Sociologists are generally in agreement that the closing decades of the twentieth century involved striking changes in the landscape against which British young people grew up. Transformations in education and the labour market had the potential to dramatically alter and re-shape patterns of social inequality. This thesis addresses the importance of family effects upon educational attainment, early career prospects and, in turn, the post-16 trajectories of young adults against the contextual changes of this period. Recently, youth researchers have been keen to argue that we are continuing to progress towards a ‘post-modern era’, which centres on the ‘individualisation’ or ‘detraditionalisation’ arguments of Beck and Giddens; where structural factors, such as gender and social class are diminishing as the defining elements of the pathway a young person will take. In this study, the British Household Panel Survey (BHPS), a contemporary source of longitudinal data from the early 1990s onwards, is used to demonstrate a lack of evidence of detraditionalisation, or the weakening of structural factors in determining the outcomes of young people. To the contrary, the gap between those from advantaged and less advantaged backgrounds remains wide. Furthermore, this research augments and extends previous studies of educational and early labour market outcomes by providing more comprehensive and integrated statistical analyses of household, family and parental effects, using techniques for longitudinal data analysis which give insight into patterns of social inequality being replicated in current contexts. Evidence using 17 years of longitudinal panel data indicate that, over time, family effects on school attainment and early labour market outcomes remain strong.

Background: Vitamin D may have beneficial effects on cardiometabolic disease, but the evidence is equivocal. This may be due to unaccounted confounders, such as lifestyle factors and genetic variation. We examined the association between circulating 25-hydroxyvitamin D [25(OH)D] and biomarkers of cardiometabolic disease risk, including biomarkers of inflammation, glycemic dysregulation and lipid metabolism, and a panel of 54 plasma proteomic biomarkers, and determined whether lifestyle variables and genetic variation modified these associations. Methods: Participants were from the Toronto Nutrigenomics and Health Study, an ethnically diverse population of individuals aged 20-29 years. Anthropometric measurements were obtained. Participants answered general health and lifestyle and food frequency questionnaires and provided a fasting blood sample for biochemical measurements and genotyping. Results: Across ethnic groups, women who used hormonal contraceptives (HC) had higher 25(OH)D and C-reactive protein (CRP) than women HC non-users and men. Circulating 25(OH)D was positively associated with CRP in the entire population in models not accounting for HC use. However, there was no association after accounting for HC use. 25(OH)D was also not associated with inflammatory cytokines after adjusting for HC use. 25(OH)D was inversely associated with insulin, HOMA-IR, and HOMA-Beta among Caucasians and East Asians and among men and women HC non-users. No biomarkers were associated with 25(OH)D among South Asians and women HC users, although non-significant inverse trends were observed for markers of glycemic dysregulation. Only two of the 54 plasma proteomic biomarkers were associated with 25(OH)D in women HC non-users, and none were associated in men. Among women HC users, after accounting for hormone dose, only three proteins were associated with 25(OH)D. Finally, 25(OH)D affected the association between rs2239182, a variant in the vitamin D receptor (VDR) and the pro-inflammatory cytokine interferon gamma-induced protein 10 (IP-10). However, the association was suggestive of heterosis and may have been due to chance. Conclusions: We identified a confounding effect of HC use on the association between 25(OH)D, biomarkers of inflammation and plasma proteomic biomarkers. In addition, HC use might also affect the association between 25(OH)D and biomarkers of glycemic dysregulation. Genetic variation in VDR did not modify any associations.

