Improving test efficiency for a grid multidimensional computerized classification test by the application of a conditional latent-trait distribution to a sequential probability ratio test.

The measurement efficiency of a multidimensional computerized adaptive testing (MCAT) can be improved by taking the correlations between the dimensions into account during the item selection and latent-trait estimation procedures (Segall, 1996; Wang & Chen, 2004). Although a multidimensional computerized classification test (MCCT), which was based on a multidimensional itemresponse model, was previously found more efficient than its unidimensional counterpart, the difference was negligible (Seitz & Frey, 2013); the researchers had adopted a sequential probability ratio test (SPRT) as the termination criterion in this MCCT study. To make a classification decision on each dimension, which is called a grid classification (Wang et al., 2019), only items that loaded on that dimension were used to calculate the likelihood ratio, which squandered the available information of the correlations between the dimensions. The current study utilizes such useful information to improve the measurement efficiency of the MCCT by applying a conditional distribution of the latent-trait estimates and then including all the administered items to calculate the likelihood ratio in the SPRT. The performance of this newly proposed method was evaluated through a series of simulation studies. The results showed that the proposed method can sizably improve the measurement efficiency of an MCCT by saving 1% to 32% of the test length in comparison with the SPRT when the two test dimensions are at least moderately correlated. The findings and further applications of this study are discussed.

Safe sexual behaviors intention among female youth: The construction on extended theory of planned behavior.

AIM: To examine female youth's intentions for safe sex with the relationship partners based on the extended theory of planned behaviour (TPB) model and explore the direct and indirect impact of parent-child communication about sex, peer interaction related to sexual issues, and exposure to sexually explicit materials on female youth's safe sexual behaviour intentions. DESIGN: A non-experimental, cross-sectional research design. METHODS: A convenience sampling was employed for data collection and 731 female youth aged 15-24 years old were recruited in 2013-2014. An anonymous, self-report structured questionnaire was used as a research instrument to collect participants' basic information and measure the internal and additional variables in the extended TPB model. RESULTS: The extended TPB model explained 42-45% of the total variance. Perceived behavioural control (PBC) and subjective norms had a positive effect on female youth's intentions for contraceptive use, condom use, and dual use with relationship partner; PBC was found to have the greatest influence. Among the additional variables in the extended TPB model, more parent-child communication about sex was found to lead to more positive dual use intentions. More peer interaction related to sexual issues was found to lead to less dual use intentions. CONCLUSIONS: To improve female youth's sexual health, the priorities are to reinforce their PBC and subjective norms and enhance parent-child communication about sex. Future efforts should strengthen sex education in families and schools and shape a social environment that facilitates safe sex. IMPACT: The extended TPB model can successfully predict female youth's safe sexual behaviour intentions. Empowering female youth to establish a sense of subjectivity and awareness of being a mature individual with physical autonomy, is importance for their sexual health.

Heroin craving and its correlations with clinical outcome indicators in people with heroin dependence receiving methadone maintenance treatment.

BACKGROUND: Craving for substance use has been added as one of the diagnostic criteria of substance use disorders in DSM-5. However, further research is necessary to examine and expand the clinical potential of craving in the assessment and treatment for heroin users. This study aimed to examine the psychometrics of the Desire for Drug Questionnaire-Chinese Mandarin version (DDQ-CM) and its clinical utility of assessing craving for heroin measured among heroin users with methadone maintenance treatment (MMT). METHOD: Self-reported craving for heroin use was measured on the DDQ-CM and visual analog scale among 314 intravenous heroin users receiving MMT. Self-reported heroin dependence, attitude toward heroin use, readiness to change heroin use, and depression were collected. RESULTS: The results found that although the original three-factor model was acceptable for applying the DDQ-CM for heroin users with MMT, only the concurrent validity of the subscales of Desire and Intention and Negative Reinforcement was supported but not that of Control. Meanwhile, the levels of craving on the subscales of Desire and Intention and of Negative Reinforcement on the DDQ-CM were positively associated with the levels of heroin dependence, positive and negative attitudes toward heroin use, and depression, but negatively associated with readiness to change heroin use. CONCLUSIONS: This study supported the application of the subscales of Desire and Intention and Negative Reinforcement on the DDQ-CM to measure heroin craving in Taiwanese-Chinese heroin users and supported the clinical implication of craving in heroin users with MMT.

