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Year : 2017  |  Volume : 6  |  Issue : 4  |  Page : 199-203

How vulnerable are our adolescents to noncommunicable diseases? A school-based study in Kolkata

Department of Preventive and Social Medicine, All Institute of Hygiene and Public Health, Kolkata, West Bengal, India

Date of Web Publication12-Dec-2017

Correspondence Address:
Dr. Anubrata Karmakar
Madarat, Battala, P. O. - Madarat, P.S- Baruipur, South 24 Parganas, Kolkata - 743 610, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijhas.IJHAS_52_17

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BACKGROUND: Noncommunicable diseases (NCDs) account for two-third of all deaths in India, and its risk factors are on the rise among adolescents. All lifestyle-related risk factors such as unhealthy diet, tobacco and alcohol consumption, low physical activity (LPA), and high screen time (HST) use are modifiable. With this background, a study was conducted to assess the magnitude and predictors of risk factors of NCDs among adolescents in Kolkata.
MATERIALS AND METHODS: A cross-sectional study was conducted among 276 adolescents of 8th–10th standard in a government-aided boys' school in Kolkata in September–October 2016. Data were collected on sociodemographic profile and lifestyle-related practices along with anthropometry and blood pressure measurement for each student. Analysis was done with the help of SPSS version 16.0 using descriptive statistics, univariate and multivariable logistic regression.
RESULTS: Among 276 students, 29% ever used tobacco. More than 80% of participants failed to meet the recommended guideline for fruit and vegetable intake, around 80% consumed soft drinks and junk foods regularly, 26% had LPA, 55% were HST user, 23.6% were overweight or obese, and 18.8% were prehypertensive. Multivariable regression revealed the factors associated with being overweight included unhealthy soft drinks intake habit (adjusted odds ratio [AOR] confidence interval [CI]: 4.39 [1.42–13.57]), LPA (AOR [CI]: 6.84 [3.53–13.25]), and HST (AOR [CI]: 2.89 [1.42–5.87]) and those with prehypertension were age (AOR [CI]: 2.62 [1.68–4.10]), LPA (AOR [CI]: 6.19 [2.68–14.29]), HST (AOR [CI]: 3.91 [1.56–9.86]), and overweight [AOR (CI): 8.62 (3.04–24.46)].
CONCLUSION: The findings may be used in developing policies to generate awareness about the modifiable lifestyle-related risk factors of NCDs among adolescents.

Keywords: Adolescent, hypertension, noncommunicable diseases, overweight, risk factors

How to cite this article:
Dasgupta A, Karmakar A, Bandyopadhyay L, Garg S, Paul B, Dey A. How vulnerable are our adolescents to noncommunicable diseases? A school-based study in Kolkata. Int J Health Allied Sci 2017;6:199-203

How to cite this URL:
Dasgupta A, Karmakar A, Bandyopadhyay L, Garg S, Paul B, Dey A. How vulnerable are our adolescents to noncommunicable diseases? A school-based study in Kolkata. Int J Health Allied Sci [serial online] 2017 [cited 2018 Jan 23];6:199-203. Available from: http://www.ijhas.in/text.asp?2017/6/4/199/220525

  Introduction Top

There is an increasing trend of noncommunicable diseases (NCDs) globally. Of 56 million global deaths in 2012, 38 million (68%) were due to NCDs.[1] Three-quarters of these deaths were in low-middle-income countries,[1] where it is growing disproportionately. NCDs contribute to 60% of all deaths in India.[2] Behavioral risk factors that are responsible for significant proportions of these diseases are tobacco use, unhealthy diet, physical inactivity, and harmful use of alcohol. Major metabolic risk factors are obesity, hypertension, raised blood glucose, and raised blood total cholesterol levels. The prevalence of obesity and physical inactivity is also increasing rapidly among Indian adolescents.[2],[3]

