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Full-Text Articles in Psychology

Trajectories Of Depression Severity In The First Semester Of College, Nicole A. Kelso May 2024

Trajectories Of Depression Severity In The First Semester Of College, Nicole A. Kelso

Theses and Dissertations

Depression is a major public health concern among students in higher education. Prior work suggests that depressive symptoms increase during the transition to college. Transfer students face unique challenges during the transition to a new academic institution that may make them particularly vulnerable. There is a critical need to expand prevention efforts. Research that improves identification of students at greatest risk for developing impairing depressive symptoms, and etiological processes contributing to depressive symptoms could aid in the provision of limited prevention resources. Furthermore, longitudinal research tracking symptom trajectories during the transition to college could help inform the timing of preventive …


The Evaluation Of Non-Specific Risk Indicators In Improving Detection Of Psychosis-Spectrum Liability, Thomas W. O'Kane Apr 2024

The Evaluation Of Non-Specific Risk Indicators In Improving Detection Of Psychosis-Spectrum Liability, Thomas W. O'Kane

Theses and Dissertations

Psychosis-spectrum disorders remain a leading cause of disability for both individuals and society, with early identification and prevention efforts representing a promising avenue of research for addressing these concerns. One potential impediment to improving early risk identification is the historical focus on indicators thought to be exclusive to the psychosis-spectrum. This focus often comes at the expense of non-specific risk factors (e.g., disrupted sleep, adverse childhood experiences) which contribute to the risk of developing psychosis as well as other mental illnesses. Research suggests the inclusion of these non-specific factors may improve our ability to identify those at risk. The present …


Resisting Internalized Stigma (Ris): Acceptability And Feasibility Of A Cognitive Behavioral Stigma Intervention For Early Psychosis, Francesca Maria Crump Jan 2024

Resisting Internalized Stigma (Ris): Acceptability And Feasibility Of A Cognitive Behavioral Stigma Intervention For Early Psychosis, Francesca Maria Crump

Theses and Dissertations

The clinical high-risk state for psychosis (CHR-P) was created to help identify individuals experiencing early signs of psychosis to help forestall worsening symptoms. CHR-P individuals may experience stigma that may stem from internal or external processes, including from receiving specialized care. Research has demonstrated associations between internalized stigma and psychosocial and functional outcomes, which underscores the need for interventions to help mitigate the impact of stigma while balancing the need for treatment. To date, there is only one stigma intervention specifically designed for individuals designated as CHR-P, which is psychoeducational in nature. Based on the recent call to action that …


Determining The More Effective Behavior Analytic Intervention For Children With Autism Who Exhibit Pica Behaviors, Jennifer J. Lanham Jan 2024

Determining The More Effective Behavior Analytic Intervention For Children With Autism Who Exhibit Pica Behaviors, Jennifer J. Lanham

Theses and Dissertations

Abstract

Determining the More Effective Behavior Analytic Intervention for Children With Autism Who Exhibit Pica Behaviors. Jennifer J. Lanham, 2024: Applied Dissertation, Nova Southeastern University, Abraham S. Fischler College of Education and School of Criminal Justice. Keywords: autism, pica, eating disorders, intervention, applied behavior analysis

This dissertation was designed to determine which behavior analytic intervention was more effective in the treatment and reduction of mouthing non-nutritive substances in children diagnosed with autism. This study included four participants in an A-B-A reversal design with a component analysis across four intervention phases. The study participants were enrolled in a center-based treatment environment …


Change In Rape Myth Acceptance As A Function Of Sexual Assault Experiences: A Prospective Analysis, Danielle Suzanne Citera Jan 2024

Change In Rape Myth Acceptance As A Function Of Sexual Assault Experiences: A Prospective Analysis, Danielle Suzanne Citera

Theses and Dissertations

In the United States, one in five women reports experiencing sexual assault while in college. Rape myths, or stereotypical beliefs that serve to blame survivors (i.e., “She Asked For It” and “She Lied”) and exonerate sexual assault perpetrators (“He Didn’t Mean To”), may influence how women conceptualize their own sexual assault experiences and relatedly, their post-assault functioning. Several demographic characteristics, including race and ethnicity, generational status, education level, sexual orientation, and religiosity, have been found to be associated with rape myth acceptance (RMA). Researchers have reported mixed findings, however, regarding the association between sexual assault history and RMA. This study …


