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Robertson NM, Mangino AA, South AM, Fanucchi LC. Medications for opioid use disorder associated with reduced readmissions for patients with severe injection-related infections: A matched cohort study. J Subst Use Addict Treat 2024; 160:209298. [PMID: 38262559 DOI: 10.1016/j.josat.2024.209298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Hospitalizations due to severe injection-related infections (SIRIs) and patient-directed discharge (PDD) in people who inject drugs (PWID) are increasing, but research on readmission outcomes at PDD is limited. In this retrospective, matched cohort study we evaluated predictors of 30-day readmission by discharge status among PWID. METHODS Among patients diagnosed with SIRIs at a tertiary hospital, Fisher's exact tests assessed differences in readmission rates by discharge status. Medications for opioid use disorder (MOUD) at discharge was defined as either having a buprenorphine dose dispensed within 24 h of discharge and buprenorphine being included in the discharge summary as a prescription, or a methadone dose dispensed inpatient within 24 h of discharge. Logistic regression analyses evaluated predictors of readmission outcomes. RESULTS Among 148 PWID with SIRI diagnosis, 30-day readmission rate following PDD was higher than standard discharge (25.7 % vs. 9.5 %, p = 0.016) and MOUD decreased odds of 30-day readmission (OR = 0.32, 95 % CI: 0.12,0.83, p = 0.012). >7 missed days of antibiotic treatment increased odds of 30-day readmission (OR 4.65, 95 % CI: 1.14, 31.72, p = 0.030) within PDD patients. CONCLUSIONS PDD carries higher 30-day readmission rate compared to standard discharge. Strategies to reduce PDD rates and increase MOUD initiation may improve readmission outcomes.
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Affiliation(s)
- Nicole M Robertson
- Department of Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Anthony A Mangino
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - Anna-Maria South
- Division of Hospital Medicine, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Laura C Fanucchi
- Division of Infectious Diseases, Department of Internal Medicine, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, USA.
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Levy BE, Mangino AA, Castle JT, Stephens WA, McDonald HG, Patel JA, Beck SJ, Bhakta AS. Effect of Medicaid expansion on inflammatory bowel disease and healthcare utilization. Am J Surg 2024:S0002-9610(24)00017-5. [PMID: 38281872 DOI: 10.1016/j.amjsurg.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/08/2024] [Accepted: 01/17/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Kentucky was among the first to adopt Medicaid expansion, resulting in reducing uninsured rates from 14.3% to 6.4%. We hypothesize that Medicaid expansion resulted in increased elective healthcare utilization and reductions in emergency treatments by patients suffering Inflammatory Bowel Disease (IBD). METHODS The Hospital Inpatient Discharge and Outpatient Services Database (HIDOSD) identified all encounters related to IBD from 2009 to 2020 in Kentucky. Several demographic variables were compared in pre- and post-Medicaid expansion adoption. RESULTS Our study analyzed 3386 pre-expansion and 24,255 post-expansion encounters for IBD patients. Results showed that hospitalization rates dropped (47.7%-8.4%), outpatient visits increased (52.3%-91.6%) and Emergency visits decreased (36.7%-11.4%). Admission following a clinical referral similarly increased with a corresponding drop in emergency room admissions. Hospital costs and lengths of stay also dropped following Medicaid expansion. CONCLUSION In the IBD population, Medicaid expansion improved access to preventative care, reduced hospital costs by decreasing emergency care, and increased elective care pathways.
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Affiliation(s)
- Brittany E Levy
- University of Kentucky Department of Surgery, 780 Rose Street, Lexington, KY, 40536, USA.
| | - Anthony A Mangino
- University of Kentucky Department of Biostatistics, 111 Washington Ave, Lexington, KY, 40536, USA.
| | - Jennifer T Castle
- University of Kentucky Department of Surgery, 780 Rose Street, Lexington, KY, 40536, USA.
| | - Wesley A Stephens
- University of Kentucky Department of Surgery, 780 Rose Street, Lexington, KY, 40536, USA.
| | - Hannah G McDonald
- University of Kentucky Department of Surgery, 780 Rose Street, Lexington, KY, 40536, USA.
| | - Jitesh A Patel
- University of Kentucky Division of Colorectal Surgery, 780 Rose Street, Lexington, KY 40536, USA.
| | - Sandra J Beck
- University of Kentucky Division of Colorectal Surgery, 780 Rose Street, Lexington, KY 40536, USA.
| | - Avinash S Bhakta
- University of Kentucky Division of Colorectal Surgery, 780 Rose Street, Lexington, KY 40536, USA.
