ABSTRACT ASSOCIATION OF ANTIOXIDANT INTAKE AND BODY MASS INDEX IN PRE-TO-EARLY ADOLESCENT CHILDREN by E. Kelly Imboden Background: The prevalence of overweight (Body Mass Index [BMI]85-<95th percentile) and obesity (BMI>95thpercentile) for individuals aged 2-19 years in the United States in 2009-2010 was estimated to be 31.8%. Excessive body fat increases the risk for chronic conditions such as hypertension and type 2 diabetes mellitus. Studies have established an association between obesity and oxidative stress and inflammation in children and adolescents. Antioxidants have been shown to have protective effects against inflammation and oxidative stress. However, the effect of dietary antioxidant intake on obesity is not fully understood. Objective: To examine dietary antioxidant intake by BMI classification in a population of normal, overweight and obese children. Methods: The study population included 296 healthy pre-to-early adolescent (age 6-15 years) African American and Caucasian children residing in Pittsburgh, PA. Demographic characteristics, anthropometric measures and nutrient intake were assessed at baseline and six months. A food frequency questionnaire was used to assess antioxidant intake (vitamin C, carotene, total vitamin A, zinc and vitamin E). Frequency analysis was used to describe demographic, anthropometric and nutrient data. The Kruskal Wallis test was used to evaluate difference in median antioxidant and kilocalorie intake by BMI classification at baseline. A Kendall’s tau correlation was performed to test for a linear relationship between BMI and antioxidant intake at baseline. Results: The median age of the population was 10 years (range, 8 to 11 years). The majority of the population was male (53%) and African American (60%). Weight and BMI (p = 0.028 and 0.000, respectively) were the only demographic and anthropometric characteristics that differed by gender. For the total cohort, median nutrient intake by BMI classification was significantly different for vitamin C (p = 0.015), zinc (p = 0.019), vitamin E (p = 0.022) and kilocalories (p = 0.015). When divided by gender, zinc intake in males (p = 0.047) and kilocalorie intake in females (p = 0.017) were the only nutrients found to be statistically different by weight classification. No linear relationship was observed between antioxidant intake and BMI for the total cohort and for each gender. Conclusion: Our results do not support a linear relationship between antioxidant intake and BMI. In contrast to our hypothesis, antioxidant intake was found to be highest in children who were overweight. Future studies should include a serum measure of inflammation and antioxidant levels in addition to antioxidant intake to better understand the impact, if any, of antioxidants in overweight and obese children and adolescents.

Healthy spiritual development of adolescents is lacking in our society. Research shows that the topic of spiritual development for adolescents has been neglected for some time. It is clear from Scripture that spiritual development needs to take place in the life of a believer and that it is in fact an ongoing process. Even though spirituality has not been classified as something scientific during the modern era, spirituality has made its way back in scientific circles. The scientific disciplines of sociology and psychology have indicated that adolescents have a need for spiritual development and that spiritual issues are important to them. However, adolescents of the twenty-first century also face some unique challenges that have an impact on their spiritual development. Both the quantitative and qualitative methods of research were used and it was clear from both these studies that there were certain areas with regard to spiritual development that needed attention. The results in particular showed that the majority of those adolescents who took part in the research did not spend enough time on spiritual practices and most of them have taken part in some form of risky behaviour. The overall influences from family, friends and youth leaders were positive and in general it seemed that the majority of adolescents who took part in the research had a good relationship with parents and youth leaders. Adolescents need help in their spiritual development and according to Scripture parents and youth/church leaders have the responsibility to assist them. Guidance was given to adolescents and to major role players in their lives to assist them in the process of spiritual development. / Thesis (MA (Pastoral Studies))--North-West University, Potchefstroom Campus, 2013

