<p>Body image concerns and dieting emerge at an early age among girls and become more pronounced with increasing age. Knowledge about risk factors for disturbed eating is crucial in order to develop theoretical models and to suggest new paths for preventive efforts. The aim of the present thesis was to investigate the development of disturbed eating and to evaluate a conceptual model of predictors of body dissatisfaction and disturbed eating in girls. The included studies are part of a seven-year longitudinal project employing an accelerated multi-cohort design, including several age groups (7, 9, 11, 13, 15 years at inclusion). </p><p>Study I demonstrated a marked increase in the wish to be thinner and dieting attempts between the ages 10–14 and 9–13 years, respectively. In Study II, the Body Mass Index (BMI) predicted weight-related teasing and body dissatisfaction, and body dissatisfaction predicted restrained eating among Swedish girls in Grade 8 and Australian girls in Grades 7 and 8. Weight-related teasing partially mediated between BMI and body dissatisfaction in all three samples. Study III partially supported a conceptual model implying that BMI, weight-related teasing, and body dissatisfaction at 7–11 years predicted restrained eating among girls 12–14 years old. Study IV provided support for a conceptual model positing that BMI, body esteem, and to some extent weight-related teasing, predict body dissatisfaction and restrained eating during adolescence and young adulthood. </p><p>In conclusion, there was partial support for a conceptual model including these risk factors for disturbed eating among girls.</p>

<p>The main aims were to investigate emotional reactions during in vitro fertilization (IVF) treatment among women and men, attitudes of IVF couples towards cryopreserved embryos and public attitudes towards various aspects of oocyte donation in Sweden. Assessments of emotional, physical and social reactions were made on a daily reaction scale and attitudes on the basis of study-specific questionnaires. Both women and men experienced the stages of oocyte retrieval and embryo transfer, as well as the luteal phase, as being particularly stressful and there was a similarity in the type of reaction pattern. Presence of supernumerary embryos for cryopreservation increased the women’s optimism, but did not seem to reduce their level of distress on the day of embryo transfer. One-third of IVF couples chose not to use their cryopreserved embryos. The main reasons among the respondents concerned family planning and too short a legally allowed time of embryo storage. There was strong support for oocyte donation among a subset of the Swedish population. Women were more positive than men towards oocyte donation and to disclosure of the origin to offspring. Factors that might increase the likelihood of women becoming oocyte donors were talking to women with experience of donating oocytes, proximity to the clinic, accessibility of counselling and having children of their own. These results indicate that different approaches to psychological care for women and men may not be warranted during IVF treatment. Contact should be maintained during the cryopreservation period in order to adress the couple’s questions and concerns about the embryos. To increase the donor pool, IVF clinics could provide information about donation to potential donors through the Internet and through experienced donors. The information to donors and recipient couples about different consequences of donation seems to be of great importance.</p>

<p>The aim was to study consumer attitudes to and perceptions of organic and genetically modified (GM) foods and factors influencing the purchase/non purchase of these two types of foods. Data were collected by two questionnaire surveys (random nation-wide samples of 2000 consumers, response rate 58% and 39% respectively) and one interview study (n=40).</p><p>A majority of the consumers had positive attitudes towards purchasing organic foods but few reported purchasing organic foods regularly. The most common beliefs about organic foods were that they are more expensive and healthier. Choice of organic foods was related to the perceived consequences for human health and to environmentally friendly behaviour. Perceived positive health consequences appeared to be a stronger motive for purchasing organic foods than were environmental benefits.</p><p>Attitudes towards genetic engineering (GE) appear to be dependent on the application area. Medical applications were generally more easily accepted than were food and agricultural applications. However, all medical applications were not equally accepted. Consumers had generally rather negative attitudes towards GM foods, which were perceived as not being healthy. GM of animals for food production was perceived more negative than GM of plants. Tangible benefits of GM foods, like being better for the environment or healthier, seemed to have a potential to increase willingness to buy.</p><p>The results indicate that the attitudes to organic and GM foods differ: the attitude to organic foods is positive while the attitude to GM foods is more negative. Further, the perceptions of organic and GM foods are opposed in relation to health. The purchase of organic foods and the potential willingness to purchase GM foods appear to be related to positive consequences for health and the environment.</p>