Background: Vitamin D may have beneficial effects on cardiometabolic disease, but the evidence is equivocal. This may be due to unaccounted confounders, such as lifestyle factors and genetic variation. We examined the association between circulating 25-hydroxyvitamin D [25(OH)D] and biomarkers of cardiometabolic disease risk, including biomarkers of inflammation, glycemic dysregulation and lipid metabolism, and a panel of 54 plasma proteomic biomarkers, and determined whether lifestyle variables and genetic variation modified these associations. Methods: Participants were from the Toronto Nutrigenomics and Health Study, an ethnically diverse population of individuals aged 20-29 years. Anthropometric measurements were obtained. Participants answered general health and lifestyle and food frequency questionnaires and provided a fasting blood sample for biochemical measurements and genotyping. Results: Across ethnic groups, women who used hormonal contraceptives (HC) had higher 25(OH)D and C-reactive protein (CRP) than women HC non-users and men. Circulating 25(OH)D was positively associated with CRP in the entire population in models not accounting for HC use. However, there was no association after accounting for HC use. 25(OH)D was also not associated with inflammatory cytokines after adjusting for HC use. 25(OH)D was inversely associated with insulin, HOMA-IR, and HOMA-Beta among Caucasians and East Asians and among men and women HC non-users. No biomarkers were associated with 25(OH)D among South Asians and women HC users, although non-significant inverse trends were observed for markers of glycemic dysregulation. Only two of the 54 plasma proteomic biomarkers were associated with 25(OH)D in women HC non-users, and none were associated in men. Among women HC users, after accounting for hormone dose, only three proteins were associated with 25(OH)D. Finally, 25(OH)D affected the association between rs2239182, a variant in the vitamin D receptor (VDR) and the pro-inflammatory cytokine interferon gamma-induced protein 10 (IP-10). However, the association was suggestive of heterosis and may have been due to chance. Conclusions: We identified a confounding effect of HC use on the association between 25(OH)D, biomarkers of inflammation and plasma proteomic biomarkers. In addition, HC use might also affect the association between 25(OH)D and biomarkers of glycemic dysregulation. Genetic variation in VDR did not modify any associations.

Midlife adults who have divorced or never married represent a growing demographic in North America. Despite this fact, little research has examined the dating and sexual behaviours of these individuals. Research has instead focused on the dating and sexual lives of young adults, particularly undergraduate students. The current research program examined young (aged 18-24 years) and midlife (aged 35-54 years) single (or recently single) heterosexual North American adults’ typical first date scripts and their retrospective perceptions of their first date experiences. More specifically, Study 1 examined young and midlife adults’ typical first date scripts. Participants were asked to list at least 20 actions that a woman would typically perform on a first date with someone new, from the beginning of the date to its end, putting the actions in the order in which they would occur. Participants were then instructed to carry out the task a second time, focusing on the actions that a man would typically perform on a first date with someone new. Study 2 examined young and midlife adults’ retrospective accounts of their actual first date scripts, as well as their actual first date sexual behaviour. Participants were asked to list at least 20 actions that they performed on their most recent first date, from the beginning of the date to its end, putting them in the order in which they occurred. They were also asked to complete a revised Guttman scale of sexual behaviours, checking off from a list the behaviours that occurred on their most recent first date. Across both studies, analyses revealed three key patterns with respect to gender roles. First, contrary to expectations, young adults tended to be more traditional than midlife adults with respect to first dates. Second, midlife adult women tended to be less traditional than expected with respect to first dates. Lastly, in keeping with expectations, women were depicted as taking a passive role and men were depicted as taking a more active role in the scripts. Implications of the findings and recommendations for future research follow.

