This dissertation includes three studies that examined the impact of inadequate sleep duration in adolescents and young adults on asthma and systemic inflammation. We used data from the Florida Youth Risk Behavior Survey (YRBS), years 2009-2013, and from the National Longitudinal Study of Adolescent to Adult Health (Add health), which was conducted between 1994 and 2008. The first study used data from 16,738 high school students participating in the Florida YRBS. We examined the cross-sectional association between sleep duration and asthma, and the interactive effects of sleep duration and BMI. We found that short and long sleep durations were associated with increased odds of current asthma. Compared with 7-8 hours of sleep per night, sleeping for(95% CI) of 1.22 (1.07, 1.40), while sleeping for ≥ 9 hours had and OR of 1.31 (1.06, 1.63). We found a significant effect modification by BMI, with the associations between sleep duration and asthma mostly limited to overweight adolescents. Compared with normal weight students who sleep for 7-8 hours per night, those who are overweight and sleep for≥ 9 hours have approximately twice the odds of having current asthma [OR= 1.75 (1.45, 2.11), and OR=2.00 (1.32, 3.02) respectively]. No significant associations were found in normal-weight adolescents. The second study used data from 12,633 adolescents (age 13-19) participating in the National Longitudinal Study of Adolescent to Adult Health (Add health), and followed through 4 waves of interviews through their young adulthood (age 24-32). We constructed trajectories of sleep duration through 4 waves of data for participants without asthma at wave I (n=11,016), and examined the association between sleep duration and the risk of asthma by young adulthood. Similarly, we constructed trajectories of sleep duration for participants with asthma at wave I (n=1,395) through 3 waves of data, and examined the association between sleep duration and persistence of asthma into young adulthood. Sleep trajectories in non-asthmatic participants showed that 13.8% of them had persistent short sleep duration, while 80.7% had adequate sleep durations from adolescence though young adulthood. Those with consistently short sleep had 1.59 times the risk of new onset asthma by age 32 (95% CI 1.12, 2.26), compared with consistently adequate sleepers. Among adolescents with asthma, 10.2% had consistently short sleep through age 24, while 81.2% had adequate sleep. Short sleepers were 2.35 times more likely than adequate sleepers to have their asthma symptoms persist into young adulthood (95% CI 1.12, 4.96). The third study used data from waves III and IV of the Add health study, and examined the association between sleep trajectories over a 6-year follow-up in young adulthood, and the risk of elevated high sensitivity C-reactive protein (hs-CRP), a marker of systemic inflammation. Short sleep trajectories were associated with a significant increase in log-transformed hs-CRP (coefficient=0.11, p-value 0.03), and with a significant increase in the odds of having hs-CRP levels >3 mg/dl (OR=1.85, 95% CI 1.29, 2.67). The association was modified by sex, with the association between short sleep duration and hs-CRP limited to males. In males, both the continuous (coefficient 0.117, p-value=0.0362) and the categorized hs-CRP (OR= 2.21, 95% CI 1.48, 3.30) were significantly increased with short sleep durations, while no significant associations were seen in females with short sleep durations. By contrast, there was a significant increase in log hs-CRP in females with long sleep durations (coefficient=0.232, p-value=0.0296), and a non-significant increase in the odds of having hs-CRP levels greater than 3 mg/dl (OR=1.48, 95% CI 0.75, 2.93), while there were no associations with long sleep duration in males. The results of this dissertation research point to the detrimental effects of sleep loss on the bodies of adolescents and young adults. We found sleep loss to be associated with the incidence of asthma and its persistence, in addition to heightened systemic inflammation, which is a likely pathway that links sleep duration with the above outcomes. Our findings indicate that males are more susceptible to the effect of insufficient sleep on the risk of heightened inflammation, while females are more susceptible to the effects of long sleep durations. Interestingly, adolescents in the more recent YRBS study had shorter sleep durations than those who participated in the earlier Add health study. The prevalence of sleeping less than 7 hours was 16.5% in the add health study (years 1994-1995), compared with 47.2% in the YRBS study (years 2009-2013), indicating a progressive decrease in the average sleep duration of adolescents.

