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Globally, there has been little growth in vaccination coverage, with countries in the Horn of Africa having the lowest vaccination rates. This study investigated factors associated with vaccination status among children under five years old in Somaliland. The 2020 Somaliland Demographic and Health Survey surveyed women aged 15–49 years from randomly selected households. This multilevel analysis included 2673 primary caregivers of children under five. Only 34% of children were ever vaccinated. Childhood vaccination coverage was positively associated with high-budget regions, high healthcare facility density, and children older than 23 months. Vaccination coverage was greater for urban and rural residents than for nomadic people. Children whose mothers could read part of one sentence or one complete sentence were more likely to be vaccinated than illiterate mothers. Children whose mothers received antenatal care (ANC) once, two to three times, or four times or more were more likely to be vaccinated than those whose mothers received no ANC. Childhood vaccination coverage in Somaliland is low. Promoting maternal ANC visits and increasing women’s literacy may enhance vaccination coverage. Funds should be allocated to areas with low resources, particularly for nomadic people, to boost vaccination uptake.

ObjectivesOlder adults often experience functional limitations that affect their everyday lives, but many of them continue to make positive contributions to society and benefit from these contributions themselves. We examine (a) whether older adults' functional limitations are associated with diurnal cortisol patterns and (b) whether these associations vary on volunteering days versus nonvolunteering days.MethodsParticipants were adults aged older than 60 years (N = 435) from the National Study of Daily Experiences, part of the Midlife in the United States Study. They completed an initial interview on functional limitations and background characteristics, indicated volunteering activities in daily interviews, and also provided salivary samples across 4 days.ResultsMultilevel models showed that older adults with greater functional limitations exhibited dysregulated cortisol awakening responses and diurnal cortisol slopes throughout the rest of the day, compared to older adults with lower limitations. Yet, we also observed a significant moderating effect of volunteering on these associations.DiscussionThis study advances our understanding of functional limitations and cortisol stress responses, revealing the benefits of volunteering to older adults who experience these limitations. Rather than treating these older adults solely as care recipients, interventions should offer them opportunities to help others.

With decades of advance research and recent developments in the drug and medical device regulatory approval process, patient-reported outcomes (PROs) are becoming increasingly important in clinical trials. While clinical trial analyses typically treat scores from PROs as observed variables, the potential to use latent variable models when analyzing patient responses in clinical trial data presents novel opportunities for both psychometrics and regulatory science. An accessible overview of analyses commonly used to analyze longitudinal trial data and statistical models familiar in both psychometrics and biometrics, such as growth models, multilevel models, and latent variable models, is provided to call attention to connections and common themes among these models that have found use across many research areas. Additionally, examples using empirical data from a randomized clinical trial provide concrete demonstrations of the implementation of these models. The increasing availability of high-quality, psychometrically rigorous assessment instruments in clinical trials, of which the Patient-Reported Outcomes Measurement Information System (PROMIS®) is a prominent example, provides rare possibilities for psychometrics to help improve the statistical tools used in regulatory science.

Abstract Background Drinking water quality has been a major public health concern in lower and middle income countries where access to improved water supplies is limited. Ethiopia is thought to have one of the worst drinking water infrastructures in the world. This study aimed to assess the spatial variation and determinants of using unimproved sources of drinking water in Ethiopia using recent nationally representative data. Methods A population-based cross-sectional study was employed with the recent EDHS data of 2019. A total of 8663 households were sampled using a stratified two-stage cluster sampling method. Kuldorff’s SaTScan version 9.6 software was used to generate spatial scan statistics. ArcGIS version 10.7 software was used to visualize the spatial patterns of unimproved drinking water sources. A multilevel multivariable mixed-effect logistic regression was used to identify factors associated with the use of an unimproved drinking water source. In the multivariable multilevel analysis, those variables with a p-value

Abstract Background Unintended pregnancy is one of the most common reproductive health problems. The problem makes women with disabilities doubly burdened by their disabilities. The previous evidences are inconsistent and do not address all women with disabilities. The study aimed to assess the prevalence of unintended pregnancy and its associated risk factors among women with disabilities in Dale and Wonsho districts and Yirgalem city administration central Sidama National Regional State, Ethiopia. Methods A community-based cross-sectional study design was conducted among 355 randomly selected women with disabilities living in the selected districts from June 20 to July 15, 2022. The data were collected through face-to-face interviews using a structured questionnaire. A multilevel logistic regression analysis model was employed to identify factors associated with an unintended pregnancy. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the measures of associations. Results In this study, the prevalence of unintended pregnancy among women with disabilities was 65.6% (95% CI: 60.4, 70.6). After adjusting for potential confounding variables, middle economic status (AOR = 2.07; 95% CI: 1.02, 4.20), giving birth (AOR = 2.20; 95% CI: 1.21, 3.99), extremity paralysis types of disability (AOR = 0.26; 95% CI: 0.12, 0.57), living in urban residences (AOR = 0.22; 95% CI: 0.12, 0.40) and alcohol using (AOR = 0.28; 95% CI: 0.11, 0.74) were risk factors with unintended pregnancy. Conclusions Unintended pregnancy among women with disabilities is remarkably high in central Sidama National Regional State, Ethiopia. Economic status, giving birth, types of disability, residence, and alcohol use were factors associated with an unintended pregnancy. As a result, economic empowerment, strengthening education and information about unintended pregnancy and its prevention strategies in rural settings are vital.

