On the Interpretation and Use of Mediation: Multiple Perspectives on Mediation Analysis

Exploring jump experience, risk perception, anxiety and self-confidence in skydiving: A mixed methods approach

Skydivers are required to interpret person-context characteristics to overcome inherent internal challenges (i.e., fear and anxiety) and external challenges (i.e., equipment malfunctions) to successfully perform. Research suggests that as skydiving experience increases, skydivers' self-confidence in their actions increases, while their perception of risk and anxiety decreases. However, there is a lack of research investigating the influence of experience and considerations of performance in extreme sports. This study examined the influence of skydiving experience on the interpretation of risk perception, anxiety and self-confidence. Participants comprised 503 experienced Australian skydivers (Mage = 40.10, SDage = 12.40; 79.5 % male). Using a mixed methods approach, skydivers completed measures of risk perceptions, anxiety, and self-confidence related to skydiving, as well as open-ended questions on their skydiving experiences. The findings indicated that increases in jumping experience led to greater self-confidence, and self-confidence mediated the relationship between all elements of jumping experience and cognitive and somatic anxiety associated with skydiving. Thematic analysis reinforced that skydivers understood the inherent risks associated with skydiving, and that skydivers adopted positive strategies that promoted self-confidence and mastery to perform successfully, while also managing their interpretations of risk and associated anxiety that potentially exists. Further research is needed to better understand the interpretation of person-context situations in extreme sports and recognize the important affordances for performance.

Cultural sips: Exploring sociodemographic and dominance factors in French wine appraisal

This study investigates the intricate relationship between sociodemographic factors, social dominance orientation (SDO), and perceptions of wine in France. Emphasizing the symbolic role of wine in French culture, and employing a survey-based approach, the research explores how societal hierarchies and individual positioning within these structures influence the appraisal of rosé wine. The findings revealed that sociodemographic factors, particularly education level, significantly influence wine appraisal, while social dominance orientation serves as a mediating factor. This research contributes to the understanding of the cultural and social dynamics shaping wine consumption in France, highlighting the fact that wine appraisal is deeply embedded in societal structures.

Indirect effects in mediation analyses should not be tested for statistical significance

BACKGROUND AND OBJECTIVE

Mediation analysis is used to gain insight into the mechanisms of exposure-outcome effects by dividing this effect into a direct and an indirect effect. One of the problems of mediation analysis is that in many situations, the standard error of the indirect effect is much lower than the standard errors of the total and direct effect. Because this problem is ignored in the epidemiological literature, the purpose of this paper was to illustrate this problem and to provide an advice regarding the statistical testing of indirect effects in mediation analysis.

METHODS

To illustrate the problem of the estimation of the standard error of the indirect effect two real life datasets and several simulations are used.

RESULTS

The paper shows that the problem of estimating the standard error of the indirect effect was most pronounced when the relationship between exposure and mediator and the relationship between mediator and outcome were equally strong. Furthermore, the magnitude of the estimation problem is different for different strengths of the mediation effect.

CONCLUSION

The indirect effect in mediation analysis should not be tested for statistical significance but the importance of mediation should be evaluated by its clinical relevance.

Arthritis is associated with high nutritional risk among older Canadian adults from the Canadian Longitudinal Study on Aging

This study assessed the association between arthritis, functional impairment, and nutritional risk (NR). Cross-sectional data were from the Canadian Longitudinal Study on Aging, a nationally representative sample of 45-85-year-old community-dwelling Canadians (n = 41,153). The abbreviated Seniors in the Community: Risk Evaluating for Eating and Nutrition II (SCREEN II-AB) Questionnaire determined NR scores (continuous), and high NR (score < 38); the Older American Resources and Services scale measured functional impairment. NR scores and status (low/high) were modelled using multiple linear and logistic regressions, respectively. Analyses adjusted for demographic characteristics, functional impairment, and health (body mass index, self-rated general and mental health). Additional analyses stratified the models by functional impairment. People with arthritis had poorer NR scores (B: - 0.35, CI - 0.48, - 0.22; p < 0.05) and increased risks of high NR (OR 1.11, 95% CI 1.06, 1.17). Among those with functional impairment, the likelihood of high NR was 31% higher in people with arthritis compared to those without arthritis (95% CI 1.12, 1.53). Among those with no functional impairment, the likelihood of high NR was 10% higher in people with arthritis compared to those without (95% CI 1.04, 1.16). These relationships differed based on the type of arthritis. Arthritis is associated with high NR in community-dwelling older adults, both with and without functional impairment. Findings highlight the need for further research on these relationships to inform interventions and improve clinical practices.

Why adolescents conform to high-status peers: Associations among conformity, identity alignment, and self-esteem

This study examined whether conformity to high- but not low-status e-confederates was associated with increases in identification with popular peers and subsequent increases in self-esteem. A sample of 250 adolescents (55.1% male; Mage = 12.70 years; 40.3% White, 28.2% Black, 23.4% Hispanic/Latino, and 7.7% multiracial/other) participated in a well-established experimental chat room paradigm where they were exposed to norms communicated by high- and low-status e-confederates. Results revealed that for boys in the high-status condition only, but not girls, the positive relation between conformity and self-esteem was mediated by greater response alignment with popular peers. These findings bolster prior research by suggesting that conformity to popular peers may be partly motivated by drives for self-esteem and alignment with a valued reference group.

Impulsivity mediates the association between narcissism and substance-related problems beyond the degree of substance use: a longitudinal observational study

BACKGROUND

Narcissism has been implied as a putative risk factor for substance use disorders (SUDs). However, previous research did not disentangle the degree of substance use from substance-related problems, the symptoms of SUDs. This preregistered study addressed the open question whether grandiose and vulnerable narcissism and their constituent traits convey specific SUD risk, that is, explain substance-related problems beyond the degree of use. Furthermore, we tested whether impulsivity or substance use motives linked to narcissistic self-regulation mediate this association.

METHODS

Narcissism, impulsivity, substance use motives, past-year substance use, and substance-related problems were assessed in 139 (poly-)substance users, 121 of whom completed a one-year follow-up. For significant longitudinal associations between narcissism factors and substance-related problems controlled for the degree of use, we tested impulsivity and substance use motives as mediators.

RESULTS

Grandiose narcissism (r =.24, p =.007) and its constituent factors antagonistic (r =.27, p =.003) and agentic narcissism (r =.18, p =.050), but not vulnerable narcissism, prospectively predicted substance-related problems beyond the degree of substance use. Associations of grandiose narcissism and antagonistic narcissism with substance-related problems were fully mediated by impulsivity, but not substance use motives. Impulsivity explained roughly one third of the association of both grandiose (P̂M = 0.30) and antagonistic narcissism (P̂M = 0.26) with substance-related problems.

DISCUSSION

We demonstrate that grandiose narcissism- particularly antagonistic but also agentic narcissism- is specifically linked to substance-related problems beyond the degree of substance use. The mediating effect of impulsivity but not substance use motives suggests that impulsivity may be a more important mechanism than narcissistic self-regulation in promoting SUD in narcissism. However, future studies may use more targeted measures than substance use motives to further probe the role of self-regulation. Similar result patterns for alcohol compared to all substances together indicate that mechanisms may be alike across substances. In conclusion, narcissistic individuals may not use substances more but have a higher SUD risk, informing prevention and treatment.

Child sleep problems, maternal sleep and self-efficacy: Sleep's complicated role in maternal depression

Depression, poor sleep duration and low self-efficacy are common in mothers of children with sleep problems. However, research rarely extends beyond the postpartum period. This study investigated the multifaceted relationship between child sleep and maternal depression in early motherhood. A confidential survey assessed child sleep problems, maternal sleep duration, parental self-efficacy and depressive symptoms in 477 Australian mothers of children aged 3 months to 5 years. We found no relationship between child age and maternal depression, supporting our decision to look beyond postpartum depression. Robust bootstrapped mediation modelling tested the hypothesis that both maternal sleep duration and parental self-efficacy would mediate child sleep problems as predictors of maternal depression. After controlling for child age, results showed a significant parallel mediation effect, demonstrating that maternal sleep duration and parental self-efficacy both mediate the relationship between child sleep problems on maternal depression. While the total effect of child sleep problems on maternal depression was statistically significant, after partialling out the effects of other variables, child sleep problems no longer predicted maternal depression. Akaike information criterion analyses supported the full model, with both mediators explaining meaningful variance in maternal depression. This study expands our knowledge beyond the postpartum period, and divulges the disparate effects of sleep deprivation and parental self-efficacy on the relationship between child sleep and depression in early motherhood. Maternal sleep duration and self-efficacy are modifiable risk factors of maternal depression, indicating possible efficacious treatments. Parental self-efficacy stands out as a direction for clinical practice and further psychobiological study.

