Sleep disturbances are common in persons with Alzheimer's disease (AD) (Hart et al., 2003) and pose a great strain on their family caregivers (Hope, Keene, Gedling, Fairburn, & Jacoby, 1998) including their emotional functioning (Schulz & Martire, 2004). The current study is the first to examine the impact of daily sleep and mood in persons with AD on their caregiver's sleep and emotional functioning. The study examined sleep and mood across eight days in 40 family caregivers of persons with AD. It was hypothesized that poor sleep in the person with AD person would have a negative impact on caregiver emotional functioning the next day. Furthermore, it was hypothesized that sleep disruption or the mood in the person with AD would mediate the association between AD person sleep and caregiver mood. The results demonstrated a direct link between poor sleep in persons with AD and caregiver negative affect (NA), but not positive affect (PA). The results also indicated that poor caregiver sleep and NA in the person with AD partially mediated the relationship between AD person sleep and caregiver NA. The results suggest that addressing AD person and caregiver sleep and AD person affect may improve caregiver emotional functioning. Improving AD person sleep and mood, and caregiver emotional functioning has important implications that may prolong the time until institutionalization.

Procrastination is a problem for many individuals - especially university students - who may struggle to keep up not only with the requirements of a demanding life domain (i.e., education), but also with the demands of their other life domains (e.g., health, family, finances, and community). Past research on procrastination has mainly focused on understanding why some individuals procrastinate more than others and the consequences of procrastination for those individuals (i.e., between-person level). However, given that almost all individuals procrastinate to a certain extent, there has been an increased interest over the last few years in studying procrastination as a phenomenon that fluctuates within each person, especially over time (i.e., within-person level). Inspired by these burgeoning multilevel perspectives, the purpose of my doctoral thesis was to propose three new multilevel studies to increase our understanding of the antecedents and outcomes of procrastination when comparing university students to one another (i.e., between-person level) and when comparing time points and contexts within each student (i.e., within-person level). In Article 1, I examined the influence of between-person procrastination on the within-person achievement trajectory of students from their last year of high school to their first year at university. A sample of 269 first-year undergraduate students completed a self-reported measure of trait procrastination and their objective grades were obtained at three time points, namely the last year of high school, the first semester at university, and the second semester at university. Using piecewise multilevel growth modeling, the results revealed that students who procrastinated more than their peers tended to have a larger grade decrease from high school to the first semester at university. Although procrastination did not influence the grade change from the first semester to the second semester at university, students who procrastinated more tended to maintain their achievement disadvantage compared to students who procrastinated less. In Article 2, I examined whether procrastination could act as a mediator in the associations between two dimensions of motivation and achievement and affective outcomes both when comparing students to one another (i.e., between-person level) and when comparing the courses taken by each student during a semester to each other (i.e., within-person level). A sample of 359 university students completed self-reported measures of autonomous/controlled motivation, procrastination, and positive/negative affect in each course and their final course grades were obtained at the end of the semester. Using multilevel structural equation modeling, the results showed that procrastination was associated with worse achievement and affective outcomes at both levels of analysis. However, controlled motivation was significantly positively associated with procrastination only at the between-person level, whereas autonomous motivation was significantly negatively associated with procrastination only at the within-person level. This study highlights that, although procrastination tends to generally be detrimental to the success and emotional well-being of students, the motivational antecedent of procrastination differs depending on the level of analysis. In Article 3, I went beyond the academic domain by examining whether procrastination could act as a mediator in the associations between two dimensions of motivation and achievement and affective outcomes both when comparing students to one another (i.e., between-person level) and when comparing the life domains in which each student is invested to each other (i.e., within-person level). A sample of 330 undergraduate students completed self-reported measures of autonomous/controlled motivation, procrastination, self-actual-to-ideal proximity, goal progress, and positive/negative affect in each of their life domains. Using multilevel structural equation modeling, the results showed that autonomous and controlled motivation were associated with less and more procrastination, respectively, and in turn, procrastination was associated with worse achievement and affective outcomes but only at the within-person level. At the between-person level, only controlled motivation was positively related to procrastination, and in turn, procrastination was related to more negative affect and, surprisingly, more goal progress. Overall, all three articles contribute in complementary ways to the idea that proposing new multilevel perspectives can enrich our understanding of procrastination and its associations with antecedents and outcomes. Specifically, the studies in my thesis showed that the multilevel findings sometimes corroborate existing knowledge in the literature (e.g., the negative association between procrastination and academic achievement) and other times offer nuances and unexpected insights in our comprehension of the nomological network related to procrastination (e.g., the motivational antecedents of procrastination and the different relation between procrastination and goal progress depending on the level of analysis).