Abstract Background Ideal number of children (INC) is the number of children that a woman or man would have if they could go back to the time when they did not have any children and could choose accurately the number of children to have in their total life. Despite numerous studies on the prevalence and associated factors of the ideal number of children, there is a lack of studies that incorporated spatial and multilevel analysis. Thus, this study was aimed at the spatial and multilevel analysis of an ideal number of children and associated factors. Methods The study design was a cross-sectional study in which the data was obtained from Ethiopian Demographic and Health Survey (EDHS) in 2016. About 13,961 women ages 15–49 who fulfill the inclusion criterion were considered. A negative binomial regression model that incorporates spatial and multilevel analysis was employed. Results About 33 and 12.8% of the women had four and six ideal numbers of children respectively. The highest INC per woman was recorded in Oromia region 5055 (36.1%) and the lowest in Harare 35(0.2%). The INC per woman is high in rural 10,726 (76.6%) areas as compared to urban areas 3277(23.4%). The ideal number of children was spatially clustered (Global Moran’s I = 0.1439, p

Abstract Background Sexual violence is one of the most common problems in reproductive health that causes different traumatic events that lead to mental, social, and physical problems. Females with disabilities are subjected to more traumatic events and consequences. In Ethiopia, there are limited evidences about the prevalence and associated factors of sexual violence among reproductive-aged females with disabilities. Therefore, this study aimed to assess the prevalence and associated factors of sexual violence among females with disabilities in reproductive-age in central Sidama National Regional State, Ethiopia. Methods A multistage sampling technique was used to select 645 reproductive-age females with disabilities. Initially, three districts were purposefully selected, from which 30 kebeles and study participants were selected randomly from June 20 to July 15, 2022. A face-to-face interviewing technique was used to collect the data. The data were analyzed using a multilevel logistic regression analysis model. The measures of associations were reported using the adjusted odds ratio (AOR) and its 95% confidence interval (CI). Results The prevalence of sexual violence among reproductive-age females with disabilities was 59.8% (95% CI: 56, 63.56). Residing in an urban setting (AOR = 0.51; 95% CI: 0.29, 0.88), being an adult (25 to 34 years old) (AOR = 5.9; CI: 3.01, 11.6), being an adult (35 to 49 years old) (AOR = 3.47; CI: 1.48, 8.14), having no sexuality information (AOR = 11.3; CI: 6.24, 20.5), and having hearing disabilities (AOR = 3.19; CI: 1.49, 6.83) were factors associated with sexual violence. Conclusions Sexual violence among reproductive-age females with disabilities is noticeably high. Place of residence, sexual orientation, age, and disability type were all factors associated with sexual violence. Therefore, providing sexuality education, giving high attention (information and education about sexuality) to rural residents, and considering females with hearing disabilities are important to minimize sexual violence among reproductive-age females with disabilities.

Abstract Background Overweight among adolescents remains a serious concern worldwide and can have major health consequences in later life, such as cardiovascular diseases and cancer. Still, 33% of secondary school adolescents in the Netherlands consume sugar-sweetened beverages daily and over 26% do not consume water every day. The Dutch Healthy School program was developed to support schools in stimulating healthier lifestyles by focusing on health education, school environments, identifying students’ health problems, and school policy. We examined the variation between secondary schools regarding the daily consumption of water and sugar-sweetened beverages and whether this variation can be explained by differences between schools regarding Healthy School certification, general school characteristics, and the school population. Methods We performed a cross-sectional multilevel study. We used data from the national Youth Health Monitor of 2019 on secondary schools (grades 8 and 10, age range about 12 to 18 years) of seven Public Health Services and combined these with information regarding Healthy School certification and general school- and school population characteristics. Our outcomes were daily consumption of water and sugar-sweetened beverages. In total, data from 51,901 adolescents from 191 schools were analysed. We calculated the intraclass correlation to examine the variation between schools regarding our outcomes. Thereafter, we examined whether we could explain this variation by the included characteristics. Results The school-level explained 4.53% of the variation in the consumption of water and 2.33% of the variation in the consumption of sugar-sweetened beverages. This small variation in water and sugar-sweetened consumption could not be explained by Healthy School certification, yet some general school- and school population characteristics did: the proportion of the school population with at least one parent with high educational attainment, the educational track of the adolescents, urbanicity (only for water consumption) and school type (only for sugar-sweetened beverages consumption). Conclusions The low percentages of explained variation indicate that school-level characteristics in general (including Healthy School certification) do not matter substantially for the daily consumption of water and sugar-sweetened beverages. Future research should examine whether school health promotion can contribute to healthier lifestyles, and if so, under which level of implementation and school conditions.

