Public involvement in health services is an area of policy where ostensibly good intentions appear to repeatedly fail in implementation. Since the late 1990s public involvement in the UK NHS has been subject to frequent reforms, and this has continued in Scotland since devolution. Reformers have criticised mechanisms for being subject to manipulation by managers, parochial in their outlook, and crucially, ‘unrepresentative’ of the wider public. Academic literature has responded primarily by seeking to ‘fix’ the problems of public involvement, offering typologies and models of participation intended to apply across a wide range of settings and to the entire ‘public’. Taking a different route focused on the complexity of a single case, this thesis explores the multiple meanings and goals contained within the public involvement agenda in Scotland, and argues that these are far-removed from the way that many individual patients seek to influence their health-care in the everyday. In particular this project illuminates the creative and political potential of citizens’ interactions with public services. Research comprises an interpretive case study of the implementation of public involvement policy within one Community Health Partnership in Scotland, and a nested case study of interviews with ‘ordinary’ young adults in the area. Fieldwork across twelve months included semi-structured interviews with staff, participants, and young adults; observation of public and private meetings of the Community Health Partnership and the Public Partnership Forum; and analysis of local reports and plans for public involvement. Given a low level of awareness or interest in public involvement, interviews with young adults concentrated instead on accounts of using health services. Rather than simply illuminating ‘non-participation’, the resulting data act as a lens through which public involvement policy can be seen anew. Public involvement is depicted as an unevenly embedded assemblage of actors and materials pursuing a range of goals, including the strengthening of public influence and the diversification of the public voice. I argue that many current participants in the Public Partnership Forum seek not to change the NHS, but to serve or assist it, and accordingly that their actions can best be understood as work or volunteering, not as activism. Finally, drawing on the reported experiences of my young adult interviewees, I argue that the transition from individual patient to participant is an unlikely one, revealing a range of alternative (oppositional) tactics available to individuals who feel unhappy with some aspect of their care. I conclude by arguing that NHS staff confront the inherently chimerical nature of participatory projects within public services. By operating without a sense of what amount or degree of participation is ‘good enough’, public involvement re-interprets my young adult interviewees as apathetic nonparticipants, and NHS managers and staff as failed engagers. The thesis uncovers the neglected, often-mundane everyday realities of public involvement as both governmental practice and citizen participation. In doing so it troubles the growing literature on contemporary forms of citizen participation and engagement, demonstrating the need for a critical approach to an ostensibly compelling policy agenda.

Prominent theories in political participation literature predict that those with higher levels of income and education are more like to engage in politics. Given the perception of Asian New Zealanders as wealthy and well educated it is puzzling not only to find that this community has low levels of political participation, but that a similar pattern emerges in the United States. It is to this background that this thesis aims to shed light on the political attitudes and participation of young Asian New Zealanders, and reports on results from depth interviews held in Christchurch between December 2007 and early 2008. A small pilot study of six Asian New Zealanders aged between 18-24 years and five of their parents were interviewed regarding their voting habits, their participation in other political activities, and their interest in politics. This thesis identifies six prominent theories of political participation and assesses their ability to explain the political participation of this small sample of young Asian New Zealanders. The results of this study are also compared with research conducted on Asian participation in the United States so as to gain a more in depth perspective of Asian immigrant political participation. This thesis finds that while the participants in this study relate closely to their ethnic and cultural backgrounds, they often identify New Zealand as ‘home’ and see their future in New Zealand. The participants also discussed politics and participation in terms commonly associated with a typical youth cohort, rather than what might be expected of a minority youth cohort. While the six youth participants in this study did not participate extensively in political activities, the interviewees indicated they are interested in politics and feel that they can influence politics in New Zealand, should they choose to do so. Furthermore, this research highlights how theories which have been found to be influential in predicting the political engagement of majority groups may not adequately explain the engagement of immigrant communities. While most theories of participation have had their widest application in relation to majority communities, minority groups are faced with a unique set of informational, legal and linguistic barriers. Thus, traditional assumptions about what serves to influence political engagement may not fully explain immigrant political participation.