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Surveys and a brief-interval longitudinal design were employed to investigate the relationships between selected proactive leader influence behaviors (PLIBs) and followers' commitment to their leaders. Selected elements of followers' implicit leadership theories (ILTs) were expected to moderate the PLIBs – commitment relationships. Hypotheses were generated and tested in order to determine the extent to which (1) PLIBs constituted group-level phenomena and (2) PLIBs and ILTs were related to follower commitment. Empirical evidence did not support treating PLIBs as group-level variables. While PLIBs were related to commitment, hypotheses specifying ILT dimensions as moderators of the PLIB – commitment relationships were not supported. / Ph. D.

Inhalants are a critical, under-studied substance used by young adolescents in the United States (U.S.). Despite the serious negative consequences that can accompany use (most notably neuropsychological damage) the topic of inhalants has been neglected by clinicians and prevention scientists, particularly in comparison to other drugs. The present research focused on the etiology of U.S. adolescent inhalant use in two ways, both of which utilized large, nationally representative data sets for secondary data analysis. Study I examined long-terms trends in inhalant use prevalence rates and changing proportions of gender and ethnic groups among lifetime inhalant users. Study I also evaluated the effects of policies aimed at other drugs, including regional "three strikes laws" and national methamphetamine laws, on changing inhalant use prevalence rates among twelfth graders. Inhalant use increased during the early-1990s but has declined from the mid-1990s to the present day; lifetime inhalant users have increasingly become female and non-White. Importantly, "three strikes laws" and a national methamphetamine law were related to increases in annual inhalant use rates for twelfth graders. Study II evaluated the applicability of Self-Determination Theory (SDT)-related constructs, namely self-perceived autonomy, competence and parental relatedness, to concurrent and prospective inhalant use. Competence was consistently related to inhalant use and inhalant use severity; parental relatedness was related to concurrent but not prospective use and use severity. The findings from both studies are discussed in terms of their commonalities and differences, implications for clinicians and prevention scientists, overall strengths and limitations, and directions for future inhalant use research. / Master of Science

Social and emotional learning (SEL) programs have become increasingly popular during last 20 years, and have shown to reduce risky behaviors (i.e., substance use), improve communication skills, academic performance, and relationships among students of all ages when implemented in schools (Weissberg, Durlak, Domitrovich, & Gullotta, 2015; Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011). Although the benefits of SEL programs are significant, the issue of implementation fidelity often arises. The purpose of this study was to assess the impact of implementation fidelity in the Life Skills Training program (LST) implemented with middle school students of a large South Florida school district. A not-for-profit-organization (NFPO) facilitated the training of teachers who implemented LST within the school district and provided the materials necessary to carry out the program’s lessons. Fidelity was assessed by eight observers from the NFPO by utilizing the Botvin Life Skills Training Fidelity Checklist-Middle School Level 1. Three core elements of implementation fidelity, adherence, quality of delivery, and participant responsiveness, were assessed. The school district was tasked with modifying and conducting the LST Pretest/Posttest Measure to assess student behavior gains. Multilevel modeling was used to assess the effect of individual-level (gender, race/ethnicity, and socioeconomic status [SES]) and classroom-level characteristics (adherence, participant responsiveness, and quality of delivery) on student behavior outcomes measured at posttest. Results from this study indicated that on the individual level, students’ race/ethnicity and SES were significantly associated with predicting student behavior gains at posttest. On the classroom level, participant responsiveness was significantly associated with predicting student behavior gains at posttest. The findings from this study make a unique contribution to the literature as it examined frequently overlooked core elements of fidelity such as participant responsiveness and quality of delivery.

<p dir="ltr">Gestational Diabetes Mellitus (GDM) is defined as glucose intolerance with first onset during pregnancy in women without previous history of diabetes. The global prevalence of GDM oscillates between 2% and 17%, varying across countries and ethnicities. In the United States (U.S.), every year up to 13% of pregnancies are affected by this disease. Several risk factors for GDM are well established, such as race, age and BMI, while additional factors have been proposed that could affect the risk of developing the disease; some of them are modifiable, such as diet, while others are not, such as environmental factors.</p><p dir="ltr">Taking effective preventive actions against GDM require the early identification of women at highest risk. A crucial task to this end is the establishment of factors that increase the probabilities of developing the disease. These factors are both individual characteristics and choices and likely include environmental conditions.</p><p dir="ltr">The first part of the dissertation focuses on examining the relationship between food insecurity and GDM by using the National Health and Nutrition Examination Survey (NHANES), which has a representative sample of the U.S. population. The aim of this analysis is to determine a national estimate of the impact of food environment on the likelihood of developing GDM stratified by race and ethnicity. A survey weighted logistic regression model is used to assess these relationships which are described using odds ratios.</p><p dir="ltr">The goal of the second part of this research is to determine whether a woman’s risk of developing GDM is affected by her environment, also referred to in this work as level 2 variables. For that purpose, Medicaid claims information from Indiana was analyzed using a multilevel logistic regression model with sample balancing to improve the class imbalance ratio.</p><p dir="ltr">Finally, for the third part of this dissertation, a simulation study was performed to examine the impact of balancing on the prediction quality and inference of model parameters when using multilevel logistic regression models. Data structure and generating model for the data were informed by the findings from the second project using the Medicaid data. This is particularly relevant for medical data that contains measurements at the individual level combined with other data sources measured at the regional level and both prediction and model interpretation are of interest.</p>

