Darbo tikslas: Įvertinti asmens sveikatos priežiūros įstaigų pagrindinių žmogiškųjų išteklių būklę, pagrindžiant jų formavimo politikos pokyčių poreikį. Uždaviniai: Įvertinti Lietuvos gydytojų demografinę situaciją ir jų pasiskirstymo regioninius netolygumus, ištirti ligoninėse dirbančių gydytojų rizikos profilį susirgti lėtinėmis neinfekcinėmis ligomis, išanalizuoti ligoninėse dirbančių gydytojų dalyvavimo profilaktiniuose sveikatos patikrinimuose mastą. Tyrimo metodika. Siekiant įvertinti gydytojų demografinę situaciją ir jų regioninį pasiskirstymą, buvo atlikta iš Lietuvos sveikatos informacijos centro, Lietuvos statistikos departamento ir Valstybinės akreditavimo sveikatos priežiūros veiklai tarnybos prie Sveikatos apsaugos ministerijos gautų oficialių duomenų statistinė analizė. Gydytojų sveikatos būklės įvertinimui buvo pasirinkta po vieną ligoninę iš didmiesčio ir rajono (Vilniaus regione – Vilniaus miesto ir Ukmergės miesto ligonė, Kauno regione – Kauno miesto ir Marijampolės ligoninė). Visiems tose ligoninėse dirbantiems gydytojams buvo išdalintos anketos, suskirstytos į šešias dalis: I dalis – asmens duomenys ir darbinė veikla, II – pasitenkinimas darbu, III – klausimai apie sveikatą, IV – klausimai apie profilaktinius sveikatos patikrinimus, V – klausimai apie gyvenseną ir VI – nuomonė apie sveikatos priežiūrą. Dalyvauti tyrime buvo pakviesti visi tyrimo dieną dirbantys gydytojai. Anketinėje apklausoje dalyvavo 281 gydytojas (76 proc.). Sveikatos patikrinime... [toliau žr. visą tekstą] / Aim of the study: To evaluate the main human resources’ status in the health care institutions in support of their policy-making need to change. Objectives: To evaluate demographic situation of Lithuanian physicians and regional inequalities in the distribution of physicians; to assess the risk profile of chronic noncommunicable diseases of hospital-employed physicians; to analyse participation of hospital-employed physicians in screening programmes. Material and methods. The official statistical data obtained from Lithuanian Health Information Centre, Lithuanian Department of Statistics and the State Health Care Accreditation Agency under the Ministry of Health were used for evaluation of demographic situation of physicians and their regional distribution. The assessment of health status of physicians was carried out in four randomly selected hospitals from Vilnius and Kaunas regions. Two hospitals were selected from Vilnius and Kaunas cities, one hospital - from Ukmergė municipality and one hospital - from Marijampolė municipality. The questionnaire, which was distributed to physicians, consisted from six parts: I - personal data, and working activities, II - job satisfaction, III – health status, IV - preventive health check-up, V – health behaviours, and VI - opinion of health care. All physicians who were working in the hospital on the day of survey were invited to participate. Questionnaires were filled in by 281 physicians (response rate was 76%), and 242 physicians... [to full text]

Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2018-07-17T20:01:37Z No. of bitstreams: 2 Tese - Lídia Moraes Ribeiro Jordão - 2017.pdf: 10330980 bytes, checksum: 958da85b145a6a814c69f594e41c0102 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2018-07-18T11:38:58Z (GMT) No. of bitstreams: 2 Tese - Lídia Moraes Ribeiro Jordão - 2017.pdf: 10330980 bytes, checksum: 958da85b145a6a814c69f594e41c0102 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-07-18T11:38:58Z (GMT). No. of bitstreams: 2 Tese - Lídia Moraes Ribeiro Jordão - 2017.pdf: 10330980 bytes, checksum: 958da85b145a6a814c69f594e41c0102 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-01-23 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This thesis focuses on oral and general health-compromising behaviours among Brazilian adolescents. Such behaviours constitute major causes of morbimortality in the worldwide population, are often initiated during adolescence, and tend to track into adulthood. Oral diseases, like dental caries, periodontal disorders and cancer, share a number of behavioural risk factors that are common to other preventable chronic noncommunicable diseases. Nevertheless, there is no evidence about the overtime distribution, and socioeconomic inequalities, neither about clustering patterns with other health behaviours and associated factors of oral health- compromising behaviours among Brazilian adolescents. The present studied aimed to analyze oral health-compromising behaviours based on the Brazilian National School-based Student Health Surveys (PeNSE) as regards to: a) overtime distribution and social inequalities, and b) clustering patterns with other health behaviours and associated factors. The first approach is presented in one original paper regarding oral health behaviours changes over time in Brazilian adolescents, in relation to maternal educational inequalities. For this, we used data from PeNSE for the years 2009 and 2012, a survey that investigates health risk and protective factors among Brazilian adolescents attending schools. The results showed that: the proportion of adolescents with low toothbrushing frequency increased, and the consumption of sweets and soft drinks, and cigarette experimentation decreased. In private schools, we found higher soft drink consumption and higher