To prevent unwanted pregnancies and sexually transmitted infections, sexually active individuals should practice safer sex (World Health Organisation 2008). This is important across the lifespan (Nusbaum and Rosenfeld 2004). But older and heterosexual populations are typically overlooked in safer sex interventions (Bodley-Tickell et al. 2008; Bowleg 2011). The Theory of Planned Behaviour (TPB) has been used to predict behaviour, and develop safer sex interventions (Fishbein and Ajzen 2010). But a criticism of the TPB is that it fails to recognise the emotional aspect of safer sex (Norton et al., 2005). Extending the TPB to include affective attitudes has enhanced the effectiveness of safer sex interventions (Ferrer et al. 2011). Furthermore, safer sex typically involves a series of five condom-related behaviours; accessing, carrying, negotiating, using and disposing (Moore et al. 2006). Yet most interventions promote only one condom-related behaviour. In addition, the internet is now being used more as a platform for delivering interventions (Kraft and Yardley 2009). For safer sex interventions, online delivery may help reduce the embarrassment individuals often report when discussing sexual health (Qulliam 2011). Therefore, the aim of this thesis was to develop and evaluate an online safer sex intervention to promote performance of multiple condom-related behaviours in a broad population. A series of studies were conducted in order to develop the intervention. Study 1, an online elicitation study with 26 individuals, used an extended TPB framework to explore attitudinal, normative and control beliefs toward performing five condom-related behaviours. Findings suggested that individuals hold a range of attitudinal, normative and control beliefs toward performing these condom-related behaviours. Study 2, an online questionnaire study with 363 individuals identified beliefs and behaviours for intervention target. Findings suggested that three condom-related behaviours should be promoted; carrying, negotiating and using. In addition, analysis showed that affective and moral norm beliefs were most predictive of intention to perform these three condom-related behaviours, and should be the intervention targets. Study 3 was an online intervention with 439 individuals. Individuals were randomised to one of three conditions; control message, positively- or negatively-framed persuasive message. TPB and self-report behaviour measures were taken pre-, immediately post-intervention and three months later. Findings demonstrated that performance of condom-related behaviours did not significantly increase from participation in the intervention. However, intention to carry and use condoms increased over time regardless of intervention condition in all populations sampled. Overall, findings from this thesis support the development of safer sex interventions that promote multiple condom-related behaviours in a broad population. However, findings suggested that persuasive messages targeting psychological constructs of the TPB do not change intentions better than a control message in a broad population. From a public health perspective, these findings suggest that highlighting the benefits of performing condom-related behaviours may be sufficient to strengthen intentions. These strengthened intentions may be protective in the future if the situation arises for an individual which requires the performance of these behaviours. Recommendations for future safer sex research are considered.

Background: Pregnancy has been described as a period when women experience heightened behavioural surveillance. Young single women have commonly been described as a population who engage in high risk behaviours during pregnancy (e.g. smoking), yet they are also a population who often has access to fewer resources to make expected behaviour changes during pregnancy. Purpose: To explore the experiences of young single pregnant and parenting women regarding behavioural expectations and behaviour change during pregnancy. Research Questions: (1) What are the perceived behavioural expectations for young single women during pregnancy? (2) Who or what reinforces the perceived behavioural expectations? (3) To which behavioural expectations do young single women conform (or resist) and why? Methods: Nine single pregnant or parenting women between the ages of 15 and 24 were recruited from two urban community health settings between November 2011 and January 2012. Data was collected through individual semi-structured photo-elicitation interviews and analyzed using qualitative content analysis. Results: The main findings of the study include: (1) young single pregnant women are subject to a multitude of health and social behavioural expectations, (2) young single women experience internal and external behavioural surveillance during pregnancy, and (3) young single pregnant women experience these behavioural expectations as a tension between the potential for opportunity and oppression. Implications for Practice: By understanding young single pregnant women’s perceptions of how they are expected to behave, who and what reinforces such expectations, and how young women conform to or resist such expectations, the results of this project will inform the development of effective individual, community, and systemic level interventions and better inform interactions with young pregnant women.

