Youth health promotion activities should reflect the concerns and interests of the youth being served. A quantitative exploration of youth concern related to health risk behaviour (HRB) engagement was conducted among youth in Winnipeg, MB. This study involved descriptive and inferential analysis of HRB engagement and attitude data from a cross-sectional survey of 250 youth (14–24 years). Chi-squared tests, Fisher’s exact tests, logistic regression and cluster analyses were employed to explore relationships between sociodemographic traits, HRB engagement, and HRB-specific concern. Findings demonstrated that A) youth in Winnipeg, regardless of their sociodemographic characteristics, do express concern about HRBs that they engage in; B) the likelihood of concern varies depending on what HRB one is examining; and C) while youth display similar trends in their concern about HRBs, different groups of youth, characterized by different patterns of engagement and sociodemographic traits vary in their likelihood of being concerned about particular HRBs. / October 2016

Magister Scientiae (Physiotherapy) - MSc(Physio) / Background: Several chronic health conditions that previously manifested in adulthood are now increasingly being identified in young people. Various health risk behaviours established during youth results in chronic diseases of lifestyle as well as behaviours leading to injury, trauma and substance abuse. Current evidence proposes that a school health programme could become one of the most efficient means available to improve the health promotion and education of people as it reaches large numbers of young people in a replicable and sustainable way. Aim: The purpose of the study was to determine health risk behaviours and investigate the understanding and perception of health promotion among adolescent learners attending secondary schools in the Theewaterskloof region. Objectives: 1) To determine the health risk behaviours that secondary school learners in the Theewaterskloof region engage in; 2) to explore and describe the understanding and perceptions of health promotion among secondary school learners in the Theewaterskloof region and 3) To explore and describe the understanding and perceptions of health promotion among life orientation educators in the Theewaterskloof region Methodology: The study used a sequential explanatory mixed methods approach. Quantitative data was collected by means of the Youth Risk Behaviour Surveillance Survey and qualitative data through focus group discussions. Ethics was obtained from the Research Ethics Committee of the University of the Western Cape (13/2/3) and permission was obtained from the Western Cape Education Department, school governing bodies, learners, parents and guardians of identified schools regarding the research. Results: Data from 276 participants in Grades 8-11 from secondary schools in a rural district within the Western Cape, South Africa was analysed. The most significant health risk behaviours engaged in by the participants was substance abuse, sexual activity and physical inactivity. In focus group discussions held with both the learners and educators, the most prevalent health risk behaviours were; substance use and sexual activity. Although the health risk behaviours were such a pertinent issue for both the learners and educators, current health promotion strategies were inadequate. In terms of health promotion strategies the learners highlighted the need for adequate support and guidance from both their parents and educators. They also made reference to themselves, their parents and educators playing a role in the improvement of their health status. The educators felt that parents needed to play their role in health promotion by disciplining their children and by being better role models. They were also of the opinion that the current socio-economic climate of the Theewaterskloof region predisposes learners to specific health risk behaviours. According to them, an effective health promotion strategy would include parents, educators and learners working together to promote better health behaviours. Conclusion: Health risk behaviours are rife in rural communities. Even though the adolescents feel that the management of the trajectory of their health is their responsibility, they see a need for collaboration between educators, parents and themselves in developing health promotion. / National Research Foundation (NRF)

Master of Public Health - MPH / The HIV incidence among young people aged 15 to 24 years remains a global health concern. Sub-Saharan Africa (SSA) is the home of approximately four million young people living with HIV, and young people in the region account for about 70% of new infections annually. Over 85% of HIV infections among young people in SSA is sexually transmitted. Therefore, the aim of the study was to understand young people’s experiences and perspectives on HIV prevention in four communities in Zambia.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Background: Health risk behaviours can directly affect health outcomes. Healthy behaviours such as exercising and eating sensibly can lower the risk of conditions like heart disease and diabetes, while unhealthy behaviours such as smoking and excessive drinking raise the risk of conditions like lung cancer and liver disease. In a study using two large national data sets, the Youth Risk Behaviour Survey (YRBS) and Add Health, the Center on Addiction and Substance Abuse (CASA) found that teenagers who consume alcohol or take illicit drugs are more likely to engage in sex, to do so at a younger age, and to have several partners. For adolescents who are 14 years old and younger, consuming alcohol or using drugs doubles and quadruples, respectively, the likelihood that sexual intercourse has ever been experienced compared to adolescents who have never used these substances. A study reported that early onset of alcohol, tobacco and other drugs, school problems, delinquency, and physical aggression are significantly associated with early onset of sexual behaviour. Alcohol use in adolescence has also been found to be related to more frequent sexual activity and less frequent use of condoms. Aim: To investigate and explore the effect of a youth development programme (YDP) of combatting health risk behaviours amongst 250 Grade 8 learners in a selected high school in the Paarl area.