Childhood Adversity, Timing of Puberty and Adolescent Depressive Symptoms: A Longitudinal Study in Taiwan.

Childhood adversity contributes to depressive symptoms in adolescence, but far less research has focused on an Asian context. This study aims to identify the long-term impact of childhood adversity on adolescents' depressive symptoms and whether this association is moderated by gender and early pubertal timing in Taiwan. Data in this study are from the Taiwan Education Panel Survey, a longitudinal study that surveyed and followed 4261 junior high school students in year 2001 (at age 13) and three more waves (at ages 15, 17, and 18). Conditional latent growth model results show that having adversity is positively associated with the intercept, but negatively associated with the linear trend of changes of depressive symptoms in adolescence (p < .01). Early pubertal timing is only positively associated with baseline levels for boys (p < .01). Both adversity and early pubertal timing contributes to depressive symptoms when adolescents start junior high school.

Mediating effects of depression and anxiety on the relationship between bullying involvement and pain problems among adolescents in Taiwan.

BACKGROUND: This study aimed to examine the mediating effects of depression and anxiety on the relationships of bullying victimization and perpetration with pain among adolescents in Taiwan. METHOD: A total of 4976 students of junior and senior high schools completed the questionnaires. Bullying victimization and perpetration, pain problems, depression, and anxiety were assessed. The mediating effects of depression and anxiety on the relationship between bullying involvement and pain problems and the moderating effects of sex on the medicating roles of depression and anxiety were examined by structural equation model. RESULTS: Both depression and anxiety were significant mediators of the relationship between bullying victimization and pain problems among adolescents. Depression was also a significant mediator of the relationship between bullying perpetration and pain problems among adolescents. Sex had no moderating effect on the mediating role of depression/anxiety on the association between bullying involvement and pain problems. CONCLUSIONS: Medical and educational professionals should survey and intervene in depression and anxiety when managing pain problems among adolescents involved in bullying.

The relation between family adversity and social anxiety among adolescents in Taiwan: effects of family function and self-esteem.

This study aimed to examine the relationship between three indicators of family adversity (domestic violence, family substance use, and broken parental marriage) and the severity of social anxiety among adolescents in Taiwan, as well as the mediating effects of perceived family function and self-esteem on that relationship, using structural equation modeling (SEM). A total of 5607 adolescents completed the social anxiety subscale of the Multidimensional Anxiety Scale for Children; the Family APGAR Index; the Rosenberg Self-Esteem Scale; and a questionnaire for domestic violence, family substance use, and broken parental marriage. The relation between family adversity and social anxiety, as well as the mediating effects of family function and self-esteem, was examined using SEM. SEM analysis revealed that all three indicators of family adversity reduced the level of family function, that decreased family function compromised the level of self-esteem, and that a low level of self-esteem further increased the severity of social anxiety. The results indicated that, along with intervening to change family adversity, evaluating and improving adolescents' self-esteem and family function are also important clinical issues when helping adolescents reduce their social anxiety.

Wechsler Intelligence Scale for Children 4th edition-Chinese version index scores in Taiwanese children with attention-deficit/hyperactivity disorder.

AIM: The Wechsler Intelligence Scale for Children 4th edition-Chinese version (WISC-IV-Chinese) has been in clinical use in Taiwan since 2007. Research is needed to determine how the WISC-IV, modified from its earlier version, will affect its interpretation in clinical practice in a Mandarin-speaking context. METHODS: We attempted to use WISC-IV-Chinese scores to identify the cognitive strengths and weaknesses in 334 Taiwanese children with attention-deficit/hyperactivity disorder (ADHD). Comparison of cognitive profiles of WISC-IV-Chinese scores between subtypes of ADHD was also performed. RESULTS: The results indicated that the four-factor model of the WISC-IV-Chinese fitted well for Taiwanese children with ADHD. The profiles showed that performance in the index score of the Processing Speed Index was the weakness domain for the Taiwanese children with ADHD, as confirmed by two different kinds of analytic methods. Cognitive profile analysis of ADHD subtypes revealed children with inattentive subtypes to have a greater weakness in processing speed performance. CONCLUSION: The implications of the profiles of the index scores on the WISC-IV-Chinese version for Taiwanese children with ADHD were explored.

