The purpose of the current study is to examine the association between self-esteem and the forms and functions of aggression. Research supports the existence of four aggressive subtypes (i.e., reactive overt, reactive relational, proactive overt, and proactive relational), and past research has found associations between aggression and self-esteem. However, past studies have not examined the relationships between all four subtypes of aggression and self-esteem together. 141 adolescents were recruited from the community with a mean age of 13.55. The sampled group was composed of 51% females and 52% Caucasians. Participants completed self-report questionnaires on self-esteem and aggression. The results provide support for an association between proactive aggression and self-esteem. Additionally, overt aggression was more associated with self-esteem than relational aggression. These findings will help fill the gap in literature on the forms and functions of aggression and will further define the relationship between aggression and self-esteem.

Magister Artium (Child and Family Studies) - MA(CFS) / Adolescence can be understood as the transitional period between childhood and adulthood. During adolescence individuals tend to experiment and discover who they are in terms of their unique social identity and are more susceptible to health risk behaviour engagement. Health risk behaviour place individuals at risk for numerous health complications. The most common forms of health risk behaviours are smoking, drinking, illicit drug use, risky sexual behaviour, violence and physical inactivity. Life skills development has been proven to reduce many health risk behaviours in adolescents. The Life Effectiveness Questionnaire (LEQ) is a psychometric instrument which has been developed to measure life skills. Social Cognitive Theory posits that people are not driven by inner forces nor are they controlled by external stimuli, rather there is a reciprocal triadic relationship where the environment, cognition and personal factors influences learning through observation. When in the presence of their peers, adolescents are more likely to engage in health risk behaviour because of peer influence and immediate rewards. This study aimed to study the effects of the LEQs life skills domains as it relates to the engagement in health risk behaviour among Grade 8 learners in a selected high school in Paarl. This study used a quantitative methodology with a cross-sectional design employing written surveys. The sample consisted of 104 Grade 8 learners. The data was collected using self-reported questionnaires. One was the LEQ (Appendix 5 and 6) which measures life skills and the other was the Youth Risk Behaviour Surveillance Survey (YRBSS) (Appendix 7) which measures the prevalence of health risk behaviour engagement. The data was analysed using the Statistical Package for Social Sciences V24 (SPSS). The results suggested that there is still a high prevalence of health risk behaviour engagement among Grade 8 learners with increases evident in some of the health risk behaviours.

Magister Public Health - MPH / Adolescents living with HIV (ALHIV) are notably underserved by national HIV programmes globally due to their unique needs. Of particular concern is limited access to and availability of adolescent-friendly ART services, which contributes to poor ART adherence and retention in care in many sub-Saharan African countries. Poor adherence in adolescents has been associated with medicine side effects, pill fatigue, non-disclosure of status to the child, inadequate information on HIV, caregiver-child communication, caregiver’s health beliefs and stigma, and lack of knowledge on the rationale of taking medicines. Several interventions have been developed to improve ART adherence and retention in care amongst ALHIV through peer groups and psychosocial support. The Teen Club intervention was introduced in 2010 at Intermediate Hospital Katutura Paediatric ART clinic in Windhoek to improve ART adherence and retention in care amongst ALHIV by providing psychosocial support in a group environment. However, to date no formal evaluation of the effectiveness of the Teen Club intervention in Namibia has been conducted. The aim of the study was to compare the effects of the Teen Club intervention against standard care on treatment outcomes for ART (i.e. adherence, retention in care and viral suppression) in adolescents at Intermediate Hospital Katutura Paediatric ART clinic in Namibia. Methods: A retrospective cohort analysis of HIV positive adolescents aged 10-19 years, who were accessing ART between 1 July 2015 and 30 June 2017 was conducted. Patient data was extracted from the electronic Patient Monitoring System (ePMS), individual Patient Care Booklets and the teen club attendance register. Adherence to ART was measured through pill counts; and retention by kept clinic visits. Viral load results were assessed to measure levels of viral suppression. Adolescents with viral loads ≥ 1000 copies/ml were classified as not virally suppressed whilst those with viral loads <1000 are virally suppressed (with those <40 fully suppressed). Results: The total sample was 385 participants; with 78 of them in the Teen Club (exposed) and 307 adolescents in standard care (unexposed).

