0
MEDICAL ACADEMY FACULTY OF PUBLIC HEALTH
DEPARTMENT OF PREVENTIVE MEDICINE
PARAMJIT KAUR
HEALTH BEHAVIOUR OF SCHOOL-AGED CHILDREN IN
PUNJAB, INDIA
MASTER THESIS
Supervisor:
Prof. Dr. Linas Šumskas
Student: Paramjit Kaur
1
CONTENTS List of abbreviations
1. Summary
2. INTRODUCTION.
3. AIM AND OBJECTIVES... 4. LITERATURE REVIEW 4.1 Health behaviour in children. 4.2 Main health problems in children.
4.3 Prevalence of low physical activity in children 4.4 Obesity and overweight
4.5 Risking taking behaviour –smoking alcohol drug use 4.6 Healthy diet in children
4.7 Importance of physical activity in children 4.8 Social determinants in children
4.9 Lifestyle of children in Punjab and other countries 4.10 Intervention to change health behaviour
5. MATERIAL AND METHODS 6. RESULTS AND DISCUSSION 7. CONCLUSIONS 8. PRACTICAL RECOMMENDATIONS 9. REFERENCES 10. ANNEX 1. 11. ANNEX 2 2 3 4 7 8 8 13 14 15 17 20 21 21 22 24 27 28 48 49 53 57 66
2
LIST OF ABBREVIATIONS
CVD- Cardio Vascular Diseases NCD- Non Communicable Diseases
MPVA- Moderate to Vigorous Physical Activity PA- Physical Activity
WHO - World Health Organization SES- Socio Economic Status
HSBC-Health Behaviour in School-Aged Children BMI- Body Mass Index
3
1.SUMMARY
Aim. To analyze the profile health behaviour in school aged children in Punjab, India.
Objectives. To analyze the profile health behaviour (nutrition, low physical activity, smoking, use of
alcohol and perceived health evaluation by gender; to compare and analyze health behaviour of school children in urban and rural schools in Punjab. To compare the profile of lifestyle of students in Punjab with students of other countries (seven reference HBSC network countries).
Methods. The data on health behaviour analysed below were collected in a school-based,
cross-sectional, anonymous survey conducted during December 2016 in 2 different schools in Punjab (India). The sample of students covered6 to 10 grade students (5 classes) in one public school in the rural area (n=150) and in one private school (n=150) in urban area. In total 300 students aged 13 to 17 years took part in the survey. Questionnaire forms were distributed by the author of this research to students in each classroom. It was explained shortly to respondent’s methodology of filling in the questionnaire forms. Questionnaire comprised 45 questions regarding respondents the main demographical data (gender, age, place of residence) and health behaviours – perceived health, illness and health complaints, unhealthy behaviours (smoking, alcohol) eating habits, physical activity, leisure time, injury behaviour, relations with family and peers, school related behaviour.
Results.Majority of school children from Punjab State, India, aged 13-17 years reported good and
excellent their perceived health condition. Boys have demonstrated better perceived health scores than girls (91.5% VS. 77, 4%, respectively, p<0.05). 82.1 % of boys and 83.0 % girls were eating vegetables every day (p>0.05). In overall, boys reported eating fruits less frequently in comparison to girls (22.6% VS. 34.6%, respectively, p<0.05). Girls reported higher frequency of sweets use, but boys showed higher consumption of soft drinks on every day basis (p<0.05). Data showed that boys were more physically active than girls. Only few percent of school-aged boys and girls have reported smoking and alcohol drinking behaviour in Punjab. It was established that urban students were less likely to eat breakfast everyday (71.6% and 85.8%, p<0.05) in comparison with rural students. Urban students consumed more fruits but less vegetables every day (p<0.05). Study showed that urban students (85.6 %) reported good and excellent health more frequently than rural (77,4%) school children (p<0.05).
Comparison of health behaviour of students aged 13-17 years in Punjab and seven selected HBSC countries (Lithuania, Sweden, Italy, Spain, Wales, Canada, Scotland) showed that some relatively small differences exist between school students in Punjab and HBSC countries.
Conclusions. The general profile of health behaviour in school-aged children aged 13-17 years in Punjab,
India, presented by this study. Small percentage of alcohol users and weekly smokers was established among students in Punjab. Relatively small differences were demonstrated between school students in Punjab and students in seven HBSC countries (2014 survey data compared).
Keywords: health behaviour, school-aged children, nutrition, physical activity, smoking, alcohol,
4
2. INTRODUCTION
Most individuals engage in multiple unhealthy lifestyle behaviours with the potential for negative health consequences. Evidence gathered over the last two decades shows that disadvantaged social circumstances are associated with increased health risks.
