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Cette thèse est basée sur le constat du manque d’activité physique (AP) chez les adolescents : environ 80% de cette tranche d’âge n’atteint pas les 60min quotidiennes recommandées. Cette situation aux conséquences sanitaires importantes, impacte davantage les jeunes les plus vulnérables comme les adolescents obèses et ceux issus de familles de position sociale et économique défavorisée. Deux études visant à promouvoir l’AP auprès de ces publics ont été menées : des mesures objectives de l’AP avant, pendant et après des interventions ont été réalisées dans deux contextes de prise en charge différents. L’objectif de la première étude était de tester la faisabilité et l’impact d’un programme d’AP à destination d’adolescents issus de milieux défavorisés en impliquant également un de leur parent. 18 parents et 22 adolescents ont participé au programme 1 parent – 1 ado. Il comportait deux fois deux heures d’AP par semaine pendant onze semaines pour chacun des groupes participants. Les niveaux d’AP ainsi que plusieurs paramètres anthropométriques, physiologiques et psychologiques ont été recueillis. Tous les participants ont suivi les onze semaines d’intervention. Les analyses ont montré que le seuil de 60 min d’AP quotidienne était atteint, uniquement pendant la durée du programme pour les adolescents. Celui de 30 min pour les parents l’était à tous les temps de mesures. Des analyses complémentaires ont révélé 1) des effets de la prise en charge sur l’AP modulés par l'âge chez les adolescents et par l'assiduité chez les parents, 2) une diminution de l’amotivation pour les adolescents les plus assidus et 3) une augmentation du bien-être pour les adolescents. Les résultats de cette étude pilote ont mis en évidence la faisabilité et l'efficacité d'un tel programme qui pourrait maintenant être déployé sous la forme d'un essai randomisé incluant un groupe contrôle.L’objectif de la deuxième étude était de tester les effets d’une prise en charge pluridisciplinaire de 10 mois sur l’indice de masse corporelle (IMC) et les niveaux d’AP d’adolescents obèses (21 garçons et 41 filles âgés de 14 ans avec un IMC de 33 kg/m²) dans un centre de Soins de Suite et de Réadaptation (SSR). Le rôle modulateur du climat parental et de la motivation de l’adolescent sur l’efficacité de la prise en charge a été évalué. Les résultats indiquent un effet positif de la prise en charge avec une diminution de l’IMC et une augmentation de l’AP au cours de la cure et quatre mois après. De type curvilinéaire, la perte de poids est forte en début de cure puis se stabilise à la fin. Le climat parental semble jouer un rôle facilitateur lors de cette amélioration, notamment par le père, lorsqu’il est perçu comme étant plus chaleureux, plus impliqué et soutenant davantage l’autonomie. Ces programmes de promotion de l’AP génèrent des résultats prometteurs sur les niveaux d’AP des adolescents. Cependant, l’étude des déterminants du maintien des changements obtenus pendant les interventions doit être poursuivie. / This thesis is based on the observation of the lack of physical activity (PA) in adolescents: approximately 80% of this age group does not reach the recommended daily 60 minutes. This situation and its important health consequences, has a greater impact on the most vulnerable young people, such as obese adolescents and those from socioeconomically disadvantaged families. Two studies aiming at promoting PA to these audiences were conducted: objective measures of PA before, during and after interventions were performed in two different PA program settings.The goal of the first study was to test the feasibility and the impact of a PA program for adolescents from disadvantaged backgrounds. For each adolescent, one of their parents was also involved. Thus, 18 parents and 22 adolescents participated in the “1 parent - 1 adolescent” program. Two hours of PA twice a week during eleven weeks were proposed for each of the participating groups. PA levels and several anthropometric, physiological and psychological parameters were collected. All participants followed the eleven weeks of intervention. The analyzes showed that the daily 60-min AP threshold was reached only during the program for adolescents. The daily 30 min for parents was reached at all measurements times of. Additional analyzes revealed 1) that program efficacy on PA level was modulated by age for adolescents and by attendance rate for parents, 2) a decreased of amotivation for the most assiduous adolescents, and 3) an increase in well-being for adolescents. The results of this pilot study highlighted the feasibility and effectiveness of such a program, which could now be deployed in the form of a randomized trial including a control group.The goal of the second study was to test the effects of 10-month multidisciplinary residential weight reduction program on body mass index (BMI) and PA levels of obese adolescents (21 boys and 41 girls aged 14 years with a BMI of 33 kg / m²). The modulating role of parental climate and motivation of the adolescent on the effectiveness of the care was evaluated. The results indicated a positive effect of the program with a decrease in BMI and an increase in PA during the course of treatment and four months after. With a curvilinear shape, the weight loss was strong at the beginning of the cure and then stabilized at the end. The parental climate seemed to play a facilitating role in this improvement, especially by the father, when he was perceived as being warmer, more involved and more supportive of autonomy. These PA promotion programs generate promising results on adolescent PA levels. However, the study of the determinants of the maintenance of changes during interventions must be continued.

