The Latino immigrant population in the United States has grown rapidly, now standing at over 56 million people. Due to this increase in Latino immigrants, investigation of their mental and physical health is crucial. Few studies have investigated conjointly both physical and mental health in Latino immigrant adults. Daily discrimination and acculturative stress have been found to affect the mental and physical health of Latino immigrants. Cultural strengths including social support, religiosity, and enculturation have been linked to Latino immigrant health. In the minority stress model, cultural strengths have been theorized to moderate relationships between discrimination and health. The purpose of this study was to examine the relationships among acculturative stress, discrimination, and mental and physical health. A secondary aim was to examine whether direct and indirect effects among these series of variables are moderated by social support, religiosity, and enculturation. A community sample of 204 Latino immigrants were recruited. Generally, bivariate associations between variables were congruent with previous research. Anxiety was found to mediated the effects of both acculturative stress and discrimination on physical health. Depression was found to mediate the effect of discrimination on physical health. Social support was found to moderate indirect effect of discrimination on physical health through depression. Enculturation moderated the indirect effects of both acculturative stress and discrimination on physical health through anxiety. Results from this study indicate that minority stressors can impact physical health through mental health, and these relationships can be buffered by links to cultural strengths including social support and enculturation.

Introduction: Recently there has been increasing interest in understanding and addressing health inequalities and enhancing the well-being of the population as a whole through anticipatory care and better health care delivery. The current study aimed to investigate the predictive relationships between smoking behaviour, physical health, and mental health in a deprived population using models of mediation. Method: Participants had attended a Keep Well health check, a national programme offering health screening, advice, referrals and signposting to individuals aged 45-64 living in deprived areas. Participants completed a questionnaire measuring smoking status, physical health (RAND general health subscale), mental health symptoms (GHQ-12), positive mental health (WEMWBS), and demographic information. Results: The current study found that smoking mediated the relationship between mental health problems and physical health, as well as mediating the relationship between positive mental health and physical health. Discussion: These findings suggest that by offering interventions to encourage individuals to stop smoking health care providers can hope to reduce mental health problems via direct effects but also via an indirect benefit of improvements in physical health. There are also opportunities to improve physical health via the direct effects of reducing mental health problems and increasing positive mental health, as well as the indirect effect of smoking.

Extensive literature in the social and medical sciences link religiosity to positive health outcomes. Conversely it is often assumed that secularity carries negative consequences for health; however, recent research outlining different types of secular individuals complicates this assumption. Using a national sample of American adults, we compare physical and mental health outcomes for atheists, agnostics, religiously nonaffiliated theists, and theistic members of organized religious traditions. Results indicate better physical health outcomes for atheists compared to other secular individuals and members of some religious traditions. Atheists also reported significantly lower levels of psychiatric symptoms (anxiety, paranoia, obsession, and compulsion) compared to both other seculars and members of most religious traditions. In contrast, physical and mental health were significantly worse for nonaffiliated theists compared to other seculars and religious affiliates on most outcomes. These findings highlight the necessity of distinguishing among different types of secular individuals in future research on health.

The findings of this PhD provide a significant contribution to early intervention research. The ability to detect those at ultra-high risk for psychosis (UHR) has been made possible in recent years. It is well known that people with serious mental illness have poor physical health, yet prior to this PhD little was known about the physical health of UHR individuals. This PhD explores the physical health and lifestyle of the UHR group, and makes recommendations for the development of a physical health intervention. A range of methods have been used including quantitative and qualitative methods, systematic reviews and meta-analyses, and a clinical audit. Therefore, a multifaceted approach to investigate the physical health and lifestyle of UHR individuals has been taken. Papers 1-3 suggest UHR individuals are more likely to live an unhealthy lifestyle than their peers. This includes lower levels of physical activity, and higher levels of substance use (generally cannabis, tobacco and alcohol). Paper 4 contains a clinical audit showing physical health and lifestyle factors are not monitored routinely in early detection services, despite the UHR phase being an ideal opportunity to intervene. Living an unhealthy lifestyle can have a detrimental effect on physical and mental health. Papers 1-4 emphasise the need to intervene to promote a healthy lifestyle for the UHR group. In line with the Medical Research Guidelines for the development of complex interventions, a theoretical model is applied in Paper 5. The final paper presents a qualitative study with UHR individuals, their parents and clinicians to explore barriers and facilitators to living a healthy lifestyle and inform the development of a physical health intervention. A final evidence synthesis includes recommendations for future work and the clinical implications of this thesis. The findings of this PhD provide an important and timely contribution to early intervention research. Prior to this work, the physical health of UHR individuals had been largely under researched. For the first time, this PhD presents evidence to suggest individuals at ultra-high risk for psychosis experience cardiovascular risk, and there is an opportunity to intervene to promote physical health. Although not all UHR individuals will develop psychosis, many will continue to experience difficulties with their mental health. Given that this group are also more likely to live an unhealthy lifestyle, it is important to take a holistic approach to treating those at imminent risk for psychosis, considering both mental and physical health.

The objective of this thesis is to assess the prevalence of low quality of life in adult cancer survivors and predictors for these low scores, separately for physical and mental quality of life. Possible predictors can include sociodemographic, clinical, and behavioral factors. The data source for this thesis is the National Health and Nutrition Examination Survey (NHANES) 2005-2012. The sample population included 1244 cancer survivors 20 years or older that answered “yes” to the question “have you ever been told by a doctor or other health professional that had cancer or malignancy of any kind?” Mental and physical health scores were determined based on the number of days physical and mental health was not good and dichotomized according to mean value. The four groups identified were low mental health and low physical health (n=148, 11.9%), low mental health and high physical health (n=239, 19.2%), high mental health and low physical health (n=143, 11.5%), and high mental health and high physical health (n=714, 57.4%). The diet quality was calculated using the Healthy Eating Index 2015, which measures adherence to the Dietary Guidelines for Americans 2015-2020. The SAS Survey Analysis Procedures was used to account for the random multi-stage sampling of NHANES. Also, ANOVA and chi-square tests were used to determine the possible predictors of low quality of life while multivariable logistic regression analysis was performed to examine the independent predictors of low physical and mental health. Statistical significance was set at a two-sided p-value of

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