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Multidimensional causal model of dental caries development in low-income preschool children.

Despite the decline in the incidence of dental caries in the United States over the past several years, the condition remains a significant problem for the nation's poor children. Efforts to identify the factors responsible for caries development in samples of children of low socioeconomic status have primarily focused on a limited number of variables, and those have been predominantly biological (mutans streptococci, for example). Resulting models of caries development have usually shown good sensitivity but poor specificity. They have had limited implications for treatment. In an effort to produce a comprehensive model of caries development, 184 low-income preschool children were clinically assessed for mutans streptococci and for decayed, missing, or filled surfaces of deciduous teeth twice, first at age 4 years (baseline) and again a year later (year 1 assessment). As the clinical assessments were being done, caretakers were being interviewed to obtain data from five domains: demographics, social status, dental health behaviors, cognitive factors such as self-efficacy (self-confidence) and controllability, and perceived life stress. Data were analyzed using a structural equations modeling approach in which variables from all domains, plus baseline decayed missing and filled surfaces and baseline mutants, were used together to create a model of caries development in the year 1 assessment. Results confirmed earlier work that suggested that caries development at a 1-year followup was strongly dependent on earlier caries development. Early caries development in this sample was determined in part by mutans levels and by dental health behaviors. These behaviors themselves were accounted for partly by a cognitive factor. The results support the advantages of employing multidimensional models and provide some direction for intervention to reduce caries incidence.

Causality↗

PubMed2026

From fear to empowerment: the impact of employees AI awareness on workplace well-being - a new insight from the JD-R model.

PURPOSE: The primary purpose of the study was to explore the impact of health workers' awareness of artificial intelligence (AI) on their workplace well-being, addressing a critical gap in the literature. By examining this relationship through the lens of the Job demands-resources (JD-R) model, the study aimed to provide insights into how health workers' perceptions of AI integration in their jobs and careers could influence their informal learning behaviour and, consequently, their overall well-being in the workplace. The study's findings could inform strategies for supporting healthcare workers during technological transformations. DESIGN/METHODOLOGY/APPROACH: The study employed a quantitative research design using a survey methodology to collect data from 420 health workers across 10 hospitals in Ghana that have adopted AI technologies. The study was analysed using OLS and structural equation modelling. FINDINGS: The study findings revealed that health workers' AI awareness positively impacts their informal learning behaviour at the workplace. Again, informal learning behaviour positively impacts health workers' workplace well-being. Moreover, informal learning behaviour mediates the relationship between health workers' AI awareness and workplace wellbeing. Furthermore, employee learning orientation was found to strengthen the effect of AI awareness on informal learning behaviour. RESEARCH LIMITATIONS/IMPLICATIONS: While the study provides valuable insights, it is important to acknowledge its limitations. The study was conducted in a specific context (Ghanaian hospitals adopting AI), which may limit the generalizability of the findings to other healthcare settings or industries. Self-reported data from the questionnaires may be subject to response biases, and the study did not account for potential confounding factors that could influence the relationships between the variables. PRACTICAL IMPLICATIONS: The study offers practical implications for healthcare organizations navigating the digital transformation era. By understanding the positive impact of health workers' AI awareness on their informal learning behaviour and well-being, organizations can prioritize initiatives that foster a learning-oriented culture and provide opportunities for informal learning. This could include implementing mentorship programs, encouraging knowledge-sharing among employees and offering training and development resources to help workers adapt to AI-driven changes. Additionally, the findings highlight the importance of promoting employee learning orientation, which can enhance the effectiveness of such initiatives. ORIGINALITY/VALUE: The study contributes to the existing literature by addressing a relatively unexplored area - the impact of AI awareness on healthcare workers' well-being. While previous research has focused on the potential job displacement effects of AI, this study takes a unique perspective by examining how health workers' perceptions of AI integration can shape their informal learning behaviour and, subsequently, their workplace well-being. By drawing on the JD-R model and incorporating employee learning orientation as a moderator, the study offers a novel theoretical framework for understanding the implications of AI adoption in healthcare organizations.

Humans↗

PubMed2026

Innovation-related perception as a key driver of alternative protein acceptance: evidence from an early-stage model for cultivated meat and algae-/microalgae-based alternative protein products in Italy.