Measurement equivalence across child self-reports and parent-proxy reports in the Chinese version of the pediatric quality of life inventory version 4.0.

An important assumption for comparing children's quality of life (QoL) between children's and parents' perceptions is that measurement equivalence/invariance (ME/I) exists. The ME/I across the child- and parent-reported Chinese PedsQL was examined, and the latent means between child self-reports and parent-proxy reports were compared. Third-grade to sixth-grade children (n = 519) and their parents (n = 270) respectively completed the child- and parent-reported PedsQL. Seventy-eight parents completed parent-proxy reports twice. Full ME/I across child and parent reports was found in first- and second-order factor loadings. Partial ME/I was supported in item intercepts and item residual variances. The latent means of child self-reports and of parent-proxy reports were not significantly different, which suggested interchangeability between child- and parent-reported PedsQL. The ME/I results support the use of PedsQL scores to compare children's and parents' perceptions of children's QoL.

Transient insomnia versus chronic insomnia: a comparison study of sleep-related psychological/behavioral characteristics.

OBJECTIVES: Vulnerability to transient insomnia is regarded as a predisposing factor for chronic insomnia. However, most individuals with transient insomnia do not develop chronic insomnia. The current study investigated the differential contributing factors for these two conditions to further the understanding of this phenomenon. METHOD: Chronic insomnia patients and normal sleepers with high and low vulnerability to transient insomnia completed measures of pre-sleep arousal, dysfunctional sleep beliefs, and sleep-related safety behaviors. RESULTS: Both cognitive and somatic pre-sleep arousals were identified as significant predictors for transient insomnia. Dysfunctional beliefs regarding worry about insomnia and cognitive arousal were predictors for chronic insomnia. Sleep-related safety behavior, although correlated with insomnia severity, was not a significant predictor for both conditions. CONCLUSIONS: Dysfunctional beliefs associated with worry and losing control over sleep are the most critical factors in differentiating chronic insomnia from transient insomnia. These factors should be addressed to help prevent individuals with high sleep vulnerability from developing chronic sleep disturbance.

Factor structure of the Center for Epidemiologic Studies Depression Scale in Taiwanese adolescents.

BACKGROUND: The original study of Radloff (Appl Psychol Meas. 1977. 1:385-401) on the Center for Epidemiologic Studies Depression Scale (CES-D) indicated a 4-factor model in the adult population. However, the factor structure of the CES-D in Asian adolescents has not been extensively validated. The aim of this study was to examine the factor structure of the Chinese version of the CES-D in a large representative Taiwanese adolescent population. METHOD: A total of 10 116 adolescents completed the Chinese version of the CES-D. We used confirmatory factor analysis to examine the adequacy of 5 models of the factor structure in adolescents who were divided into 4 groups by sex and age. We also enrolled the variables of suicide tendency, insomnia, and peer relationships into the confirmatory factor analysis to examine the factor structure of the CES-D and examined the correlations between the CES-D factors and these variables. RESULTS: The results of this study indicated that the four-factor model (depressed affect, somatic symptoms, interpersonal problems, and positive affect) had the highest validity in Taiwanese adolescents. We also found that although the 4 factors of the CES-D were correlated with each other, their correlations with suicide tendency, insomnia, and peer relationships were different. CONCLUSIONS: This study supported the usefulness of the Chinese version of the CES-D as a tool to understand the concept of depression in Taiwanese adolescents.

Diabetes Empowerment Process Scale: development and psychometric testing of the Chinese version.

