D.Ed. (Psychology of Education) / The purpose of the research was to develop, implement and evaluate a psycho· educational programme to prevent young adults to withdraw from their community. The assumption was made that withdrawal from interpersonal relationships has a detrimental effect on the mental health and well-being of young adults. Isolation has a very destructive effect on young adults. The results of the data collection especially elicit the result of a sometimes not well· thought through decision to isolate oneself from relationships ...

The purpose of this study is to confirm whether or not group counseling improves the self-concept and associated behaviors in Black American adolescents who are assessed to be conduct disordered. The instruments utilized in the study are the Tennessee Self-Concept Scale and the Devereux Adolescent Behavior Rating Scale. Twenty (20) subjects were randomly selected from a population of behavior disordered adolescents. Ten (10) subjects were randomly placed in control and ten (10) experimental groups. The study was implemented by two counselors employed by the community agency conducting the study. Two (2) hypotheses were examined in this study. Analysis of Covariance was used to analyze the data. The variables selected for the study included the following: Positive Score-Identity, Moral-Ethical Self, Personal Self, Total Positive Score, Unethical Behavior, Defiant-Resistive, Poor Emotional Control and Inability Defiant-Resistive, Poor Emotional Control and Inability to Delay. The two null hypotheses were rejected and were significant at the p<.05 level indicating a significant difference between the control and experimental groups. The results of this study supported the hypotheses that Black American conduct disordered adolescents who received group counseling will have significantly higher self-concept and behavioral profiles than adolescents who do not receive such counseling. The utilization of this counseling modality can improve the behaviors of Black American adolescents who have conduct disorders.

A THESIS Submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa in fulfillment of the requirements for the degree of Doctor of Philosophy, 2014 / Introduction: An increase in the prevalence of eating disorders, body image dissatisfaction, low self-esteem and unhealthy weight control behaviors have been reported among adolescents worldwide, and are a public health concern with physical and psychological consequences. Although underweight and stunting still persists in South Africa, overweight and obesity is increasing in all ages, gender, and ethnic groups. Obesity is a biological risk factor for body dissatisfaction, low self-esteem and eating disorders among adolescents, all of which have been found to be associated with various weight change behaviors and strategies. South Africa being a culturally diverse country is undergoing rapid political, socioeconomic, nutrition and epidemiological transitions, and therefore offers a unique opportunity to investigate this area of research. Study design: There are two study components: (1) A cross-sectional study to determine gender and ethnic (black and white) differences in eating attitudes, self-esteem and body satisfaction in 13, 15 and 17 year-old boys (n=391) and girls (n=340) living in urban Johannesburg; (2) A longitudinal survey of the Birth-to-Twenty (Bt20) cohort at ages 13 and 17 years (n=1435) to compare eating attitudes, body-esteem and weight control behaviors between black and mixed ancestry adolescents, to examine the changes over time in these variables, and to investigate ethnic differences in the male and female perceptions of female body silhouettes at age 17 years. These ages were selected to provide a diverse sample of adolescents (early, mid and late adolescence). Methods: Anthropometric measurements were performed on all participants. Overweight and obesity were determined using age-gender specific cut-offs for BMI for children aged up to 17 years. Eating attitudes test-26 (EAT-26) scores were used to determine an increased risk of developing an eating disorder. The total EAT-26 score is the sum of the 26 items and scores range from 0 to 78. Participants who score more than 20 are considered to be at greater risk of developing an eating disorder, and represent more unhealthy attitudes towards food, body weight and eating. Body-esteem was measured using a body esteem scale. It consists of a set of 21 questions which measure 1) global feelings about one’s body e.g. “I like what I see when I look in the mirror”, 2) satisfaction with one’s weight e.g. “I really like what I weigh” and 3) positive evaluations about one’s body and appearance e.g. “People my own age like my looks”. The body-esteem assessment