Abstract Dental caries is one of the most widespread diseases in the world. In the industrialized world the situation improved until the 1990s, after which the good development is claimed to have almost stagnated. One of the aims of this cross-sectional study was to investigate caries prevalence in a young male population. Another aim was to investigate ways to find individuals needing restorative treatment. The hypothesis in this study was that caries prevalence among Finnish young males born in the 1990s was similar or even poorer compared to those born in earlier decades. Polarization of dental caries was still expected to exist. It was also hypothesized that caries prevalence is geographically unevenly distributed in Finland. The Finnish Defence Forces screening protocol was hypothesized to be valid for detecting individuals with restorative treatment need. Finally, it was hypothesized that restorative treatment need at the individual level associates well with a well-chosen set of questions concerning dental symptoms, dental attendance, treatment history and health behaviour. Study material consisted of 255 female and 13,564 male (total n=13,819) conscripts. Anamnestic data, along with information about the socioeconomic status, educational level and place of residence just before military service, were collected with computer-based questionnaire in connection with the oral screening (50 questions and 108 sub-questions). Validity of the screening protocol was evaluated in a sub-population (74 conscripts) examined using both the screening and the ICDAS classification. The screening protocol was validated using the ICDAS criteria and it proved to be well in accord with it considering restorative treatment need at the individual level. The study revealed that on average the conscripts had 1.4 decayed teeth (DT), third molars excluded. The number of decayed, earlier restored or extracted teeth due to caries (DMFT) was 4.1. Ten per cent had about half of the caries lesions and 30% had 90%, suggesting that polarization still exists. It was also found that living in areas with high fluoride content in drinking water, living in urban areas and a Swedish-speaking home municipality were protective factors against dental caries. A positive response to eight questions of a statistically selected set of ten questions reliably predicted restorative treatment need (OR 69.27). / Tiivistelmä Karies on yksi maailman laajimmalle levinneistä sairauksista. Menneinä vuosikymmeninä karies väheni merkittävästi aina 1990-luvulle saakka, jonka jälkeen myönteinen kehitys on hidastunut. Tämän tutkimuksen tavoitteena oli tutkia korjaavan hoidon tarpeen määrää nuorten miesten keskuudessa. Tutkimuksen toinen tavoite oli tutkia tapoja erottaa terveistä korjaavan hoidon tarpeessa olevat henkilöt. Tutkimuksen oletuksena oli, että karieksen esiintyvyys 1990-luvun alussa syntyneiden suomalaismiesten joukossa on vastaavalla tai huonommalla tasolla kuin 1970-luvun alussa. Lisäksi oletettiin, että kyseisessä ikäluokassa karies on polarisoitunut. Oletuksena oli myös, että karieksen esiintyvyys on maantieteellisesti epätasaisesti jakaantunut. Tutkimuksessa oletettiin myös, että Suomen Puolustusvoimien käyttämällä suunterveyden seulontamenetelmällä voidaan tunnistaa luotettavasti yksilötasolla korjaavan hoidon tarpeessa olevat yksilöt. Viimeisenä oletuksena oli, että korjaavan hoidon tarve yksilötasolla olisi arvioitavissa seulonnan ja hyvin valitun kysymyspaketin perusteella tutkituissa ikäluokissa. Tämän poikittaistutkimuksen satunnaistettu tutkimusaineisto koostui 13819 varusmiehestä (255 naista ja 13564 miestä) sekä esitietoihin perustuvasta aineistosta joka kerättiin seulonnan yhteydessä tietokonepohjaisella kyselylomakkeella (50 kysymystä ja 108 alakysymystä). Seulonnan tulokset vastasivat hyvin tarkastusta, jossa vauriot diagnosoitiin ICDAS kriteereitä käyttäen. Tutkimus osoitti myös että, keskimäärin yksilöllä oli 1,4 korjaavan hoidon tarpeessa olevaa hammasta viisaudenhampaat pois lukien. Aiemmin korjattujen, karieksen takia poistettujen ja karieksen vaurioittamien hampaiden lukumäärä oli 4,1. Kymmenellä prosentilla tutkimusjoukosta oli puolet kaikista vaurioista ja vastaavasti kolmanneksella tutkituista oli 90 prosenttia kaikista vaurioista. Juomaveden fluoripitoisuus ja asuminen kaupungissa tai ruotsinkielisessä kunnassa olivat suojaavia tekijöitä korjaavan hoidon tarpeen suhteen. Kymmenen esitietokysymystä valittiin tilastollisesti 108 kysymyksen joukosta. Positiivinen, korjaavalle hoidolle altistava, vastaus vähintään kahdeksaan näistä kymmenestä kysymyksestä ennusti luotettavasti (OR 69,27) korjaavan hoidon tarvetta yksilötasolla.

