Diabetes mellitus is a serious problem that affects 15.7 million individuals in the United States. The complications of this disease are catastrophic and can lead to blindness, kidney disease, lower limb amputations, nerve damage, increased risk of heart disease, stroke, and death. Among Native Americans, diabetes has reached epidemic proportions. A variety of psychosocial variables has demonstrated relationships to diabetic outcome. Past research has shown a relationship between psychological variables and glucose control. The current study of Native Americans shows a similar pattern using the psychosocial instruments to measure the constructs of depression, anger, hostility, social support, and perceived stress. Participants for this study were part of the Strong Heart Study and were 512 Native Americans from tribes in South Dakota and Oklahoma between the ages of 46 - 77. This study shows a relationship between the variables of anger, depression and hostility, and glyciemic control. A relationship between social support, perceived stress, and depression was found to be related to reported quality of life in participants who were either diabetic or had impaired glucose tolerance.

The cross-sectional Biomarkers Study was undertaken in Canberra, Australia (2000-2002) to examine the role of psychosocial factors in the socioeconomic health gradient, via physiological changes consequent upon activation of the neuroendocrine stress response.¶ The study population was derived from healthy 40-44 year old men and women already participating in a longitudinal cohort study. Using data from the cohort study, four groups with similar occupational status were formed. The study sample was randomly selected within these groups, thus representing the socioeconomic spectrum.¶ A pilot study involved 60 participants with blood and saliva samples measured on two occasions. A further 302 people had blood and saliva samples taken on one occasion. Socioeconomic status was measured by occupational code and status, personal and household income, education and perceived position in the community and in Australia. Psychosocial and behavioural factors, including job strain, job security, coping style, anxiety, depression, optimism, self-esteem, sense of belonging and trust, social support, smoking, exercise and alcohol intake were assessed by selfreport. Five biological parameters: plasma fibrinogen, glycated haemoglobin, waisthip ratio, serum neopterin and salivary IgA were measured as outcome variables.Three hypotheses were tested:¶ 1. There is a socioeconomic gradient in measures of psychosocial stress, and of psychological resilience.¶ 2. There is a socioeconomic gradient in biological measures that have a plausible¶ association with future disease. 3. Psychosocial factors mediate the demonstrated association between socioeconomic status and the biological measures.¶ Data analysis confirmed a socioeconomic gradient in some psychosocial and behavioural variables: economic strain (r=-0.44, p&lt0.001), job demands (r=0.45, p&lt0.001), job control (r=0.26, p&lt0.001), active coping style (r=0.28, p &lt0.001), sense of optimism (r=0.24, p&lt0.001), social capital (r=0.26, p&lt0.001), job security (r=0.17, p=0.002), job marketability (r=-0.16, p=0.005), sense of belonging (r=0.22, p&lt0.001), number of adverse life events (r=-0.13, p=0.01) and positive interaction with family and friends (r=0.20, p&lt0.001 ), vigorous physical activity (r=-0.16, p=0.002), alcohol consumption (r=0.30, p&lt0.001) and smoking status (r=-0.25, p&lt0.001). There was no socioeconomic gradient in anxiety, depression, neuroticism, hostility, locus of control, self-esteem, perceived stress or mental health (SF-12). Four of the five biological markers varied with socioeconomic status: plasma fibrinogen (female (F): r=-0.26, p=0.002, male (M) r=-0.08, p=0.30), glycated haemoglobin (F: r=-0.23, p=0.01, M: r=-0.11, p=0.17), waist-hip ratio (F: r=-0.19, p=0.03, M: r=-0.27, p&lt0.001), serum neopterin (F: r=-0.21, p=0.009, M: r=-0.04, p=0.56), salivary IgA (F: r=-0.07, p=0.38, M: r=0.004, p=0.97). A more adverse biological profile was associated with lower socioeconomic status. Work characteristics, coping style, smoking and exercise were particularly important mediators of the association between the biological markers and socioeconomic status. Particular psychosocial factors were consistent mediators of the association between specific biomarkers and socioeconomic status (with little variation for different measures of socioeconomic status). However, the particular psychosocial factors providing significant mediation varied for the different markers.¶ In this sample of healthy 40-44 year olds, four out of five biological markers showed moderate socioeconomic variation with a more favourable profile associated with higher SES. The data provide limited support for the importance of psychosocial factors in the socioeconomic health gradient.

