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- Nilsson, Maria, 1957-
(författare)
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Promoting health in adolescents : preventing the use of tobacco
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There is a robust evidence base for the negative health effects from smoking. Smoking is linked to severe morbidity and to mortality, and kills up to half of its regular users. Tobacco use and production also bring other negative consequences such as economic loss for countries, poverty for individuals, child labour, deforestation and other environmental problems in tobacco growing countries. A combination of comprehensive interventions at different levels is needed to curb the tobacco epidemic. Tobacco control strategies at national levels in the western world often include components of information/education, taxation, legislative measures and influencing public opinion. Two approaches have dominated at the meso and micro levels: cessation support for tobacco users and prevention activities to support young people refraining from tobacco use. Smoking uptake is a complex process that includes factors at the societal level as well as social and individual characteristics. At national level, taxation and legislation can contribute to a societal norm opposing tobacco and creating a context for primary prevention aimed at tobacco free youth. There is no magic bullet in primary prevention. At the meso and micro levels, a continued development of knowledge on the underlying mechanisms and primary prevention methods is essential to prevent young people from starting to use tobacco. The overall aim of this thesis was to gain knowledge about factors that influence young people’s use of tobacco and of preventive mechanisms. The specific aims included to study the relation between Tobacco Free Duo, an intervention program targeting youth in Västerbotten County, and tobacco use prevalence. A specific interest was to explore the role adults can play in supporting young people to refrain from tobacco use. The thesis is based on four studies with three separate sets of data, two were quantitative and one was qualitative. The studies were conducted among adolescents (aged 13-15 yr) in Västerbotten County and on national level in Sweden (aged 13, 15 and 17 yr). Tobacco Free Duo is a school-based community intervention that started in 1993. An essential component of the intervention was to involve adults in supporting adolescents to stay tobacco free. Results showed decreased smoking in adolescents among both boys and girls in the intervention area during the study period of seven years. There was no change in a national reference group during the same time period. A bonus effect was a decrease in adult tobacco use in the intervention area. One out of four adults who supported a young person taking part in the intervention stopped using tobacco. In a qualitative assessment of young smokers, starting to smoke was described as a means of gaining control of their feelings and their situation during early adolescence. They expected adults to intervene against their smoking and claimed that close relations with caring adults could be a reason for smoking less or trying to quit smoking. In a quantitative study that used three decades of national data, over time adolescents became more positive toward parental action on children’s smoking. The adolescents strongly supported the idea of parental action, regardless of whether or not they themselves smoked. Adolescents preferred that actions from parents were dissuading their children from smoking, not smoking themselves, and not allowing their children to smoke at home. These results suggest that the Tobacco Free Duo program contributed to a reduction in adolescent smoking among both boys and girls. Using a multi-faceted intervention that includes an adolescent-adult partnership can decrease adolescent smoking uptake. Engaging adults as partners in tobacco prevention interventions that target adolescents has an important tobacco reducing bonus effect in the adults. The intervention has proven sustainable within communities. A growing majority of adolescents support parental interventions to help them refrain from tobacco. The findings dismiss the notion that adolescents ignore or even disdain parental practices concerning tobacco. A common and consequent norm against tobacco from both schools and parents using a supportive attitude can prevent tobacco use in young people.
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| 2. |
- Quennerstedt, Mikael, 1966-
(författare)
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Att lära sig hälsa
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this dissertation is to contribute to an understanding of the subject content in Physical Education (PE) foremost from a health perspective. By using an approach deriving from John Dewey’s transactional perspective on meaningmaking (Bentley & Dewey 1949), and a discourse theoretical position, the discourses identified in the dissertation’s studies are consequently regarded as participants in pupils’ meaning-making. This makes it possible to discuss the results of the studies in terms of the institutional content and conditions of meaning-making in PE. The thesis consists of three different discourse analyses, where the institutionalised aspect of meaning-making in PE is examined by analysing local curriculum documents from 72 Swedish compulsory schools. The results of the dissertation show that in the study of subject content in PE a dominance of an activity discourse can be identified, although a social development discourse is also identified as being important in the documents. The results, thus, suggest that the subject content of PE can be characterised by a wide variety of activities, where pupils are expected to be active participants in the sense of being physically active. The content is also characterised by actions promoting good relationships, co-operation and consideration for others. Actions privileged within the discourses in PE are movement, physical activity, trying many different activities together, active participation, good relations and enjoyment. The results also show that health is explicitly constituted as fitness training, life-long physical activity and knowledge about physical training based on scientific facts from physiology and anatomy. Learning health in PE thus mainly consists of a pathogenic health discourse. But from a salutogenic perspective, health is also constituted as the possibility to participate in movement, physical leisure activities and social relations, and enjoy a life-long engagement in different movement and sport activities. The analysis also shows, however, that within the frame of the subject content of PE, it is also possible to regard health in terms of a commitment to health- and environmental issues, a sense of well-being in ongoing activities and an active involvement in subject content matters within PE. Health can therefore be constituted in different ways within PE, although this is not always made explicit in the local curriculum documents.
