A study of cardiovascular risk factors and its knowledge among school children of Delhi

Association of Screen Time Usage and Physical Activity With Overweight and Obesity Among School-Going Children in Uttar Pradesh

Background Being overweight during childhood refers to excess weight for a given height, while obesity denotes excess body fat. These conditions stem from surplus calorie intake and insufficient physical activity. Escalating pediatric obesity is linked to modern sedentary lifestyles, marked by increased screen time, reduced exercise, and poor diets. Once believed to be a concern in affluent nations, obesity now affects developing countries like India due to changing eating habits and urbanization. Despite limitations in measurement tools, such as body mass index (BMI) and waist circumference, recognizing sedentary behaviors such as prolonged screen time is pivotal. The rapidly rising prevalence of pediatric obesity has become a major public health concern; therefore, we conducted this study to determine the prevalence and association of screen time usage with being overweight in school-going children (aged 8-15 years). Methodology This observational, cross-sectional study was conducted in Greater Noida, Uttar Pradesh over 18 months (January 2019 to June 2020) after obtaining institutional ethical committee approval. Participants were 8 to 15-year-old students from three co-educational secondary schools in the region. Children with motor or developmental disabilities were excluded. Written informed parental consent and school permission were secured. Anthropometric measurements included weight (SECA 874 U scale) and height (SECA213 stadiometer), which were used to calculate BMI. Overweight/obesity status followed the Indian Academy of Pediatrics guidelines. A validated questionnaire assessed screen time, and a validated Physical Activity Questionnaire measured physical activity. Both questionnaires were administered twice to validate data. SPSS version 23.0 (IBM Corp., Armonk, NY, USA) was used for data analyses (descriptive, t-test, analysis of variance (ANOVA) test, and chi-square test). P-values <0.05 were considered significant. Results This study involved 604 participants. Among them, 47.7% had a normal BMI, 37.4% were overweight, and 14.9% were obese. Most participants (97.4%) reported screen time of over 60 minutes daily, while 2.6% reported lower screen time. ANOVA revealed significant differences in daily (F = 16.014, p < 0.001) and weekly (F = 16.175, p < 0.001) screen time among BMI categories. Low physical activity was prevalent (97.7%). ANOVA showed significant variations in physical activity scores and durations (p < 0.001), with normal-weight individuals exhibiting higher levels. Conclusions The rising prevalence of overweight among children underscores the need for early intervention strategies, emphasizing the importance of reducing screen time and promoting increased physical activity. These measures are critical in addressing the growing challenge of being overweight during childhood and its potential long-term health implications.

A School-based survey among adolescents on Dietary pattern, Exercise, and Knowledge of Cardiovascular risk factors (ADEK) Study

Background. Cardiovascular disease is a global emerging problem and its risk starts in children and adolescents. Adolescents have modifiable cardiovascular risk factors that have been found globally, and nationally, and early intervention programs may be able to lower these risks for both individuals and populations. Accurate risk factor evaluation at the individual level is crucial in this situation for the prevention of cardiovascular disease. Objective. The study aimed to investigate cardiovascular disease knowledge and to determine physical activity, and dietary patterns among school-going adolescents in Arakkonam, Tamil Nadu, India. Methods. A school-based cross-sectional survey was conducted to assess cardiovascular disease knowledge among 500 adolescents aged 10-18 from public schools. The study period was from September 2021 to February 2022. The measurement taken on anthropometrics such as height, weight, body mass index, and bio-physiological measurement as blood pressure, structured questionnaire assessed for knowledge, dietary questionnaire assessed previous week food consumption which the investigator developed, and physical activity standard questionnaire assessed the past week’s exercise level. Data were analyzed using IBM Statistical Package for Social Sciences version 20. Results. The mean study population age was 13.7±1.7, 53% were boys, and 47% were girls. Factors like age 16-18 years (p=0.01), site of residence from urban (p=0.001), education of teenagers (p=0.01), and family history of cardiovascular disease (p=0.001) are significantly correlated with the level of knowledge score, with better-educated adolescents having fair knowledge score than others. Level of knowledge score and demographic traits are associated with physical activity, such as 16 to 18 years (p=0.03), living in an urban region (p=0.03), being in a joint household (p=0.001), adolescents who are at higher secondary (p=0.02), and having a family history contribute more to cardiovascular disease (p=0.001) than other variables. Mean days eating diets were egg (4.18±2.27), vegetables (3.92±0.93), milk products (3.85±1.87), fried foods (3.75±1.25), toffees, and chocolates (3.35±1.81) all had higher percentages of consumed foods than others. Conclusion: There is a risk of cardiovascular disease higher among adolescents. Still a need for school-based primordial preventive educational approaches needed to improve to curb this burden.