Master of Public Health - MPH / Background: Globally, it is estimated that about 1.8 million adolescents (aged 10–19 years) were living with HIV in 2015. In Kenya an estimated 133,455 adolescents were living with HIV in 2015, of which 75% (105,679) were in need of antiretroviral therapy (ART). Among adolescents on ART in 2016, 63% reported viral suppression; which is far below the UNAIDS targets of 90%. Viral suppression (having less than 1000 copies of viral RNA/ml of blood) is a key indicator of HIV treatment success, and is associated with better quality of life and reductions in HIV incidence at a population level. Homabay County recorded the highest HIV prevalence (26%) and the highest number of adolescents living with HIV in Kenya (15,323) in 2015. By the end of June 2017 5,709 adolescents were initiated on ART in Homabay County. Despite the successes in initiating HIV positive adolescents on ART, little is known about the factors that are associated with viral suppression. The current study investigated the factors associated with viral suppression among adolescents initiated on ART before November 30, 2017 in Homabay County, Kenya. Methods: A descriptive cross-sectional study was conducted among 925 adolescents registered on ART for at least 6 months and with at least one documented viral load in the last 12 months, in six health facilities in Homabay County. Data was extracted from the electronic medical records and exported into an excel spreadsheet. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated to viral suppression using Stata 12.0.

Faculty of Arts School of Human and Community Development 0000613a Tel: 011 849 3853 / South African Speech-Language Pathologists are assessing and treating many adolescents with varying speech and language difficulties. This task is complicated by the fact that it is currently largely unknown what the language abilities of mainstream adolescents are. Some research has suggested declining language abilities, as well as significant effects of grade, gender and language background on cognitive academic language skills. As individuals grow older, the demands of the classroom environment become greater, forcing adolescents to use complex language skills in order to learn. This research paper aimed to assess the complex sentence comprehension abilities of a sample of South African adolescents, through the use of the Grammar/Listening subtest of the Test of Adolescent Language, developed by Hammill, Brown, Larsen, and Wiederholt (1980). Additionally, the effects of grade, gender, language, time spent reading for school and recreationally each week, number of television programmes watched per week, length of time spent playing computer or video games per day, preferred learning styles (group/alone and auditory/visual/both), most recent English and school report marks, and use of cellular telephones, were used to determine related factors and educational variables which might be linked to each other. Additionally, a working memory measure was included, in order to ascertain that this factor was not having a negative effect upon the comprehension scores. It was found that gender was an over-riding factor throughout the study. Females tended to do better on the complex sentence comprehension test, and also spent more time reading for school each week, obtained better English and school report marks, preferred to learn alone, and sent more sms’s. Males were only inclined to play more computer or video games per week. In opposition to the initial hypothesis that these learners would perform poorly on the TOAL subtest, it was found that participants generally performed within the average limits of the test. Correlations, one-way ANOVA’s, chi squared analyses and t-tests were performed for the secondary aims, in order to determine any relationships between the variables. Overall, though, gender was the key variable in the study, which is in line with other literature in the field. Home language and educational level had minimal effects. Further research has been recommended.