With privacy settings on social networking sites (SNS) perceived as complex and difficult to use and maintain, young adults can be left vulnerable to others accessing and using their personal information. Consequences of not regulating the boundaries their information on SNS include the ability for current and future employers to make career-impacting decisions based upon their online reputation that may include disqualifying them as job candidates. On SNS, such as Facebook, LinkedIn, and Twitter, young adults must decide on how to manage their online reputation by regulating boundaries to their own personal and professional information and identities. One known practice for the regulation of boundaries is the use of multiple profile management (MPM), where users of SNS create and use multiple accounts on a SNS and separate the social and professional identities that they disclose publicly and privately. The purpose of the study was to understand the lived experiences of young adults in how they regulate boundaries on SNS, through the use of MPM, as they manage their online reputation to different audiences. The practice was studied by applying interpretative phenomenological analysis (IPA) through interviewing young adults of 18-23 years of age, who use MPM on a SNS. Semi-structured interviews permitted participants to provide in-depth descriptions of their lived experiences. Eight themes were identified and described based on the analysis of the interviews that include: SNS use with online audiences, motivations for using MPM, the processes for the presentation of self, online search results, privacy settings, untagging SNS posts, self-editing and censorship, and new features. The themes describe the complexity and challenges that young adults face with regulating boundaries with their professional and social identities online through the use of MPM. Findings from this study have implications for a variety of audiences. Through the findings of this study, SNS developers can introduce new features, improve usability related to privacy management, and further encourage use of their networks. Users of SNS can use this study to understand risks of using SNS and for learning of practices for how to manage their online reputation on SNS.

Smoking amongst youth living with HIV (YLWH) has major public health implications. When combined with the complications associated with smoking such as chronic obstructive pulmonary disorder (COPD) or heart disease, the impact of a HIV positive diagnosis increases morbidity exponentially (Nahvi & Cooperman, 2009). The purpose of this study was two-fold, to investigate the perceptions of smoking amongst YLWH aged 18-25 who received care at the CMS Clinic located at the University of South Florida and to determine factors related to cessation. A study design utilizing two components, a systematic literature review and primary qualitative data was used in this dissertation. The systematic literature review was used to identify and examine published research studies that compared smoking cessation interventions for youth and young adults. Twenty-five in depth interviews were conducted in order to determine themes related to smoking cessation and the factors associated with the experience of smoking.

This study explored the potential for physical activity to be an effective, healthy coping strategy alternative to self-harm behaviors. Regression analyses were performed to assess how physical activity level related to risk factors (i.e., emotional dysregulation, self-esteem, and depression) and self-harm behaviors. The relationship between selfharm and exercise motivations was also examined. Participants were recruited from two high schools (n = 95) and one university (n = 72) in the southeastern region of the United States. Analyses were run using the following measures from a survey packet: adapted Exercise Questionnaire (Helmerhorst, Brage, Warren, Besson, & Ekelund, 2012), Exercise Motivations Inventory—Second Edition (Markland & Ingledew, 1997), Inventory of Statements About Self-Injury (Klonsky & Olino, 2008), Reynolds Adolescent Depression Scale – 2nd Edition (Reynolds, 2002), Eating Disorders Inventory – 3 (Garner, 2004), and Center for Epidemiologic Studies Depression Scale (Miller, Anton, & Townson, 2008). Of the 167 who participated, 41.3% endorsed at least one instance of nonsuicidal self-injury (NSSI). Results indicated that NSSI frequency was significantly negatively associated with physical activity (β = -.22, p < 0.01). An interaction was found between physical activity and depression, such that physical activity moderated the relationship between depression and self-harm. The overall model explained 28.2% of the variance, F(3,145) = 10.02, p < .01. Affiliation and appearancebased exercise motivations significantly associated with decreased (β = -.244, p = .047) and increased (β = .320, p = .001) frequencies of self-harm, respectively. Overall, the findings suggest that physical activity may possess a protective nature against self-harm behaviors, especially in individuals with depressive symptoms.

M.A. (Clinical Social Work) / This qualitative study focuses on the description and assessment of care leavers’ application of social skills into independent living. Information was gathered through semi-structured interviews with open-ended questions. The sample comprised ten young men who had been in the care of GBTSA for at least two years and who left care at the age of 17-19 years between two and five years ago. Findings of the study indicate that care leavers are faced with ongoing challenges that force them to mature more quickly than their other peers. As a result, care leavers often have to rely on skills learned while in care in dealing with these challenges. Care leavers’ understanding of skills learned and how they have used the skills in their adult life were assessed based on their lived experiences. This was done through care leavers identifying the skills they remember learning and reflecting on how they have applied these skills in their adult lives. Based on the objectives of the study and its findings, recommendations are made which include: GBTSA to explore and develop a structured mentoring programme that can be incorporated with its independent living programme to provide ongoing support to care leavers. Concerns were identified in areas such as generalisation and internalisation of skills learned, applicability of skills in “real life” contexts and a need for an ongoing support base to motivate and encourage care leavers.