Lower socioeconomic status may help explain racial disparities in asthma and atopic dermatitis prevalence: A mediation analysis

BACKGROUND

Racial disparities in atopic disease (atopic dermatitis [AD], asthma, and allergies) prevalence are well documented. Despite strong associations between race and socioeconomic deprivation in the United States, and socioeconomic status (SES) and atopic diseases, the extent to which SES explains these disparities is not fully understood.

OBJECTIVE

We sought to identify racial disparities in childhood atopic disease prevalence and determine what proportion of those disparities is mediated by SES.

METHODS

This study used the National Health Interview Survey (2011-2018) to investigate AD, asthma, and respiratory allergy prevalence in Black and White children and the extent to which measures of SES explain any identified disparities.

RESULTS

By race, prevalences were as follows: AD, White 11.8% (95% CI: 11.4%, 12.2%) and Black 17.4% (95% CI: 16.6%, 18.3%); asthma prevalence, White 7.4% (95% CI: 7.0%, 7.7%) and Black 14.3% (95% CI: 13.5%, 15.0%); respiratory allergy, White 11.4% (95% CI: 11.0%, 11.9%) and Black 10.9% (95% CI: 10.3%, 11.6%). The percentage of the disparity between racial groups and disease prevalence explained by a multivariable measure of SES was 25% (95% CI: 15%, 36%) for Black versus White children with AD and 47% (95% CI: 40%, 54%) for Black versus White children with asthma.

CONCLUSIONS

In a nationally representative US population, Black children had higher prevalence of AD and asthma than White children did and similar prevalence of respiratory allergy; a multivariable SES measure explained a proportion of the association between Black versus White race and AD and a much larger proportion for asthma.

Relationships Between Stigma, Risk Tolerance, and Buprenorphine Dispensing Intentions Among Community-Based Pharmacists: Results From a National Sample

BACKGROUND

Concerns have been raised that pharmacists sometimes act as barriers to patients with opioid use disorder (OUD) accessing buprenorphine treatment. The present research explores how community pharmacists' endorsement (vs non-endorsement) of stigmatizing beliefs about patients taking buprenorphine relate to intentions, comfort, and decisions regarding dispensing buprenorphine for OUD. In addition, we assessed attitudes toward risk in pharmacy practice as a novel correlate of dispensing intentions and decisions.

METHODS

A sample of 207 active community-based pharmacists practicing in the United States responded to survey items measuring stigma, risk tolerance, and intentions to dispense buprenorphine. The survey included 2 vignettes in which patients presented to the pharmacy with a prescription for buprenorphine, and respondents rated their comfort with dispensing and decisions regarding dispensing in the vignette.

RESULTS

Results suggest that both stigma toward patients taking buprenorphine to treat OUD and tolerance for risk in pharmacy settings are related to differences in pharmacists' intentions to and willingness to dispense buprenorphine for OUD.

CONCLUSIONS

Findings support the need for interventions to reduce stigma associated with buprenorphine use among pharmacists and suggest that risk tolerance is an important determinant of pharmacists' behavior that merits further study.

Victimization and cybervictimization: The role of school factors

INTRODUCTION

Victimization and cybervictimization can negatively affect the subjective experience of well-being. This effect can be mediated by school factors, even if a deep understanding of these factors still needs to be determined. The present study examined how peer network, teacher support, and school connectedness mediated the relationship between victimization, cybervictimization, and well-being. We developed two mediation models, considering victimization (Model 1) and cybervictimization (Model 2) as predictors, well-being as the outcome, peer network, teacher support, and school connectedness as parallel mediators, and gender as a covariate variable.

METHODS

The sample comprised 563 Italian students (Mage = 11.5; 45% females). Students filled out a purpose-built questionnaire investigating victimization and cybervictimization, peer network, teacher support, school connectedness, and well-being. Two multiple mediation models were run using Process.

RESULTS

The two models showed similar patterns [Model 1: F(8, 169) = 34.35, p ≤ .001, R2 = .34; Model 2: F(8, 169) = 40.13, p ≤ .001, R2 = .34]. Indeed, victimization (Model 1) and cybervictimization (Model 2) had negative significant effects on peer network, teacher support, and school connectedness. However, their direct effects on well-being were not significant, as peer network and school connectedness emerged as complete mediators between victimization (Model 1) and cybervictimization (Model 2) and well-being. Males displayed higher levels of well-being compared to females.

CONCLUSIONS

Peer network and school connectedness play a crucial role in mediating the impact of victimization and cybervictimization on well-being. Educators and policymakers should prioritize fostering supportive peer network and strengthening school connectedness to create an environment that mitigates the negative effects of victimization and cybervictimization, enhancing overall student well-being.

Interventional probability of causation (IPoC) with epidemiological and partial mechanistic evidence: benzene vs. formaldehyde and acute myeloid leukemia (AML)

INTRODUCTION

Causal epidemiology for regulatory risk analysis seeks to evaluate how removing or reducing exposures would change disease occurrence rates. We define interventional probability of causation (IPoC) as the change in probability of a disease (or other harm) occurring over a lifetime or other specified time interval that would be caused by a specified change in exposure, as predicted by a fully specified causal model. We define the closely related concept of causal assigned share (CAS) as the predicted fraction of disease risk that would be removed or prevented by a specified reduction in exposure, holding other variables fixed. Traditional approaches used to evaluate the preventable risk implications of epidemiological associations, including population attributable fraction (PAF) and the Bradford Hill considerations, cannot reveal whether removing a risk factor would reduce disease incidence. We argue that modern formal causal models coupled with causal artificial intelligence (CAI) and realistically partial and imperfect knowledge of underlying disease mechanisms, show great promise for determining and quantifying IPoC and CAS for exposures and diseases of practical interest.

METHODS

We briefly review key CAI concepts and terms and then apply them to define IPoC and CAS. We present steps to quantify IPoC using a fully specified causal Bayesian network (BN) model. Useful bounds for quantitative IPoC and CAS calculations are derived for a two-stage clonal expansion (TSCE) model for carcinogenesis and illustrated by applying them to benzene and formaldehyde based on available epidemiological and partial mechanistic evidence.

RESULTS

Causal BN models for benzene and risk of acute myeloid leukemia (AML) incorporating mechanistic, toxicological and epidemiological findings show that prolonged high-intensity exposure to benzene can increase risk of AML (IPoC of up to 7e-5, CAS of up to 54%). By contrast, no causal pathway leading from formaldehyde exposure to increased risk of AML was identified, consistent with much previous mechanistic, toxicological and epidemiological evidence; therefore, the IPoC and CAS for formaldehyde-induced AML are likely to be zero.

CONCLUSION

We conclude that the IPoC approach can differentiate between likely and unlikely causal factors and can provide useful upper bounds for IPoC and CAS for some exposures and diseases of practical importance. For causal factors, IPoC can help to estimate the quantitative impacts on health risks of reducing exposures, even in situations where mechanistic evidence is realistically incomplete and individual-level exposure-response parameters are uncertain. This illustrates the strength that can be gained for causal inference by using causal models to generate testable hypotheses and then obtaining toxicological data to test the hypotheses implied by the models-and, where necessary, refine the models. This virtuous cycle provides additional insight into causal determinations that may not be available from weight-of-evidence considerations alone.

When advisors do not know what is best for advisees: Uncertainty inhibits advice giving

While seeking advice can be beneficial for advisees, advisors may not always possess the necessary knowledge to provide appropriate guidance. Poor-quality advice can mislead advisees rather than offering assistance. Despite the research interest in advisees, few studies have investigated advisors' psychological and behavioral responses, especially when they faced uncertainty regarding the optimal course of action for advisees. To fill this gap, we developed novel paradigms aiming at manipulating advisors' uncertainty, allowing for a systematic investigation of advisors' behavior, motivation, and emotion. Across four studies, we consistently found that advisors under uncertainty give less advice. Furthermore, we observed that uncertainty modulates advisors' motivation to influence, worry about harm to others, and/or sense of power. The motivation to influence and/or worry about harm to others can mediate the effect of uncertainty on advice giving. Besides, we identified nuanced distinctions in the effects of ambiguity and risk, two distinct types of uncertainty, on advisors' psychological processes. Our findings shed light on advisors' self-monitoring of the quality of their advice, thereby contributing to a deeper understanding of advisor-advisee communication from the perspective of advisors.

