Uganda has a predominantly young population, and there is a need for targeted HIV/AIDS prevention programming. Peer education is a health intervention style that has been used with appreciable success in adolescent groups, but some issues exist. We hypothesize that more can be done in the program planning stages to increase the chances of sustained success, and have completed two different types of cross-sectional analyses to investigate this aspect. We used Social Network Analysis to examine the social structure of two secondary schools in Fort Portal, Uganda. We identified existing modes of influence and natural channels of communication, and used these to create a feasible model of peer educator selection. We also studied present levels of communication about sexual and reproductive health within youth relationships, and found that youth are willing to talk to their friends, but high levels of communication do not generally occur. This provides an important point of entry for health promotion programs. / Population Health

Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniv., 2007. / Härtill 4 uppsatser.

The oil and gas industry is a vital contributor to the global economy and a key source of employment within oil-producing countries. Oil production is largely dependent on a skilled population who are adept in coping with the demands of an offshore environment. Due to the high risk nature of work offshore, it is a requisite that personnel engage in health promoting behaviours. The research aimed to identify aspects of offshore workers self care which required behaviour change and the behavioural determinants which were associated with engagement in self care. A mixed methods design was utilised to generate novel data and original findings. Phase 1 used a quantitative cross-sectional online survey to assess offshore workers’ (n=352, 53.6% response rate) health, quality of life, mental wellbeing and self care status. The findings highlighted key areas of concern, as indicated by negative scoring across measures, relating to: overweight/obesity; medication adherence; absenteeism (with regard to travelling offshore); medical evacuation; lack of adherence to 5-a-day fruit and vegetable guidelines; physical activity; smoking; hazardous alcohol use, and insomnia. Phase 2 used qualitative theory-based telephone interviews to explore self care behaviours from the perspective of offshore workers (n=16). Offshore workers who had completed a survey and indicated they would like to receive further information on the interviews were invited to participate. Both the interview schedule and data analysis were informed by the Theoretical Domains Framework (TDF). Healthy eating and physical activity were the behaviours most frequently discussed by offshore workers and identified as areas requiring behaviour change. TDF domains representing both behaviours included: beliefs about capabilities; beliefs about consequences; intentions; goals; memory, attention and decision processes; environmental context and resources; social influences; emotion, and behavioural regulation. Phase 3 used qualitative theory-based telephone interviews to explore offshore workers’ (n=13) self care behaviours from the perspective of remote healthcare practitioners. Both the interview schedule and data analysis were informed by TDF. Healthy eating and harmful/hazardous alcohol use were the behaviours most frequently discussed by remote healthcare practitioners and identified as areas requiring behaviour change. TDF domains representing both behaviours included: knowledge; environmental context and resources; social influences; emotion, and behavioural regulation. The findings, when triangulated suggest that offshore workers may benefit from the implementation of a self care intervention which targets healthy eating, physical activity and alcohol consumption. It is advised that the intervention target multiple self care behaviours and that development is underpinned by behaviour change theory to ensure effectiveness. The intervention may be tailored in accordance with the TDF domains identified in this research as determinants of healthy eating, physical activity and alcohol use behaviours.