MSc (Med), Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand / Objectives: To evaluate differences in virologic outcomes between adolescents and pre-adolescents initiated on HAART and to determine the patient baseline variables associated with virologic suppression. Design: Retrospective cohort study using routinely collected clinic and outcome data. Setting: Public sector HIV paediatric facility at Harriet Shezi Children’s Clinic (Chris Hani Baragwanath Hospital) Soweto, South Africa. Patients: HIV infected pre-adolescents (5 to < 11 years) and adolescents (11 to <18 years) initiating HAART between 1 April 2004 and 31 December 2008. Main outcomes and measures: Primary: virologic suppression (HIV viral load ≤ 400 copies/ml) and viral rebound (single HIV viral load ≥ 400 copies/ml after initial suppression) at 24, 48, 72 and 96 week follow up intervals. Secondary: determination of baseline variables associated with virologic suppression. Survival analysis was performed using the Kaplan Meier method and modelling was based on Cox proportional hazards. Results: Both groups exhibited similar incidence rates of virologic suppression by the 24th week from HAART initiation. Adolescents had a slightly lower incidence rate of early virologic suppression in comparison to pre-adolescents (197/100 person years vs. 203/100 person years). However, the observed difference was not statistically significant at 5% significance level (IRR: 0.97, 95%CI: 0.81 - 1.15). In a sub-group of children who had not virologically suppressed by the 24th week (168 days) of follow up, adolescents were 42% less likely to achieve virologic suppression after this time point than pre-adolescents ([IRR: 0.58, 95%CI: 0.35, 0.93). In the sub-group of all female participants, lower hazards of virologic suppression by the 24th week (aHR 0.76, 95%CI 0.59-0.99) and 96th week (aHR 0.70, 0.55-0.90) of follow up were observed among female adolescents when compared with female pre-adolescents. Additionally, clinically advanced disease was observed as a risk factor for non-virologic suppression by the 96th week of follow up among participants of all ages (aHR 0.75, 95%CI 0.64 -0.87). After 60 weeks from the initial virologic suppression, adolescents were twice more likely to experience rebound after this point than pre-adolescents (IRR: 2.33, 95%CI: 1.00 - 5.13). Conclusion: Given the potential for resistant strains of the HIV virus and the public health threat this presents, health care teams face complicated dilemmas regarding initiation of HAART to adolescents, particularly female adolescent patients who are likely to be non-adherent. Findings from the study advocate for intensified adherence and treatment support for all adolescents initiated on HAART to achieve virologic suppression within the first 6 months of treatment, a time after which they have been shown to exhibit inferior virologic suppression rates. Once virologic suppression has been attained, adolescents require prolonged treatment support to maintain long term virologic suppression at levels observed among pre-adolescents. We recommend further research into the comparison of virologic outcomes between pre-adolescents and adolescents on HAART, through prospective study designs. Qualitative study designs are also important to bridge the knowledge gaps on the barriers to HAART encountered by female adolescents.

A Research Report submitted in partial fulfilment of the requirements for the Degree of Masters in Community Based-Counselling Psychology in the Faculty of Humanities at the University of the Witwatersrand / Train surfing or staff riding has been a part of the South African working-class economic fabric since the initiation of segregation under apartheid. Now within contemporary society the activity has gained great media attention due to the fatalities that are so commonly associated with it. Despite it being a globally and locally longstanding activity it is still an area that is under-researched. The current study was aimed at exploring the growing phenomenon and how it is constructed by youth in Soweto. A total of 32 adolescent boys and girls between the ages of 18 and 21 were recruited from a public secondary school in Orlando West, Soweto, to take part in one of four focus groups. The participants’ responses from the focus group discussions were recorded then analysed using thematic content analysis. Emerging themes, including what it means to be an adolescent living in Soweto postapartheid, what adolescents now consider having fun, and what they consider to be risky behaviour, were explored in the data analysis. In addition, alternative growing phenomena within Soweto were identified, namely biking and drag-racing. Evident from the analysis was the pressure felt and experienced by adolescents, especially by male adolescents within society and the school environment to fit in to popular constructions of a growing adult and the constructions of hegemonic masculinity in contemporary South Africa. It was also found that the train surfing participants used the practice as a means to define their identity as young, black males living in South Africa. However, as much as some of the accounts of the reasons behind risky behaviours were in line with hegemonic constructions of masculinity, also revealed were the alternative and opposing voices which appeared to be tense with emotional, personal and social sacrifices. This fluidity of identity was explored through the various components of identity such as race, class and gender that all interact within the context of Soweto and results in differing adolescent identity constructions, such as, the ambitious and inspired, as well as the risk-taking train surfers who are described as being ‘in limbo’. The research concludes by shifting contemporary understanding of the phenomenon from one of thrill seeking to a performance of identity and masculinity that is influenced by race, class, and gender.