Mindfulness intervention effect on endometriosis-related pain dimensions and its mediator role on stress and vitality: a path analysis approach

Endometriosis-related pain is supposedly mainly responsible for generating psychological stress and deteriorating the quality of life. However, the interaction between these factors has not been investigated, considering its multidimensional nature and through the path of effects of psychosocial approaches. The present study aims to investigate the effect of a brief mindfulness-based intervention (bMBI) on pain dimensions and its mediator role on psychological stress and QoL-Vitality improvement. A secondary analysis of a pilot randomized controlled trial using a series of parallel and serial mediators was carried out. The results showed that bMBI improves the sensory (B = -6.09 [-9.81, -2.52], β = -0.42) and affective (B = -3.40 [-5.02, -1.80], β = -0.47) pain. The bMBI effect on psychological stress reduction was mediated by these changes in sensory (B = -2.81 [-6.06, -0.41], β = -0.21) and affective (B = -1.97 [-5.07, -0.17], β = -0.15) pain. Serial sensory pain and psychological stress reduction (B = 2.27 [0.11, 5.81], β = -0.09) mediated the bMBI effect on quality of life vitality. Meditation training promotes additional improvement in affective and sensory pain characteristics through which psychological stress is reduced. The sensory pain dimension must be positively impacted in combination with psychological stress for the bMBI improves women's vitality. Adding a psychosocial intervention like meditation training to the standard treatment plan may be required for some women to achieve the needed changes to restore well-being.

Time-lagged associations between two adverse childhood experiences and later-life cognitive function through educational attainment and stroke

OBJECTIVE

Adverse childhood experiences (ACEs) have been associated with worse cognitive health in older adulthood. This study aimed to extend findings on the specificity, persistence, and pathways of associations between two ACEs and cognition by using a comprehensive neuropsychological battery and a time-lagged mediation design.

METHOD

Participants were 3304 older adults in the Health and Retirement Study Harmonized Cognitive Assessment Protocol. Participants retrospectively reported whether they were exposed to parental substance abuse or experienced parental physical abuse before age 18. Factor scores derived from a battery of 13 neuropsychological tests indexed cognitive domains of episodic memory, executive functioning, processing speed, language, and visuospatial function. Structural equation models examined self-reported years of education and stroke as mediators, controlling for sociodemographics and childhood socioeconomic status.

RESULTS

Parental substance abuse in childhood was associated with worse later-life cognitive function across all domains, in part via pathways involving educational attainment and stroke. Parental physical abuse was associated with worse cognitive outcomes via stroke independent of education.

CONCLUSIONS

This national longitudinal study in the United States provides evidence for broad and persistent indirect associations between two ACEs and cognitive aging via differential pathways involving educational attainment and stroke. Future research should examine additional ACEs and mechanisms as well as moderators of these associations to better understand points of intervention.

Social Isolation, Physical Activity, and Subsequent Changes in Cognition Among Middle- and Older-Aged Adults: Results From the Canadian Longitudinal Study on Aging

OBJECTIVE

The objectives of this study were to a) evaluate associations between social isolation and change in cognition over a 3-year period, and b) evaluate whether physical activity mediates the association between social isolation and cognition change.

METHODS

Using baseline and follow-up 1 data from the Canadian Longitudinal Study on Aging, latent change score models, incorporating direct and indirect pathways, were constructed to estimate the indirect effect of social isolation on cognitive change through physical activity. Multigroup models were constructed based on age group (45-65 versus 65+ years) and sex to allow for varying estimates across age and sex. The final analytic sample included 51,338 participants.

RESULTS

Indirect effects of social isolation on cognition through physical activity were evident in men and women 65+ years old for memory change ( = -0.005 [99.9% confidence interval = -0.007 to -0.002], p < .001 in both groups) and in male adults 65+ years old for executive function change ( = -0.01 [99.9% confidence interval = -0.02 to -0.006], p < .001). Statistically significant indirect effects were not observed for adults between 45 and 65 years old.

CONCLUSIONS

Social isolation is associated with diminished physical activity, and in turn, diminished physical activity is associated with decline in memory in older women and men, with larger declines in executive function in older men. Public health initiatives to promote physical activity-perhaps incorporating social interaction-among older adults experiencing social isolation could be one way to mitigate the negative impact of social isolation on cognitive health.

Identity fusion is associated with outgroup trust and social exploration: Evidence for the fusion-secure base hypothesis

Identity fusion - a powerful form of group alignment - is a strong predictor of using violence to defend the ingroup. However, recent theorizing suggests, in the absence of outgroup threat, fusion may instead promote intergroup trust and cooperation. Across five studies we find evidence that fusion to a range of groups (e.g., country, football team) was consistently positively associated with a willingness to trust others generally, trust outgroup members, and social exploration. An internal meta-analysis indicated that fusion was more strongly associated with trust and social exploration, compared to several measures of group identification. These findings provide support for the fusion-secure base hypothesis (Personality and Social Psychology Review. 2023, 27(2), 107-127) and suggest that fusion has the potential to increase a willingness to interact with, and trust, outgroup members.

Indoor air pollution and cognitive function among older adults in India: a multiple mediation approach through depression and sleep disorders

BACKGROUND

Studies across multiple countries reveal that depression and sleep disorders can lead to cognitive decline. This study aims to speculate on the effect of different sources of indoor air pollution on cognition and to explore the mediation effect of depression and sleep disorders on cognition when exposed to indoor air pollution. We hypothesize that an older adult experiences higher cognitive decline from indoor pollution when mediated by depression and sleep disorders.

METHODS

We use data from Longitudinal Aging Study in India (LASI), 2017-2018, and employ a multiple mediation model to understand the relationship between indoor air pollution and cognition through sleep disorders and depression while adjusting for possible confounders. Sensitivity analysis was applied to see the effect of different sources of indoor pollution (cooking fuel, indoor smoke products, and secondhand smoke) on cognitive performance.

RESULTS

The effect of three sources of indoor pollutants on cognition increased when combined, indicating stronger cognitive decline. Unclean cooking practices, indoor smoke (from incense sticks and mosquito coils), and secondhand smoke were strongly associated with sleep disorders and depression among older adults. Indoor air pollution was negatively associated with cognitive health (β= -0.38) while positively associated with depression (β= 0.18) and sleep disorders (β= 0.038) acting as mediators. Sensitivity analysis explained 45% variability while adjusting for confounders.

CONCLUSION

The study lays a foundation for future investigations into the nexus of indoor pollution and mental health. It is essential to formulate policies to reduce exposure to varying sources of indoor air pollutants and improve screening for mental health services as a public health priority.

Barriers to Postpartum Care: A Mixed Methods Study of Midwestern Postpartum Women

PURPOSE

Postpartum care is an opportunity to provide essential follow-up care to people who have given birth, but inequalities in access by race and socioeconomic status (SES) are well-documented. The purpose of this study is to provide an in-depth description of the barriers to postpartum care using a mixed-methods design.

METHODS

Mixed method analyses using convergent design with three stages including (1) bivariate logistic regression of survey data representative of postpartum women in Kalamazoo County, Michigan, (2) thematic qualitative analyses of focus group interviews of survey participants, and (3) bivariate logistic regression and logistic regression meditation analyses using themes operationalized with survey data measures.

RESULTS

In Kalamazoo county, 82.0% of women attended their postpartum visit. White women and women with higher SES were 2.84 (SE = 1.35, p < .001) and 5.73 (SE = 3.10, p < .001) times more likely to attend postpartum visits than women of color and those with lower SES. Qualitative analyses identified four common barriers: (1) misaligned goals for appointments, (2) time and scheduling of appointments, (3) prioritization of children, and (4) material resources and health insurance coverage. The quantitative analyses found mixed support for these barriers and found limited evidence that these barriers mediated the relationship between race or SES and postpartum attendance.

CONCLUSIONS FOR PRACTICE

The qualitative findings identify barriers that are amenable to practice-level interventions including changes to scheduling procedures and employing patient-centered care. The quantitative findings further suggest that although inequalities in postpartum care are present, interventions on these barriers may benefit women regardless of race and SES.

Evaluating a Theory-Based Online Program for Preventing Sexual Aggression: An Experimental-Longitudinal Study With German University Students

This pre-registered study evaluated an intervention designed to reduce sexual aggression perpetration and victimization by changing risky scripts for consensual sexual interactions and corresponding risky sexual behavior, and by improving sexual self-esteem, refusal assertiveness, and initiation assertiveness. In a four-wave longitudinal study covering 23 months, 1181 university students in Germany (762 female) were randomly assigned to an intervention and a no-intervention control group. The intervention group completed six weekly modules addressing the targeted theory-based risk and vulnerability factors of sexual aggression perpetration and victimization. Controlling for baseline levels (T1), the intervention group showed less risky sexual scripts one week post-intervention (T2), which predicted less risky sexual behavior nine months later (T3), which predicted lower odds of sexual aggression perpetration and victimization 12 months later (T4). No direct intervention effects on rates of sexual aggression perpetration and victimization at T3 and T4 were found. No indirect intervention effect on sexual aggression was found via sexual self-esteem and sexual assertiveness. However, sexual self-esteem at T2, which was higher in the intervention group, predicted lower odds of sexual aggression victimization at T3 via higher initiation assertiveness at T3. Implications for reducing sexual aggression and conceptualizing risk and vulnerability factors of sexual aggression are discussed.