Abstract Background Long-acting reversible contraceptives (LARCs), including hormonal implants and intrauterine devices, are highly effective pregnancy prevention methods. Aside its advantages over other hormonal methods, LARCs are cost-effective, easy to maintain, and have a low risk of non-compliance-related method failure. Besides, LARCs are also relatively safe for all sexually active women in the postpartum or post-abortion period. However, despite its effectiveness, most sexually active women use other short-term methods, such as condoms and contraceptive pills, which are associated with high discontinuation rates. Thus, this study examines the spatial distribution and multilevel factors associated with LARC use among sexually active reproductive-age women in Nigeria. Methods This is a cross-sectional analysis of a population-based study from the 2018 Nigeria Demographic Health Survey (NDHS). The NDHS is a nationally representative survey that collects data on socio-demographic characteristics, sexual and reproductive health-related indicators such as contraceptive use and child & maternal health. A sample of 3,978 sexually active reproductive-age women (15–49 years) in Nigeria was used in the analysis. Frequency distribution and spatial analysis of LARC use were displayed with tables and maps, respectively, while multilevel analysis at a 95% confidence interval (CI) and a p-value of less than 0.05 was used to determine factors associated with LARC use among the sample. Results The spatial distribution of LARC use among sexually active women of reproductive age in Nigeria ranges between 20 and 34.8%. Fifteen of the 36 states (excluding the Federal Capital Territory, FCT) recorded low utilization of LARCs. These states include Adamawa, Lagos, Ogun, Enugu, Anambra, Imo, Abia, Rivers, Kogi, Taraba, Yobe, Gombe, Jigawa, Borno, and Kebbi. Besides, the likelihood of LARC use was lower among participants with a prior history of pregnancy termination [aOR = 0.62; 95%(CI = 0.48–0.80)] compared to their counterparts without pregnancy termination history. Also, participants with no fertility intention had a higher likelihood of using LARCs [aOR = 1.65; 95%(CI = 1.30–2.08)] compared to those with fertility intention. At the community level, women with higher socioeconomic status were less likely to use LARCs [aOR = 0.66; 95%(CI = 0.45–0.97)] compared to women with lower socioeconomic status. Conclusions This study showed a relatively low utilisation of LARC among sexually active reproductive-age women in Nigeria. Notably, this low utilisation is also common in states that could be described as cosmopolitan, indicating a need for closer investigation to understand context-specific factors associated with LARC use. Population-specific family planning education and counselling for this population are important to address common misconceptions about LARCs in particular and modern contraceptive use in general.

This study examined the factors that determined the science achievement of fourth-grade students on the Trends in International Mathematics and Science Study (TIMSS) 2019 in the USA. The data were retrieved from the TIMSS international database and imported to the R program for manipulation. The EdSurvey package was used to conduct multilevel analysis, taking plausible values of outcome variables, and weighting into account. Level 1 predictors included gender, sense of school belonging, no student bullying, instructional clarity, and attitude toward science. Level 2 predictors included instruction being affected by science resource shortages, school emphasis on academic success, a lack of school discipline problems, and students’ preexisting with literacy and numeracy skills. The findings include that the variance between schools equals 33% and boys outperformed girls in science. Students’ attitudes toward science, their confidence, and the school’s emphasis on academic success were the two strongest positive predictors of both individual student’s achievement and the school’s mean science achievement. The other predictive variables were found to have only trivially positive or no effect. The utilized models could explain the variance within and between schools by 6% and 39%, respectively. The implications for policymakers and educational practitioners include boosting up confidence in learning science and by actively engaging students in inquiry-based activities and providing instant and constructive feedback, encouraging, and treating all students regardless of gender identity equally in teaching and learning science and schools should emphasize academic success.

Abstract Background A high fertility rate can have a number of expensive consequences for developing nations, such as limiting economic growth, adversely impacting women and their children’s health, and reducing access to quality education, nutrition, and employment. The problem is more obvious in Ethipia’s high fertility regions. Therefore, this study aimed to assess predictors of desire to limit childbearing among reproductive age women in high fertility regions in Ethiopia. Methods The analysis was based on secondary data using the 2016 Ethiopian Demographic and Health Survey. Stata version 14 software was used for analysis. A multi-level mixed-effect logistic regression analysis was fitted. Adjusted Odds Ratio at 95% confidence interval was used to show the strength and direction of the association. Statistical significance was declared at a P- value less than 0.05. Results The overall desire to limit childbearing in high fertility regions in Ethiopia was 37.7% (95% CI: 36.28, 39.17). Age; 25–34 (AOR = 3.74; 95% CI: 2.97, 4.73), 35–49 years (AOR = 14; 95% CI: 10.85, 18.06), women education; Primary education (AOR = 0.73; 95% CI: 0.61, 0.88), secondary and higher (AOR = 0.29; 95% CI: 0.19, 0.43), from the community level variables Oromia National Regional state (AOR = 5.86; 95% CI: 2.82, 12.23), high proportion of community level poverity (AOR = 0.67; 95% CI: 0.45, 0.98), and high proportion of community level media exposure (AOR = 1.53; 95% CI: 1.07, 2.19) were statistically significant factors for desire to limit childbearing in high fertility regions of Ethiopia. Conclusion Nearly four in ten women had the desire to limit childbearing in high fertility regions in Ethiopia. Thus, to fulfill the women’s desire to limit childbearing, Ministry of Health and health facilities are needed to increase financial support strategies and Family planning programs that enable pregnant women from poor households to use health services. In addition, increasing community level media exposure are important interventions.

Abstract Background Violence against women and girls is a major public health issue, a violation of human rights, and is linked to a number of harmful effects on one’s physical, mental, sexual, and reproductive health. Studies conducted in other parts of sub-Saharan Africa (SSA) suggest that there is an association between contextual factors and experience of intimate partner violence. However, in Zambia, this association is not well documented. Thus, this study was conducted to examine how individual and community-level characteristics influence spousal violence against women in Zambia. Methods Data from the most recent Zambia Demographic and Health Survey conducted in 2018 was used. A sample of 7,358 ever-married women aged 15–49 years was used in the analysis. Two level multilevel binary logistic regression models were employed to examine the association between individual and contextual-level factors and experience of spousal violence. Results The prevalence of spousal physical violence against women in Zambia was 21.1% [95% CI, 19.8, 22.5]. Women aged 15–19 [aOR = 2.36, 95% CI = 1.34–4.14] and 20–24 [aOR = 2.11, 95% CI = 1.38–3.22], who did not own mobile phone [aOR = 1.36, 95% CI = 1.10–1.69], and had low decision making autonomy [aOR = 1.24, 95% CI = 1.01–1.54] were more likely experience spousal physical violence. Furthermore, communities which had a low proportion of women with decision making power [aOR = 1.66, 95% CI = 1.26–2.19] were more likely experience spousal physical violence. Additionally, women whose partners’ drank alcohol [aOR = 2.81, 95% CI = 2.30–3.45] and those whose partners exhibited jealous behaviour [aOR = 2.38, 95% CI = 1.88–3.21] were more likely to experience spousal physical violence. Conclusion Both individual and community-level factors influenced spousal physical violence in Zambia. Integrating community level factors when designing interventions to address gender-based would be key to reduce women’s vulnerability to gender based violence in the country. There is need to re-evaluate and re-strategize current strategies being implemented to address gender based violence in the country to make them context specific.