A Longitudinal Examination Of The Relations Between Racial Discrimination And Executive Function, Aldona Chorzepa Jan 2024

A Longitudinal Examination Of The Relations Between Racial Discrimination And Executive Function, Aldona Chorzepa

Theses and Dissertations

Discrimination has been linked to changes in executive function. This relationship may explain links between discrimination and adverse health and mental health outcomes, including depression, substance use, and health behavior. To date, the research examining this question has been limited, as the majority of studies reviewed employed experimental manipulations for discrimination exposure and tested acute same-day effects in the lab. Clarifying the extent to which exposure to discrimination impacts executive function over time in young adults is crucial to identifying opportunities for intervention. The current study evaluates the relations of both recent and lifetime exposure to racial discrimination to three …


Using Natural Language Processing To Understand The Lived Experiences Of People Identifying With Adhd: What Themes Emerge In Social Media Posts?, Gabby C. Scalzo Jan 2024

Using Natural Language Processing To Understand The Lived Experiences Of People Identifying With Adhd: What Themes Emerge In Social Media Posts?, Gabby C. Scalzo

Theses and Dissertations

Compared to the amount of research conducted on how to identify and understand children with Attention-Deficit Hyperactivity Disorder (ADHD), there has been relatively little work done to understand the lived experiences of adults with ADHD. Increased understanding of how adults with ADHD conceptualize themselves in the context of their diagnosis would help clinical experts tailor research and treatments to better serve these communities. However, there are several barriers towards conducting high-quality qualitative research, including time- and labor-intensity. This study, informed by qualitative research traditions, used innovative data sources (i.e., social media) and analytic techniques (i.e., machine learning) to reduce these …


On The Rebound: Resilience And Subjective Cognitive Symptoms In Cancer, Giuliana V. Zarrella Jan 2024

On The Rebound: Resilience And Subjective Cognitive Symptoms In Cancer, Giuliana V. Zarrella

Theses and Dissertations

Recent studies have shown a strong connection between resilience and subjective cognitive symptoms in clinical populations. However, there is limited understanding of this relationship in cancer survivors, and no studies examine whether resilience training could alleviate subjective cognitive symptoms in these patients. This study examined the relationship between subjective cognitive function and resilience in non-CNS cancer survivors who participated in a resiliency training intervention, at baseline and from pre- to post-intervention, as well as investigated potential influences of change in subjective cognition. Adult cancer survivors (N=275) participated in the Stress Management and Resilience Training-Relaxation Response Resilience Program (SMART-3RP) …


Community Informant And Mental Health Provider Perspectives On Access To Mental Healthcare For Lgbtqia+ Communities In Virginia, Chariz Seijo Jan 2024

Community Informant And Mental Health Provider Perspectives On Access To Mental Healthcare For Lgbtqia+ Communities In Virginia, Chariz Seijo

Theses and Dissertations

The existing literature on mental health disparities for lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) populations suggests members of LGBTQIA+ populations are at greater risk of mental health disorders than cisgender and heterosexual individuals. The COVID-19 pandemic has also exacerbated mental health disparities for many, including LGBTQIA+ populations. Combined with mental health provider shortages and anti- LGBTQIA+ bills across the country, inequities in mental healthcare are a significant concern. This qualitative study was designed to gather unique perspectives of key community informants and mental health providers on their experiences with mental healthcare provision to LGBTQIA+ communities in Virginia. …


Identifying Mechanistic Pathways To Rigidity Associated With Obsessive-Compulsive Personality Disorder Traits Using A Novel Decision-Making Paradigm, Hannah L. Heintz Jan 2024

Identifying Mechanistic Pathways To Rigidity Associated With Obsessive-Compulsive Personality Disorder Traits Using A Novel Decision-Making Paradigm, Hannah L. Heintz

Theses and Dissertations

Cognitive and behavioral rigidity is observed across several mental disorders and is a defining characteristic of Obsessive-Compulsive Personality Disorder (OCPD), a highly prevalent and debilitating, yet understudied, disorder. In particular, treatments for OCPD are underdeveloped due to our poor understanding of the mechanisms leading to the disorder’s key feature of rigidity. Two related disorders, anorexia nervosa (AN) and obsessive-compulsive disorder (OCD), have shown distinct mechanistic pathways leading to symptoms of rigidity, indicating that this trait can arise as a result of a number of differentially impaired cognitive processes, each requiring unique interventions. To examine the relationship between symptoms of OCPD …