cigarette experimentation among students who reported greater maternal education, while in public schools we found higher soft drink consumption among students who reported lower maternal education, and higher cigarette experimentation among students who reported greater maternal education. There were no inequalities for toothbrushing frequency or sweets consumption in both types of school. The second approach is presented in two original papers that described the clustering patterns of oral and general health-compromising behaviours among Brazilian adolescents and identified associated factors. For these analyses, we used data from the Brazilian National School-based Student Health Survey (PeNSE) for the year 2012. The main findings are: a) oral and general health-compromising behaviours were inter-related and clustered into two specific patterns; one cluster gathered a combination of lack of adherence to preventive behaviours and the undertaking of risky conduct, while the second reflected an unhealthy lifestyle; and b) the odds for presenting two or more oral health-compromising behaviours were greater for adolescents without parental involvement in homework, from public schools, males, whose mothers had fewer years of education, and of lower family affluence. It was concluded that the oral health-compromising behaviours underwent changes in their distribution over time; however they were not related to maternal education inequalities, have clustered with other health behaviours and were associated with sociodemographic and family factors among Brazilian adolescents. Interventions aiming at reducing health-compromising behaviours among adolescents should prioritize groups that have been identified as being at most risk and preferably employ a common risk factor approach. / Esta tese tem como foco os comportamentos de risco à saúde geral e bucal em adolescentes brasileiros. Tais comportamentos constituem as principais causas de morbimortalidade na população mundial, com frequência se iniciam na adolescência e têm continuidade na vida adulta. As doenças bucais, como o câncer, a cárie dentária e as doenças periodontais compartilham fatores comportamentais que contribuem para as principais doenças e agravos não transmissíveis. No entanto, ainda não há evidência acerca da distribuição temporal e desigualdades socioeconômicas dos comportamentos de risco à saúde bucal em adolescentes brasileiros, bem como dos padrões de agrupamento com outros comportamentos e fatores associados. O objetivo do presente estudo foi analisar comportamentos de risco à saúde bucal em adolescentes brasileiros com base na Pesquisa Nacional de Saúde do Escolar (PeNSE) em relação à: a) distribuição temporal e desigualdades socioeconômicas, e b) padrões de agrupamentos com outros comportamentos em saúde e fatores associados. A primeira abordagem é apresentada em um artigo original acerca da evolução de comportamentos em saúde bucal em adolescentes das capitais brasileiras em relação às desigualdades da escolaridade materna. Para isso, foram utilizados os dados das edições de 2009 e 2012 da PeNSE, inquérito que investiga os fatores de risco e proteção à saúde de adolescentes escolares brasileiros. Os resultados mostraram: aumento da proporção de adolescentes com baixa frequência de escovação dentária e diminuição no consumo de guloseimas, refrigerantes e experimentação de cigarros no período. Em escolas privadas, verificou-se maior prevalência de consumo de refrigerantes e experimentação de cigarros para os adolescentes com mães de maior escolaridade; enquanto que em escolas públicas, verificou-se maior prevalência de consumo de refrigerantes para os adolescentes com mães de menor escolaridade e maior experimentação de cigarros para aqueles com mães de maior escolaridade; além de ausência de desigualdade para frequência de escovação e consumo de guloseimas nos dois tipos de escola. A segunda abordagem é apresentada em dois artigos originais que descreveram os padrões de agrupamentos entre comportamentos de risco à saúde geral e bucal em adolescentes brasileiros e identificaram fatores associados. Para essas análises, foram utilizados dados da PeNSE do ano de 2012, representativos do país, das regiões e das capitais. Destacam-se os seguintes achados: a) os comportamentos de risco à saúde geral e bucal associaram-se entre si e agruparam-se em dois padrões específicos; um cluster reuniu uma combinação de falta de adesão a condutas preventivas e adoção de práticas de risco, enquanto o outro representou um estilo de vida não saudável; e b) a chance de apresentar dois ou mais comportamentos de risco foi maior para adolescentes sem supervisão familiar dos deveres de casa, de escolas públicas, do sexo masculino, de menor escolaridade materna e de menor afluência familiar. Concluiu-se que os comportamentos de risco à saúde bucal apresentaram mudanças em sua distribuição no período investigado, porém não relacionadas às desigualdades de escolaridade materna; agruparam-se com outros comportamentos em saúde e estiveram associados a fatores sociodemográficos e do contexto familiar em adolescentes brasileiros. Intervenções que busquem reduzir os comportamentos de risco em saúde em adolescentes devem priorizar os grupos mais vulneráveis identificados e, preferencialmente, empregar a abordagem dos fatores de risco comuns.