Young women who serve time in adult prisons in New Zealand mix with adult prisoners, unless it is not considered safe to do so. If they do not mix, they serve their sentence in relative isolation, unable to participate in programs, recreation or other aspects of prison life. This is in contrast to male youth in prison who are placed in have specialised youth units to mitigate against the perceived negative effects of mixing with adult prisoners. Using discursive strategies to analyse texts from semi-structured interviews with young women in Aotearoa New Zealand (NZ) prisons and focus group interviews with iwi representatives, this study offers a challenge to dominant framings of both young and adult women prisoners. The study has shown that young women prisoners’ resilience is likely to be strengthened, and opportunities for health and well-being improved, within stable relationships with adults with whom they relate. Whanau-type structures in prison are in keeping with indigenous values and have the potential to provide mentoring relationships which may broaden the current limited subjectivities experienced by young women prisoners.

This thesis examines the political attitudes and behaviour of young principled non-voters in New Zealand and explores the potential influence of postmaterialist theory on their decision not to vote in general elections. This research is primarily conducted through in-depth interviews with young principled non-voters with the goal of understanding their political motivations through their own words. Democratic theory, postmaterialist theory, leading voting theories and research relating to young people and New Zealand are all focused on to place the findings from the in-depth interviews in the context of wider literature and research. The findings of this research suggest that, while postmaterialist theory is a potential influence on some of the young principled non-voters interviewed, the relationship between principled non-voters and postmaterialism is not as strong as expected. However, the findings did show consistently low levels support for the current systems of political representation and participation in New Zealand amongst those interviewed. This, as well as their support for alternative methods of participation, places the participants in line many of the current concerns for the health of representative democracies and traditional political practices. These principled non-voters also highlight the need for greater research into young non-voters in New Zealand, as they do not fit within traditional expectations of young apathetic non-voters.

The purpose of this qualitative study was to explore the phenomenon of role models for younger girls. Girls aged 5 to 12 years were asked who they chose to look up to, how significant their role models were to them, why they had chosen them and if they thought they thought that they could achieve their chosen model‟s achievements. Socio-cultural framework provides a useful perspective for understanding the significance of role models as they act as powerful transmitters and reinforcers of the tenets of socialization. In Social Cognitive Theory, it is claimed that children largely learn through modelling, observing and imitating significant others. Interview and task sessions including a field-mapping activity and the sorting of peer-generated photographs were conducted with 12 girls aged from 5 to 12 years from one urban school. In analysis of the interview data, it was found that family members or family substitutes were the most significant people that these girls chose and, despite the alleged pressure from popular culture, young girls in this study were able to make discerning judgements about the „hollowness‟ of characters of popular culture. They identified skills or attributes that their role models demonstrated rather than physical attractiveness, their popularity or the amount of money their fame had brought them. This study is a valid representation of what mattered to a group of young girls at one specific point in time and could indicate the value of further investigation of how to maximize the benefits of role models for young girls.

