Open Access. Powered by Scholars. Published by Universities.®

Experimental Analysis of Behavior Commons

Open Access. Powered by Scholars. Published by Universities.®

Health Psychology

Institution
Keyword
Publication Year
Publication
Publication Type

Articles 1 - 30 of 104

Full-Text Articles in Experimental Analysis of Behavior

Examining The Effects Of Menstrual Cycle Phase And Hormonal Contraceptive Use On Women's Sleep, Charles Ethan Coombs May 2024

Examining The Effects Of Menstrual Cycle Phase And Hormonal Contraceptive Use On Women's Sleep, Charles Ethan Coombs

Psychological Science Undergraduate Honors Theses

Women overrepresent men for sub-optimal sleep, a consequence of hormone fluctuation in the menstrual cycle affecting sleep regulatory pathways. While research has examined the prevalence of sub-optimal sleep through cycle phases, little research has examined how hormonal contraceptives (HC’s) could similarly affect women’s sleep, while also neglecting to utilize subjective sleep measures. In this study, we examine subjective sleep quality among naturally cycling (NC) women, women using different HC types, and between active and inactive phase pill users by subjecting 463 women to a subjective sleep battery. We hypothesized that HC users would report more sub-optimal sleep than NC women. …


Repeated Treatment With 5-Ht1a And 5-Ht1b Receptor Agonists: Evidence Of Tolerance And Behavioral Sensitization, Jordan Taylor Dec 2023

Repeated Treatment With 5-Ht1a And 5-Ht1b Receptor Agonists: Evidence Of Tolerance And Behavioral Sensitization, Jordan Taylor

Electronic Theses, Projects, and Dissertations

Serotonin has been found to regulate several cognitive and physiological functions, and its role in depression and other neuropsychiatric disorders has been a focus of research. More specifically, a wealth of research regarding serotonin focuses on serotonergic medications in the treatment of neuropsychiatric disorders, such as depression and anxiety, and stimulates the 5-HT1A and 5-HT1B receptors. Within the last decade, there has been an increase in prescriptions of psychotropic medication for children, however, the efficacy and adverse effects of these drugs have not been evaluated in younger populations. While antidepressants reduce symptoms of depression in adults, they are …


The Benefits Of Art Therapy On Stress And Anxiety Of Oncology Patients During Treatment, Helen Shiepe May 2023

The Benefits Of Art Therapy On Stress And Anxiety Of Oncology Patients During Treatment, Helen Shiepe

Expressive Therapies Capstone Theses

Within the last ten years research on art therapy and its positive impact on oncology patients’ stress and anxiety during treatment has been minimal. Oncology patients whether they are children or adults when diagnosed experience similar reactions due to their diagnosis, treatment, and in some cases end of life care. The current question is whether or not art therapy does have a positive impact on decreasing the stress and anxiety with oncology patients while undergoing treatment. Deane, Fitch & Carmen (2000), discussed art therapy as a healing art that is “intended to integrate physical, emotional, and spiritual care by facilitating …


Empathy And The Medical Student House Call: The Effect Of Clinical Settings On Empathy In Third Year Medical Students, Philip B. Collins, Thomas Dinzeo, Jennifer C. Sepede, John F. Bertagnolli, Christian White May 2023

Empathy And The Medical Student House Call: The Effect Of Clinical Settings On Empathy In Third Year Medical Students, Philip B. Collins, Thomas Dinzeo, Jennifer C. Sepede, John F. Bertagnolli, Christian White

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

OBJECTIVE: This study measured the effect the experience of house calls might have on third-year medical students.

METHODS: Students were surveyed via an anonymous online survey at the start of their geriatrics clerkship, again at the end of their clerkship, and once more three months later. Empathy was measured using the Jefferson Scale of Empathy - Student version (JSE) and student attitudes towards the geriatrics population was measured using the UCLA Geriatrics Attitudes Scale (GAS). Data were analyzed using SPSS version 27.0.

