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Background: Adolescence is a transitional period of life between childhood and adulthood characterized by marked acceleration of growth both physically and mentally.
Objectives: The objective of the study was to assess the lifestyle disease risk factors among high school students of government schools as compared to high school students of private schools.
Materials and Methods: This was a cross-sectional study conducted among high school students of both government and private schools for a period of 2 months in Tirupati. Among 4 government and 4 private schools, 884 high school students were included in the study. A pretested semi-structured questionnaire was used to collect information from students. This includes sociodemographic details, and lifestyle disease risk factors related to knowledge and practices were assessed. Weight and height were measured and body mass index (BMI) was calculated. Systolic blood pressure and diastolic blood pressure were measured with manual sphygmomanometer.
Results: Eight hundred and eighty-four students of age between 12 and 16 years were included in the study. Among them, 438 (49.5%) were in private schools and 446 (50.5%) were in government schools. Among all students, 1.1% (9/884) reported that they smoke tobacco products in the past 30 days and 2.3% (20/884) reported smoke tobacco products at any time in life. Most of the private school students (66.4%) were doing regular exercise compared to government school students (56.3%). The mean BMI was significantly high among private school students (18.9 ± 4.3) compared to government school students (18.1 ± 3.9).
Conclusions: School is an important place where adolescent behavior was developed and provides environment that influences the development of behavior. The study shows that both government and private school students are equally exposed to risk factors of lifestyle diseases. Therefore, it is recommended that combined and coordinated efforts of health and education departments were required for the primary and primordial prevention of lifestyle diseases.
Keywords: Habits, high school students, lifestyle disease risk factors, lifestyle practices
How to cite this URL:
Guthi VR, Monika C V, Kondagunta N. Comparative study to assess the lifestyle disease risk factors among high school students of government and private schools in tirupati. MRIMS J Health Sci [Epub ahead of print] [cited 2023 Mar 30]. Available from: http://www.mrimsjournal.com/preprintarticle.asp?id=362538 |
| Introduction | |  |
Adolescence is a transitional period of life between childhood and adulthood characterized by substantial acceleration of growth both physically and mentally.[1] In South East Asia region countries, adolescents constitute about 18%–25% of the total population. In India, adolescents constitute 20% of the total population and are considered an important human resource and they have right to get opportunity for holistic development to achieve their full potential.[2]
Risk factors such as consuming unhealthy and junk food, lack of physical activity, smoking (tobacco) and alcohol consumption, overweight and obesity, elevated blood pressure, blood glucose, and total cholesterol levels are the most important risk factors among the adult population as well as among adolescents.[3] At the age of adolescence, these risk factors are well tolerated and are not perceived as harmful to their health.
Globally, noncommunicable diseases (NCDs) are significant contributors of cause of death. 39.5 million deaths (70%) of total deaths (56.4 million deaths) were due to NCDs.[4] Risk factors for development of lifestyle diseases or NCDs are unhealthy and junk food, lack of physical activity, smoking (tobacco) and alcohol consumption, overweight and obesity, elevated blood pressure, elevated blood glucose, and elevated total cholesterol levels.[5] Majority of the risk factors were behaviorally acquired and are due to change in environment and lifestyle during adolescent age group.
Most of the world, especially developing countries like India, is undergoing rapid epidemiological transition, and the prevalence of lifestyle diseases is also increasing which is mainly due to adopting Western lifestyle and it is a significant concern as it is affecting adolescent as well as pediatric population.[6]
A global study among more than 100 countries was conducted to assess the distribution of health behaviors among adolescents and showed that 80% of them performed daily physical activities (for at least 60 min per day), 32% used the computer for more than 2 h per day, 6% smoked cigarettes and consumed tobacco products daily, 7.6% consumed alcohol weekly, and 25% had an unhealthy diet.[7]
Each of these risk factors for lifestyle diseases has a different impact on health. Adolescents with minimal physical activity have a higher risk of elevated blood pressure in later life.[8] Sedentary adolescents have a higher risk of developing overweight and obesity.[9] Another risk factor for lifestyle diseases that have a significant negative impact on the health of adolescents is unhealthy and excessive consumption of junk food, either through the low consumption of fruits and vegetables or the high intake of processed foods rich in glucose that cause type 2 diabetes mellitus.[10] In addition, excessive alcohol and drug use causes changes in the central nervous system that may be a cause of depression and other psychiatric morbidities among adolescents.