Effectiveness of structured interventional strategy for middle-aged adolescence (SISMA-PA) for preventing atherosclerotic risk factors—A study protocol

Background

Atherosclerotic risk starts at an early stage in adolescents and interventions on adolescents’ lifestyles are most important. The pandemic of obesity-related morbidities like atherosclerosis among young adults and atherosclerotic risk factors for middle-aged adolescents in India is known. Yet, there is a lack of cost-effective and integrated intervention programs to treat this important health problem.

Objective

The main objective of this study is to evaluate the effect of a 12-week structured interventional strategy program, containing integrated education and supervised physical activity interventions for middle-aged adolescents.

Methods/design

This will be a school-based pre-experimental one-group pre-post time-series research design. The sample size is estimated to include 154 adolescents of 10^th to 12^th grade; aged 15–17 years will be grouped as a single arm. Data will be collected from July 2021 to January 2022. The intervention duration will be 3 months. The following measures will be evaluated before, during, and after intervention: knowledge, body mass index, level of physical activity, dietary habits, and sedentary activity.

Discussion

We believe that the structured interventional strategy approach which includes education related to atherosclerosis, physical activity, dietary habits, and sedentary activity, and cost-effective physical activity training will be more effective in preventing atherosclerotic-related changes among middle-aged adolescents. Further, this kind of approach may be applied in similar study areas elsewhere in India.

Trial registration

Clinical Trials Registry—India (Registered Number: CTRI/2021/03/032271).

Physical Activity and Sports Participation among Adolescents: Associations with Sports-Related Knowledge and Attitudes

The impact of physical activity and sport on the development of adolescents' knowledge and attitudes has not been studied sufficiently. We assume that young people with more knowledge of sports will continue to be physically active on their own. The aim of this study is to identify the differences in the sports and physical activity-related knowledge and attitudes of adolescents who engage in organised sports training and those who do not. A total of 1033 6th-grade students from (aged 12.7 ± 0.4 years) 52 schools in Estonia were involved in the study. Logistic regression analysis was used to examine the associations between sports-related knowledge and attitudes towards students participating in organised sports training. The main reasons which hindered adolescents from being active were a lack of suitable equipment, being weaker than others, and laziness. Knowledge of physical activity, higher perceived benefits, and lower barriers to physical activity were the predictors contributing to adolescents' participation in sports training. The results demonstrated that physically active students have better knowledge of sports and physical activity. Students participating in organised sports training have strong positive benefits from being regularly physically active and feel that sports training maintains their health.

Effect of Information, Education, and Communication activity on health literacy of cardiovascular diseases among school-going adolescents in Delhi

BACKGROUND

Heart attack and stroke account for >80% of deaths due to cardio-vascular diseases (CVDs) in India. Adolescents are the most susceptible group to adopt risky behaviors causing CVDs such as use of tobacco and alcohol, sedentary lifestyle, and unhealthy diet. This study was conducted to assess the health literacy of CVDs such as heart attack and stroke among school-going adolescents and change in health literacy after different information, education, and communication (IEC) activities.

MATERIALS AND METHODS

It was a school-based interventional study conducted in two schools among students of classes 6, 7, and 8. The educational interventions were done in the form of pamphlets, posters, and lectures on heart attack and stroke. The postintervention data were collected 2 weeks after the first intervention and 3 months after the last intervention.