Emerging conversations within oncology have drawn more attention to cancer among young adults (ages 18-45). Recent research has illuminated many of the psychosocial difficulties young adults face as they go through the many trials and tribulations of chronic illness. However, a subject still understudied, much is unclear about the personal as well as the cultural implications of being diagnosed during this period of time. In a book of cancer stories, performer and young adult cancer patient Kairol Rosenthal (2009) expressed her frustration with what she saw as “stereotypes” promulgated by the limited public discourses that exist on the subject (p. 7). She sought to counterbalance these representations with stories capturing the “complexities of our real daily lives” (p. 7). Indeed, in oncological discourses young adults tend to be cast in oversimplified terms, based upon cultural expectations about what young adulthood should be and pressures to conform to those standards. Intersecting with dominant discourses within narrative identity development, two imperatives are placed upon young adults’ stories: integration of different life experiences and selves into a coherent narrative and developing a sense of self-authorship in the direction of one’s life. What seems to be lost in these imperatives within the existing research is what is at stake for individual lives (a phenomenological perspective) and how those stakes are negotiated or contested with hegemonic trajectories of life (a critical perspective). Receptive to Rosenthal’s critique of dominant discourses around cancer and young adulthood, the purpose of this thesis was to explore the complexity and diversity of young adults living with cancer. More specifically, I intended to interrogate some of their existential and biographical challenges as expressed in their narratives of cancer, as well as their engagements with ideological constructions of young adulthood, namely, the expectations of narrative coherence and self-authorship. This research marked a departure from most studies on the subject in its qualitative methodology (i.e., narrative analysis) and in its explicit evaluation of the effects of cultural discourses on young adults’ attempts to make meaning. More generally, this research shows the importance of language—in discourses, narratives, and metaphors—in constructing and communicating illness experiences. For this project, I gathered a mix of written and oral narratives (through semi-structured interviews) from 21 participants from across Canada. The foci of analyses were on what could be called narrative ‘moments of meaning’ and ‘moments of being,’ that is, situated expressions of how they made sense of their worlds and themselves. Many of these were critical moments in the sense of questioning and resisting dominant discourses of cancer and young adulthood. Their moments of meaning often expressed negotiation of personal desires and innovative intentions with familiar cultural narratives or “prototypical plots” (Good, 1994)—including stories of battling cancer, embarking on a life journey, nearing recovery, encountering unpredictability and mystery, and living with chaos. These moments of meaning served an array of purposes well beyond the expected function of constructing a coherent narrative. When telling of identity disruptions and the liminality of cancer, participants produced both more orderly moments of being (e.g., survivor, patient, or warrior identities) and more liminal moments of non-being (e.g., victim, phoenix, or trickster identities). Self-authorship seemed to be present among the former, while the latter expressed less control and certainty of being—which was not always seen as a problem. These moments of being and non-being were collaborated and contested within the intersubjective spaces of their clinical relationships, local worlds, and cancer patient communities. More specific to their age group, their moments of being and non-being often related to what may be understood as developmental identities, including the ‘traditional milestones’ such as individual autonomy, family (i.e., marriage and parenthood), and vocation (i.e., getting an education and building a career). In their struggles they sometimes reaffirmed these cultural ideals toward identity integration and other times resisted them as “normalizing ideologies” (Becker, 1997) of young adulthood. As part of these larger negotiations of meaning and being, the participants expressed struggles to understand the moral significance of their illnesses. Confronted with what may be called “causal ontologies” of suffering (Shweder, 1997), they spoke of different etiological models of cancer’s origins as well as reconciliatory models for living with cancer in the future. Their narratives sometimes led toward “remoralization” (Kleinman, 1988)—couching experiences of suffering in terms of a moral order (narrative coherence) and personal responsibility (self-authorship)—and sometimes led away from it, depending on whether they believed their illnesses originated from events in their personal and social lives. Overall, the participants in this study communicated complex and potentially chronic existential challenges. In many ways their narratives resisted dominant representations of young adults with cancer—and of cancer patients in general—suggesting that such representations need to be rethought. Their critical moments of meaning and being may serve as counternarratives to the stereotypes of concern to Rosenthal and many other cancer patients. Specifically, their narratives revealed the merits and limits of the ideological construction of young adulthood as a time of narrative coherence and self-authorship. This study has important implications for future health research and psychosocial support in the field of oncology; building upon a “narrative medicine” (Charon, 2006), sensitivity to how language is used among young adult cancer patients may lead toward more inclusive clinical practices.

Although young adult (YA) survivors of child cancer comprise a unique group from a developmental standpoint, in most treatment and research settings either child or general adult measures of quality of life (QL) are used to measure adjustment and functioning. Studies have relied heavily on survey methods, and though many hint at a variety of specific problems that a subset of YAs may experience, most identify YA survivors as relatively well adjusted. Interview studies with survivors and care-providers and interactions in survivor support venues paint a more complex and problematic picture of adjustment. To better understand the QL concerns unique to YAs this study employed grounded theory methodology to build a model of survivorship from participant perceptions. Four focus groups were conducted (N=15) with survivors between the ages of 18 and 30 years recruited from in-person and online support group settings. Themes emerged describing a larger extent of struggles than prior studies have identified. The grounded theory model detailed that having cancer can fundamentally change an individual, and these changes and resulting struggles do not end with remission. Survivors described constantly pursuing normalcy in the context of being fundamentally different, while balancing the dual roles of young adult and survivor. Survivors revealed difficulties in essentially every area of their lives (school, work, friendships, family, romance, self-esteem, outlook and attitudes, etc.), and though many could identify strategies for addressing these problems, maladaptive coping techniques dominated and survivors were left feeling overwhelmed, under-supported, and misunderstood. Results suggest that YAs could benefit from QL measures developed specifically with their unique concerns in mind. While progress has been made in developing YA-specific measures, such measures have not become widespread practice in clinical and research settings. Furthermore, this study suggests that collecting such information in a conversational, semi-structured interview format may elicit a fuller scope of survivors’ concerns than pencil and paper methods, though further research is recommended in this area.

