Graduate Studies, UNL

 

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

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First Advisor

Angela Palmer-Wackerly

Degree Name

Doctor of Philosophy (Ph.D.)

Committee Members

Ciera Kirkpatrick, Jody Koenig-Kellas, Satveer Kaur, Walid Afifi

Department

Communication Studies

Date of this Version

7-3-2026

Document Type

Dissertation

Citation

A dissertation presented to the faculty of the Graduate College at the University of Nebraska in partial fulfillment of requirements for the degree Doctor of Philosophy

Major: Communication Studies

Under the supervision of Professor Angela Palmer-Wackerly

Lincoln, Nebraska, May 2026

Comments

Copyright 2026, Hayley Stahl. Used by permission

Abstract

College students who use drugs face compounding barriers to disclosing substance use to healthcare providers, including uncertainty about health consequences and stigma-driven identity concerns. Existing disclosure tools address neither barrier in an integrated fashion. This explanatory sequential mixed-methods study examined how constructs from the Theory of Motivated Information Management (TMIM; Afifi & Weiner, 2004) and Stigma Management Communication (SMC; Meisenbach, 2010) theory suggest factors influencing substance use disclosure among college students and shape their lived disclosure experiences. In Study 1, simultaneous-entry multiple regression analyses revealed that communication efficacy was associated with information seeking, perceived benefits of disclosure were linked to disclosure extent, and internal stigma was the only SMC factor to uniquely explain both information avoidance and disclosure level among collegiate people who use drugs (CPWUD). Study 2, a theory-led collective case study of three CPWUD, surfaced themes of expectation-experience uncertainty, self-categorization, and structural fears tied to documentation. Taken together, the quantitative and qualitative findings informed the development of a preliminary decision-aid prototype grounded in the integrated TMIM x SMC framework and aligned with the International Patient Decision Aid Standards (IPDAS). This prototype represents the first application of TMIM-SMC integration to decision aid development, with implications for stigma-aware, patient-centered college health communication.

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