Multiple Indicators Multiple Causes Research Articles

Validation of the Japanese version of the Patient Health Questionnaire-4 (PHQ-4-J) to screen for depression and anxiety

ObjectiveWe aimed to validate the Japanese version of the Patient Health Questionnaire-4 (PHQ-4-J). People in Japan, especially healthcare workers (HCWs) suffer from high rates of mental health symptoms. The PHQ-4 is an established ultra-brief mental health measure used in various settings, populations and languages. The Japanese version of the PHQ-4 has not been validated.MethodsTwo hundred eighty people in Japan (142 HCWs and 138 from the general public) responded to the PHQ-4-J. Internal consistency, and factorial validity were assessed using confirmatory factor analysis (CFA) and Multiple Indicators Multiple Causes (MIMIC) models.ResultsInternal consistency was high (α = 0.70–0.86). CFA yielded very good fit indices for a two-factor solution (RMSEA = 0.04, 95% CI 0.00–0.17) and MIMIC models indicated the performance differed between HCWs and the general population.ConclusionsThe PHQ-4-J is a reliable ultra-brief scale for depression and anxiety in Japanese, which can be used to meet current needs in mental health research and practice in Japan. Disaster research and gerontology research can benefit from this scale, enabling mental health assessment with little participant burden. In practice, early detection and personalised care can be facilitated by using the scale. Future research should target specific populations in Japan during a non-emergency time.

The Shadow Economy, an Enigma, in the Agriculture of 15 EU Member States over the Period 1996–2019

The focus of this review is the shadow economy (SE) in agriculture. Our research aim is to empirically quantify the SE in the agricultural sector based on data collected in the EU-15 member states from 1996 to 2019. We apply the multiple indicators multiple causes model to estimate the levels and development of the SE in these countries. Furthermore, we investigate how the size of the agricultural SE differs between the EU-15 member states and how it affects the economy overall. The results show that (a) the main potential for SE lies in agricultural subsidies, the effects of taxation, the share of imports, and factor income in agriculture; (b) certain patterns and differences exist among the countries, which can be associated with the north-south-west divide; and (c) there are higher levels of SEs in agriculture compared to in the overall economies. This review emphasizes the potential for measuring the SE in agriculture, while recognizing current methodological limitations. Recommendations include diversifying methods, standardizing definitions internationally, and enhancing theoretical foundations. Furthermore, expanding research to include more regions and improve visibility and transparency in measurements is crucial if informed policy is to be made to benefit agriculture globally.

Explaining Implausible Results in Shadow Economy Estimation Using MIMIC Models

For decades, economists have been trying to estimate the magnitude of the shadow economy (SE), which is not directly observable. This paper explores how the MIMIC (Multiple Indicator Multiple Cause) model can yield estimates of the SE/GDP (the proportion of the SE to the gross domestic product) below 0%, above 100%, and other implausible results. The focus is on the new calibration methods by Dell’Anno (2022) and data on the Czech Republic (1993–2021). The paper concludes that one of the leading causes of implausible results is the misalignment between the SE definition implied by the MIMIC model and that used for the exogenous estimates applied for calibration. Therefore, the authors propose testing the alignment between the SE definitions, such as assessing trends in the latent variable (first-stage scores) resulting from the MIMIC model and the exogenous estimates or applying regression or correlation analysis.

Somebody to Lean on: Understanding Self-Stigma and Willingness to Disclose in the Context of Addiction.

Substance use self-stigma is a barrier to treatment and can negatively impact individuals' well-being and treatment engagement. Given the mixed findings in previous research and the limited specific investigation into the concept of self-stigma within the context of opioid misuse, examining factors associated with self-stigma in the context of opioid use disorder (OUD) is warranted. The current study examines the influence of individual-level factors (race, sex, urban/rural status, support group attendance) on self-stigma and willingness to disclose opioid use. Data for this study were from a larger study of OUD-related stigma among adults in Pennsylvania, U.S. The current study included participants who indicated a personal past or current history with OUD were included (n = 84). Exploratory factor analysis and multiple indicators, multiple causes (MIMIC) model were used to explore the associations between demographic factors (i.e., sex, age, race/ethnicity, urban/rural status), attendance at mutual support groups, and self-stigma factors. Results indicated that sex and attendance at mutual support groups significantly predicted levels of self-stigma. Women and individuals with no previous experience attending mutual support groups endorsed lower levels of self-stigma. Additionally, attendance at mutual support groups predicted willingness to self-disclose past and present opioid use. Individuals who reported no history of attending mutual support groups demonstrated less willingness to disclose past and present OUD use compared to participants who were support group attendees. The current research findings enhance the understanding of OUD-related self-stigma by examining its relationship with individual-level factors, disclosure, and attendance to mutual support groups. The results offer insights into the influence of sex and support group attendance on self-stigma and disclosure. These findings have significant clinical implications for developing future interventions and promoting health policy changes.