uses a 5-point scale ranging from “never” (1) to “always” (5) and the higher the score the more satisfied the participant is with their body. Total scores are divided into three categories; low body esteem (score 1 to 21), average body-esteem (score 22 to 42), and high body esteem (score > 43). The Rosenberg self-esteem tool was used to measure general self-esteem of the participants. Body image satisfaction tool was used to rate participants satisfaction with different parts of their body whereas, the body esteem scale was used to assess participant’s attitudes and feelings about their body and appearance. A series of randomly placed female silhouettes were used to assess participants association with different attributes. They were also asked to associate a series of randomly placed female silhouettes, with specific words or phrases including clumsy, happy, worst, strong, happiest, best, less respect, more respect, unhappy. All participants were asked a number of questions about their attempts to change their weight. Girls and boys were asked the following questions: “During the past year have you done anything to try to lose weight?”, “During the past year have you done anything to try to gain muscle?” If participants answered positively they were asked to give reasons, which included; health and cosmetic reasons e.g. to look better, clothes too tight, too fat, unhappy with self, and want to be a model. They were further asked about the methods they used to lose weight, and their responses were categorized into three groups: (i) healthy weight control behaviors (e.g. to exercise, eat more fruits and vegetables, and to eat less high fat foods and less sweets) [20] unhealthy weight control behaviors (e.g. fasting, eating very little food, skipping meals, cigarette smoking and use of food substitutes (iii) extreme weight control behaviors (e.g. use of diet pills, self-induced vomiting, use of laxatives and diuretics). Descriptive analyses were completed and stratified according to gender and ethnicity. For normally distributed data we used t-tests and ANOVAs, and for data that was not normally distributed Wilcoxon rank test was done to determine significant difference. Chi-square tests were used to determine differences between categorical data. Pearson correlation test was done to determine linear associations. A p-value of <0.05 was considered statistically significant. Results: In the non-cohort sample, the prevalence of overweight and obesity was higher in the white girls and boys compared to their black peers, significantly more black than white adolescents of both genders reported an EAT-26 score ≥20 (predisposition to an eating disorder). Although the prevalence of low self-esteem was greater in the white compared to black girls, in the study of the male adolescents, the low self-esteem was more prevalent in the black compared to the white boys. Significantly more black than white girls had high body image dissatisfaction (38.8 vs. 16.7%). There were significant differences between the male and female ethnic groups in their perception of female silhouettes, and the majority of the white girls (65.4%) wanted to be thinner compared to only 38.8% of the black girls. BMI was positively associated with self- esteem and negatively with dieting behavior in white boys , and with lower EAT-26 bulimic and oral control scores in black boys. In the Birth to Twenty cohort, black African females had a higher BMI (p<0.001) and an increased risk of developing eating disorders as well as significant increase in the prevalence of weight loss practices between the ages 13 and 17 years. At age 17 years both mixed ancestry adolescents had lower body-esteem compared to black adolescents. The prevalence of possible eating disorders was 11% and 13.1% in early and late adolescents respectively. Males and females shared similar opinions on normal silhouettes being the 'best', 'getting respect' and being the 'happiest', while the obese silhouette was associated with the 'worst' and the 'unhappiest', and the underweight silhouette with the "weakest". Conclusions: Black African urban teenagers seem to be embracing Western norms to fit in with the demands of Western culture, however there is still evidence of traditional influences in both boys and girls with regard to perceptions of female silhouettes. Our findings suggest ethnicity and gender play a major role in psychosocial disorders. Ethnicity and gender were found to be associated with an increased risk of future eating disorders, as well as weight loss and muscle gain practices. These findings are highly relevant for all African countries undergoing transition, and are important in planning the development of interventions to optimize adolescent health prior to adulthood.

