Browsing by Author "Hoyle, Rick H"
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Item Open Access Association of chronic non-cancer pain status and buprenorphine treatment retention among individuals with opioid use disorder: Results from electronic health record data.(Drug and alcohol dependence reports, 2022-06) John, William S; Mannelli, Paolo; Hoyle, Rick H; Greenblatt, Lawrence; Wu, Li-TzyBackground
Although chronic non-cancer pain (CNCP) is common among individuals with opioid use disorder (OUD), its impact on buprenorphine treatment retention is unclear. The goal of this study was to use electronic health record (EHR) data to examine the association of CNCP status and 6-month buprenorphine retention among patients with OUD.Methods
We analyzed EHR data of patients with OUD who received buprenorphine treatment in an academic healthcare system between 2010 and 2020 (N = 676). We used Kaplan-Meier curves and Cox proportional hazards regression to estimate risk of buprenorphine treatment discontinuation (≥90 days between subsequent prescriptions). We used Poisson regression to estimate the association of CNCP and the number of buprenorphine prescriptions over 6 months.Results
Compared to those without CNCP, a higher proportion of patients with CNCP were of older age and had comorbid diagnoses for psychiatric and substance use disorders. There were no differences in the probability of buprenorphine treatment continuation over 6 months by CNCP status (p = 0.15). In the adjusted cox regression model, the presence of CNCP was not associated with time to buprenorphine treatment discontinuation (HR = 0.90, p = 0.28). CNCP status was associated with a higher number of prescriptions over 6 months (IRR = 1.20, p < 0.01).Conclusions
These findings suggest that the presence of CNCP alone cannot be reliably associated with buprenorphine retention in patients with OUD. Nonetheless, providers should be aware of the association between CNCP and greater psychiatric comorbidity among patients with OUD when developing treatment plans. Research on the influence of additional characteristics of CNCP on treatment retention is needed.Item Open Access Cognitive and Interpersonal Features of Intellectual Humility.(Personality & social psychology bulletin, 2017-06) Leary, Mark R; Diebels, Kate J; Davisson, Erin K; Jongman-Sereno, Katrina P; Isherwood, Jennifer C; Raimi, Kaitlin T; Deffler, Samantha A; Hoyle, Rick HFour studies examined intellectual humility-the degree to which people recognize that their beliefs might be wrong. Using a new Intellectual Humility (IH) Scale, Study 1 showed that intellectual humility was associated with variables related to openness, curiosity, tolerance of ambiguity, and low dogmatism. Study 2 revealed that participants high in intellectual humility were less certain that their beliefs about religion were correct and judged people less on the basis of their religious opinions. In Study 3, participants high in intellectual humility were less inclined to think that politicians who changed their attitudes were "flip-flopping," and Study 4 showed that people high in intellectual humility were more attuned to the strength of persuasive arguments than those who were low. In addition to extending our understanding of intellectual humility, this research demonstrates that the IH Scale is a valid measure of the degree to which people recognize that their beliefs are fallible.Item Open Access Contra-Trait Effort and Trait Stability: A Self-Regulatory Personality Process(2010) Gallagher, Matthew PatrickDespite the considerable influence of situational factors and the resulting variability in behavior, individuals maintain stable average ways of acting. The purpose of the studies presented in this paper was to investigate one possible explanation of this trait stability. It is hypothesized that contra-trait behaviors, those that are different from typical trait levels, demand more effort, or self-control, than do trait-typical behaviors. In Study 1, participants reported on the trait content of their behavior along with several other variables. In Study 2, participants completed several tasks in the lab and were instructed to act at contra-trait or trait-typical levels of conscientiousness. Support for the contra-trait effort hypothesis was found in Study 1: Participants reported that contra-trait behavior was more effortful than trait-typical behavior. In addition, habitual contra-trait behaviors, which do not require self-control, were exempt from this effect. In Study 2, no support was found for contra-trait hypotheses: Participants generally did not rate contra-trait behaviors as more effortful, and subsequent behaviors were not affected by contra-trait behaviors. The implications of the findings and the possible explanations of the non-findings are discussed.