Like adolescents, young adults are at risk of initiating tobacco use and escalating to daily use and tobacco dependence. However, not every young adult who uses cigarettes intermittently becomes tobacco dependent, and the time-course of those who transition to daily use varies widely. Individual differences likely contribute to the variability observed in patterns of tobacco use. This dissertation uses a multi-modal research approach to examine dimensions of impulsivity and alcohol use that are associated with vulnerability for escalation of cigarette smoking, and whether alcohol’s effects on behavioral disinhibition impact cigarette consumption. Study 1 investigated the associations between dimensions of trait impulsivity, alcohol use, and smoking behavior in a cross-sectional sample of young adults who varied in frequency of cigarette smoking. Study 2 expanded on the results of Study 1 by examining the separate and combined effects of impulsivity and alcohol use on escalation of tobacco use in a longitudinal study of young adults in their first three years of college to determine whether alcohol use and dimensions of impulsivity influenced trajectories of smoking behavior, and whether alcohol use and behavioral impulsivity changed across time as a function of tobacco use trajectories. Study 3 utilized a randomized, within-subject, placebo controlled design to examine whether alcohol-induced impairments in behavioral inhibition mediated the relationship between acute alcohol administration and ad-libitum cigarette consumption. Results from studies 1 and 2 indicated that alcohol use was associated with smoking frequency, and that dimensions of impulsivity (i.e. sensation seeking, lack of premeditation, and urgency) differentiated smoking groups. Study 3 found that acute alcohol increased smoking behavior, but alcohol impairment of inhibitory control did not mediate the relationship between alcohol and smoking consumption. Taken together, the results of these studies demonstrate that alcohol use and impulsivity play a significant role in tobacco use escalation, though more research is needed to determine the mechanism(s) that drive alcohol-induced increases in cigarette consumption.

Background Suicidal behaviour among young people is one of the major public health problems in low-income countries; it is estimated that every year 70,000 young people take their lives and maybe 40 times as many attempt suicide. Nicaragua has the highest suicide rate among young people of all Latin and Central American countries. This thesis aims at examining: (1) suicidal expressions and their determinants among school adolescents in Nicaragua, (2) cross-cultural aspects on suicidal expressions comparing Nicaragua and Cambodia, (3) pathways to suicide attempts among young men, and (4) primary health care professionals’ perceptions of suicidal behaviour and mental health problems among young people. Method Paper I is a cross-sectional study of 368 school adolescents in Nicaragua using self-report instruments (Youth Self Report and Attitudes Towards Suicide). Paper II compares data from Paper I with corresponding data from a study of 316 adolescents in Cambodia using the same methodology. Paper III is a qualitative study based on interviews with 12 young men who have recently attempted suicide. Paper IV is a qualitative study with 12 primary health care professionals. Results Paper I: Among adolescents, suicide ideation during recent year was reported by 22.6%, suicide plans 10.3%, and suicide attempts 6.5%. Girls were significantly more likely to report suicidal ideation. Multivariate analyses showed that anxious/depressed syndrome (YSR), somatic complaints syndrome (YSR) and exposure to attempted or completed suicide in significant others were significantly associated with their own serious suicidal expressions. Paper II: There was no significant difference in serious suicidal expressions (plans and attempts) between countries, but milder suicidal expressions during past year were more common among Nicaraguan young people. Overall, mental health problems were more commonly reported in Cambodia, where adolescents scored significantly higher on almost all YSR-syndromes as compared to Nicaraguan adolescents, except for withdrawn/depressed syndrome among boys. The pattern of association between mental health problems and suicide plans/attempts differed between countries. In Nicaragua, all eight YSR-syndromes were significantly associated with serious suicidal expressions for both genders compared to only one syndrome among girls and two syndromes among boys in Cambodia. Paper III: A model of the pathways leading to suicide attempts among young men was constructed based on the informants’ experiences. Structural conditions such as poverty or single-headed families, along with normative expectations within a framework of hegemonic masculinity, were all involved to create a sense of failure and an inability to cope. Subsequent increased drinking and drug abuse as well as exposure to attempted and completed suicide among friends and family acted as triggers to their own suicide attempt. Paper IV: Primary health care professionals felt themselves that they lacked knowledge and competence when approached by young people with mental health problems. Misconceptions were common. They felt frustrated which made them either ignore signs of mental health problems or reject help-seeking young people. In practice, a common response from health care professionals was to refer the patient over to someone else, the “hot potato” strategy. Conclusions The prevalence of serious suicidal expressions among young people in Nicaragua is within the range reported from Western high-income countries. Health care professionals need to be aware that somatic complaints as such are related to an increased risk of serious suicidal behaviour among young people, and that those who have been exposed to the attempted or completed suicide of someone close are at increased risk of serious suicidal expressions also when there are no warning signs in terms of mental distress. The cross-cultural comparison lends support to the notion that both cultural specificity and universality characterize serious suicidal expressions, as suggested by several researchers. Whereas prevalence shows less variation between cultures, associated factors might behave differently as shown in the present study, calling for different preventive approaches. The interviews with young men who had attempted suicide tell us that not only difficult socio-economic conditions but also the normative expectations on young men need to be addressed to decrease their risk of suicide. Health care professionals need to be alerted that sometimes serious mental health problems are hidden behind help-seeking for more trivial reasons. There is a necessity of a more integral approach towards mental health problems in PHC, including integral training of staff. The continued involvement of the community, family and other institutions would be essential to develop the care further.