RESULTS

There were a higher proportion of students with satisfactory level of knowledge of heart attack and stroke both at 2 weeks and 3 months after the interventions in both the schools, and the results were statistically significant (P < 0.05).

CONCLUSION

The health literacy regarding CVDs has improved when compared to baseline after IEC activities among school-going adolescents.

Cardiovascular disease risk factors among school children of Bangladesh: a cross-sectional study

OBJECTIVE

Primarily, we assessed the distribution of cardiovascular disease (CVD) risk factors among school children living in urban and rural areas of Bangladesh. In addition to this, we sought the association between place of residence and modifiable CVD risk factors among them.

DESIGN, SETTING AND PARTICIPANTS

This cross-sectional study was conducted among 854 school children (aged 12-18 years) of Bangladesh. Ten public high schools (five from Dhaka and five from Sirajgonj district) were selected randomly and subjects from those were recruited conveniently. To link the family milieu of CVD risk factors, a parent of each children was also interviewed.

PRIMARY AND SECONDARY OUTCOME MEASURES

Distribution of CVD risk factors was measured using descriptive statistics as appropriate. Again, a saturated model of binary logistic regression was used to seek the association between place of residence and modifiable CVD risk factors.

RESULTS

Mean age of the school children was 14.6±1.1 years and more than half (57.6%) were boys. Overall, 4.4% were currently smoker (urban-3.5%, rural-5.2%) with a strong family history of smoking (42.2%). Similar proportion of school children were identified as overweight (total 9.8%, urban 14.7%, rural 5%) and obese (total 9.8%, urban 16.8%, rural 2.8%) with notable urban-rural difference. More than three-fourth (80%) of them were physically inactive with no urban-rural variation. Only 2.4% consumed recommended fruits and/ or vegetables (urban-3.1%, rural-1.7%). In the adjusted model, place of residence had higher odds for having several modifiable CVD risk factors: current smoking (OR: 1.807, CI 0.872 to 3.744), inadequate fruits and vegetables intake (OR: 1.094, CI 0.631 to 1.895), physical inactivity (OR: 1.082, CI 0.751 to 1.558), overweight (OR: 3.812, CI 2.245 to 6.470) and obesity (OR: 7.449, CI 3.947 to 14.057).

CONCLUSIONS

Both urban and rural school children of Bangladesh had poor CVD risk factors profile that demands further nation-wide large scale study to clarify the current findings more precisely.

Prevalence of hypertension among adolescents (10-19 years) in India: A systematic review and meta-analysis of cross-sectional studies

BACKGROUND

Despite the well-known short-term and long-term ill effects of elevated blood pressure in children and adolescents, pooled data on its burden among Indian adolescents have not yet been synthesized.

OBJECTIVES

We did a systematic review with meta-analysis to calculate the pooled prevalence of hypertension among adolescents (10-19 years) in India.

METHODS

We searched PubMed, Embase, Cochrane library, Google Scholar and IndMed, and included cross-sectional studies reporting data on hypertension prevalence among 10 to19 years old and published in English language from their inception till 1st March 2020. Modified New castle Ottawa scale was used to assess risk of bias based on research design, recruitment strategy, response rate and reliability of outcome determination. A random effects model was used to estimate pooled prevalence, and heterogeneity was assessed using Cochrane's Q statistic test of heterogeneity and I2 statistic. To explore the heterogeneity, we did a meta-regression, and sub-group analyses based on region, study setting and number of blood pressure readings.

RESULTS

Out of 25 studies (pooled sample of 27,682 participants) six studies were of high, eighteen of moderate, and one was of low quality. The prevalence of hypertension across studies ranged from 2% to 20.5%, with a pooled estimate of 7.6% (95% CI: 6.1 to 9.1%), I2 = 96.6% (p-value <0.001). Sub-group analysis restricted only to the western India demonstrated a smaller heterogeneity (I2 = 18.3%). In univariate model of meta-regression, diagnostic criteria was significantly associated with pooled prevalence (-4.33, 95%CI: -7.532, -1.134).

