Multilevel Linear Models Research Articles

Do Children Speaking Indigenous and Regional Languages Benefit Equally from Updated Curricula? A Report on a Longitudinal Quasi-Experimental Pilot Study in Central Asia

This study examined the effects of an updated curriculum on the literacy and numeracy development of indigenous and regional language speaking children in Kazakhstan. A quasi-experimentally designed pilot study involved 1,717 students from 27 schools. Multilevel parallel linear growth models were used to analyze the impact of the updated curriculum on the co-developmental trajectories of numeracy and literacy from Grade 1 to 3. We found that the benefits of the updated curriculum were experienced equally for both the indigenous Kazakh- and Russian-speaking children. We suggest that modern reform efforts should not assume school-based inadequacies a priori but first test for the equivalent advantage of planned curricula across varying school conditions. We also suggest that other jurisdictions where multiple languages of instruction exist might consider adopting some of the changes implemented in Kazakhstan’s new curriculum for the purpose of improving literacy and numeracy outcomes in early elementary school.

Avian Responses to Different Grazing Management Practices in Neotropical Temperate Grasslands: A Meta-Analysis

Bird populations inhabiting the Rio de la Plata Grasslands in southern Brazil, Argentina, and Uruguay are known to be affected by livestock grazing practices. Cattle grazing can lead to changes in bird assemblages by affecting the heterogeneity of vegetation structures. We conducted a meta-analysis using studies that reported bird richness and abundance under different grazing management practices. We compared ranches under continuous grazing management (control, CGM) to (1) ranches under technological inputs management (TIM, herbicides and exotic pastures) and (2) ranches under ecological process-based management (EPM), which include ranches that utilise controlled and rotational grazing. We used random effects multilevel linear models to evaluate grazing regimen impacts. Our results indicate a negative impact of TIM on both bird abundance and richness (mean ± SE: −0.25 ± 0.07 and −0.92 ± 0.10, respectively) since the use of inputs simplifies vegetation structure and results in the loss of ecological niches. Compared to CGM, the influence of EPM on total bird abundance appears to be more dependent on grassland height, as evidenced by a decline in short grasses and increase in tall grasses. Our meta-analysis suggests that EPM practices may be beneficial for the conservation of endangered tall-grass birds.

Effect of school feeding program on dietary folate intake among school adolescent girls in Sidama region, southern Ethiopia

BackgroundEthiopia recently initiated a school feeding program (SFP) that provides nutritious meals to vulnerable students during school to combat malnutrition and improve their nutrition. However, there is limited evidence regarding the program’s impact on dietary folate intake among adolescent girls. Improving folate status in adolescent girls is important to prevent neural tube defect and anemia This study was aimed at assessing the effect of the SFP on dietary folate intake among school adolescent girls in the Sidama Region, Southern Ethiopia.MethodsThis school-based cross-sectional study compared dietary folate intake among adolescent girls enrolled in schools with (n = 290) and without (n = 290) SFP. Multistage sampling method was used to select adolescent girls from 12 schools. The multiple pass 24-h dietary recall method was used to estimate the dietary intake of adolescent girls. Dietary diversity in the preceding day of the survey was assessed with the standard nine-food group score. Nutrient inadequacy was defined as a proportion of adolescents with dietary value of nutrient intake less than the recommended daily allowance (RDA). The dietary folate intake was compared between two groups using multilevel mixed effects linear regression model adjusted for potential confounders.ResultsThe result showed significantly higher mean (±SD) dietary folate intake in SFP beneficiaries (421.12 ± 78.60 μg/day) than the non-beneficiaries (393.26 ± 74.57 μg/day; β = 27.19, p < 0.001). SFP beneficiary girls had a significantly higher mean (±SD) dietary diversity score (5.24 ± 1.35) compared to non-beneficiary girls (4.83 ± 1.54; β = 0.40, p = 0.001). The prevalence of inadequate folate intake was significantly higher among no-beneficiaries (47.4%) compared to beneficiaries (36.9%; p = 0.01).ConclusionThe SFP in Sidama region improved folate intake and dietary diversity of adolescent girls. The evidence from this study supports the expansion of the program to enhance dietary intake of nutrients of adolescent girls in the region.

Do Gender Norms Relax with Displacement?