<p>The overall aim of this thesis was to investigate the knowledge of, attitudes toward, and experiences of the emergency contraceptive pill (ECP), sexual behaviour, and pornography consumption among high school students and young people. Data were obtained by questionnaires (studies I, II, and III), and by qualitative in-depth interviews (study IV). </p><p>A majority of 16-year old high-school students were aware that ECP existed, and knew where to obtain it. Attitudes toward using ECP were generally positive, but more girls than boys were hesitant as to whether ECP should be available without a prescription. Of those having experienced sexual intercourse, more than one fourth stated that they themselves or their partner had ever used ECP (I). </p><p>Almost half of the 16-year old high-school students surveyed (46%) had had sexual intercourse, a number similar in studies conducted 10 and 20 years earlier. Use of contraceptives at first intercourse had increased (to 76%) and use of alcohol had decreased (to 23%). More students in practical rather than theoretical programs smoked, had sexual intercourse at an earlier age, had more partners, and used contraceptives at first intercourse less often (II).</p><p>Three out of four 18-year old students had had sexual intercourse, of which almost three quarters reported contraceptive use at first intercourse. Anal intercourse was reported by one sixth, with infrequent condom use. Males who consumed more pornography were more likely than males who consumed less pornography to engage in a variety of sexual activities, as were males with an early age at first sexual intercourse (III).</p><p>The core category that emerged in the interviews was “Living with the current sexual norm”, pornography created sexual expectations and demands. The interviewees expressed contradictory feelings towards pornography and felt that sexuality was separated from intimacy. In order to deal with the current sexual norm, participants had different individual handling strategies, including liberal-, normalization-, distance-, feminist- and conservative strategies (IV).</p><p>Overall, the studies highlight several differences between genders and between students attending practical- and theoretical study programs in questions concerning ECP, sexual behaviour and pornography. These differences should be addressed while planning for counselling and sex education. We suggest that health- and school personnel discuss how sexuality is portrayed in pornographic material with young people.</p>

<p>The general aim of the project was to describe the situation of lesbians and gay men in a nursing environment by studying the attitudes of nursing staff and students, and the experiences of gay nursing staff in their work environment and of gay patients and partners in their encounters with nursing. The study for papers I and II had a descriptive, comparative design. Nurses, assistant nurses, and nursing students completed the Attitudes Toward Homosexuality Scale (ATHS), the Causes of Homosexuality Questionnaire (CHQ), and the Affect Adjective Checklist (AAC), along with the Nursing Behaviour Questionnaire (NBQ). In general, the participating nursing staff and students expressed positive attitudes, though some subjects reported very negative attitudes toward gay people. The participants also expressed a full spectrum of emotions from delight to anger. The studies for papers III and IV had a descriptive, explorative design. Here, the data collection was performed by semi-structured interviews. The informants were gay nursing staff, gay patients and partners of patients. The gay personnel reported fear and concern about heterosexuals' reactions when these informants 'come out', and were constantly assesing the risk being open about their sexual orientation among their workmates. Nearly all patients and partners described several situations where heteronormative assumptions were communicated by the nursing staff. Almost all informants offered recommendations for nursing staff to facilitate communication. According to the presented findings, probably only a small minority in Swedish nursing have negative attitudes toward lesbians and gay men. However, the informants told of heteronormative language and behaviour in nursing contexts that were percieved as insensitive, insulting and humaliating. Nursing staff need to learn how to communicate in a more natural way and to be aware of the norms they communicate through the language and behaviour they use.</p>