Item Open Access Differential predictability of four dimensions of affect intensity.(Cogn Emot, 2012) Rubin, David C; Hoyle, Rick H; Leary, Mark RIndividual differences in affect intensity are typically assessed with the Affect Intensity Measure (AIM). Previous factor analyses suggest that the AIM is comprised of four weakly correlated factors: Positive Affectivity, Negative Reactivity, Negative Intensity and Positive Intensity or Serenity. However, little data exist to show whether its four factors relate to other measures differently enough to preclude use of the total scale score. The present study replicated the four-factor solution and found that subscales derived from the four factors correlated differently with criterion variables that assess personality domains, affective dispositions, and cognitive patterns that are associated with emotional reactions. The results show that use of the total AIM score can obscure relationships between specific features of affect intensity and other variables and suggest that researchers should examine the individual AIM subscales.Item Open Access Do the Messages Matter? An Investigation of Classroom Messages and College Students’ Personal Theories about Education(2016) Barger, Michael M.Students hold a number of personal theories about education that influence motivation and achievement in the classroom: theories about their own abilities, knowledge, and the learning process. Therefore, college instructors have a great interest in helping to develop adaptive personal theories in their students. The current studies investigated whether specific messages that instructors send in college classroom might serve as a mechanism of personal theory development. Across 2 studies, 17 college instructors and 401 students completed surveys assessing their personal theories about education at the beginning and end of college courses. Students and instructors reported hearing and sending many messages in the classroom, including instructor help messages, conciliatory messages, uncertainty in the field messages, differential ability messages and generalized positive and negative feedback. Between-class and within-class differences in message reports were associated with students’ personal theories at the end of their courses, controlling for initial personal theories. Students’ initial personal theories were also related to the messages students reported hearing. The findings demonstrate the utility of assessing non-content messages in college classrooms as potential mechanisms for changing students’ personal theories in college. Implications for research and practice are discussed.
Item Open Access Judgments of Others' Trait Self-Control(2019) Komoski, StephaniePeople value others’ good self-control when they feel their own self-control is inadequate or need help pursuing our goals. However, the process by which people distinguish good vs. poor self-control in others has not been examined. This study examined the behavioral evidence people use to judge others’ self-control. Participants (N=297) described the behaviors of two people they know with high and low self-control. Each behavior was coded for presence of successful/failed initiation of desired behaviors (e.g., going to the gym, missing work), successful/failed inhibition of undesired behaviors (e.g., not losing one’s temper, binge drinking), and behavioral domain. Eating and financial behaviors were the most frequently cited domains for both high and low self-control others, whereas other domains were more common in descriptions of high (exercise) or low (substance use) self-control. Successful initiation and inhibition behaviors were equally prevalent in high self-control descriptions, whereas low self-control descriptions were biased toward failures of inhibition. This pattern of results held regardless of relationship length and type (e.g., spouse, friend). The results suggest people either fail to recognize others’ failures to initiate or consider them less important when judging poor self-control others. The limitations of and future directions for this line of research will be discussed.
Item Open Access Licensing in the Eating Domain: Implications for Effective Self-Control Maintenance(2015) Isherwood, Jennifer CamilleThe current study assessed the relationship between licensing and self-control maintenance. Previous research on licensing has found mixed results for the effect of perceived progress on goal pursuit. Some studies find evidence that progress increases commitment and motivation to a goal, making licensing less likely, whereas other studies have found that progress leads to coasting and feelings of earned licensing. Previous work on managing food consumption has demonstrated that using a mental budget in tandem with a salient avoidance goal is an effective means of monitoring and limiting overindulgence. The current study used a mixed event-contingent and fixed-interval experience sampling design to examine the role of licensing in the eating domain and its effect on goal pursuit. Participants in the experimental condition were prompted with personalized commitment devices each day to assess if they promoted goal pursuit and appropriate licensing. We found that licensing occurs infrequently, but when it does occur, goal progress and goal commitment increase. The use of commitment device has little impact on licensing or goal pursuit.