Philosophiae Doctor - PhD / Background: There is compelling body of evidence that coronary heart disease (CHD) risk factors are present in people of all ages. The extent to which the problem exists in university students in South Africa (SA) has not been confirmed in the literature. Furthermore, the effects of physical activity, physical fitness, diet and health behaviours on CHD risk factors has not been studied extensively in SA and needs further investigation. Aim: The aim of the study was to assess the impact of multiple behaviour health intervention strategies on CHD risk, health-related physical fitness(HRPF) and healthrisk behaviours (HRB) in first year students at the University of the Western Cape (UWC). It was hypothesized that exposure to various health behavioural interventions would reduce CHD risk factors in subjects at moderate risk, and improve health-related physical fitness, as well as health-risk behaviours.Methods and Study Design: An experimental study design was used wherein subjects at moderate risk for CHD were identified and exposed to multiple health behavioural interventions for 16 weeks in order to determine the impact of the various interventions on CHD risk, health-related physical fitness and health-risk behaviours. Population and Sample: The target population consisted of first year students at UWC aged 18 – 44 years who were screened and a sample of 173 subjects were identified as being at moderate risk for CHD. Next, the subjects were randomly assigned to a control and four treatment groups, namely, health information, diet, exercise, and a multiple group that included all three treatments. The intervention, based upon Prochaska‟s Transtheoretical Model of behaviour change, continued for a period of 16 weeks and, thereafter, the subjects were retested. Data Collection Process: Subject information was obtained using self-reported questionnaires, namely, the physical activity readiness questionnaire (PAR-Q), the stages of readiness to change questionnaire (SRCQ), the international physical activity questionnaire (IPAQ), and the healthy lifestyle questionnaire (HLQ), together with physical and hematological (blood) measurements. The measurements taken before and after the intervention programme were the following:• Coronary heart disease risk factors, namely: family history, cigarette smoking, hypertension, obesity, dyslipidemia, impaired fasting glucose and a sedentary lifestyle; • Health-related physical fitness, namely: body composition, cardiovascular fitness, muscular strength, muscular endurance, and flexibility; and • Health-risk behaviours, namely: physical activity, nutrition, managing stress, avoiding destructive habits, practising safe sex, adopting safety habits, knowing firstaid, personal health habits, using medical advice, being an informed consumer, protecting the environment and mental well-being. Types of interventions: A control group was used in which subjects did not receive any treatment. The health behavioural interventions were arranged into four groups of subjects that received either the health information, diet, exercise or a combination of all three individual treatments. Statistical analyses of data: In the analyses of the data, the procedure followed was that where the outcome variable was approximately normally distributed, the groups were compared using a two-sample t-test. For outcomes with a highly non-normal distribution or ordinal level data, the nonparametric Wilcoxon Rank Sum test was used for group comparisons. To account for baseline differences, repeated measures analysis of variance was used. In the case where nonparametric methods were appropriate, analysis was done using Cochran-Mantel-Haenszel (CMH) methodology stratifying on the baseline values. For the case of nominal level outcomes, groups were compared by Chi-square tests for homogeneity of proportions. When baseline values needed to be incorporated into the analysis, this was done using CMH methodology. Main Outcome Measures: The main outcome measures tested in the study related to the three areas of investigation, namely: • Modifiable CHD risk factors: systolic and diastolic blood pressure, cigarette smoking, total cholesterol (TC) concentration, high-density lipoprotein (HDL) cholesterol concentration, low-density lipoprotein (LDL) cholesterol concentration, triglycerides, fasting glucose, body mass index, waist circumference, waist-hip ratio and physical inactivity; • Health-related physical fitness: body mass, percent body fat, absolute body fat, percent lean body mass, absolute lean body