AIM: This paper is a report of the development and psychometric testing of the Chinese version of the Diabetes Empowerment Process Scale. BACKGROUND: In people living with diabetes, empowerment can improve metabolic and psychosocial outcomes. A scale for measuring empowerment processes can also help healthcare professionals to optimize their empowering actions and would improve their interactions with people living with diabetes. METHOD: Based on literature reviews and interviews with people living with diabetes, a 27-item Chinese Diabetes Empowerment Process Scale was developed. Fifteen items were produced after item analysis and content validity testing. To test construct validity, concurrent validity and internal consistency, 211 outpatients living with diabetes completed the Chinese Diabetes Empowerment Process Scale, a Self-care Behaviour Scale and a Diabetes Empowerment Scale. Test-retest reliability was also analysed with 30 patients. The study was conducted in 2008 and 2009 in Taiwan. RESULTS: Confirmatory factor analysis indicated that a second-order factorial model with four subscales and 15 items best fitted the data. The four subscales were Mutual participation, Raising awareness, Providing necessary information and Open communication. Scores on the Chinese Diabetes Empowerment Process Scale correlated statistically significantly with those on the Self-care Behaviour Scale (r=0.21-0.40; P<0.01) and Diabetes Empowerment Scale (r=0.35-0.65; P<0.01). Reliability was supported by acceptable Cronbach's α (range: 0.73-0.91) and test-retest reliability scores (range: 0.75-0.83). CONCLUSION: The Chinese Diabetes Empowerment Process Scale has satisfactory validity and reliability for measuring the empowerment process of health professionals. Further studies are needed to test the applicability of the scale to other populations.

Child-Mother Agreement on Experiences of School Bullying Involvement in Children With ADHD.

Objective: To examine the levels of agreement between the reports of 452 children and their mothers on children's experiences of bullying involvement at school and investigate the factors influencing the levels of agreement in children with ADHD. Method: The levels of agreement between children's and mothers' reports were examined. The influence of age, sex, ADHD symptoms, and psychiatric comorbidities on the levels of agreement was also examined. Results: The results indicated low agreement on the experiences of bullying involvement in child-mother ADHD dyads. Age and hyperactivity-impulsivity, oppositional, depressive, and anxiety symptoms significantly influenced the levels of agreement on the victimization of physical bullying. Age significantly influenced the levels of agreement on the perpetration of physical bullying. Conclusion: Multiple sources of information are required when clinicians assess the experiences of bullying involvement at school in children with ADHD. The factors influencing the levels of agreement should be considered.

Suicide risk and its correlate in adolescents who experienced typhoon-induced mudslides: a structural equation model.

BACKGROUND: The aims of this study were to examine the direct and indirect effects of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), disaster-exposure experience, gender, and perceived family support on suicide risk (including suicide ideation and attempt) in adolescents 3 months after they had experienced Typhoon Morakot-associated mudslides in Taiwan using a structural equation model (SEM). METHODS: Two hundred and seventy-one adolescents in the worst affected mountainous regions of southern Taiwan were recruited. Suicide risk and diagnoses of PTSD and MDD were assessed using the Mini-International Neuropsychiatric Interview for Children and Adolescents. The direct and indirect effects of PTSD, MDD, disaster-exposure experience, gender, and perceived family support on suicide risk were examined using SEM. RESULTS: The results of SEM indicated that increased disaster-exposure experience and female gender had direct influences on an increased suicide risk and indirect influences on increased suicide risk that were mediated by PTSD and MDD. Perceived high family support directly decreased suicide risk. Both PTSD and MDD had direct influences on an increased suicide risk, and PTSD had an indirect influence on an increased suicide risk that was mediated by MDD. CONCLUSIONS: Gender, disaster-exposure experience, perceived high family support, PTSD, and MDD all had effects on suicide risk in adolescents who had experienced the threat of mudslides caused by Typhoon Morakot. The results provide healthcare professionals with a comprehensive understanding to develop intervention programs to prevent and intervene in suicide risk.

Internalizing and externalizing problems in adolescent aggression perpetrators, victims, and perpetrator-victims.

The aims of this study were to examine the risks of internalizing and externalizing problems in aggression perpetrators, victims, and perpetrator-victims and their sex differences, and to examine the effects of the level of aggression involvement on internalizing and externalizing problems. Eight thousand eighty-five adolescents in Taiwan completed the questionnaires. The associations of aggression involvement and the level of aggression involvement with internalizing and externalizing problems were examined. Compared with the neutrals, pure aggression perpetrators and perpetrator-victims had higher risks for internalizing and externalizing problems and pure victims had higher risks for internalizing problems and theft. Differences in the risks for internalizing and externalizing problems were found among 3 groups with aggression involvement. Levels of aggression involvement increased the risks for some internalizing and externalizing problems. Sex differences were also found. Internalizing and externalizing problems need to be detected among adolescents involved in aggression, especially among perpetrator-victims, those with high levels of aggression involvements, and females.