Item Open Access Narrative centrality and negative affectivity: Independent and interactive contributors to stress reactions.(Journal of Experimental Psychology: General, 2014) Rubin, David C; Boals, Adriel; Hoyle, Rick HItem Open Access Navigating Still Waters of Infertility: Role of Goal Features in Coping with a Thwarted Goal.(International journal of behavioral medicine, 2021-07-15) Andrade, Fernanda C; Davisson, Erin K; Kwiatek, Sarah; Hoyle, Rick HBackground
The infertility experience is often surrounded by frustration and discouragement associated with the thwarted goal to have a child. Though research has identified commonly used strategies to cope with infertility, this study is the first to examine how different goal attributes and processes associated with the experience of infertility relate to coping strategy use and psychological distress.Method
Women (N = 353) recruited from online support forums reported on the nature of their goal to have a child, their psychological distress, and their use of strategies to cope with the failure to achieve that goal.Results
Women reported high striving toward a goal high in importance and commitment, coupled with high goal-related stress and feeling that achievement is blocked. Consistent with the notion that coping strategy use is specific to the features of the experience, no single goal attribute nor combination of attributes consistently accounted for coping strategy use, suggesting that the latter may be specific to the cognitions and processes of pursuit of the goal to have a child. With one exception, perceptions of impediment were better predictors of psychological distress than any level of perceived facilitators of goal pursuit, positing potential targets for future psychological interventions.Conclusion
Understanding how women cope with infertility may require a detailed conceptualization of their goal to have a child. In the present sample, dynamic processes and coping strategies that otherwise detract from success were generally beneficial by providing alternatives to the pursuit of a thwarted goal.Item Open Access Nonmedical stimulant use among young Asian-Americans, Native Hawaiians/Pacific Islanders, and mixed-race individuals aged 12-34 years in the United States.(Journal of psychiatric research, 2014-12) Wu, Li-Tzy; Swartz, Marvin S; Brady, Kathleen T; Blazer, Dan G; Hoyle, Rick H; NIDA AAPI WorkgroupThere are concerns over nonmedical use of prescription stimulants among youths, but little is known about the extent of use among young Asian-Americans, Native Hawaiians/Pacific Islanders (NHs/PIs), and mixed-race individuals-the fastest growing segments of the U.S. population. We examined prevalences and correlates of nonmedical stimulant use (NMSU) and disorder (StiUD) for these underrecognized groups. Whites were included as a comparison. Data were from young individuals aged 12-34 years in the 2005-2012 National Surveys on Drug Use and Health. We used logistic regression to estimate odds of past-year NMSU status. Significant yearly increases in lifetime NMSU prevalence were noted in Whites only. NHs/PIs (lifetime 7.33%, past-year 2.72%) and mixed-race individuals (10.20%, 2.82%) did not differ from Whites in NMSU prevalence (11.68%, 3.15%). Asian-Americans (lifetime 3.83%, past-year 0.90%) had lower prevalences than Whites. In each racial/ethnic group, "Methamphetamine/Desoxyn/Methedrine or Ritalin" was more commonly used than other stimulant groups; "got them from a friend/relative for free" and "bought them from a friends/relative" were among the most common sources. Females had greater odds than males of NMSU (among White, NH/PI, mixed-race individuals) and StiUD (among mixed-race individuals). Young adults (aged 18-25) had elevated odds of NMSU (White, NH/PI); adolescents had elevated odds of StiUD (White, mixed-race). Other substance use (especially marijuana, other prescription drugs) increased odds of NMSU and StiUD. NHs/PIs and mixed-race individuals were as likely as Whites to misuse stimulants. Research is needed to delineate health consequences of NMSU and inform prevention efforts for these understudied, rapidly-growing populations.Item Open Access Peace and war: trajectories of posttraumatic stress disorder symptoms before, during, and after military deployment in Afghanistan.