Introduction: Health behaviour is detrimental to the pathways to adulthood. Internet becomes an important way for parents to get support and to exchange information. Therefore, a scoping review and interviews with mothers had been conducted to map knowledge to investigate the extent to which the internet is being used by parents to access information relative to their adolescent’s health behaviours. Method: Scoping review was used to identify articles related to the topic. The literature search was conducted on two databases, PubMed, and PMC. In addition, semi-structured interviews conducted by telephone with mothers based in Sweden. Content analyses were used to describe common themes. Result: The searches on the PubMed and PMC electronic databases detected 274 items. Only 9 articles were relevant and matched the criteria that were relevant to the topic. Most of the studies have been conducted in developed countries such as the United States and Australia from 2004 to 2020. During semi-structured interviews, using the internet was described as a supportive tool for mothers. Conclusion: The gap was clear due to the low number of the identified articles. New studies should be conducted in developing countries. Demographic influences should be considered regarding participants recruitment for interviews.

Introduktion: Teknikutvecklingen och digitaliseringen i samhället sker i en hög hastighet. Äldre vuxna är en grupp som ofta saknar den kompetens, kunskap och de färdigheter som är nödvändiga för att kunna nyttja de hälsoresurser och hälsoinformation som finns tillgängliga online. För att kunna engagera sig i e-hälsa och söka hälsoinformation online krävs det att de äldre vuxna har en viss nivå av eHealth literacy. eHealth literacy är förmågan att söka, hitta, förstå och värdera hälsoinformation från elektroniska källor, och tillämpa den kunskap som erhålls för att lösa ett hälsoproblem. Syfte: Syftet med litteraturöversikten var att belysa om det finns ett förhållande mellan eHealth literacy och hälsobeteenden samt hälsoutfall hos äldre vuxna, 55 år och äldre. Metod: Metoden som användes var en strukturerad litteraturöversikt. Analysmetoden som användes var en induktiv tematisk analys av 10 kvalitetsgranskade tidskriftsartiklar. Resultat: Den tematiska analysen genererade i 3 teman; Förbättrad livsstil, Engagemang i egenvård och eHealth literacy en mellanliggande faktor till hälsobeteenden och hälsorelaterad livskvalité. Resultatet visade att en ökad nivå av eHealth literacy hos äldre vuxna förbättrade deras hälsobeteenden, hälsobeslut och hälsoutfall i form av välmående och hälsorelaterad livskvalité. eHealth literacy hade både en direkt och en indirekt effekt på de studerade utfallen. Slutsats: Resultatet belyste betydelsen av att arbeta förebyggande och hälsofrämjande med äldres eHealth literacy förmåga för att i sin tur stärka deras hälsa, livskvalité och delaktighet i sin egenvård. eHealth literacy är en central faktor för äldres hälsa och för att de ska kunna nyttja de e-hälsotjänster som finns tillgängliga till sin fulla potential. / Introduction: Older adults often lack the skills and competence necessary to be able to use health resources and health information available online. To be able to get involved in digital health and search for health information online older adults are required to have a certain level of eHealth literacy. eHealth literacy is defined as the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem. Aim: The purpose of the literature review was to shed light on whether there is a relationship between eHealth literacy and health behaviors and health outcomes in older adults. Methods: The method used was a structured literature review. The method of analysis used was an inductive thematic analysis of 10 peer-reviewed journal articles. Results: The thematic analysis generated in 3 themes; Improved lifestyle, Commitment to self-care and eHealth literacy an intermediate factor to health behaviours and health-related quality of life. The results showed that an increased level of eHealth literacy in older adults improved their health behaviours, health decisions and health outcomes in terms of well-being and health-related quality of life. eHealth literacy had both a direct and an indirect effect on the outcomes studied. Conclusion: The results highlighted the importance of working health-promoting with the elderly's eHealth literacy to be able to strengthen their health and participation in their own healthcare. eHealth literacy is a key factor for the health of the elderly and for theme to be able to use the e-health services available to their full potential.

