Hierarchical Regression Research Articles

A Systematic Review and Meta-Analysis of Multilevel Analysis of Risk Factors for Stunting Among Under Five-Year-Old Children in Indonesia

The causes of stunting, according to the WHO Conceptual Framework, are divided into child factors, household, and family factors, and community and social factors. Databases were systematically reviewed from 2015 until 2021 in Google Scholar, PubMed, and ScienceDirect. The selection of eligible studies was conducted according to PRISMA. A meta-analysis of studies was performed to analyze the association between multilevel risk factors stunting(child, household, family, community and social) and stunting. Of 26.492 articles, 16 articles were included to review. The results of the meta-analysis show that there are various risk factors for stunting in children under five years in Indonesia, such as the individual level (child factor), male sex OR:1.21 (95% CI 1.12-1.31), birth length <48 cm OR:14.88 (95% CI 7.68-28.87), low birth weight <2.500 gr OR:2.43 (95% CI 1.68-3.51), history of infectious diseases OR:2.83 (95% CI 1.61-5.00), not exclusive breastfeeding OR: 2.39 (95% CI 0.72-7.93), household and family level: maternal height < 150 OR:1.86 (95% CI 1.26-2.77), maternal age < 20 OR: 5.17 (95% CI 3.01-8.09), bad sanitation OR:1.28 (95% CI 1.00-1.63), low father and mother education OR:1.58 (95% CI 1.14-2.18), unavailability of food OR:3.29 (95% CI 1.35-8.02), family size > 5 OR:1.41 (95% CI 1.09-1.82) and, community level and social factors, rural area (living outside Java-Bali) OR:1.41 (95% CI 1.09-1.82), wealth quantile 1 OR:1.39 (95% CI 1.23-1.56). The findings of the meta-analysis show that reducing stunting requires integrated health promotion, prevention, and intervention using a multi-sectoral strategy involving health professionals, families, the government, and the community.

Long-term effects of changes in coparenting quality during the COVID-19 pandemic.

This study examines changes in coparenting quality during the initial stage of the COVID-19 pandemic on long-term parent, child, and family well-being. Although there is clear evidence that the COVID-19 pandemic negatively impacted families, less is known about family resilience factors that could mitigate this impact. Understanding whether positive coparenting quality is a protective factor during crises is important for promoting parent, child, and family well-being. The study collected data from 150 parents who participated in a transition-to-parenthood intervention trial 10 years prior. Hierarchical linear modeling was used to examine the association between changes in coparenting quality from before the pandemic (Time 1) to the early stage of the pandemic (Time 2) with parent, child, and family adjustment 19 months later (Time 3). Moderation effects were also explored. Over half of parents reported a decline in coparenting relationship quality between Time 1 and Time 2 while about one third reported an improvement. A more positive change in coparenting was associated with better parent and family adjustment at Time 3. Moderation analyses showed that positive changes in coparenting were associated with fewer internalizing symptoms for female children and, for families with younger children, increased positive and decreased negative parenting behaviors. These findings support the idea that positive coparenting can serve as a resilience factor during times of crisis. Practitioners working with families in crisis should consider incorporating coparenting interventions and strategies. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effect of perceived family attitudes on commuting decisions in Wenling, China

Research on carbon dioxide emissions (CDE) due to transportation has traditionally focused on objective factors and subjective attitudes toward external objective factors. There is limited research on attitudes to external subjective factors. This study investigated whether travellers emulate family members’ travel choices, affecting commuting CDE, with a focus on perceived family attitudes (PFA). The results from a survey of 5663 respondents in Wenling, China were analysed samples using hierarchical regression and bootstrap methods. It was found that PFA significantly impact commuting CDE, both directly and through influencing transportation preferences. Specifically, favourable PFA towards low carbon dioxide options like public transit reduce CDE, while positive views of high carbon dioxide modes increase CDE.

On the effectiveness of a new advisory service for parents of children in need of care: a controlled study

On the effectiveness of a new advisory service for parents of children in need of care: a controlled study Abstract: Background: Families with children in need of care are exposed to great stress. This results in risks that often lead to a poor living and care situation for families. To support them, an innovative regionally anchored support service is being developed by so-called Family Health Partners (FGP) as part of the NEST research project. Aim/Objective: The primary endpoint of the study is the quality of life of the families. Secondary outcomes are resilience factors and associated measures as well as access to care services. Methods: The effectiveness of the FGP will be tested in a controlled study with four measurement times (baseline, after 6, 12 and 18 months) between January 2022 and April 2024. A total of 204 families with children in need of care were recruited for an intervention and control group. Multilevel models are used to analyze the longitudinal data. Results: Between T0 and T1 there are statistically significant improvements in the intervention group, especially in daily and social stress in the family, in mental health and resilience. In addition, knowledge about general benefit rights as well as specific support and relief offers for caring parents has increased. Conclusions: The results of the first two measurement times indicate that a positive change in quality of life, resilience and health literacy can be achieved through the FGP.