The association between problematic cellular phone use and risky behaviors and low self-esteem among Taiwanese adolescents.

BACKGROUND: Cellular phone use (CPU) is an important part of life for many adolescents. However, problematic CPU may complicate physiological and psychological problems. The aim of our study was to examine the associations between problematic CPU and a series of risky behaviors and low self-esteem in Taiwanese adolescents. METHODS: A total of 11,111 adolescent students in Southern Taiwan were randomly selected into this study. We used the Problematic Cellular Phone Use Questionnaire to identify the adolescents with problematic CPU. Meanwhile, a series of risky behaviors and self-esteem were evaluated. Multilevel logistic regression analyses were employed to examine the associations between problematic CPU and risky behaviors and low self-esteem regarding gender and age. RESULTS: The results indicated that positive associations were found between problematic CPU and aggression, insomnia, smoking cigarettes, suicidal tendencies, and low self-esteem in all groups with different sexes and ages. However, gender and age differences existed in the associations between problematic CPU and suspension from school, criminal records, tattooing, short nocturnal sleep duration, unprotected sex, illicit drugs use, drinking alcohol and chewing betel nuts. CONCLUSIONS: There were positive associations between problematic CPU and a series of risky behaviors and low self-esteem in Taiwanese adolescents. It is worthy for parents and mental health professionals to pay attention to adolescents' problematic CPU.

Factor structure of the Chinese version of the University of Rhode Island change assessment in Taiwanese adolescents who abuse MDMA or methamphetamine.

OBJECTIVE: The University of Rhode Island Change Assessment (URICA) is a widely used tool for measuring subjects' readiness to change substance-using behaviors. The aim of this study was to examine the factor structure of the Chinese version of the URICA (C-URICA) in Taiwanese adolescents who have used methylenedioxymethamphetamine (MDMA) or methamphetamine (MAMP). METHODS: Pre-test and post-test data from the C-URICA from 92 adolescents in a juvenile abstinence center who had used MDMA or MAMP were analyzed. We used confirmatory factor analysis (CFA) to examine the adequacy of the factor structure of the C-URICA. RESULTS: CFA indicated that a three-factor structure (pre-contemplation, contemplation + action, maintenance) had a better goodness of fit than four-factor (pre-contemplation, contemplation, action, maintenance), and one-factor structures. CONCLUSIONS: The results indicated that the URICA may have different factor structures when used in the population different from the original adult population with alcohol drinking.

Risk behaviours among early adolescents: risk and protective factors.

AIM: This paper is a report of a study conducted to examine the influence of risk/protective factors on risk behaviours of early adolescents and whether protective factors moderate their impact. BACKGROUND: An understanding of how risk and protective factors operate to influence risk behaviours of early adolescents will better prepare nurses to perform interventions appropriately to reduce risk behaviours of early adolescents. METHOD: A cross-sectional study was carried out, based on a sample of public junior high schools (from 7th to 9th grades) in one city and one county in Taiwan. An anonymous questionnaire designed to measure five risk factors, six protective factors and risk behaviours was administered from October 2006 to March 2007. Data from 878 students were used for the present analysis. Pearson's correlations, anova with random effect models, and generalized linear models were used to analyse the statistically significant explanatory variables for risk behaviours. FINDINGS: Gender, perceived father's risk behaviour, perceived mother's risk behaviour, health self-efficacy, interaction of health self-efficacy and perceived peers' risk behaviour, and interaction of emotional regulation and perceived peers' risk behaviour were statistically significant explanatory variables of risk behaviours. Health self-efficacy and emotional regulation moderated the negative effects of peers' perceived risk behaviour on risk behaviours. CONCLUSION: All protective factors were negative statistically correlated with risk behaviours, and all risk factors positively statistically correlated with risk behaviours. Male adolescents should be considered an at-risk group for risk behaviour intervention. Nurses could provide early adolescents with training regarding health self-efficacy improvement, self-esteem enhancement, emotional regulation skills to reduce their risk behaviours.

