|Year : 2012 | Volume
| Issue : 4 | Page : 249-254
Assessment of risk factors of non-communicable diseases among high school students in Mangalore, India
Animesh Jain1, Juhi Dhanawat2, M Shashidhar Kotian1, Ruth Angeline1
1 Department of Community Medicine, Kasturba Medical College, (Manipal University), Mangalore, Karnataka, India
2 MBBS Student, Kasturba Medical College, (Manipal University), Mangalore, Karnataka, India
|Date of Web Publication||27-Feb-2013|
Nandgiri Ladies Hostel, Light house Hill Road, Kasturba Medical College (Manipal University), Mangalore
Source of Support: None, Conflict of Interest: None
Context: Non-communicable diseases are ever increasing and will soon outnumber the prevalence of communicable diseases. This study aims to detect prevalence of risk factors of non-communicable diseases in high school students and its comparison among students of private and government schools, Mangalore. Materials and Methods: A cross-sectional questionnaire based study was conducted amongst consenting high-school students. The data collected included socio-demographic factors, dietary habits, smoking, alcohol consumption, physical activity, height and weight. Data was tabulated and analyzed using Microsoft excel and SPSS version 11.5 software. Chi square test was used to determine the association of various factors with risk factors, P < 0.05 was considered significant. The results were presented as tables. Result: 413 students were surveyed from private and government schools. Age range was 13-15 years. One-tenth of the students had adequate dietary habits. Though most students were physically active, the type and duration of activity was inadequate. Two students were obese, both females. There were statistically significant differences among various socioeconomic classes, type of school and the presence of certain risk factors. Alcohol intake among students of upper class was significant ( P = 0.006). Conclusion: The prevalence of risk factors for NCD is low among high-school students of Mangalore. Students should be educated about having adequate amount of fruits and vegetables and advised to reduce the consumption of fast food. Vigorous activity should be encouraged amongst the students to prevent them from getting obese.
Keywords: Adolescents, high school students, India, non-communicable diseases, risk factors
|How to cite this article:|
Jain A, Dhanawat J, Kotian M S, Angeline R. Assessment of risk factors of non-communicable diseases among high school students in Mangalore, India. Int J Health Allied Sci 2012;1:249-54
|How to cite this URL:|
Jain A, Dhanawat J, Kotian M S, Angeline R. Assessment of risk factors of non-communicable diseases among high school students in Mangalore, India. Int J Health Allied Sci [serial online] 2012 [cited 2021 Dec 1];1:249-54. Available from: https://www.ijhas.in/text.asp?2012/1/4/249/107888
| Introduction|| |
Non-communicable diseases (NCDs) and the resultant morbidity and mortality due to them are ever increasing.  Cardiovascular diseases are the major contributors to morbidity burden in South Asia.  Deaths from (NCDs) are projected to rise from 4 million to 8 million a year in India. Young and adolescents are susceptible to unhealthy lifestyle and have been shown to have various risk factors that may predispose them to development of NCDs.  It is seen that NCD's has its birth in childhood and most of them are due to one's lifestyle.  India has a huge adolescent population with various social and health inequalities. To reduce the development of NCD's in adulthood, the ideal time of intervention is during adolescence because young children are amenable to correction. Detecting the risk factors of NCDs prevalent in the population is of utmost importance to achieve a healthy population. This study was undertaken to estimate the prevalence of various risk factors prevailing among high school students of Mangalore and also to identify their social correlates.
| Materials and Methods|| |
The study was carried out in three high schools of Mangalore, two government schools and one private. These schools were selected using simple random sampling method.
Sample size was calculated using Zα2 pq/L 2 (L = allowable error; 100-L = power; p = prevalence; q = 100-p). The prevalence (p) is taken as 31.2 which is the prevalence of daily smoking men between ages 15-25 in a similar study conducted in Indonesia. 
(1.96) 2 31.2 * 68.8/(31.2 * 0.15) 2 = 376
Expecting a non-response of 10% the final sample size of 414 is arrived at.
Students between ages 13-16 years from these schools were invited to participate.
The study was approved by the Institutional Ethics Committee of Kasturba Medical College, Mangalore. Permission to conduct the study was obtained from the Principals of the schools. The name of the schools and students were kept confidential. The students were explained about the purpose and methodology of the study. Participation was voluntary and anonymity was assured. A written informed consent from each student was taken prior to administering the questionnaire and physical examination.