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Roper KL, South AM, Palmer S, Johnson J, Sims L, Hustedde C, Mangino AA. Evaluation of a Novel Equity-Focused Curriculum for Early-Stage Medical Students. J Med Educ Curric Dev 2024; 11:23821205241230755. [PMID: 38361770 PMCID: PMC10868471 DOI: 10.1177/23821205241230755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/10/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVES Medical school curricula have increasingly incorporated topics and content related to health equity and affiliated social determinants of health. However, there is limited literature to guide how programs might measure the success of these initiatives. Previous studies assessed medical student attitudes and perceived knowledge, preparedness, and skills. Based on self-reported measures of these attributes, we compared within-group and between-group differences at the onset of a novel equity-focused curriculum implementation. METHODS A multi-component approach to "thread" lectures, panel discussions, and other content dedicated to health equity concepts was assessed using adapted versions of two validated survey instruments of the measured constructs. Baseline data were collected prior to coursework and at follow-up early in students' second year assessed change attributable to the equity-focused curriculum thread, with additional comparison to a cohort of second-year students who had no exposure to the curriculum. Data were collected at the beginning of academic years 2021-2022 and 2022-2023. RESULTS The multivariate analysis of variance indicated significant change over time (p < 0.001) with the analyses of variance identifying students' perceived current skills and topic knowledge increasing over time. No significant differences were found between two separate groups of M2 students. CONCLUSIONS Students' perceived skills at working with diverse patient populations and knowledge of topics focused on health equity increased across the study, despite a much smaller response rate for the same student cohort at follow-up. Students' perception that they are prepared to care for patients of diverse backgrounds was unaffected. Attitudinal assessment revealed a ceiling effect at baseline, which should be explored further with longitudinal assessment. For the ongoing effort to evaluate the success of equity-focused curricula and programs, this study contributes evidence of change on some but not all outcomes, and can help guide other programs in determining which outcomes best reflect areas of programmatic need and impact.
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Affiliation(s)
- Karen L. Roper
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Anna-Maria South
- Department of Internal Medicine, Division of Hospital Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Skyler Palmer
- University of Kentucky College of Medicine, Lexington, KY, USA
| | - Julia Johnson
- University of Kentucky College of Medicine, Lexington, KY, USA
| | - Lillian Sims
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Carol Hustedde
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Anthony A. Mangino
- Department of Biostatistics, University of Kentucky College of Public Health, Lexington, KY, USA
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Slade E, Mangino AA, Daniels L, Liford M, Quesinberry D. Modelling overdose case fatality rates over time: The collaborative process. Stat (Int Stat Inst) 2023. [DOI: 10.1002/sta4.510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Emily Slade
- Department of Biostatistics University of Kentucky Lexington Kentucky 40536 USA
| | - Anthony A. Mangino
- Department of Biostatistics University of Kentucky Lexington Kentucky 40536 USA
| | - Lara Daniels
- Kentucky Injury Prevention and Research Center University of Kentucky Lexington Kentucky 40536 USA
| | - Madison Liford
- Kentucky Injury Prevention and Research Center University of Kentucky Lexington Kentucky 40536 USA
| | - Dana Quesinberry
- Kentucky Injury Prevention and Research Center University of Kentucky Lexington Kentucky 40536 USA
- Department of Health Management and Policy University of Kentucky Lexington Kentucky 40536 USA