CONCLUSION

The pooled prevalence of hypertension among adolescent in India is 7.6% with substantial heterogeneity between the studies. To tackle the high prevalence of hypertension among adolescents, early detection by screening under school health programme and opportunistic screening at Paediatric OPD should be implemented by Policy makers.

Development and Psychometric Evaluation of the Cardiovascular Health Behavior Scale for Children

PURPOSE

The aim of this study was to develop a cardiovascular health behavior scale for children and to assess its psychometric properties.

DESIGN AND METHOD

A cross-sectional, methodological, descriptive, and correlational study design was conducted. The study sample consisted of 745 children between the ages of 10 to 15 years. The content validity of the scale was assessed by consulting 13 experts in pediatrics and cardiovascular health. Numbers, percentages, t-test, correlation analysis, Cronbach's α reliability coefficient and factor analysis were used for data analysis.

RESULTS

The Cronbach's alpha coefficient for the overall scale was 0.83, and the Cronbach's alpha values for the subscales were 0.70-0.79. The item-total score correlations ranged from 0.354 to 0.637 (p < .05). The exploratory factor analysis showed that the scale explained 54.65% of the total variance, and the factor loadings of items ranged from 0.48 to 0.84. The confirmatory factor analysis also showed that the factor loadings of the scale ranged from.30 to.83. GFI, NFI, NNFI, CFI were found to be >0.90, and RMSA was found to be <0.080.

CONCLUSION

All the statistical procedures performed in the validity and reliability stages of the study show that the scale is a valid, reliable measurement tool for the Turkish culture.

PRACTICE IMPLICATIONS

The scale can be used as a measurement tool in experimental studies about cardiovascular health and can easily be adapted for use in other societies because of its universal items regarding cardiovascular health and its user-friendly structure.

Household Chores or Play Outdoors? The Intersecting Influence of Gender and School Type on Physical Activity Among Indian Adolescents

Most Indian adolescents, particularly girls and private school students, do not engage in sufficient physical activity (PA). Current understanding of these sociodemographic differences is limited by a focus on exercise, which may not fully capture PA in developing countries. We examined how gender and school type are associated with multiple PA domains and whether associations with gender differ by school type. We randomly selected an equal number of girls and boys (ages 13-16 years) from public and private schools in Southern India (n = 395). Cross-sectional 24-hour time-use surveys measured PA, which was categorized into three domains: chores, errands, and work; play; and transportation. Negative binomial and logistic regression modeled relative differences in domain-specific PA minutes and the probability of engaging in ≥60 minutes of moderate-to-vigorous PA (MVPA), respectively, in the prior 24 hours. Girls and boys were equally likely to meet MVPA recommendations. However, girls spent twice as much active time completing chores, errands, and work (rate ratio = 1.98, 95% confidence interval = [1.32, 2.98]), while boys spent twice as much active time playing (rate ratio = 2.11, 95% confidence interval = [1.23, 3.62]). Public and private school girls spent more active time in chores, errands, and work than boys; however, gender differences were greater among public school students (p value for interaction <.05). Although comparable MVPA levels for girls and boys are beneficial for physical health, girls may gain fewer cognitive, social, and emotional benefits associated with play. Additional research may clarify why the gendered burden of household responsibilities was greater among public school students. School-based programs to engage girls in active play may help reduce inequities.

Schoolchild as a health educator for parents regarding hypertension: A quasi-experimental study among school students of South India

BACKGROUND

An alarming trend of sustained blood pressure elevation among children and adolescents has been found. Health education to schoolchildren in their formative age is the most effective method to be able to modify their habits, and further, they can be enrolled as an effective health educator for their parents.

OBJECTIVE

To study the effectiveness of health education module on study participants about prevention and control of hypertension (HTN) and the effectiveness of child as a health educator on parents' knowledge about prevention and control of HTN.

MATERIALS AND METHODS

This quasi-experimental study was conducted with a control group among high school students in two urban secondary schools. There were 110 students and 100 parents each in the intervention and control groups. Modular training with interactive teaching-learning methods was conducted for students in the intervention group. They, in turn, educated their parents.