Fitbit Engagement In An Health Physical Activity Intervention For Young Adult Cancer Survivors: A Secondary Analysis Of The Impact Randomized Controlled Trial, Jessica Gomez Smith Jan 2024

Fitbit Engagement In An Health Physical Activity Intervention For Young Adult Cancer Survivors: A Secondary Analysis Of The Impact Randomized Controlled Trial, Jessica Gomez Smith

Theses and Dissertations

Wearable devices allow for objective remote and real-time data collection and have been increasingly popular among the general public and in mHealth activity (PA) interventions. Despite this, our knowledge of feasibility and efficacy for using wearable devices to increase PA among a particularly vulnerable population—young adult cancer survivors age 18-39 (YACS)—is limited. Engaging in physical activity while undergoing cancer treatment contributes to reduced risk for recurrence and secondary cancers, and can also help to manage treatment side effects. However, there are a multitude of barriers to PA engagement among cancer survivors, with YACS in particular demonstrating low rates of PA. …


Development Of A Validity Scale For The Icd-11 Personality Disorder Measure (Psi-11), Rae Lutz Jan 2024

Development Of A Validity Scale For The Icd-11 Personality Disorder Measure (Psi-11), Rae Lutz

Theses and Dissertations

Invalid responding is a significant issue in the utilization of self-report information. Invalid responding can be assessed by stand-alone validity measures or embedded validity scales. The International Classification of Diseases (ICD) is one of two major diagnostic systems which provide guidance on diagnosing personality disorder, with the most recent version (ICD-11) providing a fully dimensional model for personality disorders. No existing measures aimed at assessing dimensional personality pathology have addressed the combination of PD severity and trait qualifiers that were based upon ICD-11 guidelines. To address this gap, Clark et al. (2021) developed the ICD-11 Personality Disorder Measure (PSI-11). However, …


Does What Doesn’T Kill You Make You Stronger? Examining The Effects Of Resilience And Functional Outcomes On Post-Traumatic Growth In Adults With Acquired Disability, Dominique Renee Ghirardi M.S. Dec 2023

Does What Doesn’T Kill You Make You Stronger? Examining The Effects Of Resilience And Functional Outcomes On Post-Traumatic Growth In Adults With Acquired Disability, Dominique Renee Ghirardi M.S.

Theses and Dissertations

Disabilities acquired in adulthood are often unexpected and disruptive because a loss of functioning can affect one’s ability to maintain employment, pursue their interests, and participate in social activity without assistance or accommodation. This is especially true for those who experience a life-altering injury or develop a chronic health condition between the ages of 18 and 64, as they likely have not planned for the financial and social adjustments that life with a disability involves. However, factors such as post-traumatic growth can reveal the extent to which someone experiences personal growth and improvement in the wake of a traumatic and …


The Effect Of Parent-Child Relationships On Healthcare Utilization Among Children With Chronic Medical Health Concerns, Karina Guerra-Guzman Dec 2023

The Effect Of Parent-Child Relationships On Healthcare Utilization Among Children With Chronic Medical Health Concerns, Karina Guerra-Guzman

Theses and Dissertations

Parents of children with chronic health complaints are more likely to utilize healthcare services for their child, and are prone to experiencing increased stress and anxiety related to their child’s compromised health status. As these parents navigate managing their child’s health and integrating parenting behaviors, they are dealt with unique stressors that are likely to impact their parenting styles, anxiety, and use of healthcare services. However, most studies that have examined HCU in the context of parent-child relationships have neglected children with chronic health concerns (CHCs). This study examined the relationship between parenting styles across parents of children with a …


Examining Nonadherence To Family Values And Anxiety In College Latinas, Veronica Paola Ramirez Dec 2023

Examining Nonadherence To Family Values And Anxiety In College Latinas, Veronica Paola Ramirez

Theses and Dissertations

Due to the rapidly growing rate of the Latinx population, mental health professionals must concentrate on finding the best treatments for this population. The group of interest for this study is young Latinas in college with anxiety symptoms. There is some research on how anxiety levels are influenced by one important factor: non-adherence to family values, however, it is important to understand what may direct this relationship. What makes this research study different is that we attempted to use family conflict as a mediator in the relationship. Furthermore, we attempted to see if levels of autonomy and emotion dysregulation …


