Public or private religiosity: which Is protective for adolescent substance use and by what pathways?

While it is well understood that adolescent religiosity is associated with the use and abuse of licit and illicit substances, few studies have revealed the pathways through which religiosity buffers youth against involvement in such behavior. The aim of this study is to examine the complexity of the relationships between religiosity, sensation seeking, injunctive norms, and adolescent substance use. Using a national sample of adolescents (N = 18,614), negative binomial regression and path analysis were used to examine the various components of the relationship between religiosity and the use of cigarettes, alcohol, and marijuana. Results indicate that private religiosity moderates the relationship between key risk factors and substance use. Public and private religiosity were associated with tolerant injunctive substance use norms which, in turn, were associated with substance use. Implications for research and theory related to religiosity and adolescent substance use are discussed

Cardiovascular disease risk factors in the urban black population in Cape Town

Includes abstract. Includes bibliographical references

Biological and behavioural correlates of protective psychosocial factors in UK and cross-cultural samples

The overall aim of this thesis is to examine the relationship between psychosocial factors and health; the specific aims are: to investigate links between psychosocial factors; to investigate the relationship between psychosocial factors, health behaviour and biology and finally, to investigate these relationships in cross-cultural samples. The recent incorporation of positive aspects, such as happiness and increased social support, into models of health has indicated a protective link between psychosocial factors and health outcomes. Psychosocial factors may impact upon health through behavioural and biological pathways, and there may be interactions between psychosocial factors, including constructs such as psychological and social function and both behavioural and biological pathways, This thesis focuses on the association of three psychosocial constructs, positive well-being, social support and optimism, with health. The first study investigates the relationship between positive well-being and health behaviour in an international sample. The findings showed that life satisfaction was associated with increased healthy behaviours for smoking, exercise, fat intake, sun protection and fruit intake, with no relationship for alcohol consumption or fibre intake. The second study investigated the associations of positive well-being, social support and optimism, and found that social support was strongly related to positive well-being. This study also found a relationship between social support and exercise; between social support and cortisol, and an association between these and positive affect. The third study presents data from a Japanese sample. This study found that social support was related to positive well-being, although effects were different to those found in the UK study. Although effects were small and there were several null findings, overall this thesis concludes that social support and positive well-being may be a part of a protective network of wider psychosocial factors, and that effects on health are exerted by moderation of behavioural and biological pathways

Adolescent Health Risk Behaviors: An Examination of the Co-occurrence of Risk Behaviors in a National Sample of U.S. High School Adolescents