In order to study jets and outflows from Young Stellar Objects (YSOs), I performed an unbiased search on a continuous 33 square degree sized region in Serpens and Aquila using data taken from the UWISH2 survey, which uses the 1-0 S(I) emission line ofH2 as a tracer. I identified 130 molecular hydrogen outflows from YSOs from which 120 (92 %) objects are new discoveries. Distances were measured by foreground star counts with an accuracy of25 %. Outflows were found in groups of 3 - 5 members with a size of about 5 pc. Groups were separated by about half a degree on the sky. About half of the objects were assigned with potential source candidates. Brighter MHOs had a higher probability to have a source candidate assigned to them. I find an over abundance of outflows with position angles between 1300 and 1500 which is almost perpendicular to the Galactic Plane. The fraction of parsec scale outflows is about 25 % which is more than twice compared to the one found in Orion A by Stanke et al. (2002) and Davis et al. (2009). The outflows are not able to provide a sufficient fraction of energy and momentum to support the turbulence levels in their surrounding molecular clouds. The typical dynamical jet age was of the order of 104 yrs, while groups of emission knots are ejected every 103 yrs. This indicates that low level accretion rate fluctuations and not Fu-Ori type events are responsible for the episodic ej ection of material. The luminosity distribution of the outflows shows a power law behaviour with N ex: LH;·9. The Milky Way star formation rate was estimated to more than 1.6 ± 0.4M0 yr-1 The Spectral Index Classification distribution plot of YSOs indicated that the number of outflows increases in line with a values and has a similar distribution to the one from Davis et al. (2009) from Orion A.