Young children are often neglected as a population group in health statistics, being either aggregated with younger children or with young adults. Less attention has been paid to inequalities related to socioeconomic status (SES), age and gender among this group. Children are critical in determining adult behaviour in relation to issues such as tobacco and alcohol use, dietary behaviour and physical activity. Health inequalities in adult life are partly determined by early life circumstances. Little attention has been paid to inequalities related to socioeconomic status (SES), age and gender among this group (1). Young people’s health choices, including eating habits, physical activity and substance use, change during adolescence. Health inequalities emerge or worsen during this developmental phase and translate into continuing health problems and inequalities in the adult years. Boys in general engage more in externalizing or expressive forms of health behaviours, such as drinking or fighting, while girls tend to deal with health issues in a more emotional or internalizing way, often manifesting as psychosomatic symptoms or mental health problems Gender differences for some health behaviours and indicators, such as current attempts to lose weight and psychosomatic complaints , tend to increase over adolescence, indicating that this is a crucial period for the development of health differentials that may track into adulthood. Targeting young people’s health from a gender perspective has considerable potential to reduce gender health differentials in adulthood (2).
Especially those which have a high content in fats, free sugars and salt and physical inactivity and low exercise are among some of the main causes of non-communicable diseases (NCDs) including cardiovascular diseases (CVD), type 2 diabetes and certain cancers and other diseases (3). The development of new technologies has enabled to children reduce the physical exercise accomplish to complete the homework or tasks in their daily lives. The effect of these new technologies in children to reduce physical Inactivity is very obvious (for example- television, mobile laptop, online games computer and electronic equipment. Intake of soft drinks among children is a matter of concern and is higher than in other age groups. It is related with a greater risk of weight gain, obesity and chronic diseases. and excessive sugar intake affect in dental health. Eating behaviour effects on children health. Unhealthy diet contributes to so many diseases in young children like diabetes is more common. The healthy eating habits contribute to the good development and positive and active behaviour and psychosocial development and adequate eating.
5 Oral health diseases have a strong association with cardiovascular and respiratory disease, diabetes and cancer, and poor oral hygiene with cardiovascular disease, hypertension, diabetes and metabolic syndrome (4, 5).
Twice-a-day tooth brushing is the main self-care method to remove plaque and prevent the most prevalent non communicable diseases, periodontal disease and dental caries (6). Now days every day tooth brushing is raising in children. Untreated tooth decay can cause pain and infections that may lead to problems with eating, speaking, playing, and learning. About 1 of 5 (20%) children aged 5 to 11 years have at least one untreated decayed tooth.1 of 7 (13%) adolescents aged 12 to 19 years have at least one untreated decayed tooth. The percentage of children and adolescents aged 5 to 19 years with untreated tooth decay is twice as high for those from low-income families (25%) compared with children from higher-income households (11%) (7).
Watching television is often associated with a range of adverse psychosocial (depression and poor academic performance) and physical (lower physical fitness and more musculoskeletal pain) health outcomes independent of MVPA in children, adolescents. Childhood obesity is associated with a higher chance of premature death and disability in adult health. Adolescents tend to spend a lot of time watching television, a behaviour that tracks moderately from childhood to adulthood. Current situation recommend that young children should limit their recreational screen time to no more than two hours per day. And do some outdoor activity and exercise at least 30 minutes every day. According to who recommended they did less than 60 minutes of moderate- to vigorous-intensity physical activity daily. Adolescents from the WHO South-East Asia Region showed by far the lowest prevalence of insufficient physical activity. Levels of insufficient physical activity were highest in the Eastern Mediterranean Region, the African Region and the Western Pacific Region. Adolescent girls were less active than adolescent boys in all WHO regions (8).
The young children in the age group of 10-17 year in India constitutes one of the precious resources often influenced by several intrinsic and extrinsic factors that affect their health and safety Nearly 10-30 per cent of young children suffer from health impacting behaviours and conditions t. Nutritional disorders (both malnutrition and over-nutrition), tobacco use, harmful alcohol use, other substance use, high risk sexual behaviours, stress, common mental disorders, and injuries (road traffic injuries, suicides, violence of different types) specifically affect this population and have long lasting impact on health. Multiple behaviours and conditions often coexist in the same individual adding a risk for their poor health. Many of these being precursors and determinants of non communicable diseases (NCDs) including mental and neurological disorders and injuries place a heavy burden on Indian society in terms of mortality, morbidity, disability and socio-economic losses. Many health policies and programmes have focused on prioritized individual health
6 problems and integrated (both vertical and horizontal) coordinated approaches are found lacking. Healthy life-style and health promotion policies and programmes that is central for health of youth (9). A review of the prevalence of physical activity and sedentary behaviours shows that many young people are active, but this decline with age. A substantial number are not adequately active for health benefits and current trends in juvenile obesity are a cause for concern. Most children and adolescents do not exceed recommended daily hours of TV viewing. Physical activity is unrelated to TV viewing. We also identified the key determinants of physical activity in this age group, highlighting demographic, biological, psychological, behavioural, social and environmental determinants. Interventions were considered for school, family and community environments. Finally, policy recommendations are offered for the education, governmental, sport and recreation, health, and mass media sectors (10). Increase fruit and vegetable consumption. Higher consumption of fruits and vegetables is associated with lower incidence of several chronic diseases, including cardiovascular disease and some cancers (11). Reduce television-viewing time. A reduction in the length of time that children and adolescents watch television may reduce the risk for obesity among young people (12).