(Psychol Sci, 2012-12) Berntsen, Dorthe; Johannessen, Kim B; Thomsen, Yvonne D; Bertelsen, Mette; Hoyle, Rick H; Rubin, David CIn the study reported here, we examined posttraumatic stress disorder (PTSD) symptoms in 746 Danish soldiers measured on five occasions before, during, and after deployment to Afghanistan. Using latent class growth analysis, we identified six trajectories of change in PTSD symptoms. Two resilient trajectories had low levels across all five times, and a new-onset trajectory started low and showed a marked increase of PTSD symptoms. Three temporary-benefit trajectories, not previously described in the literature, showed decreases in PTSD symptoms during (or immediately after) deployment, followed by increases after return from deployment. Predeployment emotional problems and predeployment traumas, especially childhood adversities, were predictors for inclusion in the nonresilient trajectories, whereas deployment-related stress was not. These findings challenge standard views of PTSD in two ways. First, they show that factors other than immediately preceding stressors are critical for PTSD development, with childhood adversities being central. Second, they demonstrate that the development of PTSD symptoms shows heterogeneity, which indicates the need for multiple measurements to understand PTSD and identify people in need of treatment.Item Open Access Perceived cannabis use norms and cannabis use among adolescents in the United States.(J Psychiatr Res, 2015-05) Wu, Li-Tzy; Swartz, Marvin S; Brady, Kathleen T; Hoyle, Rick H; NIDA AAPI WorkgroupDue to changes in cannabis policies, concerns about cannabis use (CU) in adolescents have increased. The population of nonwhite groups is growing quickly in the United States. We examined perceived CU norms and their association with CU and CU disorder (CUD) for White, Black, Hispanic, Native-American, Asian-American, Native Hawaiian/Pacific Islander (NH/PI), and mixed-race adolescents. Data were from adolescents (12-17 years) in the 2004-2012 National Surveys on Drug Use and Health (N = 163,837). Substance use and CUD were assessed by computer-assisted, self-interviewing methods. Blacks, Hispanics, Native-Americans, and mixed-race adolescents had greater odds of past-year CU and CUD than Whites. Among past-year cannabis users (CUs), Hispanics and Native-Americans had greater odds of having a CUD than Whites. Asian-Americans had the highest prevalence of perceived parental or close friends' CU disapproval. Native-Americans and mixed-race adolescents had lower odds than Whites of perceiving CU disapproval from parents or close friends. In adjusted analyses, adolescent's disapproval of CU, as well as perceived disapproval by parents or close friends, were associated with a decreased odds of CU in each racial/ethnic group, except for NHs/PIs. Adolescent's disapproval of CU was associated with a decreased odds of CUD among CUs for Whites (personal, parental, and close friends' disapproval), Hispanics (personal, parental, and close friends' disapproval), and mixed-race adolescents (personal, close friends' disapproval). Racial/ethnic differences in adolescent CU prevalence were somewhat consistent with adolescents' reports of CU norm patterns. Longitudinal research on CU health effects should oversample nonwhite adolescents to assure an adequate sample for analysis and reporting.Item Open Access Psychological and clinical correlates of the Centrality of Event Scale: A systematic review.(Clinical psychology review, 2018-11) Gehrt, Tine B; Berntsen, Dorthe; Hoyle, Rick H; Rubin, David CThe Centrality of Event Scale (CES) was introduced to examine the extent to which a traumatic or stressful event is perceived as central to an individual's identity and life story, and how this relates to Posttraumatic Stress Disorder (PTSD) symptoms. In addition, the CES has been examined in relation to a range of other conditions and dispositions. We present a systematic review of the correlates of the CES. Results from 92 publications resulted in 25 measurement categories in the six theoretical domains of trauma, negative affect and distress, autobiographical memory, personality, positive affect, and gender. The mean weighted correlations of the 25 measurement categories ranged from -.17 to .55, with standard errors from .01 to .02, allowing us to distinguish empirically among effects. Consistent with the theoretical motivation for the CES and predictions predating the review, the CES correlated positively with a range of measures, correlating most highly with measures related to trauma, PTSD, grief, and autobiographical memory. The findings show that the CES probes aspects of autobiographical memory of broad relevance to clinical disorders, and with specific implications for theories of PTSD.Item Open Access Social, Personal, and Environmental Influences on Self-Control(2008-04-21) vanDellen, MichelleCurrent accounts of self-control are highly individualistic. When individuals succeed at exerting self-control, we assume that they possess some positive internal characteristic that explans their success. Similarly, when individuals do not succeed, we blame their failure on an internal flaw. Yet many factors may influence the likelihood that an individual will exert self-control, including not only