Among persons living with, or recovering from, chronic illness, poor physical health-related quality of life is a concern, as current and residual illness symptoms and treatment side effects may deleteriously impact physical functioning and fulfillment of daily roles. Numerous cognitive, emotional, and behavioral factors may impact perceptions of health status. Optimism, for example, is conceptualized as belief in the occurrence of positive future outcomes, and is beneficially associated with physical health-related quality of life. Further, optimism may contribute to enhanced perceptions of control and efficacy over disease symptoms and general health, manifesting as proactive health behaviors (e.g., wellness behaviors; treatment adherence) and, in turn, improved health-related quality of life. Across independent samples of persons living with remitted cancer (N = 164) or fibromyalgia (N = 508), we examined the serial mediating effects of health-related self-efficacy and proactive health behaviors in the relation between dispositional optimism and physical health-related quality of life. Participants completed online self-report measures, including the Life Orientation Test – Revised, Control Beliefs Inventory, Multidimensional Health Profile – Health Functioning Index, Wellness Behaviors Inventory, Medical Outcomes Study General Treatment Adherence Scale, and the Short-Form Health Survey. Significant serial mediation was observed across samples; higher dispositional optimism was associated with greater health-related self-efficacy and, in turn, greater engagement in proactive health behaviors and better physical health-related quality of life. For persons with remitted cancer, absence of other specific indirect effects indicates a need to consider the potential impact of unique aspects of disease, such as late effects of treatment or fear of recurrence, that may limit the beneficial effects of optimism exclusively through health-related self-efficacy or wellness behaviors. For persons with fibromyalgia, we found specific indirect effects through each mediating variable, lending support for the decoupling of cognitive and behavioral factors, consistent with pathophysiological and psychosomatic explanations of illness symptoms and approaches to treatment. Interventions designed to enhance optimism (e.g., cognitive-behavioral therapy; best possible self exercise) or self-efficacy (e.g., exercise skills training) may have positive downstream effects on health behavior engagement and perceptions of physical health-related quality of life among individuals living with remitted cancer or fibromyalgia.

L'Afrique de l'Ouest se caractérise par de forts taux de pauvreté et par une protection sociale et des marchés financiers formels défaillants. Dans un tel contexte, les familles remplissent des rôles importants qui façonnent la vie économique et sociale de leurs membres. Cependant, l'efficacité de cette institution fait débat, notamment lorsqu'elle est analysée du point de vue individuel. Ainsi, un nombre croissant d'études en économie du développement se penchent sur les coûts individuels induits par les fonctions familiales. Ma thèse de doctorat s'appuie sur cette littérature et y contribue en analysant la façon dont les décisions économiques individuelles sont prises au sein de la famille au Sénégal, et illustre des cas où la famille ne parvient pas à assurer le bien-être individuel de ses membres.Le premier chapitre s'attache à mesurer les coûts individuels de la redistribution informelle qui a lieu au sein des réseaux sociaux et entre ces derniers, et en particulier au sein de la famille élargie. En effet, en tant que mécanisme d'assurance, de fortes pressions redistributives modifient les choix économiques individuels. En s'appuyant sur des données expérimentales, nous estimons une taxe sociale d'environ 9% et nos résultats indiquent l'existence de fortes distorsions dans les choix d'allocation individuels. Par ailleurs nos résultats montrent que la pression à la redistribution est du fait, principalement, de famille élargie et non du ménage, des cercles amicaux ou du voisinage. Le deuxième chapitre examine comment l'environnement sanitaire contraint les investissements parentaux en termes de santé des enfants. Son objectif est de déterminer si les risques concurrents en mortalité réduisent les investissements des parents dans la santé de leurs enfants. Pour cela nous faisons, dans cet article, l'hypothèse qu'il existe des complémentarités entre les investissements en santé spécifiques à certaines maladies ; et testons celle-ci en nous appuyant sur une intervention récente visant à éradiquer le paludisme au Sénégal. Nos résultats soutiennent ce modèle de risques concurrents et impliquent que les comportements privés d'investissement en santé des parents et les politiques publiques de santé sont complémentaires. Enfin, le troisième chapitre explore comment une stratégie de gestion des risques ex-post, le mariage d'enfants, est lié aux chocs de mortalité au sein des familles. En particulier, j'examine si les décès paternels ont des conséquences néfastes en termes de transition sur le marché du mariage des jeunes orphelines. Mes résultats mettent en évidence la grande vulnérabilité de ce groupe d'enfants en termes de mariages précoces. / In the West Africa subregion, poverty is pervasive and social protection at the state-level, as well as formal financial markets poorly function. In such