<p>För att få personalen på en arbetsplats att trivas och må bra bör en mängd faktorer tas i beaktande. Faktorer som beskrivs som viktiga är rolltydlighet och rollkonflikter, balans mellan krav och kontroll, upplevelsen av socialt stöd och balans mellan ansträngning och belöning. Då syftet med studien var att undersöka vilka psykosociala arbetsmiljöfaktorer som har ett samband med hälsan hos personal inom vård och omsorg användes en enkät som mätte alla ovanstående områden. Denna enkät kompletterades med frågor gällande kontakten med vårdtagarna. Enkätundersökningen (n = 80) följdes även upp av kvalitativa intervjuer (n = 4). Resultatet visade att de faktorer som starkast korrelerade med hälsa var hög upplevd kontroll, bra socialt stöd och bra kontakt med vårdtagarna.</p>

This thesis focuses on the role of different psychosocial factors in the course of pain over time in a general population sample of women in Sweden. The main aim was to identify and quantify such factors as predictors of pain, pain-related disability and quality of life within a biopsychosocial framework for the understanding of the pain experience over time.  The studies were based on baseline (BL) and follow-up (FU) measures with 12 months apart among 2,300 women living in Sweden, and included physical and psychological health and socio-economic status. Study I investigated associations between socio-economic status (SES) at baseline and pain and pain-related disability at follow-up, and additionally a possible mediating role of depressive symptoms in such associations. The results indicated that educational level, financial strain and occupational level were associated with pain over time. Symptoms of depression were related to all pain-and SES factors, and might be understood as a mediating factor within this context. The results of Study II showed a link between symptoms of burnout at baseline and several pain-locations. Additionally, among women with pain, the characteristics of the pain experience and pain-related disability were associated with level of burnout over time. Study III focused on the sub sample of women reporting pain at follow-up, and examined possible predictors of their perceptions of quality of life (QOL). Several psychosocial factors were associated with QOL, and seemed to be more important predictors than the characteristics of pain in terms of intensity and frequency. These factors were burnout, emotional distress, and social support. Study IV was an attempt to sum up the results of the previous studies by analysing predictors of the course of pain, i.e. by comparing women that developed pain from BL to FU with those that remained pain-free and to compare women with sustained pain with those who recovered from pain during the assessment period. These analyses showed symptoms of posttraumatic stress (PTSD) to be associated with reporting emerging pain, while pain variables, educational level and social support were related to sustained pain. The results of the four studies in this thesis indicate that psychosocial factors and their interplay with the characteristics of pain can be identified and described in a female sample, with a broad definition of pain, and that these factors play a central role in the experience of pain and its impact on the everyday life of these women. There may be several possible paths leading to the development of persistent pain among women and the identification of risk factors is complicated by never-ending interactions between biological, psychological and social processes. At an early stage, prior to pain development, several risk factors may cluster together (e.g. SES, depression), and work as indicators of, e.g. dysfunctional coping in relation to pain. In the first contact with health care and among primary care personnel the identification of such indicators is crucial so as to find women at risk for prolonged pain conditions. General indicators might then be more easily distinguishable than certain individual behaviour characteristics widely accepted as risk factors for pain and disability (e.g. fear-avoidance). To spread the knowledge of general factors in the first line of health care is therefore of great importance in preventive work. Finally, the results demonstrated that many women report pain with characteristics that to a great extent affect their lives and through interactions with psychological and social health might have grave consequences for perceptions of quality of life.

För att få personalen på en arbetsplats att trivas och må bra bör en mängd faktorer tas i beaktande. Faktorer som beskrivs som viktiga är rolltydlighet och rollkonflikter, balans mellan krav och kontroll, upplevelsen av socialt stöd och balans mellan ansträngning och belöning. Då syftet med studien var att undersöka vilka psykosociala arbetsmiljöfaktorer som har ett samband med hälsan hos personal inom vård och omsorg användes en enkät som mätte alla ovanstående områden. Denna enkät kompletterades med frågor gällande kontakten med vårdtagarna. Enkätundersökningen (n = 80) följdes även upp av kvalitativa intervjuer (n = 4). Resultatet visade att de faktorer som starkast korrelerade med hälsa var hög upplevd kontroll, bra socialt stöd och bra kontakt med vårdtagarna.