mass, the multi-stage shuttle run, handgrip strength, repeated sit-ups in a minute, and the sit-and-reach test; and • Health-risk behaviours: physical activity, nutrition, managing stress, avoiding destructive habits, practising safe sex, adopting safety habits, knowing first aid, personal health habits, using medical advice, being an informed consumer, protecting the environment and mental well-being. Results: The results showed significant decreases for body mass, waist and hip circumferences, resting heart rate, systolic blood pressure, cigarette smoking and a sedentary lifestyle (p < .05) primarily in the multiple group. No significant differences were recorded for blood biochemistry, however, favourable trends were observed in the lipoprotein ratios. For health-related physical fitness, only the multiple group showed significant (p < .005) improvements in predicted maximal oxygen consumption ( O2max), body composition, muscular strength and muscular endurance. The exercise group also recorded significant differences in muscular endurance. In all groups, including the controls, no significant differences were found for stature, waist-hip ratio, and flexibility at pre- and post-test. Overall, the participants reflected positive health behaviours, especially for managing stress, avoiding destructive habits, practising safe sex, adopting safety habits, personal health habits and mental well-being at pre- and post-test. The intervention programme had a corrective influence on providing the participants with a more realistic perception of their level of physical activity and nutritional habits. The participants scored poorly on being informed consumers and for recycling waste both at pre- and post-test. A substantial net reduction in CHD risk factors as well as in cumulative risk was achieved with treatment that impacted positively on the re-stratification of participants at moderate risk. In terms of treatment efficacy, the dietary intervention appeared to be the least effective (10.91%), with health information and exercise sharing similar levels of efficacy (32.81% and 33.93%, respectively) and, the combined treatment in the multiple group stood out as the most effective treatment (50.00%), and supported the hypothesis of the study. Conclusions: The net and cumulative decline in CHD risk factors was substantial with treatment and was directly related to the number of treatments administered. The evidence suggests that such multiple health behaviour interventions when implemented through a university-based setting have substantial benefits on reducing CHD risk and may be of considerable public health benefit. Key messages • Despite being a relatively educated population, a substantial number of first year university students are at considerable heart disease risk. • Physical inactivity constitutes one of the main CHD risk factors amongst first year students and, together with smoking, place many of them at moderate CHD risk. • The effectiveness of health behavioural strategies designed to modify lifestyle and prevent coronary heart disease is supported by this study.

Thesis (M.A. (Clinical Psychology) -- University of Limpopo, 2017 / Substantial literature connects religiousness to physical health; however, few studies have explored the influence of religiousness on risk-taking factors among Black first-entering university students. The purpose of this study was to investigate the influence of religiousness on health risk behaviours among a sample of university students (N = 333) from a predominantly Black university in the Limpopo Province, South Africa. The risk behaviours of interest were alcohol consumption, risky sexual behaviours, cigarette smoking, drug use, rates of engagement in physical activity, and patterns of consuming healthy foods daily. The study used a cross-sectional design. Results indicated that intrinsic religiosity was negatively associated with alcohol consumption; risky sexual behaviours, cigarette smoking and drug use, and the effects of gender were present in both relationships. Intrinsic religiosity’s association with alcohol consumption and risky sexual behaviours had no gender effect. Nevertheless, there was no direct relationship between diet and physical engagement, although intrinsic religiosity influenced the students’ engagement in physical activity only in the context of gender. It is recommended that a three-way design may be more effective in uncovering some of the associations between intrinsic religiosity and risk behaviours such as eating a healthy diet and engaging in physical activity.