a context, families fulfill important roles, which shape the economic and social life of its members and are key drivers of economic development. How this private institution performs is, however, quite a debate and a growing body of the literature in development economics has focused on the question of the economic inefficiencies of the family institution. My PhD thesis builds upon this literature and contributes to it by shedding light on how individual economic decisions are taken within the family in Senegal, and in which cases the family fails to ensure individual welfare of its members.The first chapter focuses on the individual costs of the informal redistribution that take place within and between social networks, and in particular within the extended family. Using a lab-in the field experiment, we aim at identifying the hidden costs of social obligations for redistribution on individual resource allocation choices. Our results are threefold: (i) we estimate a social tax of about 9\%; (ii) we provide evidence on strong distortions in individual allocation choices; (iii) our results point at people fearing redistributive pressure from the extended family members, but not from within the household or from friends and neighbors. We expand on prior literature by both identifying the individual cost of informal redistribution and then relating it to postexperiment resource-allocation decisions, and by disentangling intra- and interhousehold redistributive pressure. The second chapter investigates how the health environment prevents parents from investing in child health. Its main objective is to investigate whether the health risks faced by children, and in particular their competing nature as mortality risks, depress parental investment in child health. We argue that there are complementarities between disease-specific investments and we test this hypothesis by exploiting recent interventions that made anti-malaria products suddenly affordable to most households in 2009 in Senegal. Our first contribution is to be the first to use data on private health expenditures to validate a model with complementarities between disease-specific investments. Our second contribution is to show that parental behavioral responses clearly complement anti-malaria campaigns, whereby they magnify their impact on all-cause mortality for children. Finally, the third chapter explores how a quite harmful ex-post risk management strategy, child marriage, relates to changes in family structures (mortality shocks). In particular, I investigate whether paternal death induces adverse marriage outcomes for young orphans. I also discuss the channel that could induce such effects. My results underpinned the high vulnerability of this group of children: when the father dies, the young girls are more likely to marry as child brides and to be child mothers than their non-orphan counterparts. Those girls have more frequently broken marital trajectories, in particular due to divorce. This paper builds upon the existing demographic literature and provides at least two contributions. First, it is, to my knowledge, the first to study jointly the timing of the father's death and other dimensions of well-being such as fertility, marital dissolution and consumption. Second, it discusses the extent to which selection on unobservables might bias the analysis, an issue that is discarded in most studies.

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Obesity is one of the fastest-growing health concerns impacting all racial, ethnic, gender, and socioeconomic groups in the United States of America. More than one-third of the U.S. adult population is classified as being obese (Obesity Society, 2014). Novak and Brownell (2012) identified that “obesity rates are consistently rising higher each year than in previous years” (p. 2345). Obesity has reached epidemic proportions in all races and genders within the US with African American women comprising a majority of those impacted by this chronic health condition. Obesity rates are well documented within the literature but what is lacking is the role spirituality may play in obese African American women and their health behaviors. The purpose of this qualitative, phenomenological study was to explore and describe the lived experiences of obese African American women with attention and focus on weight, health behaviors, and spirituality. This study consisted of participant recruitment from various social organizations, beauty salons, and faith-based organizations. A naturalistic setting with a descriptive approach was taken to interview the participants and all recorded interviews were transcribed and utilized for data analysis. The analysis method for this study was the qualitative content analysis process. Upon completion of data analysis, the identification of three themes, who I am, the weight I bear, and power struggles, assisted with recognizing the gaps and concerns that supported the researcher in painting a picture of the lived experiences of obese African American women. Recommendations included diversifying healthcare providers, implementing community-based interventions and research, and completing knowledge assessments before education. A future research opportunity includes utilizing beauticians as lay community members of a research study to provide education and initiate hard conversations regarding weight, health behaviors, and interventions to their clientele.