Background: South Asian girls have reported low levels of physical activity (PA) compared to other Canadian adolescents. Potential explanations include omissions in existing PA measures that don’t capture all types of PA, and factors discouraging PA in this group. Purpose: This study examined the quality and quantity of PA; compared PA participation using two self-report methods; and, examined psychosocial and cultural factors associated with PA in adolescent South Asian girls. Methods: 113 participants were recruited from community sources in Toronto. Data were collected using a structured electronic diary (3 weekdays; 2 weekend days) and a self-administered online questionnaire that included the Leisure Time Exercise questionnaire. Diaries were content analyzed and compared to PA reports in the questionnaire. Bivariate and multivariate regression analyses identified factors associated with PA. Results: Diaries revealed that when a range of PA types were captured, like walking activities and chores, PA levels were similar to representative data for Canadian youth. 92% of respondents reported at least 30 minutes of PA per day across their diary entries. However, 19% did not report any PA at the vigorous intensity level, and PA levels were lowest on weekends. Reports of PA in the diary and questionnaire were inconsistent, with considerably higher levels of PA reported in the questionnaire. Enrolment in physical education, enjoyment, control, fewer barriers, and social provisions were associated with greater PA. Conclusions: Physical activity levels were low, but results did not suggest that South Asian girls are more vulnerable to low levels of activity compared to other Canadian girls. Findings from the diary suggest that PA questionnaires would benefit from including a broader range of activity types with a variety of walking activities, and structured reflections to enhance data quality and minimize the potential for over-reporting. PA levels may be increased through mandatory physical education, curricula that emphasize how girls may engage in vigorous activities outside of classes, and changes to neighbourhood environments that would promote walking.

The purpose of this study was to describe perceived psychosocial work environment and musculoskeletal complaints among baggage handlers, and to evaluate whether there is any linear relationship between them. The study is a questionnaire based cross-sectional study, and part of an ongoing larger project. Therefore, the number of forms has been limited to those that were collected in the project by 2010-11-25 (N=117). The questions analyzed in the study come from the Copenhagen Psychosocial Questionnaire and “Nordiska Ministerrådets formulär om besvär i rörelseorganen”, respectively. In addition, ratings of pain intensity according to Borg CR-scale have been used. Linear correlations were assessed by Spearman’s rank correlation. The results showed that the baggage handlers rated good sense of Community and low Emotional demands, but poor Influence and Feedback at the workplace. Their ratings of pain frequency and intensity were relatively low, but the regions where they had most complaints were shoulders and low back. The highest correlation was -0.36 between Meaning and pain frequency in the Shoulders. No particular psychosocial factor or body region appeared highly correlated with all or most of the other variables. For the psychosocial environment factors investigated in this study no extremely good or extremely bad values were discovered. Musculoskeletal complaints were low. No strong correlations between baggage handlers ratings of psychosocial work environment and musculoskeletal complaints were found in this study.

The aim of this study was to explore how psychosocial lived experiences of taxi drivers explain accident involvement in Uganda. Face to face in-depth semi-structured interviews were conducted with six male taxi drivers who survived accidents while driving and still served as taxi drivers. The sample was identified with purposive and snowball sampling techniques. Ethical considerations were observed during data collection through transcription, analysis to the final compilation. Interpretive phenomenological analysis (IPA) was employed to each participant’s discernment of the specific and general accounts of accident narratives in a bid to make "sense" of their lived worlds as drivers and accident involvement. Three superordinate themes illuminating accidents emerged out of the data: typical routines of taxi drivers; the socio-cultural context; and the taxi drivers’ community. These were discussed based on relevant theories and previous studies as well as pertinent concepts. Considering the study results, typical routines of taxi drivers, driver community factors and social/cultural factors affect each other, these together leave driver-accident involvement inevitable. Categorically such factors include; age, formal education, driving training, driver health status, domestic concerns, significant others, competitive driving / worse-worse, other road users, Impulsive pick and drop-off of passengers, theft, driver stress, state of the road, state of the vehicle among others. Thus behavioural and cognitive remedies are herein suggested towards ameliorative and/or transformative processes of the accident endemic.

