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Articles 91 - 120 of 145

Full-Text Articles in Health Psychology

Examining Two Structural Equation Models To Determine The Effect Of Parental Practices And Familial Cultural Values On Mexican Adolescents’ Sexual Health, Efren A. Velazquez Jan 2018

Examining Two Structural Equation Models To Determine The Effect Of Parental Practices And Familial Cultural Values On Mexican Adolescents’ Sexual Health, Efren A. Velazquez

Theses and Dissertations

Sexual behavior is a normative part of adolescence and it is important to understand how familial factors influence Latina/o adolescents’ sexual health. The current study examined two structural equation models (SEM) and the associations between familial cultural values (i.e., familismo and filial piety), maternal and paternal monitoring (i.e., disclosure and solicitation) and Latina/o adolescent’s sexual behavior (i.e., intentions to have sex, sexual behavior, sexual responsibility). A hypothesized SEM examined whether paternal/maternal monitoring mediated the relation between familial cultural values and adolescents’ sexual health, while an alternative SEM examined whether familial cultural values mediated the association between paternal/maternal monitoring and adolescents’ …


Investigating Racial Bias In Perceptions Of Free Will, Courtney J. Alderson Jan 2018

Investigating Racial Bias In Perceptions Of Free Will, Courtney J. Alderson

Theses and Dissertations

The overarching goal of this study was to examine whether perceptions of others’ free will would differ depending on perceiver race as well as target race. The current study proposed that such a racial bias may be one mechanism by which racial disparities in medical treatment recommendations arise. By bridging findings from four different lines of research (i.e., the literatures on racial health and medical treatment disparities, racial bias, free will beliefs, and social identity), it was hypothesized that: (1) participants would perceive greater amounts of free will for a hypothetical racial ingroup patient than an outgroup patient; (2) such …


A Stakeholder Examination Of Gestational Weight Gain Guidelines, Melissa Kwitowski Jan 2018

A Stakeholder Examination Of Gestational Weight Gain Guidelines, Melissa Kwitowski

Theses and Dissertations

Obesity is a significant health concern for women of childbearing age. More than 40% of women have a Body Mass Index (BMI) in the overweight or obese ranges at the time they conceive, posing significant health risks for both mother and child. Excessive weight gain during pregnancy is common and associated with numerous deleterious complications. The Institute of Medicine published gestational weight gain (GWG) guidelines based on prepregnancy BMI. However, more than 50% of women gain in excess of these recommendations. Further, many women report receiving minimal guidance from their healthcare providers regarding weight gain, nutrition, and physical activity during …


Queer Health Equity And Cervical Cancer: Identifying Social Determinants Of Papanicolaou Test Uptake In A Sample Of Sexual Minority Women And Gender Nonbinary Individuals, Ariella R. Tabaac Jan 2018

Queer Health Equity And Cervical Cancer: Identifying Social Determinants Of Papanicolaou Test Uptake In A Sample Of Sexual Minority Women And Gender Nonbinary Individuals, Ariella R. Tabaac

Theses and Dissertations

Sexual minority women (SMW) demonstrate lower rates of cervical cancer screening than heterosexual women. This is concerning as lesbian and bisexual women tend to engage in higher rates of substance-related cancer risk behaviors, unprotected sex, and tend to have higher body mass indices, all of which are risk factors for cancer development. Another major risk factor, screening avoidance, places SMW at increased risk for the development of high grade cervical lesions in the absence of early detection practices, which is likely to impact overall cervical cancer morbidity in this population. The aim of the present study was to utilize the …


A Laboratory Study Of Stress Reactions To Witnessing A Police Killing Of An Unarmed Black Man: Discrimination, Distress Tolerance, Ethnic Identity, And Risk-Taking, Michael A. Trujillo Jan 2018

A Laboratory Study Of Stress Reactions To Witnessing A Police Killing Of An Unarmed Black Man: Discrimination, Distress Tolerance, Ethnic Identity, And Risk-Taking, Michael A. Trujillo

Theses and Dissertations

Black individuals have been disproportionately targeted by law enforcement, most notably in shooting deaths at the hands of police, and has contributed to a general distrust of law enforcement. A rise in citizen journalism has helped document excessive use of force by police on video; however, little is known how individuals respond to viewing this type of media. A history of race-based stress is likely to contribute to an expectation of racism and may impact how individuals respond to videos of the treatment of unarmed Black men at the hands of police, with some evidence suggesting ethnic identity may moderate …