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| 3. |
- Jerdén, Lars
(författare)
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Health-promoting health services : personal health documents and empowerment
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In 2003, the Swedish Parliament adopted a national public health policy that included the domain - “A more health-promoting health service”. Strategies and tools are needed in the work to reorient health services. Personal health documents are documents concerning a person’s health, and are owned by the individual. Several studies that have evaluated such documents indicate that they could be of interest in health-promotion work. However, there is insufficient knowledge concerning personal health documents that target adolescents, and little is known about the feasibility of such documents in a Swedish cultural context. The concept of empowerment is gaining increased interest for health services, but the associations between empowerment, self-rated health and health behaviour are sparsely studied. The overall aim of the thesis is to explore a strategy - empowerment - and a tool - personal health documents - that might facilitate the work of the public health goal of a health-promoting health service. Specific aims are to examine the feasibility of using personal health documents in health promotion; to examine professionals’ experiences of working with health promotion and personal health documents; to examine the association between personal health documents and self-reported health behaviour change; and to examine the perception of empowerment in relation to self-rated health and health behaviour among adolescents. Two personal health documents that targeted adults and adolescents were developed and evaluated. Distribution to adults in different settings was compared in a cross-sectional study (n = 1 306). Adolescents received the document in school, and surveys were performed at baseline and after one year (n = 339). Practical use and attitudes by document owners were studied by questionnaires. Teachers (n = 69) answered a questionnaire, and community health nurses were interviewed (n = 12). The interviews also explored nurses’ experiences of working with health promotion in general, and were analysed by qualitative methodology. Adolescents’ empowerment was examined by a questionnaire (n = 1 046). Most participants reported reading in the documents; writing in the documents varied between 16% (distribution in occupational health) and 87% (adolescents). The health document was perceived as useful by 35% of the adolescents. Factors significantly related to personal usefulness were being born outside Sweden, experiencing fair treatment by teachers, being a non-smoker and having a positive school experience. Community health nurses were striving for a balance of being a doer of practical, disease-oriented tasks and a health-promotion communicator. The structural organisation in health care centres was important for their work with health promotion and the health document. Teachers were generally in favour of continued work with the document. In different settings, between 10% and 26% of adults reported changes in their health situations as a result of reading the booklet. Self-reported changes in health situations were less likely using postal distribution, and there were no significant differences between the other types of distribution. Adolescents with low empowerment scores reported poorer self-rated health and more risk-taking behaviours such as smoking and binge drinking. To conclude, personal health documents are feasible to use in different settings. Health promotion in health services needs active support from leaders as well as adequate support systems. Findings suggest that personal health documents can be tools for promoting self-reported lifestyle changes among adults in different settings. There is a close relation among adolescents between low empowerment in the domain of health, low self-rated health and health behaviours such as binge drinking and smoking.
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| 4. |
- Tinnfält, Agneta
(författare)
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Adolescents' perspectives : on mental health, being at risk, and promoting initiatives
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Mental health is a major child public health issue in Sweden. The overall aims of this thesis are to explore girls’ and boys’ perspectives on mental health and on mental health-promoting initiatives, and to deepen the knowledge of disclosure and support for ado-lescents at risk of abuse and neglect. Four studies are included in the thesis, and a qualitative descriptive design was chosen. In three of the studies (Studies I, II, and III), adolescents in Sweden were interviewed individually or in focus-groups. In the fourth study (IV) officials and politicians in nine municipalities in Sweden were interviewed, and documents were analysed in a multiple-case-study design. In study I the adolescents were asked about the mental health-promoting dialogue with the school nurse. The results reveal that what the adolescents found important were trustiness, attentiveness, respectfulness, authenticity, accessibility, and continuity. The adolescents also had certain views on what issues to talk about in the health dialogue; physical and psychological issues should be included. In Study II, the adolescents perceived “mental health” to be an emotional experience with positive and negative aspects of internal and relational feelings. Family, friends, and school were regarded as important determinants of mental health by the adolescents. Neither girls nor boys thought that there were any major differences in mental health between girls and boys, but did think they were subject to different expectations. In Study III the results show that adolescents with families with alcohol problems are unsure whether to disclose their home situation to an adult; the adolescents seem to make a risk assessment when looking for trustworthy adults. It is a disclosure process. Friends are confidants and supportive, and sometimes facilitators for contacting adults, when support from adults is needed. Study IV show that even small grants to municipalities for children-at-risk projects lead to more activities for these children and adolescents. But children or adolescents were not involved in the planning or decision-making of the activities. The studies in this thesis show that most important thing for adolescents’ mental health is the relation between adolescents and adults, foremost parents, and between adolescents and friends. In addition, gender and age, adolescents’ perspec¬tives and par-ticipation, and society’s support, including the implementation of the UN Convention on the Rights of the Child, have an impact on adolescents’ mental health, both for ado-lescents in general and for adolescents at risk of abuse and neglect. The results are viewed in relation to the bioecological model, to illustrate how all levels in society influence mental health among adolescents, on an individual and a population plane. The findings have implications for adults: to learn more about adolescents and puberty, and about the home situation for children and adolescents at risk of abuse and neglect; to listen to suggestions from children and adolescents; to include friends in support to adolescents at risk of abuse and neglect; and to include girls and boys in all matters concerning them.
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