Factor structure, reliability and validity of the Taiwanese version of the Multidimensional Anxiety Scale for Children.

The aims of this study were to examine the factor structure, internal consistency 1 month test-retest reliability and the discriminant validity for the diagnosis of anxiety disorder of the Taiwanese version of the Multidimensional Anxiety Scale for Children (MASC-T). A total of 12,536 Taiwanese children and adolescents in the community were recruited to examine the adequacy of the original four-factor structure of the MASC-T by confirmatory factor analysis and the internal-consistency reliability by Cronbach's alpha across gender and age. The 1 month test-retest reliability was examined using intraclass correlation coefficients (ICC) in 105 children and adolescents in the community. The discriminant validity of the MASC-T for the diagnosis of anxiety disorder was examined in 132 children and adolescents from clinical units. The results of this study supported the four-factor structure of the MASC-T in Taiwanese children and adolescents and the four-factor structure was invariant across gender and age. The 1 month test-retest reliability of the MASC-T was in the satisfactory to excellent range and the internal consistency reliability of the Physical Symptoms, Harm Avoidance, and Social Anxiety scales was acceptable. The discriminant validity of the total MASC-T and the anxiety disorder index for the diagnosis of any anxiety disorder was also confirmed. These results indicate that the MASC-T is appropriate for assessing anxiety in Taiwanese children and adolescents.

Psychometric evaluation of the stress scale for parents with cleft lip and/or palate children--a preliminary study.

OBJECTIVE: To develop the Stress Scale for Parents With Cleft Lip and/or Palate Children in Taiwan and to evaluate the psychometric properties of the scale with a group of parents who have children with cleft lip and/or palate. DESIGN: In phase 1, qualitative procedures were conducted in constructing the item pool for the Stress Scale for Parents With Cleft Lip and/or Palate Children. Psychometric properties of the scale were assessed in phase 2. SETTING: Outpatient department of a children's hospital in northern Taiwan. PARTICIPANTS: Phase 1 included 21 parents of children with cleft lip and/or palate. Phase 2 included 184 parents of children with cleft lip and/or palate. INTERVENTIONS: The item pool was developed by interview, content analysis, and literature review. Problematic items were identified by item analysis. MAIN OUTCOME MEASURES: Exploratory factor analysis was used to examine the construct validity. Reliabilities were evaluated by Cronbach alpha and intraclass correlation coefficients. RESULTS: Thirty-three items with a content validity index greater than .80 were recognized. They were grouped into four categories by exploratory factor analysis and accounted for 42.34% of the total variance. Internal consistency reliability was high for the total scale (Cronbach α = .90) and ranged from .71 to .84 on the subscales. Test-retest reliability with intraclass correlation coefficient was .94 on the total scale (p < .0001, 95% confidence interval) and from .90 to .96 for the subscales. CONCLUSIONS: The Stress Scale for Parents With Cleft Lip and/or Palate Children appears to be a reliable tool with strong evidence of content and construct validity that may be useful in assessing parental stress in the caretakers of children with cleft lip and/or palate.

An Exploratory Strategy to Identify and Define Sources of Differential Item Functioning.

The sources of differential item functioning (DIF) items are usually identified through a qualitative content review by a panel of experts. However, the differential functioning for some DIF items might have been caused by reasons outside of the experts' experiences, leading to the sources for these DIF items possibly being misidentified. Quantitative methods can help to provide useful information, such as the DIF status and the number of sources of the DIF, which in turn help the item review and revision process to be more efficient and precise. However, the current quantitative methods assume all possible sources should be known in advance and collected to accompany the item response data, which is not always the case in reality. To this end, an exploratory strategy, combined with the MIMIC (multiple-indicator multiple-cause) method, that can be used to identify and name new sources of DIF is proposed in this study. The performance of this strategy was investigated through simulation. The results showed that when a set of DIF-free items can be correctly identified to define the main dimension, the proposed exploratory MIMIC method can accurately recover a number of possible sources of DIF and the items that belong to each. A real data analysis was also implemented to demonstrate how this strategy can be used in reality. The results and findings of this study are further discussed.