The Relationship Between Parental Trauma History And Perceptions Regarding Their Child’S Healthcare And Utilization Of Healthcare Services, Krishna Patel Nov 2023

The Relationship Between Parental Trauma History And Perceptions Regarding Their Child’S Healthcare And Utilization Of Healthcare Services, Krishna Patel

Theses and Dissertations

Abstract

TITLE: The Relationship Between Parental Trauma History and Perceptions Regarding Their Child’s Healthcare and Utilization of Healthcare Services

Adverse child events (ACEs) have been associated with a number of physical and mental health problems and have also been linked to increased health care utilization. While parents who have an ACE history may tend to seek healthcare services for themselves, limited studies have examined the impact of their trauma history on seeking healthcare services for their child. Healthcare utilization may also depend on the parents’ level of health anxiety, as well as their anxiety about their child’s health status. This …


A Comparison Of Defensiveness In Mmpi-2-Rf Profiles Of Male Sex Offenders And Child Custody Litigants, Kyla M. Jones Nov 2023

A Comparison Of Defensiveness In Mmpi-2-Rf Profiles Of Male Sex Offenders And Child Custody Litigants, Kyla M. Jones

Theses and Dissertations

Clinical evaluations have had a long-standing role in criminal and civil legal proceedings due to the intersection between various legal criteria and aspects of psychological functioning. The Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1943) and its subsequent versions have been among the most commonly utilized and empirically supported measures of personality and psychopathology in assessing forensic populations. One application for which MMPI instruments have been particularly useful is in the evaluation of sex offenders. This is in part due to the tests’ built-in validity scales, as MMPI underreporting scales are found to be effective in assessing sex offenders’ …


Sun Protection Behaviors And Skin Cancer Risk Among Children Of Color, Williana Magloire Nov 2023

Sun Protection Behaviors And Skin Cancer Risk Among Children Of Color, Williana Magloire

Theses and Dissertations

Sun protection is beneficial for children of color as it decreases the risk for sunburns, hyperpigmentation, and most importantly, skin cancer. Invasive melanoma is commonly seen in children of color due to inadequate sun protection. Parental and caregiver modeling of sun protection behaviors may decrease the likelihood of skin cancer among children of color. The American Academy of Pediatrics (AAP, 2011) has suggested that pediatricians adopt the role of informing parents about the benefits of using sun protection products for their young children. They recommended that providers discuss sun protection behaviors with both the parent/child beginning at the age of …


Development Of Optimal Cut Scores For Within-Normal-Limits Mmpi-2-Rf Profiles Of Sex Offenders, Ilona Iikhtman Nov 2023

Development Of Optimal Cut Scores For Within-Normal-Limits Mmpi-2-Rf Profiles Of Sex Offenders, Ilona Iikhtman

Theses and Dissertations

Alleged and convicted sex offenders are generally required to undergo forensic evaluations that frequently include a psychological assessment to answer a wide range of psycho-legal questions. A critical component of the psychological assessment of sex offenders is the evaluation of personality and psychopathology. The Minnesota Multiphasic Personality Inventory (MMPI) and its subsequent editions have been the most widely used personality assessment measures in forensic evaluations, including sex offender evaluations, and in research conducted with sex offenders. The previous literature demonstrates that a subgroup of sex offenders often produce test scores reflective of the general population, which is referred to as …


An Examination Of Mmpi-3 Score Patterns Of Sex-Trafficked Women, Edleen De Jesus-Sanchez Oct 2023

An Examination Of Mmpi-3 Score Patterns Of Sex-Trafficked Women, Edleen De Jesus-Sanchez

Theses and Dissertations

Sex trafficking is a hidden crime that affects many vulnerable groups such as women and children. Prior research has demonstrated that individuals currently or formerly engaged in sex trafficking experience heightened levels of depression, anxiety, posttraumatic stress disorder (PTSD), and other mental health concerns. Most of these studies relied on structured interviews and, to date, no empirical studies have evaluated the psychological difficulties of sex trafficking victims with an empirically valid measure. The Minnesota Multiphasic Personality Inventory-3 (MMPI-3; Ben-Porath & Tellegen, 2020a) is a personality assessment measure widely used to assess sexual abuse survivors, substance abusers, and various inpatient and …