Existing literature shows that there is a strong association between changing lifestyle factors (unhealthy and junk food consumption, lack of physical activity, and alcohol and tobacco use) and the increase in prevalence of hypertension (HTN). Young people start smoke and consume tobacco products in the age early adolescent period despite knowing harmful effects of tobacco chewing and smoking and it may be due to their belief that smoking will boost their social acceptability and image.[11] With this background, the objective of the study is to assess the lifestyle disease risk factors among high school students of government schools as compared to high school students of private schools.
| Materials and Methods | | |
This was a cross-sectional study conducted among high school students of both government and private schools of Tirupati for a period of 2 months (July 2019–August 2019). In this study, students of age between 12 and 16 years or studying 8th–10th class were included. The age of the students was confirmed by school records (the completed number of years was taken as age based on date of birth noted in school records).
From the previously published literature, it was observed that 20.4% of government school students and 12.6% of private school students reported physically inactive in the last 1 week.[12]
Sample size was calculated by using the formula (Zα/2 + Zβ)2 P1 (1 – P1) + P2 (1 – P2)/(P1 – P2)2 (P1 = proportion of government school students reported physically inactive (20.4%), P2 = proportion of private school students reported physically inactive (12.6%), (Zα/2 = 1.96 for 0.05 level of significance, Zβ = 0.84 for 80% power).
The sample size calculated was 355 with 10% nonresponse rate, and the final sample size was 391 from each group. Hence, the total sample size was 782 rounded off to 800. Multi-stage random sampling techniques were used to select the study sample. In the first stage, the list of all schools in Tirupati city was obtained from Mandal education officer. There were 340 schools in Tirupati. Out of them, 68 were government schools and 272 were private and aided schools. In the second stage, 8 schools (4 from government schools and 4 from private schools) were selected randomly. After selection of schools, permission from school authority was obtained to conduct the study. In the third stage, from each school, 100 students from 8th, 9th, and 10th classes were selected randomly. High school students of both government schools and private schools of age between 12 and 16 years or students of 8th, 9th, and 10th classes were included in the study, and students of age <12 years and more than 16 years and students who were absent on the day of data collection were excluded [Figure 1].
This study was approved by the Institution Ethics Committee, SVIMS, Tirupati (Roc. No. AS/11/IEC/SVIMS/2017-IEC No. 915 dated July 9, 2019). Written informed consent from a parent or guardian was obtained before data collection. The anonymity and confidentiality of the study participants were strictly maintained throughout the study.
A pretested semi-structured questionnaire was used to collect the information from study participants. It includes sociodemographic information such as age, sex, class studying, family history of lifestyle diseases, and socioeconomic status of family.
Lifestyle disease risk factors related knowledge and practices were assessed in the following domains: awareness regarding lifestyle diseases, awareness regarding practices like smoking and consumption of tobacco products, alcohol consumption, type and duration of physical activity. Adequate physical activity was defined as moderate to vigorous activity for at least 30 min/day on average according to the guidelines of WHO for adolescent health.[13] Weight and height were measured, and body mass index (BMI) was calculated. Height was measured with measuring tape capable of measuring to an accuracy of 1 cm. The subjects were made to stand without footwear with the feet parallel and with heels, buttocks, shoulders, and occiput in a straight-line position and the head in upright position while measuring the height.[14],[15]
Weight was measured using portable digital weighing machine with an accuracy of 100 g. The students were instructed to stand on weighing machine with lightweight clothing, without footwear, with feet apart and looking straight. BMI was calculated using the formula, BMI = weight (kg)/height (m2). The subjects were categorized into various grades based on the WHO BMI for age tables (thinness: <−2 SD, overweight: between +1 SD and <+2 SD, obese: >+2 SD).[14],[15] Blood pressure measurements were made on the right arm of each study subject with manual sphygmomanometer. The cuff pressure was inflated 30 mmHg above the level at which radial pulse disappeared and then deflated slowly at the rate of about 2 mm/s and the readings were recorded to the nearest 2 mmHg. The pressures at which sound appeared and disappeared were taken as systolic blood pressure (SBP) and diastolic blood pressure (DBP), respectively.[14]
Blood pressure (BP) was classified according to Rashtriya Bal Swasthya Karyakram (RBSK) guidelines. BP was Classified as normal: SBP and DBP <90th percentile. Prehypertension: SBP or DBP >90th percentile to <95th percentile or BP >120/80 mmHg to <95th percentile. Stage 1 HTN: SBP and/or DBP > 95th percentile to <99th percentile plus 5 mmHg. Stage 2 HTN: SBP and/or DBP >99th percentile plus 5 mmHg.[14]
The Perceived Stress Scale-10 (PSS-10) in English language was used to assess stress among adolescents. It has 10 questions and each question has a 5-point Likert scale. Cronbach's alpha value of PSS-10 was 0.69. The total score ranges from 0 to 40. The total score of 0–13 was considered low stress, 14–26 was considered moderate stress, and 27–40 was considered high stress.[16]
The data were entered into Microsoft Excel. Frequency and percentages were calculated for categorical data. Mean and standard deviations were calculated for quantitative data. Pearson Chi-square test was used to test the significant difference between proportions. Shapiro–Wilk test was used to test the normality. If the data were normally distributed, Student's t-test was used to test the significant difference between two means and Mann–Whitney's U-test was used if data were not in normal distribution. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp was used for analysis of data. P < 0.05 was considered statically significant.