Background: Many adults do not take recommended amounts of physical activity (PA). This is associated with adverse health outcomes such as obesity, overweight, diabetes and heart disease. Moreover, physical inactivity is socially patterned. People with lower socioeconomic status or who live in more deprived areas do less PA which may in turn contribute to inequalities in health outcomes. Identifying the causes and possible pathways for increasing PA and addressing health inequalities is a pressing national and international priority. There is increasing evidence that features of the built environment (BE) can support physical activities such as walking. The built environment may also ameliorate health inequalities by providing a supportive context for walking across diverse sections of the population. However, there is little evidence relating to the UK and Scottish context or about inequalities in these associations for different groups such as people with different demographic characteristics or people living in areas with different levels of deprivation. This study aimed to fill this knowledge gap, examining associations between built environments and walking in urban Scotland. It considered individual and spatial inequalities in these relationships. Methods: This study had a quantitative cross-sectional design. Geographical Information Systems (GIS) was used to create neighbourhood level BE measures of Area Walking Potential (AWP) across urban Scotland. These were destination accessibility, street connectivity, residential density and walkability (a composite measure of the former three measures). An examination of the distribution of AWP across Scotland and in relation to area deprivation was made. The measures were then appended to individual level walking data for adults aged 19+ years from the 2010 Scottish Health Survey. Regression analysis tested for associations between the AWP measures with four different walking outcomes: any walking, frequency of walking, achieving 30 minutes of walking per day and total minutes walked in the previous week. Individual and area level confounders were controlled for. Associations were examined using two sizes of neighbourhood area: 500m and 1000m zones around residential centres. Interactions with individual demographic, socioeconomic, household characteristics and area deprivation were evaluated. Results: There was modest evidence of positive associations between AWP and walking. After controlling for covariates, destination accessibility showed the strongest associations with frequency of walking. There were limited associations for street connectivity and walkability and no associations between residential density and walking. Positive associations remained for some groups less likely to walk, such as older adults. However, there were also interaction effects showing inequalities in associations between AWP and walking. In particular, people with lower educational attainment were less influenced by AWP. The spatial analysis showed areas with lowest deprivation had lowest AWP although people in more deprived areas walked less overall. Conclusions: There is some evidence that the BE supports some types of walking in Scotland. The BE may also enhance walking opportunities for certain groups who generally walk less, and therefore could potentially reduce inequalities in health outcomes. However, the socioeconomic inequalities in outcomes suggest multifaceted approaches to increasing walking are more likely to reach all sections of the population. The evidence that there are geographic inequalities in levels of AWP can be used to inform geographically targeted interventions aimed at improving walking environments. This research has generated original evidence in the Scottish context, highlighting the importance of context specific research.

Abstract The purpose of the present study was to analyse and describe the health behaviour among the male population in the Kainuu region in Finland, to chart the men's attitudes towards health services and find out how they talked about their health behaviour. The objective was to produce new, cultural information about how to develope health services, and in addition to shed light into the health behaviour among the men living in the Kainuu region. The research material consisted of 20 thematic biographical interviews. The interviewees were 36–56-year-old men who were born, and currently living in the Kainuu region. In the study, the biographical method was applied, and the interviewees were asked to tell their life story from a health perspective. The research material was approached both from a factist perspective and a specimen perspective. The material was analysed in three stages by using material-based content analysis, thematic content analysis, and rhetorical analysis. The framework of the study consisted of a cultural perspective. Thus, when doing the analysis, it was essential to find the different meanings the men had given to health in their life. According to the results, the value of health did not guide the health behaviour of the interviewed men until adulthood, and health services were not used willingly. There were matters in the course of the lives of these men as well as in their growth environment that made it easier to understand their health behaviour and attitudes towards health services. Attitudes passed on from generation to generation and increased morbidity in the immediate environment were among the things that contributed to the men's behaviour and attitudes. The men also used rhetorical ways to justify their own health behaviour. The most used rhetorical strategies were the absence of agency and the use of extreme expressions. It is possible to obtain in-depth information about health behaviour with the help of biographical study that takes cultural issues into consideration. The information gathered in the present study can be used when developing and directing health services in the Kainuu region as well as when developing the national health service system in Finland. The methodological solutions used in the present study can also be applied to other studies in the field of health sciences. / Tiivistelmä Tutkimuksen tarkoituksena oli analysoida ja kuvata kainuulaisten miesten terveyskäyttäytymistä, terveyspalveluihin suhtautumista ja terveyskäyttäytymiseen liittyvää puhetta. Tavoitteena oli tuottaa uutta, kulttuurista tietoa terveyspalvelujen kehittämiseen ja lisäksi tehdä ymmärrettäväksi kainuulaisten miesten terveyskäyttäytymistä. Tutkimusaineisto muodostui 20 temaattisesta elämäkertahaastattelusta. Haastateltavat olivat syntyperäisiä kainuulaisia ja Kainuussa asuvia 36–56-vuotiaita miehiä. Tutkimuksessa sovellettiin elämäkertametodia siten, että haastateltavat kertoivat elämäntarinansa terveyden teemasta lähtien. Tutkimusaineistoa lähestyttiin sekä faktanäkökulmasta että näytenäkökulmasta. Aineisto analysoitiin kolmivaiheisesti: aineistolähtöisellä analyysillä, teemoihin pohjautuvalla analyysillä ja retorisella analyysillä. Tutkimuksen viitekehys muodostui kulttuurisuudesta. Näin ollen, aineiston analyysissä oli olennaista löytää kainuulaisten miesten terveyskäyttäytymiseen liittämiään kulttuurisia merkityksiä. Tulosten mukaan terveyden arvo ohjaa kainuulaisten miesten terveyskäyttäytymistä vasta aikuisiässä eikä terveyspalveluja käytetä mielellään. Kainuulaisten miesten elämänkulusta ja kasvuympäristöstä löytyi asioita, joiden avulla miesten terveyskäyttäytymistä ja terveyspalveluihin suhtautumista voidaan ymmärtää. Näitä ovat esimerkiksi sukupolvelta toiselle periytyneet asenteet ja lähiympäristön runsas sairastavuus. Miesten puheesta oli myös löydettävissä retorisia keinoja, joilla he argumentoivat omaa terveyskäyttäytymistään. Retorisista keinoista yleisimmin käytettyjä olivat toimijuuden kadottaminen ja ääri-ilmaisujen käyttäminen. Kulttuurisuuden huomioivan elämäkertatutkimuksen avulla on mahdollista saada syvällistä tietoa terveyskäyttäytymisestä. Tutkimuksessa tuotettua tietoa voidaan hyödyntää terveyspalvelujen laadun kehittämisessä ja yksilöllisessä suuntaamisessa sekä Kainuussa että laajemmin suomalaista terveyspalvelujärjestelmää kehitettäessä. Tutkimuksen metodologisia ratkaisuja voidaan soveltaa myös muissa terveystieteellisissä tutkimuksissa.