Philosophiae Doctor - PhD / Validation of the OHIP-14 for a South African adult population using CFA resulted in a 12-item scale (OHIP-12) with excellent reliability (α =0.94), but the structural pathway varied across the socio-economic groups. The prevalence of oral pain was 19.4%, and varied significantly only across area-level SEP. Cost of care over the six months was estimated at about one billion Rand. Of those residing in the lowest SEP areas, 20.8% reported that they “did nothing” to relieve their last pain episode. Oral pain resulted in an average of two days lost per person from work/school over a six months period. The prevalence of OHIP was 16.2%. Those who had never visited a dental clinic had significantly better OHRQoL and less pain experience compared to those who previously visited a dental clinic. Both individual-level and area-level SEP were associated with OHRQoL in the bi-variate analysis, but these effects did not remain significant in multivariable-adjusted analysis. In particular, the respondents‟ race completely attenuated the effect of individual-level SEP on OHRQoL, while the experience of oral pain in the past six months completely attenuated the effect of area-level SEP on OHRQoL. Both absolute and relative inequality in oral health among the South African adult population was greater in the highest SEP areas than in the areas of lowest SEP

Introduktion Hälsan har förbättrats för hela världens befolkning. Ekonomiska och sociala förutsättningar såsom socioekonomi påverkar möjligheten till god hälsa. Även självkänsla har en koppling till god hälsa, men också till boendeform och socioekonomiskt status.  Syfte Att undersöka om, och i så fall hur, självkänsla påverkas av självskattad hälsa, boendeform, utbildning (objektiv socioekonomisk status) och självskattad ekonomi (subjektiv socioekonomi), och dessutom om en sådan association finns, om det finns en skillnad i dessa associationer mellan könen. Metod som använts är kvantitativ metod, med tvärsnittsdesign från data som insamlats av LSH-studien (Livsvillkor, Stress, Hälsa) i Östergötland 2012/2013. För att analysera data har logistiska regressioner tillämpats. Resultat Självkänslan påvisar en stark korrelation med självskattad hälsa, men även med självskattad ekonomi och kön. Att vara man, eller att ange bra ekonomi ökar sannolikheten att ha hög självkänsla. Att äga sitt boende har även det en positiv relation med självkänsla. Konklusion Att vara man och att äga sitt boende medför ökad sannolikhet för hög självkänsla. Samma faktorer har också en samvariation med hälsa. Dessutom har subjektiv socioekonomi en starkare relation till hälsa och självkänsla, än objektiv socioekonomi. / Introduction Health has improved for the entire world population. Economic and social conditions, such as socioeconomic status, influence the possibility of good health. Self-esteem is also associated with good health, as well as housing tenure and socioeconomic status.  Purpose To investigate whether, and to what extent, self-esteem is influenced by self-rated health, housing tenure, education (objective socioeconomic status) and self-rated economic status (subjective socioeconomic status), and if there is such an association, whether there is a difference between sexes.  Method This study was quantitative, with cross-sectional design, using results from the LSH-study questionnaires 2012/13 in Östergötland. The relationship between self-esteem and independent variables was analysed using logistic regressions.  Results High self-esteem demonstrates a strong correlation with self-rated health, as well as with self-rated economic status and sex. Being a man, or indicating good economic status increases the probability of high self-esteem. Owning one’s own housing also has a positive association with high self-esteem. Conclusion Being a man who owns his own housing increases the possibilities for high self-esteem. The same variables also covariate with health. Likewise, subjective socioeconomic status has a stronger relationship with health as well as self-esteem than objective socioeconomic status does.