Introduction Lead exposure continues to be a major public health issue in South Africa, and other low and middle income countries. Environmental lead exposure has been associated with detrimental health effects in children. The aim of this thesis was to assess the prevalence of lead exposure and its association with various risk factors, its effects on puberty and socio-behavioural adjustment in adolescents. Methods The Birth to Twenty (Bt20) cohort study started in 1990, and is a long-term prospective follow-up study of children’s health and well-being. Mothers were recruited from antenatal clinics in the Johannesburg-Soweto metropolitan area between April and June 1990 (n=3273). Lead levels were analysed in samples of cord blood collected at birth (n=618) and whole venous blood collected at 13 years of age (n=1546). Data on selected child, maternal and household factors were collected using a structured questionnaire in the third trimester of pregnancy and at 13 years of age. Additional data on puberty (attainment of menarche and self-reported Tanner staging for breast and pubic development) and behaviour using the Youth Self Report was obtained at 13 years of age. Results In the Bt20 cohort the mean blood lead level at birth was 5.9 μg/dl, and at 13 years of age it was 5.7 μg/dl. The majority of children had blood lead levels above 5.0 μg/dl (52% at birth and 56% at 13 years). At birth, being a teenage mother and having low educational status were strong predictors for elevated cord blood lead levels. Being a male child, having an elevated cord blood level, and lack of household ownership of a phone were significant risk factors for high blood lead levels at 13 years. In 13 year old females with pubertal data (n= 682) the mean blood lead level was 4.9 μg/dl. Fifty percent had blood lead levels < 5.0 μg/dl, 49 % were ≥5.0 μg/dl and 1% was > 10.0 μg/dl. The average age of menarche was 12.7 years. At 13 years, 4% and 7% had reached Tanner stage 5 for pubic hair and breast development, respectively. Analyses showed that higher blood lead levels were significantly associated with delays in all measures of puberty (p <0.001). In the 13 year old sample with data on the Youth Self Report (n= 1041), the geometric mean blood lead level was significantly (P value<0.001) higher in boys (6.0 μg/dl) compared to girls (4.5 μg/dl). The bivariate analyses stratified by gender showed that boys’ blood lead levels were significantly associated with four types of aggressive behaviour. There were no significant associations found in girls. A multivariate analysis was conducted in the sample of boys and after adjusting for socio-economic factors ”Attacking People” remained significantly associated with blood lead levels. Conclusion Significant associations found in the study point to the low socio-economic status of lead exposed children. These poor circumstances frequently persist into adolescence resulting in continued high lead levels. Higher blood lead levels were associated with a delay in the onset of puberty in girls, and with anti-social behaviour among boys in early adolescence. Lead exposure in low and middle countries is generally higher compared to high income countries, and thus the effects of high blood levels are much greater and have larger personal and public health significance.

Thesis advisor: Stephanie C. Berzin / The primary aim of this study was to determine if various typologies of psychiatric diagnoses and patterns of comorbidity are differentially related to the medical lethality of adolescent suicide attempts. The secondary aim was to determine if the relationship between psychopathological comorbidity and suicide attempt lethality is significantly different across gender, age, and race in adolescents. To investigate these relationships, psychiatric evaluations were reviewed for all adolescents that presented to Children's Hospital Boston (CHB) from 2006 to 2010 for a suicide attempt (N = 375). Bivariate and OLS regression analyses were used to test hypotheses. Bivariate results showed that attempters diagnosed with a Substance Abuse Disorder comorbid with any other disorder had higher levels of suicide attempt lethality than those without the diagnosis. Additionally, having Bipolar or Mood Disorder NOS in combination with either Substance Abuse alone or Substance Abuse and Disruptive Disorders had a significant positive relationship with suicide attempt lethality when compared to other comorbidity patterns. In OLS regression, having Substance Abuse comorbid with any other disorder was the only significant diagnostic predictor of lethality. Female gender did not have a significant relationship with lethality. Age group was not predictive of lethality in regression analysis. African-American/Black race had a