Cette thèse vise un apport conceptuel et empirique au sujet du rapport à l’alcool chez les hommes et les femmes âgés de 55 ans et plus provenant de la population générale du Canada. Les deux objectifs généraux sont de mieux comprendre l’influence du contexte social/environnemental sur la consommation d’alcool des adultes âgés et de mieux comprendre la relation entre la consommation d’alcool et la santé. La thèse est composée de deux articles empiriques associés à chacun des objectifs. Plus précisément, le premier article tente d’évaluer l’impact des changements associés à l’alcool depuis les années 1990 dans le contexte canadien sur la consommation d’alcool (effet période) en comparant des adultes âgés de 55 à 74 ans provenant de deux enquêtes populationnelles canadiennes : CADS de 1994 (Canada’s Alcohol and other Drugs Survey) et GENACIS de 2004 (GENder, Alcohol, and Culture: an International Study). Il vérifie également si le contexte a un effet significatif sur les différences observées en tenant compte de l’âge, de la perception subjective de la santé et de la composition sociodémographique des échantillons. Les résultats montrent que les taux de buveurs, de consommation excessive, de buveurs de bière et de vin sont plus élevés en 2004, dans un contexte social/environnemental plus favorable à l’alcool. De plus, les profils de consommation d’alcool ne diffèrent pas entre 1994 et 2004 (volume, fréquence, quantité, quantité maximale), signifiant probablement l’influence des changements physiques qui accompagnent le vieillissement normal sur la modulation de la consommation d’alcool avec l’âge. Le deuxième article vise à dégager une typologie de buveurs et de non-buveurs chez les adultes âgés canadiens, à évaluer comment cette typologie est associée à l’état de santé ainsi qu’à comparer le rôle de l’alcool à celui d’un ensemble d’autres déterminants de la santé dans l’association à la santé (ici santé autoperçue). Les résultats issus de l’enquête GENACIS de 2004 montrent que les buveurs se perçoivent en meilleure santé que les non-buveurs, peu importe le profil de consommation d’alcool rapporté. Il est probable que l’état de santé autoperçue dicte le statut de buveur ou de non-buveur et non pas l’inverse. Les résultats montrent aussi que les caractéristiques démographiques, psychosociales et les comportements liés à la santé des adultes âgés sont davantage associés à la perception de leur santé que leur consommation (ou non-consommation) d’alcool seule. Les résultats de ce second article indiquent notamment que les bienfaits de la consommation d’alcool se définissent probablement par la biologie, mais pas seulement par la biologie. Il est recommandé de poursuivre l’étude du rapport à l’alcool chez les adultes âgés qui peut varier d’une cohorte et d’une période à l’autre. D’un point de vue de santé publique, la conceptualisation d’un modèle de santé qui cible les adultes âgés implique une meilleure compréhension de l’impact de la consommation d’alcool et d’autres déterminants de la santé sur l’état de santé. Les contributions et implications pratiques de la thèse ainsi que les principales limites et pistes de futures recherches sont présentées dans la discussion. / The aim of the thesis is to contribute to a better conceptual and empirical understanding of alcohol consumption among men and women aged 55 years and older from the general Canadian population. The two general objectives pursued are to gain a better understanding of the potential influence of the social/environmental context on drinking habits among older adults and to achieve a clearer discernment of the relation between alcohol consumption and health. The thesis comprises two empirical articles relating to each respective objective. More specifically, the first article verified whether contextual changes associated to alcohol and unique to the decade spanning the 1990s may have had an impact on alcohol consumption (period effect) by comparing two subsamples of older adults from two Canadian surveys: the 1994 CADS (Canada’s Alcohol and other Drugs Survey) and 2004 GENACIS (GENder, Alcohol, and Culture: an International Study). The article also assessed if the context had a significant effect on the differences observed when age, subjective perception of health and the sociodemographic composition of the samples were taken into consideration. Results first show that, in a social/environmental context that is more favourable to drinking in general, the rates of current drinkers, binge drinking, beer and wine drinkers are significantly higher in 2004. In addition, drinking profiles were not significantly different between 1994 and 2004 (volume, frequency, quantity, maximum quantity), pointing at the potential impact of normal physiological changes due to aging on drinking profiles. The second article aimed to build a