RESULTS: No changes in empathy were found when comparing students who completed house calls versus those who did …


Food Related Intrusive Thoughts: A Pilot Study, Hoor Ul Ain Apr 2023

Food Related Intrusive Thoughts: A Pilot Study, Hoor Ul Ain

Honors Theses

Food related intrusive thoughts (FRITs), a type of intrusive thoughts, might be associated with greater frequency of food intake, greater anxiety and distress, and negative affect in general. However, little is known about the experience of FRITs in the moment. I hypothesized that (1) momentary food related intrusive thoughts or FRITs would be positively related to momentary negative affect and (2) that time since eating will moderate this relationship such that people with more time since eating will show a stronger positive relationship between FRITs and negative affect. These relationships were not found to be significant; however, there was a …


Analyzing The Effects Of Video Games On Social Anxiety And Communication, Ana S. Quigley Jan 2023

Analyzing The Effects Of Video Games On Social Anxiety And Communication, Ana S. Quigley

Senior Projects Spring 2023

Those with high levels of social anxiety can struggle with their communication skills, and confidence in communication. By using a virtual platform such as Zoom to communicate with others, individuals with social anxiety have shown decreased levels of anxiety, even noting that they prefer the virtual platform over face-to-face encounters (Yen et al., 2012). Video games can increase this level of anonymity that could be felt through zoom, by removing the ability to see the other individual’s face. This gives video games the opportunity to decrease anxiety levels while still requiring a degree of communication. Participants will be randomly sorted …


Responses To Covid-19 Threats: An Evolutionary Psychological Analysis., Stephen M. Colarelli, Tyler J. Mirando, Kyunghee Han, Norman P. Li, Carter Vespi, Katherine A. Klein, Charles P. Fales Dec 2022

Responses To Covid-19 Threats: An Evolutionary Psychological Analysis., Stephen M. Colarelli, Tyler J. Mirando, Kyunghee Han, Norman P. Li, Carter Vespi, Katherine A. Klein, Charles P. Fales

Research Collection School of Social Sciences

Responses to COVID-19 public health interventions have been lukewarm. For example, only 64% of the US population has received at least two vaccinations. Because most public health interventions require people to behave in ways that are evolutionarily novel, evolutionary psychological theory and research on mismatch theory, the behavioral immune system, and individual differences can help us gain a better understanding of how people respond to public health information. Primary sources of threat information during the pandemic (particularly in early phases) were geographic differences in morbidity and mortality statistics. We argue that people are unlikely to respond to this type of …


K-5 Elementary Alternative Program: A Case Study, William E. Scheuer Iv Dec 2022

K-5 Elementary Alternative Program: A Case Study, William E. Scheuer Iv

Electronic Theses and Dissertations

The purpose of this case study was to examine how the K-5 elementary alternative program All Students Can Thrive (ASCT) used student-centered learning practices to influence the whole child. There is a lack of research on K-5 elementary alternative programs, such as ASCT, and specifically those that integrate student-centered learning practices to influence the whole child. Literature does not contain universally accepted interventions that are effective in the elementary alternative setting to help students return to the mainstream classroom setting better prepared to display appropriate behaviors when a student is removed from a mainstream classroom setting due to disruptive behaviors. …


In Covid-19 Health Messaging, Loss Framing Increases Anxiety With Little-To-No Concomitant Benefits: Experimental Evidence From 84 Countries, Charles A. Dorison, Et. Al., Andree Hartanto Sep 2022

In Covid-19 Health Messaging, Loss Framing Increases Anxiety With Little-To-No Concomitant Benefits: Experimental Evidence From 84 Countries, Charles A. Dorison, Et. Al., Andree Hartanto

Research Collection School of Social Sciences

The COVID-19 pandemic (and its aftermath) highlights a critical need to communicate health information effectively to the global public. Given that subtle differences in information framing can have meaningful effects on behavior, behavioral science research highlights a pressing question: Is it more effective to frame COVID-19 health messages in terms of potential losses (e.g., “If you do not practice these steps, you can endanger yourself and others”) or potential gains (e.g., “If you practice these steps, you can protect yourself and others”)? Collecting data in 48 languages from 15,929 participants in 84 countries, we experimentally tested the effects of message …


Examining The Impact Of Financial Stress On Affect And Eating Behaviors, Ellen Hunt Steele Aug 2022

Examining The Impact Of Financial Stress On Affect And Eating Behaviors, Ellen Hunt Steele