Background: Pregnancy has been described as a period when women experience heightened behavioural surveillance. Young single women have commonly been described as a population who engage in high risk behaviours during pregnancy (e.g. smoking), yet they are also a population who often has access to fewer resources to make expected behaviour changes during pregnancy. Purpose: To explore the experiences of young single pregnant and parenting women regarding behavioural expectations and behaviour change during pregnancy. Research Questions: (1) What are the perceived behavioural expectations for young single women during pregnancy? (2) Who or what reinforces the perceived behavioural expectations? (3) To which behavioural expectations do young single women conform (or resist) and why? Methods: Nine single pregnant or parenting women between the ages of 15 and 24 were recruited from two urban community health settings between November 2011 and January 2012. Data was collected through individual semi-structured photo-elicitation interviews and analyzed using qualitative content analysis. Results: The main findings of the study include: (1) young single pregnant women are subject to a multitude of health and social behavioural expectations, (2) young single women experience internal and external behavioural surveillance during pregnancy, and (3) young single pregnant women experience these behavioural expectations as a tension between the potential for opportunity and oppression. Implications for Practice: By understanding young single pregnant women’s perceptions of how they are expected to behave, who and what reinforces such expectations, and how young women conform to or resist such expectations, the results of this project will inform the development of effective individual, community, and systemic level interventions and better inform interactions with young pregnant women.

The goal of this thesis was to reposition individual preparedness within a social environmental context. First, a theoretical model was developed to more accurately represent the social environmental considerations neglected in current preparedness research and policy. A series of three studies tested this model using a mixed-methods approach: First, subjective conceptualizations of preparedness were explored in a qualitative analysis (N = 12). Findings revealed that participants evaluated their readiness not in terms of prescribed activities, but perceptions about their current resourcefulness as well as past local hazards. Participants’ had positive social environments which also reinforced their perceived coping ability in future emergency events. Subsequent thesis studies investigated the role social environment further, using quantitative data. The second study explicitly tested whether perceptions of risk and coping could explain differences in preparedness based on demographic attributes linked to variations in social environment. Data from a survey examining Canadians perceptions regarding terrorism threats (N = 1503) revealed that greater anticipated response was significantly associated with increased age, as well as female gender, higher education levels, and higher income levels. Statistically significant differences in threat appraisals were also reported based on these demographic groupings. However, mediation analyses demonstrated that with the exception of gender, differences in anticipated response could not be explained via risk perceptions or perceived coping efficacy, suggesting that social environment’s role in preparedness is not related to the internal processes often targeted in current campaigns. The third study used a multilevel design to investigate the contextual role of neighbourhood social environment in anticipated emergency response. Results demonstrated that a more deprived social neighbourhood context was related to lowered anticipated emergency response. This relationship was maintained after controlling for significant individual-level factors such as previous experience and sociodemographics, highlighting the importance of neighbourhood social context in facilitating emergency preparedness. Taken together, these findings provide novel evidence that focusing preparedness strategies to primarily target internal processes is misguided, and that future research and policy must position preparedness efforts in the context of existing social environmental resources and barriers in order to build capacity for effective emergency response.

Background: Pregnancy has been described as a period when women experience heightened behavioural surveillance. Young single women have commonly been described as a population who engage in high risk behaviours during pregnancy (e.g. smoking), yet they are also a population who often has access to fewer resources to make expected behaviour changes during pregnancy. Purpose: To explore the experiences of young single pregnant and parenting women regarding behavioural expectations and behaviour change during pregnancy. Research Questions: (1) What are the perceived behavioural expectations for young single women during pregnancy? (2) Who or what reinforces the perceived behavioural expectations? (3) To which behavioural expectations do young single women conform (or resist) and why? Methods: Nine single pregnant or parenting women between the ages of 15 and 24 were recruited from two urban community health settings between November 2011 and January 2012. Data was collected through individual semi-structured photo-elicitation interviews and analyzed using qualitative content analysis. Results: The main findings of the study include: (1) young single pregnant women are subject to a multitude of health and social behavioural expectations, (2) young single women experience internal and external behavioural surveillance during pregnancy, and (3) young single pregnant women experience these behavioural expectations as a tension between the potential for opportunity and oppression. Implications for Practice: By understanding young single pregnant women’s perceptions of how they are expected to behave, who and what reinforces such expectations, and how young women conform to or resist such expectations, the results of this project will inform the development of effective individual, community, and systemic level interventions and better inform interactions with young pregnant women.