Belief systems are core organizing factors of social attitudes and behaviors, and their study has highlighted the role of conservatism as a contributing mechanism in mitigating concerns associated with change avoidance, as well as the reduction of uncertainty and ambiguity in life. Moreover, these aspects seem to be consistently used as powerful tools in the political and social discourse of the far-right. Life and death ethics are an example of issues that deal with the need for stability and control over personal and social life that people endorsing conservative values seek to attain. There is a rich line of studies on the individual and social explanatory factors of political conservatism, but less attention has been dedicated to moral conservatism as an autonomous and meaningful concept. The current research follows a multilevel approach to disentangle the individual and contextual correlates of conservative attitudes toward life and death. Thus, besides looking at the influence of individual choices related to religion and political orientation, this study also seeks to analyse the impact of the context, introducing in the model variables measuring economic performance, social and gender inequality, religious diversity and the prevalence of materialism and post-materialism values. Multilevel models using data from the 34 countries that participated in the last wave of the European Values Study (2017–2020), revealed an association between far-right orientation and conservative attitudes toward life and death, and that this relationship is moderated by materialism/post-materialism values, economic performance, and social inequality. Our findings reinforce the role of democracy as an environment where freedom of choice and thought are indisputable rights, cherished by most of the populations, regardless of their political position or their stance on moral issues.

BackgroundSub-Saharan Africa is the most anemia-prone region, with several of the sub-region’s countries having a substantial prevalence of the anemia among women of reproductive age. Nonetheless, no adequate study has been conducted to illustrate severity levels and associated factors of anemia among women of reproductive age. Therefore, this study presents the most recent estimates on the prevalence and severity levels of anemia and its associated factors among women of reproductive age in 21 Sub-Saharan Africa countries.MethodsThis study used the most recent Demographic Health Survey (DHS) datasets, which were collected in 21 sub-Saharan African countries between 2015 and 2022. A total of 171,348 women of reproductive age were included in the analysis. Multilevel (three-level) ordinal logistic regression was done to identify factors associated with severity levels of anemia.ResultsThe pooled prevalence of anemia was 41.74%. The pooled prevalence of mild, moderate and severe anemia was 23.45, 17.05 and 1.24, respectively. Women who were living at distance to a health facility (AOR = 1.07), women living in the poorest households (AOR = 1.49), women living in the households with unimproved toilet (AOR = 1.12) and in households that were using solid cooking fuel (AOR = 1.10), pregnant women (AOR = 1.72) and those who have given birth to more than one children within 3 years (AOR = 1.43) had greater odds of higher levels of anemia as compared to their counterparts. Women who were in the age groups of 20–24 (AOR = 0.81), 25–29 (AOR = 0.78), 30–34 (AOR = 0.79), 35–39 (AOR = 0.88), and 45–49 (AOR = 0.89), women who have attended primary school (AOR = 0.50), secondary (AOR = 0.57) and higher education (AOR = 0.76) and who were living in rural area (AOR = 1.07) had lower odds of higher levels of anemia as compared to their counterparts.ConclusionConsidering individual, household and community contexts is necessary while formulating and implementing anemia prevention and control policies. Adolescent women, and women who did not attend education and at a distance to a health facility should get especial attention while implementing anemia prevention and control programs.

The study aims to explore the effect of the type of higher education institution on students’ engagement. The meta-analyses of multilevel regression coefficients revealed significant relationships between the type of higher education institution and student engagement indicators across the years from 2013 to 2019. Comparing different types of higher education institutions with the base category, our findings revealed significant differences in effective teaching practices, discussion with diverse others, and student-faculty interaction consistent throughout the years. These findings are expected to provide insights for institutional administrators, policymakers, and researchers given that student engagement in higher education has become an indicator of quality all around the world.

BackgroundExisting studies in the Sub-Saharan African (SSA) region have focused mainly on the frequency of postnatal visits, with little emphasis on the adequacy of care provided during visits. Hence, this study aimed to investigate the magnitude of receiving an adequate number of World Health Organization-recommended contents of care during the immediate postpartum visit, and its predictors in SSA countries.MethodsThe appended women file of the most recent (2016–2021) standardized Demographic and Health Survey report of eighteen Sub-Saharan African countries with a weighted sample of 56,673 women was used for the study. The influence of each predictor on the uptake of adequate postnatal care has been examined using multilevel mixed-effects logistic regression. Significant predictors were reported using the adjusted odds ratio (aOR) with their respective 95% confidence intervals (95% CI).ResultsThe pooled prevalence of adequate postnatal care service uptake was found to be 42.94% (95% CI: 34.14, 49.13). Living in the southern sub-region (aOR = 3.08 95% CI: 2.50, 3.80), institutional delivery (aOR = 3.15; 95% CI: 2.90, 3.43), early initiation of ANC (aOR = 1.74; 95% CI: 1.45, 2.09), quality of antenatal care (aOR = 1.59; 95% CI: 1.42, 1.78), Caesarean delivery (aOR = 1.59; 95% CI: 1.42, 1.78), autonomy in decision-making (aOR = 1.30; 95% CI: 1.11, 1.39), high acceptance toward wife beating attitude (aOR = 0.83; 95% CI: 0.73, 0.94), and reading newspapers (aOR = 1.37; 95% CI: 1.21, 1.56) were identified as predictors of receiving adequate postnatal services during the immediate postpartum period.ConclusionThe findings revealed low coverage of adequate postnatal care service uptake in the region. The Federal Ministry of Health and healthcare managers in each country should coordinate their efforts to develop interventions that promote women’s empowerment to enhance their autonomy in decision-making and to reduce attitudes towards wife beating. Healthcare providers ought to strive to provide skilled delivery services and early initiation of antenatal care.