Abuse Liability Of An Electronic Cigarette In Traditional Cigarette Smokers, Sarah F. Maloney Jan 2018

Abuse Liability Of An Electronic Cigarette In Traditional Cigarette Smokers, Sarah F. Maloney

Theses and Dissertations

Electronic cigarettes have grown in popularity across the U.S. and concerns have been raised about their abuse liability. The purpose of the current study was to evaluate and compare the abuse liability of an electronic cigarette with and without nicotine to a nicotine inhaler (the Nicotrol inhaler) and participants’ own brand of cigarettes. A total of 24 smokers attended four sessions in which the abuse liability of each product was examined using the Multiple-Choice Procedure (MCP), nicotine delivery, nicotine abstinence symptom suppression, and subjective reinforcing effects. Results revealed that the nicotine containing and non-nicotine containing electronic cigarette had a higher …


Women’S Decisions About Mental Health Treatment In The Perinatal Period, Marina G. Green Jan 2017

Women’S Decisions About Mental Health Treatment In The Perinatal Period, Marina G. Green

AUCTUS: The Journal of Undergraduate Research and Creative Scholarship

This study examined a mother’s decision-making process in regards to mental health treatment for emotional difficulties during pregnancy and/or in the postpartum period. The literature shows that different factors influence a woman’s ability and willingness to seek services, including demographic factors, cultural factors, and interactions with healthcare providers and acquaintances. A sample of women who experienced emotional difficulties in the perinatal period was recruited through social media. Participants answered an anonymous electronic survey; the quantitative data was analyzed through SPSS, and the qualitative data was aggregated by themes. Quantitative findings indicate that age might be an influencing factor for women …


A Hierarchical Linear Modeling Approach To Predicting Trajectories Of Posttraumatic Growth In Veterans Following Acquired Physical Disability, Lisa Goldberg Looney Jan 2017

A Hierarchical Linear Modeling Approach To Predicting Trajectories Of Posttraumatic Growth In Veterans Following Acquired Physical Disability, Lisa Goldberg Looney

Theses and Dissertations

The purpose of this study was to examine potential predictors of PTG across time in Veterans with acquired physical disabilities. Specifically, this study aimed to understand how various demographic and injury characteristics, coping styles, appraisals of injury, and social support might predict trajectories of PTG from discharge from inpatient rehabilitation through 12 months after baseline. Initial curvature analyses suggested that a cubic polynomial trend best fit the movement of PTG over time, generally conforming to an initial increase, decrease, and then plateau or slight increase. Four HLMs were run to examine whether demographic and injury characteristics, coping styles, appraisals of …


A Systematic Review Of Weight-Related Communication Trainings For Physicians: What Do We Know And How Can We Inform Future Development Of Training Programs?, Jean M. Reading, Morgan Snell, Jessica G. Larose Jan 2017

A Systematic Review Of Weight-Related Communication Trainings For Physicians: What Do We Know And How Can We Inform Future Development Of Training Programs?, Jean M. Reading, Morgan Snell, Jessica G. Larose

Graduate Research Posters

It is reported that physicians lack training to address weight-related concerns with patients. To overcome this, training programs have been implemented in medical settings to prepare physicians to have conversations with patients. However, it is unclear the degree of consistency among existing training programs and factors associated with better outcomes. The objective of this study was to systematically review the existing literature in this area to determine differences in content, outcomes, and implementation of existing studies that test weight-related communication training programs for physicians.

A systematic literature review of online databases including PubMed, PsycINFO, and Proquest was conducted with the …


Effects Of Cumulative Risk On Asthma Outcomes In Urban Children And Adolescents, Samantha A. Miadich Jan 2017

Effects Of Cumulative Risk On Asthma Outcomes In Urban Children And Adolescents, Samantha A. Miadich

Theses and Dissertations

Pediatric asthma disproportionately affects racial/ethnic minority children and children living in low-income, urban areas. Many families living in low-income, urban areas experience a number of stressors that can place children/adolescents at risk for worse asthma outcomes. This study examined the impact of a cumulative risk model of stressors (e.g., ED visits, quick-relief medication use, lung function, asthma control, QOL) in urban children (7-12 years) with persistent asthma. This study further aimed to examine both the original cumulative risk model and an adolescent-specific cumulative risk model as predictors of asthma outcomes in a sample of 60 adolescents (13-17 years). Asthma-related caregiver …