Alternative proteins are increasingly considered part of the transition toward more sustainable food systems, yet their diffusion depends critically on consumer acceptance. This study investigates the early-stage acceptance of two alternative protein categories in Italy-cultivated meat and algae-/microalgae-based alternative protein products. Focusing on the first three phases of acceptance, the analysis examines how innovation-related perception (IRP) shapes consumer perceived value (CPV), consumer perceived risk (CPR), and subsequent affective (AFF), cognitive (COG), and conative (CON) responses. Data were collected through an online survey administered to 238 Italian respondents and analysed using partial least squares structural equation modelling (PLS-SEM). The results show that IRP is the main upstream driver of early-stage acceptance in both product domains: more favourable perceptions strongly increase perceived value and reduce perceived risk. In turn, CPV exerts a much stronger influence than CPR on both affective and cognitive attitudes. A tentative cross-model comparison suggests only a descriptive variation in the final transition toward conative acceptance: affective and cognitive responses were both significant in the two models, with a relatively larger affective coefficient for cultivated meat and more balanced coefficients for algae-/microalgae-based products. Overall, the findings support a process-based interpretation of alternative protein acceptance and highlight the central role of innovation-related perception in shaping early consumer responses. These results provide relevant implications for communication strategies, product positioning, and policy actions aimed at improving the acceptability of alternative proteins in food cultures characterised by strong culinary traditions.

Italy↗

PubMed2026

Long-term petroleum pollution alters soil microbial communities via electron transfer capacity: Evidence from a 35-year chronosequence.

Petroleum pollution poses a serious threat to soil ecosystems, especially in areas surrounding oil wells, where contamination should not be overlooked. Through a 35-year longitudinal study of soils surrounding oil wells, we demonstrate that petroleum hydrocarbons accumulate predominantly in the top 10 cm of soil, reducing the electron acceptor capacity (EAC) by 61.59 % (from 12.68 to 4.87 μmole-/gC) and decreasing the electron transfer capacity (ETC) by 43 %. Structural equation modeling identified ETC as the critical mediator of microbial community shifts, with EAC playing a pivotal role in sustaining redox processes. Notably, hydrocarbon accumulation triggered a microbial succession: The abundance of Actinomycetota (including genera Rhodococcus, Arthrobacter, and Rubrobacter) showed the most significant fluctuations within 2 years, while Pseudomonadota (genera Methylobacter, Thiobacillus, and Pseudomonas), which were dominant in uncontaminated soils, decreased markedly during this period. This transition coincided with peak microbial dysbiosis (microbial dysbiosis index in 2022 reached 31.41 times that of controls). Within two to four years following mild petroleum stress, the bacterial community established a new structural configuration, revealing a crucial window for ecological recovery. The coupling between ETC reduction and microbial succession highlights the pivotal role of electron flux in soil recovery. Our findings establish a mechanistic framework for ETC-targeted restoration strategies to enhance bioremediation in petroleum-contaminated soils.

Soil Microbiology↗

PubMed1995

The contributions of disease activity, sleep patterns, and depression to fatigue in systemic lupus erythematosus. A proposed model.

OBJECTIVE: This study describes lupus fatigue multidimensionally and introduces a multivariate model: Sleep problems and depression, through reciprocal effects on each other, act as mediators through which lupus disease activity increases fatigue. METHODS: Self-reported sleep patterns, depression, and fatigue were assessed in 48 women with systemic lupus erythematosus (SLE) and 27 women from the general population. Rheumatologists rated current lupus disease activity. RESULTS: The SLE group reported greater overall fatigue than did the controls. Temporal and affective dimensions of fatigue were more differentiating than sensory or severity dimensions. The SLE group also reported longer sleep latency and total sleep time, but not higher depression. Using 2-stage regression, a form of structural equation modeling, the proposed lupus fatigue model was supported. CONCLUSION: These preliminary results describe fatigue as a multidimensional phenomenon arising out of several contributing factors. They suggest that fatigue treatment strategies should address mediating processes such as sleep and depression, in addition to disease activity.

Adult↗

PubMed1985

Organizational stress in the hospital: development of a model for diagnosis and prediction.

A model of organizational stress in the hospital was developed and tested. The model utilized measures of organizational climate, supervisory practices, and work group relations as predictors of the amount of role conflict and ambiguity that nurses perceived in providing patient care. Role conflict and ambiguity were treated as variables that intervene between organizational variables and the level of stress that the nursing staff experienced. Nursing stress was viewed as a direct cause of job dissatisfaction and as an indirect cause of absenteeism among the nursing staff. Data from 158 registered nurses, licensed practical nurses, and nursing assistants on seven nursing units in a 1,160-bed private teaching hospital were used to estimate the parameters of a structural equation model. The model was used to predict the results of a survey feedback project designed to change the supervisory style used on the units. Pre- and posttest data from four surgical units were used to validate the model. The findings suggest that, as predicted, supervisory practices that led to more open expression of views and joint problem solving resulted in reduced role conflict, ambiguity, and stress; increased job satisfaction; and lower levels of absenteeism among the nursing staff.