Background: Nursing shortage is a global and priority issue. Affective commitment has been identified as a key to retention in the workplace. Exploring the way to promote the nurse's affective commitment is necessary to maintain the nursing workforce and care quality. The staff nurse's organizational justice (procedural and interactional justice) and the manager's condition of mental health have the potential to be related to the staff nurse's affective commitment. Objective: To explore the impact on the nurse's affective commitment from procedural and interactional justices at individual and unit levels and the manager's mental health. Design: A multi-site longitudinal design. Setting(s): Nine Japanese hospitals with more than 200 beds and located in an area with more than 150,000 people. Participants: 385 staff nurses and their 42 nurse managers who completed both surveys in 2016 and 2017. Methods: We analyzed the data from a two-year national survey of the Work Environment for hospital Nurses in Japan part II. Nurse staff and their managers completed the surveys. This multilevel analysis performed four random intercept models on affective commitment and entered the variables of procedural and interactional justices and manager mental health into the models. Results: The staff nurse's affective commitment was positively associated with procedural justice climate (unit level), interactional justice climate (unit-level), and the perception of interactional justice (individual justice). The manager's mental health (psychological distress) had a negative relationship with affective commitment. Conclusions: The climates of procedural and interactional justice, the individual perception of interactional justice, and the manager's mental health impacted the nurses’ affective commitment as a predictor of retention. Moreover, the perception of interactional justice and the organizational contexts (organizational justice climates and managers’ psychological distress) were mediated by affective commitment. Thus, support to maintain the manager's mental health is required to promote staff's affective commitment related to retention. Registration: None. Tweetable abstract: Nurse staff's affective commitment was stimulated by interactional justice, two types of organizational justice climate, and the manager's mental health.

This article aims to provide knowledge on the effects of the social composition of schools and the mediating effect of emotional engagement on school absenteeism, from a comparative perspective and using a multilevel methodology. The comparative dimension of the analyses allows us to study whether there is a school effect on absenteeism and whether this differs according to organisational structures. For this purpose, three cities with three different models were considered. Data from the International Study of City Youth (ISCY) were used. Data were collected in three cities Barcelona (Spain), Ghent (Belgium) and Bergen (Norway), with a total sample of N = 6557 pupils in 82 schools. The results show, first, that absenteeism varies between cities and schools according to the model of school organisation. They also revealed the importance of instrumental and expressive student identification as prevention of absenteeism at the individual level. Finally, results reported that a high emotional engagement of pupils can contribute to reducing the effect of the social composition of the school on absenteeism. [ABSTRACT FROM AUTHOR]

Perceiving a calling toward one's career can provide kindergarten teachers sufficient internal motivation to resist massive job burnout and obtain high-level performance and well-being. Given the important role of leadership on followers' career calling, the present study takes the multilevel approach to examine the cross-level impact of team-level transformational leadership (TFL) of principals on the individual-level career calling of kindergarten teachers. Moreover, according to the identity-capability-reward (ICR) model, the present study investigates the mediating effects of kindergarten teachers' organizational identification and leader-member exchange (LMX) from the social identity and social exchange perspectives to explain why TFL could positively predict kindergarten teachers' career calling. Data were collected from 486 teachers at 57 kindergartens in China. Applying the multilevel analysis, results showed that principals' TFL could positively predict kindergarten teachers' sense of career calling, in which teachers' organizational identification and exchange quality with principals played the full mediating effects. These findings extend previous studies and provide practical implications to enhance kindergarten teachers' career calling. Plain Language Summary: The multilevel effect of transformational leadership on kindergarten teachers' career calling Purpose: The present study takes the multilevel approach to examine the cross-level impact of team-level transformational leadership (TFL) of principals on the individual-level career calling of kindergarten teachers. Moreover, according to the identity-capability-reward (ICR) model, the present study investigates the mediating effects of kindergarten teachers' organizational identification and leader-member exchange (LMX) from the social identity and social exchange perspectives to explain why TFL could positively predict kindergarten teachers' career calling. Method: The present study collected data from 486 teachers at 57 kindergartens in China and applied the multilevel analysis. Conclusions: Principals' TFL could positively predict kindergarten teachers' sense of career calling, in which teachers' organizational identification and exchange quality with principals played the full mediating effects. Implications: These findings extend previous studies and advise that principals' leadership, their exchange quality with teachers, and teachers' organizational identification should be paid attention to while considering teachers' career calling in kindergarten. [ABSTRACT FROM AUTHOR]