Implementing Integrated Care In Family Medicine: Description And Outcomes In An Underserved Population, Zach Radcliff Jan 2017

Implementing Integrated Care In Family Medicine: Description And Outcomes In An Underserved Population, Zach Radcliff

Theses and Dissertations

Introduction: Family physicians provide access to medical and behavioral healthcare for many underserved populations. Integrating behavioral health clinicians into primary care practices has been proposed as one of the most effective ways to increase access to necessary behavioral health services for many Americans. Integrated behavioral healthcare (IBHC) has begun to be implemented in family medicine practices but there is limited research examining the impact for patients and clinic staff. This study begins to fill this gap in the literature by examining the effects of implementing integrated behavioral healthcare in an urban family medicine clinic in a medically underserved area.

Objective: …


The Role Of Afrocentric Features In Mental Healthcare Utilization And Counselor Preferences In Black College Students, Randl B. Dent Jan 2017

The Role Of Afrocentric Features In Mental Healthcare Utilization And Counselor Preferences In Black College Students, Randl B. Dent

Theses and Dissertations

Though mental health issues are prevalent in Black young adults, they underutilize mental healthcare services. This research examined the role of feature-based discrimination in mental healthcare (under)utilization. Study 1, a secondary analysis of the National Longitudinal Study of Adolescent to Adult Health, provided no evidence supporting a link between skin tone and mental healthcare utilization, when controlling for depression diagnosis. However, when controlling for depression symptoms, there was a trend such that Black young adults with darker, as opposed to lighter, skin tone utilized healthcare less. Study 2, an experimental study with 33 Black college students, showed 73% of the …


Non-Medical Use Of Prescription Drugs, Stress, Cultural Orientation, Utilization Of Healthcare, And Protective Factors Among College Students In China, Cheuk Chi Tam Jan 2017

Non-Medical Use Of Prescription Drugs, Stress, Cultural Orientation, Utilization Of Healthcare, And Protective Factors Among College Students In China, Cheuk Chi Tam

Theses and Dissertations

Background: Non-medical use of prescription drugs (NMUPD) refers to the use of prescription drugs which are traditionally utilized to manage pain or treat psychiatric problems but without a doctor’s prescription. In 2010, an investigation by the Substance Use and Mental Health Services Administration (SAMHSA) revealed that 5.3% of young adults (18 to 25-year-olds) in the United States reported past-month NMUPD. NMUPD has become a growing concern owing to associations with consequences such as college dropout, poor academic achievement, and health jeopardizing behaviors. College students' NMUPD has been well documented in the United States. Limited studies, however, have been conducted among …


Examining Health Behaviors In College Students With And Without Chronic Conditions, Duc-Thi J. Barsell Jan 2017

Examining Health Behaviors In College Students With And Without Chronic Conditions, Duc-Thi J. Barsell

Theses and Dissertations

Many college students are in a developmental period in which they are transitioning from pediatric to adult health care. This time period can be challenging for all college students and especially for students with a chronic condition. The current study investigated the association between various health-related factors (health locus of control [HLOC], health literacy, health self-efficacy, and health-related quality of life [HRQOL]) and health behaviors in college students, as well as the moderating effect of having a chronic condition on those associations. These health behaviors were further operationalized as healthy lifestyle behaviors (preventative and wellness behaviors, dietary behaviors, physical activity) …


An Integrated Behavioral Model Of Healthcare Utilization Among Transgender And Gender-Nonconforming Adults, Megan Elizabeth Sutter Jan 2017

An Integrated Behavioral Model Of Healthcare Utilization Among Transgender And Gender-Nonconforming Adults, Megan Elizabeth Sutter

Theses and Dissertations

Transgender and gender-nonconforming (TGNC) individuals in the United States experience significant marginalization due to stigma enacted at the structural, interpersonal, and individual levels. As a result, this population has reported increased behavioral and physical health needs, as well as unique barriers to healthcare. Moreover, TGNC individuals have reported greater experiences of childhood abuse compared to cisgender individuals. The cumulative experiences of stigma-related stressors and adverse childhood experiences put this population at risk for the development of mental and physical health problems, increasing need for health services. However, TGNC individuals have reported being denied medical care and postponing seeking care due …


