Point-of-choice prompts consistently increase stair climbing in public access settings. Comparison of message content, however, is rare. Chapter two reports that, after controlling for the effects of traffic, similar effects on stair climbing were evident for a more specific and a simpler heart-health message. Chapters three to five demonstrate that specific, calorific expenditure messages were associated with significantly increased stair climbing in public access and workplace settings, with greater increases in overweight than normal weight individuals (chapter four). Chapter three investigated the single and combined effects of volitional and motivational intervention components, in a tram station, to test the theory underpinning the success of point-of-choice prompts. Both components positioned simultaneously were required to increase stair climbing where choosing the stairs resulted in a time delay for pedestrians due to the site layout. Similarly, a motivational intervention alone did not increase stair climbing in the workplace (chapter five). When supplemented with a volitional, point-of-choice prompt at the time the choice of ascent method is made, a significant increase in stair climbing occurred. Analysis should adjust for potential moderating effects of pedestrian traffic, time of day, demographics and building characteristics; failure to do so may mask the true impact of the intervention.

This cross-sectional study aimed to determine whether dietary intake is associated with food retailing. 5044 adults aged 16-97 years completed a 134-item food frequency questionnaire (FFQ), from which three dietary indices were derived. Data on 33 retailed foods were obtained from 560 food stores in Newcastle upon Tyne, UK. Poorer people lived closer to stores selling a wider range of foods. Fresh fruits and vegetables were more costly in more affluent areas. Higher fat and lower fruit and vegetable intake, poorer dietary knowledge, more frequently shopping at discount and convenience stores, and travel by foot or public transport, were all more common among less affluent households. In multilevel regression analyses, no area level variables were associated with variation in dietary indices, which was most strongly associated with lifestyle variables and dietary knowledge. Retail access to healthy foods is important for a healthy diet. However, where such access is uniformly good, dietary quality is most importantly associated with lifestyle choices, which are driven by dietary knowledge and socio-economic factors. Interventions to improve diet need to focus on the knowledge and behaviours needed to acquire, prepare and consume a healthy diet, as well as the economic means to do so.

This thesis investigated the effects of daily changes in exposure (delta) and short-term exposure patterns on the relationship between air pollution and health in time series studies. Using data from London and Hong Kong, delta was defined as the difference in particulate matter (PM10) concentration between successive days. Short-term exposure pattern series were defined based on number of peaks in PM10 within rolling weekly blocks. The mathematical equivalence of identifiable models for delta with conventional distributed lag model was derived and alternative model specifications were proposed. Measurement error and missing data exhibited more impact on delta than the absolute metrics in simulation studies. Evidence of association for delta PM10 with mortality was found only in Hong Kong which attenuated towards the null with more rigorous adjustment for weather. The pattern analysis approach hypothesized, in addition to amount (dose) and duration of exposure, epidemiological studies ought to take patterns of exposure into account. However, convincing evidence was not found for the effect of short-term exposure patterns on mortality risk estimates both in London and Hong Kong. Refining the definition of exposure patterns and methodological improvements including analysing data from multiple cities are highly recommended in related studies in the future.

Understanding why persons repeatedly place themselves at risk for Human Immunodeficiency Virus (HIV), amidst the wealth of prevention information available is of profound importance. Presently, scientific research of this phenomenon has been dominated by the cognitive models of health behaviour, but these were criticised for ignoring emotional, social and cultural influences on sexual behaviour. This thesis explored and investigated some of these non-cognitive factors within the specific cultural context of St. Vincent and the Grenadines, with sole reference to women, to understand why women put themselves at risk and also help inform the country’s efforts to tackle the problem. This research comprised of four studies, each targeting women ages (18-40 yrs) and sexually involved in relationships. Study one was a qualitative study (N= 10), which explored women’s perceptions of the socio-cultural influences which contributes to their decision to engage in risky sex. Study two was a quantitative study in which (N=75), HIV+ women were surveyed, on whether they contracted HIV from within their long term relationships. Study three was a qualitative Interpretative Phenomenological Analysis (IPA) study (N=9); in-depth interviews investigated the intricacies of long-term relationships that made them more likely to influence unsafe sexual practices. Study four was a quantitative study (N=60) women; used questionnaires to investigate the validity that tolerance to infidelity and non use of condoms in long term relationships, which contributes to HIV transmission amongst Vincentian women. This research confirmed the existing limitations of the Cognitive models on health when applied to sexual behavior and produced evidence that Vincentian women more at vulnerable to contracting HIV within their long term relationships.

This thesis presents the findings of a qualitative exploration of how Community Health Workers (CHWs) conceptualise their role in delivering health improvement. The characteristics of CHWs described in the literature, and their role in health improvement, are examined critically. Interview data from 27 CHWs and 15 others across four services is used to explore the health improvement mechanism from the perspective of CHWs. Theory from a range of disciplines is used to explain it. The literature provides incomplete accounts of the mechanism. The empirical work suggests that, in the services sampled, the mechanism may predominantly be one of social support (informational, instrumental, appraisal and emotional support). Three distinct and essential processes emerge (needs assessment, effective service provision, and client engagement). The analysis reports how who CHWs are, and what they do, appear to be important influences on the social support processes, and that CHWs may be better at delivering this kind of support than traditional professional workers, particularly to socially excluded individuals. Overall, this work suggests that CHWs may perform a unique role, as experts in social support. The proposed mechanism can be used to inform service design and evaluation, to maximise CHWs’ potential to deliver effective social support.