<p>This thesis deals with clinical pain intervention research from a behavioural medicine perspective. The general aim was to develop and evaluate an individually tailored treatment protocol focused on pain management in everyday life in people who experience persistent musculoskeletal pain. Another aim was to develop and incorporate an idiographic outcome measure for behavioural goal assessment in the formal evaluation of the clinical significance of treatment outcomes. </p><p>The studies were conducted in a primary health care setting demonstrating a contribution from physical therapists in the field of behavioural medicine. Two separate samples of patients with musculoskeletal pain with a duration exceeding one month, n = 197 (Study I, descriptive and correlational design), and n = 97/82 (Study III/IV, randomized group-study) were included. In addition, four women were recruited for a series of experimental single-case studies (Study II).</p><p>The treatment protocol that was individually tailored to each participant’s behavioural treatment goals and assumed determinants of pain-related disability was more effective in reducing pain-related disability, pain intensity, fear-avoidance, and in increasing pain control when compared to an intervention including physical exercises. The individually tailored treatment was generally more beneficial for resumption of everyday life activity, increasing satisfaction, fulfilling pre-treatment expectations, and in preparing individuals for self-management of pain. The Patient Goal Priority Questionnaire that was elaborated over the course of the project can be used to a) identify and assess behavioural treatment goals, b) elaborate individual functional behavioural analyses relevant for everyday life functioning, and c) determine the clinical significance of treatment outcomes – that is, whether interventions produce outcomes of relevance for each individual’s everyday life. The inclusion of idiographic outcome measures in clinical pain intervention research is necessary and improves the ecological validity of the evaluation of clinical significance. </p>

<p><b>Aims</b><i>: </i>The general aim of this thesis was to describe the life situation of women and men during their first year after myocardial infarction (MI) with regard to problems in daily life, how they coped with them, the social support available and the patients’ perceived quality of life (QoL). An additional aim was to examine differences over time and between women and men in coping, social support and QoL. <b>Methods</b><i>:</i> A consecutive series of 74 women and 97 men were selected 1 month after MI and followed over the first year. A qualitative approach was used to describe experiences of everyday life of 20 women and 19 men from the study group, from the onset of MI through the first months after the event (retrospectively). Focus was on managing problems and support from the network (<b>I</b>). Also experiences at 4 to 6 months and expectations of the future were explored (<b>II</b>). Coping, social support and QoL were compared between women and men both with a cross-sectional (at 1 month; 74 women and 97 men; <b>III</b>) as well as with a longitudinal design (at 1, 4 and 12 months; 60 women and 88 men; <b>IV</b>). <b>Findings</b><i>: </i>Physical symptoms and emotional distress were the most commonly described problems during the first months after MI. The patients managed the problems by negotiating with themselves, relying on their own capabilities, changing attitudes and behaviour and taking their own decisions. The network was generally supportive but also communication problems were described (<b>I</b>). Many of the patients had not established a stable health condition after 6 months. They managed the consequences of their disease, found a meaning in what had happened, and confidence in the future. The support from their social network encouraged them to move on (<b>II</b>). Women used more evasive and supportive coping than men 1 month after MI. More women perceived support being available from grandchildren and friends and more men from their partners. Compared with men, women rated lower health-related QoL and QoL (<b>III</b>). Coping and social support were stable over time, women used more evasive coping than men and health-related QoL increased for both women and men. (<b>IV</b>). <b>Conclusions</b><i>: </i>The first month after MI seems to be a vulnerable period especially for women. They had difficulties interpreting their heart symptoms, did not want to bother others with their worries and rated lower QoL than men. Patients redefined normal life, found hopes for the future and women did not demonstrate a poorer QoL profile than men over time. </p>