The Association Between Symptoms Of Adhd And Alcohol Use And Related Consequences In College Students: Social And Environmental Protective And Risk Factors As Moderators Of This Relation, Cameron Shepard Massey Oct 2023

The Association Between Symptoms Of Adhd And Alcohol Use And Related Consequences In College Students: Social And Environmental Protective And Risk Factors As Moderators Of This Relation, Cameron Shepard Massey

Theses and Dissertations

Alcohol use, while common in college student populations, can bring about significant mental health and educational problems that have negative consequences (Harris et al., 2017; White & Hingson, 2013). Attention-deficit/hyperactivity disorder (ADHD) can also result in significant impairment in academic settings (Kuriyan et al., 2012; Blase et al., 2009, Barbaresi et al., 2007), and those with ADHD often show increased rates of alcohol consumption and related problems, which can greatly increase the risk for students to struggle in college (Barbaresi et al., 2013; Baker et al., 2012). Examining the impact that specific risk and protective factors play in this relation …


Development And Validation Of The Contemporary Sexual Violence Scale, Corey Frederick Doremus Sep 2023

Development And Validation Of The Contemporary Sexual Violence Scale, Corey Frederick Doremus

Theses and Dissertations

College students face an increased risk of sexual violence victimization and perpetration compared to the general population. Although sexual violence experiences within this population have received substantial attention by researchers, studies typically focus on male perpetrators and female victims. Although a number of measures have been developed to assess male sexual violence perpetration, comparatively few have been developed to measure other types of SV such as female perpetration. The current project aimed to develop an empirically supported measure of sexual violence perpetration which assesses the frequency and severity of engagement in discrete sexual violence behaviors and tactics among individuals of …


The Effect Of Non-Offending Caregiver Substance Use On Posttraumatic Stress Symptoms In Survivors Of Child Sexual Abuse, Katelynn Robison Jones Sep 2023

The Effect Of Non-Offending Caregiver Substance Use On Posttraumatic Stress Symptoms In Survivors Of Child Sexual Abuse, Katelynn Robison Jones

Theses and Dissertations

Prevalence rates for child sexual abuse and substance use have often been difficult to determine. The Centers for Disease Control and Prevention (2022) estimated that one in four girls and one in thirteen boys experience childhood sexual abuse (CSA) in the United States. Similarly, the Substance Abuse and Mental Health Services Administration (2021) estimated that 58.7% of individuals over the age of 12 have used a substance in the last month. Despite the identification of both of these experiences as relatively common societal concerns, the impact of parental substance use on children and families has primarily been evaluated in a …


User Engagement With Apps For Depression, Danielle Rae Schweitzer Aug 2023

User Engagement With Apps For Depression, Danielle Rae Schweitzer

Theses and Dissertations

Depression is a debilitating and prevalent psychiatric condition, however, few individuals with depression seek mental health treatment. Mental health apps (MHapps) represent one treatment delivery option that may reduce gaps in mental health care. Current evidence suggests that MHapps are efficacious for reducing depressive symptoms, yet little is known about how MHapps are effective. Thus, the aims of the present study were 1) to examine whether two MHapps were effective for reducing depressive symptoms and 2) to determine whether variables such as user engagement, guidance, outcome expectancies, preferences, and coping skill development were associated with effectiveness. A community sample (N=20) …


Medical Interpreters' Experience Working With Distressed Families In Pediatric Settings, Paulina Lim Aug 2023

Medical Interpreters' Experience Working With Distressed Families In Pediatric Settings, Paulina Lim

Theses and Dissertations

Effective communication between families and pediatric clinicians is essential for mitigating family stress and improving quality of care. Families who speak a primary language other than English must contend with the added stress of language barriers during stressful encounters, which could impact the quality of patient care and health outcomes. Trained medical interpreters facilitate communication, including distress expressions, during interpreted medical encounters (IME). Little is known about how interpreters identify distress and what factors impact distress identification during IME. This project describes how interpreters identify distress of families during IME, and how they identify cultural nuances in distress expression and …


Behavioral And Eye-Movement Correlates Of Item-Specific And Relational Memory In Autism, Greta Nicole Minor Aug 2023