Introduction: Research on the health status of United States\u27 youths has shown that the main adolescent health threats result from behavioral choices (health risk behaviors) that place boys and girls at risk for leading causes of morbidity and mortality. The aims of this study were to examine the co-occurrence of health risk behaviors and determine patterns of the co-occurrence of risk behaviors that may differ based on sex (aim 1); the association of health risk behaviors with weight status (aim 2); and the association of tobacco use, poor dietary habits, physical inactivity, and sedentary behavior among adolescents using nationally representative data (aim 3).;Methods: This study uses cross-sectional data from the Youth Risk Behavior Surveillance System (YRBSS) conducted between the years 2012 and 2013. The sampling frame for this survey included all adolescents in Grades 9 to 12 who attended regular public, private, or Catholic schools in the 50 states and the District of Columbia. The main outcomes of interest for the first two studies included indicators of health risk behaviors including substance use, intentional and unintentional injuries, risky sexual behavior, mental health, bullying, unhealthy weight control, poor dietary habits, physical inactivity, and sedentary behavior. The main outcome for the third study was tobacco use. Latent class analysis was conducted to determine the co-occurrence of health risk behaviors among adolescents. Regression analyses were conducted to examine the associations between weight status and risky behaviors for the second study; and tobacco use, poor dietary habits, physical inactivity, and sedentary behavior.;Results: With respect to findings for aim one, the latent class analysis yielded five distinct subgroups (classes). The majority of adolescents belonged to the low risk subgroups; however, our analyses identified three distinct high risk subgroups, high risk-- depressed and suicidal youth, high risk- tobacco and alcohol users, and high risk-polysubstance users. Girls and boys both reported low risk and high risk behaviors. However, girls had a distinct subgroup with particularly high probabilities of depressive symptoms and suicidal behavior. The second aim examining the association of weight status and risky behavior found that compared to normal weight students, obese students were more likely to use cigarettes (AOR = 1.44, 95% CI, 1.15-1.79), less likely to engage in behaviors that result in unintentional injury (e.g. driving drunk, riding with a drunk driver, texting and driving) (AOR = 0.83; 95% CI, 0.73-0.95), more likely to get bullied on school property, and electronically (AOR = 1.47, 95% CI, 1.28-1.68; AOR = 1.20, 95% CI, 1.003-1.447, respectively) and more likely to engage in unhealthy weight control (AOR = 7.56, 95% CI, 6.33-9.04 ). Findings for the third aim showed that both male and female adolescents who engaged in poor dietary behavior were more likely to use tobacco than those who did not engage in poor dietary behavior. For instance, both boys and girls who skipped breakfast every day for the past seven days were more likely to use tobacco than those who did not skip breakfast (AOR=1.54, 95% CI 1.16-2.03 and AOR = 1.32, 95% CI 1.06-1.64, respectively). Physical inactivity and playing video or computer games more than three hours per day yielded an inverse association with tobacco use among boys (AOR = 0.62, 95% CI 0.49-0.79).;Conclusions: Distinct subgroups of risky behaviors were identified for the study sample. Differences were found in the pattern of the co-occurrence of risky behavior by sex. Obesity was found to be positively associated with most of the risk behaviors examined in this project. The results of the third aim found that tobacco use was significantly associated with poor dietary habits, physical inactivity, and sedentary behavior. Longitudinal studies of risky behavior among adolescents are needed to establish definitive conclusions and to prove causality. In addition, future research is needed to evaluate risk behaviors among adolescents by sociodemographic factors and geographic region

Integrated out-of-hours care arrangements in England: observational study of progress towards single call access via NHS Direct and impact on the wider health system

Objectives: To assess the extent of service integration achieved within general practice cooperatives and NHS Direct sites participating in the Department of Health’s national “Exemplar Programme” for single call access to out-of-hours care via NHS Direct. To assess the impact of integrated out-of-hours care arrangements upon general practice cooperatives and the wider health system (use of emergency departments, 999 ambulance services, and minor injuries units). Design: Observational before and after study of demand, activity, and trends in the use of other health services. Setting: Thirty four English general practice cooperatives with NHS Direct partners (“exemplars”) of which four acted as “case exemplars”. Also 10 control cooperatives for comparison. Main Outcome Measures: Extent of integration achieved (defined as the proportion of hours and the proportion of general practice patients covered by integrated arrangements), patterns of general practice cooperative demand and activity and trends in use of the wider health system in the first year. Results: Of 31 distinct exemplars 21 (68%) integrated all out-of-hours call management by March 2004. Nine (29%) established single call access for all patients. In the only case exemplar where direct comparison was possible, cooperative nurse telephone triage before integration completed a higher proportion of calls with telephone advice than did NHS Direct afterwards (39% v 30%; p<0.0001). The proportion of calls completed by NHS Direct telephone advice at other sites was lower. There is evidence for transfer of demand from case exemplars to 999 ambulance services. A downturn in overall demand for care seen in two case exemplars was also seen in control sites. Conclusion: The new model of out-of-hours care was implemented in a variety of settings across England by new partnerships between general practice cooperatives and NHS Direct. Single call access was not widely implemented and most patients needed to make at least two telephone calls to contact the service. In the first year, integration may have produced some reduction in total demand, but this may have been accompanied by shifts from one part of the local health system to another. NHS Direct demonstrated capability in handling calls but may not currently have sufficient capacity to support national implementation

Investigating Associations between Health Behaviours, Constructs of the Job Demands-Resources Model, and Work-Related Outcomes

Health behaviours are important determinants of health, yet have received inadequate attention within the organisational behaviour literature. Three empirical studies were conducted to enhance conceptual and empirical understanding of the associations between employee wellbeing and a range of health behaviours. The findings of this research provide a valuable starting point for researchers interested in refining job demands-resources theory to take into account health behaviours, and may inform organisations seeking to enhance work well-being initiatives

An Investigation of Substance Use and Sexual Behavior with STD Incidence Among 18-year Olds Who Had Adverse Childhood Experiences in the U.S.