The purpose of this study was to examine what factors contribute to and result from body dissatisfaction using the theoretical framework of the Tripartite Model of Influence, which included family, peer, and media influence. Participants were recruited from SONA and student organizations and participated in an online survey (N =148). A MANCOVA indicated that Asian and White females did not differ in body dissatisfaction and other health outcomes. Thin-ideal internalization mediated the relationships between media influence, peer influence, and body dissatisfaction among Asian American females. Moderation analyses indicated that ethnic identity, Asian American identity, and acculturation did not moderate the relationship between the three tripartite influences and body dissatisfaction. Finally, a series of multiple regressions indicated that body dissatisfaction significantly predicted disordered eating, cosmetic surgery endorsement, and cigarette use among Asian Americans. Findings suggest that Asian American body dissatisfaction may be more related to Western influence than current literature shows.

O consumo de drogas resulta em consequências para o indivíduo tanto no âmbito social quanto no de saúde. Conhecimentos sobre comportamentos de saúde dos usuários de drogas tornam-se relevante para melhor compreender esse grupo. O estudo teve por objetivo avaliar as propriedades psicométricas do Questionário Comportamentos de Saúde em usuários de substâncias psicoativas. Trata-se de um estudo quantitativo do tipo descritivo. O estudo foi desenvolvido no Centro de Atenção Psicossocial - Álcool e Drogas de Ribeirão Preto, SP, Brasil. A amostra foi composta por 140 usuários do serviço. O instrumento utilizado foi composto por: Informações sociodemográficas, Escala de Severidade da Dependência de Drogas, Severity Alcohol Dependence Data e o Questionário Comportamentos de Saúde. Utilizou-se a análise descritiva dos dados e a validade de construto por meio da análise fatorial. Para a consistência interna do instrumento e de seus fatores utilizou-se o coeficiente alfa de Cronbach. A amostra caracteriza-se predominantemente por usuários do sexo masculino, adultos, solteiros, cor da pele branca, com baixo nível de escolaridade. A maior parte deles já esteve em tratamento e a busca por atendimento ocorreu voluntariamente ou por meio de seus familiares. A droga de maior consumo foi o crack. Os usuários, em sua maioria apresentaram níveis graves de severidade da dependência alcoólica e também da dependência de cocaína e crack. A maconha foi a droga de primeiro uso. A análise fatorial resultou em um modelo composto por oito fatores, sendo: comportamentos sexuais seguros; autocuidado com poluição ambiental; saúde; atividades físicas; autocuidado com alimentação; alimentação saudável; automedicação e consumo de bebidas alcoólicas, além da segurança motorizada. Os coeficientes de alfa de Cronbach mostraram-se satisfatórios com índices acima de 0,50 para os fatores, e 0,82 para o questionário Comportamentos de Saúde global. Os resultados confirmam a confiabilidade do Questionário Comportamentos de Saúde na versão brasileira para sua aplicabilidade em usuários de substâncias psicoativas. / Drugs consumption results in consequences for the individual both in the social as in health environment. Knowledge about health behaviors of drug users becomes important to better understand this group. The study aimed to evaluate the pschycometric propriety of the health behavior questionnaires in users of psychoactive substances. It is about a quantitative descriptive study. The study was conducted at the Center of Psychosocial Care - Alcohol and Drugs from Ribeirão Preto, SP, Brazil. The sample consisted of 140 service users. The instrument used was composed of: Sociodemographic Information, Severity of Dependence Scale, Severity Alcohol Dependence Data and the Health Behaviors Questionnaire. It has been used a descriptive analyses of the data and construct validity using factor analysis. For the internal consistency of the instrument and it\'s factors it was used the Cronbach Alpha Coefficient. The sample is characterized predominantly by male users, adults, singles, white color (Caucasian) with a low educational level. Most of them have already been on treatment and the search for it happened voluntarily or through their families. The most consumed drug was crack. The majority of users presented serious levels of severity of alcohol dependence and also the dependence of cocaine and crack. Cannabis was the first used drug. Factor analysis resulted in a model composed of eight factors, as follows: safe sexual behavior; self care with environmental pollution; health; physical activity; self care with food; healthy eating; self medication and alcohol consumption, as well as motorized safety. The Cronbach\'s alpha coefficients were satisfactory with indexes above 0.50 for the factors, and 0.82for the global Health Behaviors Questionnaire. The results confirm the reliability of the Health Behaviors Questionnaire in Brazilian version forits applicability in users of psychoactive substances.