internal characteristics of individuals but also external factors. In this dissertation, I develop a framework for understanding the multiple sources of influence on individuals' state self-control that groups these factors into three categories: social, personal, and environmental. Further, I detail the multiple mechanisms by which the factors in the Social, Personal, and Environmental Control of Self (SPECS) model may influence self-control. Specifically, I examine the potential role of regulatory accessibility as a mechanism of influence on state self-control. In Study 1, I show that individuals who think about a friend with good self-control demonstrate increased performance on a persistence task than do participants who think about a friend with bad self-control. In Study 2, I replicate this effect, showing increased inhibitory capacity among individuals who wrote about a friend with good self-control compared to a control group, and decreased inhibitory capacity among individuals who wrote about a friend with bad self-control. In Study 3, I show that regulatory exertion increases among individuals subliminally primed with the name of a friend with good self-control and that regulatory exertion decreases among indivdiuals primed with the name of a friend with bad self-control. These findings support my hypothesis that models of self-control should account for sources of influence external to the individual, as well as explore the multiple pathways by which regulatory exertion is influenced. These findings support my hypothesis that social factors influence regulatory exertion, or state self-control. Further, they provide evidence that state self-control is influenced not only by regulatory capacity, but also by other mechanisms, including regulatory accessibility. Further research following the SPECS model will investigate the combined influence of social and environmental influences on self-control and the indirect influences of personal characteristics, such as trait self-control, on regulatory exertion.Item Open Access Strengthening Self-Control by Practicing Inhibition and Initiation(2013) Davisson, Erin KathleenAn abstract of a dissertation that examines the effect of practicing different forms of self-control, inhibition and initiation, on the occurrence of subsequent behaviors reflecting one or both types of self-control. Previous work based on the limited strength model of self-control has demonstrated that practicing small acts of self-control can improve self-control over time. However, past research involving self-control practice has operationalized self-control primarily as the inhibition of impulses. The current set of studies distinguishes between two forms of self-control: self-control by inhibition and self-control by initiation. This work also contributes to the self-control literature by treating self-control as an idiosyncratic process. Study 1 tested whether fluctuations in each form of self-control, aggregated at the daily level, would predict the degree to which people reported engaging in other self-control behaviors. Study 1 was a two-week experience sampling study in which 101 undergraduates reported several times daily on their self-control behaviors. The results of Study 1 support a distinction between self-control by inhibition and initiation. Moreover, the finding that participants actually studied more on days when they reported exerting more self-control by initiation seems to support a possible practice effect on self-control that may be specific to form. Study 2 introduced a practice manipulation, testing whether practicing one form of self-control (either inhibition or initiation) leads to improvement in only that type of self-control (but across domains), or across both forms. Study 2 was four weeks in total: two weeks of a practice manipulation (either inhibition, initiation, or a no-practice control) and two weeks of experience sampling. Analyses were carried out using multilevel modeling in SAS Proc Mixed and SAS Proc Glimmix. However, results indicated that there was no main effect of practice on subsequent self-control behaviors. Follow-up analyses revealed that the effect of practice varied across dependent variables and as a function of reported exertion of inhibition and initiation. Several effects from Study 1, including the effect of within-person exertion of initiation on subsequent self-control behaviors, were replicated. Possible explanations for the unexpected findings, including the strength of the practice manipulation, are discussed. Ideas for future research, including tailoring self-control practice to specific demands on self-control, are presented. Implications for the effect of practice on future self-control pursuits and a distinction between inhibition and initiation are also discussed.