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Castle JT, Levy BE, Mangino AA, McDonald HG, McAtee E, Patel JA, Evers BM, Bhakta AS. Impact of the Affordable Care Act on Providing Equitable Healthcare Access for IBD in the Kentucky Appalachian Region. Dis Colon Rectum 2023; 66:1273-1281. [PMID: 37399124 PMCID: PMC10527721 DOI: 10.1097/dcr.0000000000002942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND Medicaid expansion improved insurance coverage for patients with chronic conditions and low income. The effect of Medicaid expansion on patients with IBD from high-poverty communities is unknown. OBJECTIVE This study aimed to evaluate the impact of Medicaid expansion in Kentucky on care for patients with IBD from the Eastern Kentucky Appalachian community, a historically impoverished area. DESIGN This study was a retrospective, descriptive, and ecological study. SETTINGS This study was conducted in Kentucky using the Hospital Inpatient Discharge and Outpatient Services Database. PATIENTS All encounters for IBD care for 2009-2020 for patients from the Eastern Kentucky Appalachian region were included. MAIN OUTCOME MEASURES The primary outcomes measured were proportions of inpatient and emergency encounters, total hospital charge, and hospital length of stay. RESULTS Eight hundred twenty-five preexpansion and 5726 postexpansion encounters were identified. Postexpansion demonstrated decreases in the uninsured (9.2%-1.0%; p < 0.001), inpatient encounters (42.7%-8.1%; p < 0.001), emergency admissions (36.7%-12.3%; p < 0.001), admissions from the emergency department (8.0%-0.2%; p < 0.001), median total hospital charge ($7080-$3260; p < 0.001), and median total hospital length of stay (4-3 days; p < 0.001). Similarly, postexpansion demonstrated increases in Medicaid coverage (18.8%-27.7%; p < 0.001), outpatient encounters (57.3%-91.9%; p < 0.001), elective admissions (46.9%-76.2%; p < 0.001), admissions from the clinic (78.4%-90.2%; p < 0.001), and discharges to home (43.8%-88.2%; p < 0.001). LIMITATIONS This study is subject to the limitations inherent in being retrospective and using a partially de-identified database. CONCLUSION This study is the first to demonstrate the changes in trends in care after Medicaid expansion for patients with IBD in the Commonwealth of Kentucky, especially Appalachian Kentucky, showing significantly increased outpatient care utilization, reduced emergency department encounters, and decreased length of stays. IMPACTO DE LA LEY DEL CUIDADO DE SALUD A BAJO PRECIO EN LA PROVISIN DE ACCESO EQUITATIVO A LA ATENCIN MDICA PARA LA ENFERMEDAD INFLAMATORIA INTESTINAL EN LA REGIN DE LOS APALACHES DE KENTUCKY ANTECEDENTES: La expansión de Medicaid mejoró la cobertura de seguro para pacientes con enfermedades crónicas y bajos ingresos. Se desconoce el efecto de la expansión de Medicaid en pacientes con enfermedad inflamatoria intestinal de comunidades de alta pobreza.OBJETIVO: Este estudio tuvo como objetivo evaluar el impacto de la expansión de Medicaid en Kentucky en la atención de pacientes con enfermedad inflamatoria intestinal de la comunidad de los Apalaches del este de Kentucky, un área históricamente empobrecida.DISEÑO: Este estudio fue un estudio retrospectivo, descriptivo, ecológico.ESCENARIO: Este estudio se realizó en Kentucky utilizando la base de datos de servicios ambulatorios y de alta hospitalaria en pacientes hospitalizados.PACIENTES: Se incluyeron todos los encuentros para la atención de la enfermedad inflamatoria intestinal de 2009-2020 para pacientes de la región de los Apalaches del este de Kentucky.MEDIDAS DE RESULTADO PRINCIPALES: Los resultados primarios medidos fueron proporciones de encuentros de pacientes hospitalizados y de emergencia, cargo hospitalario total y duración de la estancia hospitalaria.RESULTADOS: Se identificaron 825 encuentros previos a la expansión y 5726 posteriores a la expansión. La posexpansión demostró disminuciones en los no asegurados (9.2% a 1.0%, p < 0.001), encuentros de pacientes hospitalizados (42.7% a 8.1%, p < 0.001), admisiones de emergencia (36.7% a 12.3%, p < 0,001), admisiones desde el servicio de urgencias (8.0% a 0.2%, p < 0.001), la mediana de los gastos hospitalarios totales ($7080 a $3260, p < 0.001) y la mediana de la estancia hospitalaria total (4 a 3 días, p < 0.001). De manera similar, la cobertura de Medicaid (18.8% a 27.7%, p < 0.001), consultas ambulatorias (57.3% a 91.9%, p < 0.001), admisiones electivas (46.9% a 76.2%, p < 0.001), admisiones desde la clínica (78.4% al 90.2%, p < 0.001), y las altas domiciliarias (43.8% al 88.2%, p < 0.001) aumentaron después de la expansión.LIMITACIONES: Este estudio está sujeto a las limitaciones inherentes de ser retrospectivo y utilizar una base de datos parcialmente desidentificada.CONCLUSIONES: Este estudio es el primero en demostrar los cambios en las tendencias en la atención después de la expansión de Medicaid para pacientes con enfermedad inflamatoria intestinal en el Estado de Kentucky, especialmente en los Apalaches de Kentucky, mostrando un aumento significativo en la utilización de la atención ambulatoria, visitas reducidas al departamento de emergencias y menor duración de la estancia hospitalaria. (Traducción-Dr. Jorge Silva Velazco ).