College students and emerging adults have been found to be at risk for smoking cigarettes, drinking to excess, using illicit drugs, driving dangerously, and engaging in risky sexual and delinquent behaviour. Psychosocial correlates (Sensation Seeking, peer behaviour, parent behaviour, and peer and parent anti-substance use messages) from three domains of influence (personality, parent, and peer) were examined together to provide a greater context for the occurrence of such health-risk behaviours. The strongest predictor(s) of each behaviour were identified to better inform intervention practices. Three groups were compared— 1) those who never tried substances, 2) those who tried substances in the past, and 3) those who continue to use substances at present, in a population of emerging adults. Self-report data was gathered from 203 Collèges d'Enseignement Général Et Professionnel (CEGEP) students in the Montreal region. Measures included: Reckless Behaviour Questionnaire, Reckless Driving Measure, Health Behaviour Survey, Sensation Seeking Scale—Form V, and the Marlowe-Crowne Social Desirability Scale. Results revealed that peer behaviour was the most significant predictor of substance use in emerging adults, whereas parent behaviour was only a significant predictor of reckless driving. Sensation Seeking, specifically Disinhibition, was found to predict more global reckless behaviours, including illegal activities, such as stealing or using marijuana (p < .01). Neither peer nor parent anti-substance messages were significantly related to any of the health-risk behaviours measured in this study. It would appear that health-risk behaviours tend to be related to the same underlying factors but to varying degrees. Intervention implications are discussed.

College students and emerging adults have been found to be at risk for smoking cigarettes, drinking to excess, using illicit drugs, driving dangerously, and engaging in risky sexual and delinquent behaviour. Psychosocial correlates (Sensation Seeking, peer behaviour, parent behaviour, and peer and parent anti-substance use messages) from three domains of influence (personality, parent, and peer) were examined together to provide a greater context for the occurrence of such health-risk behaviours. The strongest predictor(s) of each behaviour were identified to better inform intervention practices. Three groups were compared— 1) those who never tried substances, 2) those who tried substances in the past, and 3) those who continue to use substances at present, in a population of emerging adults. Self-report data was gathered from 203 Collèges d'Enseignement Général Et Professionnel (CEGEP) students in the Montreal region. Measures included: Reckless Behaviour Questionnaire, Reckless Driving Measure, Health Behaviour Survey, Sensation Seeking Scale—Form V, and the Marlowe-Crowne Social Desirability Scale. Results revealed that peer behaviour was the most significant predictor of substance use in emerging adults, whereas parent behaviour was only a significant predictor of reckless driving. Sensation Seeking, specifically Disinhibition, was found to predict more global reckless behaviours, including illegal activities, such as stealing or using marijuana (p < .01). Neither peer nor parent anti-substance messages were significantly related to any of the health-risk behaviours measured in this study. It would appear that health-risk behaviours tend to be related to the same underlying factors but to varying degrees. Intervention implications are discussed.

College students and emerging adults have been found to be at risk for smoking cigarettes, drinking to excess, using illicit drugs, driving dangerously, and engaging in risky sexual and delinquent behaviour. Psychosocial correlates (Sensation Seeking, peer behaviour, parent behaviour, and peer and parent anti-substance use messages) from three domains of influence (personality, parent, and peer) were examined together to provide a greater context for the occurrence of such health-risk behaviours. The strongest predictor(s) of each behaviour were identified to better inform intervention practices. Three groups were compared— 1) those who never tried substances, 2) those who tried substances in the past, and 3) those who continue to use substances at present, in a population of emerging adults. Self-report data was gathered from 203 Collèges d'Enseignement Général Et Professionnel (CEGEP) students in the Montreal region. Measures included: Reckless Behaviour Questionnaire, Reckless Driving Measure, Health Behaviour Survey, Sensation Seeking Scale—Form V, and the Marlowe-Crowne Social Desirability Scale. Results revealed that peer behaviour was the most significant predictor of substance use in emerging adults, whereas parent behaviour was only a significant predictor of reckless driving. Sensation Seeking, specifically Disinhibition, was found to predict more global reckless behaviours, including illegal activities, such as stealing or using marijuana (p < .01). Neither peer nor parent anti-substance messages were significantly related to any of the health-risk behaviours measured in this study. It would appear that health-risk behaviours tend to be related to the same underlying factors but to varying degrees. Intervention implications are discussed.