RESULTS

Postintervention, the study results showed a higher median for various domains in the intervention group as compared to the control group among both students and parents. On applying Mann-Whitney test, this difference was statistically significant with P < 0.001.

CONCLUSION

The increase in the knowledge of parents belonging to the intervention group suggests the effective transfer of knowledge from the students to their parents.

Cardiovascular Risk Factor Knowledge and Behaviors Among Low-Income Urban Women in Mysore, India

BACKGROUND

Cardiovascular diseases (CVDs) are the leading causes of death among women globally. Cardiovascular disease-related events are more common in older women compared with men and are more likely to result in death. Although research in high-income countries suggests that women have unique sociobiological CVD risk factors, only a few study authors have examined risk factor knowledge among women from low- and middle-income countries.

OBJECTIVE

The aim of this study was to assess CVD risk factor knowledge among low-income urban Indian women.

METHODS

A cross-sectional study was conducted among a nonprobability sample of 607 slum-dwelling women, 40 to 64 years old, living in Mysore, India, between October 2017 and May 2018. Participants underwent an interviewer-administered questionnaire measuring demographics, CVD risk factor knowledge, and medical history.

RESULTS

Cardiovascular disease risk factor knowledge was low in this population and was associated with age, education, income, and caste. Approximately half of the participants (47%) answered less than 50% of the questions correctly, and a third had knowledge scores greater than 70%, which we defined as "good knowledge." Only 4 of 7 traditional CVD risk factors (ie, physical activity, smoking, overweight, and high cholesterol) were recognized by greater than half of the participants. The lowest knowledge levels were among older single women with no education and monthly household incomes less than Rs 3000 (approximately US $42).

CONCLUSIONS

Previous research among slum dwellers in India reported a high prevalence of modifiable CVD risk factors compared with more affluent urban peers. Interventions aimed at CVD risk factor knowledge may be an important first step in controlling heart disease in this vulnerable population.

Physical Activity Among Adolescents in India: A Qualitative Study of Barriers and Enablers

Inadequate physical activity (PA) levels are reported in Indian youth, with lowest levels among adolescents, particularly girls. We aimed to identify barriers to and enablers of PA among school children in New Delhi and examine potential differences by gender and school type (government vs. private). A total of 174 students (private school students = 88, 47% girls; government school students = 86, 48% girls) aged 12 to 16 years from two Delhi schools participated in 16 focus group discussions (FGDs) conducted by bilingual moderators. We conducted FGDs separately for girls and boys, for students in Grades VIII and IX, and for private and government schools. We conducted FGDs among government school students in Hindi and translated the transcriptions to English for analysis. We coded transcriptions using a combination of inductive and deductive approaches, guided by the "youth physical activity promotion model." We identified various personal, social, and environmental barriers and enablers. Personal barriers: Private school girls cited body image-related negative consequences of PA participation. Social barriers: Girls from both schools faced more social censure for participating in PA. Environmental barriers: Reduced opportunity for PA in schools was commonly reported across all participants. Personal enablers: All participants reported perceived health benefits of PA. Social enablers: Several participants mentioned active parents and sports role models as motivators for increasing PA. Few environmental enablers were identified. This study highlights the need for further investment in physical activity within schools and for gender-sensitive policies for encouraging PA participation among adolescents in India.

Family characteristics and children's knowledge of cardiovascular risk factors

BACKGROUND

Cardiovascular disease has the highest mortality rate than any other disease globally. Some major risk factors seem to be established in the early stages of life, suggesting preventive strategies as a major means to reduce cardiovascular mortality. The aim of the present study was to investigate the role of socioeconomic status and family characteristics on children's knowledge and perceptions concerning cardiovascular disease risk factors.