Introdução - A obesidade é uma doença crônica de origem multifatorial, considerada como um dos principais problemas de saúde pública nos países desenvolvidos, que constitui fator de risco para outras doenças graves. Sua prevalência vem aumentando mundialmente e em especial, em crianças e adolescentes. Acredita-se que as principais causas estão ligadas tanto a fatores genéticos como ambientais. Objetivo - Identificar por meio do relato de pais e de equipe interdisciplinar as facilidades e as dificuldades à adesão de adolescentes obesos com deficiência intelectual e de suas famílias para cumprir programa de orientação e prevenção das complicações da obesidade. Métodos - Trata-se de estudo de coorte histórica, descritiva e quali-quantitativa com um número de 47 adolescentes obesos com deficiência intelectual, seus responsáveis e equipe interdisciplinar, que no período de 2006 a 2008, participaram de um programa de orientação e prevenção de complicações da obesidade (POPO), oferecido pela Sociedade Pestalozzi de São Paulo. Os dados foram coletados dos prontuários, das fichas de acompanhamento do programa, dos questionários de estudo sócio-econômico e por meio de entrevistas utilizando um roteiro de questões específicas dirigidas às famílias e profissionais envolvidos no processo. Resultados - A caracterização dos adolescentes envolvidos no estudo mostrou uma prevalência da Síndrome de Down representada em 19 (40,4%) deles. Observou-se também, concentração de maior grau de obesidade com aumento da idade sendo, 63,2% estão na faixa etária de 17 a 20 anos e foram conceituados ao Grupo 3 (IMC>35). As famílias estudadas foram caracterizadas em sua grande maioria moradoras da Zona Norte SP, condições sócio-econômicas precárias com renda familiar de 1 a 2 salários mínimos e grau de escolaridade da mãe apresentando na sua grande maioria o ensino fundamental incompleto. Os profissionais que compõem a equipe interdisciplinar são na maioria absoluta do sexo feminino, atuam as áreas da medicina, psicologia e fisioterapia e apresentam experiência na área da deficiência intelectual que varia de um a 21 anos. Os resultados foram apresentados e descritos segundo dois eixos norteadores: Conclusão - A falta de locais especializados para pratica de atividades físicas, preço elevado dos alimentos sugeridos, não colaboração dos demais familiares, falta de autonomia e independência dos deficientes intelectuais e pouca freqüência às reuniões de orientações realizadas pela equipe, foram apontados como sendo os principais fatores que dificultam uma maior adesão ao programa. E quanto aos aspectos facilitadores destacou-se a comodidade do programa ser na própria instituição, a persistência da equipe e preocupação com a saúde dos filhos. / Introduction - There are many factors that contribute to the chronic disease of obesity. It is regarded as a major public health problem in developed countries. It is also a risk factor for other serious diseases. It\'s prevalence is increasing worldwide and especially in children and adolescents. It is believed that the main causes are linked to genetic and environmental factors. Objective - To identify through the report of parents and interdisciplinary teams, the facilities and the difficulties that obese adolescents with intellectual disabilities and their families have in accessing the ***Obesity Education and Prevention Program (POPO). Méthodos - It refers to a historical cohort study, that was descriptive, qualitative and quantitative. It included 47 obese adolescents with intellectual disabilities, their caregivers and the multidisciplinary team that from 2006 to 2008, participated in an ***Obesity Education and Prevention Program (POPO), offered by the Pestalozzi Society of Sao Paulo. Data was collected from medical records, the monitoring reports of the program, questionnaires from a socio-economic study and through interviews using a script of questions targeted at families and professionals involved in the process. Results - The results were presented and described according to five guiding principles: The characterization of adolescents involved in the study showed a prevalence of Down syndrome represented in 19 (40.4%) of them. The results was also indicated a greater degree of obesity with increasing age and 63.2% are between the ages of 17 and 20 years, which was representede in the Group 3 (BMI> 35). The families studied were characterized mostly living in the North Zone - SP, the socio-economic situations indicated family income between 1 to 2 minimum wages, the majority of the mothers had elementary school education and the majority of the professionals who comprise the interdisciplinary team are female. They include medical professionals, psychologists and physical therapists who have between 1-21 years of experience in the area of intellectual disabilities.Conclusion - It was determined that the main factors that render lower adherence to the program are: the lack of places to practice physical activities, the high price of food, the lack of cooperation from other family members, lack of autonomy and independence of the intellectually disabled and the infrequently meetings for feedback from the team. However, it was indicated as a facilitie, that the program was convieniently located within the institution and the team was persistent and concerned about the health of the children.