Stigma prevents individuals with serious mental illness from seeking assistance (Fung et al., 2007; Vogel et al., 2006). Self-Determination Theory (SDT) seeks to explain how individuals are motivated by environmental factors and how these elements affect their well-being (Deci & Ryan, 1985). Limited information is available about how young adults with mental illness experience stigma, and how this affects their self-determination and ability to recover. This study explores factors that facilitated recovery and thriving behaviors in nine young adults (ages 18-25) with psychosis, by using a combination of interviews and questionnaires. Findings suggest that having a variety of supports and a determination to recover facilitates high self-determination and thriving behavior in these individuals. By identifying factors that assist these individuals ability to thrive, it is anticipated that professionals will intervene with young adults experiencing psychosis more effectively.

The purposes of this study were to: 1) evaluate the effect of walking speed on gait, balance and cognitive task performance and 2) examine the effect of dual task (cognitive load) on gait balance and cognitive task performance. Twenty young healthy adults (24+6 years of age) were recruited and each participant walked on a motorised treadmill at two speeds(0.5m/s and 0.8m/s), first without performing cognitive tasks, then while performing three types of cognitive loaded tasks. The speed had a significant effect on average and coefficient of variation of temporal gait parameters (P<0.001), cognitive task performance (P<0.001) and center of pressure excursion (P<0.001). No statistically significant effect of speed was found ML trunk displacement. However, dual task (cognitive load) had significant effect on COV of temporal gait (P<0.001), cognition (P<0.001) and trunk motion (P<0.001). In conclusion, the speed and dual task had significant effect on locomotors rhythm, balance, and cognitive performances.

Objectives: To describe utilization of specialised prenatal care by high-risk survivors and evaluate echocardiogram use in echocardiogram-need survivors, as per survivorship guideline recommendations. Methods: Retrospective population-based matched survivor:control study utilizing Ontario health administrative data. Survivors were classified as high-risk/low-risk for obstetrical outcomes, and as echocardiogram-need (yes/no) for echocardiogram outcomes. Associations were tested using logistic regression. Results: 11% (n=363) of 3,204 pregnant survivors were classified as high-risk. Over 90% received specialized prenatal care. Living in a rural area was associated with lower use. (AOR 0.51; 95% CI 0.44-0.59). Since 2003, 32% (560/1,737) of survivors had an echocardiogram-need. Only 14% (77/560) had ≥1 echocardiogram, this was not associated with rurality nor neighbourhood income quintile. Conclusions: Although the majority of high-risk survivors receive specialized prenatal care, geographic inequality in care persists. Despite survivorship guidelines, >85% of echocardiogram-need pregnant survivors do not have an echocardiogram performed; future work should address this gap in care.

Objectives: To describe utilization of specialised prenatal care by high-risk survivors and evaluate echocardiogram use in echocardiogram-need survivors, as per survivorship guideline recommendations. Methods: Retrospective population-based matched survivor:control study utilizing Ontario health administrative data. Survivors were classified as high-risk/low-risk for obstetrical outcomes, and as echocardiogram-need (yes/no) for echocardiogram outcomes. Associations were tested using logistic regression. Results: 11% (n=363) of 3,204 pregnant survivors were classified as high-risk. Over 90% received specialized prenatal care. Living in a rural area was associated with lower use. (AOR 0.51; 95% CI 0.44-0.59). Since 2003, 32% (560/1,737) of survivors had an echocardiogram-need. Only 14% (77/560) had ≥1 echocardiogram, this was not associated with rurality nor neighbourhood income quintile. Conclusions: Although the majority of high-risk survivors receive specialized prenatal care, geographic inequality in care persists. Despite survivorship guidelines, >85% of echocardiogram-need pregnant survivors do not have an echocardiogram performed; future work should address this gap in care.