Conflict-induced displacement is associated with loss of human and physical capital as well as psychological trauma. Households and social structures that produce and reproduce gender norms are disrupted. This paper investigates the extent to which gender norms relax in situations of displacement using predetermined indicators in the Colombia Demographic and Health Survey. Results of a two-step estimation involving kernel-based propensity score matching and multilevel linear regression models show that gender norms condoning violence against women relaxed with displacement, while those that limit women’s economic opportunities became more rigid. Findings also reveal a misalignment between attitudes and behaviors in specific domains of gender norms. Displaced women expressed lower support for patriarchy than non-displaced women, but they had less ability to make independent decisions over the use of contraceptives and over their own earnings. This implies that attitudes and behaviors do not always shift together, and, in displacement settings, do not always progress towards greater gender equality.

Effects of cannabis use on cigarette smoking cessation in LGBTQ+ individuals.

Sexual and gender minority individuals are more likely to use tobacco and cannabis and have lower cigarette cessation. This study examined cannabis use associations with daily cigarettes smoked in sexual and gender minority individuals before and during a quit attempt. Participants included dual smoking same-sex/gender couples from California that were willing to make a quit attempt (individual n = 205, 68.3% female sex). Participants reported baseline past 30-day cannabis use and number of cigarettes smoked and cannabis use (yes/no) during 35 nightly surveys. Individuals with current cannabis use reported baseline cannabis use and/or nightly survey cannabis use. Multilevel linear models predicted number of cigarettes smoked by cannabis use. Number of cigarettes decreased from before to during a quit attempt, but this decrease was smaller in individuals with current cannabis use compared to no current cannabis use (p < .001). In individuals with current cannabis use, number of cigarettes smoked was greater on days with cannabis use (p < .001). Furthermore, cannabis use that day increased overall number of cigarettes in those with relatively high overall cannabis use but only during a quit attempt in those with relatively low cannabis use (Within-Subject Cannabis Use × Between-Subject Cannabis Use × Quit Attempt interaction; p < .001). Sexual and gender minority individuals with cannabis and cigarette use may have a harder time quitting smoking than those who do not use cannabis. For those with cannabis use, guidance on not using cannabis during a quit attempt may improve cigarette cessation outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The relationship between barriers despite schooling and school engagement in adolescent students: A multilevel linear modeling analysis

The relationship between barriers despite schooling and school engagement in adolescent students: A multilevel linear modeling analysis

Can a Universal Mindfulness Programme Improve Well-Being in Adolescents?

Abstract Background Approx. 14% of adolescents experience mental health disorders. Mindfulness-based interventions (MBIs) could be one way to support adolescents’ well-being. We investigated the effectiveness of a 9-week school-based mindfulness intervention on adolescents’ well-being, moderated by gender, grade, and independent practice. Methods In total 3519 Finnish adolescents (aged 12 - 15) from 56 schools were randomized into intervention, active (relaxation), and inactive (normal school curriculum) control groups. Well-being was assessed with two life satisfaction measures (Life Satisfaction [OECD] and The Satisfaction with Life Scale-Child [SWLS-C]) and positive and negative affects (Positive and negative affects [PANAS]) at baseline, at 9 weeks and 26 weeks and analyzed using multilevel linear modeling. Results Significant improvement in life satisfaction (SWLS-C) was found at 9 weeks in the MBI group (β = 0.38, 95 % CI 0.08-0.68, p = 0.009) compared to the active control. Furthermore, MBI demonstrated an increase in life satisfaction (OECD) among boys (β = 0.25, 95 % CI 0.04-0.46, p = 0.016) and 6th graders (β = 0.26, 95 % CI 0.04-0.49, p = 0.015) at 9 weeks compared to the active control. Additionally, MBI participants engaging in independent practice at least once a week had a higher increase in positive affect at week 26 compared to both the active (β = 3.01, 95 % CI 0.55-5.47, p = 0.009) and inactive control groups (β = 2.81, 95 % CI 0.23-5.40, p = 0.026). Those practicing MBI almost daily also demonstrated a higher increase in positive affect at week 26 compared to the active control group (β = 2.95, 95 % CI 0.28-5.62, p = 0.023). Conclusions MBI in the school context seems to have the potential to increase the well-being of adolescents, especially those who commit to regular independent mindfulness practice. Gender and grade may moderate the effects of MBI. Therefore, we need to better understand how gender and age influence the effectiveness of MBI. Key messages • The findings indicate the need to further examine potential mediators and moderators that may influence the effectiveness of MBI on adolescents. • According to this study, regular mindfulness practice in schools appears to be a promising way to improve well-being of adolescents.