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Affiliation(s)
- Jennifer T. Castle
- Department of Surgery, University of Kentucky, Lexington, Kentucky
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Brittany E. Levy
- Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - Anthony A. Mangino
- Department of Biostatistics, University of Kentucky, Lexington, Kentucky
| | - Hannah G. McDonald
- Department of Surgery, University of Kentucky, Lexington, Kentucky
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Erin McAtee
- Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - Jitesh A. Patel
- Department of Surgery, University of Kentucky, Lexington, Kentucky
- Division of Colorectal Surgery, University of Kentucky, Lexington, Kentucky
| | - B. Mark Evers
- Department of Surgery, University of Kentucky, Lexington, Kentucky
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Avinash S. Bhakta
- Department of Surgery, University of Kentucky, Lexington, Kentucky
- Division of Colorectal Surgery, University of Kentucky, Lexington, Kentucky
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Mangino AA, Bolin JH, Finch WH. Fixed Effects or Mixed Effects Classifiers? Evidence From Simulated and Archival Data. Educ Psychol Meas 2023; 83:710-739. [PMID: 37398843 PMCID: PMC10311958 DOI: 10.1177/00131644221108180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
This study seeks to compare fixed and mixed effects models for the purposes of predictive classification in the presence of multilevel data. The first part of the study utilizes a Monte Carlo simulation to compare fixed and mixed effects logistic regression and random forests. An applied examination of the prediction of student retention in the public-use U.S. PISA data set was considered to verify the simulation findings. Results of this study indicate fixed effects models performed comparably with mixed effects models across both the simulation and PISA examinations. Results broadly suggest that researchers should be cognizant of the type of predictors and data structure being used, as these factors carried more weight than did the model type.
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Affiliation(s)
- Anthony A. Mangino
- Ball State University, Muncie, IN, USA
- University of Kentucky, Lexington, USA
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Fritz MK, Mangino AA, Hunt TV, Pitcock CT, Dugan AJ, Karri K, Yarra P. Clinical Outcomes of Oral Zinc Therapy in Hepatic Encephalopathy Treatment. Ann Pharmacother 2023; 57:899-906. [PMID: 36367093 DOI: 10.1177/10600280221134283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Additional therapies for hepatic encephalopathy (HE) treatment are warranted. There are data evaluating the use of zinc for HE; however, clinical outcomes, specifically in the United States, are unknown. OBJECTIVE To compare 30-day and 1-year all-cause readmission rates in patients with cirrhosis complicated by HE on lactulose and rifaximin to those on lactulose, rifaximin, and zinc. METHODS This retrospective study included patients admitted with documented cirrhosis and home medications of lactulose and rifaximin, with or without zinc. Patients were stratified into 2 groups: those receiving lactulose and rifaximin for HE (control) and those receiving lactulose, rifaximin, and zinc for HE (treatment). The primary outcomes were 30-day and 1-year all-cause readmission rates. RESULTS One-hundred fifty-seven patients were included (102 in control group, 55 in treatment group). Regarding 30-day and 1-year all-cause readmission rates, there was no difference between the control and treatment groups. CONCLUSION AND RELEVANCE This is the first study conducted in the United States evaluating zinc for HE treatment. Zinc did not impact 30-day or 1-year all-cause readmission rates. Further studies are warranted to evaluate the potential benefit of zinc for HE, possibly in correlation with Model for End-stage Liver Disease-Sodium (MELD-Na) scores.