Absenteeism↗

PubMed1995

Social support, coping, and depressive symptoms in a late-middle-aged sample of patients reporting cardiac illness.

This study tests a 1-year predictive model of depressive symptoms in a late-middle-aged sample of patients reporting diagnoses of cardiac illness. Results based on 325 individuals (248 men and 77 women) diagnosed with chronic cardiac illness, 71 individuals (52 men and 19 women) diagnosed with acute cardiac illness, and 219 healthy controls (129 men and 90 women) strongly supported the hypotheses. Compared with healthy persons, individuals with chronic and those with acute cardiac illness reported more depressive symptoms at follow-up. Women overall showed more depressive symptoms than did men, and women with cardiac illness were particularly vulnerable to behavioral manifestations of depressive symptoms. Integrative time-lag and prospective structural equation models indicated that, for individuals with cardiac illness, social support and adaptive coping strategies predicted fewer depressive symptoms.

Adaptation, Psychological↗

PubMed1991

Differentiation of early adolescent predictors of drug use versus abuse: a developmental risk-factor model.

Many psychosocial factors are associated with adolescent drug use, though most have not been tested as true predictors of drug use in prospective studies. Studies to date have also not differentiated predictors of drug use from abuse and have not addressed differential effects for specific substances. To address these concerns, we expanded the multiple risk-factor approach using 2-year longitudinal data from a sample of seventh graders. Frequencies of use for alcohol, cigarettes, marijuana, cocaine, and hard drugs were assessed at Time 1 and Time 2 and used to reflect latent constructs of polydrug use. From a set of 29 risk factors, unique predictors of any substance were separated conceptually according to whether they most related to initiation/experimental or problem/heavy drug use and were then summed into two-unit weighted indexes at each time. Distribution-free structural equation models were used to accommodate the nonnormal distributions of the illicit drug use measures. The problem risk index was strongly correlated with polydrug use at Time 1 and increased polydrug use at Time 2. Several specific relationships between risk and drug use across time also were noted.

Adolescent↗

PubMed1994

Psychosocial, behavioral, and medical outcomes in children with epilepsy: a developmental risk factor model using longitudinal data.

OBJECTIVE: We studied factors predicting the risk of adverse long-term psychosocial, behavioral, and medical outcomes in children with epilepsy. METHODS: Children (N = 157, 4.5 to 13 years) were enrolled in a prospective longitudinal study when first seen. Potential subjects were excluded if they were moderately or severely mentally retarded, had motor or sensory handicaps interfering with testing, or did not speak either English or Spanish. MEASURES: To develop risk predictors, we collected information regarding the child's medical and seizure history, cognitive functioning, and behavior problems, and family functioning. Children and their families were followed for a minimum of 18 months, then underwent reassessment of medical status, parent's attitudes toward epilepsy, and the child's behavioral and cognitive functioning. Data were analyzed by confirmatory factor analysis to develop baseline factors (Sociocultural Risk, Seizure Risk, and Behavior Problems) and outcome factors (Medical/Seizure Problems, Parent's Negative Attitudes Toward Epilepsy, and Behavior Problems), followed by structural equation modeling to determine across-time causal effects. Eighty-eight subjects completed all baseline and outcome measures. RESULTS: Among significant across-time effects, Medical Outcome was predicted by Seizure Risk. An increased number of stressful life events predicted better Medical Outcome. Low acculturation increased Parent's Negative Attitudes and was associated with increased Behavior Problems at baseline. Behavior Problems were stable across time. It is interesting that IQ did not affect any of the outcomes, although its effect may have been mediated through other baseline measures. CONCLUSIONS: Seizure history was the best predictor of ongoing medical difficulties, whereas the most important causes of ongoing parental anxiety and negative attitudes toward epilepsy were sociocultural. Variation in medical or attitudinal outcomes was not influenced by either the child's IQ or reported behavioral problems. These findings suggest that to alter attitudes toward epilepsy, programs should be tailored to the sociocultural background of the family. Studies of quality of life of children with epilepsy should include appropriate sociocultural measures.