An Enhanced Progressive Damage Model for Laminated Fiber-Reinforced Composites Using the 3D Hashin Failure Criterion: A Multi-Level Analysis and Validation

An Enhanced Progressive Damage Model for Laminated Fiber-Reinforced Composites Using the 3D Hashin Failure Criterion: A Multi-Level Analysis and Validation

Elucidating Heterogeneity of Intimate Partner Violence Among Women: Latent Class Analysis of Daily IPV, PTSD, and Substance Use Collected via Experience Sampling Methodologies.

The co-occurrence of physical, psychological, and sexual intimate partner violence (IPV) is associated with heightened risk for deleterious mental and physical health outcomes, including PTSD symptoms and substance use. However, few studies have investigated the heterogeneity of experiences with respect to this co-occurrence among women who experience IPV as it unfolds naturally in women's daily lives. In this study, we developed a novel approach to classify and visualize daily patterns of IPV experiences, PTSD-related distress, and substance use among women who experience IPV. Women (N = 244, Mage = 37.1 years) who reported experiencing IPV and using substances were recruited from the community. Micro-longitudinal data were collected four times per day for 14 days using automated telephone-based data collection. Analyses included latent class analysis (LCA) and multilevel analysis (interval-, day-, and person-level), complimented by novel data visualization tool (EventFlow). We identified three classes that significantly differed in the prevalence of and patterns among IPV types, PTSD, and substance use. Based on examination of LCA results and visualization of the latent classes in EventFlow. Different patterns of associations among IPV types, PTSD symptoms, and substance use were identified within classes at the interval-, day-, and person-level. Results from this study provide greater insight into the heterogeneity of women's lived experiences than do studies solely relying on cross-sectional survey data. Findings with this type of data collection can inform the development of interventions to increase the precision in clinical practice, identify new avenues for future research, and have important policy implications.

Development and validation of an electronic frailty index in a national health maintenance organization.

Frailty constitutes a major factor that puts the elderly at risk of health and functional deterioration. To develop and validate an Electronic Frailty Index based on electronic data routinely collected in the HMO. A retrospective cohort of the HMO members. 120,986 patients, aged 65 years and over at the beginning of 2023. A cumulative frailty index including 36 medical, functional, and social deficits. One-year all-cause mortality or hospitalization. One-year hazard ratios were estimated for composite outcome of mortality or hospitalization using multivariable hierarchical Cox regression. The mean EFI score increased with the Social Security Nursing Benefit. Compared to fit patients, mild, moderate, and severe frailty patients had 2.07, 3.35, and 4.4-fold increased risks of mortality or hospitalization, after controlling for covariates. The findings showed that the Electronic Frailty Index version we created is valid in predicting mortality or hospitalization. In addition, the Electronic Frailty Index converged with an independent measurement produced by National Social Security.

A regularized Cox hierarchical model for incorporating annotation information in predictive omic studies

BackgroundAssociated with high-dimensional omics data there are often “meta-features” such as biological pathways and functional annotations, summary statistics from similar studies that can be informative for predicting an outcome of interest. We introduce a regularized hierarchical framework for integrating meta-features, with the goal of improving prediction and feature selection performance with time-to-event outcomes.MethodsA hierarchical framework is deployed to incorporate meta-features. Regularization is applied to the omic features as well as the meta-features so that high-dimensional data can be handled at both levels. The proposed hierarchical Cox model can be efficiently fitted by a combination of iterative reweighted least squares and cyclic coordinate descent.ResultsIn a simulation study we show that when the external meta-features are informative, the regularized hierarchical model can substantially improve prediction performance over standard regularized Cox regression. We illustrate the proposed model with applications to breast cancer and melanoma survival based on gene expression profiles, which show the improvement in prediction performance by applying meta-features, as well as the discovery of important omic feature sets with sparse regularization at meta-feature level.ConclusionsThe proposed hierarchical regularized regression model enables integration of external meta-feature information directly into the modeling process for time-to-event outcomes, improves prediction performance when the external meta-feature data is informative. Importantly, when the external meta-features are uninformative, the prediction performance based on the regularized hierarchical model is on par with standard regularized Cox regression, indicating robustness of the framework. In addition to developing predictive signatures, the model can also be deployed in discovery applications where the main goal is to identify important features associated with the outcome rather than developing a predictive model.