| Results | | |
Eight hundred and eighty-four high school students of age between 12 and 16 years or studying 8th, 9th, and 10th classes were included in the study. Among them, 438 (49.5%) were in private schools and 446 (50.5%) were in government schools.
It is observed from [Table 1] that boys and girls are equally distributed in both government and private schools. Among all students, private school students have a high proportion of lifestyle diseases in their families (51.1%) compared to government school students (44.6%). Majority of the private school students' families belong to upper- and upper-middle-class socioeconomic status (42.7%) and most of the government school students' families belong to lower- and lower-middle-class socioeconomic status (52.1%). Among both government and private school nonvegetarians are more than vegetarians. Among vegetarians, 8.9% were in private schools and 10.9% were in government schools. Among nonvegetarians, 91.1% were in private schools and 89.1% were in private schools.
[Table 2] shows that among all students, 1.1% (9/884) reported that they smoke tobacco products in the past 30 days and 2.3% (20/884) of students reported smoke tobacco products at any time in life. 3.4% and 2.2% of government school students reported smoke tobacco products at any time in life and consumed tobacco products at any time in life, respectively, as compared to 1.2% and 0.2% of private school students. 1.6%, 3.1%, and 0.9% of government school students consumed tobacco products in any form in the past 30 days, consumed alcohol at any time in life, and consumed alcohol in the preceding 30 days, respectively, as compared to 0.5%, 0.7%, and 0.7% of private school students.
It is observed from [Table 3] that most of the private school students (66.4%) were doing regular exercise compared to government school students (56.3%) and a greater number of private school students were doing moderate-intensity sports (slow bicycling, tennis doubles, etc.) (37.9%) and doing vigorous-intensity sports or activities (fast bicycling, football or volleyball or basketball games, etc.) (72.1%). However, doing yoga was significantly high among government school students (52.9%). Unhealthy dietary habits such as taking adverse food (89.5%), taking extra salt intake (46.3%), eating in between regular meals (72.6%), and experience stress during examination (80.1%) were mostly present among private school students as compared to government school students.
It is observed from [Table 4] that among 201 students who consume fruits daily, 22.8% of students were in private schools and 22.6% were in government schools. Among 196 students who consume fruits 3 times a week, 20.4% were in private schools and 24% were in government schools. Among 156 students who consume fruits weekly twice, 20.4% were in private schools and 15.1% were in government schools. Among 296 students who consume weekly once, 33.1% were in private schools and 33.8% were in government schools. Among 35 students who never consume fruits, 3.3% are in private schools and 4.5% are in government schools.
Among 637 students who consume vegetables daily, 75.6% of students were in private schools and 68.6% were in government schools. Among 97 students who consume vegetables 3 times a week, 10.5% were in private schools and 11.4% were in government schools. Among 65 students who consume vegetables weekly twice, 8% were in private schools and 6.7% were in government schools. Among 56 students who consume weekly once, 4.3% were in private schools and 8.3% were in government schools. Among 29 students who never consume vegetables, 1.6% were in private schools and 5% were in government schools. 69.2% of private school students were spending time on watching TV and playing video games of 1 h or more as compared to 52.5% of government school students. 54.3% of private school students were spending time on sports of 1 h or less as compared to 52.1% of government school students. 7.3% of private school students perceived high stress as compared to 4.6% of government school students [Table 4].