The prevalence of obesity is high and the primary care setting enables treatment to be offered to large numbers of people. This thesis investigates behavioural weight management interventions in primary care. A noninferiority analysis was used to examine whether four behavioural weight management programmes differed in weight loss at three and 12 months. Commercial programmes resulted in similar weight losses and the NHS programme was inferior at three months, with an inconclusive result at 12 months. GPs can refer patients to commercial weight management programmes, however not all people use these types of programmes. There is a need to find simple effective interventions that can be offered in primary care. Self-weighing may be one such strategy for weight loss; a randomised controlled trial investigated this. There were no significant differences in weight loss between baseline and three months. Self-weighing may be more effective for weight loss maintenance as people have developed skills to manage their weight. A quasi randomised controlled trial was used to investigate this and found encouragement to self-weigh prevented 0.7 kg weight regain. A systematic review and meta-analysis investigated the effect of self-weighing. Overall, self-weighing as part a multicomponent weight loss intervention resulted in greater weight loss but isolated there was no evidence of effectiveness. In conclusion commercial weight management programmes result in similar weight losses and patients could be referred to such programmes by primary care. Self-weighing may be an effective strategy that primary care practitioners could advise patients to use combined with other behavioural strategies.

This thesis examined self-management (SM) strategies of cancer survivors from pre-diagnosis, through treatment and into survivorship. A healthcare definition of SM as a lifestyle modifying behaviour potentially impacting on cancer survivors’ health, wellbeing and quality of life (QoL) was given. Due to a lack of existing literature, a systematic review and meta-analyses investigating whether complementary and alternative medicine (CAM) improves cancer survivors’ QoL was undertaken, finding moderate to poor quality evidence of this. A mixed methods study explored SM patterns over time. The questionnaire study examined the prevalence and distribution of SM patterns, finding SM uptake was highest in survivorship. Subgroup analyses found SM uptake was highest in breast cancer and chemotherapy respondents, whilst correlation analysis revealed significant associations between SM uptake and both QoL and internal health locus of control (HLC), but none between SM uptake and work ability. The interview study explored how and why cancer survivors made decisions about incorporating SM practices into their daily lives. The concept of normality in survivorship emerged, with cancer survivors assembling a new health-related normality to adapt to their new lives post-cancer. A theoretical framework proposed that cancer survivors use SM as a supportive mechanism to attain their new health-related normality.

Flow cytometry (FCM) was utilized for monitoring the physiology of \(E.\) \(coli\) cells in orange juice (OJ) as well as a model orange juice (MOJ). Compared to FCM, plate counts highly underestimated the true number of viable cells in OJ. As a part of this study, the effects of the change in major components of OJ on viability of the cells in OJ and MOJ was investigated using FCM. Increase in ascorbic acid and amino acid concentrations of MOJ improved both the culturability and FCM viability of the cells. FCM was also employed for studying the effects of OJ clarification on viability of \(E.\) \(coli\) in OJ. Although, reduction in cloud content of OJ increased the number of healthy cells, however, the removal of cloud particles of larger than 0.7 μm appeared to increase the antimicrobial efficacy of particles of smaller than 0.7 μm. The effects of washing E. coli cells with available chlorine, H\(_2\)O\(_2\) and organic acids on their subsequent viability in OJ was also investigated. While increase in concentration of sanitizers resulted in a significant reduction in healthy populations, the total number of viable cells either remained constant or increased particularly in case of H\(_2\)O\(_2\)-washed cells.

Liver disease is the fifth largest killer in the United Kingdom and with the numbers of diagnoses increasing each year there is an urgent need for novel therapeutic interventions. This thesis examines one potential target, Vascular Adhesion Protein (VAP)-1: an amine oxidase enzyme with reported adhesin functionality. The results herein confirm a primarily sinusoidal localisation of VAP-1, expression of which was upregulated in the liver during chronic inflammation correlated with diminished enzyme activity. Functional analysis of sinusoidal VAP-1 in vitro did not demonstrate any effect of inhibition on leukocyte recruitment, unlike that observed in other tissues. Furthermore, only neutrophils were capable of binding to recombinant VAP-1 under flow conditions. Further investigation highlighted the importance of this intimate relationship during neutrophil-endothelial interactions; revealing the first evidence that neutrophils also express catalytically active VAP-1. Neutrophil effector functions, such as the formation of extracellular traps, were also hindered by recombinant VAP-1. This was also observed in wild-type mice but not those expressing a catalytically inactive form of VAP-1 (SSAOKO). Following acute injury, these mice also exhibited expanded intrahepatic macrophage and NKT cell populations compared to control. In combination, these data highlight the complex role that VAP-1 plays during inflammatory liver disease.

This thesis is submitted as part of the Doctorate in Clinical Psychology at the University of Birmingham and consists of two volumes. Volume I contains the research component of this thesis and consists of a systematic literature review, empirical research paper, and public dissemination document. The systematic review found that content on social networking sites can provide researchers with tentative information about the psychopathology and personality traits of the user. However, research displaying greater internal and external validity is required before this information could reliably inform the development of targeted online public health information or interventions. The research paper presents a study exploring the relationships between drinking identity, alcohol use, mental health symptoms, and alcohol content in social networking site pictures, in a community sample of young females. Drinking identity may be an important factor to consider in alcohol reduction and prevention efforts. The public dissemination document provides an accessible overview of the review and research paper. Volume II consists of five Clinical Practice Reports (CPRs). CPR I presents a Cognitive-Behavioural and Systemic formulation for a 21-year-old female experiencing low mood. CPR II presents a service evaluation of non-attendance to psychological assessment appointments in an adult community mental health setting. CPR III presents a single-case research design to assess the effects of a Positive Behavioural Support intervention with a 40-year-old female displaying behaviour that challenges. CPR IV presents a case study of Acceptance and Commitment Therapy with a 69-year-old female experiencing chronic pain and depression. CPR V presents a presentation abstract for a case study of Cognitive Behavioural Therapy with a 31-year-old female experiencing Bulimia Nervosa.