Sustainable Adapted Treatments For Eating Disorders: The Role Of Cultural Adaptation In Prevention, Sarah J. Javier Jan 2017

Sustainable Adapted Treatments For Eating Disorders: The Role Of Cultural Adaptation In Prevention, Sarah J. Javier

Theses and Dissertations

Despite demonstrating eating disorder rates equivalent to White women, African American and Asian American women are less likely to seek treatment and are more likely to terminate treatment prematurely. One of the most successful programs for eating disorder prevention has only focused on surface-level cultural adaptations. Prevention literature maintains that deep-structure cultural adaptation (e.g., integrating cultural values and beliefs) can enhance outcomes for ethnic minorities. This dissertation examined the feasibility of Sustainable Adapted Treatments for Eating Disorders (SATED), a pilot intervention that included a culturally- targeted pre-treatment to an eating disorder dissonance-based intervention. A sample of 72 women (ages 18-30) …


Protective Factors In The Association Between Child Sexual Abuse And Telomere Length In Adults, David Sosnowski Jan 2017

Protective Factors In The Association Between Child Sexual Abuse And Telomere Length In Adults, David Sosnowski

Theses and Dissertations

The purpose of the present study was to examine if childhood sexual abuse (CSA) was associated with decreases in mean telomere length (TL), and if social support and/or optimism moderated this association. The study included 99 Caucasian female monozygotic twins, ranging in age from 19-48 (Mage = 30.5, SD = 7.8) at Time 1. Linear mixed effects models were employed to test study hypotheses. Analyses with all participants did not detect an effect of CSA exposure or severity on mean TL, nor were there effects with optimism. However, in analyses that only included women exposed to abuse, increases …


Exploring The Role Of Motivational Interviewing In Adolescent Patient-Provider Communication About Type 1 Diabetes, Laura J. Caccavale Jan 2017

Exploring The Role Of Motivational Interviewing In Adolescent Patient-Provider Communication About Type 1 Diabetes, Laura J. Caccavale

Theses and Dissertations

Type 1 diabetes (T1D) is one of the most common pediatric chronic illnesses. Glycemic control among patients with T1D often deteriorates during adolescence; yet little is known about the most effective way for providers to communicate with adolescents to prevent this decline. Given the importance of effective communication, examination of effective patient-provider communication strategies is needed. The current investigation used Motivational Interviewing (MI) as a framework to help characterize naturally-occurring adolescent patient-provider communication in medical encounters and examined the relations between provider communication and T1D self-management and control.

Participants were five pediatric endocrine providers and 55 adolescents with T1D (49% …


Mechanisms Of Motivational Interviewing In A Parent-Focused Pediatric Obesity Intervention, Nadia Islam Jan 2017

Mechanisms Of Motivational Interviewing In A Parent-Focused Pediatric Obesity Intervention, Nadia Islam

Theses and Dissertations

Pediatric obesity is a major public health epidemic with serious physical and psychological consequences. Difficulty engaging families in treatment is a significant obstacle in addressing pediatric obesity, especially among underserved populations. Motivational interviewing (MI) is a collaborative, person-centered communication style that has been shown to reduce attrition, increase attendance, and improve patient treatment adherence; however, little is known about the process of MI and how it improves treatment engagement. This study examined clinician and parent language in a pre-treatment MI session that increased initial engagement in a parent- focused pediatric obesity intervention (N= 81). Results showed that increased parent change …


Pathways Linking Sleep Timing To Obesity In Midlife Women, Dana R. Schreiber Jan 2016

Pathways Linking Sleep Timing To Obesity In Midlife Women, Dana R. Schreiber

Theses and Dissertations

Midlife women are vulnerable to developing obesity. Both sleep timing and negative emotion are risk factors, yet limited research has explored their role on weight outcomes in this population. The current investigation explored the association of sleep timing (i.e., mean sleep time, sleep time variability) and obesity (i.e., BMI, waist circumference) in midlife women, considering emotional pathways (i.e., depressive symptoms, anger) that might mediate this association. PROCESS parallel mediation models assessed direct and indirect pathways. In follow-up analyses, sleep duration was explored as an indirect pathway linking sleep timing to obesity. Results demonstrated that sleep timing does not directly predict …