Adolescence is the critical transitional stage of physical and psychological development from puberty to adulthood. It is a period of rapid learning. Habits acquired during childhood remain throughout the life. With increasing urbanization, lifestyle of adolescents has changed drastically making them susceptible to NCDs. If healthy lifestyle behaviors such as healthy dietary habit, adequate physical activity, adequate sleep, and low screen time use are inculcated at this stage of life, then, in the long run, this could be the most effective prevention of NCDs. While adolescence is a time of great potential, it is also a time of considerable risk during which social environment exerts powerful influences. This makes them vulnerable to risk-taking behaviors such as smoking and alcohol consumption which increase many folds due to peer pressure.[4] NCDs such as obesity, diabetes mellitus, hypertension, coronary artery disease, and stroke in the later part of life have been related to the prevalence of risk factors in childhood and in adolescence.[5]

Lifestyle-related risk factors are all modifiable. Early recognition of the risk factors in adolescence is important to plan necessary preventive strategies for NCDs, which in the long run can pave the way for a better and healthier life. Hence, there is a definite need to monitor the magnitude of these risk factors in this age group and plan appropriate, feasible, and effective intervention measures for the same.

There is a dearth of study addressing this issue in this part of the country. Hence, this study was conducted among school-going adolescents in Kolkata with the objective to assess the magnitude of several risk factors of NCDs and also to determine the predictors of overweight and hypertension among them.

  Materials and Methods Top

A cross-sectional analytical study was conducted during September–October 2016, among school-going adolescents in a government-aided boys' school, situated in Kolkata. All the students of 8th, 9th, and 10th standard who were present on the day of survey were included in the study. Those who were unwilling to participate were excluded from the study. The total participants were 279 (absenteeism rate was 11.4%). Ethical clearance was obtained from the Institute ethics committee before the start of the study.

A pretested, self-administered questionnaire in local language (Bengali) was used to collect data regarding sociodemographic status, parental education and occupation, family history of NCDs, consumption of tobacco, exposure to secondhand smoke, dietary habits, physical activity, screen time use, and sleep duration. The researcher was present throughout the survey and students were clarified of their doubts during the data collection. After finishing the questionnaire, height, weight, and blood pressure (BP) of each student were measured by the investigator following standard operative procedures.

Those who had used any form of tobacco in the past 30 days were considered as a current tobacco user.[6] Taking fruits <5 days/week or not eating vegetables every day and/or <3 times/day was considered as inadequate intake of fruits and vegetables.[7] Consuming aerated sugar-containing drinks and eating fast food even once in a week was regarded as unhealthy food habit. Those who were not doing moderate to vigorous intensity physical activity for at least 60 min/day were regarded as individuals having low physical activity (LPA).[8] Time spent on television, computer, videogames, or mobile for more than 2 h in a day was defined as high screen time use (HST).[9] Less than 7 h of sleep in 24 h was considered as inadequate sleep.[10] Body mass index was classified based on the WHO growth reference standards for age (2007 standards).[11] Hypertension was defined as average systolic BP (SBP) and/or diastolic BP (DBP) (after three measurements) which was ≥95th percentile for sex, age, and height. Prehypertension in children and adolescent was defined as average SBP or DBP levels that are ≥90th percentile but <95th percentile.[12]

Data were analyzed using the software SPSS for Windows, Version 16.0, (Chicago, SPSS Inc.). Descriptive statistics were used. Univariate and multivariable logistic regression (force entry method) analysis was performed to identify the predictors for overweight and prehypertension among the adolescents. Significance level was set at P < 0.05.

  Results Top

Three questionnaires were incomplete out of 279, so the final analysis was done on 276 participants. Mean (standard deviation [SD]) age of the total population was 14.3 (1.08) years ranging from 12 to 17 years. The education level of fathers ranged from illiterate (6.2%) to postgraduate (2.5%) with 40% with secondary level or above education. The education level of mothers ranged from illiterate (6.5%) to postgraduate (0.7%) with 37% secondary level or above. Majority of the students' father was a businessman (35.8%) by occupation followed by laborer (31.1%), skilled worker (15.5%), and servicemen (11.2%). Most of the mothers were homemaker (87.3%). Half of the students had a family history of hypertension, whereas a family history of diabetes, heart attack, and stroke was 42.8%, 24.6%, and 12.3%, respectively.

Among 29% who had ever used any form of tobacco, 23.2% had smoked bidi/cigarette, and 14.1% had used smokeless tobacco (SLT). Nearly 5.4% and 7.6% were current smokers and SLT users, respectively. The mean (SD) age of initiation of smoking was 12.2 (1.7) years and that of SLT use was 12.3 (1.9) years. The current smokers (n = 15) were smoking on an average 3.7 units/day and current SLT users (n = 21) were consuming 2.4 units (packs/dips)/day. Almost 50.7% of the students were exposed to secondhand smoke where, in 75.7% cases, the person responsible for it was their father.