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Affiliation(s)
| | - Anthony A Mangino
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - Taylor V Hunt
- Department of Pharmacy, UK HealthCare, Lexington, KY, USA
| | | | - Adam J Dugan
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - Kishore Karri
- Department of Hospital Medicine, UK HealthCare, Lexington, KY, USA
| | - Pradeep Yarra
- Department of Hospital Medicine, UK HealthCare, Lexington, KY, USA
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Thomas KJ, Mangino AA, Walker SJ. Translational Research on Caregiver Reading and Playing Behaviors: Evidence from an In Vivo Community-based Intervention throughout the COVID-19 Pandemic. J Child Fam Stud 2022; 31:2187-2201. [PMID: 35729872 PMCID: PMC9189447 DOI: 10.1007/s10826-022-02334-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 06/15/2023]
Abstract
This study provides a rigorous assessment of a community-based early child development (ECD) intervention to understand the drivers of caregivers' reading and playing practices in a low-resourced township in South Africa. Mentors visited 157 homes biweekly (2474 observations from 2019-21; children ages 0-5), completing surveys regarding caregiver behaviors and engagement. One hundred and fifty-seven caregivers (mostly Black, Zulu women) participated in the program during this time period and completed surveys biannually on their support system (modified version of the Multidimensional Scale of Perceived Support) and ECD beliefs (modified versions of the Parental Play Beliefs Scale and the Parent Opinion Survey). Longitudinal Hierarchical Linear Model revealed that several behaviors and beliefs significantly predicted positive parenting behaviors. Regression discontinuity plots suggest that positive parenting behaviors could continue and even improve following Covid-19 shutdowns, especially in homes with more intervention visits. This paper provides translational evidence on tangible ways interventions can engage caregivers in stimulating ECD behaviors.
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Abstract
Oftentimes in many fields of the social and natural sciences, data are obtained within a nested structure (e.g., students within schools). To effectively analyze data with such a structure, multilevel models are frequently employed. The present study utilizes a Monte Carlo simulation to compare several novel multilevel classification algorithms across several varied data conditions for the purpose of prediction. Among these models, the panel neural network and Bayesian generalized mixed effects model (multilevel Bayes) consistently yielded the highest prediction accuracy in test data across nearly all data conditions.
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Affiliation(s)
| | - W Holmes Finch
- Ball State University, Teachers College, Muncie, IN, USA
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Mangino AA, Smith KA, Finch WH, Hernández-Finch ME. Improving Predictive Classification Models Using Generative Adversarial Networks in the Prediction of Suicide Attempts. Measurement and Evaluation in Counseling and Development 2021. [DOI: 10.1080/07481756.2021.1906156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Thomas KJ, Rodrigues H, de Oliveira RT, Mangino AA. What Predicts Pre-adolescent Compliance with Family Rules? A Longitudinal Analysis of Parental Discipline, Procedural Justice, and Legitimacy Evaluations. J Youth Adolesc 2019; 49:936-950. [PMID: 31707580 DOI: 10.1007/s10964-019-01158-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/20/2019] [Indexed: 11/29/2022]
Abstract
During adolescence, individuals make judgements on the legitimacy of authorities to make and enforce rules and they differentiate between various types of rules. This study tracked a socially and racially diverse sample (47% White) of 800 Brazilians for three years, ages 11-13 (50% female), allowing for variation between issues and individuals. The strongest predictors of compliance were adolescents' beliefs that parents were legitimate authorities. Other significant predictors were authorities' procedural justice and disciplinary practices. Legitimacy attributions partially mediated the relationship between procedural justice and compliance. Compliance and legitimacy varied across issues. Across time, parenting variables diminished in predictive strength while legitimacy attributions increased. Procedural justice practices may partially establish parental legitimacy, while disciplinary practices are less effective and perhaps counter-productive.
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Affiliation(s)
- Kendra J Thomas
- College of Applied Behavior Science, University of Indianapolis, 1400 E Hanna Ave, Indianapolis, IN, 46227, USA.
| | - Herbert Rodrigues
- Sociology and Anthropology, Missouri State University, 901S. National Ave, Springfield, MO, 65897, USA
| | - Renan T de Oliveira
- Núcleo de Estudos da Violência, Universidade de São Paulo, Av. Prof. Almeida Prado, 520 Cidade Universitária São Paulo, São Paulo, SP, Brazil
| | - Anthony A Mangino
- Department of Educational Psychology, Ball State University, Teachers College, Room 505, Muncie, IN, 47306, USA
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