Persistent infection with certain subtypes of Human papillomavirus (HPV) is a necessary cause of cervical cancer, the second most common cancer among women worldwide. Uptake of HPV vaccines in the targeted Canadian female population has been lower than anticipated. This study’s primary objective was to determine undergraduate women’s perceptions about HPV vaccination. A total of 401 female University of Ottawa undergraduate students completed a newly developed cross-sectional web survey. The prevalence of HPV vaccination was 49%. While the overall attitude towards receiving the vaccine was positive, vaccinated respondents had more favorable attitudes toward the vaccine. Lack of vaccine knowledge and cost were the primary barriers that have prevented HPV vaccination among non-vaccinated respondents. Offering HPV vaccination for women aged 18 to 25 presents a strategy for addressing suboptimal vaccination coverage in the targeted female population and may reduce health inequities demonstrated by variations in cervical cancer incidence within jurisdictions.

Diet contributes to a large proportion of preventable deaths and diseases. Adolescence is a period during which diet may particularly evolve, and therefore represents an opportunity to develop long-lasting healthy dietary behaviours. However, dietary habits are particularly subject to social variations, which may lead to social inequalities in health. Tackling them requires public health actions based on a comprehensive approach of social determinants at this life stage. This doctoral thesis aimed to examine socioeconomic and sociocultural disparities in dietary habits among adolescents, using the repeated cross-sectional Health Behaviour in School-aged Children (HBSC) surveys conducted in French- and Dutch-speaking Belgian schools. The three specific objectives of this aim were: (i) to study the socioeconomic disparities in dietary habits of adolescents from different migration status; (ii) to determine trends in dietary disparities between 1990 and 2014; (iii) to estimate disparities in dietary habits according to the socioeconomic and migration status at both individual and contextual levels. Firstly, different socioeconomic disparity patterns according to the migration status were observed, with narrower disparities in 1st-generation immigrants than among natives, highlighting the major role of cultural influences in immigrant populations. Secondly, the long-term trend analyses emphasised increasing disparities for healthy foods and decreasing disparities for unhealthy foods. In addition, when the consumption of a food group increased overall, disparities decreased, and vice-versa. Finally, the multilevel analyses showed that individual and school disparities were independently associated with food consumption frequencies. Furthermore, this observational assessment revealed the weak relationships between nutrition policy in schools and dietary habits. Note that in the Brussels-Capital Region, native adolescents were at higher risk of unhealthy dietary behaviours than immigrants, but the risk of unhealthy behaviours tended to be higher when, in the school, the socioeconomic index decreased, and the proportion of immigrants increased. Overall, our analyses underlined the need to include, in addition to the socioeconomic factors, cultural components in public health actions aimed at addressing social inequalities in adolescent diet, in a multicultural context such as Belgium. Support to schools, with a greater emphasis on those disadvantaged in order to prevent increased inequalities, is needed to develop a consistent and effective nutrition policy. Finally, further studies are needed to better understand the mechanisms behind dietary disparities among adolescents, particularly those related to their migration status and broader socioeconomic environment. / Doctorat en Santé Publique / info:eu-repo/semantics/nonPublished