Introduction The health of young people in England is an area of concern, nationally and internationally. This has prompted a range of strategies and policies to try to address how health may be improved. However, there has not necessarily been agreement as to how this should best be done. There appeared a case for consideration of alternative or additional approaches to health promotion. Aim This research aimed to construct an assets based model to shape health promotion practice and policy for young people in England. Methods A narrative synthesis was undertaken and highlighted the lack of information regarding which assets might be important for young people’s health in England. This programme of research was developed from those initial findings. Quantitative and qualitative methods were employed to gain a more comprehensive understanding than could be gained by individual methods. This mixed methods research involved secondary data analysis of the Health Behaviours in School Aged Children (HBSC) dataset using regression analysis to identify the assets associated with life satisfaction for English youth. Focus groups and interviews were employed to capture the views of young people regarding assets, health and health promotion. Findings were discussed with practitioners to gather their ideas as to the potential of an assets approach. The different research methods were drawn together by the underpinning theoretical frameworks provided by Assets models and the New Social Studies of Childhood. Results Two themes emerged from the narrative synthesis providing suggestions for health promotion; the ecological approach acknowledged the range of settings that young people inhabit, whilst the holistic approach recognised the interrelationship between risks and assets. Critical discussion consolidated the research findings to propose a list of health promoting assets for young people in England; constructive relationships, safety, positive attributes, independence and opportunity. These findings were brought together into a descriptive model to guide health promotion policy and practice (Figure 1). Constructive relationships appeared as a core asset, providing a foundation from which young people could develop. Having positive attributes was also fundamental to this process, which emphasises the importance of promoting physical and mental health simultaneously. Safety was the third core asset identified through the research strands. There was variation between young people regarding the definition of, and priority assigned to, the additional assets of independence and opportunity. Figure 1: Assets model to shape health promotion with young people Conclusion This research contributes to previous work in the field of assets models by providing new insight into the relatively little researched area of assets approaches to health promotion with young people in England. The complex interrelationships between mental health and assets have been highlighted; providing challenge to frameworks that focus on the quantitative accumulation of assets. The inclusion of young people’s perspectives provided new depth to previous theoretical models and interpretation of quantitative findings. The variation highlighted within this research raises implications for tackling health inequalities. This assets based model provides a framework to shape professional practice and policy thus providing the potential to improve young people’s health and wellbeing in a sustainable and non-stigmatising way.

Contexte: Les facteurs de risque comportementaux, notamment l’inactivité physique, le comportement sédentaire, le tabagisme, la consommation d’alcool et le surpoids sont les principales causes modifiables de maladies chroniques telles que le cancer, les maladies cardiovasculaires et le diabète. Ces facteurs de risque se manifestent également de façon concomitante chez l’individu et entraînent des risques accrus de morbidité et de mortalité. Bien que les facteurs de risque comportementaux aient été largement étudiés, la distribution, les patrons d’agrégation et les déterminants de multiples facteurs de risque comportementaux sont peu connus, surtout chez les enfants et les adolescents. Objectifs: Cette thèse vise 1) à décrire la prévalence et les patrons d’agrégation de multiples facteurs de risque comportementaux des maladies chroniques chez les enfants et adolescents canadiens; 2) à explorer les corrélats individuels, sociaux et scolaires de multiples facteurs de risque comportementaux chez les enfants et adolescents canadiens; et 3) à évaluer, selon le modèle conceptuel de l’étude, l’influence longitudinale d’un ensemble de variables distales (c’est-à-dire des variables situées à une distance intermédiaire des comportements à risque) de type individuel (estime de soi, sentiment de réussite), social (relations sociales, comportements des parents/pairs) et scolaire (engagement collectif à la réussite, compréhension des règles), ainsi que de variables ultimes (c’est-à-dire des variables situées à une distance éloignée des comportements à risque) de type individuel (traits de personnalité, caractéristiques démographiques), social (caractéristiques socio-économiques des parents) et scolaire (type d’école, environnement favorable, climat disciplinaire) sur le taux d’occurrence de multiples facteurs de risque comportementaux chez les enfants et adolescents canadiens. Méthodes: Des données transversales (n = 4724) à partir du cycle 4 (2000-2001) de l’Enquête longitudinale nationale sur les enfants et les jeunes (ELNEJ) ont été utilisées pour décrire la prévalence et les patrons d’agrégation de multiples facteurs de risque comportementaux chez les jeunes canadiens âgés de 10-17 ans. L’agrégation des facteurs de risque a été examinée en utilisant une méthode du ratio de cas observés sur les cas attendus. La régression logistique ordinale a été utilisée pour explorer les corrélats de multiples facteurs de risque comportementaux dans un échantillon transversal (n = 1747) de jeunes canadiens âgés de 10-15 ans du cycle 4 (2000-2001) de l’ELNEJ. Des données prospectives (n = 1135) à partir des cycle 4 (2000-2001), cycle 5 (2002-2003) et cycle 6 (2004-2005) de l’ELNEJ ont été utilisées pour évaluer l’influence longitudinale des variables distales et ultimes (tel que décrit ci-haut dans les objectifs) sur le taux d’occurrence de multiples facteurs de risque comportementaux chez les jeunes canadiens âgés de 10-15 ans; cette analyse a été effectuée à l’aide des modèles de Poisson longitudinaux. Résultats: Soixante-cinq pour cent des jeunes canadiens ont rapporté avoir deux ou plus de facteurs de risque comportementaux, comparativement à seulement 10% des jeunes avec aucun facteur de risque. Les facteurs de risque comportementaux se sont agrégés en de multiples combinaisons. Plus précisément, l’occurrence simultanée des cinq facteurs de risque était 120% plus élevée chez les garçons (ratio observé/attendu (O/E) = 2.20, intervalle de confiance (IC) 95%: 1.31-3.09) et 94% plus élevée chez les filles (ratio O/E = 1.94, IC 95%: 1.24-2.64) qu’attendu. L’âge (rapport de cotes (RC) = 1.95, IC 95%: 1.21-3.13), ayant un parent fumeur (RC = 1.49, IC 95%: 1.09-2.03), ayant rapporté que la majorité/tous de ses pairs consommaient du tabac (RC = 7.31, IC 95%: 4.00-13.35) ou buvaient de l’alcool (RC = 3.77, IC 95%: 2.18-6.53), et vivant dans une famille monoparentale (RC = 1.94, IC 95%: 1.31-2.88) ont été positivement associés aux multiples comportements à risque. Les jeunes ayant une forte estime de soi (RC = 0.92, IC 95%: 0.85-0.99) ainsi que les jeunes dont un des parents avait un niveau d’éducation postsecondaire (RC = 0.58, IC 95%: 0.41-0.82) étaient moins susceptibles d’avoir de multiples facteurs de risque comportementaux. Enfin, les variables de type social distal (tabagisme des parents et des pairs, consommation d’alcool par les pairs) (Log du rapport de vraisemblance (LLR) = 187.86, degrés de liberté = 8, P < 0,001) et individuel distal (estime de soi) (LLR = 76.94, degrés de liberté = 4, P < 0,001) ont significativement influencé le taux d’occurrence de multiples facteurs de risque comportementaux. Les variables de type individuel ultime (âge, sexe, anxiété) et social ultime (niveau d’éducation du parent, revenu du ménage, structure de la famille) ont eu une influence moins prononcée sur le taux de cooccurrence des facteurs de risque comportementaux chez les jeunes. Conclusion: Les résultats suggèrent que les interventions de santé publique devraient principalement cibler les déterminants de type individuel distal (tel que l’estime de soi) ainsi que social distal (tels que le tabagisme des parents et des pairs et la consommation d’alcool par les pairs) pour prévenir et/ou réduire l’occurrence de multiples facteurs de risque comportementaux chez les enfants et les adolescents. Cependant, puisque les variables de type distal (telles que les caractéristiques psychosociales des jeunes et comportements des parents/pairs) peuvent être influencées par des variables de type ultime (telles que les caractéristiques démographiques et socioéconomiques), les programmes et politiques de prévention devraient également viser à améliorer les conditions socioéconomiques des jeunes, particulièrement celles des enfants et des adolescents des familles les plus démunies. / Background: Behavioural risk factors including physical inactivity, sedentary behaviour, cigarette smoking, alcohol drinking, and being overweight are major modifiable causes of chronic diseases such as cancer, cardiovascular diseases and diabetes. These lifestyle risk factors also co-occur in individuals and lead to increased risks of chronic diseases morbidity and mortality. Although single behavioural risk factors have been extensively studied, little is known about the distribution, clustering patterns and potential determinants of multiple behavioural risk factors for chronic diseases, particularly in children and adolescents. Objectives: This thesis aims 1) to describe the prevalence and clustering patterns of multiple chronic disease behavioural risk factors in Canadian children and adolescents; 2) to explore potential individual, social and school correlates of multiple chronic disease behavioural risk factors in Canadian children and adolescents; and 3) to assess, based on the conceptual framework of this study, the longitudinal influence of selected individual (sense of self, sense of achievement), social (social relations, others’ behaviours) and school (collective commitment to success, comprehension of rules) distal variables (variables situated at an intermediate distance from behaviours), as well as selected individual (demographics and personality traits), social (parental socioeconomic characteristics) and school (type of school, supportive environment, disciplinary climate) ultimate variables (variables situated at an utmost distance from behaviours) on the rate of occurrence of multiple chronic disease behavioural risk factors in Canadian children and adolescents. Methods: Cross-sectional data (n = 4724) from Cycle 4 (2000-2001) of