Study of Selected Noncommunicable Disease Risk Factors Among Adolescents in A Rural Area of Karnataka

Introduction

Non-communicable diseases (NCD) in recent times have attained a magnitude of epidemic proportions, with an increasing number of adolescents being reported as obese. Communicable diseases and NCD pose a double burden to developing countries like India. NCD's contribute to 80% mortality, of which Cardiovascular diseases (CVDs) (17.5 million), cancer (8.2 million), respiratory diseases (4 million), and diabetes (1.5 million) are the major causes.

Most rural areas in India are witnessing a social and demographic transformation. Rapid industrialization, urbanization, and globalization are associated with a high prevalence of risk factors like unhealthy diet, physical inactivity, obesity, and tobacco and alcohol abuse in low and middle-income countries. Some of the risk factors developed during adolescence are increasing weight for age, poor physical activity and dietary habits, and smoking habits early in life. It is already evident that nearly 75% of obese adolescents remain obese as adults, increasing the chances of developing NCD's. Hence, it is vital to assess the magnitude of these risk factors among adolescents to achieve the goal of primordial prevention n vulnerable years of life.

Adolescents aged 10 to 14 years are understudied and difficult to reach. It is indeed necessary that we acknowledge that their needs differ from those aged 15 to 19. Most nutrition studies focus on children 0 to 6 years of age and adolescents 15 to 19 years old. There is no information on the nutritional needs of 10 to 14-year olds. The impact of malnourishment on the cognitive development and academic performance of adolescents needs more research, as does, the emerging health problem of obesity among adolescents. Research related to nutrition has largely focussed on girls; the nutritional needs of adolescent boys have been neglected.¹

Materials and Methods

The objective of this study was to determine the proportion of selected non-communicable risk factors in the age group of 10-19 years living in the villages. Young individuals from 10-19 years were included, while those who had not been residents of the area for at least one year were excluded. A complete enumeration of all young individuals from 10-19 years in the 10 villages of Santhekalahalli Primary Health Centre for the Community Orientation Programme was done. Students studying from Vth Standard to Xth Standard were contacted in the school. Adolescents from 17-19 years were contacted either in college or through a house-to-house survey. The sociodemographic details were collected using a pre-designed semi-structured questionnaire, along with a nutrition questionnaire for adolescents. (Source: Bright Future Nutrition), and a Global school-based student health survey. Global school-based student health survey and Bright Future nutrition questionnaire were modified and used for data collection. The global school-based survey has ten core modules with questionnaires on alcohol use, dietary behaviors, drug use, hygiene, mental health, physical activity, protective factors, sexual behaviors, tobacco use, violence, and unintentional injury. Bright Future nutrition questionnaire for adolescents was also used to collate and a common questionnaire was developed, pilot tested, and validated. The data was collected for at least 3 days /3 times a week to substantiate for 50% consumption. Details on the quantity and types of varieties of seasonal fruits and easily available vegetables were not ascertained due to recall bias. Weight was measured using a bathroom scale with an accuracy of 100g. The adolescent was told to remove the footwear or shoes and wear minimal clothing before weighing them. The standing height was measured using a stadiometer to the nearest 0.5 cm with the shoulder in a relaxed position and arms hanging by the side. The Indian Academy of Pediatrics (IAP) growth charts in 2015 were used for height, weight, and BMI classification. Adolescents below the 3rd percentile for height and weight were classified as underweight and under height and those above the 95th percentile were classified as obese. Institutional scientific and ethical clearance was obtained prior to the start of the study. Sample size calculation was done based on the proportion of adolescents using tobacco usage as 13.1%.2 With a 95% confidence level, 3% absolute precision, and a non-response rate of 10% the final sample size was calculated as 486. However, all adolescents available during the community programme were part of the sample. The obtained data were entered into an MS Excel sheet and analyzed using SPSS software version 21.0. Descriptive statistics were used to summarize the percentages of alcohol consumption, tobacco usage, dietary behaviour, and physical activity. The Chi-square test was used to find the association between nutrition and unhealthy behaviors like inadequate/poor physical activity, mental health, and poor academic performance. 

Results

Among the 516 adolescents surveyed, 245 males (47.5%) and 271 females (52.5%) took part in the study. The maximum number of members in the family was 5-8 (48.4%) and most of them belonged to the nuclear family (67%) (Table 1). 

The proportions of behavioural factors responsible for NCD's like tobacco use, alcohol use, unhealthy food practices, and physical inactivity were 6.6%, 3.1%, 20.7%, and 27.0% respectively. Additionally,psychosocial issues such as parents' quarrels, physical violence, and other personal problems could be reason behind poor academic performance (9.8%) (Table 2).

The study findings indicated that consuming alcohol, eating food outside more than three times per week, and consuming fruits and vegetables less than three times per week were determinants of the nutritional status of the adolescents (Table 4).

Discussion

The World Health Organization (WHO) defines adolescence as the age group spanning from 10 to 19 years. According to the census 2011 report, 20.9% of the population in India comprises adolescents. The urban and rural populations constitute 22% and 19% of adolescents, respectively.³ They are precious resources but vulnerable to several intrinsic and extrinsic factors that affect their health.