Theses and Dissertations

Economic pressure and concomitant financial stress have been associated with mental and physical health problems, conflict, and poorer education and employment outcomes. Moreover, financial stress can be seen in specific hardships (e.g., food insecurity) and lead to maladaptive attempts to regulate emotions stemming from financial stressors. Women may be more vulnerable to consequences of food insecurity and attempts to regulate emotions with eating than men. Thus, the current study examined the impact of a randomized financial stress induction on affect and snack food choice while accounting for the influence of food insecurity and gender. Participants included 269 validly responding individuals. …


Mental Health Stigma And Law Enforcement Officers, Moses Park May 2022

Mental Health Stigma And Law Enforcement Officers, Moses Park

Dissertations

Purpose: The purpose of this phenomenological research was to describe the perception of law enforcement officers (LEOs) about the stigmatizing behavior they experienced from fellow officers in their organization, after they sought mental health services, following a traumatic event they were involved in.

Methodology: The methodology for this research study will be qualitative from a phenomenological perspective. Data was collected via semi-structured interviews with a purposive sample of 12 active and retired LEOs who served in southern California.

Findings: After the analysis, seven major findings were yielded. The major findings of the study are: (a) Within the law enforcement …


Examining The Effects Of Different Coping Styles On Dependent Stress Generation, Whitney Skaggs May 2022

Examining The Effects Of Different Coping Styles On Dependent Stress Generation, Whitney Skaggs

Psychological Science Undergraduate Honors Theses

In this study, I prospectively examined the associations between different coping styles and stress. Stress can be classified as independent, which is stress that an individual has no control over, or dependent stress, which is stress that occurs because of the individuals’ actions. Coping is how individuals deal with that stress. With the role that coping plays in stress, I expected that it would relate to stress generation. I hypothesized that some forms of coping would prospectively predict the occurrence of less dependent stress but not independent stress. To test this hypothesis, I had college students (N=73) complete …


Non-Verbal Pride Expressions As A Predictor Of Lgbtq Health, Craig Gilbert Apr 2022

Non-Verbal Pride Expressions As A Predictor Of Lgbtq Health, Craig Gilbert

Theses and Dissertations

Pride is a self-conscious, positive emotion that has been assessed in a wide range of populations and with a variety of pre-validated measures. Research has shown that the presence of pride can function as a potential resilience factor against minority based stress and has been linked to increased emotional well being, life satisfaction, and self-esteem. However, a majority of this research relies upon self-report questionnaires as opposed to observational data. To evaluate the predictive power of non-verbal pride behaviors, a group of LGBTQ+ individuals (n=125) were asked during a recorded interview to describe an experience where they felt prideful about …


Evaluation Of Hippocampal Allostatic Load-Associated Factors In Animal Models Of Post-Traumatic Stress Disorder: Relevance To Human Ptsd, Dennis Parker Kelley Mar 2022

Evaluation Of Hippocampal Allostatic Load-Associated Factors In Animal Models Of Post-Traumatic Stress Disorder: Relevance To Human Ptsd, Dennis Parker Kelley

LSU Doctoral Dissertations

Post-traumatic stress disorder (PTSD) is associated with elevated allostatic load, nearly double the risk for metabolic syndrome, reduced hippocampal volume, and contextual memory processing deficits. Emerging evidence suggests that these stress effects may predispose individuals to the development of PTSD, and there is a known relationship between chronic stress and metabolic dysfunction. In this work, we utilized two rat models of PTSD to explore these connections. We used an acute predator odor stressor to investigate the relationship between PTSD-like behaviors and mitochondrial dysfunction in the hippocampus of rats, and we observed that conditioned place avoidance was associated with reduced mitochondrial …


The Impacts Of Learning 2 Breathe On Rumination, Adessa Flack Jan 2022

The Impacts Of Learning 2 Breathe On Rumination, Adessa Flack

West Chester University Doctoral Projects

The present study examined the impact of Learning2Breathe (L2B), a mindfulness-based stress reduction program developed for use with adolescents on rumination. The program was applied to rumination in college-age men and women. Our experiment utilized a quasi-experimental design. The sample consisted of 50 undergraduate students that were placed in either the experimental or control group. Data was collected pretest and posttest through a variety of measures including the Rumination Reflection Questionnaire (RRQ) which consisted of a rumination and reflection subscale, and the Mindfulness Attention Awareness Scale (MAAS). A two-way mixed ANOVA design was used to analyze data. There was no …