Background: According to the existing evidence base, the experience of ending therapy, from the perspectives of adolescents who are looked after, is substantially under researched. Moreover, the ending of therapy is highlighted as an important phase of the therapy process and previous research into ending therapy indicates this as a valuable area of research. The available literature indicates that those with a history of loss may find the ending phase particularly challenging. It was hoped that the research findings may assist Clinical Psychologists and other therapists to make sense of how young people experience ending therapy, and may also highlight ways in which therapists can support looked after young people through this transition. Aims: The study aims to provide an in-depth understanding of the way in which young people who are looked after make sense of ending psychological therapy. Methodology: Semi-structured interviews were conducted with six looked after adolescents who had recently ended psychological therapy. The transcripts of the interviews were then analysed using Interpretative Phenomenological Analysis (IPA). Results: Four master themes emerged from analysis: inextricable link between therapy and therapy relationship, ambivalence, means of coping and moving on from therapy. Implications and Conclusion: This study highlights the need for careful and on going consideration of the ending phase of therapy with this population. It also gives further support to the significance of the therapeutic relationship and consideration of this at the end of therapy. Areas for future research are highlighted, notably the value of conducting further research with looked after young people, to explore factors such as culture and gender on the experience of ending therapy.

The studies described in this thesis were undertaken to examine the factors affecting adolescents cognitive function across the school morning. Specifically, the effects of breakfast consumption, breakfast glycaemic index (GI) and a mid-morning bout of exercise were examined, whilst the final experimental chapter examined their combined effects. The battery of cognitive function tests used in the present study was administered via a laptop computer and took approximately 15 min to complete. Across all experimental chapters, the visual search test (assessing visual perception), the Stroop test (assessing attention) and the Sternberg paradigm (assessing working memory) were used. Furthermore, in chapter V the Flanker task (also assessing attention) was added to the testing battery. The first experimental study (chapter IV) examined the effects of consuming a self-selected breakfast on cognitive function, compared to breakfast omission. Ninety-six adolescents (12 to 15 years old) completed two experimental trials (breakfast consumption and breakfast omission), scheduled seven days apart, in a randomised crossover design. Following breakfast consumption, accuracy on the more complex level of the visual search test was higher than following breakfast omission (p = 0.021). Similarly, accuracy on the Stroop test was better maintained across the morning following breakfast consumption when compared with breakfast omission (p = 0.022). Furthermore, responses on the Sternberg paradigm were quicker later in the morning following breakfast consumption, on the more complex levels (p = 0.012). Breakfast consumption also produced higher self-report energy and fullness, lower self-report tiredness and hunger, and higher blood glucose concentrations, compared with breakfast omission (all p < 0.001). Overall, the findings suggested that breakfast consumption enhanced adolescents cognitive function, when compared with breakfast omission. The second experimental study (chapter V) examined the effects of consuming a high GI breakfast, a low GI breakfast and breakfast omission on cognitive function. Forty-one adolescents (12 to 14 years old) completed three experimental trials, each scheduled seven days apart, in a randomised crossover design. There was a greater improvement in response times across the morning following a low GI breakfast, compared to breakfast omission on the complex level of the Stroop test (p = 0.009) and both levels of the Flanker task (p = 0.041), and compared to following a high GI breakfast on the complex level of the visual search test (p = 0.025) and all levels of the Sternberg paradigm (p = 0.013). Furthermore, accuracy was enhanced following a low GI breakfast, compared to breakfast omission on the more complex levels of the visual search test (p = 0.032), Sternberg paradigm (p = 0.051) and Flanker task (p = 0.001), and compared to following a high GI breakfast on both levels of the Stroop test (p = 0.033) and the more complex levels of the Sternberg paradigm (p = 0.002) and Flanker task (p = 0.014). Furthermore, participants exhibited a lower glycaemic response following the low GI breakfast (p < 0.001), though there was no difference in the insulinaemic response (p = 0.063), compared to following the high GI breakfast. Overall, the findings suggest that a low GI breakfast is the most beneficial for adolescents cognitive function, compared with a high GI breakfast and breakfast omission. The third experimental study (chapter VI) examined the effects of a mid-morning bout of exercise, following a self-selected breakfast, on cognitive function. Forty-five adolescents (12 to 13 years old) completed two experimental trials (exercise and resting), scheduled seven days apart, in a randomised crossover design. There was a greater improvement in response times across the morning following the mid-morning bout of exercise on all levels of the Sternberg paradigm (p = 0.010). There was also a greater improvement in response times across the morning on the visual search test following the exercise (p = 0.009), but this improved speed was combined with a greater decrease in accuracy following the exercise (p = 0.044). This suggests that following exercise, the adolescents exhibited a speed-accuracy trade-off, whereby they responded quicker, but this was to the detriment of accuracy. Overall, the findings suggest that whilst the mid-morning bout of exercise improved some components of cognitive function (e.g. response times on the Sternberg paradigm), it did not affect other components (e.g. Stroop test performance). The final experimental study (chapter VII) examined the combined effects of breakfast GI and a mid-morning bout of exercise on adolescents cognitive function. Forty-two adolescents (11 to 13 years old) were allocated to matched high GI (n = 22) and low GI (n = 20) breakfast groups. Within the matched groups, participants completed two experimental trials (exercise and resting) in a randomised, crossover design. The findings indicate that, for the complex level of the Stroop test, following the high GI breakfast there was a greater improvement in response times across the morning on the resting trial, whereas following the low GI breakfast response times improved across the morning on both the exercise and resting trials, though the magnitude of the improvement was greatest on the exercise trial (p = 0.012). On the Sternberg paradigm, response times improved across the morning following the low GI breakfast regardless of exercise, whereas following the high GI breakfast response times improved across the morning on the exercise trial, though remained similar across the morning on the resting trial (p = 0.019). Overall, the findings suggest that the effects of the mid-morning bout of exercise were dependent upon the breakfast GI and the component of cognitive function being examined and that, for the Stroop test, the beneficial effects of the low GI breakfast and mid-morning bout of exercise were additive. Overall, the results from this thesis suggest that breakfast consumption is more beneficial than breakfast omission and more specifically, that a low GI breakfast is more beneficial than both a high GI breakfast and breakfast omission, for adolescents cognitive function across the school morning. However, the effects of exercise appear to be more variable, with the effect of exercise depending upon the component of cognitive function examined and the GI of the breakfast consumed. Overall, the findings presented in this thesis suggest that the nutritional effects on adolescents cognitive function (i.e. the effects of breakfast consumption and GI) were stronger and more consistent than the exercise induced effects.