negative relationship with lethality in bivariate and multivariate analyses. Study findings have important implications for practice, policy, and future research with suicidal adolescents. Results suggest that improvements in the assessment and treatment of substance abuse in suicidal adolescents can play a critical role in decreasing the adolescent suicide rate. Screening for symptoms other than depression, such as substance use, will be critical to effective suicide prevention practices. Future research should focus on the development of effective treatment strategies with suicidal adolescent substance abusers, and aim for a better understanding of suicidal behaviors of adolescents with comorbid bipolar and substance abuse diagnoses. In order to further develop prevention and treatment strategies with this population, policies must be initiated that will support their advancement. / Thesis (PhD) — Boston College, 2011. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Mahmood Ahmed. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1991. / Includes bibliographical references. / Title / Contents --- p.i-iii / Abstract --- p.2 / Introduction --- p.5 / Definitions : --- p.7 / Chapter - --- Bone --- p.7 / Chapter - --- Bone Cells --- p.9 / Chapter - --- Types of Bone & the Mineral Contents --- p.10 / Chapter - --- Composition of Bone Mass --- p.11 / Chapter - --- Bone Mass --- p.11 / Chapter - --- Factors Affecting The Bone Mass --- p.12 / Bone Minerals --- p.13 / Non Invasive Methods of Measurement of BMC : --- p.16 / Chapter - --- Radiograph --- p.16 / Chapter - --- Quantitative Morphometric --- p.16 / Chapter - --- Radiographic Photodensitometry --- p.16 / Chapter - --- Neutron Activation --- p.17 / Chapter - --- Quantitative Computed Tomography --- p.17 / Chapter - --- Bone Absorptiometery --- p.18 / Chapter - --- Transmission of Ultrasonics --- p.18 / Chapter - --- Dual Photon Absorptiometry --- p.19 / Chapter - --- Bone Scan --- p.19 / Chapter - --- Bone - Specific Biochemical Markers --- p.20 / Chapter - --- Summary --- p.20 / Effects of Drugs on Bone Mass: --- p.22 / Chapter - --- Alcohol --- p.22 / Chapter - --- Tetracycline --- p.22 / Chapter - --- Corticosteroid --- p.23 / Chapter - --- Antacids --- p.23 / Chapter - --- Estrogen --- p.24 / Chapter - --- Vitamins --- p.24 / Causes of Osteopenia in Children --- p.25 / Physical Activity and BMC --- p.28 / Bone Mineral Content - Reviews : --- p.30 / Chapter - --- In Neonates --- p.30 / Chapter - --- Normative Surveys in Children --- p.32 / Chapter - --- Skeletal Abnormalities --- p.35 / HK Chinese Children: / Chapter - --- A General View --- p.37 / Objectives of Study --- p.40 / Chapter - --- Determination of Normal Range --- p.40 / Chapter - --- Determination of Peak Bone Mass --- p.41 / Measurement of BMC : --- p.43 / Chapter - --- Material --- p.43 / Methods and Subjects --- p.46 / Chapter - --- Location of Scanning Site --- p.46 / Chapter - --- Recruitment of Subjects --- p.47 / Chapter - --- Statistical Analysis --- p.48 / Reproducibility of Measurement: --- p.56 / Chapter - --- The Means --- p.56 / Chapter - --- The Correlations --- p.57 / Results --- p.58 / Chapter - --- 6 months to 3 years --- p.58 / Chapter - --- 3 to 7 years --- p.60 / Chapter - --- 7 to 18 years --- p.61 / Chapter - --- 3 to 18 years --- p.62 / Chapter - --- Dual Energy X-Ray Absorptiometry versus Single Photon Absorptiometry --- p.66 / Graphs & Charts / Chapter - --- Age Distribution --- p.50 / Chapter - --- Dominance Distribution --- p.51 / Chapter - --- BMC from 0.6 to 2.9 years --- p.59 / Chapter - --- BMC Male & Female Difference --- p.63 / Chapter - --- BMC Dominance Difference --- p.64 / Chapter - --- BMC Predicted & Measured Value --- p.65 / Chapter - --- BMD by SPA vs DEXA --- p.67 / Discussions --- p.68 / Chapter - --- BMC & Total Body Calcium --- p.68 / Chapter - --- Age --- p.70 / Chapter - --- Handedness --- p.71 / Chapter - --- Bone Width --- p.72 / Chapter - --- Weight --- p.73 / Chapter - --- Sex --- p.73 / Chapter - --- Height --- p.74 / Chapter - --- "Nutritional Status, Calc. Intak" --- p.74 / Comparison --- p.75 / Chapter - --- BMC in Pathological Conditions --- p.75 / Chapter - --- Comparison with other series --- p.76 / Conclusion --- p.82 / Diagram --- p.45 / Chapter - --- Schematic Diagram of Equipment --- p.45 / Picture --- p.52 / Chapter - --- Single Photon Absorptiometry --- p.52 / Chapter - --- Dual Energy X-Ray Absorptiometry --- p.53 / Chapter - --- Single Photon Absorptiometry (Neonates) --- p.54 / Chapter - --- Photon Absorption Technique --- p.55 / Table --- p.78 / Chapter - --- Table I (Average yearly BMC & BMD) --- p.78 / Chapter - --- Table II(Average yearly Change in BMC) --- p.79 / Chapter - --- TableIII(BMC from 3 to 18 years) --- p.80 / Chapter - --- Table IV (Regression Analysis) --- p.81 / Appendix --- p.83 / Acknowledgements --- p.95 / References --- p.96-99