A self administered questionnaire, developed based on the WHO STEPS questionnaire  and the Global School Health Survey (GSHS) questionnaire  was used to collect the data from the students. The questionnaire focused on smoking, alcohol consumption, intake of fruits and vegetables, consumption of fast food and carbonated drinks. Since one of the schools was a Kannada medium school, the students were given a questionnaire that was translated to Kannada, the regional language of Karnataka. The questionnaire was administered to the students in the classroom after obtaining permission from the teacher concerned. The students were briefed in detail about the study and the questions. They were given 20 minutes to answer the questions after which the questionnaires were collected. Care was taken to prevent discussion among the participants to avoid bias or peer influence in the answering of questions.
Prior to the study, the questionnaire was pre -tested on 5 individuals in the age group of 13-16 years, different from those students enrolled as sample for the study.
After collecting the questionnaires, weight and height were measured using standard techniques for each student. (Weight was measured by making each student stand on the bathroom weighing machine straight, without their shoes, all pockets empty. Height was measured by making the child stand erect, heels, buttocks and back in contact with the height measuring rod. The head was positioned with the Frankfurt's plane. The head piece firmly pressed over the vertex, and then the height was recorded.) Blood pressure of each student was recorded in the left arm in sitting position using a mercury sphygmomanometer by one of the authors (Juhi Dhanawat). Standard technique was followed. Two readings were taken and the average was calculated. (Korotkoff sound IV was taken as the diastolic pressure). Body mass index (BMI) was calculated from the obtained height and weight for each student and BMI > 25 kg/m 2 was considered obese. 
Definitions and standards used for socio: Economic and behavioral risk profile
The information was collected with the help of a self administered questionnaire. The socio economic status was classified using the Kuppuswami scale. 
Student smoking daily or having smoked in the past 30 days was considered as current smoker; one who hadn't smoked at all was considered as a non-smoker, while one who had smoked at least once was considered as ever smoker.
A standard measure of 30ml was used to assess information on the amount of alcohol consumed. A measurement cup having markings till 100 ml was shown to the students to help in estimating and reporting the intake.
Information on total fruits and vegetables consumed was obtained by asking the serving size (100 gm was taken as one serving, a standard 100 gm bowl was shown to the students) of consumed vegetables and fruits. 
The type of physical activity undertaken by the student was assessed by guidelines provided by the Centre for Disease Control (CDC), Atlanta, USA.  Based on these guidelines, activities undertaken as part of work, travel and leisure were measured and classified as moderate and vigorous intensity. The subjects undertaking at least 30 minutes of moderate - intensity activity daily in any sphere of their daily routine activities (during work hours, travelling and leisure) were considered as active.
Students who had three or more than three risk factors were considered to be "at risk". 
The collected data was entered into Microsoft Excel spreadsheet and statistical analysis was done using Statistical Package for Social Sciences (SPSS) software version 16 for Windows.  The frequency for variables and risk factors was calculated in percentages. Results were summarized as tables in terms of proportions and percentages. Chi-square test of significance was used to determine the association between presence of risk factors and sex, socioeconomic status and type of school. P value < 0.05 was considered significant.
| Results|| |
A total of 413 students (233 boys and 180 girls) with almost equal representation from government and private schools were surveyed. The socio-demographic characteristics of the participants are depicted in [Table 1]. The mean age of students was 13.72 (SD = 0.8; SE = 0.04) with an age range of 13 to 15 years.
Only 5 (1.2%) of students admitted to have smoked tobacco and all were boys [Table 2]; and only 4 students have smoked in the past 30 days making them current smokers. They admitted to smoking about 5 cigarettes, three times a week.
Alcohol consumption was admitted to by 19 (4.6%) students. Of these 19, 11 (57.9%) were boys and 8 (42.1%) were girls [Table 2]. Seventeen (89.4%) of the students consuming alcohol were from private school and only 2 from government schools. This was found to be statistically significant (χ2 = 0.956, P = 0.001) [Table 3]. Based on the socioeconomic status, 16 students consuming alcohol belonged to the upper class (χ2 = 12.46, P = 0.006). Out of the 19 students, 16 students consume alcohol occasionally, 60 ml, once a month. Three students consumed alcohol more than 60 ml, once a week.
|Table 3: Prevalence of risk factors among the students of government and private school|
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Most students (382; 92.5%) consumed fruits, of which 160 students (38.7%) had fruits daily. More than half of students surveyed (212; 55.5%) ate approximately 100 grams fruits every day. Less than one tenth (35; 9.2%) of students ate more than 400 grams fruits everyday, which is the prescribed minimum. Adequate intake of fruits (daily intake more than 400 grams/day)  was seen only in 7.9% (33) students.