Development And Testing Of Remote Facilitation Of Prevent-Teach-Reinforce For Families To Address Challenging Behavior In Young Children (Ptr-F:R), Abby Hodges Jan 2022

Development And Testing Of Remote Facilitation Of Prevent-Teach-Reinforce For Families To Address Challenging Behavior In Young Children (Ptr-F:R), Abby Hodges

Electronic Theses and Dissertations

As children advance through developmental stages, they often present behavioral difficulties such as tantrums, lack of cooperation, and aggression. For some children, behaviors are serious enough that they interfere with the child’s ability to engage in positive relationships, participate in necessary routines, and learn new skills, warranting behavioral intervention (Dunlap et al., 2017). Being responsive to the needs of the family and appreciation for the central role that they play is crucial to the success of behavioral interventions and the maintenance of positive outcomes (Bailey, 2013; Campbell, 1995), thus, their input should be at the center of all recommendations and …


The Program To Reduce Implicit Bias In Carroll Hospital Center Using The Implicit Association Test, Katherine E. Traynor Jan 2022

The Program To Reduce Implicit Bias In Carroll Hospital Center Using The Implicit Association Test, Katherine E. Traynor

Capstone Showcase

Natural brain processes make all individuals susceptible to unconscious bias; however, stressful, fearful, or anger-evoking situations as well as the negative influence of media and social surroundings increase the risk of holding obstructive bias, and there is a greater risk of being negatively impacted by this phenomenon when belonging to a minority population (Rose & Flores, 2020). As a result, high rates of infant mortality (10.2 deaths per 1,000 live births for the Non-Hispanic Black population compared to 4.1 in the White population) and cardiovascular related diseases (190.0 cases per 1,000 in the Non-Hispanic Black population compared to 161.3 in …


The Importance Of Sleep For Flexibly Coping With Daily Stress, Calissa Leslie-Miller Jan 2022

The Importance Of Sleep For Flexibly Coping With Daily Stress, Calissa Leslie-Miller

Dissertations, Theses, and Masters Projects

Coping flexibility, the ability to match coping strategy choice to the demands of a situation, has been found to diminish the effects of daily stress. Despite the importance of high levels of coping flexibility, little research has explored factors that can predict one’s ability to demonstrate coping flexibility. One promising avenue for such research is the role of sleep. This research aims to explore the importance of sleep as a predictor of daily coping flexibility across two studies. Study one consists of one hundred and fifty college student participants who were recruited in the Spring 2021 semester at the College …


The Effects Of Situational And Individual Factors On Algorithm Acceptance In Covid-19-Related Decision-Making: A Preregistered Online Experiment, Sonja Utz, Lara N. Wolfers, Anja S. Göritz Sep 2021

The Effects Of Situational And Individual Factors On Algorithm Acceptance In Covid-19-Related Decision-Making: A Preregistered Online Experiment, Sonja Utz, Lara N. Wolfers, Anja S. Göritz

Human-Machine Communication

In times of the COVID-19 pandemic, difficult decisions such as the distribution of ventilators must be made. For many of these decisions, humans could team up with algorithms; however, people often prefer human decision-makers. We examined the role of situational (morality of the scenario; perspective) and individual factors (need for leadership; conventionalism) for algorithm preference in a preregistered online experiment with German adults (n = 1,127). As expected, algorithm preference was lowest in the most moral-laden scenario. The effect of perspective (i.e., decision-makers vs. decision targets) was only significant in the most moral scenario. Need for leadership predicted a stronger …


The Impact Of The Covid-19 Pandemic On Young Adults Regularly Using Alcohol And Opioids, Mimi Mead, Kylie Thorwardson, Ryan Carpenter Sep 2021

The Impact Of The Covid-19 Pandemic On Young Adults Regularly Using Alcohol And Opioids, Mimi Mead, Kylie Thorwardson, Ryan Carpenter

Undergraduate Research Symposium

The COVID-19 pandemic, via the need for social distancing, has had an enormous impact on how individuals use substances that we are only beginning to understand. Some factors (e.g., increased social isolation) may have led to increased substance use, while others (e.g., restrictions on access) may have made it harder to use. The impact of COVID-19 is particularly important to understand in individuals whose use puts them at high risk of overdose. Our study sought out how exactly substance use patterns changed due to the pandemic in young adults reporting regular use and co-use of alcohol and opioids. Participants were …