[Table 5] shows that the mean BMI was significantly high among private school students (18.9 ± 4.3) compared to government school students (18.1 ± 3.9). The mean pulse rate was significantly high among private school students (82.1 ± 12.5 vs. 79.8 ± 10.4); the mean SBP (115.9 ± 9.9 vs. 109.9 ± 12.1) and DBP (72.1 ± 8.1 vs. 70.5 ± 8.5) were significantly high among private school students. | Table 5: Distribution according to means of body mass index, pulse rate, and blood pressure
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| Discussion | | |
This was a cross-sectional study conducted among high school students of both government and private schools. The strengths of this study were as follows: this is a multistage random sample survey and students of both government and private school students were included randomly in this study. This study is showing a rising level of risk factors of lifestyle disease among adolescents of school-going children. This study's results can be generalizable to high school students only and may not be applicable to adolescents who are not going to school. Among all students, private school students have a high proportion of lifestyle diseases in their families (51.1%) compared to government school students (44.6%). Among both government and private schools, nonvegetarians are more than vegetarians. Both government and private school students are almost equally distributed according to gender, positive family history of lifestyle disease, and type of diet except according to socioeconomic status.
Similarly, in a study done by Gupta et al., among 452 students, 247 (54.6%) were boys and 205 (45.4%) were girls.[17] In a study done by Anand et al., majority of the obese and overweight students were studying in private schools and from higher socioeconomic status families and it was significant (P = 0.016).[10] Similar findings were observed in school surveys done by Mudur in Indian cities which have shown that almost one-third of the adolescents from India's higher economic groups were overweight, and 14% of students belonged to urban schools.[18]
Among all students, 1.1% (9/884) have reported smoke tobacco products in the last 30 days and 2.3% (20/884) have reported smoke tobacco products at any time in life. 3.4% and 2.2% of government school students reported smoke tobacco products at any time in life and consumed tobacco products at any time in life, respectively, as compared to 1.2% and 0.2% of private school students. 1.6%, 3.1%, and 0.9% of government school students consumed tobacco products in any form in the past 30 days, consumed alcohol at any time in life, and consumed alcohol in the past 30 days, respectively, as compared to 0.5%, 0.7%, and 0.7% of private school students.
In a study done by Gupta et al., out of 542 students, 1.32% of boys and 3.12% of private school students were smokers.[13] In Singh et al.'s study, 3.6% of boys and 1.3% of girls were smokers.[19] Jaisoorya et al. reported that the prevalence of alcohol consumption among the age group of 12–13 years was 9.9%.[20] In another study by Parsekar et al. in Udupi, the prevalence of alcohol consumption was 5.7%.[21] A study on high school students in Uttar Pradesh by Mahmood et al. showed that 3.2% and 5.2% of students reported that they consumed alcohol in the past 30 days and consumed alcohol in the past.[22] Dhanawat et al. reported that the prevalence of alcohol use was 4.6%, of which 57.9% were males and 42.1% were females.[23] These findings were similar to this study.
In this study, the mean BMI is significantly high among private school students (18.9 ± 4.3) compared to government school students (18.1 ± 3.9). The mean pulse rate is significantly high among private school students (82.1 ± 12.4 vs. 79.8 ± 10.4), and the mean SBP (115.9 ± 9.93 vs. 109.9 ± 12.01) and DBP (72.1 ± 8.1 vs. 70.5 ± 8.5) were significantly high among private school students.