Item Open Access The Relation Between Self-Regulation and Academic Achievement: A Meta-Analysis Exploring Variation in the Way Constructs are Labeled, Defined, and Measured(2013) Dent, Amy L.Guided by an integrative conceptual framework, a meta-analysis was conducted to explore the relation between the capacity aspect of self-regulation and academic achievement across childhood and adolescence. This meta-analysis of over 150 studies draws upon diverse research traditions and approaches to test moderators of theoretical, methodological, and practical importance. In the theoretical moderator analyses, results were broken down by the specific self-regulation construct (e.g., emotion regulation, executive functions), students' grade level, and academic subject. Doing so permitted an exploration of developmental and domain differences in the relation between each self-regulation construct and achievement. In the methodological moderator analyses, results were broken down by the type of self-regulation measure (e.g., teacher-report, direct assessment) and the type of achievement measure (e.g., standardized test, course grade). Doing so permitted a formal test of how these measures relate to each other, which has garnered considerable debate among self-regulation researchers.
Findings from the five moderator analyses largely supported hypotheses. The average correlation with achievement was strongest for effortful control and composite measures of executive functions, with updating significantly exceeding both shifting and inhibiting. A strong correlation also emerged for self-control, though it differed significantly based on whether the construct was categorized by author labels or definitions. Composite measures of self-regulation revealed a stronger correlation with achievement than any of its domains, as expected. Across all self-regulatory capacities, correlations became significantly stronger after the transition to kindergarten but assumed different trajectories based on the specific construct during the rest of elementary and secondary school. Domain differences also emerged, favoring math and science for executive functions but not producing significant differences with language arts for effortful control. As expected, self-regulatory capacities with an indirect effect on achievement (e.g., effortful control, emotion regulation) had the strongest correlation with course grades while self-regulatory capacities with a direct effect on achievement (e.g., executive functions) had the strongest correlation with standardized tests. Finally, direct assessments and teacher reports produced significantly stronger correlations with academic performance than when students reported their own self-regulation. Theoretical, methodological, and practical implications of these findings are discussed alongside results.
A new meta-analytic method was also developed to identify and resolve inconsistencies in the way psychological constructs are labeled, defined, and measured. This new method provided needed conceptual clarity in the diverse and interdisciplinary literature on self-regulation. Implications for other literatures characterized by variation in the way constructs are labeled, defined, and measured are discussed.
