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Objective: To examine the prevalence of adverse childhood experiences and associations with early alcohol use initiation and alcohol use patterns among high-risk urban youth in Kampala, Uganda. Methodology: Data from the Kampala Youth Survey (N=457) conducted in May through June 2011 in Kampala, Uganda was used for analysis. Indicators of adverse childhood experiences (ACEs) included: hunger, having parents, talking to parents, ever having lived on the street, parents hitting each other, parents hitting children and parental use of alcohol. These were dichotomized as either possessing the characteristic or not. Alcohol outcomes assessed were; age at alcohol initiation (age 13 was the cutoff point), frequent drinking and heavy drinking. Bivariate and multinomial logistic regression analyses were computed to determine statistical association between ACEs and alcohol use. Results: Findings in this study showed that parents hitting the youth, parental alcohol use, hunger, having ever lived on the street, and having been raped were significantly associated with the youth’s age of alcohol initiation by age 13, frequent drinking and heavy drinking in bivariate analyses. Results also showed gender differences for: parental alcohol use, parents hitting each other, being hungry, ever having lived on the street and having been raped. Girls reported higher values for most measures. Parental use of alcohol, having ever lived on the street and having been raped were particularly significant included in a multivariate model. Conclusion: This study demonstrates that adverse childhood experiences are strongly associated with early alcohol use initiation as well as frequent and heavy drinking.

Thesis advisor: Thanh V. Tran / It has been well documented that El Salvador faces tremendous challenges in terms of youth involvement in problem behavior. It has also been observed that spirituality and religiosity are important factors in the lives of many Salvadoran youth. While scholarship in developed nations among adolescents and young adults has consistently found spirituality and religiosity to be protective factors against delinquency, violence, and substance abuse, few studies have systematically examined the relationships between these concepts in the Salvadoran context. The principal purpose of this dissertation is to examine the direct and mediated relationships between spirituality, religiosity, and problem behavior among high-risk and gang-involved youth in San Salvador, El Salvador. Structured interviews were conducted with 301 high-risk youth and gang members (81.6% male) between the ages of 11 and 25 (M age = 18.5, SD = 3.3) living in marginalized Salvadoran neighborhoods. Drawing from the Social Development Model, it was hypothesized that higher levels of spirituality and religiosity, as mediated by antisocial bonding and antisocial beliefs, would be associated with lower levels of participation in delinquency, violence, and substance use and abuse. Structural equation modeling, as well as logistic and multiple regression analyses, were employed to examine the direct and mediated associations between these variables. The results of this dissertation indicate that spirituality and, to a lesser degree, religiosity are of relevance to the behavior of Salvadoran high-risk and gang-involved youth. In examining the relationship of spirituality and religiosity to social developmental factors of relevance to problem behaviors, it is evident that spirituality has implications across the board in terms of setting in motion dynamics that are associated with youth involvement in problem behaviors. While not associated with minor forms of problem behavior, religiosity was found to be protective against several severe manifestations of problem behavior. Findings from this dissertation have several implications for social work research and practice. These implications relate to the salience of spirituality and religiosity as protective factors in the Salvadoran context, the differential impact of spirituality and religiosity on problem behavior involvement, and the identification of factors that mediate the relationship between spirituality, religiosity, and problem behavior. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

The findings of this PhD provide a significant contribution to early intervention research. The ability to detect those at ultra-high risk for psychosis (UHR) has been made possible in recent years. It is well known that people with serious mental illness have poor physical health, yet prior to this PhD little was known about the physical health of UHR individuals. This PhD explores the physical health and lifestyle of the UHR group, and makes recommendations for the development of a physical health intervention. A range of methods have been used including quantitative and qualitative methods, systematic reviews and meta-analyses, and a clinical audit. Therefore, a multifaceted approach to investigate the physical health and lifestyle of UHR individuals has been taken. Papers 1-3 suggest UHR individuals are more likely to live an unhealthy lifestyle than their peers. This includes lower levels of physical activity, and higher levels of substance use (generally cannabis, tobacco and alcohol). Paper 4 contains a clinical audit showing physical health and lifestyle factors are not monitored routinely in early detection services, despite the UHR phase being an ideal opportunity to intervene. Living an unhealthy lifestyle can have a detrimental effect on physical and mental health. Papers 1-4 emphasise the need to intervene to promote a healthy lifestyle for the UHR group. In line with the Medical Research Guidelines for the development of complex interventions, a theoretical model is applied in Paper 5. The final paper presents a qualitative study with UHR individuals, their parents and clinicians to explore barriers and facilitators to living a healthy lifestyle and inform the development of a physical health intervention. A final evidence synthesis includes recommendations for future work and the clinical implications of this thesis. The findings of this PhD provide an important and timely contribution to early intervention research. Prior to this work, the physical health of UHR individuals had been largely under researched. For the first time, this PhD presents evidence to suggest individuals at ultra-high risk for psychosis experience cardiovascular risk, and there is an opportunity to intervene to promote physical health. Although not all UHR individuals will develop psychosis, many will continue to experience difficulties with their mental health. Given that this group are also more likely to live an unhealthy lifestyle, it is important to take a holistic approach to treating those at imminent risk for psychosis, considering both mental and physical health.

It is well documented that students from low socioeconomic backgrounds face a significant degree of deficiencies in college opportunity. Previous researchers have shown an estimated 1 in 5 student athletes given the opportunity to compete at the college level come from low socioeconomic backgrounds and encounter more adjustment issues than other students because of the psychological barriers they face. Using Pearlin's theory of psychological distress and Selye's GAS as the foundation, this study explored the extent to which the difference between the perceived time needed and actual time spent in both sports and academic commitment predict psychological distress in first-year high-risk student athletes. Data were collected from 132 first-year high-risk student athletes via an online survey. The survey included Health & Human Service SES questionnaire, Sport and Academic Commitment Questionnaire, and the Kessler Psychological Distress Scale. Multiple regression analysis revealed that sports commitment differences and academic differences were shown not to predict psychological distress. However, the results consistently showed the student athlete has time discrepancies with sport and academics and on average has moderate to severe psychological distress levels. The results are key to continuing the conversation of student athletes' psychological distress levels and establishing better interventions that specifically address the challenges of being a high-risk student athlete. If specific interventions target high-risk student athletes' mental health, they can be better served and more prepared to make the most of the college experience.