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.

Longitudinal Study of Bereavement Outcomes Among Palliative Caregivers Mourners: Psychological Profiles in Prolonged Grief and Psychopathology.

Prolonged grief (PG) is a mental health condition characterized by severe distress following a loss. This study examines the roles of attachment styles, social support, stressful life events (SLEs), and pre-existing psychopathology in predicting PG and post-bereavement psychopathology among 74 caregivers of palliative patients. Using validated assessment tools, the study employed hierarchical regression and fuzzy-set qualitative comparative analysis (fsQCA) to identify predictors of prolonged grief and psychological outcomes over six months. Results showed that pre-existing psychopathology and PG risk predicted post-bereavement psychopathology, though not PG itself. Low social support and high SLEs were linked to worse outcomes, while strong social support and low stress predicted positive outcomes. These findings highlight the importance of multiple interacting factors in understanding grief and emphasize the need for interventions that enhance social support, manage stress, and address mental health conditions to reduce psychological distress in bereaved caregivers.

Multilevel modeling of technology use, student engagement, and fitness outcomes in physical education classes

Multilevel modeling of technology use, student engagement, and fitness outcomes in physical education classes

Metabolic and Inflammatory Profiles in Children and Adolescents with Autism Spectrum Disorder: A Cross-Sectional Study

Background/Objectives: Autism spectrum disorder (ASD) is associated with several coexisting diseases or comorbidities, including inflammatory and metabolic disorders. In fact, ASD symptoms may be associated with immune system dysfunction. However, studies investigating the peripheral blood levels of immune cells are lacking and have provided mixed findings. In this study, we evaluated the relationship between the intensity level of ASD symptoms and the inflammatory and metabolic profiles in 154 children and adolescents (2–17 years). Methods: Bayesian multilevel models were used to examine the relationship between their symptom intensities and inflammatory/metabolic profiles. Results: Heavier children had higher values for triglyceride and insulin levels. Children with a level 3 of ASD intensity had higher free fatty acids levels. However, when adjusting for ASD intensity, gender, medication use, or weight status, older children appeared to have higher values of triglycerides, insulin levels, and free fatty acids. Conclusions: We concluded that as Brazilian children with ASD became older, they had a higher risk for insulin resistance.

Perceived distress and relational boredom during the COVID-19 pandemic: The role of shared leisure time

The COVID-19 pandemic was a time of heightened distress that may have informed couples’ time engaging in shared leisure and, ultimately, negative relational outcomes. A growth-security framework was used to classify shared leisure time into security-restorative (i.e., familiar and comfortable) and growth-enhancing (i.e., novel and exciting). We followed a community sample (N = 257) of people in intimate relationships over six-weeks during the lockdown. Each week we measured perceived distress, subjective shared leisure time, and relational boredom. Multilevel modeling revealed a lack of evidence to support distress increasing shared security-restorative leisure time. However, perceived distress was positively related to relational boredom. Specifically, people who were more distressed than others reduced their time spent engaging in growth-enhancing activities with their partner which, in turn, was associated with relational boredom. Therefore, in the long-term, high environmental distress resulted in less time spent on growth-enhancing shared leisure, likely resulting in more relational boredom.

National school food standards in England: a cross-sectional study to explore compliance in secondary schools and impact on pupil nutritional intake.

Many countries have introduced school food standards to improve the dietary intakes of school-aged children. England has school food standards (SFS) legislation in place but little is known about how well secondary schools comply with this. We aimed to assess compliance with the SFS legislation in English secondary schools and explore the impact of the SFS on pupils' nutritional intake. We conducted a cross-sectional study with English secondary schools from 2019 to 2022. We compared SFS compliance and pupil nutritional intake in schools mandated or not mandated to comply with the SFS legislation, and explored the association between school compliance and pupil nutritional intake. We assessed the percentage of SFS (%SFS) complied with by reviewing school food menus and observing food served in school canteens. We assessed pupil nutritional intake using a 24-hour dietary recall measure (Intake24) and estimated intakes of free sugar (primary outcome) and other nutrients/foods. We used adjusted multilevel models to compare pupil intakes in the SFS-mandated and SFS-non-mandated schools, and to explore the association between school SFS compliance and pupil intakes. 36 schools (23 not mandated and 13 mandated to comply with the SFS) and 2,273 pupils participated. The median %SFS complied with was 63.9% (interquartile range 60.0-70.0%). This was similar for SFS-non-mandated (64.5%) and SFS-mandated schools (63.3%). Compliance was highest for standards applying to lunchtime (median = 81.3%) and lowest for those applying across the whole school day (median = 41.7%). It was also lower for standards restricting high fat, sugar and energy-dense items (median = 26.1%) than for standards aiming to increase dietary variety (median = 92.3%). Pupils from SFS-mandated schools had a lower mean lunchtime intake of free sugar (g) (adjusted mean difference: -2.78g; 95% CI: -4.66g to -0.90g). There were few significant associations between %SFS complied with and pupil nutritional intake. English secondary schools do not fully comply with SFS legislation regardless of whether they are mandated to comply. Schools and caterers may require monitoring and support to fully comply. There is little evidence that SFS compliance is associated with better pupil nutritional intake. Food environments outside of school also need to be considered. ISRCTN68757496 (17-10-2019).