The Directive on Adequate Minimum Wages represents a watershed initiative adding substance to the EU's social dimension. It contains two ambitious objectives: establishing the minimum level of statutory minimum wages at 60% of the gross median wage, and increasing collective bargaining coverage (CBC) to at least 80% of workers. In this article, we assess how statutory minimum wages and collective bargaining coverage are associated with the likelihood of low pay. Using a time series cross-section of EU-SILC for income years 2004–2019, we identify and assess the absolute and relative size of 'effective wage floors' for full-time employees in 30 countries. We specify multilevel, random effects within-between regression models to assess the individual and joint associations of SMW and collective bargaining coverage with wage floors. Our results indicate that SMWs and CBC both have distinct roles in establishing the effective wage floor. First, higher collective bargaining coverage is on average associated with a lower share of workers earning below 60% gross median wages. Second, higher SMWs are strongly associated with higher effective wage floors. Third, both collective bargaining coverage and union density are strongly associated with higher wage floors. [ABSTRACT FROM AUTHOR]

Multilevel methods allow researchers to investigate relationships that expand across levels (e.g., individuals, teams, and organizations). The popularity of these methods for studying organizational phenomena has increased in recent decades. Methodologists have examined how these methods work under different conditions, providing an empirical base for making sound decisions when using these methods. In this article, we provide recommendations, tools, resources, and a checklist that can be useful for scholars involved in conducting or assessing multilevel studies. The focus of our article is on two-level designs, in which Level-1 entities are neatly nested within Level-2 entities, and top-down effects are estimated. However, some of our recommendations are also applicable to more complex multilevel designs. [ABSTRACT FROM AUTHOR]

Drawing on a dataset following the careers of 214 early-career popular music acts in the Dutch live music industry over a period of eight years, this paper maps trends in the number of live shows early-career acts play and the fees they receive. In addition, it investigates factors that may explain success in live music. Descriptive statistics indicate that a small number of acts manage to perform a lot of shows and receive high fees. However, most acts are only able to play a few shows per year for a relatively low fee, indicating a winner-takes-all market mechanism. A multilevel analysis showed that critical recognition and popular recognition are positively related to the number of shows acts performed. Furthermore, label and booker representation and attending a pop academy has a positive effect on success in live music, adding insights to our conceptualization of the structural dynamics of live music industries. [ABSTRACT FROM AUTHOR]

Background: Poor infant and young child feeding (IYCF) practices are a significant issue both globally and in developing nations, and they have a significant role in undernutrition, healthy growth, and development, particularly in the first 2 years of life. Improving children's general health and wellbeing requires recognizing and decreasing preventable drivers of malnutrition. Hence, this study aimed to assess the prevalence and possible determinants of minimum dietary diversity among 6–23 months old babies in the Gambia. Methods: Data from the 2019–2020 Gambia demographic and health survey were used. The study included a total of 2100 weighted 6–23 months old children. To identify characteristics significantly linked with minimum dietary diversity among infants, a multilevel fixed-effect analysis approach was used. After adjusting other confounding variables, variables with a p value of 0.25 were incorporated into a multivariable multilevel regression analysis to determine associated variables. An adjusted odds ratio with a 95% confidence interval was then applied. Results: Only 22.22% (95% CI 18.55, 21.99) of infants had received the minimum dietary diversity. Mothers, who had mass media exposure (aOR = 2.71, CI = (1.02, 6.21), wealthier (aOR = 1.70, CI = 1.02, 2.85), child age of (aOR = 4.14, CI = 2.98, 5.76), and (aOR = 4.97, CI = 3.54, 6.98), have shown a positive statistical association with the outcome variable, respectively. Regarding regions mothers who came from Kanifing (aOR = 0.49, CI = 0.25, 0.94), Janjanbureh (aOR = 0.38, CI = 0.18, 0.82), and Basse (aOR = 0.51, CI = 0.26, 0.99) had showed less likelihood odds to provide the minimum dietary diversity (MDD) for their babies compared to Banjul local government area, respectively. Conclusion: The World Health Organization dietary evaluation tool suggests that the MDD value be extremely low, even though it might be slightly higher than the numbers for some nations. The country may need to take drastic measures to tackle child malnutrition. [ABSTRACT FROM AUTHOR]

The European Union (EU) faces challenges that affect its persistence, including the revival of national populism in many EU member states. Studies have shown that individuals with immigration histories identify less strongly with Europe than individuals without immigration histories. Therefore, fostering a strong identification with Europe is more relevant than ever. This paper will explore the possible historical roots of different levels of identification and examine if differing access to learning opportunities can explain the difference. Drawing on data from the German sample of the International Civic and Citizenship Study 2016, this paper aims to determine the relevance of individual variables and learning opportunities for the development of students' identification with Europe. Multilevel analyses at individual and classroom level were conducted introducing different independent variables. Results show that having no immigration history from outside the EU, being Christian or atheist, and learning about Europe at school are predictors of a stronger level of identification with Europe. The effect of having an immigration history from outside the EU loses significance when socio-economic status classroom composition is entered into the model. We conclude that differences in identification are not due to different access to learning opportunities, but likely due to personal characteristics. [ABSTRACT FROM AUTHOR]

"Culture of honor" means that individuals deter others by signaling their commitment to violent retaliation. We develop a multilevel explanation of cross-level interdependence of honor and violence. According to our concept of system-level honor, a social system is loaded with deterrence signaling if culture of honor is highly prevalent in the system. In line with the Smith and Price (1973, in Nature,https://www.nature.com/articles/246015a0) model, we argue that high system-level honor discourages Prober-Retaliator behavior: some individuals might tend to challenge others they assume to be inferior to increase their own reputation. Both individual culture of honor and system-level honor contribute to an increase in violence (H1; H2). However, as system-level honor and deterrence become more prevalent, the impact of individual honor diminishes because engaging in violent behavior becomes increasingly expensive within such a system (H3). As a second contextual effect, inequality in culture of honor should therefore increase violent behavior because it encourages Prober-Retaliator behavior (H4). We analyze the effect of culture of honor on school violence among 15-year-old adolescents. Disentangling the micro- and context-level effects of culture of honor on violent behavior in a multilevel analysis framework allows the estimation of a cross-level interaction using a large data set from more than 25,000 adolescents in more than 1,300 schoolroom contexts. Results are in line with our H3, but not with H4. Model-based predictions show that the deterrent effect must be unrealistically high to generate an equilibrium of average violence. [ABSTRACT FROM AUTHOR]