the National Longitudinal Survey of Children and Youth (NLSCY) were used to describe the prevalence and clustering patterns of multiple behavioural risk factors in Canadian youth aged 10-17 years. Clustering was assessed using an observed to expected ratio method. Ordinal logistic regression was used to explore correlates of multiple behavioural risk factors in a cross-sectional sample (n = 1747) of Canadian youth aged 10-15 years from Cycle 4 (2000-2001) of the NLSCY. Prospective data (n = 1135) from Cycle 4 (2000-2001), Cycle 5 (2002-2003) and Cycle 6 (2004-2005) of the NLSCY were used to assess the longitudinal influence of selected distal and ultimate variables (as described above in the objectives) on the rate of occurrence of multiple behavioural risk factors in Canadian youth aged 10-15 years; this analysis was performed using longitudinal Poisson models. Results: Sixty-five percent of Canadian youth had two or more behavioural risk factors compared to only 10% with no risk factor. Behavioural risk factors clustered in multiple combinations. Specifically, the simultaneous occurrence of all five risk factors was 120% greater in males (observed/expected (O/E) ratio = 2.20, 95% confidence interval (CI): 1.31-3.09) and 94% greater in females (O/E ratio = 1.94, 95% CI: 1.24-2.64) than expected by chance. Older age (odds ratio (OR) = 1.95, 95% CI: 1.21-3.13), caregiver smoking (OR = 1.49, 95% CI: 1.09-2.03), reporting that most/all of one’s peers smoked (OR = 7.31, 95% CI: 4.00-13.35) or drank alcohol (OR = 3.77, 95% CI: 2.18-6.53), and living in a lone-parent family (OR = 1.94, 95% CI: 1.31-2.88) increased the likelihood of having multiple health risk behaviours. Youth with high self-esteem (OR = 0.92, 95% CI: 0.85-0.99) and youth from families with post-secondary education (OR = 0.58, 95% CI: 0.41-0.82) were less likely to have a higher number of behavioural risk factors. Finally, social distal variables (caregiver smoking, peer smoking, peer drinking) (Log-likelihood ratio (LLR) = 187.86, degrees of freedom = 8, P < 0.001) and individual distal variables (such as self-esteem) (LLR = 76.94, degrees of freedom = 4, P < 0.001) significantly influenced the rate of occurrence of multiple behavioural risk factors. Individual ultimate variables (age, sex, anxiety) and social ultimate variables (parental education, household income, family structure) exerted a less pronounced influence on the rate of co-occurrence of behavioural risk factors among youth. Conclusion: The results suggest that public health interventions should primarily target the individual distal (such as self-esteem) and social distal variables (such as parental smoking, peer smoking and peer drinking) to reduce or prevent the occurrence of multiple behavioural risk factors among youth. However, since distal variables (such as psychosocial characteristics and others’ behaviours) may be influenced by ultimate variables (such as demographic and socioeconomic characteristics), prevention programs and policies should also aim to improve the socioeconomic conditions of children and adolescents, particularly those of youth from less affluent families.

Contexte: Les facteurs de risque comportementaux, notamment l’inactivité physique, le comportement sédentaire, le tabagisme, la consommation d’alcool et le surpoids sont les principales causes modifiables de maladies chroniques telles que le cancer, les maladies cardiovasculaires et le diabète. Ces facteurs de risque se manifestent également de façon concomitante chez l’individu et entraînent des risques accrus de morbidité et de mortalité. Bien que les facteurs de risque comportementaux aient été largement étudiés, la distribution, les patrons d’agrégation et les déterminants de multiples facteurs de risque comportementaux sont peu connus, surtout chez les enfants et les adolescents. Objectifs: Cette thèse vise 1) à décrire la prévalence et les patrons d’agrégation de multiples facteurs de risque comportementaux des maladies chroniques chez les enfants et adolescents canadiens; 2) à explorer les corrélats individuels, sociaux et scolaires de multiples facteurs de risque comportementaux chez les enfants et adolescents canadiens; et 3) à évaluer, selon le modèle conceptuel de l’étude, l’influence longitudinale d’un ensemble de variables distales (c’est-à-dire des variables situées à une distance intermédiaire des comportements à risque) de type individuel (estime de soi, sentiment de réussite), social (relations sociales, comportements des parents/pairs) et scolaire (engagement collectif à la réussite, compréhension des règles), ainsi que de variables ultimes (c’est-à-dire des variables situées à une distance éloignée des comportements à risque) de type individuel (traits de personnalité, caractéristiques démographiques), social (caractéristiques socio-économiques des parents) et scolaire (type d’école, environnement favorable, climat disciplinaire) sur le taux d’occurrence de multiples facteurs de risque comportementaux chez les enfants et adolescents canadiens. Méthodes: Des données transversales (n = 4724) à partir du cycle 4 (2000-2001) de l’Enquête longitudinale nationale sur les enfants et les jeunes (ELNEJ) ont été utilisées pour décrire la prévalence et les patrons d’agrégation de multiples facteurs de risque comportementaux chez les jeunes canadiens âgés de 10-17 ans. L’agrégation des facteurs de risque a été examinée en utilisant une méthode du ratio de cas observés sur les cas attendus. La régression logistique ordinale a été utilisée pour explorer