Sixty-two percent of the participants had inadequate fruit consumption. Fifty-seven percent participants had not taken vegetables every day, and only 25% had taken vegetables three or more servings/day. Seventy-eight percent students were consuming soft drinks and 85% students were eating fast food once or more/week and 10% were consuming them almost every day. LPA was found among 26% students. Fifty-five percent of participants had HST. Twenty-one percent students had inadequate sleep. Nearly 23.6% were overweight and 18.8% were having prehypertension.

The predictors of overweight and prehypertension among adolescents are shown in [Table 1] and [Table 2], respectively. No elaboration of these tables is being made by the researchers.
Table 1: Factors associated with overweight: Univariate and multivariable logistic regression analysis (n=276)

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Table 2: Factors associated with prehypertension: Univariate and multivariable logistic regression analysis (n=276)

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  Discussion Top

This study pointed toward the presence of alarming level of NCD risk factors among school-going adolescents. It was found that 29% of the students had ever used any tobacco product and 9.4% of the students were currently using any tobacco product compared to Global Youth Tobacco Survey which reported the prevalence of present tobacco use as 14.6%.[13] The lower prevalence can be explained by social desirability bias leading to underreporting by the students. The most alarming fact was that, for some students, the age of initiation was as low as 9 years which is quite similar to the findings of Sashidhar et al., in which it was 10 years. More than half of the students were exposed to secondhand smoke, and in 75% of these cases, the source was their father, which is consistent with the findings of Sashidhar et al.[14]

The present study revealed only 10.9% students had met the Indian Council of Medical Research dietary guidelines for fruits and vegetables intake. Almost 80% of the adolescents had unhealthy habit of consuming soft drinks and eating fast food often, which is less than the findings of Joseph et al. where fast food consumption prevalence was as high as 97%.[15] Thirty-three percent adolescents in this study consumed fast food three or more days in a week, which is similar to the findings of studies in urban Baroda and Delhi.[16],[17] This similarity in findings with different studies indicates that unhealthy food habits have affected adolescents across India. Thirty-eight percent of study participants in the present study consumed fruits for five or more days per week which is similar to the findings of Singh et al.[17] In this study, 26% of the study participants had LPA, whereas, in a study in Delhi, about 40% children reported LPA which may be due to the difference in the lifestyle in urban Delhi.[17] Fifty-five percent spent more than 2 h watching television, mobile, or computer in this study, whereas, in a udy in Imphal, this proportion was 39.8% which indicates HST usage is more in metropolitan cities.[4]

Almost 23.6% of students in this study were overweight or obese which is higher than that of a study in Guwahati which may be due to the difference in the lifestyle behavior of the study participants.[18] In a study by Deshpande, prehypertension is 15.9% which is almost similar to the present study where 18.8% were in prehypertensive stage.[19]

This study showed that the predictors of overweight among adolescents were unhealthy habit of consumption of soft drinks, LPA, and HST, whereas the predictors of prehypertension were increasing age, LPA, HST, and being overweight. Therefore, increased physical activity, reducing screen time, and avoiding soft drinks, other junk foods, and also fast foods are very important for prevention of NCDs among adolescents.

In the present study, almost all the important risk factors of NCDs except mental stress had been investigated, which had made the study more conclusive. The present study not only explored the risk factors of NCDs but also assessed the predictors of prehypertension and overweight among the adolescents. The limitation was that most of the data were self-reported and so there might be a chance of social desirability and recall bias.