Representational shifts: increasing motivation for bottled water through simulation-enhancing advertisements

BACKGROUND

Despite its numerous health benefits, consumers' daily water consumption is below recommend levels while soft drink consumption remains high. Previous research has shown that the degree to which drinks are cognitively represented in terms of consumption and enjoyment (i.e., through simulations of consumption and reward) predicts desire and intake. Here, we examined whether simulation-enhancing advertisements that frame water in terms of consumption and reward change cognitive representations and increase motivation for a fictitious bottled water.

METHODS

In three pre-registered online experiments (Nexp1 = 984; Nexp2 = 786; Nexp3 = 907), UK participants viewed three advertisements that either highlighted the rewarding consumption experience of water (e.g., "Refresh all your senses with this smooth, cool water"; simulation-enhancing ads), the health consequences of drinking water (e.g., "This water takes care of your health"; health-focused ads), or control ads. We assessed cognitive representations of the bottled water with a semantic feature production task, and we coded the words used as consumption and reward features or positive long-term health consequences features. We assessed motivation through ratings of the attractiveness of the water (Exp. 1 only), desire to drink it, and willingness to pay for it (WTP).

RESULTS

In line with our hypotheses, participants represented the bottled water more in terms of consumption and reward after viewing simulation-enhancing advertisements, and more in terms of positive long-term health consequences after viewing health-focused advertisements. There was no direct effect of advertisement condition on motivation ratings. However, significant indirect effects showed that simulation-enhancing advertisements increased desire and WTP through the proportion of consumption and reward features, whereas health-focused advertisements increased motivation through an increase in the proportion of positive long-term health consequences features. The effects through consumption and reward were stronger.

CONCLUSIONS

These findings are consistent with research suggesting that the experience of immediate reward from drinking water underlies intake. Public health interventions should emphasize the enjoyment of drinking water, rather than the long-term health benefits.

Believing in science: Linking religious beliefs and identity with vaccination intentions and trust in science during the COVID-19 pandemic

Despite evidence supporting numerous scientific issues (e.g. climate change, vaccinations) many people still doubt the legitimacy of science. Moreover, individuals may be prone to scepticism about scientific findings that misalign with their ideological beliefs and identities. This research investigated whether trust in science (as well as government and media) and COVID-19 vaccination intentions varied as a function of (non)religious group identity, religiosity, religion-science compatibility beliefs, and/or political orientation in two online studies (N = 565) with university students and a Canadian community sample between January and June 2021. In both studies, vaccination intentions and trust in science varied as a function of (non)religious group identity and beliefs. Vaccine hesitancy was further linked to religiosity through a lack of trust in science. Given the ideological divides that the pandemic has exacerbated, this research has implications for informing public health strategies for relaying scientific findings to the public and encouraging vaccine uptake in culturally appropriate ways.

Cognitive-affective changes mediate the mindfulness-based intervention effect on endometriosis-related pain and mental health: A path analysis approach

BACKGROUND

There is poor knowledge about the therapeutic mechanisms of the conservative interventions for endometriosis. We hypothesized that the effects of a brief mindfulness-based intervention (bMBI) on pelvic pain intensity (PPI), pain unpleasantness (PU) and quality of life mental health (QoL-MH) are mediated by direct and indirect paths of changes in pain catastrophizing (PC), positive affect (PA) and negative affect (NA).

METHODS

A secondary analysis of a pilot randomized controlled trial of women with endometriosis, assigned to standard medical treatment (n = 32) and standard medical treatment plus bMBI (n = 31). We tested a series of parallel and serial mediators (PC, PA and NA) of the relationship between bMBI and outcomes (PPI, PU and QoL-MH).

RESULTS

The bMBI group demonstrated improvement in PA (Cohen's f2  = 0.12 [0.01, 0.36]), decreases in NA (Cohen's f2  = 0.06 [0.00, 0.24]) and PC (Cohen's f2  = 0.16 [0.02, 0.42]). The PC reduction mediated the effect of the bMBI on PPI and PU directly; however, the PC effect through PA increase mediated the PU marginally but not PPI changes. bMBI effect on Qol-MH was mediated directly by PA and NA. The PC improved Qol-MH through PA increase and Pain decrease but not via NA.

CONCLUSIONS

Our findings showed that bMBI impacts pain through changes in pain-related cognitive-affective factors. bMBI can improve QoL-MH by multiple pathways, including but not limited to pain reduction, highlighting the independent potential of improvement in affect to restore mental health in endometriosis.

SIGNIFICANCE

Brief mindfulness-based intervention improves endometriosis pain through pain-related cognitive-affective factors and quality of life mental health via pain and affect changes unrelated to pain.

When it's not safe to be me: employee authenticity mediates the effect of perceived manager psychopathy on employee well-being

BACKGROUND

Psychopathy in managers is often measured on global scales and associated with detrimental outcomes for subordinates, such as bullying and reduced well-being. Yet some features of psychopathy, like boldness, appear to have beneficial outcomes. Using the triarchic model of psychopathy, we differentiate between adaptive and maladaptive traits in managers and model their effects on employee engagement and burnout. In addition, we test the extent to which authenticity, known to ameliorate the effect of some negative experiences on well-being, might mediate the influence of managers' perceived psychopathic traits on employee well-being.

METHODS

In a two-wave study, full-time employees (N = 246) reported on their manager's psychopathic traits (boldness, meanness, disinhibition), their own authenticity and, six weeks later, their engagement and burnout.

RESULTS

In support of our hypotheses, manager boldness enhanced engagement and reduced burnout while meanness and disinhibition reduced engagement and increased burnout. Additionally, employee authenticity was a partial mediator of the effect of managerial psychopathy on engagement and burnout.

CONCLUSIONS

Perceived psychopathic traits in managers have the potential to influence whether employees feel able to be their authentic selves at work, which consequently affects their well-being. A work culture that values authenticity can directly improve well-being and help employees to deal with managerial behaviour that stems from maladaptive psychopathic traits. We also highlight the importance of discriminating between constituent psychopathic traits to identify the potentially adaptive nature of the boldness element of psychopathy.

Racial and ethnic differences in colon cancer surgery type performed and delayed treatment among people 45 years old and older in the USA between 2007 and 2017: Mediating effect on survival

BACKGROUND

This study examined the associations of socioeconomic status (SES), race/ethnicity, surgery type, and treatment delays with mortality among colon cancer patients. In addition, the study also quantifies the extent to which clinical and SES factors' variations explain the racial/ethnic differences in overall survival.

PATIENTS AND METHODS

We studied 111,789 adult patients ≥45 years old who were diagnosed with colon cancer between 2010 and 2017, identified from the Surveillance, Epidemiology, and End Results (SEER) database. We performed logistic regression models to examine the association of SES and race/ethnicity with surgery type and first course of treatment delays. We also performed mediation analysis to quantify the extent to which treatment, sociodemographic and clinicopathologic factors mediated racial/ethnic differences in survival.

RESULTS

Non-Hispanic (NH) Blacks [adjusted Odds Ratio (aOR) = 1.19, 95% CI:1.13-1.25] were significantly more likely to undergo subtotal colectomy and to experience treatment delays [aOR = 1.39, 95% CI: 1.31-1.48] compared to NH Whites. Hispanics [aOR = 1.59, 95% CI: 1.49-1.69] were more likely to experience treatment delays than NH Whites. Delayed first course of treatment explained 23.56% and 56.73% of the lower survival among NH Blacks and Hispanics, respectively, compared to their NH White counterparts.

CONCLUSIONS

Race/ethnicity is significantly associated with the surgery type performed and the first course of treatment delays. Variations in treatment, SES, and clinicopathological factors significantly explained racial disparities in overall mortality. These disparities highlight the need for multidisciplinary interventions to address the treatment and social factors perpetuating racial disparities in colon cancer mortality.

Mental Health Variables Impact Weight Loss, Especially in Patients with Obesity and Binge Eating: A Mediation Model on the Role of Eating Disorder Pathology

BACKGROUND

Various mental health and eating behavior variables have been independently associated with predicting weight loss in individuals with obesity. This study aims to investigate a mediation model that assesses the distinct contributions of these variables in predicting weight changes in patients with obesity following an outpatient behavioral weight loss intervention (BWLI).

METHODS

General mental health (depression, anxiety, stress, impulsivity), eating behavior (cognitive restraint, disinhibition, hunger), eating disorder pathology, and body mass index (BMI) were assessed in a group of 297 patients with obesity at the admission of a BWLI program. BMI was re-evaluated during the final treatment session. A mediation model was employed to examine whether mental health and eating behavior variables predicted BMI changes, with eating disorder pathology serving as a mediator. The model was tested both overall and within two patient subgroups: those with regular binge eating (≥four episodes/month) and those without.

RESULTS

In the overall sample (n = 238), the relationships between depression, impulsivity, and cognitive restraint with BMI change were mediated by eating disorder pathology. In the subgroup with regular binge eating (n = 99, 41.6%), the associations between stress and disinhibition with BMI change were additionally mediated by eating disorder pathology. In the subgroup without regular binge eating, eating disorder pathology showed no mediating effect.