drinking typology (including drinkers and non-drinkers) among older Canadian adults, to assess how the drinking typology was related to health status and to compare the role of alcohol with other determinants of health (demographic, psychosocial and health-related factors) in explaining health status. To do so, the subjective perception of health (subjective health) was used as a proxy for actual health status. Results from the 2004 GENACIS survey indicated that drinkers perceived themselves as being in better physical health than nondrinkers, regardless of the drinking pattern. Health status may explain drinking status and not the opposite. Results also showed that the demographic, psychosocial and health-related characteristics of older adults contributed significantly more to the variation in subjective health than the drinking status alone. Health benefits of drinking are explained by biological factors, but not exclusively by biological factors. In conclusion, alcohol research needs to emphasize the study of drinking among older adults, which can vary depending on the cohort and period under study. From a public health perspective, health-predicting models focusing on older adults need to be built on a better understanding of the impact of alcohol and other determinants of health on health status. Main contributions, practical implications, limitations of the thesis and recommendations for future research are presented in the discussion.

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Background Adolescent subjective health and mental problems have become a public health concern not only in Sweden but worldwide. The overall aim of this thesis is to deepen and widen the understanding of young peoples’ subjective health, psychosomatic and stress-related problems. A special focus is put on experienced stress among adolescent girls and young women. The study setting is one youth health centre, and three upper secondary schools in Umeå, a university town in northern Sweden. The research design combines qualitative and quantitative methods with the main focus on qualitative methods. An interdisciplinary theoretical synthesis is utilised, primarily based on bio-psycho-social, phenomenological, and social constructionist approaches. The three qualitative papers (I-III) are based on the same sample of 40 young women who had sought help at the youth health centre because of their stress-related problems. Paper I explores the stressors experienced by the young women, whereas Paper II explores the lived experiences of stress. Paper III examines the young women’s experiences of living in a violent partner relationship as young teenagers, and how this has affected their lives and health over time. Paper IV investigates perceived stress and subjective health complaints among older adolescents in upper secondary school.   Methods Data was derived from: a) a qualitative interview study with 40 adolescent girls and young women, aged between 16–25 years, who had sought help at the youth health centre for stress problems. Qualitative content analysis was used in combination with discourse-orientated analysis (Paper I); a phenomenological approach (Paper II), and narrative method (Paper III); b) a school-based survey with a sample of 16–18-year-old boys and girls (n=1027), in upper secondary school, grades 1 and 2, from different educational programs at three schools. Perceived stress, self-rated health, subjective health complaints, anxiety, and depression, were measured with a questionnaire including a set of instruments. Statistical analyses were descriptive and analytical.   Results Paper I identified multiple stressors of modernity, gender orders and youth. Contextual factors, including social constructions and practices of gender, played an important role for the stress experienced by these young women. The results revealed that multiple and intersecting stressors and demands connected to essential life spheres, contributed not only to experiences of distress but also to feelings of constraint. Moreover, the roles of excessive taking of responsibility and failing adult support were revealed. Paper II illuminated multidimensional lived and embodied experiences of distress. ‘Living close to the edge’ emerged as the common theme running through all of the interviews and captured the young women’s sometimes unbearable situations. The theme contains dimensions of physical, emotional, cognitive, social, and existential distress, as well as dimensions of distrust and disempowerment. Paper III examined two Swedish adolescent girls’ experiences of living in a violent relationship as teenagers, and how this has affected their lives and health over time. The analysis revealed violation, stress, trauma, coping, and agency during adolescence and the transition into adulthood. Paper IV showed a high level of perceived stress, and subjective health and stress complaints among boys and girls. High pressure and excessive demands from school were experienced by a majority of boys and girls. Perceived stress was correlated with subjective health and stress complaints and anxiety. There was a clear gender difference: two to three times as many girls than boys reported subjective health complaints, e.g. headaches, tiredness and sleeping difficulties, musculoskeletal pain, sadness and anxiety.   