All students consumed vegetables of which 265 students (64.2%) consumed them daily. However, majority 211 (51.1%) students consumed only 100 grams vegetables every day. Only 13.6% (56) students took adequate vegetables i.e., daily, more than 400 grams per day. Most (91.9%) of government school students consumed less than 400 grams per day compared to 84.7% students doing so in the private school. Among the students from government school, 17.1% had vegetables less than 3 days per week whereas 25.6% private school students took vegetables less than 3 days per week [Table 3].
Fast food consumption on more than 3 days per week was admitted to by 179 (43.3%) students. Approximately equal number of boys and girls consumed fast food ≥3 days/week [Table 2]. Consumption of fast food was more amongst government school students (56.9%) compared to private school students (29%) [Table 3]. Majority (77.8%) of students consuming fast food ≥3 days/week belonged to of upper lower class.
Majority of students in our study were doing vigorous activity ( n = 341; 82.6%); out of which 235 (56.9%) students did it daily. Nearly half of those doing vigorous activity (161 students; 47.2%) did so for up to 30 minutes every day. Most (407; 98.5%) students did moderate activity with 92% (320) students doing it daily. However, only 28% (116) students did it for up to 30 minutes. About one-fifth (21%) of government school students did vigorous activity for less than 3 days a week compared to 53.7% of private school students. Time for vigorous activity and moderate activity less than or equal to 30 minutes was higher in the government school students that of private school students [Table 3]. 53.7% (101) students of upper class, 48.1% of upper middle class did vigorous activity less than 3 days per week. 50% of upper class, 59.2% of upper middle class, 63.9% of lower middle class and 44.4% of lower class gave less than 30 minutes for vigorous activity work. Adequate vigorous activity was done only by 25.6% students and adequate moderate activity was done by 66.3% students.
Stress and obesity
We asked a question regarding self perceived stress and if there was any family pressure or stress due to studies. A total of 106 (25.7%) students reported that they were stressed with an almost equal distribution among boys and girls [Table 2]. Self perceived and reported stress levels were higher in private school students (74; 36.5%) compared to the government school students (32; 15.2%) [Table 3]. Stress was more (38.8%) among students of the upper class.
Only 2 students, one from government school and from private school was found to have BMI more than 25 kg/m 2 , both were females. The mean BMI was found to be 17.73 kg/m 2 (SD = 3.30; SE = 0.16).
No student was found to have blood pressure more than 140/90 mmHg. Six students were found to have systolic blood pressure more than 130 mmHg of which 2 belonged to the government school and 4 belonged to the private school; among these 4 were females and 2 were males. The mean systolic pressure was found to be 117 mmHg. 6 students had diastolic pressure 90 mmHg. The mean diastolic pressure was found to be 77 mmHg.
Overall in our study, none of the students was found to be "at risk" of non communicable diseases because none of the students were found to have 3 or more risks; although there were students having two risk factors [Table 4].
|Table 4: Overall prevalence of risk factors of NCDs among the students (n=413)|
Click here to view
| Discussion|| |
In general, smoking and consuming alcohol among youth and school students are noted to be increasing. , With increasing age, individuals are less under the supervision of parents and have more peer influence.  In the present study, the number of current smokers was less compared to other studies carried out in India and elsewhere in the world. ,, In the present study and a study carried out in Chandigarh, all the smokers were male.  On the contrary studies in Brazil and Europe showed higher number of females smoking than men. , Similarly alcohol consumption among our study population was lower than that found at Chandigarh and Delhi. ,
Consuming fruits and vegetables is very essential. They form a very important component of a balanced diet. In this study, although majority of students consumed fruits and all students consumed vegetables, very few consumed adequate amount of fruits and vegetables respectively (adequate amount being 400g or more of each everyday). In a study carried out in Delhi only 39.4% of students consumed fruits daily which was approximately equal to the findings of the present study, i.e., 38.7% students consumed fruits daily.  Fast food consumption leads to obesity. Fast food is now replacing daily meals, thus depriving individual of adequate nutrients, loading them with more calories and fat. Students consuming fast food was higher (43.3%) compared to the 10% of students consuming fast food in Brazil.  34.4% of boys and 29.4% of girls consumed fast food more than three times a week in a study conducted in Delhi  which was less compared to the present study. In the present study 45.1% boys and 41.1% girls consumed fast food.