Bibliometric Survey On The Effects Of Technology Addiction, Dipashri Sisodiya Miss, Dhanya Pramod Mrs Jul 2021

Bibliometric Survey On The Effects Of Technology Addiction, Dipashri Sisodiya Miss, Dhanya Pramod Mrs

Library Philosophy and Practice (e-journal)

In today’s technology-centric era, our lives have become vastly dependent on the internet. The internet is widely used for social media to connect, communicate, share and collaborate. However, constant usage of technology can increase compulsion or addiction. This bibliometric survey describes the various types of effects of technology addiction on Human body. The purpose of this research is to examine the different types of technology addiction research published in the journal between 2001 to 2020 in different regions in the World. The Bibliometric analysis is done using Scopus. Scopus and VOS Viewer were used to plot a recurrence of keywords, …


Reiki For Recovery: Incorporating Japanese Health Practices To Increase Contemporary Resiliency In American Health, Leif Peterson May 2021

Reiki For Recovery: Incorporating Japanese Health Practices To Increase Contemporary Resiliency In American Health, Leif Peterson

Master's Projects and Capstones

The Japanese health practice of Reiki attempts to maximize the latent ability of the human system to heal itself. The Reiki system, established over a century ago, combines multiple Asian health traditions, experimenting with practices that maximize the natural processes of the body to perform its own repairs. Reiki encourages healthy behaviors that balance the mind and body, return the human system to a lowered stress level, and allow for an optimal recovery state for the patient. This paper illustrates how this Japanese health-affirming method can be integrated and utilized within existing health and medical practices. An area that is …


Identity-Specific Positive Psychology Intervention For Sexual Minorities: A Randomized Control Trial, Sarah Job May 2021

Identity-Specific Positive Psychology Intervention For Sexual Minorities: A Randomized Control Trial, Sarah Job

Electronic Theses and Dissertations

Sexual minorities experience mental and physical health disparities in comparison to heterosexual individuals due to minority stress (Branstrom et al., 2016; Kerridge et al., 2017; Meyer, 2003). Positive psychology interventions have improved mental and physical health (Antoine et al., 2018; Lambert D'raven et al., 2015), and therefore these interventions have potential to address health disparities. The current study tested an identity-specific intervention (n = 30) to a general positive psychology intervention (n = 30) and a control group (n = 30) among sexual minorities. This built on a recent pilot study which tested the efficacy of an …


The Impact Of Mindfulness On Healthy Food Choices, Kaylea Hopfer May 2021

The Impact Of Mindfulness On Healthy Food Choices, Kaylea Hopfer

Graduate Theses and Dissertations

The practice of mindfulness has a long history in research, particularly psychological studies. In this paper I examine the effects of a short mindfulness intervention on healthy food purchases. Specifically, I developed an online survey and recruited 634 participants via Prolific between July 24 - July 27, 2020. I randomly assigned participants to either a mindfulness manipulation or a control condition. Following treatment (or control) participants completed a food choice task and various other control. Following the survey, I analyzed data using R version 4.0.2 (2020-06-22) and R-Studio. I estimated three different regression models, ordinary least squares (OLS), Poisson, and …


Cannabis Use, Sedentary Behavior, And Physical Activity In A Nationally Representative Sample Of Us Adults, Lydia Q. Ong, John Belletierre, Citlali Alvorado, Paul Chavez, Vincent Berardi Apr 2021

Cannabis Use, Sedentary Behavior, And Physical Activity In A Nationally Representative Sample Of Us Adults, Lydia Q. Ong, John Belletierre, Citlali Alvorado, Paul Chavez, Vincent Berardi

Psychology Faculty Articles and Research

Background

Prior research examining the relationship between cannabis use, sedentary behavior, and physical activity has generated conflicting findings, potentially due to biases in the self-reported measures used to assess physical activity. This study aimed to more precisely explore the relationship between cannabis use and sedentary behavior/physical activity using objective measures.