Urban Stressors And Child Asthma: An Examination Of Child And Caregiver Models, Gillian G. Leibach Jan 2016

Urban Stressors And Child Asthma: An Examination Of Child And Caregiver Models, Gillian G. Leibach

Theses and Dissertations

The purpose of the present study was to examine how low-income, racial and ethnic minority, urban families experience and manage their child’s asthma. The rationale for this study stems from existing literature on asthma disparities and documented predictors of increased asthma morbidity and mortality. In particular, this study considered how specific types of stress may disproportionately impact low-income, racial and ethnic minority, urban families that have a child with asthma. This study aimed to determine associations between urban stressors (stressful life events, perceived discrimination, subjective socioeconomic status) and child asthma outcomes (emergency department visits, school days missed, asthma control), and …


Chronic Pain Causal Attributions In An Interdisciplinary Primary Care Clinic: Patient-Provider And Provider-Provider Discrepancies, Bryan Jensen Jan 2016

Chronic Pain Causal Attributions In An Interdisciplinary Primary Care Clinic: Patient-Provider And Provider-Provider Discrepancies, Bryan Jensen

Theses and Dissertations

The purpose of the present study was to investigate the influence of pain causal attributions on patient pain-related functioning, treatment engagement, and clinical outcomes. Additionally, the impact of discordant pain causal attributions between patients and their providers as well as between interdisciplinary providers was examined. Patients rated their pain functioning and causal pain attributions during a regular clinic visit. Following the patient’s visit both the behavioral medicine provider and internal medicine resident provided ratings of similar pain-related functioning domains and causal attributions. Follow-up data were collected from the electronic medical record three months following that clinic visit. Overall, results revealed …


An Examination Of The Technical And Relational Hypotheses Of Motivational Interviewing In A Sample Of African American Adolescent Girls Seeking Obesity Treatment, Rachel L. Boutte Jan 2016

An Examination Of The Technical And Relational Hypotheses Of Motivational Interviewing In A Sample Of African American Adolescent Girls Seeking Obesity Treatment, Rachel L. Boutte

Theses and Dissertations

Adolescent obesity has increased exponentially over the past three decades in the United States. In response, behavioral interventions have been developed and implemented to address this epidemic; however, treatment adherence is often suboptimal. Motivational interviewing (MI) is a directive, person centered approach to reducing patient ambivalence about change, which has been shown to increase engagement in obesity interventions. The current study investigated the underlying process of MI by exploring two different, but related pathways that explain how change happens (e.g., the technical and relational hypotheses) in the context of a multidisciplinary obesity intervention with African American adolescent girls (N …


The Netflix Effect And Defining Binge-Watching, Brenna C. Davis Jan 2016

The Netflix Effect And Defining Binge-Watching, Brenna C. Davis

UROP Posters

With the accessibility of television programs provided by popular streaming platforms, like Netflix, consumers can watch episodes or seasons of their favorite programming in just one sitting. This new practice of watching television has been referred to as binge-watching, and is defined by Netflix as watching two to six episodes of the same show in one sitting. Netflix’s definition is the most widely used definition of binge-watching, but does not account for the varying lengths of episodes for the different types of programming. There is a lack of standardization in what constitutes a television binge, like the standards that exist …


The Relationship Between Exercise And Depression And Anxiety In College Students, Joshua Frank, Dr. Amy Adkins, Nathan Thomas, Dr. Danielle Dick Jan 2016

The Relationship Between Exercise And Depression And Anxiety In College Students, Joshua Frank, Dr. Amy Adkins, Nathan Thomas, Dr. Danielle Dick

UROP Posters

The literature shows an inverse association between exercise and mental disorders. The aim of this study is to further elaborate on this association with regards to exercise and its relationship with anxiety and depression in a college sample. The subject group focused on seniors in the Spit for Science data set which incorporated a total of 821 students. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ) to estimate the overall metabolic equivalents (MET’s) each student spent in walking, moderate, or vigorous activity levels in the previous week. Sum scores were used to measure depression and anxiety. Overall,the …


The Effects Of Pet Ownership On Anxiety And Depression Among Trauma-Exposed College Students, Dung N. Nguyentran, Marlene A. Michniak, James J. Jung, Christine Q. Do Jan 2016