Moderating effect of contextual factors on the relationship between travel motivation and destination loyalty among domestic tourists in the Coast region of Kenya

Despite the marginal growth recorded in the tourism sector in Kenya, the domestic visits and estimates fall far below the expectations. The study was guided by the following specific objective; to assess the moderating effect of contextual factors on the relationship between travel motivation and destination loyalty among domestic tourists in the Coast Region of Kenya. The study area comprised frequented attractions in the Coast region of Kenya. The study adopted an embedded mixed approach comprising descriptive survey and explanatory research designs. Simple random sampling and purposive techniques were adopted for domestic tourists, destination managers and experts respectively. Data was collected using questionnaires and interview schedules. Four hundred (400) questionnaires were distributed while 10 destination managers and 5 experts were interviewed. Data analysis was done using multiple regression models, hierarchical multiple regression and descriptive analysis. The multiple regression model results without interaction terms indicated that R-square = 0.442, implying that destination attributes and socio-psychological factors explain 44.2% of destination loyalty. The hierarchical multiple regression demonstrated that contextual factors have a moderating effect on interaction between travel motivation and destination loyalty since the model was significant {R2 = 0.255, F (7, 371) = 12.12, p =0.0001}. The model accounted for 25.5% of variation on destination loyalty. This means that the composite elements of contextual factors namely; political, economic, technological and socio-cultural factors significantly moderates the interaction between travel motivation and loyalty behaviour of domestic tourists. The null hypotheses were tested and rejected. The study recommends need for destinations and service providers to engage more on digital marketing and deploy technology during marketing initiatives and product development to capture niche segments since majority of the respondents were youth travelers

The War on Drugs in Juvenile Court? The Influence of Community Context on Juvenile Court Outcomes for White, Black, and Hispanic Youth

Prior research on race/ethnicity and juvenile court processing have found that youth of color often receive disadvantaged outcomes compared to their White counterparts, and that community context may condition this relationship. The current study examined this association between race/ethnicity (White, Black, Hispanic) and type of drug offense (possession vs. distribution) with adjudication and disposition outcomes, especially the tempering effect of disadvantaged community characteristics. Results from multi-level models indicated that Black youth who were charged with a drug distribution offense were more likely to receive residential placement compared to similarly situated Whites. Underclass poverty and racial/ethnic inequality moderated these associations, but the significance and direction of the results differed depending on the stage examined. The findings reveal ongoing racial/ethnic disparities in the juvenile justice system, and offer clearer insights into the conditions under which youth of color charged with different drug offenses are processed in juvenile court.

Associations among preschool classroom chaos, work climates, and child outcomes

This study examined the associations between two unique features of classroom chaos (chaotic structure and chaotic atmosphere) in preschool settings and teacher-perceived child functioning, and the roles of teacher- and director-perceived work climates. Multilevel modeling was used to analyze the nested data of 329 children within 53 classrooms. The study found distinct roles of chaotic structure and atmosphere. Moreover, the congruence/incongruence between teacher- and director-perceived work climates significantly moderated the associations between classroom chaos and teacher-perceived child outcomes. The findings highlight the importance of considering multidimensional preschool environments and promoting positive work climates perceived by both teachers and directors.

Exploring reciprocal links between early adolescent coping and internalizing symptoms.