les corrélats de multiples facteurs de risque comportementaux dans un échantillon transversal (n = 1747) de jeunes canadiens âgés de 10-15 ans du cycle 4 (2000-2001) de l’ELNEJ. Des données prospectives (n = 1135) à partir des cycle 4 (2000-2001), cycle 5 (2002-2003) et cycle 6 (2004-2005) de l’ELNEJ ont été utilisées pour évaluer l’influence longitudinale des variables distales et ultimes (tel que décrit ci-haut dans les objectifs) sur le taux d’occurrence de multiples facteurs de risque comportementaux chez les jeunes canadiens âgés de 10-15 ans; cette analyse a été effectuée à l’aide des modèles de Poisson longitudinaux. Résultats: Soixante-cinq pour cent des jeunes canadiens ont rapporté avoir deux ou plus de facteurs de risque comportementaux, comparativement à seulement 10% des jeunes avec aucun facteur de risque. Les facteurs de risque comportementaux se sont agrégés en de multiples combinaisons. Plus précisément, l’occurrence simultanée des cinq facteurs de risque était 120% plus élevée chez les garçons (ratio observé/attendu (O/E) = 2.20, intervalle de confiance (IC) 95%: 1.31-3.09) et 94% plus élevée chez les filles (ratio O/E = 1.94, IC 95%: 1.24-2.64) qu’attendu. L’âge (rapport de cotes (RC) = 1.95, IC 95%: 1.21-3.13), ayant un parent fumeur (RC = 1.49, IC 95%: 1.09-2.03), ayant rapporté que la majorité/tous de ses pairs consommaient du tabac (RC = 7.31, IC 95%: 4.00-13.35) ou buvaient de l’alcool (RC = 3.77, IC 95%: 2.18-6.53), et vivant dans une famille monoparentale (RC = 1.94, IC 95%: 1.31-2.88) ont été positivement associés aux multiples comportements à risque. Les jeunes ayant une forte estime de soi (RC = 0.92, IC 95%: 0.85-0.99) ainsi que les jeunes dont un des parents avait un niveau d’éducation postsecondaire (RC = 0.58, IC 95%: 0.41-0.82) étaient moins susceptibles d’avoir de multiples facteurs de risque comportementaux. Enfin, les variables de type social distal (tabagisme des parents et des pairs, consommation d’alcool par les pairs) (Log du rapport de vraisemblance (LLR) = 187.86, degrés de liberté = 8, P < 0,001) et individuel distal (estime de soi) (LLR = 76.94, degrés de liberté = 4, P < 0,001) ont significativement influencé le taux d’occurrence de multiples facteurs de risque comportementaux. Les variables de type individuel ultime (âge, sexe, anxiété) et social ultime (niveau d’éducation du parent, revenu du ménage, structure de la famille) ont eu une influence moins prononcée sur le taux de cooccurrence des facteurs de risque comportementaux chez les jeunes. Conclusion: Les résultats suggèrent que les interventions de santé publique devraient principalement cibler les déterminants de type individuel distal (tel que l’estime de soi) ainsi que social distal (tels que le tabagisme des parents et des pairs et la consommation d’alcool par les pairs) pour prévenir et/ou réduire l’occurrence de multiples facteurs de risque comportementaux chez les enfants et les adolescents. Cependant, puisque les variables de type distal (telles que les caractéristiques psychosociales des jeunes et comportements des parents/pairs) peuvent être influencées par des variables de type ultime (telles que les caractéristiques démographiques et socioéconomiques), les programmes et politiques de prévention devraient également viser à améliorer les conditions socioéconomiques des jeunes, particulièrement celles des enfants et des adolescents des familles les plus démunies. / Background: Behavioural risk factors including physical inactivity, sedentary behaviour, cigarette smoking, alcohol drinking, and being overweight are major modifiable causes of chronic diseases such as cancer, cardiovascular diseases and diabetes. These lifestyle risk factors also co-occur in individuals and lead to increased risks of chronic diseases morbidity and mortality. Although single behavioural risk factors have been extensively studied, little is known about the distribution, clustering patterns and potential determinants of multiple behavioural risk factors for chronic diseases, particularly in children and adolescents. Objectives: This thesis aims 1) to describe the prevalence and clustering patterns of multiple chronic disease behavioural risk factors in Canadian children and adolescents; 2) to explore potential individual, social and school correlates of multiple chronic disease behavioural risk factors in Canadian children and adolescents; and 3) to assess, based on the conceptual framework of this study, the longitudinal influence of selected individual (sense of self, sense of achievement), social (social relations, others’ behaviours) and school (collective commitment to success, comprehension of rules) distal variables (variables situated at an intermediate distance from behaviours), as well as selected individual (demographics and personality traits), social (parental socioeconomic characteristics) and school (type of school, supportive environment, disciplinary climate) ultimate variables (variables situated at an utmost distance from behaviours) on the rate of occurrence of multiple chronic disease behavioural risk factors in Canadian children and adolescents. Methods: Cross-sectional data (n = 4724) from Cycle 4 (2000-2001) of the National Longitudinal Survey of Children and Youth (NLSCY) were used to describe the prevalence and clustering patterns of multiple behavioural risk factors in Canadian youth aged 10-17 years. Clustering was assessed using an observed to expected ratio method. Ordinal logistic regression was used to explore correlates of multiple behavioural risk factors