DISCUSSION

Multiple mental health and eating behavior variables assessed at admission predicted BMI changes, particularly when mediated by eating disorder pathology in patients with regular binge eating. A comprehensive psychopathological assessment prior to starting BWLI may help identify multiple factors affecting prognosis and treatment outcomes. Long-term follow-up studies in this field are required.

Mediating mechanisms of the relationship between exposure to deprivation and threat during childhood and adolescent psychopathology: evidence from the Millennium Cohort Study

The key aim of our study was to examine pathways from exposure to childhood adversities (i.e., deprivation and threat) to adolescent psychopathology. The assessed mediating mechanisms included cognitive ability and emotion regulation, as proposed by the Dimensional Model of Adversity and Psychopathology (DMAP). The study comprised participants from the nationally representative Millennium Cohort Study. Latent scores for deprivation and threat were derived using confirmatory factor analysis from indicators collected when participants were at age of 9 months, 3 and 5 years. Cognitive ability was measured using the Verbal Similarities subscale of the British Ability Scales II at age 11, and emotion regulation was measured using emotion dysregulation subscale of the Child Social Behavioural Questionnaire at age 7. Psychopathology, defined as psychological distress, was assessed using the Kessler 6 scale at age 17. We conducted causal mediation analysis adjusting for multiple confounding factors. We did not find total effect of either exposure to deprivation or threat on psychological distress, but we did find significant indirect effects of exposure to deprivation on psychological distress via cognitive ability (- 0.11, 95% CI - 0.20 to - 0.05) and emotion regulation (0.03, 0.02 to 0.12), and exposure to threat on psychological distress via cognitive ability (- 0.04, - 0.07 to - 0.01) and emotion regulation (0.09, 0.03 to 0.15). The lack of associations between deprivation or threat and psychological distress may be due to reporting bias or developmental period of psychopathology. Results of mediation analysis partially support the DMAP but indicate limited benefits to reduce adolescent psychological distress by targeting cognitive ability or emotion regulation to those exposed to childhood adversities.

The road to recovery: Financial resilience and mental health in post-apartheid South Africa

Following the post-apartheid era in South Africa, global economic hardships and financial shocks have forced most households to endure various mental and psychological stresses.. This has hindered the achievement of Sustainable Development Goal 3 (SDG-3)-good health and wellbeing-prompting policymakers and academics to search for remedies to mitigate such stresses. Highlighting resilience as a means of improving wellbeing, this paper focuses on financial resilience and constructs an index using a multidimensional framework to investigate its association with mental health disorders. Using the South Africa National Income Dynamic Study alongside several robust estimation techniques, we uncover a negative association between financial resilience and mental health disorders among South Africans. More specifically, financial resilience is associated with an approximately 37% decrease in the occurrence of mental health disorders. The results also reveal disparities in the correlation between financial resilience and mental health disorders across different subgroups. Non-Whites (especially Blacks), urban dwellers, and male household heads are shown to most strongly experience the depression-reducing effect of financial resilience. This paper also shows that life satisfaction and household expenditure mediate the relationship between financial resilience and mental wellbeing. Toward the end of this paper, we discuss the implications of our results and offer some policy recommendations.

The Impact of Sexual Violence on Quality of Life and Mental Wellbeing in Transgender and Gender-Diverse Adolescents and Young Adults: A Mixed-Methods Approach

Transgender (trans) and gender-diverse (GD) adolescents and young adults have remained largely invisible in health research. Previous research shows worse outcomes in health indicators for trans and GD people, compared to cisgender controls. Research on the impact of sexual violence focuses on mainly cisgender female adult victims. This study assessed the impact of sexual violence on the quality of life (QoL) and mental wellbeing (GHQ-12) among trans and GD adolescents and young adults, while taking into account the possible role of gender nonconformity in sexual violence and mental wellbeing. An online, anonymous survey and interviews/focus groups were conducted between October 2021 and May 2022 in Belgium. Multiple analyses of covariance (ANCOVAs) were used to assess the associations between sexual violence, mental wellbeing, and gender nonconformity, while controlling for different background variables (gender identity, sexual orientation, age, economic vulnerability, etc.). The interviews and focus groups were used to validate associations between variables that were hypothesized as important. The quantitative sample consisted of 110 respondents between 15 and 25 years old, with 30 trans respondents (27.3%) and 80 GD respondents (72.7%). A total of 73.6% reported experiences with sexual violence over the past two years (n = 81). The mean QoL score was 5.3/10, and the mean GHQ-12 score was 6.6/12. Sexual violence was not significantly associated with QoL (p = 0.157) and only marginally significantly associated with GHQ-12 (p = 0.05). Changing one's physical appearance to conform to gender norms, out of fear of getting attacked, discriminated against, or harassed was significantly associated with QoL (p = 0.009) and GHQ-12 (p = 0.041). The association between sexual violence and changing one's physical appearance to conform to gender norms was analyzed, to assess a possible mediation effect of sexual violence on mental wellbeing. No significant association was found (p = 0.261). However, the interviews suggest that sexual violence is associated with changing one's physical appearance, but this association is not limited to only trans and GD victims of sexual violence. Non-victims also adjust their appearance, out of fear of future sexual victimization. Together with the high proportion of sexual violence, as well as the lower average QoL and higher average GHQ-12 scores among trans and GD adolescents and young adults, compared to general population statistics, this highlights the need for policy makers to create more inclusive environments.

Pain and Inflammation as Mediators of Tofacitinib Treatment Effect on Fatigue in Patients with Ankylosing Spondylitis: A Mediation Analysis

INTRODUCTION

Tofacitinib is an oral Janus kinase inhibitor for treatment of ankylosing spondylitis (AS). Using mediation modelling, we describe interrelationships between fatigue, pain, morning stiffness, C-reactive protein (CRP) and tofacitinib treatment in patients with AS.

METHODS

Data from phase 2 (NCT01786668)/phase 3 (NCT03502616) studies of patients receiving tofacitinib 5 mg twice daily (BID) or placebo were used. Initial models included treatment as the independent binary variable (tofacitinib 5 mg BID versus placebo); fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-F; model A] or Bath AS Disease Activity Index [BASDAI] Q1 [model B]) as the dependent variable; and pain (total back pain/nocturnal spinal pain [model A] or pain measured by BASDAI Q2/3 [model B]), morning stiffness (BASDAI Q5/6) and CRP as mediator variables.

RESULTS

Pooled data from 370/371 patients were included in models A/B. Initial models demonstrated that tofacitinib treatment affects fatigue mainly indirectly via pain and morning stiffness. As a result, initial models were respecified to exclude direct treatment effect and the indirect effect via CRP. For respecified model A, 44.0% of the indirect effect of tofacitinib treatment on fatigue was mediated via back pain/morning stiffness, 40.0% via morning stiffness alone and 16.0% via back pain alone (all P < 0.05). For respecified model B, 80.8% of the indirect effect of tofacitinib treatment on fatigue was mediated via pain/morning stiffness and 19.2% via pain alone (both P < 0.05).

CONCLUSIONS

In tofacitinib-treated patients with AS, improvements in fatigue were collectively mediated through combined treatment effects on morning stiffness and pain.

Urinary Copper Excretion Is Associated with Long-Term Graft Failure in Kidney Transplant Recipients

INTRODUCTION

In chronic kidney disease, proteinuria increases urinary copper excretion, inducing oxidative tubular damage and worsening kidney function. We investigated whether this phenomenon occurred in kidney transplant recipients (KTRs). In addition, we studied the associations of urinary copper excretion with the biomarker of oxidative tubular damage urinary liver-type fatty-acid binding protein (u-LFABP) and death-censored graft failure.

METHODS

This prospective cohort study was performed in the Netherlands between 2008 and 2017, including outpatient KTR with a functioning graft for longer than 1 year, who were extensively phenotyped at baseline. Twenty-four-hour urinary copper excretion was measured by inductively coupled plasma mass spectrometry. Multivariable linear and Cox regression analyses were performed.

RESULTS

In 693 KTR (57% men, 53 ± 13 years, estimated glomerular filtration rate [eGFR] 52 ± 20 mL/min/1.73 m2), baseline median urinary copper excretion was 23.6 (interquartile range 11.3-15.9) µg/24 h. Urinary protein excretion was positively associated with urinary copper excretion (standardized β = 0.39, p < 0.001), and urinary copper excretion was positively associated with u-LFABP (standardized β = 0.29, p < 0.001). During a median follow-up of 8 years, 109 (16%) KTR developed graft failure. KTR with relatively high copper excretion were at higher risk of long-term graft failure (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.32-1.86 per log2, p < 0.001), independent of multiple potential confounders like eGFR, urinary protein excretion, and time after transplantation. A dose-response relationship was observed over increasing tertiles of copper excretion (HR: 5.03, 95% CI: 2.75-9.19, tertile 3 vs. 1, p < 0.001). u-LFABP was a significant mediator of this association (74% of indirect effect, p < 0.001).

