Background University can be stressful, and some students use alcohol to handle their stress. The alcohol consumption in our youth affects future alcohol habits. Caregivers experience and attitude towards alcohol affects patients care and treatment. Purpose To investigate the stress level and number of hazardous drinkers among physiotherapy students at Uppsala Universitet. It was also to investigate the difference between the genders regarding stress and alcohol consumption, also the correlation between stress and alcohol consumption. Design and method This was a cross-sectional study with a correlating and comparative design where physiotherapy students answered a survey regarding stress and alcohol consumption. Results In this survey, 176 students participated of which 169 were analyzed. Twenty-one percent had a high stress level and 30% had a hazardous drinking. The women were more stressed (p=0,02), but no difference was seen between the genders regarding alcohol consumption (p=0,06). There was no correlation between stress and alcohol consumption for the whole group (r= 0,22, p=0,78), for women (r=0,12, p=0,21) or for men (r=-0,12, p=0,34). Conclusion A moderate to high stress level was common and 35% had a hazardous drinking or an abuse/dependence. The women had a higher stress level, but the alcohol consumption was similar between the sexes. There was no correlation between stress and alcohol consumption. However, interventions against stress and alcohol could be necessary since these students will have an important role in the future.

This thesis details a continuing body of research investigating the contribution of personality to disordered eating and alcohol abuse in young women. There is growing evidence of high levels of reward sensitivity in women with both disorders, and high levels of punishment sensitivity in dysfunctional eating women. However, it is unlikely that personality alone accounts for the development of such dysfunctional behaviour. Two studies were conducted to further examine the contribution of reward and punishment sensitivity to these disorders. In the first study, 443 university women completed self-report measures of alcohol use, dysfunctional eating, reinforcement sensitivity, parental drinking, family environment and maternal eating. Reward and punishment sensitivity were better predictors of disordered behaviour than family factors, although maternal dysfunctional eating significantly increased the risk of daughters' dysfunctional eating. Punishment sensitive daughters of bulimic mothers reported the highest level of bulimic symptoms themselves. Punishment sensitivity also functioned as a partial pathway variable between family risk and disordered eating. Given the stronger contribution of personality to disordered behaviour, a second study was conducted in which 131 women completed behavioural tasks under conditions of reward and punishment. Performance on a computerised measure of punishment sensitivity was associated with greater levels of dysfunctional eating but not drinking. However, performance on a card-sorting task of reward sensitivity failed to correlate with self-reported reward sensitivity or disordered behaviour. It was concluded that an innate sensitivity to reward increases the risk of disorders characterised by strong approach tendencies, whilst high punishment sensitivity, perhaps due to a chaotic family, increases the risk of dysfunctional eating, particularly daughters of eating disordered mothers.