Pitfalls in the assessment of higher education learning gains in Brazil through multilevel regression: handling the ceiling effect.

This work assesses the validity of the Brazilian Indicator of the Difference between Observed and Expected Performances (IDD), which applies a multilevel regression model to rank university courses. It proposes a methodology to test for inconsistencies and research for the causes. With this objective, we develop an experimental methodology, applied to a database with 4,432 production engineering students distributed over 329 undergraduate courses, from the government’s National Institute for Educational Studies and Research. We display a graphical analysis of the expected and achieved grades in final graduation exams, the gap in which determines the learning gains for every course. Then we apply the multilevel linear regression model of the IDD in a particular scenario, to test for consistency in value-added learning measurements using the technique reductio ad absurdum. The result reveals that the present methodology for the calculation of the IDD is inadequate and inconsistent, and that this can be explained by the ceiling effect. It needs to be radically revised to prevent unfair judgements. Finally, we propose and implement a production frontier technique to correct for the ensuing ceiling effect, namely a variable returns to scale data envelopment analysis model for adjusting the measurements using evidence based benchmarks.

No Place Like Home? Local Crime and Older Adults’ Time at Home

ABSTRACT Home is a locus of everyday activity among a growing population of Americans who are “aging in place,” and for whom leaving the home is generally thought to benefit quality of life and well-being. Sociological and criminological theory has often assumed that higher levels of local crime constrain individuals’ activities to the residential environment, although few studies have empirically tested this assumption. We use longitudinal smartphone-based GPS data and ecological momentary assessments from 409 older adults in the Chicago Health and Activity Space in Real-Time study, linked with administrative crime data, to test this relationship through a series of multilevel linear regression models. Our findings suggest that older adults living in higher crime areas spend less time at home, on average, compared to older adults who live in lower crime areas. This association is especially evident among older adults who experience higher levels of unsafety at home. We discuss the implication that neighborhood characteristics can permeate the boundaries of the home, adversely affecting an already vulnerable population in ways that may exacerbate inequality in community engagement, collective efficacy, and health. Our findings prompt a more nuanced understanding of what leaving the home represents among the aging population.

Mediating Role of Psychological Capital in Korean Teachers’ Grit and Burnout

This study aimed to investigate whether psychological capital mediates the relationship between grit and teacher burnout. Data from 574 Korean elementary and secondary school teachers were analyzed using correlation and regression analyses to determine whether psychological capital negatively mediates the link between grit and burnout. The results revealed that grit significantly reduces teacher burnout and confirmed the negative mediating role of psychological capital in this relationship. Given the limited research in this area, these findings contribute to the theoretical and empirical understanding of how grit, psychological capital, and burnout are interconnected in the teaching profession. For future research, the author suggests exploring group differences in burnout, grit, and psychological capital based on teachers' demographic factors, using multilevel or hierarchical linear models to identify distinct strategies and the impact of individual and organizational characteristics.

Sex Differences in Subclinical Psychotic Experiences: The Role of Daily-Life Social Interactions.

Sex differences in psychosis are reported across the psychosis spectrum, including in subclinical stages. An important factor in understanding these variations is the subjective experience of everyday social interactions (SI). We investigated whether the presence of psychotic experiences (PEs), as well as associated distress, differs between men and women. We focused on the role of daily-life SI quality and whether its association with PEs varies by sex. We included adolescents from SIGMA, a general youth population study in Flanders, Belgium (n = 344; mean age = 18.7; 63.4% female). Psychotic experiences were measured using the PQ-16. We used Experience Sampling Methodology to assess daily-life SI. A multilevel model and multiple linear regressions were used to assess, respectively, the relationship between sex and SI quality and whether PEs and their association with SI quality differ between young men and women. The results of the multilevel linear regression model indicate that the prevalence of and distress associated with PEs were higher in women. No significant difference was observed in the subjective quality of daily SI. Social interaction quality was strongly related to PEs. This association did not seem to vary for the prevalence of PEs, though women's distress about PEs appeared to be more affected by SI quality. Present findings highlight the role of the subjective quality of SI in subclinical psychosis. More research is needed to investigate the mechanisms through which SI quality relates to PEs, and whether these differ between young men and women.