Can the digital economy development limit the size of the informal economy? A nonlinear analysis based on China's provincial panel data

This paper investigates whether and how digital economy (especially digital platforms and digital finance) restrains the informal economic activities in China measured by the MIMIC (multiple indicators multiple causes) model. Using Chinese provincial panel data from 1995 to 2020, we find that the average size of China's provincial informal economy displays a five-stage fluctuation, ranging from 13.63 % to 17.53 %. More importantly, we uncover a robust “inverted U-shaped” nonlinear relationship between the digital platform development and the informal economy, with a turning point of 0.4189. Initially, the development of digital platforms increases informal economic activities by disrupting traditional sectors, causing new types of tax evasion, challenging regulators and raising digital crime. However, beyond a certain threshold, digital platforms can overcome these problems through more job creations and improved regulation. Meanwhile, the digital financial development is proved to have a negative impact on the informal economy because it can offer much more advantages in addressing informality such as making payments transparent, easing credit constraints, raising total income, helping governments reach people and businesses. Our study provides convincing evidence and valuable advice for policymakers when developing digital economy to curb the informal economy.

Conducting cross-cultural, multi-lingual or multi-country scale development and validation in health care research: A 10-step framework based on a scoping review.

Valid, reliable and cross-cultural equivalent scales and measurement instruments that enable comparisons across diverse populations in different countries are important for global health research and practice. We developed a 10-step framework through a scoping review of the common strategies and techniques used for scale development and validation in a cross-cultural, multi-lingual, or multi-country setting, especially in health care research. We searched MEDLINE, Embase, and PsycINFO for peer-reviewed studies that collected data from two or more countries or in two or more languages at any stages of scale development or validation and published between 2010-22. We categorised the techniques into three commonly used scale development and validation stages (item generation, scale development, and scale evaluation) as well as during the translation stage. We described the most commonly used techniques at each stage. We identified 141 studies that were included in the analysis. We summarised 14 common techniques and strategies, including focus groups or interviews with diverse target populations, and involvement of measurement experts and linguists for item content validity expert panel at the item generation stage; back-and-forth translation, collaborative team approach for the translation stage; cognitive interviews and different recruitment strategies and incentives in different settings for scale development stage; and three approaches for measurement invariance (multigroup confirmatory factor analysis, differential item functioning and multiple indicator multiple causes) for scale evaluation stage. We provided a 10-step framework for cross-cultural, multi-lingual or multi-country scale development and validation based on these techniques and strategies. More research and synthesis are needed to make scale development more culturally competent and enable scale application to better meet local health and development needs.

Identifying neurofunctional domains across substance use disorders

ABSTRACT Background: Substance use disorders (SUDs) are heterogeneous across multiple functional domains. Various frameworks posit that domains (e.g., executive function) contribute to the persistence of SUDs; however, the domains identified in different studies vary. Objectives: We used factor analysis to identify the underlying latent domains present in a large sample (N = 5,244, 55.8% male) with a variety of SUDs to yield findings more generalizable than studies with a narrower focus. Method: Participants (1,384 controls and 3,860 participants with one or more SUDs including alcohol, cocaine, cannabis, and/or opioid use disorders) completed the Semi-Structured Assessment for Drug Dependence and Alcoholism, the NEO Personality Inventory, and the Wisconsin Card Sorting Test. Exploratory factor analysis (EFA) and fit indices (root mean-squared error of approximation (RMSEA), Comparative Fit Index (CFI), and Tucker-Lewis Index (TLI)) were used to examine different latent variable models. A multiple indicators, multiple causes (MIMIC) approach-tested associations of the latent variables with sociodemographics, substance use, and a history of abuse/neglect. Results: A six-factor model (predominant alcohol, predominant cocaine, predominant opioid, externalizing, personality, and executive function) provided the best fit [RMSEA = 0.063 (90% CI 0.060, 0.066), CFI = 0.98, TLI = 0.96]. All factors were moderately correlated (coefficient = 0.25–0.55, p < .05) with the exception of executive function. MIMIC analysis revealed different patterns of associations (all p < .0001) with sociodemographics, substance use, and a history of abuse/neglect among the factors. Conclusions: The domains identified, particularly executive function, were parallel to those observed previously. These factors underscore the heterogeneous nature of SUDs and may be useful in developing more targeted clinical interventions.