in a cross-sectional sample (n = 1747) of Canadian youth aged 10-15 years from Cycle 4 (2000-2001) of the NLSCY. Prospective data (n = 1135) from Cycle 4 (2000-2001), Cycle 5 (2002-2003) and Cycle 6 (2004-2005) of the NLSCY were used to assess the longitudinal influence of selected distal and ultimate variables (as described above in the objectives) on the rate of occurrence of multiple behavioural risk factors in Canadian youth aged 10-15 years; this analysis was performed using longitudinal Poisson models. Results: Sixty-five percent of Canadian youth had two or more behavioural risk factors compared to only 10% with no risk factor. Behavioural risk factors clustered in multiple combinations. Specifically, the simultaneous occurrence of all five risk factors was 120% greater in males (observed/expected (O/E) ratio = 2.20, 95% confidence interval (CI): 1.31-3.09) and 94% greater in females (O/E ratio = 1.94, 95% CI: 1.24-2.64) than expected by chance. Older age (odds ratio (OR) = 1.95, 95% CI: 1.21-3.13), caregiver smoking (OR = 1.49, 95% CI: 1.09-2.03), reporting that most/all of one’s peers smoked (OR = 7.31, 95% CI: 4.00-13.35) or drank alcohol (OR = 3.77, 95% CI: 2.18-6.53), and living in a lone-parent family (OR = 1.94, 95% CI: 1.31-2.88) increased the likelihood of having multiple health risk behaviours. Youth with high self-esteem (OR = 0.92, 95% CI: 0.85-0.99) and youth from families with post-secondary education (OR = 0.58, 95% CI: 0.41-0.82) were less likely to have a higher number of behavioural risk factors. Finally, social distal variables (caregiver smoking, peer smoking, peer drinking) (Log-likelihood ratio (LLR) = 187.86, degrees of freedom = 8, P < 0.001) and individual distal variables (such as self-esteem) (LLR = 76.94, degrees of freedom = 4, P < 0.001) significantly influenced the rate of occurrence of multiple behavioural risk factors. Individual ultimate variables (age, sex, anxiety) and social ultimate variables (parental education, household income, family structure) exerted a less pronounced influence on the rate of co-occurrence of behavioural risk factors among youth. Conclusion: The results suggest that public health interventions should primarily target the individual distal (such as self-esteem) and social distal variables (such as parental smoking, peer smoking and peer drinking) to reduce or prevent the occurrence of multiple behavioural risk factors among youth. However, since distal variables (such as psychosocial characteristics and others’ behaviours) may be influenced by ultimate variables (such as demographic and socioeconomic characteristics), prevention programs and policies should also aim to improve the socioeconomic conditions of children and adolescents, particularly those of youth from less affluent families.

MCur / Department of Advanced Nursing Science / Background: Adolescent sexual health is fundamental to the physical and emotional health, and well-being of individuals, couples, and families, as well as the social and economic development of communities and countries. The purpose and the aim of this study was to explore and describe the community’s perceptions of adolescent sexual health in Mutale Municipality, Vhembe District of Limpopo Province. Methodology: The research design of this study was qualitative, explorative, descriptive and contextual in nature. The population comprised of every adult community member or resident of Tshiungani Village. Both genders were included in the sample. Parents and guardians of adolescents made up the sample. Data were collected by means of in-depth face-to-face interviews. Data were analysed qualitatively using Teschs’ qualitative analysis. Findings: The study involved six themes, six categories and nineteen sub-themes. The community expressed concerns related to degradation of cultural norms and values, change in family structure, effects of media, politics, religion and poverty as affecting adolescent sexual health. Conclusion: The study explored and described the perceptions of community members regarding adolescent sexual health although the findings could not be generalized as it represents only part of the population. Recommendations: The study recommended intense sexual health education and promotion at early primary phase, career guidance to enhance and promote selfesteem, parental and community involvement in assisting and engaging adolescents with life skills within communities.

Adolescent perspectives on health and the social and literate values of their health related behaviours require exploration and examination in health literacy, as knowledge gaps related to the constituents of health literate practices, and the functions and acquisition of health literacy exist in the literature. Research addressing this was approached based on socio-cultural and socio-ecological principles using a collective instrumental case design. Participants were new adolescent mother aged 15-18 recruited from 4 different community/education programs around Victoria, BC. Data was collected over a four month period, and consisted of individual and focus group interviews, journals, and researchers’ observations and field notes. Findings show that participants’ health behaviours changed significantly in tandem with their identities, the groups they associated with, and the social contexts they moved within. Findings indicate that identity, informal social environments, and unconscious cognitive process and psychosocial needs play a role in adolescents health literacy and literate practices.