  Conclusion Top

The findings of the study may help the policymakers to address these issues in upcoming policies for adolescents for the prevention and control of NCD. Adolescents should be made aware of the harmful effects of fast food and soft drinks. Physical activity should be given more emphasis in the school curriculum, and adolescents should be motivated to increase outdoor playtime instead of HST use.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

WHO. Global Health Observatory (GHO) Data; 2012. Available from: http://www.who.int/gho/ncd/mortality_morbidity/en. [Last accessed on 2016 Sep 05].  Back to cited text no. 1
WHO. Global Status Report on NCDs; 2014. Available from: http://www.searo.who.int/india/topics/noncommunicable_diseases/ncd_situation_global_report_ncds_2014.pdf. [Last accessed on 2016 Sep 05].  Back to cited text no. 2
UNICEF. Adolescent in India; 2013. Available from: http://www.in.one.un.org/img/uploads/Adolescents_in_India.pdf. [Last accessed on 2016 Sep 03].  Back to cited text no. 3
Kumarasamy P, Thingujam AS. Modifiable lifestyle risk factors for non-communicable diseases among adolescents. Indian J Youth Adolesc Health 2016;3:9-17.  Back to cited text no. 4
Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: The Bogalusa Heart Study. Pediatrics 1999;103:1175-82.  Back to cited text no. 5
WHO. GATS-Indicator Guidelines Final Edition; July, 2009. Available from: http://www.who.int/tobacco/surveillance/en_tfi_gats_indicator_guidelines.pdf. [Last accessed on 2016 Sep 05].  Back to cited text no. 6
ICMR. Dietary Guideline India 2nd Edition; 2011. Available from: http://www.ninindia.org/dietaryguidelinesforninwebsite.pdf. [Last accessed on 2016 Sep 13].  Back to cited text no. 7
WHO. Global Recommendation on Physical Activity for health; 2012. Available from: http://www.apps.who.int/iris/bitstream/10665/44399/1/9789241599979_eng.pdf. [Last accessed on 2016 Sep 10].  Back to cited text no. 8
Nguyen PV, Hong TK, Nguyen DT, Robert AR. Excessive screen viewing time by adolescents and body fatness in a developing country: Vietnam. Asia Pac J Clin Nutr 2016;25:174-83.  Back to cited text no. 9
Paruthi S, Brooks LJ, D'Ambrosio C, Hall WA, Kotagal S, Lloyd RM, et al. Recommended amount of sleep for pediatric populations: A Consensus Statement of the American Academy of Sleep Medicine. J Clin Sleep Med 2016;12:785-6.  Back to cited text no. 10
WHO. BMI for Age (5-19 years) Boys (z-score) Growth Reference; 2007. Available from: http://www.who.int/growthref/who2007_bmi_for_age/en/. [Last accessed on 2016 Sep 11].  Back to cited text no. 11
National Institutes of Health. The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents 2005, May. NIH Publication No. 05-5267. Available from: https://www.nhlbi.nih.gov/files/docs/resources/heart/hbp_ped.pdf. [Last accessed on 2016 Sep 11].  Back to cited text no. 12
India (Ages 13-15) Global Youth Tobacco Survey (GYTS). Available from: http://www.who.int/fctc/reporting/Annexoneindia.pdf. [Last accessed on 2016 Sep 13].  Back to cited text no. 13
Sashidhar A, Harish J, Keshavamurthy RS. Adolescent smoking - A study of knowledge, attitude and practice in high school children. Pediatric Oncall. 2011;8 (1). Art #7. Available From : http://www.pediatriconcall.com/pediatric journal/View/fulltext-articles/380/J/0/0/118/0.  Back to cited text no. 14
Joseph N, Nelliyanil M, Rai S, Babu YP, Kotian SM, Ghosh T, et al. Fast food consumption pattern and its association with overweight among high school boys in Mangalore city of Southern India. J Clin Diagn Res 2015;9:LC13-7.  Back to cited text no. 15
Kotecha PV, Sangita V, Patel P, Baxi RK. Dietary pattern of school going adolescents in Urban Baroda, India. J Health Popul Nutr 2013;31:490-6.  Back to cited text no. 16
Singh AK, Maheshwari A, Sharma N, Anand K. Lifestyle associated risk factors in adolescents. Indian J Pediatr 2006;73:901-6.  Back to cited text no. 17
Bhattacharya PK, Gogoi N, Roy A. Prevalence and awareness of obesity and its risk factors among adolescents in two schools in a Northeast Indian city. Int J Med Sci Public Health 2016;5:1111-22.  Back to cited text no. 18
Deshpande AV. Study of prevalence of hypertension in adolescent in central India. Int J Basic Med Clin Res 2014;1:66-71.  Back to cited text no. 19


  [Table 1], [Table 2]


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