7
3. AIM AND OBJECTIVES
AIM: To analyze the profile of health behaviour in school children aged 13-17 in Punjab, India. OBJECTIVES:
1. To analyze the profile health behaviour (nutrition, low physical activity, nutrition, smoking, use of alcohol and perceived health evaluation by gender.
2. To compare and analyze health behaviour of school children in urban and rural schools in Punjab.
3. To compare the profile of lifestyle of students in Punjab with students of other countries (seven reference HBSC network countries).
11
4. LITERATURE REVIEW
4.1 Health Behaviour in Children
According to study conducted by Trembla the Behaviours is established during this transition period can continue into adulthood, affecting issues such as mental health, the development of health complaints, alcohol and tobacco use, physical activity levels and diet (2011). School aged children independent of physical activity levels; behaviours are associated with increased risk of cardio-metabolic disease, all-cause mortality, and a variety of physiological and psychological problems. In this literature review 232 studies including 983,840 participants met inclusion criteria and were included in the review. Television (TV) watching was the most of sedentary behaviour and body composition was the most common outcome measure in youngster life they are mostly use laptop television games on mobiles etc. Qualitative analysis of all studies revealed a response between sedentary behaviours of children and unfavourable television. Child's health includes physical, mental and social well-being. Most parents know the basics of keeping children healthy, like offering them healthy foods, making sure they get enough sleep and exercise and insuring their safety.
Watching TV for more than 2 hours per day was associated with unfavourable body composition, decreased fitness, lowered scores for self-esteem and pro-social behaviour and decreased academic achievement according to literature review advised that decreasing any type of sedentary time is associated with lower health risk in youth aged children the evidence suggests that daily TV viewing in excess of 2 hours is associated with reduced physical and psychosocial health, and that lowering activity time leads to reductions in BMI .so they should watch television 2 hours per a day(13).
Other researchers showed (Rampersaud, 2005) that nutrition practices observed in children and adolescents may have detrimental consequences on their health. Health consequences that may result from excessive intake of soda and sweetened beverages; fast-food consumption; inadequate intakes of fresh fruits, vegetables, fibre rich foods, and dairy and other calcium-rich foods; reduced levels of physical activity; and increasing obesity rates indicate a need to revisit the diet and lifestyle characteristics of this age group. Nutritional diet is also main important part of children daily lifestyle. How much they eat daily or proper healthy diet. In this literature review researchers said Children consumed more daily calories yet are less likely to be overweight, although not all studies associated breakfast skipping with overweight. Studies suggest that breakfast consumption may
12 improve cognitive function related to memory, test grades, and school attendance. Breakfast as part of a healthful diet and lifestyle can positively impact children’s health and well-being (15).
In this literature review the key of recommendations within Canada's child and youth physical activity guides are:
● Increase the time currently spent on physical activity by 30 minutes per day, and progress over approximately 5 months to 90 minutes more per day.
● Physical activity can be accumulated throughout the day in periods of at least 5 to 10 minutes.
● The 90 minutes increase in physical activity should include 60 minutes of moderate activity (e.g., brisk walking, skating, and bicycle riding) and 30 minutes of vigorous activity (e.g., running, basketball, soccer).
● Participate in different types of physical activities - endurance, flexibility, and strength - to achieve the best health results.
● Reduce non-active time spent on watching television and videos, playing computer games, and surfing the Internet. Start with 30 minutes less of such activities per day and progress over the course of approximately 5 months to 90 minutes less per day. Many other countries and organizations have developed physical activity recommendations for school-aged children and youth (16).