CONCLUSION

In KTR, urinary protein excretion is positively correlated with urinary copper excretion. In turn, higher urinary copper excretion is associated with an independent increased risk of kidney graft failure, with a substantial mediating effect through oxidative tubular damage. Further studies are warranted to investigate whether copper excretion-targeted interventions could improve kidney graft survival.

Body Positivity or Humorous Parody? The Impact of Instagram Imagery on Body Image Concerns

Research has shown that Instagram imagery can affect women's body image. However, it remains unclear how Instagram images are perceived, and which type of images can have a positive impact on body image. In this study (N = 170), we examined whether exposure to body positive and humorous parody (vs. body ideal) imagery would be perceived as critiques of thin body ideals, would elicit photo-based activity in the form of "likes", and would positively affect women's body image. Results showed that both body positivity and humorous parody images elicited more "likes" and were perceived as critiquing thin body standards more than body ideal images. Moreover, women's body satisfaction and positive mood were higher after exposure to body positivity and humorous parody compared to exposure to body ideal images. Women exposed to humorous parody also reported a lower drive for thinness. These findings demonstrate that both body positivity and humorous parody can be considered critiques that improve body image.

Maternal metabolic syndrome in pregnancy and child development at age 5: exploring mediating mechanisms using cord blood markers

BACKGROUND

There is limited evidence on how the classification of maternal metabolic syndrome during pregnancy affects children's developmental outcomes and the possible mediators of this association. This study uses a cohort sample of 12,644 to 13,832 mother-child pairs from the UK Born in Bradford Study to examine the associations between maternal metabolic syndrome classification (MetS) and child development outcomes at age 5, using cord blood markers as candidate mediators.

METHODS

Maternal cardiometabolic markers included diabetes, obesity, triglycerides, high-density lipoprotein cholesterol, blood pressure, hypertension, and fasting glucose during pregnancy. Cord blood markers of high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, leptin, and adiponectin were used as child mediators. Child outcomes included two starting school variables: British Picture Vocabulary Scale (BPVS) and the Letter Identification Assessment (LID), and five developmental milestone domains from a national UK framework: (1) communication and language (COM); (2) personal, social, and emotional (PSE); (3) physical development (PHY); (4) literacy (LIT); and (5) mathematics (MAT). Mediation models were used to examine the associations between the classification of maternal metabolic syndrome and child developmental milestones. Models were adjusted for potential maternal, socioeconomic, and child confounders such as maternal education, deprivation, and gestational age.

RESULTS

In mediation models, significant total effects were found for MetS associations with children's development in the LIT domain at age 5. MetS predicted individual cord blood mediators of lower HDL and increased leptin levels in both adjusted and unadjusted models. Total indirect effects (effects of all mediators combined) for MetS on a child's COM and PSE domain were significant, through all child cord blood mediators of LDL, HDL, triglycerides, adiponectin, and leptin for adjusted models.

CONCLUSIONS

The results support the hypothesis that maternal metabolic syndrome classification during pregnancy is associated with some child developmental outcomes at age 5. After adjusting for maternal, child, and environmental covariates, maternal metabolic syndrome classification during pregnancy was associated with children's LIT domain through direct effects of maternal metabolic health and indirect effects of cord blood markers (total effects), and COM and PSE domains via changes only in a child's cord blood markers (total indirect effects).

The impact of pre-adulthood urbanicity on hippocampal subfield volumes and neurocognitive abilities in young adults

BACKGROUND

Urbanicity refers to the conditions that are particular to urban areas and is a growing environmental challenge that may affect hippocampus and neurocognition. This study aimed to investigate the effects of the average pre-adulthood urbanicity on hippocampal subfield volumes and neurocognitive abilities as well as the sensitive age windows of the urbanicity effects.

PARTICIPANTS AND METHODS

We included 5,390 CHIMGEN participants (3,538 females; age: 23.69 ± 2.26 years, range: 18-30 years). Pre-adulthood urbanicity of each participant was defined as the average value of annual night-time light (NL) or built-up% from age 0-18, which were extracted from remote-sensing satellite data based on annual residential coordinates of the participants. The hippocampal subfield volumes were calculated based on structural MRI and eight neurocognitive measures were assessed. The linear regression was applied to investigate the associations of pre-adulthood NL with hippocampal subfield volumes and neurocognitive abilities, mediation models were used to find the underlying pathways among urbanicity, hippocampus and neurocognition, and distributed lag models were used to identify sensitive age windows of urbanicity effect.

RESULTS

Higher pre-adulthood NL was associated with greater volumes in the left (β = 0.100, 95%CI: [0.075, 0.125]) and right (0.078, [0.052, 0.103]) fimbria and left subiculum body (0.045, [0.020, 0.070]) and better neurocognitive abilities in information processing speed (-0.212, [-0.240, -0.183]), working memory (0.085, [0.057, 0.114]), episodic memory (0.107, [0.080, 0.135]), and immediate (0.094, [0.065, 0.123]) and delayed (0.087, [0.058, 0.116]) visuospatial recall, and hippocampal subfield volumes and visuospatial memory showed bilateral mediations for the urbanicity effects. Urbanicity effects were greatest on the fimbria in preschool and adolescence, on visuospatial memory and information processing from childhood to adolescence and on working memory after 14 years.

CONCLUSION

These findings improve our understanding of the impact of urbanicity on hippocampus and neurocognitive abilities and will benefit for designing more targeted intervention for neurocognitive improvement.

The indirect influence of 'invisible' support on pulmonary function among adults with chronic obstructive pulmonary disease

Individuals living with chronic obstructive pulmonary disease (COPD) often require support from family or friends. We examined whether invisible support - support that is provided but goes unnoticed - is related to pulmonary function, and whether this association is mediated by depressive symptoms and illness perceptions. Sixty-six dyads of individuals with COPD and their informal caregivers reported on receipt and provision of support, respectively. Those with COPD completed measures of depressive symptoms, illness perceptions and pulmonary function. Although invisible support was not directly related to pulmonary function, mediation analyses revealed a combined indirect effect through lower depressive symptoms and less negative illness perceptions. Interventions teaching skillful delivery of support to caregivers may reduce depressive symptoms and threatening illness cognitions, which may contribute to improvements in symptom burden among patients with COPD.

Towards a successful implementation of environmental sanitation policy in Ghana: An assessment of key impeding factors

Environmental sanitation policy implementation is a vital factor that ensures that citizens are kept healthy and productive. The study sought to assess key factors impeding the implementation of environmental sanitation policy in Ghana. Using an explanatory design, a sample of 384 respondents was selected from the population of Accra through a simple random sampling technique. The questionnaire was the main instrument used to collect the data. The Partial Least Square-Structural Equation Modeling (PLS-SEM) technique was used to analyse the hypothesised path models. Based on the results, government approach, community representation, and lack of citizens' commitment were found to be statistically significant. The study also revealed that the government approach partially mediated the relationship between community representation and environmental sanitation policy implementation, and lack of citizens' commitment and environmental sanitation policy implementation. The study has contributed to knowledge in the research endeavour by demonstrating that the implementation of public policy can easily be realised when the government uses the right approach in involving its citizens in policy decision-making and enhance their commitment to policy implementation.

Maternal antenatal depression's effects on child developmental delays: Gestational age, postnatal depressive symptoms, and breastfeeding as mediators

BACKGROUND

Maternal antenatal depression experienced around conception or during pregnancy may adversely affect child development. This study explores three potential mechanisms of the effects of antenatal depression on children's developmental delays at 2-3 years: gestational age of the child, continued depressive symptoms postnatally, and interrupted breastfeeding practices.

METHODS

Mothers (N = 2888) of 3450 children, including 2303 singletons and 1147 multiples from the Upstate KIDS cohort provided data. Linked hospital discharge data was combined with mothers' reports to identify women with moderate to severe antenatal depression. Gestational age was extracted from birth certificates. Mothers completed a depression screener at 4 months postpartum, reported about their breastfeeding practices from 4 to 12 months postpartum, and completed a developmental delay screener when children were 24, 30, and 36 months.

RESULTS

In unadjusted path analysis models, mothers with antenatal depression had more postnatal depressive symptoms and breastfed fewer months, which translated into children being more likely to have developmental delays. Gestational age was not a mediator. Effects were similar across girls and boys and singletons and twins, and largely held when adjusting for covariates.

LIMITATIONS

Main limitations were the relatively advantaged sample and reliance on maternal report.

CONCLUSIONS

Maternal antenatal depression may impact child development through continued depressive symptoms in the postpartum period and through reduced breastfeeding duration suggesting additional targets for intervention.

The role of brain structure in the association between pubertal timing and depression risk in an early adolescent sample (the ABCD Study®): A registered report

BACKGROUND

Earlier pubertal timing is associated with higher rates of depressive disorders in adolescence. Neuroimaging studies report brain structural associations with both pubertal timing and depression. However, whether brain structure mediates the relationship between pubertal timing and depression remains unclear.