Young adults in Sweden have grown up with dental care free of charge until the age of twenty. Their self-perceived oral health has been reported as being good, but rapid changes in society have led to a weaker economic situation for many young adults, which may influence their dental attendance and priorities concerning oral health and oral health care. The overall aim of this thesis was to explore the views of young adults on dental care, oral health and Oral Health-Related Quality of Life (OHRQoL). The thesis is based on four scientific papers which all apply a qualitative approach. In Paper I, the views of young adults on dental care were explored. Paper II investigated the views of young adults on their oral health and OHRQoL. In Paper III, measures of OHRQoL were described and analysed from a public health perspective, and in Paper IV, the views of young adults on the relevance of three measures of OHRQoL were explored. In Paper I, II, and IV, data collection was performed through qualitative interviews. The selection of informants was strategic with reference to age (21-29 years), sex and education. For Paper III, a literature search for OHRQoL measures was made in the PubMed database. The data in Paper I was analysed in accordance with the constant comparative method (inspired by Grounded Theory), and in Papers II, III and IV, qualitative content analysis was used. The results showed that young adults were satisfied with the dental care that they had received but reported specific views and demands on dental care (Paper I). They perceived their oral health as good, but an array of oral health problems was described (Paper II). The young adults’ perceived control of their OHRQoL depended on their future prospects of oral health, in relation to their perceptions of their past and present oral health. In Paper III, the search for measures of OHRQoL in the PubMed database generated 22 measures. The measures were analysed with regard to their theoretical framework and in relation to four principles of health promotion. Some elements of public health principles were found in all the measures, but most of them originated in disease-oriented theories. The occurrence of oral problems was reflected in young adults’ views on the measures of OHRQoL (Paper IV). The analysed measures were deemed to have both advantages and disadvantages but to be fairly equal. The conclusions are that young adults’ OHRQoL was dependent on their earlier experiences of dental care and their former and present oral health, as well as their future prospects regarding oral health. Elements of public health principles were present to a varying degree in all the measures of OHRQoL. Young adults regarded the frequently used measures of OHRQoL as being equal. The measures were mainly disease-oriented and no specific measures had been developed for young adults. / Unga vuxna i Sverige har vuxit upp med fri tandvård till och med det år de fyller 19 år och de upplever ofta en god munhälsa. Snabba samhällsförändringar har bl a medfört sämre ekonomi för många unga och detta kan ha påverkat deras tandvårdsbesök och deras prioriteringar vad gäller tandvård. Det övergripande syftet med avhandlingen var att utforska unga vuxnas syn på tandvården, deras munhälsa och munhälsorelaterade livskvalitet (OHRQoL). Avhandlingen baseras på fyra studier. I Studie I undersöktes unga vuxnas syn på tandvården. Studie II undersökte och beskrev unga vuxnas syn på sin munhälsa och OHRQoL. I Studie III beskrevs och analyserades mätinstrument för OHRQoL ur ett folkhälsoperspektiv och i Studie IV beskrevs hur unga vuxna ser på tre mätinstrument för OHRQoL. I Studie I, Studie II och Studie IV samlades data in genom kvalitativa intervjuer. Urvalet var strategiskt i förhållande till ålder (21-29 år), kön (hälften kvinnor) och utbildning (gymnasienivå/mer). De flesta deltagarna i studierna besökte tandvården regelbundet. I Studie III gjordes sökningar i databasen PubMed för att finna mätinstrument för OHRQoL.  Data i Studie I analyserades genom komparativ metod som är inspirerad av ”Grounded Theory”. I Studie II, Studie III och Studie IV genomfördes dataanalysen med kvalitativ innehållsanalys. Resultaten visade att unga vuxna var nöjda med den tandvård de erhållit men att de hade speciella önskemål och krav på denna (Studie I). Unga vuxna beskrev sin munhälsa som god men angav trots det en mängd olika munhälsoproblem. Deras upplevda kontroll över sin OHRQoL var relaterad till deras syn på sin framtida munhälsa i relation till tidigare erfarenheter av tandvården och synen på sin egen munhälsa (Studie II). I Studie III genererade datasökningen 22 mätinstrument för OHRQoL. Mätinstrumenten analyserades utifrån deras teoretiska utgångspunkter och i relation till fyra principer för folkhälsoarbete (empowerment, medinflytande, holism, rättvisa). Aspekter av de fyra principerna återfanns i varierande grad hos alla mätinstrumenten varav de flesta hade sin utgångspunkt i sjukdomsinriktade teorier. I Studie IV framkom att de unga vuxnas upplevelse av sin egen munhälsa hade betydelse för deras syn på de tre undersökta mätinstrumenten för OHRQoL. Alla mätinstrumenten ansågs ha för- och nackdelar men bedömdes som ungefär likvärdiga. Konklusionen är att unga vuxnas OHRQoL är beroende av deras tidigare erfarenheter från tandvården och deras tidigare och nuvarande munhälsa samt i deras syn på sin framtida munhälsa. Principer för folkhälsoarbete uppfylldes i varierande grad i analyserade mätinstrument för OHRQoL och unga vuxna ansåg att mätinstrumenten var ungefär likvärdiga. Mätinstrumenten var i huvudsak sjukdomsinriktade. Det saknas ett speciellt instrument för att mäta unga vuxnas munhälsorelaterade livskvalitet. / <p>Odontologie doktorsexamen i ämnet odontologisk vetenskap</p>

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