Introduction Non Communicable Diseases (NCDs) are leading cause of death worldwide including India. So much so that about 53% of deaths in our country are because of NCDs. Majority of NCD related deaths are attributed to four groups of diseases, cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases. Main risk factors for NCDs include dietary habits , physical inactivity, tobacco and alcohol use.
Other risk factors include high blood pressure, high cholesterol levels, high blood glucose levels, and genetic susceptibility (history of premature death or disability due to coronary heart disease or stroke, diabetes, and hypertension).
Treating NCDs bears a huge cost in terms of money and productive lives lost. Hence, it is wise to prevent NCDs by all means. Focusing on prevention of even risk factors in young people is likely to be more effective. Adolescence is probably the last best opportunity to build positive health habits and to limit the harmful behaviors. Adolescence is an age of developing brain and the time of habit formation. Habits adopted during this time are likely to persist in adult life. Hence, it is important to detect and manage harmful behaviors related to NCDs early.
These risk factors can be less damaging if identified early in life when habits are still forming. This offers for better health, more years of productivity and certainly a lesser cost of health care to nation.
|Risk Factor||Current Status||Implications on Health|
Most (90%) of adult smokers begin smoking before age of 18 years.
One in four adolescents who smoke start using tobacco before the age of ten
Exposed young people have two to three times the risk of asthma and lower respiratory conditions.
Smoking by teen girls as adverse effect on fertility as well as morbidity and mortality in the fetus, newborn, infant and toddlers.
|Physical inactivity/or lack of exercise||
Insufficient physical activity and unhealthy sedentary behaviors are no rise.
Rapid urbanization is also a driving force behind these risks
|Inactivity may lead to high blood pressure and overweight/obesity, which can trigger NCDs, such as cardiovascular diseases, diabetes, and cancers in adulthood|
|Poor eating habits/unhealthy diets
Food containing high levels of saturated fats, trans-fat, sugar and salt lead to weight gain and adverse metabolic changes
unhealthy diet also leads to overweight /obesity and various nutritional deficiencies
Overweight and obesity are important determinants of health, increases in blood pressure unfavourable cholestrol levels and increased resistance to insulin.
They raise the risks of coronary heart diseases, stroke, diabetes mellitus, and many forms of cancer
Adolescents who begin drinking earlier are more likely to become dependent on alcohol within 10 years than those who begin drinking at an older age.
Major risk factor for premature death and disability. There is a direct relationship between harmful levels of alcohol consumption and NCDs such as cancers and cardiovascular disease.
This also increases risk of road traffic accidents, unprotected sex,intentional and unintentional injuries,poor mental health, and gender-based violence.
|Best period to begin||Factors influencing||interventions needed||Policies|
Adolescence is the last best opportunity to build positive health habits and limit harmful ones.
Unless prevention is done from the adolescent,age habits are very hard to change once they get established as a life style.
Some risks, such as poor nutrition, begin in childhood and are a clear precursor for later health problems.
Adolescence is a time when the influence of peers is extremely important
Parental influence of being role model for healthy or unhealthy life styles is maximum during this period.
Media influences and the targeted marketing of unhealthy products and lifestyles for adolescent are on rise.
To lower the likelihood of youth smoking and chewing tobacco, protect against alcohol use, and support healthy diet and physical activity.
Communities must also work together to promote physical activity and healthy eating habits based on cultural appropriateness, especially within schools.
Some of the most cost-effective strategies to combat tobacco use and harmful use of alcohol include raising taxes and enforcing bans on advertising especially targeted to adolescents.
Public promotion of what constitutes a healthy diet and the appropriate amount of physical activity specifically 60 minutes a day for adolescents, is important.
National and local governments can do more to ensure their communities are eating healthier by encouraging clear food labels; managing food taxes and subsidies; promoting healthy eating in schools and workplaces; restricting marketing of junk food and sugary beverages to children and adolescents; and providing incentives for the food industry to prepare foods with less sodium, trans-fat and saturated fat.
Identification of the risk factors in adolescents
As stated above many of the risk factors might have already started in the adolescents. Thus it is better to identify them as early as possible. It is important to look for the risk factors in all adolescents and if found then ‘selective screening’ by some blood tests can be added to clinical screening.
Risk Factors - Non-Communicable Diseases
|Modifiable Risk Factors||Non-Modifiable Risk Factors|
Leading risk factors
Other Risk factors
It is important to include some questions related to unhealthy diet, physical activity or inactivity, smoking and substance (including tobacco and alcohol) use/misuse, and then family history of diabetes, hypertension, coronary heart diseases, stroke or early (<45 years of age) death or disability due to acquired heart disease or stroke in parents or grand parents. These questions can be incorporated in HEADSS review of psychosocial interview. Some questions are given below for illustration.
Whenever these screening tests are abnormal then a thorough physical examination and detailed laboratory evaluation is required and such adolescents should be referred to experts’ evaluation.
Behavioral risk factors like smoking, alcohol intake, inadequate physical activity and sedentary activities, and unhealthy diets can be managed by appropriate counseling of parents and adolescents. Healthy habits are likely to be followed when the whole family is ready to change and adopt healthy habits. Barriers to healthy habits should be identified and managed accordingly. Algorithm (I am too thin/too fat) can be used for management of overweight and obesity.
It is important to identify genetic risk factors like enhanced susceptibility in view of family history as described above. Such adolescents and family should be advised to adopt healthy dies, regular physical activity, and less (<2 hours per day) of sedentary activities (screen time like television, video games and mobile phones).
Smoking and other tobacco use should be managed by counseling techniques. Following texts from WHO Job Aids can be used to educate parents and adolescents for promoting healthy eating and physical activity, for prevention of unintentional injuries and for preventing use of tobacco, alcohol and other substances.
Adolescents need a healthy diet to grow and develop, and to function optimally. A healthy diet consists of:
There are five basic food groups:
Balanced food intake
A young person should eat a diet balanced across the five food groups. They should eat:
If adolescents do not have enough to eat, they will be underweight. Being undernourished will affect their physical growth and development as well as their ability to learn and to work. Young women who are underweight tend to have babies who are smaller and more liable to health problems.
If adolescents have too much to eat, particularly foods high in fat and sugar, this can lead to them becoming overweight. Being overweight can lead to health and social problems during adolescence and later in life.
Messages for adolescents
Messages for parentsWhat you should know:
What you should do:
Regular physical activity has important physical, mental and social benefits both during adolescence and later in life. Physical activities include sports such as football and exercise such as jogging. They also include regular daily activities such as walking to school and work done at home (e.g. cleaning the floor) or at work (e.g. painting a room).
Messages for adolescents
Around sixty minutes of physical activity on most, if not all days, can provide you with the following benefits:Physical benefits
Messages for parents
What you should know:
What you should do:
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