Background: South Asian girls have reported low levels of physical activity (PA) compared to other Canadian adolescents. Potential explanations include omissions in existing PA measures that don’t capture all types of PA, and factors discouraging PA in this group. Purpose: This study examined the quality and quantity of PA; compared PA participation using two self-report methods; and, examined psychosocial and cultural factors associated with PA in adolescent South Asian girls. Methods: 113 participants were recruited from community sources in Toronto. Data were collected using a structured electronic diary (3 weekdays; 2 weekend days) and a self-administered online questionnaire that included the Leisure Time Exercise questionnaire. Diaries were content analyzed and compared to PA reports in the questionnaire. Bivariate and multivariate regression analyses identified factors associated with PA. Results: Diaries revealed that when a range of PA types were captured, like walking activities and chores, PA levels were similar to representative data for Canadian youth. 92% of respondents reported at least 30 minutes of PA per day across their diary entries. However, 19% did not report any PA at the vigorous intensity level, and PA levels were lowest on weekends. Reports of PA in the diary and questionnaire were inconsistent, with considerably higher levels of PA reported in the questionnaire. Enrolment in physical education, enjoyment, control, fewer barriers, and social provisions were associated with greater PA. Conclusions: Physical activity levels were low, but results did not suggest that South Asian girls are more vulnerable to low levels of activity compared to other Canadian girls. Findings from the diary suggest that PA questionnaires would benefit from including a broader range of activity types with a variety of walking activities, and structured reflections to enhance data quality and minimize the potential for over-reporting. PA levels may be increased through mandatory physical education, curricula that emphasize how girls may engage in vigorous activities outside of classes, and changes to neighbourhood environments that would promote walking.

Thesis advisor: Summer S. Hawkins / Thesis advisor: David Takeuchi / Adolescence is a critical developmental stage where the health behaviors and choices that adolescents make have the potential to affect their long-term health and well-being (Centers for Disease Control and Prevention, 2014). This dissertation contributes three distinct studies on the contextual influences that shape adolescents' health behaviors. The first study, "The Role of Psychosocial Conditions on Sexually Transmitted Infection (STI) Risk among U.S. Young Adults," grounded in life course and syndemics theory, utilized logistic regressions to examine the role of co-occurring psychosocial conditions (childhood sexual abuse and physical abuse; depression and illicit drug use in adolescence) on STI infection (chlamydia and trichomoniasis) and sexual risk behaviors among U.S. young adults. Multiple co-occurring psychosocial conditions had an additive effect on sexual risk behaviors but no effect was observed on STIs. The second study, "Sexually Transmitted Infections and Neighborhood Poverty: The Role of Individual Resilience and Social Connectedness," utilized resilience and ecological systems theory, and logistic regressions to test if individual resilience and social connectedness (maternal, peer, and school) moderate the association between concentrated neighborhood poverty and STIs (chlamydia and trichomoniasis) among U.S. young adults. The study's main finding is that youth who reported more school connectedness and lived in high concentrated poverty in adolescence were less likely to test positive for chlamydia but were more likely to test positive for trichomoniasis. Utilizing a similar framework, "Sleeping in a Digital World: The Role of Excessive Media Use on Sleep Inadequacy Among U.S. Adolescents," examined family and neighborhood determinants that shape adolescent sleep behaviors. Grounded in the ecological systems theory and social learning theory, logistic regressions, stratified by age (aged 10-12 vs. 13-17), were used to examine the associations between excessive media use and sleep inadequacy. The study found that among older adolescents, sleep inadequacy was associated with excessive computer use. Older adolescents who watched television excessively and had media present in the bedroom were more likely to be sleep inadequate. Together, these three studies shed light on the different contextual environments in which adolescents experience health risks and resilience and will help to inform interventions that promote adolescent health and well-being. / Thesis (PhD) — Boston College, 2015. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.