Early life experiences such as childhood maltreatment are important contributors to depression, one of the most significant mental health problems in Canada; approximately 11.2% of Canadian adults will experience major depression at some point in their life (Knoll & MacLennan, 2017). Although psychological maltreatment and neglect are the most common forms of child maltreatment, and it has been suggested that they are linked to later depression, the underlying mechanisms explaining this relation have yet to be determined. The current investigation examined the role of adult attachment and relationship satisfaction in the prediction of depressive symptomology in 676 university students (74% female). Both anxious and avoidant attachment were mediators of the relationship between childhood psychological maltreatment (CPM) and adult depressive symptoms. Only avoidant attachment was a mediator of the relationship between childhood psychological neglect (CPN) and depressive symptoms. Relationship status did not moderate the relationship between maltreatment and attachment. However, for those currently in romantic relationships, the effect of CPM on avoidant attachment was moderated by relationship satisfaction. Specifically, those with a history of CPM who were currently in a satisfying relationship experienced heightened attachment avoidance along with subsequent depressive symptoms. Implications and strategies for clinical intervention are discussed. / Graduate

No description available.

Aim: The overall aim of this thesis, using a salutogenic framework, was to develop knowledge about experiences and perceptions of living with recessive limb-girdle muscular dystrophy and its influences on health, from the affected young adults’ and their parents’ perspectives. Methods: A qualitative explorative and descriptive study design was used. Semi-structured interviews were held with 14 young adults diagnosed with recessive limb-girdle muscular dystrophy, aged 20–0 years, and 19 parents. Data analyses were conducted using content analysis (I, II, III) and phenomenography (IV). In order to mirror the interview data, the participants also answered the 13-item sense of coherence questionnaire. Findings: Recessive limb-girdle muscular dystrophy has a major impact on the affected young adults’ and their parents’ lives as the disease progresses. Health described in terms of well-being was thus perceived to be influenced, not only by physical, emotional and social consequences due to the disease and worry about disease progression but also by external factors, such as accessibility to support provided by society and other people’s attitudes. There was, however, a determination among the participants to try to make the best of the situation. The importance of being able to mobilize internal resources, having social support, meaningful daily activities, adapted environment, the young adult being seen as a person and having support from concerned professionals, including personal assistance when needed, was thereby described. Self-rated sense of coherence scores varied. Those who scored above or the same as median among the young adults (≥56) and the parents (≥68) expressed greater extent satisfaction regarding social relations, daily activities and external support than those who scored less than median. Conclusion: This thesis highlights the importance of early identification of personal perceptions and needs to enable timely health-promoting interventions. Through dialogue, not only support needed for the person to comprehend, manage and find meaning in everyday life can be identified, but also internal and external resources available to enhance health and well-being, taking into account the person’s social context as well as medical aspects.

Non-suicidal self-injury (NSSI) is a destructive behaviour engaged in by a large proportion of youth and young adults in current society. Despite previous work, the recent revision of the DSM does not include NSSI as a distinct syndrome; instead it remains in a category for disorders requiring additional research. Thus, in order to better understand the many etiological components underlying NSSI behaviour, still more investigation is required. To this end the current investigations aimed to further elaborate upon known links between NSSI behaviour and parent-child relationships from two perspectives: first, with regard to the overall quality of relationships with parents, and second, with specific focus on the impact of attachment representations of early relationships with parents. Though both perspectives have been investigated in the past, the current studies were developed to alleviate methodological limitations of the existing literature. Study 1 adopted a person-centered approach to examine patterns of perceived relationship quality reported by self-injuring youth based on the combination of multiple relational characteristics; these patterns were then compared with several indices related to different manifestations of NSSI behaviour. Results show heterogeneity in the perceptions of parent-child relationship quality in self-injurers, such that both negative and positive family backgrounds were implicated in the behaviour. Further analyses demonstrate that the level of risk presented by a self-injuring individual can be differentiated based on perceived quality of parent-child relationship. Study 2 investigated how individuals’ internalized states of mind regarding early attachment experiences are related to NSSI, with particular attention dedicated to the relative influences of child maltreatment and attachment representation. Attachment representations reflecting deficits in emotion regulation (preoccupied, unresolved/cannot classify) were most common in self-injurers. Moreover, self-reported childhood maltreatment and attachment states of mind independently contributed to the prediction of NSSI. Lastly, findings suggest that distinct relational influences characteristic of relationships with mothers and fathers are associated with NSSI. The two studies presented here significantly contribute to existing knowledge concerning parental influences in the etiology of NSSI. These investigations add to existing knowledge of NSSI, and may ultimately aid in preventing and treating this damaging behaviour.