby making a case for expanding preschool access.

Relations between traditional gender-role attitudes, personality traits, and preference for the stay-at-home mother role in Lebanon

Why do some college-educated mothers of minor children prefer to stay at home to care for the family and the house, while others prefer to work outside the house in addition to caring for the children? The Social Role Theory suggests that mothers’ preference for the homemaking role is influenced by their endorsement of traditional gender-role attitudes. We propose that mothers’ personality traits are also associated with their preference for the homemaking role. The aim of this study is to test this proposition by examining the relations between mothers’ Big Five personality traits and their preference for being a stay-at-home mother, controlling for their endorsement of traditional gender-role attitudes. For this purpose, four hundred and nine college-educated mothers of minor children in Lebanon were recruited through social media platforms to fill an online survey about their personality traits, traditional gender-role attitudes, preference for the homemaking role, and demographics. Data was analyzed using hierarchical regression. It was found that preference to be a stay-at-home mother was positively predicted by mothers’ neuroticism, and negatively predicted by mothers’ openness to experience above and beyond their internalized traditional gender-role attitudes. The findings suggest that both personality and cultural factors should be considered when understanding mothers’ employment status preferences. They also call employers and policy makers to continue working on creating more mother-friendly work environments to retain women of all personalities in the workforce.

Spatial variations and determinants of modern contraceptive utilization among sexually active rural women in Ethiopia using mini EDHS 2019 data: spatial and multilevel analysis

BackgroundModern contraceptive prevents unwanted pregnancy and play a paramount role in birth spacing and improving health care costs for the individual, family, community, and the country at large. However, there is limited evidence on the modern contraceptive utilization of rural women in Ethiopia. Hence, this study aimed to assess the spatial distributions and determinants of modern contraceptive utilization of rural women in Ethiopia.MethodData was drawn from the 2019 Ethiopian mini-demographic health survey. Total weighted samples of 5934 mothers who were sexually active in the last five years preceding the survey were included. STATA version 14 was used to clean and analyze the data. The Arc GIS version 10.7 and Sat Scan version 10.1 were used for the spatial analysis to locate hot and cold spot areas in modern family planning among rural Ethiopian women. Multilevel multivariable logistic regression was employed to identify factors associated with modern family planning utilization in Ethiopia. In the multivariable analysis, an adjusted odd ratio with a 95% confidence level indicated a statistical association with the outcome variable at a P- value < 0.05.ResultThe overall prevalence of modern family planning utilization was 23.00% [95%CI (21.92–24.06)] among reproductive age (15–49) year-old Ethiopian rural women. Those women whose age 25–34 was [AOR = 0.79,95%CI(0.64, 0.98)], age of 35–49 years [AOR = 0.39,95%CI(0.03, 0.49)], being catholic[AOR = 1.46, 95%CI (1.18, 4.03)], not married[AOR = 0.05, 95%CI(0.04, 0.07)], having formal education[AOR = 1.59,95%CI(1.34, 1.88)], being primi-para[AOR = 2.27,95%CI(1.23, 9.33)], being multi-para[AOR = 2.43, 95%CI(1.94, 3.03)], house hold seize 11–24[AOR = 1.89,95%CI(1.38, 4.84)], having sons [AOR = 2.03,95%CI(1.67, 3.84)], having daughters[AOR = 1.55,95%CI(1.19, 2.33)], being middle wealth status[AOR = 1.22,95%CI(1.01, 1.47 )], and having high level community literacy were [AOR = 1.99, 95%CI(1.43, 2.79)] times to utilize modern. In this study, the spatial analysis revealed that SNNPR and Amhara regions have had a high modern contraceptive utilization rate. Whereas, the clusters with low utilization rates were located in Somalia and Afar regions of Ethiopia.ConclusionLess than a quarter of reproductive-age rural women used modern contraceptives in Ethiopia. The study revealed that there were considerable variations in utilizing modern contraceptives across rural areas in the regions of Ethiopia. Hence, the clusters with cold spots shall be emphasized beefing up the services.

Data sharing practices in high-impact rehabilitation journals

BackgroundThe demand for rehabilitation services is rising due to the aging population and increasing number of chronic conditions. High-quality research is essential to address these challenges, with recent mandates emphasizing the importance of data sharing for transparency and reproducibility. However, data sharing remains limited across clinical research. Data sharing statements (DSS) have been proposed to improve accessibility, but their implementation and effectiveness in rehabilitation research remain unclear. We aim to identify barriers and guide future policies for standardizing data sharing in the field of rehabilitation.MethodsOn June 6th, 2024, a PubMed/MEDLINE search identified clinical studies from five top rehabilitation journals based on impact factor. We extracted DSS and general characteristics in a duplicated and masked fashion to identify influential factors on DSS inclusion and then used a hierarchical logistic regression and thematic analysis. Email requests were sent to authors to verify their willingness to share data.ResultsOf 1,278 studies that underwent data extraction, 25.5% of studies in our sample featured a DSS; however, this figure was significantly influenced by one journal with a 99% inclusion rate, while the other four journals collectively had only a 5% rate. Further analysis of 314 DSS revealed the majority designated a gatekeeper role for handling data requests. After emailing authors to verify their commitment to the reported DSS, only 22.7% adhered to them.ConclusionsOur study found substantial variation in DSS inclusion across rehabilitation journals, reflecting inconsistencies in how data sharing policies are implemented. We also identified a significant gap between stated data sharing intentions and actual author follow-through. These findings highlight the need for stronger accountability mechanisms. We recommend adopting the Transparency and Openness Promotion (TOP) to provide a framework for data sharing in the field of rehabilitation. Further standardization of DSS is needed, as alternative methods like data repositories have been shown to improve transparency and reproducibility.Trial registrationClinical trial number: not applicable.

Multiracial Shifting Expression and Internalized Racism: Testing a Minority Stress Mediation Model

The current study applied critical multiracial theory and the minority stress model to explore how racial discrimination, multiracial discrimination, internalized racism, and shifting racial expressions contribute to psychological distress among multiracial adults in the United States. Utilizing a sample of 261 multiracial adults, findings indicated a positive correlation between psychological distress and all race and racism-related variables. Internalized racism predicted variance in psychological distress beyond racial discrimination in hierarchical linear regression. Results indicated that shifting racial expressions was positively associated with psychological distress, and the relationship between multiracial discrimination and psychological distress was mediated by shifting racial expression and internalized racism, as indicated using PROCESS macro 4.2 with 10,000 bootstrap samples to construct 95% confidence intervals for indirect effects. These results suggest that multiracial discrimination, shifting racial expressions, and internalized racism are significant factors in the mental health of multiracial adults. Implications for research, practice, training, and advocacy are discussed.