Background: A range of factors contribute to men with cancer having worse mortality and morbidity rates than women. The research specifically focused on psychosocial issues and health behaviours in men with cancer, and factors affecting help seeking behaviour. Methods: A mixed-methods study recruited adult men with cancer in the East of Scotland. The quantitative cross-sectional study explored psychosocial issues, health behaviours, and desire for support. Data from the Scottish Longitudinal Study were accessed to check sample representativeness. The qualitative study built on the preliminary findings of the quantitative study and used semi-structured interviews to explore factors affecting men's access to support. Inductive thematic analysis was undertaken. Results: 127 men with cancer completed the questionnaire. Being separated or divorced, younger and living in a high deprivation area was associated with poor psychosocial outcomes and some lifestyle behaviours. Social support was also influential. Twenty participants were interviewed. Appraisal of, and coping with, cancer in addition to biopsychosocial antecedents, the role of masculinity, and service contexts impacted on help seeking. The findings support a modified model of the transactional model of stress and coping relevant to men with cancer, which is new and original since it specifically incorporates the role of masculinity, highlights feedback from coping to appraisal, and recognises important service context factors that impact men's service access choices. Discussion: Legitimisation of help seeking and the use of emotion-focused coping styles were needed by some men, particularly where ideas about masculinity played a strong role in men's appraisal of, and coping with cancer. Implications for practice and policy relate to the survivorship agenda given the ongoing support men with cancer may need. Related to this, there is a need to carefully tailor and advertise services to men, and for health professionals to help legitimise the use of certain coping strategies and services.

Objectives: The aim of this thesis is to study the association between social relations and health in different social spheres, and to examine possible interaction effects. Material and Methods: In Paper I, the link between measures of the psychosocial neighbourhood environment, the psychosocial working environment, and psychosomatic health is analyzed by using a subset of data from the survey Life and Health 2000. In Paper II, the association between adolescent social relationships in school and psychosomatic health was analyzed by using the survey Young in Värmland. In Paper III, the association between parental monitoring, peer activity frequency, and adolescent alcohol use was studied by using Young in Värmland as the data source. In Paper IV, the links between adolescent perceptions of the psychosocial school climate, activities with parents, and psychosomatic health, were analysed by using Young in Värmland as the data source. Results: The results from Paper I indicate that social relations in the neighbourhood environment, as well as the working environment, are independently related to psychosomatic health. The independent contributions imply that efforts to improve health can be successfully directed to the psychosocial neighbourhood environment, as well as to the psychosocial working environment. The results from Paper II show that the social relations adolescents have in school may differ between subgroups of adolescents. The health effects of teacher contacts were stronger for the theoretically oriented students compared to the non-theoretically oriented students, suggesting that adolescents should be considered a heterogeneous group rather than a homogeneous one with respect to their social relations in school. Efforts to improve equity in health should consider these differences in order to be successful. In Paper III the results imply that even though both parents and the peer group are important in order to understand the alcohol use patterns of adolescents, the importance of parents should not be underestimated. Parental monitoring had a protective effect on adolescent alcohol use, regardless of the frequency of peer activities. In Paper IV, both the psychosocial school climate, and the frequency of activities with parents were related to psychosomatic health. The positive health effects of the psychosocial school climate were, furthermore, reinforced as a function of the frequency of activities with parents. This suggests that efforts to improve health should be directed to the school environment as well as to the family environment in order to be successful. Conclusions: The importance and meaning of social relations differ between different social arenas as well as between sub-groups of individuals.