Hematocrits of red blood cell units increase during storage due to changes in mean corpuscular volume, impacting outcomes of red cell exchange procedures

Abstract Introduction Hematocrits of red blood cell (RBC) units are generally not measured by blood centers or transfusion services. Red blood cell exchange (RCE) is commonly used to treat sickle cell disease, and a key parameter needed in RCE is the average hematocrit of RBC units. However, there is no consensus on the average hematocrit to use or how it is affected by storage. The goal of our study is to determine the average hematocrit of RBC units by measuring hematologic parameters RBC units during storage and performing statistical modeling of hematocrit changes over time. Methods We sampled aliquots of leukoreduced RBC units in AS-1 (n=10) using the Terumo TSCD-II Sterile Tubing Welder to sterilely collect ~15mL of RBCs in transfer-pack containers. Aliquots were collected weekly from Day 7 to Day 42 of storage. Complete blood counts were performed using the Sysmex XN-3100 Hematology Analyzer. We statistically modeled changes in RBC units during storage by utilizing Bayesian multilevel linear regression models, allowing for capturing effects at the individual RBC-unit level. Posterior distributions of model parameters were estimated and processed using Stan and the rethinking and rstan packages in R. Posterior distributions are summarized with posterior means and 95%-credible intervals in parentheses. Model selection was done by calculating Akaike weights using the widely applicable information criterion (WAIC) to signify statistical support for each model. Results Multilevel linear regression models of hematologic parameters as a function of storage time were developed. Hematocrits increased with a posterior mean of 1.4% (0.98–1.75%) per week of storage, with posterior mean hematocrits of: 61.9% (60.2–63.6%) on Day 7, 63.9% (61.5–66.4%) on Day 21, and 66.0% (62.8–69.7%) on Day 42. These results indicate that a single average cannot be used for RBC units since hematocrits dramatically increase during storage. Mean corpuscular volume (MCV) increased with a posterior mean of 2.31 fL (1.4–3.71) per week whereas hemoglobin remained stable with a posterior mean increase of 0.008 g/dL (-0.016–0.031) per week. Using these results, we subsequently developed a multilevel regression model of hematocrit as a function of MCV. The model using MCV (WAIC=100.2, weight=100%) was favored over the model using time (WAIC=120.0, weight=0%), suggesting that changes in MCV are driving the increasing hematocrits. Conclusion Our study is the first to leverage Bayesian statistics to carefully quantify the average hematocrits of RBC units during storage time and to demonstrate that increasing hematocrits are caused by changes in MCV. These results indicate that transfusion protocols must consider the age of RBC units for RCE calculations, and provisions (e.g., requiring use of fresh units for RCE) may help minimize the variability in post-exchange testing. Moreover, our findings suggest that transfusion services should regularly measure hematocrits of RBC units in their inventory.

Frailty Indicator over the Adult Life Cycle as a Predictor of Healthcare Expenditure and Mortality in the Short to Midterm.

Assessing frailty from middle age onward offers valuable insights into predicting healthcare expenditures throughout the life cycle. This paper examines the use of physical frailty as an indicator of healthcare demand across all age groups. The originality of this work lies in extending the analysis of frailty indicators beyond the typical focus on individuals under 50 years old to include those in mid-life and older. For this study, we used a database where frailty was measured in 2012 in a sample of individuals aged 15 to over 90. These individuals were tracked for their healthcare expenditures from 2012 to 2016. Among the sample of 6928 individuals, frailty in 2012 resulted in a statistically significant increase in costs at the 5% level for the population aged 15 to 65. We applied multilevel linear regression models with year fixed effects, controlling for demographic factors, education level, precarity, social dimensions, lifestyle factors (e.g., vegetable consumption), physical activity, emotional well-being, and medical history. A Hausman test was conducted to validate the model choice. For mortality rate analysis, Cox models were used. Our findings demonstrate that physical frailty provides valuable information for understanding its impact on healthcare expenditure. The effect of frailty on mortality is particularly significant for the elderly population. Moreover, frailty is a predictor of healthcare costs not only in older adults but also across the entire life cycle.

