Power and Bias in Hierarchical Linear Growth Models: More Measurements for Fewer People

Hierarchical Linear Modeling (HLM) sample size recommendations are mostly made with traditional group-design research in mind, as HLM as been used almost exclusively in group-design studies. Single-case research can benefit from utilizing hierarchical linear growth modeling, but sample size recommendations for growth modeling with HLM are scarce and generally do not consider the sample size combinations typical in single-case research. The purpose of this Monte Carlo simulation study was to expand sample size research in hierarchical linear growth modeling to suit single-case designs by testing larger level-1 sample sizes (N1), ranging from 10 to 80, and smaller level-2 sample sizes (N2), from 5 to 35, under the presence of autocorrelation to investigate bias and power. Estimates for the fixed effects were good for all tested sample-size combinations, irrespective of the strengths of the predictor-outcome correlations or the level of autocorrelation. Such low sample sizes, however, especially in the presence of autocorrelation, produced neither good estimates of the variances nor adequate power rates. Power rates were at least adequate for conditions in which N2 = 20 and N1 = 80 or N2 = 25 and N1 = 50 when the squared autocorrelation was .25.Conditions with lower autocorrelation provided adequate or high power for conditions with N2 = 15 and N1 = 50. In addition, conditions with high autocorrelation produced less than perfect power rates to detect the level-1 variance

Exploring Relationships Between Genito-Pelvic Pain/Penetration Disorder, Sex Guilt, and Religiosity Among College Women in the U.S.

Introduction: Despite a growing body of research on psychosocial factors in Genito-Pelvic Pain/Penetration Disorder (GPPPD) during sexual intercourse, there are few studies examining adolescent and young adult women\u27s experiences with painful sex and the effects of religiosity, sexual education, and sex guilt. Aim: The purpose of the study was to examine the occurrence of GPPPD among sexually active female college students, including psychosocial factors of religiosity and religious practice, sexual education, sex guilt, and sexual distress. Methods: Data were collected from 974 college women from a university in the Northeastern U.S. We limited our sample to sexually active women (n = 593, 60.9%; mean age: 18.96) who responded to the questionnaire item, “In general, do you feel pain with sexual intercourse?” Participants completed the Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS), Revised Mosher Sex Guilt Scale, Abbreviated Santa Clara Strength of Religious Faith Questionnaire, 10-item Gender Role Beliefs Scale, and measures on sexual wellness and practice and sexual education experiences. Data were analyzed using standard bivariate and regression analyses as well as path analysis. Main Outcome Measures: Women were asked, “In general, do you feel pain with sexual intercourse?” and categorized into one of three pain groups: occasional (10%–25% of the time), frequent (50% or more), and no pain (less than 10%). Results: GPPPD with sex was prevalent among young college women, with 113 (19.1%) reporting frequent pain and 143 (24.1%) occasional pain (control n = 337, 56.8%). Numerous statistically significant factors were identified, including frequency of sex, ability to orgasm, sensations during intercourse, presence of a steady sexual partner, expectations of painful sex, sex guilt, and sexual distress. Sex guilt acted as full mediator between religiosity and painful sex. Implications: Healthcare providers should proactively initiate conversations with young female patients about painful intercourse to identify issues and normalize language on pain with sex. Educators are urged to teach evidence-based information on pain-free and guilt-free sexual experiences inside and outside religious contexts. Conclusion: Painful sex affects adolescent and young adult women at a similar rate as non-college adult women and while religiosity does not directly impact young women\u27s GPPPD, religiosity does lead to painful sex if it causes sex guilt. Further research is needed into the mechanisms of religion-based sexual shaming and among religiously conservative women who practice abstinence until marriage. Azim KA, Happel-Parkins A, Moses A, et al. Exploring Relationships Between Genito-Pelvic Pain/Penetration Disorder, Sex Guilt, and Religiosity Among College Women in the U.S. J Sex Med 2021;18:770–782

Understanding caregivers' decision to vaccinate childhood cancer survivors against COVID‐19