Objectifs : Les objectifs principaux de cette thèse sont les suivants : 1) analyse de l’évolution du profil épidémiologique des patients coinfectés VIH-VHC initiant le traitement de l’hépatite C; 2) l’évaluation de l’impact des comportements de santé et des styles de vie sur l’évolution clinique de la maladie Résultats : J’ai pu mettre en évidence que le profil des patients coinfectés VIH-VHC initiant un traitement de l’hépatite C a changé en France avec l’évolution des traitements.Mes travaux ont permis de montrer que, chez les patients coinfectés VIH-VHC, une consommation élevée de café (3 tasses par jour et plus) diminue le risque de fibrose hépatique avancée. Cet effet bénéfique du café est également observé chez les patients coinfectés VIH-VHC avec une consommation élevée d’alcool. De plus, mes travaux ont mis en évidence une relation dose-dépendante entre la fréquence de consommation de cacao et la réduction du risque de fibrose hépatique avancée chez les patients coinfectés VIH-VHC. Par ailleurs, mes analyses n’ont pas mis en évidence un effet significatif de la consommation de café sur le risque de fibrose hépatique avancée chez les femmes coinfectées VIH-VHC. Enfin l’un des résultats marquant de la relation entre VHC et risque d’obésité qui est connue est que la guérison augmente davantage ce risque sur le long terme. Conclusion : Des interventions pour modifier certains styles de vie et comportements ont le potentiel de diminuer le risque de survenue ou d’aggravation de comorbidités, en particulier après la guérison VHC, un événement désormais atteignable pour tous les patients coinfectés. / Objectives: The main objectives of this thesis are: 1) analysis of the evolution of the epidemiological profile of co-infected HIV-HCV patients initiating the treatment of hepatitis C; 2) assessment of the impact of health behaviors and lifestyles on the clinical course of the diseaseResults: I was able to highlight that the profile of co-infected HIV-HCV patients initiating treatment for hepatitis C has changed in France with the evolution of treatments.My work has shown that, in HIV-HCV coinfected patients, high coffee consumption (3 cups per day or more) decreases the risk of advanced liver fibrosis. This beneficial effect of coffee is also observed in co-infected HIV-HCV patients with high alcohol consumption. In addition, my work has shown a dose-dependent relationship between the frequency of cocoa consumption and the reduced risk of advanced liver fibrosis in coinfected HIV-HCV patients. Furthermore, my analyzes did not reveal a significant effect of coffee consumption on the risk of advanced liver fibrosis in coinfected HIV-HCV women. Finally, one of the striking results of the relationship between HCV and known risk of obesity is that healing increases this risk in the long term.Conclusion: Interventions to modify certain lifestyles and behaviors have the potential to reduce the risk of developing or worsening comorbidities, particularly after HCV healing, an event now achievable for all co-infected patients.