Comparison of Patient Health Questionnaire-9, Edinburgh Postnatal Depression Scale and Hospital Anxiety and Depression – Depression subscale scores by administration mode: An individual participant data differential item functioning meta-analysis

Administration mode of patient-reported outcome measures (PROMs) may influence responses. We assessed if Patient Health Questionnaire-9 (PHQ-9), Edinburgh Postnatal Depression Scale (EPDS) and Hospital Anxiety and Depression Scale – Depression subscale (HADS-D) item responses and scores were associated with administration mode. We compared (1) self-administration versus interview-administration; within self-administration (2) research or medical setting versus private; and (3) pen-and-paper versus electronic; and within interview-administration (4) in-person versus phone. We analysed individual participant data meta-analysis datasets with item-level data for the PHQ-9 (N = 34,529), EPDS (N = 16,813), and HADS-D (N = 16,768). We used multiple indicator multiple cause models to assess differential item functioning (DIF) by administration mode. We found statistically significant DIF for most items on all measures due to large samples, but influence on total scores was negligible. In 10 comparisons conducted across the PHQ-9, EPDS, and HADS-D, Pearson's correlations and intraclass correlation coefficients between latent depression symptom scores from models that did or did not account for DIF were between 0.995 and 1.000. Total PHQ-9, EPDS, and HADS-D scores did not differ materially across administration modes. Researcher and clinicians who evaluate depression symptoms with these questionnaires can select administration methods based on patient preferences, feasibility, or cost.

A Bayesian Moderated Nonlinear Factor Analysis Approach for DIF Detection under Violation of the Equal Variance Assumption

AbstractResearch has shown that multiple‐indicator multiple‐cause (MIMIC) models can result in inflated Type I error rates in detecting differential item functioning (DIF) when the assumption of equal latent variance is violated. This study explains how the violation of the equal variance assumption adversely impacts the detection of nonuniform DIF and how it can be addressed through moderated nonlinear factor analysis (MNLFA) model via Bayesian estimation approach to overcome limitations from the restrictive assumption. The Bayesian MNLFA approach suggested in this study better control Type I errors by freely estimating latent factor variances across different groups. Our experimentation with simulated data demonstrates that the BMNFA models outperform the existing MIMIC models, in terms of Type I error control as well as parameter recovery. The results suggest that the MNLFA models have the potential to be a superior choice to the existing MIMIC models, especially in situations where the assumption of equal latent variance assumption is not likely to hold.

Examining individuals’ adoption of flex route transit

ABSTRACT This study aims to comprehensively identify the contributing factors affecting the adoption of flex route transit. A survey was conducted in 2019, and a multiple indicators multiple causes (MIMIC) model was utilized to capture individuals’ preferences toward car, fixed route, and flex route transit. Subsequently, the multinomial logit model with attitudinal features is employed to identify the key factors influencing the shift from car or fixed route to flex route transit. Results indicate that several factors contribute to flex route transit adoption, with the top three being car restriction, travel cost, and age groups. Car restriction is positively associated with flex route transit adoption (marginal effects 11.67%). Travel costs (≥1.49 US$) and elderly groups also contribute to an increase in flex route transit adoption, with marginal effects of 9.18% and 8.01%, respectively. These findings provide insightful implications for decision-makers in identifying potential adopters and improving flex route transit adoption.

Psychometric characteristics of the career adapt-abilities scale in Thai undergraduate students: a multiple indicators multiple causes model.

This study aimed to evaluate the psychometric properties of the Career Adapt-abilities Scale (CAAS) and analyze the relationships between sociodemographic variables and career adaptability using the MIMIC model with DIF. In this cross-sectional study, the CAAS, consisting of four sub-scales-concern, control, curiosity, and confidence-each comprising six items, was administered to 620 undergraduate students from 34 universities in Thailand. Among the participants, women constituted 66.77%, while men accounted for 32.58% (Mean Age = 20.33). To explore the influence of sociodemographic characteristics on specific CAAS item responses, a Multiple-Indicators, Multiple-Causes model with Differential Item Functioning (MIMIC-model with DIF) was employed. The findings revealed robust internal consistency and reliability in the CAAS. Both the four-factor and second-order factor models exhibited excellent fit indices, emphasizing the significance of each item within the measure. Sociodemographic characteristics did not demonstrate a significant direct effect on the four CAAS subscales, it is worth noting the exception regarding paternal education. Paternal education was found to have a statistical significance impact on two specific CAAS items: "looking for opportunities to grow as a person" and "becoming curious about new opportunities." These findings underscore the intricate influence of paternal education on specific aspects of career adaptability, suggesting that certain dimensions of career adaptability may be shaped by factors extending beyond the conventional sociodemographic variables examined in this study. Future research could delve deeper into the complex interplay of sociodemographic factors and individual attributes to provide a more holistic perspective on career adaptability in Thailand.