METHODS

A cross-sectional survey was conducted among 1,728 children (46% male) aged 10-12 years, attending Greek primary schools in Athens; Heraklion (capital city of the island of Crete); Kalamata; Pyrgos; and Sparti (Peloponnese peninsula), Greece. Sampling was conducted on school premises, during the school years 2014-15 and 2015-16 (participation rate, 95-100%). Data were collected via self-administered, anonymous questionnaire. Children's knowledge of various issues related to cardiovascular risk, such as nutrition, physical activity and smoking was also examined. Data on family characteristics were collected through another questionnaire completed by parents.

RESULTS

Paternal education level and living with both parents instead of single-parent upbringing, were positively associated with children's knowledge of cardiovascular risk factors (b = 0.42; 95%CI: 0.01-0.83; P = 0.04; and b = 0.78; 95%CI: 0.013-1.43; P = 0.02 respectively). Moreover, children with more siblings seemed to have less sufficient knowledge compared with peers with fewer siblings (b per 1 sibling = -0.24; 95%CI: -0.47 to -0.014; P = 0.04).

CONCLUSIONS

The present findings enhance the link between the micro-environment and children's knowledge and perceptions concerning cardiovascular health, providing information to health-care professionals while counseling youths.

A contemporary picture of the burden of death and disability in Indian adolescents: data from the Global Burden of Disease Study

Background

Adolescents (10-19 years old) comprise a fifth of the Indian population (253.2 million), yet there is very little published information about the burden of disease and injury for this age group. This paper aims to provide a contemporary picture of the leading causes of death and disability for Indian adolescent girls and boys for 2013, and changes in deaths and disability between 1990 and 2013.

Methods

Data from the Global Burden of Disease (GBD) study for India, for the years 1990 and 2013, were accessed. Data were categorized into two age groups: 10 to 14 years (younger adolescents) and 15 to 19 years (older adolescents) and analysed separately for girls and boys.

Results

The study shows that for both younger and older adolescent boys and for older adolescent girls, non-communicable diseases (NCDs) and injuries are responsible for a greater number of deaths and disability-adjusted life-years (DALYs) than communicable diseases. Communicable diseases are still important causes of death and disability for young adolescents. Among older adolescents there is an increasing burden of death and disability due to self-harm, road traffic injuries, fire- and heat-related injuries and mental disorders such as depressive disorders.

Conclusions

Although strategies to reduce the burden of communicable diseases among adolescents must continue to be an important focus, innovative, evidence-based strategies aimed at reducing the growing burden of NCDs and injuries must be elevated as a priority.

Undernutrition and Overnutrition Burden for Diseases in Developing Countries: The Role of Oxidative Stress Biomarkers to Assess Disease Risk and Interventional Strategies

The increased life expectancy, urbanization, and unhealthy lifestyle characterized by a shift towards a sedentary lifestyle and decreased energy expenditure are considered the main drivers of epidemiological transition. In particular, developing countries are facing a double burden caused by coexisting under- and over-nutrition, which causes a change in the disease profile from infectious diseases to a chronic degenerative pattern. This review discusses the under- and over-nutrition context in Mauritania and India, two countries that are experiencing a nutritional transition, and where we began a collaboration with local medical staff to integrate interventional and diagnostic guidelines. If many studies about diet and its relationship to non-communicable diseases are available for India, very few nutrition and cardiovascular risk studies have been conducted in Mauritania. Presently, with the exponential increase of nutrition-related diseases, targeted approaches are needed to provide balanced diets in parallel with the development of national preventive health systems and screening programs adapted to local needs. In this context, the measurement of oxidative stress biomarkers could be promising as an additive tool to assess cardiovascular (CV) risk in general population, and ameliorating prevention in patients at CV risk or with overt CV disease. Moreover, the possibility of improving the outcome by the direct employment of antioxidant remains plausible. Moreover, studies on the content of antioxidant in different foods may be helpful to develop a balanced diet, and achieve the maximal nutritional and functional properties of cultivars with benefits for human health.