Abstract Background Vaccination against COVID‐19 is recommended for childhood cancer survivors (CCS). This study aimed to identify antecedents contributing to caregivers' decisions to vaccinate CCS aged 5–17 years against COVID‐19 by applying the Theory of Planned Behavior. Methods Participants in this cross‐sectional study completed an online survey assessing caregiver attitudes, subjective norms, perceived behavioral control, intention to vaccinate CCS, CCS vaccination status, COVID‐19 health literacy, and frequency of COVID‐19 information‐seeking. Surveys were completed between May and June 2022 following approval for the emergency use of COVID‐19 vaccines among children aged ≥5 years in the U.S. Data were analyzed using unadjusted linear regressions and structural equation modeling. Results Participants were caregivers (n = 160, 87.5% biological mothers, 75.6% white/non‐Hispanic) of CCS (n = 160, 44.4% female, mean (M) = 12.5 years old, M = 8.0 years off treatment). 70.0% (n = 112) of caregivers and 53.8% (n = 86) of CCS received a COVID‐19 vaccine. Over one‐third (37.5%) of caregivers reported disagreement or indecision about future COVID‐19 vaccination for the CCS. Caregivers' intention (β = 0.962; standard error [S.E.] = 0.028; p < 0.001) was highly related to CCS vaccination status. Attitudes (β = 0.568; S.E. = 0.078; p < 0.001) and subjective norms (β = 0.322; S.E. = 0.062; p < 0.001) were associated with intention. Higher frequency of COVID‐19 information‐seeking (β = 0.313; S.E. = 0.063; p < 0.001) and COVID‐19 health literacy (β = 0.234; S.E. = 0.059; p < 0.001) had a positive indirect effect on intention through attitudes and subjective norms. Conclusions Caregivers' vaccination intentions for minor CCS are highly related to vaccination behavior and shaped by attitudes, subjective norms, COVID‐19 health literacy, and frequency of COVID‐19 information‐seeking. Promoting tailored communication with caregivers of CCS and encouraging them to review reputable sources of information can address their vaccine hesitancy

Reasons for Polytobacco Use among Young Adults: Scale Development and Validation

Introduction Limited research has examined reasons for polytobacco use, an increasing public health problem, particularly among young adults. We examined reasons for polytobacco use among users of more than one tobacco product in the past 4 months enrolled in an ongoing six-wave longitudinal study of 3,418 students aged 18-25 from seven US colleges and universities. Methods An expert panel generated items related to reasons for polytobacco use, included in Wave 3 (administered in Summer 2015). Participants reporting use of more than one tobacco product in the past four months (n=540) were asked to complete the Reasons for Polytobacco Use scale and measures related to tobacco/nicotine use/dependence, use motives, perceptions of tobacco, parental/friend use, other substance use, and mental health. We conducted a factor analysis and then examined convergent and discriminant validity for the derived factors. Results Our sample was an average age of 20.40 (SD=1.84), 48.0% male, and 21.9% Black. Four factors were identified: Instrumentality, Social Context, Displacement, and Experimentation. Instrumentality was the only factor associated with little cigar/cigarillo and marijuana use. Displacement and Social Context showed similar associations; however, Social Context was associated with having friends who used tobacco while Displacement was not. Experimentation was associated with greater perceived addictiveness and harm of using tobacco products as well as greater perceived social acceptability of tobacco use. Conclusions Each of the four factors identified demonstrated unique convergent and discriminant validity. The use of this scale to characterize polytobacco using young adults may help inform and target cessation or prevention interventions

Process evaluation of health fairs promoting cancer screenings

Abstract Background Low income and uninsured individuals often have lower adherence to cancer screening for breast, cervical and colorectal cancer. Health fairs are a common community outreach strategy used to provide cancer-related health education and services. Methods This study was a process evaluation of seven health fairs focused on cancer screening across the U.S. We conducted key-informant interviews with the fair coordinator and conducted baseline and follow-up surveys with fair participants to describe characteristics of participants as well as their experiences. We collected baseline data with participants at the health fairs and telephone follow-up surveys 6 months following the fair. Results Attendance across the seven health fairs ranged from 41 to 212 participants. Most fairs provided group or individual education, print materials and cancer screening during the event. Overall, participants rated health fairs as very good and participants reported that the staff was knowledgeable and that they liked the materials distributed. After the fairs, about 60% of participants, who were reached at follow-up, had read the materials provided and had conversations with others about cancer screening, and 41% talked to their doctors about screening. Based on findings from evaluation including participant data and coordinator interviews, we describe 6 areas in planning for health fairs that may increase their effectiveness. These include: 1) use of a theoretical framework for health promotion to guide educational content and activities provided, 2) considering the community characteristics, 3) choosing a relevant setting, 4) promotion of the event, 5) considerations of the types of services to deliver, and 6) evaluation of the health fair. Conclusions The events reported varied in reach and the participants represented diverse races and lower income populations overall. Most health fairs offered education, print materials and onsite cancer screening. Participants reported general satisfaction with these events and were motivated through their participation to read educational materials or discuss screening with providers. Public health professionals can benefit from this process evaluation and recommendations for designing and evaluating health fairs