Acculturation↗

PubMed1983

Path analysis in genetic epidemiology: a critique.

Path analysis, a form of general linear structural equation models, is used in studies of human genetics data to discern genetic, environmental, and cultural factors contributing to familial resemblance. It postulates a set of linear and additive parametric relationships between phenotypes and genetic and cultural variables and then essentially uses the assumption of multivariate normality to estimate and perform tests of hypothesis on parameters. Such an approach has been advocated for the analysis of genetic epidemiological data by D. C. Rao, N. Morton, C. R. Cloninger, L. J. Eaves, and W. E. Nance, among others. This paper reviews and evaluates the formulations, assumptions, methodological procedures, interpretations, and applications of path analysis. To give perspective, we begin with a discussion of path analysis as it occurs in the form of general linear causal models in several disciplines of the social sciences. Several specific path analysis models applied to lipoprotein concentrations, IQ, and twin data are then reviewed to keep the presentation self-contained. The bulk of the critical discussion that follows is directed toward the following four facets of path analysis: (1) coherence of model specification and applicability to data; (2) plausibility of modeling assumptions; (3) interpretability and utility of the model; and (4) validity of statistical and computational procedures. In the concluding section, a brief discussion of the problem of appropriate model selection is presented, followed by a number of suggestions of essentially model-free alternative methods of use in the treatment of complex structured data such as occurs in genetic epidemiology.

Asian↗

PubMed1995

Genetic, environmental, and phenotypic links between body mass index and blood pressure among women.

Greater relative weight is associated with higher blood pressure, but the reasons are unknown. The inability of current technology to induce sustained weight loss among overweight persons precludes experimental tests of whether this association is causal. We evaluated the degree to which the covariation between body mass index (BMI; kg/m2) and blood pressure (BP) among women is due to pleiotropic genetic factors, environmental factors, or phenotypic causation. The sample included 75 monozygotic (MZ) and 39 dizygotic (DZ) pairs of adult female twins. "BP" was calculated as the unit-weighted mean of systolic and diastolic. Data were analyzed through structural equation modeling. A model was specified stipulating that additive genetic effects (A) and unique environmental effects (E) each contributed to the covariance between BMI and BP, thus allowing for both pleiotropic and unique environmental influences on the covariance between BMI and BP. Dropping the pleiotropic influences significantly worsened the model (chi 2 = 4.62, df = 1, P = .032), suggesting significant pleiotropic effects. Dropping the environmental influences on the cross-phenotype covariance did not significantly worsen the model (chi 2 = 1.42, df = 1, P = .233). This indicates no significant effect of the environment on the covariance between BMI and BP. Finally, a model of phenotypic causation in which BMI directly influenced BP was fitted. This model provided the best single parameter explanation of the BP-BMI covariation. These data suggest that, among women, regardless of the source of variation, changes in BMI should lead to long-standing changes in BP.

Adult↗

PubMed1992

Genetic and environmental contributions to the variance of body height in a sample of first and second degree relatives.

Height was measured in a health screening of the population in Nord-Trøndelag, Norway. Correlations were computed for 24,281 pairs of spouses, 43,613 pairs of parents and offspring, 19,168 pairs of siblings, 1,318 pairs of grandparents and grandchildren, 1,218 cognate avuncular pairs, 849 noncognate avuncular pairs, 175 pairs of same-sexed twins, and smaller groups of other types of relatives. Fitting of structural equation models showed proportions of additive genetic variance of approximately 0.8 for both sexes and small sex-specific effects that probably reflect genetic dominance or environmental sibling effects. The correlations between parents and offspring were significantly lower in old than young cohorts, seeming to imply some kind of interaction effect between genes and environment.

Age Factors↗

PubMed1992

Psychological factors, immunologic activation, and disease activity in rheumatoid arthritis.

The purpose of this study was to use structural equation modeling techniques to examine potential interrelationships among psychological factors, immunologic activation, and disease activity in rheumatoid arthritis (RA). The subjects were 80 male patients with a diagnosis of classic or definite RA. Measures included the Beck Depression Inventory, the Arthritis Helplessness Index, and the Arthritis Impact Measurement Scales (AIMS) pain score. Joint counts and immunophenotypic analyses of peripheral blood lymphocytes also were collected. Path analysis showed that percentage of HLA-DR+ cells in the peripheral blood and helplessness were related to join count. In addition, joint count had an effect upon depression. Depression had an effect upon pain, but there was no reciprocal effect of pain upon depression. This study describes a preliminary path model of interrelationships among psychological factors, immunologic activation, and disease activity in RA.