Introduction: Key studies have found an association between attachment style and poor diabetes outcomes in the adult diabetic populations. Specifically insecure attachment has been found to predict elevated glycated haemoglobin levels (HbA1c). Further studies have indicated that substance use and mental health difficulties also influence HbA1c. These factors have been looked at individually making it difficult to directly assess the overall effect of attachment on HbA1c and the potential mediating effects of substance use and mental health. The adolescent population has not been considered in studies examining these relationships. This study compares attachment security, level of substance use, interpersonal problems, anxiety and depression in relation to their role in blood glucose control in an adolescent population with Type 1 diabetes. Method: A quantitative, cross sectional, questionnaire design was employed to examine the role of the aforementioned factors in relation to HbA1c level. The target population included all patients aged 14 years to 18 years, inclusive, who attended for review at Diabetes Clinics across Lothian. Participants had a diagnosis of Type 1 Diabetes for at least one year and no additional diagnoses of mental health disorder or other chronic condition. At the clinic patients were approached and asked to complete a set of self report questionnaires. Measures of attachment were adapted versions of the Relationship Questionnaire (RQ) and the Relationship Scales Questionnaire (RSQ). Interpersonal problems were assessed using the short version of the Inventory of Interpersonal Problems (IIP-32). The Hospital Anxiety and Depression Scale (HADS) assessed levels of anxiety and depression. The Adolescent Substance Abuse Subtle Screening Inventory- A2 (SASSI-A2) was used to measure substance use. Blood glucose levels (HbA1c%) were obtained from clinic staff. A total of 88 participants returned completed questionnaires (response rate 79.3%). Results: When all correlations between predictors and HbA1c were examined, a negative correlation was found between attachment and HbA1c level. A positive correlation was found between anxiety and HbA1c level. Multiple regression analyses examined the relationship between attachment security and HbA1c before analysing additional predictors in the same model. No significant relationships emerged however the multiple regression model was not a significant fit for the data. Path Analysis considered all relationships between variables simultaneously while also providing information on how the model fits the data. Attachment security directly related to HbA1c levels when the contributions of gender, interpersonal problems and substance use were considered. Anxiety and depression did not predict HbA1c nor did they contribute to any other relationships with HbA1c. Interpersonal problems had a direct relationship with HbA1c when the contribution of substance use and attachment were considered. Conclusion: Attachment predicts HbA1c. The nature of this relationship is further understood when the contribution of additional psychological variables are considered. Methodological issues, clinical implications and directions for future research are discussed.