Conclusion Several issues of relevance to public health were raised throughout the thesis. According to the interview results, the young women face multiple and intersecting stressors of modernity, gender orders and being young, which correspond to their multidimensional experiences of ‘living close to the edge’. Their experiences of stress are multidimensional, and include physical, emotional, cognitive, social and existential dimensions. Findings from the qualitative study were also mirrored in the findings from the larger group of adolescents in the school survey, where a high proportion of older adolescents, particularly girls, reported perceptions of stress. Moreover, perceived stress correlated to a variety of subjective health complaints and anxiety. The results can be understood and explained from a variety of perspectives. The experience of ‘managing alone’ indicated perceptions of inadequate social support. The overall results indicated a risk of more negative health development, particularly among adolescent girls and young women. Stressors of modernity, gender orders and youth were prominent. The continuation and normalisation of oppression and violence are also discussed as a severe gendered stressor in young women’s lives. This calls for a broad contextualised and gender-sensitive approach to young people’s stress and health problems. In conclusion, the age and gender gap in adolescent health needs to be further explored, and processes of distress, distrust and disempowerment have to be taken more seriously. / Under det senaste decenniet har medier och flertalet nationella forskningsrapporter informerat om ökande psykisk ohälsa och stress bland barn och unga i Sverige. Denna avhandlings syfte är att med hjälp av en utforskande och tvärvetenskaplig ansats fördjupa förståelsen av subjektiva ohälsoproblem och upplevd stress bland unga i Sverige, med speciellt fokus på flickors och unga kvinnors upplevda stressproblem. Avhandlingen har en explorativ och flexibel studiedesign som kombinerar kvalitativa och kvantitativa forskningsmetoder med särskild tyngdpunkt på de kvalitativa metoderna. Datainsamling har genomförts med a) kvalitativa forskningsintervjuer med en grupp flickor och unga kvinnor (16–25 år) som sökt hjälp för stressrelaterade problem på en ungdomshälsomottagning i Umeå, och b) en skolbaserad enkätunder-sökning med totalt 1027 pojkar och flickor, 16–18 år, i åk 1–2 på tre kommunala gymnasieskolor i Umeå. Forskningsintervjuerna har huvudsakligen analyserats med kvalitativ innehållsanalys. Innehållsanalysen har i de olika delarbetena sedan kombinerats med diskursorienterad analys (Artikel I), med fenomenologisk ansats (Artikel II) och med narrativ metod (Artikel III). Skolenkäten har analyserats med deskriptiva och analytiska statistiska metoder (Artikel IV). Resultaten från den kvalitativa intervjuundersökningen med unga kvinnor belyser a) multipla stressorer som kan hänföras till flera parallella områden i livet – men även till samhälleliga diskurser: modernitetens stressorer, genusordningarnas stressorer och ungdoms-årens stressorer, b) multidimensionella, levda och förkroppsligade erfarenheter av stress och ”att leva på gränsen” som innefattar fysiska, emotionella, kognitiva, sociala och existentiella dimensioner och c) erfarenheter av våld och kontroll i partnerrelationer samt deras konsekvenser. Resultaten från enkätundersökningen med gymnasielever visar att en stor andel av ungdomarna rapporterar subjektiva hälso- och stressbesvär av olika slag inklusive oro och ångest. Jämfört med pojkarna så är det två till tre gånger fler flickor som rapporterar besvär och denna skillnad är signifikant. En majoritet av ungdomarna håller ett högt tempo och upplever sig också pressade av krav från skolan samt av egna inre krav. Upplevelserna av stress i form av högt tempo och höga krav korrelerar med de subjektiva hälso- och stressbesvären samt med ångest.   Sammanfattningsvis visar avhandlingen att ungas stressrelaterade och subjektiva hälsobesvär bör förstås i ett vidare socialt sammanhang som inkluderar ett genusperspektiv. Kontext- och genusspecifika interventionsmodeller behöver utvecklas för att möta dessa hälsoproblem, men stress bland unga behöver också diskuteras och studeras vidare i relation till hur samhällsutvecklingen och dess värdegrunder påverkar unga av idag.