Background: Pregnancy has been described as a period when women experience heightened behavioural surveillance. Young single women have commonly been described as a population who engage in high risk behaviours during pregnancy (e.g. smoking), yet they are also a population who often has access to fewer resources to make expected behaviour changes during pregnancy. Purpose: To explore the experiences of young single pregnant and parenting women regarding behavioural expectations and behaviour change during pregnancy. Research Questions: (1) What are the perceived behavioural expectations for young single women during pregnancy? (2) Who or what reinforces the perceived behavioural expectations? (3) To which behavioural expectations do young single women conform (or resist) and why? Methods: Nine single pregnant or parenting women between the ages of 15 and 24 were recruited from two urban community health settings between November 2011 and January 2012. Data was collected through individual semi-structured photo-elicitation interviews and analyzed using qualitative content analysis. Results: The main findings of the study include: (1) young single pregnant women are subject to a multitude of health and social behavioural expectations, (2) young single women experience internal and external behavioural surveillance during pregnancy, and (3) young single pregnant women experience these behavioural expectations as a tension between the potential for opportunity and oppression. Implications for Practice: By understanding young single pregnant women’s perceptions of how they are expected to behave, who and what reinforces such expectations, and how young women conform to or resist such expectations, the results of this project will inform the development of effective individual, community, and systemic level interventions and better inform interactions with young pregnant women.

The goal of this thesis was to reposition individual preparedness within a social environmental context. First, a theoretical model was developed to more accurately represent the social environmental considerations neglected in current preparedness research and policy. A series of three studies tested this model using a mixed-methods approach: First, subjective conceptualizations of preparedness were explored in a qualitative analysis (N = 12). Findings revealed that participants evaluated their readiness not in terms of prescribed activities, but perceptions about their current resourcefulness as well as past local hazards. Participants’ had positive social environments which also reinforced their perceived coping ability in future emergency events. Subsequent thesis studies investigated the role social environment further, using quantitative data. The second study explicitly tested whether perceptions of risk and coping could explain differences in preparedness based on demographic attributes linked to variations in social environment. Data from a survey examining Canadians perceptions regarding terrorism threats (N = 1503) revealed that greater anticipated response was significantly associated with increased age, as well as female gender, higher education levels, and higher income levels. Statistically significant differences in threat appraisals were also reported based on these demographic groupings. However, mediation analyses demonstrated that with the exception of gender, differences in anticipated response could not be explained via risk perceptions or perceived coping efficacy, suggesting that social environment’s role in preparedness is not related to the internal processes often targeted in current campaigns. The third study used a multilevel design to investigate the contextual role of neighbourhood social environment in anticipated emergency response. Results demonstrated that a more deprived social neighbourhood context was related to lowered anticipated emergency response. This relationship was maintained after controlling for significant individual-level factors such as previous experience and sociodemographics, highlighting the importance of neighbourhood social context in facilitating emergency preparedness. Taken together, these findings provide novel evidence that focusing preparedness strategies to primarily target internal processes is misguided, and that future research and policy must position preparedness efforts in the context of existing social environmental resources and barriers in order to build capacity for effective emergency response.

Despite a clear impact on the Canadian economy, little is known about the subsequent health impacts of the 2008 Global Financial Crisis (GFC). This thesis aims to fill this gap in knowledge by conducting a secondary analysis of Canadian Community Health Survey (CCHS) data to assess the impact of the GFC on health in Canada – a country that has not yet been thoroughly studied from this angle. Based on when the respondent completed the survey, exposure to the GFC was categorized into four phases: pre-crisis, crisis, stimulus, and austerity. Outcomes investigated include measures of mental health, physical health, and health-related behaviours. Statistically significant associations were observed between several health outcomes and the austerity period as compared to the pre-crisis period. Austerity has been linked to worsening health in other studies and represents an example of how the policy response can have greater detrimental impact on health than the financial crisis itself.