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Cannabis use among teenagers in Canada is a concern because of the long-term and irreversible effects cannabis has on the developing body and mind. Nurses can be instrumental in screening for cannabis abuse by implementing a tool to assess for substance use disorder (SUD) and triage drug users to appropriate treatment. This project focused on how to implement the CRAFFT screening tool while gaining insight of the practitioner's knowledge base about the tool and how SUD is being screened for, currently. The CRAFFT screening tool aligns with the DSM-IV's SUD diagnosis criteria, allowing for efficient identification of those at risk for SUDs. Rotter's social-behavioural learning theory is presented to provide a greater understanding of how one's environment affects SUDs. Sources of evidence were primary health care providers (N = 10) at the health centre where this project was conducted. Data were collected before and after the participants engaged in the learning module on the CRAFFT screening tool. A descriptive analysis found that being acquainted with the tool allowed health care providers to understand the significance of screening for cannabis use among young adults and teenagers and to have more detailed documentation of patients' relationships with cannabis. The screening tool was favoured by 90% of the participants for cannabis use assessment after learning about the tool with this project. Nine out of ten of the participants indicated that they will now use the tool to aide in identifying SUD. Once SUD has been identified with the use of the CRAFFT screening tool, 80% of the participants indicated that they would refer their patients for further assessment and treatment for this substance abuse, which would promote positive social change.

All over the world, adolescent obesity is a serious health problem. Many researchers have focused on diet and exercise, because those behaviors are modifiable risk factors for obesity. To reduce or prevent the prevalence of adolescent obesity, contributions of diverse contextual factors to adolescents’ diet and exercise have been studied. However, little is known about peer influences on adolescents’ diet and exercise, compared to the studies of other contextual factors such as parents and school. In addition, in contrast to Western countries with higher prevalence of adolescent obesity, few studies have been conducted in countries with different cultures. Exploring the influence of peers on diet and exercise of adolescents in those countries could help to develop culturally-appropriate interventions to prevent adolescents from becoming obese. Thus, the purpose of this set of three studies was to examine adolescents’ diet and exercise in the context of peer factors and relationships. The purpose of the first study was to systematically review research assessing contribution of peer to adolescents’ diet and exercise. Twenty four articles were identified, using the electronic databases, PubMed, CINAHL, Web of Science, and SCOPUS. According to the findings from this review, the diet and exercise of adolescents was positively associated with that of their peers. Additionally, gender, the type of diet and exercise, and the closeness of friends could influence these associations. The second study identified the parent-, school-, and peer-factors contributing to dietary and exercise behaviors of adolescents in the United States, by using data from the Health Behaviour of School-Aged Children study. Findings from the current analysis indicated that parent- and peer-factors could influence either diet or exercise of adolescents; while school-factor were found to be associated only with adolescents’ diet. The third study explored the diet and exercise of Korean female adolescents within their classroom-based peer networks. Using social network analysis, dietary behaviors of female adolescents in this study were clustered within their classrooms. Several adolescents played a role in bridging two or more peer networks. However, less information about female adolescents’ exercise behaviors within classroom-based peer network was obtained. In summary, peers are an important contextual factor for developing adolescents’ diet and exercise behaviors that could contribute to adolescent obesity. These associations could be influenced by the characteristics of friendships such as gender of friends, the closeness of friends, and network characteristics of friendships. Peers can be potential targets for interventions to reduce or prevent the development of adolescent obesity.

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