Nutritional disorders, tobacco and alcohol use, physical inactivity, and stress are some of the precursors for their poor health. Since these lifestyle factors bear a heavy burden on India in terms of morbidity, mortality, and socioeconomic losses, the present study has been undertaken. Diet plays an important role during the developmental stages in an adolescent. So they have to develop the right eating habits at this period of life. 

In a study of dietary patterns among school-going adolescents of Baroda of English and local schools (n= 1440 students), 80% consumed home-made foods, 50% had reported consuming chocolate.4 In our study,140 (27.1%) adolescents consume sweets more than 3 times a week. In our study, more adolescents smoke (n=34, 6.6%) compared to consuming alcohol (n=16, 3.1%). In a study conducted among adolescents in Udupi, tobacco usage and alcohol consumption was 7.2% and 5.7%, respectively.5 In the MyHeART study, among 1361 children in the 13-year-old age group, the prevalence of smoking was 8.8%.6 In a national survey done among 1531 adolescents, the usage of tobacco was 3.1% (95% CI 2.0% to 4.7%).7 In the present study, 139(27%) adolescents did not denote any particular physical activity time. It was observed that leisure time is utilized for watching television for more than 3 hours per day (n=324, 62.7%), especially in the younger age group.

In a study of dietary patterns among school-going adolescents of Baroda of English and local schools (n= 1440 students), 80% consumed home-made foods, 50% had reported consuming chocolate.⁴ In our study,140 (27.1%) adolescents consume sweets more than 3 times a week. In our study, more adolescents smoke (n=34, 6.6%) compared to consuming alcohol (n=16, 3.1%). In a study conducted among adolescents in Udupi, tobacco usage and alcohol consumption was 7.2% and 5.7%, respectively.⁵ In the MyHeART study, among 1361 children in the 13-year-old age group, the prevalence of smoking was 8.8%.⁶ In a national survey done among 1531 adolescents, the usage of tobacco was 3.1% (95% CI 2.0% to 4.7%).⁷ In the present study, 139(27%) adolescents did not denote any particular physical activity time. It was observed that leisure time is utilized for watching television for more than 3 hours per day (n=324, 62.7%), especially in the younger age group.

In a Global school-based student health survey (CBSE), 8130 students aged 13-15 years, 30.2% of students were physically active for 60 minutes per day for 7 days a week. 23.2% of the students spent more than 3 hours per day watching television and playing on computer games.⁸ In the National cross-sectional survey, 25.2% (95% CI: 22.2% to 28.5%) of adolescents showed insufficient levels of physical activity.⁷

In a study in Brazil among 916 adolescents, physical inactivity, excessive alcohol consumption, unhealthy diet, and sedentary behaviour were observed in 18.4%.⁸ In a study among school children of South Karnataka which was cross-sectional less than the expected intake of vegetables and fruits was 80.1% and the intake of fried foods and items containing high content of salt was seen in 166 (55.9%) of the participants.⁹ In the present study, among 516 adolescents, inadequate intake of vegetables and fruits was seen in 120, 23.2% and 81, 15.6%, respectively. In a National survey in Bangladesh (2018- 19) among 4,907 boys and 4,865 girls aged 10-19 years, the prevalence of insufficient fruit and vegetable intake, inadequate physical activity, tobacco use, and being overweight/obese was 90.72%, 29.03%, 4.57%.¹⁰ In a study by Samanta et al. on behavioural problems among 199 adolescents, a physical attack by a family member was reported among 17% of the students.¹¹ In the present study, 15 (2.9%) adolescents mentioned that parents fight between themselves History of physical violence (n=360, 69.7%) and personal problems (n=190, 36.8%) may be a reason for poor academic performance among 51 (9.8%). Moreover, the pressure for performing well in academics among 203 (39.3%) may increase the problems furthermore.

In a study in Salem in 2012-13 among 11-15 year olds, the prevalence rate of overweight/obese among them was 12.11%.¹² In the My Heart study, overweight/obese prevalence was 23.9%. In the national-level survey by Mathur et al., 6.2% (95% CI: 4.9% to 7.9%) of those in the age group of 15-17 years were overweight. The prevalence of behavioural risk factors were: tobacco usage (18.4%) alcohol use (4.7%), poor diet (87.1%), lack of physical activity (23%). However, in the present study, 29.1% were underweight. In a study in Gujarat, among 484 school-going adolescents, 202 (41.7%) were underweight.¹³ In a study in Salem, among 1898 school going adolescents, among the age group of 11 to 15 years, the proportion of overweight overweight/obesity was 12.11%,¹⁴ whereas in our study the proportion was 7.3%. 

In a community-based study of 365 adolescents residing in a village, overweight observed was 28.5%.2 This study being descriptive, self-reported behavioural risk factor may be biased due to social reasons. Adolescents in rural areas are exposed to the same harmful behaviours compared to the urban counterparts. Timely and prompt action is needed to halt the influencers in this vulnerable group.

Conclusion

The results of the present study show that non communicable disease risk factors are showing an increasing trend, which can be alarming. Peer group interaction and family education are vital to halt the progress of unhealthy practices. The health teams in the villages have a vital role to play in this epidemic.

Conflict of interest

Nil

Acknowledgments

III and IV Term Medical students, teaching staff, postgraduates, and Medico social workers of the Department of Community Medicine