Examining real-time physical activity in adolescents using the Multi-Process Action Control Model: An ecological momentary assessment study

The purpose of this study was to examine real-time associations between reflective (i.e., state motivation), regulatory (i.e., self-control), and reflexive (i.e., habit) constructs from the Multi-Process Action Control (M-PAC) model and real-time moderate-to-vigorous physical activity (MVPA) behaviour among adolescents using ecological momentary assessments. One hundred and ninety adolescents (Mage = 15.76 ± .47 years; n = 101 males) wore an accelerometer for seven consecutive days and responded to digital survey prompts up to four times daily during the after-school periods. MVPA in the 60-minute time window following each survey prompt was recorded. Multilevel mixed-effects linear and logistic models were computed with disaggregated between- and within-person effects to analyze the data. Results from both linear and logistic multilevel models revealed adolescents with higher state motivation in general and experiencing higher state motivation than one’s typical levels were associated with engaging in more MVPA and higher likelihood of engaging in ≥10 minutes of MVPA. Engaging in activities less consistent with habitual behaviours were associated with more MVPA and higher likelihood of engaging in ≥10 minutes of MVPA. By contrast, self-control was not associated with MVPA. Results from this study extend previous work demonstrating the importance of conscious and non-conscious processes on MVPA behaviour by examining associations in real-time using intensive longitudinal methods. Collectively, this study provides partial support for use of the M-PAC framework to explain acute MVPA among adolescents in real-time and natural contexts.

Effectiveness of the active communication education program in improving the general quality of life of older adults who use hearing aids: a randomized clinical trial

BackgroundHearing loss in older adults affects general, generic health-related and disease-specific quality of life (QoL). The conventional strategy to address it is through hearing aids, which have been shown to improve disease-specific QoL. However, the long-term results regarding general quality of life are unknown, and communication problems and stigma associated with hearing loss may persist. An effective intervention strategy to address these problems is group communication programs, most notably Active Communication Education (ACE). This program has been shown to increase communication strategies and reduce communication activity limitations and participation restrictions. These precedents allow us to hypothesize that this program could improve general QoL.MethodsA randomized clinical trial was conducted on 114 older adult hearing aid users. Fifty-four subjects composed the intervention group that received the ACE program, while 60 subjects composed the control group that received an informational-lectures type intervention. The WHOQOL-BREF questionnaire was used to measure general QoL. Measurements were taken before and right after the intervention, with follow-ups at 6 and 12 months. Multilevel linear mixed models were estimated, considering the WHOQOL-BREF dimension scores and total score as the outcomes, and an interaction term between time since intervention and group as the predictor. Within- and between-group comparisons were made.ResultsCompared to the baseline time-point, the ACE group showed significant improvements right after the intervention, and at the 6-month and 12-month follow-ups for the dimensions of psychological health, social relationships, environment, and total score. Compared to the control group, the ACE group exhibited significantly greater improvements in the social dimension at all postintervention assessments, as well as in the environment dimension and total score at the 12-month follow-up.ConclusionsThe ACE program improved general QoL in terms of social relationships and environment dimensions, which lasted up to 12 months after the intervention. Therefore, ACE is positioned as an effective complement for HA users, enhancing and delivering new benefits related to broader aspects of QoL not necessarily tied to health.Trial registrationISRCTN54021189 (retrospectively registered on 18/07/2023).

Assessing a Couples-Based, Digital HIV Serostatus-Neutral Intervention (Para Ti, Para Mí, Para Nosotros) for Adult Cisgender Sexual Minority Male Couples in Lima, Peru: Protocol for a 6-Month Pilot Randomized Controlled Trial.