Background: Neighborhood-, school-, and peer-contexts play an important role in adolescent alcohol use behaviors. Methodological advances permit simultaneous modeling of these contexts to understand their relative and joint importance. Few empirical studies include these contexts, and studies that do typically: examine each context separately; include contexts for the sole purpose of accounting for clustering in the data; or do not disaggregate by sex. Objectives: This study takes an eco-epidemiologic approach to examine the role of socio-contextual contributions to variance in adolescent alcohol use. The primary parameters of interest are therefore variance rather than beta parameters (i.e. random rather than fixed effects). Sex-stratified models are also used to understand how each context may matter differently for male and female adolescents. Method: Data come from the National Longitudinal Study of Adolescent to Adult Health (n = 8,534 females, n = 8,102 males). We conduct social network analysis and traditional and cross-classified multilevel models (CCMM) in the full and sex-disaggregated samples. Results: In final CCMM, peer groups, schools, and neighborhoods contributed 10.5%, 10.8%, and 0.4%, respectively, to total variation in adolescent alcohol use. Results do not differ widely by gender. Conclusions: Peer groups and schools emerge as more salient contributing contexts relative to neighborhoods in adolescent alcohol use for males and females. These findings have both methodological and practical implications. Multilevel modeling can model contexts simultaneously to prevent the overestimation of variance in youth alcohol use explained by each context. Primary prevention strategies addressing youth alcohol use should focus on schools and peer networks. [ABSTRACT FROM AUTHOR]

Rationale, Aims and Objectives: Ensuring equitable access to primary care (PC) contributes to reducing differences in health related to people's socioeconomic circumstances. However, there is limited data on system‐level factors associated with equitable access to high‐quality PC. We examine whether individual‐level socioeconomic variation in general practitioner (GP) quality‐of‐care varies by area‐level organisation of PC services. Methods: Baseline data (2006–2009) from the Sax Institute's 45 and Up Study, involving 267,153 adults in New South Wales, Australia, were linked to Medicare Benefits Schedule claims and death data (to December 2012). Small area‐level measures of PC service organisation were GPs per capita, bulk‐billing (i.e., no copayment) rates, out‐of‐pocket costs (OPCs), rates of after‐hours and chronic disease care planning/coordination services. Using multilevel logistic regression with cross‐level interaction terms we quantified the relationship between area‐level PC service characteristics and individual‐level socioeconomic variation in need‐adjusted quality‐of‐care (continuity‐of‐care, long‐consultations, and care planning), separately by remoteness. Results: In major cities, more bulk‐billing and chronic disease services and fewer OPCs within areas were associated with an increased odds of continuity‐of‐care—more so among people of high‐ than low education (e.g., bulk‐billing interaction with university vs. no school certificate 1.006 [1.000, 1.011]). While more bulk‐billing, after‐hours services and fewer OPCs were associated with long consultations and care planning across all education levels, in regional locations alone, more after‐hours services were associated with larger increases in the odds of long consultations among people with low‐ than high education (0.970 [0.951, 0.989]). Area GP availability was not associated with outcomes. Conclusions: In major cities, PC initiatives at the local level, such as bulk‐billing and after‐hours access, were not associated with a relative benefit for low‐ compared with high‐education individuals. In regional locations, policies supporting after‐hours access may improve access to long consultations, more so for people with low‐ compared with high‐education. [ABSTRACT FROM AUTHOR]

To identify gestational weight gain trajectories and their association with demographic, obstetric, and anthropometric characteristics. Information of 599 pregnant women undergoing prenatal care in public health units was collected through questionnaires and medical records, resulting in 4,272 measures of body weight. Group-based trajectory models were applied to identify patterns of gestational weight gain. The average gestational weight gain at 40 weeks was 14.1 kg (95%CI: 13.2, 15.0). Three different trajectory groups were identified: low (9.9%), intermediate (66.4%), and high (23.7%). Pregnant women who smoked and those classified above IOM's weight gain recommendations were more likely to be classified in the group with a high weight gain trajectory; while those with pre-pregnancy overweight or obesity, and with greater parity were more likely to be categorized in the low weight gain trajectory. After adjusting for other variables in the model, parity remained significantly associated with gestational weight gain (β: 0.88; 95%CI: 0.27, 0.73). In the multilevel model, weight gain remained different among the categories of group-based trajectory, even after adjustment for other investigated variables for intermediate (β: 2.94; 95%CI: 2.32, 3.58) and high (β: 5.88; 95%CI: 5.09, 6.66) gestational weight gain trajectory groups. Behavioral, obstetric, and anthropometric characteristics determined the belonging to groups with a high or low trajectory of gestational weight gain. The findings contribute to a better understanding of patterns of gestational weight gain in middle-income women groups. [ABSTRACT FROM AUTHOR]

Since the accessory dwelling unit (ADU) has emerged as a policy alternative to increase housing stock and provide affordable options for areas impacted by housing shortages, many local governments recently adopted ADU policies that promote the construction of ADUs. Taking the City of Los Angeles as the study area, this paper examines how the city's ADU ordinance impacts the relationship of the characteristics of the properties and neighborhoods with ADU development by constructing multilevel logistic regression models. The outputs of the models suggest that the ordinance contributes to diversifying the types and locations of the properties and neighborhoods where ADUs are built. The influence of the property characteristics associated with ADU development before the implementation of the ordinance significantly diminished after the ordinance. The outputs also indicate that the ordinance probably attracted ADU developments in the areas with higher accessibility to bus transit. These findings will help planners take appropriate actions and policies that support ADU developments. [ABSTRACT FROM AUTHOR]