Confirmatory factor analysis of the Hyperacusis Impact Questionnaire, Sound Sensitivity Symptoms Questionnaire, and Screening for Anxiety and Depression in Tinnitus, including preliminary analyses of the parent versions for use with children.

We previously reported the results of exploratory factor analysis (EFA) of the Hyperacusis Impact Questionnaire (HIQ), the Sound Sensitivity Symptoms Questionnaire (SSSD) and the Screening for Anxiety and Depression in Tinnitus (SAD-T). Confirmatory Factor Analysis (CFA) is necessary to confirm the latent constructs determined using EFA. CFA should use different samples but with similar characteristics to those used for EFA. The aim was to use CFA to confirm latent constructs derived using EFA of the HIQ, SSSQ and SAD-T. We further evaluated the psychometric properties of parent versions of these questionnaires (indicated by -P), which are intended for use with children. This was a retrospective cross-sectional study. Data for 323 consecutive adults and 49 children who attended a Tinnitus and Hyperacusis Therapy Clinic in the UK within a six-month period were included. Data were collected retrospectively from the records of patients held at the audiology department. CFA with the weighted least-squares mean and variance-adjusted estimator was applied to assess the previously proposed factor structures of the HIQ, SSSQ and SAD-T. The internal consistency of the scales was assessed via Cronbach's alpha (α). The items of the HIQ, SSSQ and SAD-T were tested for measurement invariance regarding age and gender using the multiple indicator multiple cause (MIMIC) model. All questionnaires showed good to excellent internal consistency, with α = 0.93 for the HIQ, 0.87 for the SSSQ, and 0.91 for the SAD-T. The parent versions showed acceptable to good internal consistency, with α = 0.88 for the HIQ-P, 0.71 for the SSSQ-P, and 0.86 for the SAD-T-P. CFA showed that the HIQ, SSSQ, and SAD-T were all one-factor questionnaires and the factors generally were similar to those obtained for the EFA. The MIMIC model showed that all three questionnaires can be considered as measurement invariant, with scores similar across genders and ages. The HIQ, SSSQ and SAD-T are internally consistent one-factor questionnaires that can be used in clinical and research settings to assess the impact of hyperacusis, the severity of sound sensitivity symptoms, and to screen for anxiety and depression symptoms. Future studies should further explore the psychometric properties of the parent versions of the HIQ and SSSQ and SAD-T.

Determinants of residents’ support for urban tourism in times of uncertainty: Exploring the case of the city of Madrid

Residents are key actors in the management of tourist destinations, especially in times of uncertainty such as those that characterize the current context of multidimensional crisis (ecological, political, social or economic). The role of tourism in these crises, its contribution to their acceleration or its work in recovery, makes it necessary to deepen the support of residents for tourism in complex times such as the present. The context generated by the COVID-19 health crisis is a good framework for this reflection, although it has not been sufficiently explored. This article draws on Social Exchange Theory to explain residents' support for tourism in urban destinations during periods of uncertainty such as those generated by the health crisis, focusing on factors that have so far been little explored: risk perception, community involvement and the management of tourism constraints. A structural multiple indicator multiple cause (MIMIC) model is proposed to test the theoretical model. Using data derived from a survey of 342 residents in the city of Madrid (Spain), the results show that, in addition to benefits as a predictor of residents' support for tourism in contexts of uncertainty, risk perception and the management of tourism constraints are also relevant determinants of this support. The findings have important implications for decision-makers and public managers of urban destinations in the current period of multiple crises.