Syfte och frågeställningar Syftet med studien var att undersöka samband mellan socialt stöd och nätverk gentemot upplevd fysisk och psykisk hälsa hos gymnasielever i årskurs tre. Frågeställningarna var huruvida det fanns några samband mellan socialt stöd och nätverk gentemot upplevd fysisk och psykisk hälsa, vilken form av socialt stöd och nätverk som var mest relevant och vilken roll dess storlek har, samt om det fanns några skillnader mellan könen i förhållandet till socialt stöd och nätverk. Metod Undersökningen är en explorativ och kvantitativ enkätstudie där totalt 326 individer från olika skolor i Eskilstuna, Stockholm och Filipstad ingick. Åldern på deltagarna varierade mellan 17 och 21 år och medelålder var 18 (±0,7) år. 198 var tjejer och 123 killar, fem personer ville ej svara på frågan eller uppfattade sig inte som något av alternativen. Deltagarna besvarade frågor med fasta svarsalternativ kring kvalitén på sitt sociala stöd och storleken på sitt sociala nätverk, samt om upplevd fysisk och psykisk hälsa. Därefter genomfördes olika korrelationsobservationer för att finna eventuella samband mellan de olika faktorerna. Deltagarna till studien har valts utifrån ett icke slumpmässigt, till viss del typiskt, bekvämlighetsmässigt urval. Resultat Signifikanta positiva samband noterades mellan graden av socialt stöd (kvalitet) och upplevd psykisk respektive fysisk hälsa. Starkast korrelation fanns mellan psykisk hälsa och socialt stöd (r = 0,46). Svaga positiva korrelationer fanns mellan antalet (kvantitet) vänner (r = 0,19) respektive familjemedlemmar och släktingar (r = 0,19) gentemot psykisk hälsa, och i förhållande till familj och släkt även den fysiska (r = 0,14). Inga signifikanta skillnader kunde ses mellan könen. Slutsats Studiens hypotes om en positiv samvariation mellan upplevd hälsa och socialt stöd och nätverk stämde i de flesta fall och kvalitet visade sig vara överordnad kvantitet. / Aim The purpose of this study was to examine relations between social support and networks, against the perceived physical and mental health of high school students in grade three. The question formulations were whether there was any correlation between social support and networks against perceived physical and mental health, which form of social support and network that were most relevant and what role its size has, and if there were any gender differences in relation to social support and networks. Method The study is an exploratory and quantitative survey in which a total of 326 individuals were included from various schools in Eskilstuna, Stockholm and Filipstad. The age of the participants ranged between 17 and 21 years, and mean age was 18 (±0.7) years, 198 were girls and 123 boys, five people did not answer the question or did not perceived themselves as either one of the options. The participants answered questions with response sets about the quality of their social support and the size of their social network and perceived physical and mental health. After that, observations were completed to find eventual correlations between the different factors. Participants for this study were selected on a non-random, somewhat typical, conveniences based method. Results Significant positive correlations were observed between the degree of social support (quality) and perceived mental and physical health Strongest correlation was found between mental health and social support (r = 0,46). Low positive correlation was found between the number (quantity) of friends (r = 0,19) and family/relatives (r = 0,19) in relation to mental health, and in relation to family and relatives also the physical health (r = 0,14). No significant differences were seen between the sexes. Conclusion The study’s hypothesis of a positive correlation between perceived health and social support and network sued in most cases, and the quality was shown to be superior to the quantity.