High prevalence rates and negative outcomes of peer-based aggression and victimization during early adolescence underscore the need to identify causes and consequences of these outcomes. Limited research has examined the impact of environmental and contextual factors, such as school climate, on peer aggression and victimization. Few studies have addressed relations between school climate and specific subtypes of physical and relational aggression and victimization. Although school climate has been assessed via interpersonal subsystems (i.e., student-student and student-teacher relationships), little research has incorporated the role of student awareness and reporting of violence and safety concerns. Further, studies are needed that consider the bi-directional relations between school climate and peer aggression and victimization over time. To address these limitations, the current longitudinal study examined associations between school climate (i.e., student-student and student-teacher relationships and awareness/reporting) and peer aggression and victimization over six months among a sample of 265 middle school students.

Background: Diabetes is a chronic metabolic disease and an increasing public health problem. Treatment of type 1 diabetes requires daily insulin injections. Young people living with diabetes may feel that they do not fit in among others of the same age. Aim: Illustrate young people's experiences of living with diabetes type 1. Method: This study was a qualitative literature-based study with an inductive approach. The result was based on 10 qualitative scientific articles. Result: The analysis resulted in three main themes and seven subthemes. The main themes were: To live in a process of adaptation, A buffet of challenges and How the social surroundings impact the life. Conclusion: The results showed that young people who lived with type 1 diabetes felt that they had to adapt their lives to the disease. For young people it was also important to become independent in their illness. It was obvious that living with type 1 diabetes was an experience of both physical and mental challenge, and the people in the studies expressed a desire to be normal and to be able to compare themselves with others. The social surroundings had a clear impact in many ways, though the support from the environment was perceived as valuable. / Diabetes typ 1 är en ständigt ökande folksjukdom som ofta drabbar unga människor. Diabetes typ 1 är en kronisk ämnesomsättningssjukdom som ställer krav på den unga individen och skapar utmaningar i vardagen. Unga som lever med diabetes påverkas av sin omgivning och är i behov av stöd på olika sätt. Diabetes innebär att individen ständigt har förhöjda blodsockernivåer, till följd av brist på insulin. Unga människor lever i en turbulent period av livet, och att leva med en kronisk sjukdom kan förhindra en utveckling av den egna identiteten. Egenvården upplevs som en viktig del på vägen mot självständighet hos de unga, och sjuksköterskan har en central del i att hjälpa den unga individen att främja hälsa. Syftet är att belysa unga människors upplevelse av att leva med diabetes typ 1. Tio kvalitativa vetenskapliga artiklar har använts som material i resultatet. Resultatet visar att sjukdomen kräver en anpassning av livet. Det är en dragkamp om ansvaret för sjukdomen mellan de unga och deras föräldrar, då självständighet anses viktigt av unga människor för att uppnå frihet, vilket relateras till begreppen livsvärld och hälsa. De unga upplevde både känslomässiga och praktiska utmaningar i livet med diabetes, vilket diskuteras i relation till livskvalitet. En önskan om att få vara normal och kunna jämföra sig med andra i samma ålder finns, eftersom det är en betydande del i de ungas sökande efter en egen identitet. De unga anser att omgivningen påverkar dem på olika sätt, stödet från vänner och familj upplevs som betydelsefullt.

This study gives attention to the effects of instability of placement, emotional disturbances, and at-risk behaviors on the academic performance of adolescents in foster care, specifically males. The purpose of this study was to examine the academic success of male adolescents in foster care and environmental influences that prevent many children from excelling. Data were extracted and analyzed (Chi-Square) from 50 of200 case files (active and discharged). The sample represented male residents (12 to 18 years of age) of a privately run, state licensed residential group home in Georgia. Academic performance was measured by grade point average. Twenty-eight percent did not function on grade level while 72% functioned on grade level. There was no statistical significance between academic achievement and instability of placement (X2= .577, p = .448), emotional disturbances(X2= .759, p = -.348), aggressive/violent behavior (X2= .020, p = .887), and sexual activity (X2=.732, p = .392). However, there was statistical significance found between academic achievement and substance use (X2= 4.095, p = .043). An additional key finding in this study was 74% of the adolescents had a mental health diagnosis but had only been in foster care less than one year. Therefore, additional research should be conducted to determine the preexisting conditions adolescents experience before entering foster care. The findings from this study can perhaps encourage the child welfare community to investigate other variables that may impact the academic achievement of adolescents in foster care.