Cultural adaptation to Bolivian Quechua and psychometric analysis of the Patient Health Questionnaire PHQ-9

ObjectiveCultural adaptation of the Patient Health Questionnaire-PHQ-9 to Bolivian Quechua and analysis of the internal structure validity, reliability, and measurement invariance by sociodemographic variables.MethodsThe PHQ-9 was translated and back-translated (English-Quechua-English) to optimise translation. For the cultural adaptation, experts, and people from the target population (e.g., in focus groups) verified the suitability of the translated PHQ-9. For the psychometric analysis, we performed a Confirmatory Factor Analysis (CFA) to evaluate internal validity, calculated α and ω indices to assess reliability, and performed a Multiple Indicator, Multiple Cause (MIMIC) model for evaluating measurement invariance by sex, age, marital status, educational level and residence. We used standard goodness-of-fit indices to interpret both CFA results.ResultsThe experts and focus groups improved the translated PHQ-9, making it clear and culturally equivalent. For the psychometric analysis, we included data from 397 participants, from which 73.3% were female, 33.0% were 18–30 years old, 56.7% reported primary school studies, 63.2% were single, and 62.0% resided in urban areas. In the CFA, the single-factor model showed adequate fit (Comparative Fit Index = 0.983; Tucker-Lewis Index = 0.977; Standardized Root Mean Squared Residual = 0.046; Root Mean Squared Error of Approximation = 0.069), while the reliability was optimal (α = 0.869—0.877; ω = 0.874—0.885). The invariance was confirmed across all sociodemographic variables (Change in Comparative Fit Index (delta) or Root Mean Square Error of Approximation (delta) < 0.01).ConclusionsThe PHQ-9 adapted to Bolivian Quechua offers a valid, reliable and invariant unidimensional measurement across groups by sex, age, marital status, educational level and residence.

Measurement equivalence of the English and French versions of the self-efficacy to manage chronic disease scale: a Scleroderma Patient-Centered Intervention Network (SPIN) study.

The Self-Efficacy to Manage Chronic Disease (SEMCD) scale is widely used, including in systemic sclerosis (SSc). The SEMCD has been validated in SSc, but the metric equivalence of the English and French versions has not been assessed (i.e., whether psychometric properties are equivalent across English and French). Participants were adults from the Scleroderma Patient-Centered Intervention Network (SPIN) Cohort (N = 2159) who completed baseline measures in English (n = 1473) or French (n = 686) between May 2014 to July 2020. Analyses assessed internal consistency reliability via Cronbach's alpha and McDonald's omega, convergent validity via Pearson's correlations, structural validity via confirmatory factor analysis (CFA), and differential item functioning via the Multiple-Indicator Multiple-Cause (MIMIC) model. Internal consistency reliability was high in English (α = .93, ω = .93) and French (α = .92, ω = .93). All correlations between the SEMCD and measures of health outcomes were moderate to large, statistically significant, and in the hypothesized direction in both languages. The CFA demonstrated that the one-factor model of self-efficacy, overall, fit reasonably well (CFI = .96, TLI = .93, SRMR = .03, RMSEA = .14). Standardized factor loadings were large (.76 to .88). Three items displayed statistically significant uniform DIF and all six displayed nonuniform DIF; all DIF was of minimal magnitude. Comparison of unadjusted and DIF-adjusted models indicated that DIF did not meaningfully impact total score (ICC = 0.999, r = 0.999). Scores from English- and French-speaking adults with SSc can be combined for analysis or compared.

School emphasis on academic success: the role of principal qualifications.

The purpose of the present study was to relate a principal's qualifications with a school's emphasis on academic success. Participants were n = 206 principals of respective schools in Saudi Arabia that took part in the study as a function of the TIMSS-2019 assessment. Principals were administered the eleven-item "School Emphasis on Academic Success" scale. A binary covariate defining low and high principal qualifications was computed. The Multiple Indicators Multiple Causes (MIMIC) model was involved with the latent means of both a general and three specific factors being regressed on the covariate to evaluate latent mean differences across differentially qualified principals. Furthermore, each one of the instrument's indicators was regressed on the principal covariate to evaluate the presence of Differential Item Functioning (DIF) or in other words additional effects due to item content. Results indicated a significant omnibus effect for the general factor only, with highly qualified principals holding significantly more positive beliefs about how parents, teachers, and students feel about their school's emphasis on academic success. Further analyses at the item level indicated that "teacher expectations" were the single item presenting a DIF effect with highly qualified principals having stronger beliefs about their teacher's expectations of student success over and above the latent factor mean. Results are discussed on how they inform educational policy and practice.