HIV disproportionately affects sexual minority men (SMM; eg, gay, bisexual, and other men who have sex with men) in Lima, Peru; epidemiological data estimate that 32% to 39% of new HIV infections occur among adult cisgender SMM within primary partnerships (ie, male couples). Most HIV prevention-care research in Lima, Peru, has focused on SMM as individuals and not couples. To help address this critical gap in prevention care, we developed Para Ti, Para Mí, Para Nosotros (P3): a couples-based, digital HIV serostatus-neutral intervention (DHI) for adult cisgender SMM couples in Lima, Peru. The P3 DHI is designed to facilitate couples with skill-building, communication, decision-making, and working together to form and adhere to a detailed prevention care plan that aligns with their explicit sexual agreement. The P3 DHI is theoretically informed, self-guided, directed, sequential, and fully automated. This pilot randomized controlled trial (RCT) aims to examine the preliminary effects of P3 on couples' formation and adherence to a detailed prevention care plan containing evidence-based strategies that also aligns with their explicit sexual agreement over time. In addition, the feasibility of enrollment and retention and couples' acceptability of P3 will be assessed. The research implements a prospective, 6-month pilot RCT with a 3-month delayed control condition. After baseline, 60 enrolled SMM couples will be randomized to 1 of 2 conditions. Couples randomized to the unmatched, delayed control condition will receive access to the P3 DHI to use during the last 3 months of the trial after the 3-month assessment. Couples randomized to the immediate intervention condition will immediately receive access to the P3 DHI for 6 months. Study assessments will occur at baseline and months 3 and 6. Descriptive, comparative, qualitative, and longitudinal analyses using generalized linear mixed-effect, multilevel, and actor-partner interdependence models will be conducted to address the specific aims. The 6-month pilot RCT is ongoing. Recruitment, enrollment, and data collection began in January 2023 and ended in April 2024. A total of 74 adult cisgender SMM couples met all inclusion criteria, provided consent, and were enrolled in the pilot RCT. Retention was 92% (68/74) at month 6. Data are currently being analyzed to address the 3 specific aims regarding feasibility, acceptability, and preliminary efficacy. Findings from this research will reveal whether couples deemed the P3 DHI to be acceptable. Findings will also highlight the preliminary efficacy of the P3 DHI on couples managing their vulnerability to HIV and other sexually transmitted infections (STIs) over time via alignment of their prevention-care plan and sexual agreement. Trial findings will help shape the future direction of the P3 DHI while addressing the existing gap in prevention and care services for couples in the local context. ClinicalTrials.gov NCT05873855; https://clinicaltrials.gov/study/NCT05873855. DERR1-10.2196/63106.

Associations Between Acculturation, Discrimination, and Adolescent Relationship Abuse: A Matched Parent-Adolescent Study of Latine Families.

Adolescent relationship abuse (ARA) is prevalent among adolescents, including those who identify as Latine. However, there is limited research that has considered the cultural and structural mechanisms that may impact ARA experiences among Latine youth. Further, although parents play a crucial role in ARA prevention, few studies have investigated how adolescent-parent differences in acculturation and discrimination are associated with ARA. The objective of this exploratory study of Latine families was to examine how acculturation, discrimination, and adolescent-parent acculturation/discrimination differences relate to ARA victimization and perpetration. Parent-adolescent dyads recruited from clinic and community-based settings in Pittsburgh and Kansas City completed matched surveys. Parent-adolescent acculturation and discrimination differences were calculated using multilevel linear models. Multivariable logistic regression was used to examine associations among ARA victimization and perpetration and adolescent-reported acculturation, adolescent-reported discrimination, and adolescent-parent acculturation and discrimination differences. One hundred eighty-two adolescents and their parent/caregiver (n = 364) completed a matched survey in English or Spanish from March 2020 to March 2021. Forty-three percent of adolescents reported that they had started dating; of these 35% and 24% reported ARA victimization and perpetration, respectively. Higher levels of adolescent-reported acculturation conflict were associated with lower ARA victimization (adjusted odds ratio [aOR]: 0.24; 95% confidence interval, CI [0.08, 0.75]); conversely, higher adolescent-reported discrimination was associated with ARA victimization (aOR: 2.50 [1.30, 4.60]) and perpetration (aOR: 2.10 [1.10, 3.90]). Wider adolescent-parent acculturation differences in Spanish language (aOR: 3.40 [1.04, 11.30]) and interpersonal discrimination (aOR: 2.40 [1.10, 5.20]) were associated with increased ARA victimization. Results underscore the importance of discrimination in understanding ARA experiences among Latine youth. Future work should consider developing culturally and linguistically affirming ARA prevention programs for Latine adolescents and parents.