Physical activity keeps the body active, keeps the heart and lungs healthy. Sedentary lifestyle will lead to obesity, lethargy, and eventually giving rise to diseases in the body. In the present study, 74.4% of the students did not do adequate vigorous activity and 33.7% students did not do adequate moderate activity. This proportion was higher in the females than in the males, and this was higher compared to any study done in India or elsewhere in the world. , We found that only two students were obese which is comparatively much lower than the studies carried out elsewhere in India. , The sample studies currently was found to be healthy compared to the studies conducted elsewhere, although there were many risk factors prevalent in the present population.
Risk factors of non-communicable diseases lead to chronic, morbid diseases. These risk factors set in at a very early age. Hence, identifying them early and trying to modify them would help in combating non communicable disease. We recommend that the students should be educated about having healthy diets and should be advised to lessen the consumption of fast food. Vigorous activity should be encouraged amongst the students to prevent them from getting obese.
| Conclusion|| |
From the present study, it is concluded that high school students of Mangalore are not "at risk" for non- communicable disease although many students were found to have certain risk factors. There was no significant difference between males and females regarding the various risk factors. However, there were statistically significant differences among various socioeconomic classes and type of school and the presence of certain risk factors. Parents should be educated about the importance of playing games and balanced diet.
| Acknowledgment|| |
The authors are indebted to the principals of the schools and the participants. We are thankful to the Indian Council of Medical Research (ICMR). This research was done as a part of ICMR short term studentship 2010.
| References|| |
|1.||Galhotra A, Abrol A, Agarwal N, Goel N, Gupta S. Life style related risk factors for cardiovascular diseases in Indian adolescents. Internet J Health 2009;9:2. |
|2.||Ghaffar A, Reddy KS, Singhi M. Burden of non communicable diseases in South Asia. BMJ 2004;328:807 10. |
|3.||Selvan MS, Krupad AV. Primary prevention: Why focus on children and young adolescents? Indian J Med Res 2004;120:511 8. |
|4.||Nawi N, Stenlund H, Bonita R, Hakim M, Wall S, Weinehall L. Preventable risk factors for non communicable diseases in rural Indonesia: Prevalence study using WHO steps approach. Bull World Health Organ 2006;84:305 15. |
|5.||Bonita R. Surveillance of risk factors for the NCD′s: The WHO STEPS approach. Geneva: WHO; 2001. |
|6.||Centre for Disease Control and Prevention. Global School based Student Health Survey (GSHS). Available from: http://www.cdc.gov/gshs/ [Last accessed on 2008 Mar 29]. Archived at web citation Available from: http://www.webcitation.org/5×vkxAzPy [Last accessed on 2011 Mar 07]. |
|7.||India reworks obesity guidelines, BMI lowered. Available from: http://www.igovernment.in/site/India reworks obesity guidelines BMI lowered [accessed on 2012 Aug 18]. |
|8.||Park K. Park′s Textbook of Preventive and Social Medicine. India: Bhararidas Bhanot; 2011. p. 639. |
|9.||Mehan MB, Kantharia NB, Surabhi S. Risk factor profile of non communicable diseases in an industrial productive (25 59 years) population of Baroda. Int J Diab Dev Ctries 2007;27:116 21. |
|10.||World Health Organization. The Asia Pacific Perspective: Redefining obesity and its treatment. Geneva, Australia: WHO; 2000. |
|11.||SPSS for Windows, Rel. 16.0.2. 2008. Chicago, Illinois, USA: SPSS Inc; 2008. |
|12.||Diet, nutrition and prevention of chronic diseases. Report of a joint FAO/WHO Expert Consultation, Geneva: WHO; 2003 (WHO Technical Report Series No.916). |
|13.||Nath A, Garg S, Deb S, Ray A, Kaur R. Profile of behavioral risk factors of non communicable disease in an urban setting in New Delhi. Indian J Public Health 2009;53:28 30. |
|14.||Castro IR, Cardoso LO, Engstorm EM, Monteiro CA. Surveillance of risk factors for non communicable diseases among adolescents: The experience in Rio de Janeiro, Brazil. Cad Saude Publica 2008;24:2279 88. |
[Table 1], [Table 2], [Table 3], [Table 4]
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