Driving Stress Partial Model Considering Time Domain Applying for Two Wheelers Drivers: A Case of Primary Arterial Roads

The physiological response of motorcyclists, which is substantially correlated with driving stress, can be utilised to assess traffic safety. Heart rate and respiratory rate can be used to measure driver tension using the heart rate variability method. This investigation was conducted in Aceh province along the urban arterial roads Jl. T. Nyak Arief and Jl. T. Muhammad Daud Bereueh. This study seeks to provide the anticipated empirical findings for determining the stress threshold of motorcyclists on Banda Aceh's primary arterial roads. The Polar Vantage V2 Smartwatch Multisport measures the pulse rate and respiratory rate of voluntarily participating motorcycle riders. This research was conducted using direct observation and direct observation related to volunteer travel activities as a sample, with volunteers selected at random and questioned about their willingness to participate. Direct interview surveys with volunteers were used to collect socioeconomic information about volunteers. The Multiple Indicators Multiple Causes (MIMIC) model empirically examined which road conditions and land use variables influence driving tension among motorists. The results revealed that the highest heart rate (HR) was recorded in the commercial land use area, at 94.029 beats per minute, while the highest HR was recorded at road bends, at 94.244 beats per minute. The time domain stress model is influenced by land use variables, with the most significant types of land use being offices and education, with the forming variables consisting of SDNN, RMSSD, and TINN.

Direct effect of personality traits and work engagement on job crafting: A structural model

Research in job crafting is relevant to creating healthier organizations and is attracting increasing attention. This study contributes to identifying the predictors of job crafting from a new conceptualization that considers three dimensions, i.e., job crafting towards strength, job crafting towards interests, and job crafting towards development. On this basis, the present study aims to explore two predictors of job crafting in the personal domain, the Big Five personality traits and Work Engagement. The study sample consists of 327 Spanish employees who completed standardized questionnaires. A Multiple Indicator Multiple Cause (MIMIC) like Structural Equational Model (SEM) was applied to the data. Results showed that job crafting towards strength was significantly and positively predicted by Work Engagement (dedication and absorption) as well as extraversion, agreeableness, conscientiousness, and intellect/imagination. Furthermore, job crafting towards interest was predicted by Work Engagement (absorption), extraversion, and intellect/imagination. Last, job crafting towards development was predicted by Work Engagement (dedication and absorption), agreeableness, conscientiousness, and intellect/imagination. Vigor and neuroticism were unrelated to job-crafting dimensions. These findings can be useful for managers and organizations looking to facilitate job crafting as a means of promoting employees' performance as well as satisfaction and well-being.

Validation of the Modified Weight Bias Internalization Scale (WBIS-M) among First-Generation Asian Immigrants.

Internalized weight bias (i.e., the application of negative weight-based stereotypes to one's self-evaluation) is associated with adverse physical and mental health outcomes. The 10-item version of the Modified Weight Bias Internalization Scale (WBIS-M) is one of the most commonly used measures to assess internalized weight bias. However, studies examining the psychometric properties of the WBIS-M are limited in racially minoritized U.S.-based populations. The current study sought to examine the factor structure of the 10-item version of the WBIS-M in a sample of first-generation Asian immigrants, as both native and foreign-born Asian populations have consistently demonstrated higher rates of weight-related concerns relative to other racially minoritized groups. Confirmatory factor analysis was used to assess the factor structure, and a multiple indicator multiple cause modeling approach was used to assess associations between internalized weight bias and sociodemographic predictors. Results confirm the unidimensionality of the WBIS-M and provide preliminary support for a nine-item version. Identifying as a woman (p = .027) and perceiving oneself as overweight (p < .001) were significantly associated with greater internalized weight bias. When working with Asian and Asian American clients, mental health service providers should be aware of potential weight-related concerns and may consider using the WBIS-M to assess for internalized weight bias.

Customers’ behavioral intentions when visiting upscale restaurants: Enjoying the experience or posturing?

High-level gastronomy is booming and, in many cases, has become the main purpose for travel. This research aims to investigate the relationships between the performance of high-level restaurants, the affective components they generate, and how they can affect customer behavior both in regard to the restaurant and the destination in which it is located. The empirical work was analyzed by means of a multiple indicators multiple causes model (MIMIC) and structural equation modeling (SEM). The survey was administered to customers who visited Michelin-star restaurants. The main results indicate that enjoyment of the experience and the status it provides are important factors motivating consumers to visit these types of restaurants and that their behavioral intentions can influence their family, friends, acquaintances, and destination. Therefore, it is suggested that restaurant owners and destination managers develop joint strategies beneficial for the gastronomic tourism sector.