Methods

Data were obtained from the 2005–2006 National Health and Nutrition Examination Survey. A total of 2,092 participants (ages 20–59; 48.8% female) had accelerometer-measured sedentary behavior, light physical activity, and moderate-to-vigorous physical activity. Participants were classified as light, moderate, frequent, or non-current cannabis users depending on how often they used …


Everyday Memory In People With Down Syndrome, Yingying Yang, Zachary M. Himmelberger, Trent Robinson, Megan Davis, Frances Conners, Edward Merrill Apr 2021

Everyday Memory In People With Down Syndrome, Yingying Yang, Zachary M. Himmelberger, Trent Robinson, Megan Davis, Frances Conners, Edward Merrill

Department of Psychology Faculty Scholarship and Creative Works

Although memory functions in people with Down Syndrome (DS) have been studied extensively, how well people with DS remember things about everyday life is not well understood. In the current study, 31 adolescents/young adults with DS and 26 with intellectual disabilities (ID) of mixed etiology (not DS) participated. They completed an everyday memory questionnaire about personal facts and recent events (e.g., school name, breakfast). They also completed a standard laboratory task of verbal long-term memory (LTM) where they recalled a list of unrelated words over trials. Results did not indicate impaired everyday memory, but impaired verbal LTM, in people with …


How Multidimensional Is Emotional Intelligence? Bifactor Modeling Of Global And Broad Emotional Abilities Of The Geneva Emotional Competence Test, Daniel Simonet, Katherine E. Miller, Kevin Askew, Kenneth Sumner, Marcello Mortillaro, Katja Schlegel Mar 2021

How Multidimensional Is Emotional Intelligence? Bifactor Modeling Of Global And Broad Emotional Abilities Of The Geneva Emotional Competence Test, Daniel Simonet, Katherine E. Miller, Kevin Askew, Kenneth Sumner, Marcello Mortillaro, Katja Schlegel

Department of Psychology Faculty Scholarship and Creative Works

Drawing upon multidimensional theories of intelligence, the current paper evaluates if the Geneva Emotional Competence Test (GECo) fits within a higher-order intelligence space and if emotional intelligence (EI) branches predict distinct criteria related to adjustment and motivation. Using a combination of classical and S-1 bifactor models, we find that (a) a first-order oblique and bifactor model provide excellent and comparably fitting representation of an EI structure with self-regulatory skills operating independent of general ability, (b) residualized EI abilities uniquely predict criteria over general cognitive ability as referenced by fluid intelligence, and (c) emotion recognition and regulation incrementally predict grade point …


Distracted Pedestrians: Looking Left?, Emma Hood, Bryan E. Porter Jan 2021

Distracted Pedestrians: Looking Left?, Emma Hood, Bryan E. Porter

Psychology: Interdisciplinary Research in Behavioral Sciences of Transportation Issues

Distracted pedestrians, those talking or texting on phones as examples, are potentially at risk when crossing urban intersections. They may lack traffic awareness of risk as distracted drivers often do. The transportation field has limited data on distracted pedestrians. This study aimed to contribute to the literature by observing pedestrian behaviors at four urban-area, downtown crosswalks over five weeks in June-July 2021. Overall, 2,055 pedestrians were observed, with 25.4% being distracted. Common distractions were texting, talking on a cell phone, and using headphones. Chi-square analyses found that while distraction did not predict looking left, one behavior that keeps them out …


Post-Bariatric Surgery Patients Fail To Exercise Consistently: Exploring The Potential Role Of Self-Compassion, Naomi Teeter Jan 2021

Post-Bariatric Surgery Patients Fail To Exercise Consistently: Exploring The Potential Role Of Self-Compassion, Naomi Teeter

EWU Masters Thesis Collection

Many bariatric weight loss surgery patients do not exercise after surgery. One potential reason this population may not exercise is due to body image shame and low self-compassion, which can contribute to lower appreciation for one’s body. Adult participants from an international bariatric population sample (N = 805) and an Eastern Washington University undergraduate student sample (N = 104) completed a one-time online questionnaire that included measures of self-compassion, physical activity frequency, body appreciation, and body image shame. In the bariatric sample, self-compassion was indirectly associated with exercise frequency via body appreciation and body image shame. Additionally, at the highest …


The Youthful Pandemic, Brook Sahlemariam Dec 2020

The Youthful Pandemic, Brook Sahlemariam

Nursing | Senior Theses

This paper attempts to examine the neurological, physical, and societal effects of e-cigarette use among youth and young-adults in North America. Furthermore, the paper investigates the parallels between e-cigarette users, tobacco users, and dual users in regard to behavioral patterns, reasons for use, and age of initiation.