Body image concerns and dieting emerge at an early age among girls and become more pronounced with increasing age. Knowledge about risk factors for disturbed eating is crucial in order to develop theoretical models and to suggest new paths for preventive efforts. The aim of the present thesis was to investigate the development of disturbed eating and to evaluate a conceptual model of predictors of body dissatisfaction and disturbed eating in girls. The included studies are part of a seven-year longitudinal project employing an accelerated multi-cohort design, including several age groups (7, 9, 11, 13, 15 years at inclusion). Study I demonstrated a marked increase in the wish to be thinner and dieting attempts between the ages 10–14 and 9–13 years, respectively. In Study II, the Body Mass Index (BMI) predicted weight-related teasing and body dissatisfaction, and body dissatisfaction predicted restrained eating among Swedish girls in Grade 8 and Australian girls in Grades 7 and 8. Weight-related teasing partially mediated between BMI and body dissatisfaction in all three samples. Study III partially supported a conceptual model implying that BMI, weight-related teasing, and body dissatisfaction at 7–11 years predicted restrained eating among girls 12–14 years old. Study IV provided support for a conceptual model positing that BMI, body esteem, and to some extent weight-related teasing, predict body dissatisfaction and restrained eating during adolescence and young adulthood. In conclusion, there was partial support for a conceptual model including these risk factors for disturbed eating among girls.

The main aims were to investigate emotional reactions during in vitro fertilization (IVF) treatment among women and men, attitudes of IVF couples towards cryopreserved embryos and public attitudes towards various aspects of oocyte donation in Sweden. Assessments of emotional, physical and social reactions were made on a daily reaction scale and attitudes on the basis of study-specific questionnaires. Both women and men experienced the stages of oocyte retrieval and embryo transfer, as well as the luteal phase, as being particularly stressful and there was a similarity in the type of reaction pattern. Presence of supernumerary embryos for cryopreservation increased the women’s optimism, but did not seem to reduce their level of distress on the day of embryo transfer. One-third of IVF couples chose not to use their cryopreserved embryos. The main reasons among the respondents concerned family planning and too short a legally allowed time of embryo storage. There was strong support for oocyte donation among a subset of the Swedish population. Women were more positive than men towards oocyte donation and to disclosure of the origin to offspring. Factors that might increase the likelihood of women becoming oocyte donors were talking to women with experience of donating oocytes, proximity to the clinic, accessibility of counselling and having children of their own. These results indicate that different approaches to psychological care for women and men may not be warranted during IVF treatment. Contact should be maintained during the cryopreservation period in order to adress the couple’s questions and concerns about the embryos. To increase the donor pool, IVF clinics could provide information about donation to potential donors through the Internet and through experienced donors. The information to donors and recipient couples about different consequences of donation seems to be of great importance.

The aim was to study consumer attitudes to and perceptions of organic and genetically modified (GM) foods and factors influencing the purchase/non purchase of these two types of foods. Data were collected by two questionnaire surveys (random nation-wide samples of 2000 consumers, response rate 58% and 39% respectively) and one interview study (n=40). A majority of the consumers had positive attitudes towards purchasing organic foods but few reported purchasing organic foods regularly. The most common beliefs about organic foods were that they are more expensive and healthier. Choice of organic foods was related to the perceived consequences for human health and to environmentally friendly behaviour. Perceived positive health consequences appeared to be a stronger motive for purchasing organic foods than were environmental benefits. Attitudes towards genetic engineering (GE) appear to be dependent on the application area. Medical applications were generally more easily accepted than were food and agricultural applications. However, all medical applications were not equally accepted. Consumers had generally rather negative attitudes towards GM foods, which were perceived as not being healthy. GM of animals for food production was perceived more negative than GM of plants. Tangible benefits of GM foods, like being better for the environment or healthier, seemed to have a potential to increase willingness to buy. The results indicate that the attitudes to organic and GM foods differ: the attitude to organic foods is positive while the attitude to GM foods is more negative. Further, the perceptions of organic and GM foods are opposed in relation to health. The purchase of organic foods and the potential willingness to purchase GM foods appear to be related to positive consequences for health and the environment.