Across Australia and other developed nations, morbidity and mortality follows a socioeconomic gradient whereby the lowest socioeconomic groups experience the poorest health. The dietary practices of low socioeconomic groups, which are comparatively less consistent with dietary recommendations, have been thought to contribute to the excess morbidity and mortality observed among low socioeconomic groups, although this phenomenon is not well understood. Using a socioecological framework, this thesis examines whether the local food retail environment and confidence to cook contribute to socioeconomic differences in fruit and vegetable purchasing. To achieve this, four quantitative analyses of data from two main sources were conducted. The food retail environment was examined via secondary analysis of the Brisbane Food Study (BFS) and confidence to cook was examined in a cross-sectional study designed and carried out by the author. The first three manuscripts were based on findings from the BFS. Briefly, the BFS was a multilevel cross-sectional study, designed to examine determinants of inequalities, that was conducted in Brisbane in the year 2000. A stratified random sample was taken of 50 small areas (census collection districts, CCDs) and 1003 residents who usually shopped for their households were interviewed face-to-face using a schedule that included a measure of fruit and vegetable purchasing and three socioeconomic markers: education, occupation and gross household income. The purchasing measure was based on how often (never, rarely, sometimes nearly always or always) participants bought common fruits and vegetables for their households in fresh or frozen form, when in season. Food shops within a 2.5 km radius of the CCDs in which survey respondents lived were identified and audited to determine their location, type, their opening hours, and their price and availability of a list of food items. The first publication demonstrated there was minimal to no difference in the availability of supermarkets, greengrocers and convenience stores between areas that were most and least disadvantaged, in terms of the number of shops, distance to the nearest shop, or opening hours. Similarly, the second publication showed the most disadvantaged and least disadvantaged areas had no large or significant difference in the price and availability of fruits and vegetables within supermarkets, greengrocers and convenience stores, but small differences were consistently apparent, such that on average, low socioeconomic areas had lower prices but also lesser availability than more advantaged areas. The third submitted manuscript presents results of multilevel logistic regression analyses of the BFS data. While there were some associations between environmental characteristics and fruit and vegetable purchasing, environmental characteristics did not mediate socioeconomic differences in purchasing the fruit and vegetable items since there was no substantial socioeconomic patterning of the price or availability of fruits and vegetables. The fourth submitted manuscript was based on the cross-sectional study of cooking skills. A stratified random sample of six CCDs in Brisbane was taken and 990 household members ‘mostly responsible’ for preparing food were invited to participate. A final response rate of 43% was achieved. Data were collected via a self-completed questionnaire, which covered household demographics, vegetable purchasing (using the same measure employed in the BFS for continuity), confidence to prepare these same vegetables, and confidence to cook vegetables using ten cooking techniques. Respondents were asked to indicate how confident they felt (ranging from not at all- to very- confident) to prepare each vegetable, and to use each technique. This fourth study found respondents with low education and low household income had significantly lower confidence to cook than their higher socioeconomic counterparts, and lower confidence to cook was in turn associated with less household vegetable purchasing. Collectively, the four manuscripts comprising this thesis provide an understanding of the contribution of food accessibility, affordability and cooking skills to socioeconomic differences in fruit and vegetable purchasing, within a socioecological framework. The evidence provided by this thesis is consistent with a contributory role of confidence to cook in socioeconomic differences in fruit and vegetable purchasing, but is not definitive. Additional research is necessary before promoting cooking skills to improve population nutrition or reduce nutritional inequalities. An area potentially useful to examine would be how cooking skills integrate with psychosocial correlates of food and nutrition, and socioeconomic position. For example, whether improvement of cooking skills can generate interest and knowledge, and improve dietary behaviours, and whether a lack of interest in food and nutrition contributes to a lack of both fruit and vegetable consumption and cooking skills. This thesis has demonstrated that an inequitably distributed food retail environment probably does not contribute to socioeconomic variation in fruit and vegetable purchasing, at least in contemporary Brisbane, Australia. Findings are unlikely to apply to other time periods, rural and regional settings, and perhaps other Australian cities as residential and retail development, and the supply and pricing of produce vary substantially across these dimensions. Overall, the main implication for public health is that interventions targeting the food supply in terms of ensuring greater provision of shops, or altering the available food and prices in shops may not necessarily carry a great benefit, at least in major cities similar to Brisbane. Future studies of equitable food access may need to look beyond mapping the distribution of shops and prices, perhaps to more personal and subjective facets of accessibility and affordability that incorporate individuals’ perceptions and ability to access and pay for foods.