In a study done by Gupta et al., among private school and government-aided school students, the mean SBP is 118.7 ± 10.8 mmHg and 107.2 ± 13.2 mmHg, respectively. Among private school government-aided school students, the mean DBP is 73.4 ± 9.3 mmHg and 71.8 ± 7.9 mmHg, respectively. Blood pressure was high in boys and private school students.[17] A study by Singh et al. observed that SBP of male and female students was 121.9 ± 13.8 and 111.8 ± 12.9, respectively, and DBP was 70.4 ± 9.4 and 68.2 ± 8.6 among boys and girls, respectively.[19] Lauer and Clarke demonstrated that childhood blood pressure was positively correlated with adult blood pressure.[24]
Among 637 students who consume vegetables daily, 75.6% of students were in private schools and 68.6% were in government schools. Among 97 students who consume vegetables 3 times a week, 10.5% were in private schools and 11.4% were in government schools. Among 65 students who consume vegetables weekly twice, 8% were in private schools and 6.7% were in government schools. Among 56 students who consume weekly once, 4.3% were in private schools and 8.3% were in government schools. Among 29 students who never consume vegetables, 1.6% were in private schools and 5% were in government schools. Unhealthy dietary habits such as taking adverse food (89.5%), taking extra salt intake (46.3%), eating in between regular meals (72.6%), and experience stress during examination (80.1%) are mostly present among private school students as compared to government school students (74.4%). This shows that private school students were consuming healthy diet like vegetables compared to government school students.
In a study done by Gupta et al. it was observed that the most common food items with high-fat content which were consumed three or more servings per week by students included fast food (55.5%), ghee and butter (22.6%), red meat (6.4%), cold drinks (3.1%), ice cream (4.9%). Healthy food items which were consumed three or more servings per week included fruits (57.7%) and vegetables (84.3%).[19] Bukelo et al. reported that 21.5% of adolescents consumed fruits and vegetables more than 2 days a week.[25] Mahmood et al. reported that 70.8% of students consumed fast food daily, 64% consumed fruits 3 days per week, and 75.6% consumed vegetables 3 days per week.[22]
In this study, 69.2% of private school students were spending time on watching TV and playing video games of 1 h or more as compared to 52.5% of government school students. 54.3% of private school students were spending time on sports of 1 h or less as compared to 52.1% of government school students. 7.3% of private school students perceived high stress as compared to 4.6% of government school students. A study done by E Juulia Paavonen et al. among school children of age 8–12 years showed that 12% of students were experiencing persistent sleep disturbances and perceived stress was identified as the most significant risk factor for sleep disturbance in the study.[26]
Most of the private school students (66.4%) are doing regular exercise compared to government school students (56.3%) and a greater number of private school students are doing moderate-intensity sports (37.9%) and doing vigorous-intensity sports or activities (72.1%). However, doing yoga is significantly high among government school students (52.9%).
In a study done by Anand et al., more than 50% of the students reported that they have taken junk food such as chips and soft drinks more than 3 times a week. Moreover, more than 2/3rd of students did not get enough time for sports apart from studies. More than 70% said that their choice of recreation mode was largely sedentary and only 27% of the students played outdoor games as a mode of recreation and 73% opted for a sedentary mode of either watching TV or playing video games or browsing the Internet.[10] The study done in Europe showed that only 38.5% of students were doing adequate physical activity.[27] The GSHS 2007 revealed that among students of 8th to 10th class, only 30.2% ± 3.0% were physically active for a total of at least 60 min per day on all 7 days during the past 7 days.[28] In a study done by Shariff ZM et al. it was observed that there was a positive association between inadequate physical activity and occurrence of non-communicable diseases among school-going children.[29] A study by Dhanawat et al. in Mangalore observed that 25.6% of students were doing adequate vigorous physical activity and 66.3% of students were doing adequate moderate activity.[23] Bukelo et al. reported that 22.1% of students were doing physical activity daily.[25]
Müller-Riemenschneider et al. showed that the prevalence of risk factors of cardiovascular diseases is increasing rapidly among children of age between 11 and 17 years.[30]
Limitations
This study was conducted in one urban area only. It is recommended to conduct a multicenter study for unbiased results. There may be recall bias for behavioral risk factors such as smoking, alcohol, and junk food consumption. This study's results can be applicable to school-going adolescents.
| Conclusions | | |
School is an important place where adolescent behavior was developed and provides environment that influences the development of behavior The study shows that both government and private school students are equally exposed to risk factors of lifestyle diseases and school may play a vital role in minimizing or preventing the lifestyle disease risk factors among adolescents by imparting health education and providing facilities for adequate physical activity and healthy recreation. Therefore, it is recommended that combined and coordinated efforts of health and education departments were required for the primary and primordial prevention of lifestyle diseases.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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Correspondence Address:
Visweswara Rao Guthi,
Department of Community Medicine, SVIMS-Sri Padmavathi Medical College for Women, Tirupati, Andhra Pradesh
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/mjhs.mjhs_83_22
[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5] |
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