METHODS

The current registered report examined associations between pubertal timing (indexed via perceived pubertal development), brain structure (cortical and subcortical metrics, and white matter microstructure) and depressive symptoms in a large sample (N = ∼5000) of adolescents (aged 9-13 years) from the Adolescent Brain Cognitive Development (ABCD) Study. We used three waves of follow-up data when the youth were aged 10-11 years, 11-12 years, and 12-13 years, respectively. We used generalised linear-mixed models (H1) and structural equation modelling (H2 & H3) to test our hypotheses.

HYPOTHESES

We hypothesised that earlier pubertal timing at Year 1 would be associated with increased depressive symptoms at Year 3 (H1), and that this relationship would be mediated by global (H2a-b) and regional (H3a-g) brain structural measures at Year 2. Global measures included reduced cortical volume, thickness, surface area and sulcal depth. Regional measures included reduced cortical thickness and volume in temporal and fronto-parietal areas, increased cortical volume in the ventral diencephalon, increased sulcal depth in the pars orbitalis, and reduced fractional anisotropy in the cortico-striatal tract and corpus callosum. These regions of interest were informed by our pilot analyses using baseline ABCD data when the youth were aged 9-10 years.

RESULTS

Earlier pubertal timing was associated with increased depressive symptoms two years later. The magnitude of effect was stronger in female youth and the association remained significant when controlling for parental depression, family income, and BMI in females but not in male youth. Our hypothesised brain structural measures did not however mediate the association between earlier pubertal timing and later depressive symptoms.

CONCLUSION

The present results demonstrate that youth, particularly females, who begin puberty ahead of their peers are at an increased risk for adolescent-onset depression. Future work should explore additional biological and socio-environmental factors that may affect this association so that we can identify targets for intervention to help these at-risk youth.

Training parameters and longitudinal adaptations that most strongly mediate walking capacity gains from high-intensity interval training post-stroke

Background

Locomotor high-intensity interval training (HIIT) has been shown to improve walking capacity more than moderate-intensity aerobic training (MAT) after stroke, but it is unclear which training parameter(s) should be prioritized (e.g. speed, heart rate, blood lactate, step count) and to what extent walking capacity gains are the result of neuromotor versus cardiorespiratory adaptations.

Objective

Assess which training parameters and longitudinal adaptations most strongly mediate 6-minute walk distance (6MWD) gains from post-stroke HIIT.

Methods

The HIT-Stroke Trial randomized 55 persons with chronic stroke and persistent walking limitations to HIIT or MAT and collected detailed training data. Blinded outcomes included 6MWD, plus measures of neuromotor gait function (e.g. fastest 10-meter gait speed) and aerobic capacity (e.g. ventilatory threshold). This ancillary analysis used structural equation models to compare mediating effects of different training parameters and longitudinal adaptations on 6MWD.

Results

Net gains in 6MWD from HIIT versus MAT were primarily mediated by faster training speeds and longitudinal adaptations in neuromotor gait function. Training step count was also positively associated with 6MWD gains, but was lower with HIIT versus MAT, which decreased the net 6MWD gain. HIIT generated higher training heart rate and lactate than MAT, but aerobic capacity gains were similar between groups, and 6MWD changes were not associated with training heart rate, training lactate, or aerobic adaptations.

Conclusions

To increase walking capacity with post-stroke HIIT, training speed and step count appear to be the most important parameters to prioritize.

Mediation analysis of circadian preferences and other behavioral and sociodemographic factors associated with subjective well-being in undergraduate students

Undergraduate students are usually subjected to a routine with constant pressure, stress, circadian misalignment, and sleep irregularity that impairs their subjective well-being. Recent evidence suggests that circadian preference is also a risk factor for impaired mental health and factors related to subjective well-being. This study aimed to identify the sociodemographic factors associated with subjective well-being and describe the mediating behavioral variables. Between September 2018 and March 2021, 615 Brazilian students enrolled in higher educational institutions completed an electronic form containing questionnaires on subjective well-being, sociodemographic, and behavioral-related factors (convenience sample). A statistical mediation model was applied to describe how these variables influence subjective well-being. We observed that Morningness (p < .001), identification with the male gender (p = .010), not working while studying (p = .048), and the practice of Pilates/yoga (p = .028) were associated with greater subjective well-being. Except for employment status, no direct effects were observed, which reinforces the need to consider a multidimensional approach. The relationship between subjective well-being and sociodemographic factors exists only in the presence of behavioral mediators, specifically perceived stress, daytime sleepiness, symptoms of depression, sleep quality, and positive and negative affects. Future work should investigate in more detail the impact of sleep, stress, and circadian preferences on this relationship.

Examining the Contributions of Parents' Daily Hassles and Parenting Approaches to Children's Behavior Problems during the COVID-19 Pandemic

The present study was designed to examine the direct and indirect contributions of parenting daily hassles and approaches to children's externalizing and internalizing behavior problems during the COVID-19 pandemic. The sample for this study was 338 preschool children (53.6% girls, M_age = 56.33 months, SD = 15.14) and their parents in Turkey. Parents reported their daily hassles, parenting approaches, and children's behavior problems. Findings from the structural equation model showed that higher levels of parenting daily hassles predicted higher levels of externalizing and internalizing behavior problems. In addition, we found an indirect effect of daily hassles on children's internalizing behaviors via positive parenting. Further, there was an indirect path from parenting daily hassles to children's externalizing behaviors through the negative parenting approach. Results are discussed in the context of the COVID-19 pandemic.

The Association Between Prenatal Maternal Stress and Adolescent Affective Outcomes is Mediated by Childhood Maltreatment and Adolescent Behavioral Inhibition System Sensitivity

Prenatal maternal stress is linked to offspring outcomes; however, there is little research on adolescents, behavioral, transdiagnostic outcomes, or the mechanisms through which relations operate. We examined, in N = 268 adolescents (Mage = 15.31 years; SD = 1.063; 57.8% boys) whether prenatal maternal stress is associated with adolescent affective outcomes; whether this association is mediated, serially, by childhood home atmosphere and adolescent behavioral inhibition system (BIS) sensitivity; and whether mediational effects are moderated by adolescent attention-deficit/hyperactivity disorder or maternal internalizing symptomology. Prenatal maternal daily stress and major life events were associated with adolescent outcomes through childhood negative atmosphere/neglect and BIS sensitivity, with no evidence of moderation. Results have implications regarding the effect of prenatal maternal stress on offspring outcomes and regarding corresponding sensitive periods.

Childhood adversity and educational attainment: Evidence from Zambia on the role of personality

Introduction

We examine whether personality traits mediate the association between childhood adversity and educational attainment using longitudinal data from a cohort in Zambia.

Methods

We fit a structural equation model using data on three forms of childhood adversity-household poverty, stunting as a measure of chronic malnutrition, and death of a parent-and data on the "Big Five" personality traits and educational attainment assessed at 15 years of age.

Results

We find that childhood poverty and death of a parent are associated with lower openness to experience. Furthermore, openness to experience mediates 93% of the negative association between death of a parent and school enrollment and 19% of the negative association between childhood poverty and enrollment.

Discussion

Our findings reinforce a diverse and growing body of evidence linking childhood adversity to educational attainment while also placing it in a new light. Future work should continue to examine the biological and psychosocial pathways that determine openness to experience and other personality traits, as well as their role in shaping important life outcomes.

Rapid Interactions of Widespread Brain Networks Characterize Semantic Cognition

Language comprehension requires the rapid retrieval and integration of contextually appropriate concepts ("semantic cognition"). Current neurobiological models of semantic cognition are limited by the spatial and temporal restrictions of single-modality neuroimaging and lesion approaches. This is a major impediment given the rapid sequence of processing steps that have to be coordinated to accurately comprehend language. Through the use of fused functional magnetic resonance imaging and electroencephalography analysis in humans (n = 26 adults; 15 females), we elucidate a temporally and spatially specific neurobiological model for real-time semantic cognition. We find that semantic cognition in the context of language comprehension is supported by trade-offs between widespread neural networks over the course of milliseconds. Incorporation of spatial and temporal characteristics, as well as behavioral measures, provide convergent evidence for the following progression: a hippocampal/anterior temporal phonological semantic retrieval network (peaking at ∼300 ms after the sentence final word); a frontotemporal thematic semantic network (∼400 ms); a hippocampal memory update network (∼500 ms); an inferior frontal semantic syntactic reappraisal network (∼600 ms); and nodes of the default mode network associated with conceptual coherence (∼750 ms). Additionally, in typical adults, mediatory relationships among these networks are significantly predictive of language comprehension ability. These findings provide a conceptual and methodological framework for the examination of speech and language disorders, with additional implications for the characterization of cognitive processes and clinical populations in other cognitive domains.SIGNIFICANCE STATEMENT The present study identifies a real-time neurobiological model of the meaning processes required during language comprehension (i.e., "semantic cognition"). Using a novel application of fused magnetic resonance imaging and electroencephalography in humans, we found that semantic cognition during language comprehension is supported by a rapid progression of widespread neural networks related to meaning, meaning integration, memory, reappraisal, and conceptual cohesion. Relationships among these systems were predictive of individuals' language comprehension efficiency. Our findings are the first to use fused neuroimaging analysis to elucidate language processes. In so doing, this study provides a new conceptual and methodological framework in which to characterize language processes and guide the treatment of speech and language deficits/disorders.