Die Ergebnisse des Kinder- und Jugendgesundheitssurveys (KiGGS) enthüllen Unterschiede im Gesundheitsstatus und Gesundheitsverhalten in Deutschland je nach Einkommen, Bildungsstand und Berufswahl der Kinder und Jugendlichen selbst bzw. von deren Eltern. Besonders stark ausgeprägt sind die sozialen Unterschiede im Hinblick auf den allgemeinen Gesundheitszustand, psychische und Verhaltensauffälligkeiten sowie Übergewicht. Auch in allen anderen europäischen Staaten kumulieren Mortalität, Morbidität und verhaltensbedingte Risikofaktoren in den unteren sozioökonomischen Statusgruppen. In Europa differiert die Lebenserwartung bei Männern in höheren und niedrigeren sozialen Positionen durchschnittlich um fünf Jahre. Die Entwicklung von Strategien zur Bekämpfung sozialer Ungleichheiten in der Gesundheit ist eine der größten Herausforderungen unserer heutigen Gesellschaft. / The national representative survey on the health of children and adolescents in Germany (KiGGS) revealed social inequalities in health and health behaviour in Germany according to income, education and occupation of both the children and adolescents themselves and their parents. Social inequalities in general health status, psychological or behavioural disorders, and overweight seem to be most alarming. Mortality, morbidity and detrimental health behaviour accumulate in the subpopulation with a low socioeconomic position (SEP) across Europe. The average difference in life expectancy in European men with a high and low SEP is 5 years. The development of policies and strategies to tackle this important public health issue is a major present and future challenge.

The Air Quality Health Index (AQHI) is a 10-point scale that communicates the cumulative health risks associated with air pollution (ECCC, 2016). The general theme of this dissertation centers on an understanding of AQHI adoption while accounting for socioeconomic status (SES) in order to facilitate AQHI uptake by the public with particular focus on “at risk” populations (i.e. young children, seniors, and those with pre-existing respiratory and/or cardiovascular conditions). The study is unique since it approaches AQHI adoption consistent with the ecological model and an equity lens, and AQHI adoption is considered at the individual, organizational and community levels. The study area for this dissertation is Hamilton, Ontario, Canada. The findings from this dissertation contribute to an understanding of why AQHI is or is not being adopted and suggests potential intervention strategies to increase its uptake. Consistent with health behaviour theory, demographics (gender, age, education, area of residence), knowledge/understanding and individual risk perceptions (neighbourhood air effects on health) were found to be significant predictors of AQHI adoption. Additionally, perceived benefits of AQHI adoption included protection of health for self and those cared for via familial and/or occupational duties. While perceived barriers of AQHI adoption included lack of time required to check and follow AQHI health messages and the inability to “self-identify” as belonging to the “at risk” population. This dissertation proposes that increases in AQHI adoption may be achieved by increasing AQHI knowledge and emphasizing the benefits and relevance of AQHI such that “at risk” populations can self-identify. Additionally, AQHI uptake may be increased by providing AQHI information at a neighbourhood scale via local media sources and wearable devices. / Dissertation / Doctor of Philosophy (PhD)

Objectives: This cross-sectional survey aimed to evaluate the oral health behaviour of patients prior to endoprosthesis (EP), as well as the handling of oral health topics by German orthopaedic surgeons. Materials and methods: Consecutive patients prior to EP answered a questionnaire regarding oral health behaviour, oral hygiene, oral complaints and information on the relationship between EP and oral health. Another questionnaire was digitally mailed to orthopaedic centres throughout Germany. This questionnaire included the importance of oral health for EP and issues on dental referrals/consultations prior to EP. Results: A total of 172 patients were included in the study, of whom 35.5% of patients reported that they were informed about oral health and EP. Half of the individuals reported regular professional tooth cleaning, and less than one-third (29.1%) reported of the performance of interdental cleaning. Information on oral health and EP was associated with regular professional tooth cleaning (yes: 59.8% vs. no: 35.6%, p = 0.01). A total of 221 orthopaedic clinics were included in the study, of which only a few had dental contact (14%), although the majority (92.8%) of the clinics were familiar with causal relationships between oral health and EP infections. Less than half of the centres reported of either verbal (48%) or written (43.9%) referrals for their patients to the dentist. University Medical Centres reported of more frequent dental contacts (p < 0.01). Conclusion: Prior to EP, patients exhibited deficits in oral health behaviour, and orthopaedic clinics exhibited a lack of dental collaboration. Improvements in interdisciplinary care, especially regarding practical concepts for patient referral and education on oral health, appear to be necessary.