Efficacy and Feasibility of Web-Based ACT-Enhanced Behavioral Treatment for Skin Picking in Adults: A Randomized Waitlist-Controlled Trial

Skin picking disorder is a chronic repetitive condition that impacts daily functioning and causes significant distress. Acceptance and commitment therapy (ACT) enhanced behavioral training (A-EBT) has shown promise in targeting skin picking symptoms but is not widely disseminated among providers. This study examines the efficacy and feasibility of an eight-week fully-automated online A-EBT program for skin picking disorder. Participants with skin picking disorder (N = 84) were randomized into either an online intervention (n = 43) or a waitlist control (n = 41). All participants completed self-report assessments at baseline, mid-, post-intervention, and 1-month follow-up. Analyses used multilevel linear modeling with the full intent-to-treat sample. Results demonstrated statistically stronger improvements from baseline to 1-month follow-up in the intervention condition compared to waitlist for skin picking symptoms (SMD=0.90), skin picking-related psychological flexibility (SMD=-0.82), and well-being (SMD=-0.31), with no significant effects on distress. Treatment effects were maintained at one-month follow-up, with 29.0% of intervention participants meeting responder status, compared to 0.1% of waitlist participants. High usability and acceptability scores provide preliminary evidence of its feasibility as a fully automated intervention. These findings suggest an automated online A-EBT program may be an effective and scalable treatment for individuals with skin picking disorder.

Influence of park visitation on physical activity, well-being and social connectedness among Australians during COVID-19.

This cross-sectional study examined associations of park visitation with physical activity (PA), well-being, and social connectedness among 1089 participants during the coronavirus disease 2019 pandemic. In August 2020, adolescents and adults in Australia self-reported demographics, usual park visitation, frequency and duration of park visits, PA, well-being and social connectedness. Multilevel linear regression models examined associations of park visitation with well-being and social connectedness. Multilevel mixed-effects negative binomial regression models examined associations between visitation and PA. Compared to not visiting a park, visitation was positively associated with well-being (B = 3.92, 95% confidence interval [CI] = 1.24, 6.60) and days/week performing PA for 30 min (B = 1.24, 95% CI = 1.11, 1.39) per day and negatively associated with social connectedness (B = -3.75, 95% CI = -7.11, -0.39). Compared to visiting a park less than once/week, visiting once/week was positively associated with well-being (B = 3.90, 95% CI = 0.53, 7.21). Visiting more than once/week was positively associated with days/week performing PA for 30 min (B = 1.37, 95% CI = 1.21, 1.58) and 60 min (B = 1.34, 95% CI = 1.09, 1.64) per day and with well-being (B = 4.19, 95% CI = 0.90, 7.49). Duration of park visits was positively associated with days/week performing PA for 30 min (B = 1.09, 95% CI = 1.04, 1.13) and 60 min (B = 1.09, 95% CI = 1.02, 1.17) per day. Our findings highlight the role of parks in positively influencing health-related outcomes and the 'dosage' of park use needed to attain health benefits.

Effect of a gamified-based intermittent teaching unit in Physical Education on schoolchildrenʼs accelerometer-measured weekly physical activity: A cluster-randomized controlled trial. School-fit study

The main objective of the present study was to analyze the effect of a gamified-based intermittent teaching unit using behavior modification strategies in the Physical Education setting on schoolchildren’s accelerometer-measured weekly physical activity levels. A total of 203 primary schoolchildren (39.8% females; 9-12 years) from two public schools were cluster-randomly assigned into the experimental (n = 121) and control (n = 82) groups. The experimental group performed a gamified-based intermittent teaching unit (using the first 15 minutes of each session) three times per week for five weeks. Behavior modification strategies such as activity wristbands, goal setting, and educational counseling were also applied to promote habitual physical activity. Before and during the last intervention week, schoolchildren’s physical activity levels were objectively measured through ActiGraph wGT3X+/BT accelerometers. The Multilevel Linear Model results showed that the experimental group schoolchildren statistically significantly improved weekly moderate-to-vigorous physical activity (p < .05, d = 0.42). Moreover, the intervention statistically significantly improved the percentage of schoolchildren achieving, on average, at least 60 minutes of moderate-to-vigorous physical activity and 10,000 steps per day (p < .05, Cramerʼs V = .521–.549). A gamified-based intermittent teaching unit using behavior modification strategies seems effective for improving schoolchildrenʼs physical activity levels.