INTRODUCTION: Approximately two-thirds of the U.S. population have had at least one adverse childhood experience (CDC-Kaiser Permanente Adverse Childhood Experiences [ACE] Study, 2009). Some consequences of ACEs are manifested as the child grows into late teenage years and young adulthood. Research suggests that children exposed to traumatic events during childhood subsequently experience negative health outcomes like substance abuse, engagement in risky and harmful sexual behavior, and STD occurrence. AIM: In this thesis I explore the associations of 18 year olds’ described use of alcohol, risky sexual behavior and sexually transmitted diseases (STDs) with childhood exposure to caregiver substance abuse, violence and family circumstances METHODS: Data were obtained from the Longitudinal Studies of Childhood Abuse and Neglect (LONGSCAN) Assessments 0 - 18 from the National Data Archive on Child Abuse and Neglect (NDACAN). Variables on adverse childhood experiences, sex behaviors, STDs and substance use were observed in SAS. Multiple logistic regression models were used to identify odds ratios and strength of associations. RESULTS: Results suggests significant associations among participants who were exposed to parent/caregiver use of illicit drugs during participant’s childhood and subsequent self-reported heavy alcohol use 1.60 (95% CI: 1.18, 2.22), having early sexual initiation (at age 13 or younger) 1.60 (95% CI: 1.18, 2.22), having 6 or more sexual partners 1.36 (95% CI: 1.09, 1.68) and having STDs 1.83 (95% CI: 1.36, 2.46). Eighteen year olds with who were African American, were at a greater odds of having greater than 6 sexual partners, having sexual intercourse at or before age 13 and having (an) STD(s). No significant associations were found between having a parent/caregiver or member of household who was incarcerated, being exposed to violence, being exposed to yelling often or parental often use of alcohol and subsequent alcohol abuse, having greater than 6 sexual partners, having sexual intercourse at or before age 13 and having (an) STD(s) . DISCUSSION: Based on the findings of these analyses, programs for adolescents should focus time and resources on young children who may be currently experiencing, or at risk for experiencing, parental/ caregiver illicit drug use in the home

EVALUATING NOVEL RISK FACTOR ASSOCIATIONS FOR SUBCLINICAL CARDIOVASCULAR DISEASE

Globally, cardiovascular disease (CVD) is the leading cause of death. Increased risk for CVD can be attributed to smoking, high blood pressure, poor lipid profiles, obesity and psychosocial factors. Markers of subclinical CVD are non-invasive measures that detect early atherosclerotic changes. The purpose of this dissertation was to evaluate novel risk factor associations for subclinical CVD in three distinct populations. The protective effect of HDL-c for subclinical CVD was diminished in a population of postmenopausal women compared to premenopausal women. Furthermore, the concentration of small HDL particles was higher among postmenopausal women. Lipid profile changes with the menopausal transition may in part explain the increased risk of CVD seen after menopause.The protective effect of education for subclinical CVD was evident only among females from an Afro-Caribbean population. Educational differences in SBP and lipids varied for males and females providing insight into potential mechanisms for the education-subclinical CVD relationship observed on the island of Tobago.Tonic cardiac sympathetic activity and parasympathetic reactivity were independent predictors of subclinical CVD in a population of overweight and obese young adults. The effect of C-reactive protein (CRP) on subclinical CVD is potentially explained by the autonomic anti-inflammatory mechanisms linking heart rate variability and CRP. Identifying novel risk factor associations for subclinical CVD in various populations supports the important public health objective of reducing the global burden of CVD morbidity and mortality through early detection of atherosclerosis