Intimate Partner Violence, Legal Systems and Barriers for African American Women

Although many African American IPV survivors need services, they often do not access care. Hopelessness may partially explain low rates in help-seeking for this population and serve as a significant barrier to care for African American IPV survivors particularly those who have had prior legal system involvement. In a sample of 185 African American women, we first examined whether hopelessness mediated the relation between IPV and barriers to services. If such a mediation effect was found, we then would explore whether legal system involvement moderated the mediated effect of hopelessness on the relation between IPV and barriers to services. As anticipated, hopelessness partially served to explain (i.e., mediated) the relation between IPV and barriers to services. Further, this mediated effect was moderated by legal system involvement such that when legal system involvement was included as a moderator, hopelessness mediated the association between IPV and barriers to services only for those survivors who had been involved with the legal system. These results underscore the critical role of hopelessness as a barrier to accessing services for African American IPV survivors, especially those with prior involvement with the legal system. Recommendations are offered that underscore the importance of interventions that empower African American women who have survived violence instead of penalizing them.

A history of collective resilience and collective victimhood: Two sides of the same coin that explain Black Americans' present-day responses to oppression

Collective victimhood and collective resilience are two sides of the same coin. However, most literature to date has focused on the experiences and consequences of collective victimhood. In the present research, we focused on the experiences of Black Americans, a group that has a legacy of victimization and resilience. As a part of Black Americans' collective memory, we explored the nature of historical collective resilience and examined its role in explaining collective responses to present-day oppression, over and above any effect of historical collective victimhood. When they were asked to reflect on their group's history, across Studies 1 (N = 272) and 2 (N = 294), we found that Black Americans generated narratives of collective resilience. In both studies, we also found evidence that perceived historical collective resilience was linked to a greater sense of collective continuity, which, in turn, explained greater support for the ongoing Black Lives Matter movement. Our findings underscore the importance of considering narratives of resilience in a group's history and point to the way such collective resilience narratives can serve as a resource for the group in the present.

Mediating Role of Emotional Intelligence in the Relationship between Anxiety Sensitivity and Academic Burnout in Adolescents

(1) Background: Increased stress and study overload during adolescence could be related to academic burnout. Anxiety sensitivity of students seems to affect burnout levels, while emotional intelligence enables emotion management under stressful conditions. The objective of this study is to analyze the roles of anxiety sensitivity and emotional intelligence in academic burnout. (2) Methods: In this quantitative cross-sectional study conducted in Spain, the sample comprised 1287 high school students aged 14 to 18 who filled out the Maslach Burnout Inventory-General Survey, the Spanish version adapted for high school students of the Anxiety Sensitivity Index-3, and Brief Emotional Intelligence Inventory. (3) Results: Anxiety sensitivity was significantly higher in cynicism and emotional exhaustion. Furthermore, the mediation analysis showed that high anxiety sensitivity directly affected student exhaustion, cynicism, and efficacy levels. These effects were mediated mainly through stress management but also through the effect of stress management on mood, both emotional intelligence factors. (4) Conclusions: The academic changes that occur during high school hinder engagement and performance. Promoting the development of emotional skills would enable young people to manage their emotions when they become overwhelming and diminish their lack of interest and exhaustion in the classroom.

Aggression and burnout in nurses during COVID-19: A cross-sectional study

Workplace violence against nurses, an ever-present problem in the healthcare workplace, has been increasing with COVID-19 and affects occupational health. This study analyzed the consequences of COVID-19 on violence against nurses, identifying its association with burnout, emphasizing the importance of work-related variables. A total of 1013 actively employed nurses in Spain with a mean age of 34.71 years filled out a computer-assisted web interviewing survey. Aggression as a consequence of their work was reported by 73.44% of the nurses. Those most affected were in primary care, and verbal aggression by patients and their families was the most frequent. Nurses who were attacked scored significantly higher in emotional exhaustion and depersonalization. Furthermore, 83.22% said that COVID-19 was an important factor in the increase in violence toward healthcare workers. Analysis showed that a perceived secure environment was a mediator between the belief that COVID-19 was an influential factor in the increase of violence and the depersonalization dimension of burnout. Increasing perceived security in the work environment among nurses can be effective in promoting well-being, work performance, and commitment to the profession.

Do you see my effort? An investigation of the relationship between e-government service quality and trust in government

Purpose

Electronic government (e-government) has been suggested as an important tool to improve public services and enhance citizens’ trust in government. Several studies have examined the relationship between e-government service quality, satisfaction and trust in government with conflicting results. This conflict reveals the need for additional examination of the process relating e-government service quality to trust in government. This study aims to introduce a theoretical approach that considers a crucial factor, which is perceived government effort. The model proposes that perceived e-government service quality first leads to satisfaction, which in turn increases perceived effort that finally translates into trust in government.

Design/methodology/approach

This study proposes and tests a conceptual model that examines the relationship between e-government service quality, satisfaction, perceived effort and trust in government. The model is tested using mediated regression analyses and Hayes’s PROCESS macro. Data were collected from an online survey of 723 individuals who interacted with e-government services in Kuwait.

Findings

The results supported the proposed theoretical model and particularly confirmed the mediating role of perceived effort in the link between e-government service quality and trust in government.

Research limitations/implications

The findings improve the understanding of the behavioral process linking satisfaction with citizen’s trust in the government.

Originality/value

The model introduces a crucial yet previously overlooked factor to the trust-building effect of e-government, which is perceived effort. This factor is particularly important in electronic services that inherently lack face-to-face interaction between citizens and government representatives.

Why people keep watching: neurophysiologic immersion during video consumption increases viewing time and influences behavior

Streaming services provide people with a seemingly infinite set of entertainment choices. This large set of options makes the decision to view alternative content or stop consuming content altogether compelling. Yet, nearly all experimental studies of the attributes of video content and their ability to influence behavior require that participants view stimuli in their entirety. The present study measured neurophysiologic responses while participants viewed videos with the option to stop viewing without penalty in order to identify signals that capture the neural value of content. A post-video behavioral choice was included to reduce the likelihood that measured neurophysiologic responses were noise rather than signal. We found that a measure derived from neurophysiologic Immersion predicted how long participants would watch a video. Further, the time spent watching a video increased the likelihood that it influenced behavior. The analysis indicates that the neurologic value one receives helps explain why people continue to watch videos and why they are influenced by them.

Downstaging and survival after Neoadjuvant chemotherapy for bladder cancer in Norway; a population-based study

BACKGROUND

Neoadjuvant chemotherapy (NAC) before radical cystectomy is associated with pathological downstaging (DS) and improved overall survival (OS) in patients with muscle-invasive bladder cancer (MIBC). Population-based studies have not unequivocally shown improved survival. The aim of this population-based study was to evaluate the effect of NAC on DS and OS in Norwegian patients with MIBC.

METHODS

Patients in the Cancer Registry of Norway undergoing radical cystectomy (2008-2015) with or without NAC diagnosed with MIBC between 2008 and 2012 were included. Follow-up data were available until 31 December 2019. Logistic regression estimated the odds of DS with NAC, and a Cox model investigated the effect of DS on OS. Cox models, a mediator analysis and an instrumental variable approach were used to investigate the effect of NAC on OS.

RESULTS

A total of 575 patients were included. NAC was administered to 82 (14%) patients. Compared to cystectomy only, NAC increased the proportion (43% vs. 22%) and the odds of DS (OR 2.51, CI 1.37-4.60, p = 0.003). Independent of NAC, the proportion of pN0 was higher in patients with DS (89% vs. 60%) and DS yielded a 78% mortality risk reduction (HR 0.22, CI 0.15-0.34, p = 1.9∙10-12), compared to patients without DS. We did not find an association between NAC and OS, neither by Cox regression (HR 1.16, CI 0.80-1.68, p = 0.417) nor by an instrumental variable approach (HR = 0.56, CI = 0.07-4.57, p = 0.586). The mediation analysis (p = 0.026) confirmed an indirect effect of NAC on OS through DS. Limitations include limited information of the primary tumour, details of NAC treatment and treatment indications.

CONCLUSIONS

NAC increases the probability of DS and is indirectly associated to OS. DS is related to the absence of regional lymph node metastases and is associated with an OS benefit. Improved staging and biomarkers are needed to identify patients most likely to achieve DS and to benefit from NAC.