Objetivos: Investigar as diferenças entre os fatores associados ao consumo de frutas e de hortaliças entre os adolescentes brasileiros. Método: Os dados do consumo de frutas e de hortaliças foram obtidos do banco de microdados sobre consumo alimentar da Pesquisa de Orçamentos Familiares 2008/2009 do IBGE. Foram utilizados os fatores de expansão para a obtenção de representatividade nacional e estimar um modelo, por meio da regressão Tobit ajustada por sexo, idade, raça/cor, IMC, escolaridade do chefe da família, zona residencial, região, renda per capita, preço de frutas e de hortaliças para identificar os fatores associados ao consumo de frutas e de hortaliças. Para a construção do modelo, adotou-se o método de stepwise forward p<0,20 e nível de significância de 5% para a significância conjunta e das variáveis independentes. Foi utilizado o Programa STATA versão 14. Não foi incluído o consumo de frutas e de hortaliças presentes nos alimentos preparados. Resultados: Foram analisados o consumo de frutas e de hortaliças de 7.613 adolescentes. Mais de 47,61% dos adolescentes não consumiram frutas e hortaliças nos dias avaliados; 3,20% consumiram a quantidade de frutas e hortaliças dentro do recomendado de 440g/dia. Os fatores associados do consumo de frutas foram sexo, IMC, a zona residencial e a renda per capita e; os fatores associados ao consumo de hortaliças foram região, renda per capita e preço implícito de hortaliças. A renda per capita foi o único fator associado comum ao consumo de frutas e de hortaliças, porém com diferentes efeitos marginais. Conclusões: A maioria dos adolescentes brasileiros não consome a quantidade de frutas e hortaliças recomendada. Os fatores associados ao consumo de frutas são diferentes dos fatores associados ao consumo de hortaliças. / Objective: To investigate the differences between the factors associated to the consumption of fruits and of vegetables among Brazilian adolescents. Methods: Data were obtained from the IBGE 2008/2009 Household Budget Survey. To identify the factors associated with fruit and vegetable consumption it was used Tobit regression adjusted for sex, age, race/color, BMI, household educational level, residential area, region, per capita income, implicit fruit price and implicit vegetable price. For the construction of the model, we adopted the stepwise forward method p<0.20 and significance level of 5% for the joint significance and the independent variables. The STATA version 14 program was used. The consumption of fruits and vegetables present in prepared foods was not included. Results: The fruit and vegetable consumption of 7,613 adolescents were analyzed. More than 47,6% of the adolescents did not consume any fruit and vegetable; 3.20% consumed the amount of fruits and vegetables within the recommended. The associated factors of fruit consumption were BMI, residential area and per capita income; The factors associated with the consumption of vegetables were region, per capita income and implicit vegetable price. Per capita income was the only common factor associated with the consumption of fruits and vegetables, but with different marginal effects. Conclusion: Most Brazilian adolescents do not consume the recommended amount of fruits and vegetables. The factors associated with fruit consumption are different from the factors associated with the consumption of vegetables.