Item Open Access The role of psychological science in efforts to improve cardiovascular medication adherence.(The American psychologist, 2018-11) Bosworth, Hayden B; Blalock, Dan V; Hoyle, Rick H; Czajkowski, Susan M; Voils, Corrine IPoor adherence to cardiovascular disease medications carries significant psychological, physical, and economic costs, including failure to achieve therapeutic goals, high rates of hospitalization and health care costs, and incidence of death. Despite much effort to design and evaluate adherence interventions, rates of adherence to cardiovascular-related medications have remained relatively stagnant. We identify two major reasons for this: First, interventions have not addressed the time-varying reasons for nonadherence, and 2nd, interventions have not explicitly targeted the self-regulatory processes involved in adherence behavior. Inclusion of basic and applied psychological science in intervention development may improve the efficacy and effectiveness of behavioral interventions to improve adherence. In this article, we use a taxonomy of time-based phases of adherence-including initiation, implementation, and discontinuation-as context within which to review illustrative studies of barriers to adherence, interventions to improve adherence, and self-regulatory processes involved in adherence. Finally, we suggest a framework to translate basic psychological science regarding self-regulation into multicomponent interventions that can address multiple and time-varying barriers to nonadherence across the three adherence phases. The field of psychology is essential to improving medication adherence and associated health outcomes, and concrete steps need to be taken to implement this knowledge in future interventions. (PsycINFO Database Record (c) 2018 APA, all rights reserved).Item Open Access The Role of Self-Control, Social Support, and Reliance on Others in the Religiosity-Health Link(2015) Hopkin, CameronReligious observance has been reliably shown to improve a wide variety of health outcomes across the lifespan. Significant work has already been done to find mediating processes that explain this relationship, but as yet no studies have been published that attempt to integrate these mediators into a single model to see if they all work together. The current study presents three possible mediators of the religiosity-health link: social support, self-control, and reliance on others. Participants were recruited from Amazon.com’s Mechanical Turk worker system (N = 112) for a 14-day diary study in which all relevant constructs were measured on a daily basis, with daily health behaviors being the outcome. Social support, self-control, and reliance on others were all found to be simultaneous partial mediators of the religiosity-health link, though some questions remain as to the causal flow between religiosity and each of these mediators. It is concluded that each of these mechanisms is related to religiosity and in turn aid in the pursuit of superior health.
Item Open Access The serotonin transporter gene polymorphism (5HTTLPR) moderates the effect of adolescent environmental conditions on self-esteem in young adulthood: a structural equation modeling approach.(Biol Psychol, 2012-09) Jonassaint, Charles R; Ashley-Koch, Allison; Whitfield, Keith E; Hoyle, Rick H; Richman, Laura Smart; Siegler, Ilene C; Royal, Charmaine D; Williams, RedfordHere we examine the effects of both self-reported and independent observer-reported environmental risk indices, the serotonin transporter gene promoter (5HTTLPR) polymorphism, and their interaction on self-esteem. This trait was assessed during early and mid adolescence (mean age=14 and 16.5, respectively) and young adulthood (mean age=21.8) in a prospective cohort of 1214 unrelated participants in the Longitudinal Study of Adolescent Health (Add Health). Using structural equation modeling we identified a gene-environment (G×E) interaction using observer-report but not self-report measures of environmental stress exposure during adolescence: 5HTTLPR genotype and observer-reports of home and neighborhood quality (HNQ) during adolescence interacted to predict self-esteem levels in young adulthood (p<.004). Carriers of the s allele who lived in poor HNQ conditions during adolescence reported lower self-esteem in young adulthood than those with a good HNQ during adolescence. In contrast, among individuals with the l/l genotype, adolescent HNQ did not predict adulthood self-esteem. Genes may moderate the effect of adolescent environmental conditions on adulthood self-esteem.Item Open Access Understanding How Language, Design, and Processing Fluency Affect Cognition(2018) Santistevan-Swett, StephanieJudgment and decision-making in a healthcare context often involve complex information and difficult tradeoffs. In order to understand key concepts and receive help with difficult decisions, patients may turn to written materials, like informed consent forms. Unfortunately, these materials can actually increase confusion. This dissertation explores the relationship between written health materials and cognitive processes, specifically comprehension, memory, judgment, and decision-making. The first goal was to investigate how language and design affect cognition for informed consent forms. We developed a Standard informed consent form and two Enhanced versions that had simplified language and modified design, and compared comprehension and memory between the three versions. As written health materials undergo changes to make their content more accessible to readers, they also become more fluent. The second goal was to explore how this fluency affects judgments and decision-making, especially for materials that have a negative valence. This question was studied in the context of two competing fluency theories, the Hedonic Fluency Model and the Fluency Amplification Model. We manipulated the fluency of various materials, including medications, diseases, and risks, and asked participants to make several judgments about the fluent and disfluent materials. Our results highlight the complexities and nuances that characterize fluency’s effects.