Copyright of Journal of International Business Studies is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

As not all firms benefit to the same extent from regional competitiveness, this article investigates the influence of the regional context on the productivity of a sample of family and non-family manufacturing firms in Spain. Using a multilevel approach to account for the nested structure of the data, and a composite indicator of regional competitiveness, to capture the spatial endowment of tangible and intangible resources, we found family firms to be more sensitive to the regional context than non-family businesses. Cross-level interactions show that family firms achieve higher productivity gains from their location in more competitive regions than their non-family counterparts. This result is in line with our theoretical arguments postulating the unique social capital of family firms which allows them to benefit most from location advantages. Implications for regional and family business studies, as well as policymakers, are discussed. [ABSTRACT FROM AUTHOR]

Among the many approaches to leadership, servant leaders stand out for the emphasis they place on the importance of service to their followers, the organization, and the broader community. We develop and test a multilevel mediation model, in which the relationship between servant leadership and team performance is sequentially transmitted through individual‐level organizational citizenship behavior (OCB) and team‐based internal social capital. Multilevel structural equation modeling was applied to a sample of 343 teams, reflecting 835 respondents from various departments at 171 hotels in Spain; both top‐down (between team leaders and individual employees) and bottom‐up relationships (individual employee behavior and team outcomes) were assessed. As anticipated, individual‐level OCB and group‐level internal social capital fully mediated the positive effect of servant leadership on team performance. Our findings illustrate that servant leadership in the team‐based business enterprise context can foster virtuous individual‐level OCB to help build task‐focused community, in which leaders, followers, and teams can flourish for the common good. Thus, managers should know that serving their team members first and foremost is a positive for the flourishing of all involved. As such, policymakers should pursue communication and training initiatives to encourage the practice of servant leadership. [ABSTRACT FROM AUTHOR]

Summary: The purpose of this study is to examine the micro‐level dynamics underlying macro‐level associations between organizational change and its outcomes, focusing in particular on the role of networks in shaping individual reactions to change. Drawing upon multilevel research on situational and individual antecedents of change, we first argue that the magnitude of change at the unit level has a nonlinear effect on change recipients' tendency to resist change, which in turn influences their adaptive behaviors. We argue, further, that the attitudinal and structural composition of the professional networks in which change recipients are embedded account for differences in their adaptive behaviors. Finally, we argue that individual adaptivity coalesces at the collective, that is, unit level, and predicts the attainment of desired change goals. We find general support for our arguments in a longitudinal study using multi‐source data on 170 physicians in 29 units of a large hospital that experienced a major restructuring intervention. Results confirm that multilevel mechanisms involving individuals and their social context fundamentally undergird macro‐level outcomes of change. We discuss the theoretical and practical implications of bringing a network perspective to bear on issues of individual and collective reactions to organizational change. [ABSTRACT FROM AUTHOR]

Copyright of Publicaciones s de la Facultad de Educacion y Humanidades del Campus de Melilla (Universidad de Granada, Espana) is the property of Universidad de Granada and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Publicaciones s de la Facultad de Educacion y Humanidades del Campus de Melilla (Universidad de Granada, Espana) is the property of Universidad de Granada and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Lung cancer has been the leading cause of American deaths from cancer. Although Medicare started covering lung cancer screening (LCS) with low-dose computed tomography (LDCT) in 2015, the uptake of LDCT-LCS remains low. This study examines the changes in adherence to provider referrals for LDCT-LCS and the factors at patient, provider, and health system levels that influence the completion rate of LDCT-LCS orders before and during the COVID-19 pandemic. Methods: Our study examined electronic health record data (December 2013 - December 2020) from a large, community-based clinical healthcare delivery system in California. We plotted monthly trends in the frequency of LDCT-LCS orders and completion rate and compared the annual LDCT-LCS completion rate between LCS-eligible, LCS-ineligible, and unknown eligibility groups. We then explored multilevel factors associated with the completion of LDCT-LCS orders using hierarchical generalized linear models. Results: There was an increase in LDCT-LCS orders (N = 12,469) from 2013 to 2019, followed by a sharp decline in March 2020 due to the onset of the COVID-19 pandemic. Thereafter, LDCT-LCS orders slowly increased again in June 2020. The completion rate of LDCT-LCS increased from 0% in December 2013 to approximately 70% in 2018–2019 but declined to 50–60% in 2020 during the pandemic. Ineligible patients had lower completion rates of LDCT-LCS. Patients who were new to the healthcare system, Black, received the LDCT-LCS order in the first few years after Medicare coverage (2016 or 2017), during the pandemic, had major comorbidities, and smoked less than 30 pack-years were less likely to complete an order. Patients were more likely to complete LDCT-LCS orders if they were younger, received the LDCT-LCS order from a physician (vs. nonphysician provider), from family medicine or other specialties (vs. internal medicine), or saw a provider with more experience in LDCT-LCS. Conclusions: The beginning of the COVID-19 pandemic largely decreased the volume of LDCT-LCS orders, but rates have since been slowing recovering. Future interventions to improve lung cancer screening should consider doing more targeted outreach to new patients and Black patients as well as providing additional education to nonphysician practitioners and those providers with lower rates of LDCT-LCS referral orders. [ABSTRACT FROM AUTHOR]