The Effects Of Pet Ownership On Anxiety And Depression Among Trauma-Exposed College Students, Dung N. Nguyentran, Marlene A. Michniak, James J. Jung, Christine Q. Do

UROP Posters

Rates of anxiety and depression are prevalent in college students and can be attributed in part to stress and trauma-related events. However, studies suggest that pet ownership has the possibility of alleviating symptoms of anxiety, depression, negative emotions, and suicide. The purpose of this study was to determine the relationship between pet ownership and levels of anxiety and depression among those who have experienced a traumatic event. The sample was comprised of five hundred and forty-seven VCU students who completed an online survey from Spit for Science during their junior year. Linear regressions were performed to determine the nature and …


Rage And Social Media: The Effect Of Social Media On Perceptions Of Racism, Stress Appraisal, And Anger Expression Among Young African American Adults, Morgan Maxwell Jan 2016

Rage And Social Media: The Effect Of Social Media On Perceptions Of Racism, Stress Appraisal, And Anger Expression Among Young African American Adults, Morgan Maxwell

Theses and Dissertations

Recently, social media has become a sociopolitical hotbed for discussions of racism. However, no extant studies have questioned if social media use increases how often African Americans vicariously and/or personally experience discrimination in America. The current study sought to answer this question. By examining the relationships between social media use, general stress, race-related stress, and anger expression, and the mediating role of perceived racism, this study explored if frequent social media use influences young African American adults’: a) perceptions of racism, b) experiences with general and race-related stress, and/or c) expressions of anger. The current study conducted an online survey …


The Role Of N-Acetyl-L-Cysteine (Nac) As An Adjuvant To Opioid Treatment In Patients With Inadequately Controlled Chronic Neuropathic Pain, Thomas B. Moore Jan 2016

The Role Of N-Acetyl-L-Cysteine (Nac) As An Adjuvant To Opioid Treatment In Patients With Inadequately Controlled Chronic Neuropathic Pain, Thomas B. Moore

Theses and Dissertations

Introduction. While opioid medications are commonly prescribed for management of neuropathic pain (NP), long-term use has been associated with increased risk for overdose, drug interactions and addiction. New strategies are necessary to better manage chronic pain, thereby reducing need for opioid medications and their associated adverse consequences. N-acetyl-L-cysteine (NAC), an over-the-counter supplement, has shown promise in the treatment of psychiatric and addictive disorders. In addition, NAC has shown promise for reducing physiological signs of NP in laboratory rat models, prompting this study.

Purpose. The present study was an open-label clinical trial of NAC as an adjuvant to opioid treatment for …


Gender And Sexual Health: Applying Gender Role Theory To Men And Women’S Intention To Engage In Sexual Health Information Seeking Behaviors, Ariella R. Tabaac Jan 2016

Gender And Sexual Health: Applying Gender Role Theory To Men And Women’S Intention To Engage In Sexual Health Information Seeking Behaviors, Ariella R. Tabaac

Theses and Dissertations

The purpose of the present study is to examine the pathways between gender and behavioral intention to engage in sexual HISB through application of the Theory of Planned Behavior (TPB). It was found that feminine and masculine gender role stress differentially influence perceived behavioral control and behavioral attitudes, and that intention to engage in HISB was higher among women than men. Attitudes and PBC significantly predicted behavioral intention in this model. Further, women in the sample were more likely to search for sexual health information, with online sources being the most frequently reported resource. Additionally, past HISB was a significant …


Are You Covered? Examining How Knowledge Of The Patient Protection And Affordable Care Act Influences Use Of Preventive Reproductive Health Services, Ashlee Sawyer Jan 2016

Are You Covered? Examining How Knowledge Of The Patient Protection And Affordable Care Act Influences Use Of Preventive Reproductive Health Services, Ashlee Sawyer

Theses and Dissertations

The Patient Protection and Affordable Care Act (PPACA) expanded access to insurance coverage and health care services for many citizens, and has increased access for women in particular by including preventive reproductive health services as essential health benefits. The current national rates of sexually transmitted infections (STIs), reproductive cancer diagnoses, and unintended pregnancy serve as major areas of concern for women’s health and public health. The present study examined how knowledge of the PPACA influences receipt of preventive reproductive health services among women. Results indicate that higher levels of knowledge of the PPACA are associated with a greater likelihood of …