La présente recherche s’intéresse aux élèves du primaire (6-9ans) qui ont des problèmes de comportement, en particulier les filles, et concerne la qualité de leur adaptation lors du passage à l’adolescence. À risque élevé de persistance lorsqu’ils débutent à l’enfance, les problèmes de comportement sévères sont reliés au développement de conséquences négatives futures. Par contre, dans certains cas, les jeunes ne persisteront pas dans une trajectoire de trouble de comportement à l’adolescence. Il reste tout de même à savoir si leur niveau d’adaptation est acceptable. L’étude vise d’abord à identifier, chez des enfants (N=435) en troubles de comportement précoces, des sous-groupes latents selon la qualité de leur adaptation, puis à décrire et comparer les facteurs individuels et environnementaux qui sont associés à la qualité de leur adaptation au début de l’adolescence en vérifiant l’effet modérateur du sexe. Les résultats montrent un modèle à trois classes ; un sous-groupe d’enfants présentant une adaptation positive à l’adolescence, un sous-groupe ayant une adaptation plus négative et un troisième sous-groupe où les enfants, surtout des filles, présentent une adaptation encore plus difficile. De plus, seuls trois facteurs individuels (opposition, agressivité indirecte et performance scolaire) et trois facteurs environnementaux (consommation des parents, discipline coercitive et fréquentation de pairs déviants) prédisent l’appartenance à un sous-groupe. Les résultats soutiennent l’importance d’une meilleure connaissance des facteurs prédicteurs de la qualité d’adaptation afin d’intervenir dès l’apparition des premiers indices du trouble de comportement en ciblant particulièrement les filles.

Adolescence entails a reorganization of social, interpersonal interactions (Ávila, Heredia, Gómez & Martínez, 2006; Cardozo & Alderete, 2008), which generates stress (Frydenberg & Lewis, 2009). To deal with it, a variety of actions and cognitions are used, which prepare us to tolerate or minimize the effects produced by it (González, Montoya, Martina and Bernabeu, 2002). The purpose of this research is to describe the coping strategies used by adolescent high school students, making comparisons by sex and age. The work was done with 724 adolescents: 413 females and 311 males; ranging between 14 and 17 years of age, from Valle de Toluca, Estado de México. The Adolescent Coping Scale (ACS), developed by Frydenberg and Lewis (2000) was applied. The results obtained regarding the strategies used by adolescents in stressful situations are: to work hard and achieve, seek relaxing diversions, and worry. Females use more strategies focused on solving the problem, and they handle their emotions, unlike males who evade the problem and are more emotionally reserved. Regarding the age comparison, it was found that 16-year olds employ problem-evasion strategies. The implications of this study are discussed. / La adolescencia supone una reorganización de las interacciones sociales, interpersonales (Ávila, Heredia, Gómez y Martínez, 2006; Cardozo y Alderete 2009), lo que genera estrés (Frydenberg y Lewis, 2000). Para afrontarla, se emplea un conjunto de acciones y cogniciones que capacitan para tolerar o minimizar los efectos producidos (González, Montoya, Martina y Bernabéu, 2002). El propósito de la investigación es describir las estrategias de afrontamiento que emplean los adolescentes estudiantes del nivel medio superior, realizando comparaciones por género y edad. Se trabajó con 724 adolescentes, 413 mujeres y 311 hombres, con un rango de edad entre 14 a 17 años, del Valle de Toluca, Estado de México. Se aplicó la Escala de Afrontamiento para Adolescentes (ACS), elaborada por Frydenberg y Lewis (2000). Los resultados obtenidos de las estrategias que emplean los adolescentes ante situaciones estresantes son: esforzarse y tener éxito, buscar diversiones relajantes y preocuparse. Las mujeres emplean más estrategias centradas en resolver el problema e intervienen sus emociones, a diferencia de los hombres que evaden el problema y son más reservados emocionalmente. Con respecto a la comparación por edad, se encontró que los de 16 años emplean estrategias de evasión del problema. Se discuten las implicancias del estudio.