Thesis advisor: Henry I. Braun / City Connects is a school-based model that identifies the strengths and needs of every student and links each child to a tailored set of intervention, prevention, and enrichment services in the school or community. The purpose of this study was to conduct a comprehensive evaluation of the City Connects treatment effects on academic performance (both MCAS scores and grade point average (GPA) grades) in middle school using student longitudinal records. Parallel analyses were conducted: one evaluated the City Connects elementary intervention (serving kindergarten to fifth grades) and the other one evaluated the City Connects middle school intervention (serving sixth to eighth grades). A series of two-level hierarchical linear models with middle school achievement scores adjusted and/or propensity score weights applied were used to answer the research questions of interest. In addition, to make a causal inference, a sensitivity analysis was conducted to examine whether or not the estimated treatment effects resulted from the first two analyses were robust to the presence of unobserved selection bias. The results showed that students who were exposed to the City Connects elementary intervention significantly outperformed their counterparts, who graduated from the comparison elementary schools, on academic achievement in all middle school grades. However, in the case of the City Connects intervention schools that served middle school grades, since all students only received a maximum of one year of City Connects middle school intervention, it was still too soon to expect any significant changes. Moreover, the estimated treatment effects of the City Connects elementary intervention were only mildly sensitive to the presence of some forms of hidden bias, which made the causal inference of City Connects on middle school academic achievement quite plausible. / Thesis (PhD) — Boston College, 2015. / Submitted to: Boston College. Lynch School of Education. / Discipline: Educational Research, Measurement and Evaluation.

abstract: In most of the work using event-related potentials (ERPs), researchers presume the function of specific components based on the careful manipulation of experimental factors, but rarely report direct evidence supporting a relationship between the neural signal and other outcomes. Perhaps most troubling is the lack of evidence that ERPs correlate with related behavioral outcomes which should result, at least in part, from the neural processes that ERPs capture. One such example is the NoGo-N2 component, an ERP component elicited in Go/NoGo paradigms. There are two primary theories regarding the functional significance of this component in this context: that the signal represents response inhibition and that the component reflects conflict. In this paper, a trial-level method of analysis for the relationship between ERP component potentials and downstream behavioral outcomes (in this case, response accuracy) using a multi-level modeling framework is proposed to provide discriminatory evidence for one of these theories. Following a description of the research on the NoGo-N2, preliminary data supporting the conflict monitoring theory are presented, noting important limitations. Next, an EEG simulation study is presented in which NoGo-N2 data are generated with a known relationship to fabricated reaction time data, showing that, with added levels of complexity and noise within the data, the MLM approach is consistently successful at extracting the known relationships that occur in real NoGo-N2 data. Next, using independent components analysis (ICA) to extract spatiotemporal components that best represent the signal of interest, a well-powered analysis of the relationship between the NoGo-N2 and response accuracy is used to provide strong discriminatory evidence for the conflict monitoring theory of the NoGo-N2. Finally, implications for the NoGo-N2, as well as all ERP components, are discussed with a focus on how this approach can and should be used. the paper concludes with potential expansions of this approach to areas beyond identifying the function of ERP components. / Dissertation/Thesis / Doctoral Dissertation Psychology 2019

The prolonged wars in Iraq and Afghanistan have taken a toll on the United States as a whole and the United States military in particular. The primary aim of this research is to determine what impact the wars in Iraq and Afghanistan have had on the performance of military hospitals over the fiscal years 2001-2006. Specifically, what direct effect has the war in Iraq and Afghanistan had on the productivity and quality of military hospitals, and, do productivity and quality trends differ based on hospital characteristics? Since observations over multiple time periods are nested within hospitals, multilevel mixed effects regression and Poisson regression models are used to evaluate changes in productivity and quality while accounting for differences within hospitals. Using a contingency theory framework, this study fills the gap in looking at the impact of war on permanent military hospitals’ productivity and quality using nationally developed and implemented quality indicators (Agency for Healthcare Quality and Research Inpatient Quality Indicators and Patient Safety Indicators). Structural characteristics of the hospital, teaching status and branch of Armed Service influenced productivity and certain quality indicators. The structural components were not able to reliably predict differences in productivity and all quality indicators, but overseas hospitals and non-teaching hospitals were most likely to differ from major teaching hospitals. The wars in Iraq and Afghanistan, denoted by the variables for wounded discharges and deployed staff, were only partially related to the productivity of military hospitals. Only an increase in the percentage of wounded discharges was related to productivity of military hospitals, and none were related to the quality indicators. In essence, the war affected the workload and productivity of military hospitals, but it did not affect the quality provided in the hospitals, as measured by AHRQ inpatient and patient safety quality indicators. Structural characteristics account for more of the variation in quality among military hospitals than the impact of war within the timeframe studied.