The rising prevalence of depression and anxiety among adolescents is a public health concern. Early adolescence is a key developmental period to reduce risks for internalizing symptoms through primary prevention programs, yet additional research is needed on modifiable factors, such as coping skills, to target to mitigate risk factors. Therefore, we investigated the reciprocal link between coping style and internalizing symptoms among a racially/ethnically diverse sample of early adolescents (n = 1273) from 12 middle schools over 1 year. We leveraged a longitudinal data set of a cluster, randomized trial of a preventive intervention from 12 middle schools in a large public-school district in the United States to test our hypotheses using multilevel modeling. The sample was 49% female and racially/ethnically diverse (39% Hispanic/Latinx, 23% Black/African American, 12% Asian or Pacific Islander, 11% other, 9% White, and 5% multiracial). Participants (ages 12-14) completed a baseline questionnaire in 7th grade (Spring 2018) and a 1-year follow-up questionnaire in 8th grade (Spring 2019). Depressive and anxious symptoms affected levels of active and avoidant coping skill use over the 1-year period of the study, indicating that symptoms can be an impetus for maladaptive coping. We also identified bidirectional links between active coping and depression in addition to avoidant coping and anxiety. Our findings have implications for augmenting coping psychoeducation within prevention programs to reduce internalizing symptoms among early adolescents and for future longitudinal and qualitative research exploring how coping skills reduce risks for internalizing symptoms throughout adolescence and into early adulthood.

National Seclusion and Restraint Trends within Child Residential Treatment Facilities: 2010-2020 in Review.

This study aimed to estimate the percentage of child RTCs utilizing seclusion and restraint (S/R) practices and examine predictors associated with increased likelihood of S/R use between 2010 and 2020. A secondary analysis of the National Mental Health Services Survey was conducted (n-range = 580-781). Facility-level client demographics and facility characteristics were examined using multi-level logistic regression. One-way ANOVA indicated that the percentage of child RTCs using S/R significantly decreased between 2010 and 2020 [F(4, 58074) = 75.62, p <.001]. A post-hoc Bonferroni test found that the percentage of facilities reporting the use of SR in 2010 was significantly higher than in 2014, 2016, 2018, and 2020 (all p <.001). Multi-level logistic regression analysis found that facility-level client demographics (percent male, white, and involuntarily committed) did not significantly predict facility use of SR in 2010, 2014, or 2016. However, facility-level characteristics of SED program (all p <.01), use of psychotropic medication (all p <.001), and facility size as measured by number of mental health beds (all p <.01) consistently predicted usage of SR in 2010 [F(11) = 68.38, p <.001], 2014 [F(12) = 74.25, p <.001], and 2016 [F(12) = 74.48, p <.001]. Facility ownership and accepting Medicare payments did not significantly predict facility usage of SR. Use of SR within child RTCs significantly declined between 2010 and 2020. Larger facilities, facilities with an SED program, and facilities that used psychotropic medications with clients were more likely to use SR practices between 2010 and 2016. More high-quality, publicly available data for monitoring S/R use in mental health services within the United States is needed.

Antenatal Care Services Uptake and Associated Factors in Somaliland: Further Analysis of the 2020 Somaliland Demographic Health Survey

Purpose Antenatal care (ANC) is vital to maintain the health of pregnant women and their unborn babies. It was linked to a positive pregnancy experience. However, ANC uptake remained low in Somaliland, and no study has been conducted to assess possible predictors. Hence, the current study aimed to determine the level of ANC utilization and to identify its associated factors in Somaliland. Materials and Methods Somaliland Demographic Health Survey (SLDHS) Data 2020 were used. A weighted sample of 3,192 women aged 15-49 years participated in the study. The survey used a two-stage cluster design for sample selection. Descriptive statistics in the form of frequency and percentage and multilevel multinomial logistic regression analysis were carried out to determine associated factors and statistical significance was declared by p&lt; 0.05. Results The findings showed that 62.4% (95% CI: 60.7-64.1) of the women did not utilize ANC services, while 23.4% (95% CI: 21.9, 24.9) partially utilized and 14.2% (95% CI: 13.0, 15.4) adequately utilized ANC services. The odds of adequately utilizing ANC service decreased by a factor of 0.88 for women aged 35 and above compared to 15 - 24 year old women (AOR= 0.88, 95% CI: 0.61, 1.26). Women with higher educational levels had significantly higher odds (AOR=4.31, 95% CI: 1.54, 12.02) of adequately utilizing ANC compared to those with no formal education. The employment status, marital status, household wealth index, residence and region were also found to be associated with the utilization of Antenatal care. Conclusion The study showed low adequate utilization of ANC services in Somaliland. The variables, including age, education, wealth index, marital status, employment status, residence and region, were significantly associated with ANC utilization. Governmental and non-governmental organizations should enact a strategy with targeted intervention focusing on women from nomadic and rural communities, those from poor households, and low educational levels.