Behavioral And Eye-Movement Correlates Of Item-Specific And Relational Memory In Autism, Greta Nicole Minor

Theses and Dissertations

Recent work has challenged past findings that documented relational memory impairments in autism. Previous studies have often relied solely on explicit behavioral responses to assess relational memory integrity, but successful performance on behavioral tasks may rely on other cognitive abilities (e.g., executive functioning) that are impaired in some autistic individuals. Eye-tracking tasks do not require explicit behavioral responses, and, further, eye movements provide an indirect measure of memory. The current study examined whether memory-specific viewing patterns toward scenes differ between autistic and non-autistic individuals. Using a long-term memory paradigm that equated for complexity between item and relational memory tasks, participants …


Pinpointing The Cognitive Structure Of The Cpt-3: A Case For Distribution Appropriate Statistical Methods, Chandler J. Zolliecoffer Aug 2023

Pinpointing The Cognitive Structure Of The Cpt-3: A Case For Distribution Appropriate Statistical Methods, Chandler J. Zolliecoffer

Theses and Dissertations

The present study used the CPT-3 as a model to illustrate the complementary use of distribution-appropriate statistical methods to analyze non-normally distributed empirical datasets. Study results reaffirmed that while group-level analysis (e.g., via traditional parametric group-level analysis or distribution-appropriate group-level analysis procedures) offers insights into performance of the group in aggregate, it is oftentimes inappropriate to presume that patterns reflected by the group are, necessarily, applicable to a smaller subset of respondents. Thus, understanding how subgroups within the population navigate and approach a given task can have direct implications for more personalized/individualized assessment and treatment, especially in clinical and research …


Impact Of Childhood Maltreatment And Endocannabinoid Function On Posttraumatic Stress Symptoms In Traumatically-Injured Adults, Elizabeth Parisi Aug 2023

Impact Of Childhood Maltreatment And Endocannabinoid Function On Posttraumatic Stress Symptoms In Traumatically-Injured Adults, Elizabeth Parisi

Theses and Dissertations

The ECSS plays a crucial role in regulation of the stress response, is modulated by exposure to acute and chronic stressors, and shows potential as a biomarker for PTSD. Changes in ECSS function are apparent in adults with a history of childhood maltreatment. Further, childhood maltreatment is a well-established pre-trauma risk factor for development of PTSD following a traumatic event in adulthood. No study to date has examined the contribution of ECSS function to the relationship between childhood maltreatment and PTSD following a subsequent trauma in adulthood. The current study aimed to investigate the relationship between exposure to threat and …


Comorbid Adhd And Pediatric Sickle Cell Disease: Prevalence And Risk Factors, Sarah Bills Jul 2023

Comorbid Adhd And Pediatric Sickle Cell Disease: Prevalence And Risk Factors, Sarah Bills

Theses and Dissertations

Objective: Sickle cell disease (SCD) is a genetic blood condition that places youth at increased risk for deficits in attention and executive functioning suggestive of increased rates of Attention Deficit/Hyperactivity Disorder (ADHD). There is pronounced inconsistency in reported prevalence rates for attention deficits and ADHD diagnoses among youth with SCD, which is due in part to variability in methodology of previous studies. The primary aim of the present study is to use systematic screening to identify the prevalence of inattentive ADHD symptoms and ADHD diagnoses in a pediatric SCD population seen at a large hematology clinic. A secondary aim is …


The Effects Of Poly-Strengths On Psychological Wellbeing Amongst Young Adults With Childhood Poly-Victimization, Nakisa Asefnia Jul 2023

The Effects Of Poly-Strengths On Psychological Wellbeing Amongst Young Adults With Childhood Poly-Victimization, Nakisa Asefnia

Theses and Dissertations

The field of trauma and victimization has undergone many evolutions in its efforts to conceptualize the impacts of victimization and more recently poly-victimization. Poly-victimization refers to the experiencing of multiple types of victimization over the lifespan. This has led to an ever-growing base of literature highlighting the many deleterious effects of these experiences on individuals’ wellbeing, and the factors which may make a person more vulnerable to victimization. However, a growing movement in the field aims to take a more strengths-based perspective that highlights the resilience of individuals, rather than risk factors, in the hopes of better understanding the factors …