Social capital, or social cohesion or group connectedness, can influence both HIV risk behavior and substance use. Because recent immigrants undergo a change in environment, one of the consequences can be a change in social capital. There may be an association among changes in social capital, and HIV risk behavior and substance use post immigration. The dissertation focused on the interface of these three variables among recent Latino immigrants (RLIs) in South Florida. The first manuscript is a systematic review of social capital and HIV risk behavior, and served as a partial background for the second and third manuscripts. Twelve papers with a measure of social capital as an independent variable and HIV risk as the dependent variable were included in the analysis. Eleven studies measured social capital at the individual level, and one study measured social capital at the group level. HIV risk was influenced by social capital, but the type of influence was dependent on the type of social capital and on the study population. Cognitive social capital, or levels of collective action, was protective against HIV in both men and women. The role of structural social capital, or levels of civic engagement/group participation, on HIV risk was dependent on the type of structural social capital and varied by gender. Microfinance programs and functional group participation were protective for women, while dysfunctional group participation and peer-level support may have increased HIV risk among men. The second manuscript was an original study assessing changes in social capital and HIV risk behavior pre to post immigration among RLIs in South Florida (n=527). HIV risk behavior was assessed through the frequency of vaginal-penile condom use, and the number of sexual partners. It was a longitudinal study using secondary data analysis to assess changes in social capital and HIV risk behavior pre immigration to two years post immigration, and to determine if there was a relationship between the two variables. There was an 8% decrease in total social capital (p ˂ .05). Reporting of ‘Never use’ of condoms in the past 90 days increased in all subcategories (p ˂ .05). Single men had a decrease in number of sexual partners (p ˂ .05). Lower social capital measured on the dimension of ‘friend and other’ was marginally associated with fewer sexual partners. The third manuscript was another original study looking at the association between social capital and substance use among RLIs in South Florida (n=527). Substance use with measured by frequency of hazardous alcoholic drinking, and illicit drug use. It was a longitudinal study of social capital and substance-use from pre to two years post immigration. Post-immigration, social capital, hazardous drinking and illicit drug use decreased (p˂.001). After adjusting for time, compared to males, females were less likely to engage in hazardous drinking (OR=.31, p˂.001), and less likely to engage in illicit drug use (OR=.67, p=.01). Documentation status was a moderator between social capital and illicit drug use. ‘Business’ and ‘Agency’ social capital were associated with changes in illicit drug use for documented immigrants. After adjusting for gender and marital status, on average, documented immigrants with a one-unit increase in ‘business’ social capital were 1.2 times more likely to engage in illicit drug use (p˂.01), and documented immigrants with one-unit increase in ‘agency’ social capital were 38% less likely to engage in illicit drug use (p˂.01). ‘Friend and other’ social capital was associated with a decrease in illicit drug use among undocumented immigrants. After adjusting for gender and marital status, on average, undocumented immigrants with a one-unit increase in ‘friend and other’ social capital were 45% less likely to engage in hazardous drinking and 44% less likely to use illicit drugs (p˂.01, p˂.05). Studying these three domains is relevant because HIV continues to be a public health issue, particularly in Miami-Dade County, which is ranked among other U.S. regions with high rates of HIV/AIDS prevalence. Substance use is associated with HIV risk behavior; in most studies, increased substance use is associated with increased chances of HIV risk behavior. Immigration, which is the hypothesized catalyst for the change in social capital, has an impact on the dynamic of a society. Greater immigration can be burdensome on the host country’s societal resources; however immigrants are also potentially a source of additional skilled labor for the workforce. Therefore, successful adaption of immigrants can have a positive influence on receiving communities. With Florida being a major receiver of immigrants to the U.S, this dissertation attempts to address an important public health issue for South Florida and the U.S. at large.

Background and Aims: Prior cross-sectional research finds that electronic cigarette (e-cigarette) use clusters with higher rates of harmful alcohol consumption in the United States adult population. The current study examined prospectively the association between e-cigarette use, cigarette use and the combined use of e-cigarettes and tobacco cigarettes and alcohol use outcomes. Design: A nationally representative multi-wave cohort survey (wave 1: September 2013–December 2014, wave 2: October 2014–October 2015). Setting: United States. Participants: A representative sample of civilian, non-institutionalized adults who completed waves 1 and 2 of the Population Assessment of Tobacco and Health survey (n = 26 427). Measurements: Participants were categorized into exposure groups according to their e-cigarette and cigarette use during wave 1. Past 30-day alcohol use outcomes were (1) National Institute on Alcohol Abuse and Alcoholism (NIAAA)-defined hazardous alcohol use, (2) total alcohol drinks consumed and (3) alcohol-related consequences. Findings: After controlling for socio-demographic risk factors and alcohol use at wave 1, all exposure groups showed higher odds of hazardous alcohol use [adjusted odds ratios (aORs) = 2.05–2.12, all P < 0.001] and reported higher past-month total drinks (B = 0.46–0.70, all P < 0.001) and more alcohol consequences (B = 0.63–0.89, all P ≤ 0.10) at wave 2 compared with non-users. Cigarette users (B = 0.24, P = 0.038) and dual e-cigarette/cigarette users (B = 0.32, P = 0.038) reported higher past-month total drinks compared with e-cigarette users. There was no conclusive evidence that non-daily use of e-cigarettes or cigarettes predicted poorer alcohol use outcomes compared with daily use. Conclusions: In the United States between 2013 and 2015, after adjustment for socio-demographic characteristics, cigarette and e-cigarette use were associated with alcohol use 1 year later.