Introdução: A atividade física desempenha função importante na prevenção de doenças crônicas não transmissíveis. Objetivo: Estudar a importância da atividade física sobre parâmetros bioquímicos, pressão arterial sistêmica e elasticidade arterial na adolescência. Métodos: Na primeira fase da pesquisa foram envolvidos 3.000 adolescentes de 15 a 17 anos de idade, estudantes da rede estadual de ensino de Joinville-SC. A amostra foi obtida mediante procedimento de sorteio por conglomerado sob critério de partilha proporcional ao tamanho em único estágio, cuja unidade de sorteio foi a sala de aula. Na segunda fase, 300 alunos foram sorteados para a determinação dos parâmetros bioquímicos (glicose, insulina, colesterol total, HDL-c, LDL-c, triglicerídeos, homocisteína, ácido fólico, vitamina B12, Proteína C-reativa (PCR) e fibrinogênio), aferição dos índices de elasticidade arterial e medidas antropométricas, hábitos relacionados ao estilo de vida e nível de atividade física. Resultados: Retornaram o termo de consentimento, 1.104 adolescentes, sendo que 16,9 por cento relataram que algum membro da família sofreu infarto agudo do miocárdio e 31,4 por cento acidente vascular cerebral. Quanto à prática de atividade física, 80,6 por cento foram classificados como ativos e 20,7 por cento considerados com excesso de peso. Em relação aos dados bioquímicos, foram encontradas concentrações acima do recomendado para glicose (63,0 por cento), colesterol total (58,3 por cento), triglicerídeos (14,7 por cento), LDL-c (14,7 por cento), PCR (5,2 por cento), homocisteína (5,1 por cento) e fibrinogênio (5,5 por cento) e abaixo do recomendado para HDL-c (5,5 por cento). Foram encontrados baixos valores para elasticidade das grandes (LAEI) (67,8 por cento) e das pequenas (SAEI) (8,8 por cento) artérias. A atividade física apresentou correlação positiva com os LAEI e SAEI e negativa com o batimento cardíaco/minuto. Entretanto, não apresentou correlação com nenhum parâmetro bioquímico. Os adolescentes ativos e não ativos apresentaram médias diferentes (p<0,05) para as seguintes variáveis: circunferências da cintura e pescoço, dobra cutânea triciptal, batimento cardíaco/minuto, LAEI e SAEI. A atividade física não mostrou influência sobre os parâmetros bioquímicos, apenas sobre os índices de elasticidade (LAEI e SAEI) de forma independente. Após ajustes nos modelos de regressão linear a atividade física passou a influenciar a pressão arterial sistêmica e manteve sua influência sobre os índices de elasticidade. Conclusão: Apesar da maioria dos adolescentes serem classificados como ativos, o perfil nutricional do grupo estudado revelou elevada prevalência de excesso de peso e de alterações dos parâmetros bioquímicos. A atividade física influenciou a medida da pressão arterial sistêmica e o aumento da elasticidade arterial dos adolescentes. Entretanto, o mesmo comportamento não foi evidenciado para os parâmetros bioquímicos avaliados. / Introduction: The physical activity performs important function in the prevention of non-transmissible chronic diseases. Objective: To study the importance of physical activity over biochemical parameters, systemic arterial blood pressure and arterial elasticity in adolescence. Methods: In the first phase of research involved 3,000 adolescents who were 15 to 17 years old, students from statewide network of teaching in Joinville-SC. The sample was obtained through the draw procedure under cluster criterion of a size proportional share in a single stage, and the classroom was the draw unit. In the second phase, 300 students were drawn to determine the biochemical parameters (glucose, insulin, cholesterol, HDL-c, LDL-c, triglycerides, homocysteine, folic acid, vitamin B12, C-reactive protein (CRP) and fibrinogen), measurement of arterial elasticity index and anthropometric measures, habits related to lifestyle and level of physical activity. One thousand one hundred and four adolescents returned the consent terms, 16.9 per cent reported that a family member suffered acute myocardial infarction and 31.4 per cent stroke. Regarding physical activity, 80.6 per cent were classified as active and 20.7 per cent were considered overweight. For the biochemical data, concentrations were above the recommended for glucose (63.0 per cent), cholesterol (58.3 per cent), triglycerides (14.7 per cent), LDL-c (14.7 per cent), CRP (5.2 per cent), homocysteine (5.1 per cent) and fibrinogen (5.5 per cent), and below the recommended level for HDL-c (5.5 per cent). Low values were found to large (LAEI) (67.8 per cent) and small artery elasticity index (SAEI) (8.8 per cent). The physical activity showed positive correlation with LAEI and SAEI and negative correlation with the heartbeat per minute. However, the values showed no correlation with any biochemical parameter. The active and not active adolescents had different means (p<0.05) for the following variables: waist circumference, neck circumference, triceps skinfold, heartbeat per minute, LAEI and SAEI. The physical activity showed no influence on the biochemical parameters, only on the indices of elasticity (LAEI and SAEI) independently. After adjustments in the linear regression models, the physical activity began to influence systemic arterial blood pressure and remained its influence on the indices of elasticity (LAEI and SAEI). Conclusion: Although most adolescents are classified as active, the nutritional profile of the group studied revealed high prevalence of overweight and changes in biochemical parameters. The physical activity influenced the measure of the systemic blood pressure and the increase of the arterial elasticity of the adolescents. However, the same behavior was not evidenced for the biochemical parameters.