Aged↗

PubMed1992

Determinants of isometric muscle strength in men of different ages.

Values of maximal isometric strength of five muscle groups and associated factors including occupational status, life style and health were studied in three groups of men aged from 31 to 35, 51 to 55, and 71 to 75 years. The results indicated significant differences between the age groups in isometric handgrip, elbow flexion, knee extension, trunk extension and trunk flexion strength. In the youngest group, the manual workers tended to have higher strength values in all muscle groups than the lower and higher status white collar workers, whereas among the middle-aged and oldest men the manual workers tended to have the poorest performance. Good self-rated health and the intensity of physical exercise during leisure were positively associated with muscle strength in the youngest and middle-aged groups whereas in the oldest group the most important variable was home gymnastics. The multivariate structural equation models of isometric strength differed somewhat among the age groups and in these models the above-mentioned variables accounted for from 33% to 43% of the variance in isometric strength within the age groups. The results illustrated the most important factors associated with isometric strength in samples of men of different ages and also provided suggestions as to how these determinants might influence comparisons between different age groups in respect of muscle strength.

Adult↗

PubMed1995

Social skills in schizophrenia: assessing the relationship between social skills, psychopathology and community functioning.

Social skills training (SST) has been widely used in attempts to rehabilitate chronic schizophrenic patients. The key assumption underlying SST is that social skills deficits are important determinants of the social isolation, poor social role functioning, and low quality of life characteristic of schizophrenic patients. To test this assumption, 89 patients meeting DSM-III-R criteria for schizophrenia were assessed on behavioural and self-report measures of social skills. A structured clinical interview, a self-report inventory of distress during social interaction, and self-monitoring of time in social interaction were used to assess social functioning. Positive psychotic symptoms were assessed in a standardised clinical interview. A structural equation modelling analysis showed that observed social skills predicted social functioning, and that this association was statistically independent of severity of psychotic symptoms. This finding is consistent with the hypothesis that social skills are important in the social functioning of patients with schizophrenia.

Activities of Daily Living↗

PubMed1991

AIDS-related health behavior: coping, protection motivation, and previous behavior.

The purpose of this study was to examine Rogers' protection motivation theory and aspects of Janis and Mann's conflict theory in the context of AIDS-related health behavior. Subjects were 84 heterosexual men and women and 147 homosexual men with multiple sexual partners; LISREL's path-analysis techniques were used to evaluate the goodness of fit of the structural equation models. Protection motivation theory did fit the data but had considerably more explanatory power for heterosexual than for homosexual subjects (49 vs. 22%, respectively). When coping styles were added, different patterns of findings were found among both groups. Adding variables such as social norms and previous behavior increased the explained variance to 73% for heterosexual subjects and to 44% for homosexual subjects. It was concluded that although protection motivation theory did fit the data fairly adequately, expanding the theory with other variables--especially those related to previous behavior--could improve our understanding of AIDS-related health behavior.

Acquired Immunodeficiency Syndrome↗

PubMed1995

Early disruptive behavior, IQ, and later school achievement and delinquent behavior.

A series of structural equation model is developed to examine the relationship between early externalizing behaviors (conduct problems, attention deficit) and IQ measured at age 8 years, academic achievement over the period 10 to 13 years, and delinquent behavior to the age of 15 in a birth cohort of New Zealand children. These models indicated that early externalizing behaviors and IQ were related to later academic achievement and delinquent behavior by two quite distinct but highly correlated developmental sequences. In one sequence early conduct problems were predictive of later delinquency but were not directly related to later academic achievement. In the other sequence, attention deficit and IQ were prognostic of later school achievement but were not directly related to delinquency. Further, the apparent correlations between academic achievement and delinquency were adequately explained by the common and correlated effects of early behavior and IQ on later achievement and delinquency. These conclusions remained unchanged when the sample was stratified by gender, and when further explanatory factors were introduced into the model.

Achievement↗

PubMed1989

The relationships between neuroticism and depressive symptoms.

A structural equation model designed to estimate the reciprocal associations which may exist between mental state and personality trait variables is presented. This model is applied to measures of neuroticism and depression obtained for a sample of over 1000 women studied over a two year period. The fitted model suggests that while measures of neuroticism are contaminated by the effects of short term mental state on the reporting of personality, there is still a fairly substantial relationship between trait neuroticism (corrected for the effects of mental state contamination) and reports of depressive symptoms.

Depression↗