Exercise and eating habits among urban adolescents: a cross-sectional study in Kolkata, India

BACKGROUND

Unhealthy eating and lack of exercise during adolescence culminated into earlier onset and increasing burden of atherosclerotic cardiovascular diseases (CVDs) worldwide. Among urban Indian adolescents, prevalence of these risk factors of CVD seemed to be high, but data regarding their pattern and predictors was limited. To address this dearth of information, a survey was conducted among urban adolescent school-students in Kolkata, a highly populated metro city in eastern India.

METHODS

During January-June, 2014, 1755 students of 9th-grade were recruited through cluster (schools) random sampling. Informed consents from parents and assents from adolescents were collected. Information on socio-demographics, CVD-related knowledge and perception along with eating and exercise patterns were collected with an internally validated structured questionnaire. Descriptive and regression analyses were performed in SAS-9.3.2.

RESULTS

Among 1652 participants (response rate = 94.1%), about 44% had poor overall knowledge about CVD, 24% perceived themselves as overweight and 60% considered their general health as good. Only 18% perceived their future CVD-risk and 29% were engaged in regular moderate-to-vigorous exercise. While 55% skipped meals regularly, 90% frequently consumed street-foods and 54% demonstrated overall poor eating habits. Males were more likely to engage in moderate-to-vigorous exercise [adjusted odds ratio (AOR) = 3.40(95% confidence interval = 2.55-4.54)] while students of higher SES were less likely [AOR = 0.59(0.37-0.94)]. Males and those having good CVD-related knowledge were more likely to exercise at least 1 h/day [AOR = 7.77(4.61-13.07) and 2.90(1.46-5.78) respectively]. Those who perceived their future CVD-risk, skipped meals more [2.04(1.28-3.25)] while Males skipped them less [AOR = 0.62(0.42-0.93)]. Subjects from middle class ate street-foods less frequently [AOR = 0.45(0.24-0.85)]. Relatively older students and those belonging to higher SES were less likely to demonstrate good eating habits [AOR = 0.70(0.56-0.89) and 0.23(0.11-0.47) respectively]. A large knowledge-practice gap was evident as students with good CVD-related knowledge were less likely to have good eating habits [AOR = 0.55(0.32-0.94)].

CONCLUSIONS

CVD-related knowledge as well as eating and exercise habits were quite poor among adolescent school-students of Kolkata. Additionally, there was a large knowledge-practice gap. Multi-component educational interventions targeting behavioral betterment seemed necessary for these adolescents to improve their CVD-related knowledge, along with appropriate translation of knowledge into exercise and eating practices to minimize future risk of CVDs.

Cardiovascular risk reduction intervention among school-students in Kolkata, West Bengal - the CRRIS study protocol

BACKGROUND

Increasing burden of cardiovascular risk-factors among adolescent school-children is a major concern in India. Dearth of information regarding the burden of these factors and the efficacy of educational intervention in minimizing them among urban school-students of India called for a school-based, educational intervention involving a representative sample of these students and their caregivers.

METHODOLOGY

Using a randomized-controlled design with stratified-random sampling, 1000 students (approximately 50/school) of 9th grade from 20 randomly selected schools (representing all socio-economic classes and school-types) and their caregivers (preferably mothers) will be recruited. Objectives of the study will include: estimation of the baseline burden and post-interventional change in cardiovascular risk-factors, related knowledge, perception and practice among participants in Kolkata.

DATA COLLECTION

After obtaining appropriate consent (assent for adolescents), collection of the questionnaire-based data (regarding cardiovascular disease/risk-factor related knowledge, perception, practice), anthropometric measurements, stress assessment and cardiological check-up (pulse and blood pressure measurement along with auscultation for any abnormal heart sounds) will be conducted for each participating students twice at an interval of six months. In between 6 educational sessions will be administered in 10 of the 20 schools randomized to the intervention arm. After the follow-up data collection, same sessions will be conducted in the non-interventional schools.

DATA ANALYSES AND DELIVERABLE

Descriptive and inferential analyses (using SAS 9.3) will be conducted to determine the distribution of the risk-factors and efficacy of the intervention in minimizing them so that policy-making can be guided appropriately to keep the adolescents healthy in their future life.