Greater independence of food choice among older children may play a role. Family affluence differences may reflect food environments within and across countries and regions. Boys generally report greater soft-drink consumption, with intakes increasing significantly with age in just over half of countries and regions against just over a third for girls. Similar to other food and dietary items of interest, greater independence in food choice among older children may play a role (17). Younger boys brush less regularly, many countries and regions have targeted this group for oral health promotion. It is encouraging that the tooth brushing habits of 11-year-olds have improved, which may in time lead to an increase in brushing in older adolescents and adults, but 15-year-old boys currently brush less often than 11-year-olds (18).
13
4.2 Main health problems in children
Over the past several decades, increases the risk of numerous diseases/disorders including several forms of cancer, diabetes, hypertension, coronary and cerebrovascular diseases, overweight/obesity, and all-cause mortality, among others (19).
The world health report 2002 States that 2.7 million deaths are attributable to diets low in fruits and vegetables. Worldwide, low intake of fruits and vegetables is estimated to cause about 19% of gastrointestinal cancer, about 31% of coronary heart disease and 11% of stroke. 1.9 million Deaths are attributable to physical inactivity. At least 60% of the global population does not achieve the minimum recommendation of 30 minutes of moderate intensity physical activity daily. Physical inactivity and unhealthy diets are major contributors to overweight (Body Mass Index: 25–29.9) and obesity (BMI greater than 30). Extra body weight increases the risk of serious health consequences such as:
• Cardiovascular disease (mainly heart disease and stroke) • Diabetes
• Breast, colon and endometrial cancers (20).
The fundamental cause of childhood overweight and obesity is an energy imbalance between calories consumed and calories expended. Global increases in childhood overweight and obesity are attributable to a number of factors including:
● A global shift in diet towards increased intake of energy-dense foods that are high in fat and sugars but low in vitamins, minerals and other healthy micronutrients;
● A trend towards decreased physical activity levels due to the increasingly sedentary nature of many forms of recreation time, changing modes of transportation, and increasing urbanization (21).
According to this literature review Children health problems during childhood because of their weight. Health problems can include type 2 diabetes, high blood pressure, high cholesterol levels, fatty liver disease, gallstones and risk factors for heart disease. These health problems have traditionally been problems just affecting adults, with overweight and obese adults having an increased risk of developing them. In this article they mentioned medical problems related low physical activity rarely, a child has a medical cause for being overweight or obese. There are some rare genetic diseases that can cause overweight and obesity in children. Conditions such as an underactive thyroid gland (hypothyroidism) or other hormone problems may also be a cause. Some medicines can also make children more likely to put on weight. However, in general, a
14 medical cause for being overweight or obese is unusual. Not getting enough sleep has been suggested as another possible risk factor for obesity in children. There seems to be a trend of children going to bed later but, also, too little physical exercise can lead to poor sleep. Two hormones called Leptin and ghrelin may be important here. Leptin is released by fat cells to tell your brain that fat stores are sufficient. Ghrelin is released by your stomach as a signal of hunger. In someone who does not have enough sleep, leptin levels are low and ghrelin levels are high. These changes in hormone levels may encourage a child to eat more (22).
4.3 Prevalence of low physical activity in children
According to WHO studies globally, 81% of school going adolescents aged 11–17 years were insufficiently physically active in 2010, they did less than 60 minutes of moderate- to vigorous-intensity physical activity daily, as recommended by WHO. School going adolescent girls were less active than boys, with 84% versus 78% not meeting WHO recommendations. WHO South-East Asia Region showed by far the lowest prevalence of insufficient physical activity (74%). Levels of insufficient physical activity were highest in the Eastern Mediterranean Region, the African Region and the Western Pacific Region (88%, 85% and 85%, respectively). Adolescent girls were less active than adolescent boys in all WHO regions studies (23). The study was to quantify the prevalence of overweight and its risk factors in adolescent children in urban India. School students in the age group of 13–18 years (N=4700, Male: Female 2382:2318) were studied. Body mass index (BMI) was measured. Data on physical activity, food habits, occupation of parents and their economic status, birth weight of the children and age at menarche in girls were obtained by questionnaire. Age-adjusted prevalence of overweight was 17.8% for boys and 15.8% for girls. It increased with age and was higher in lower terciles of physical activity and in higher socio-economic group. Birth weight and current BMI were positively associated. The study highlighted the high prevalence of overweight in adolescent children in urban India (24). WHO recognizes that the increasing prevalence of childhood obesity results from changes in society. Childhood obesity is mainly associated with unhealthy eating and low levels of physical activity, but the problem is linked not only to children's behaviour but also, increasingly, to social and economic development and policies in the areas of agriculture, transport, urban planning, the environment, food processing, distribution and marketing, as well as education the studies shows the percentage of children aged 12 to 17 years who have seen people selling drugs is higher in the African American community than in communities with a majority of white or Hispanic children (41.2% vs 7.4% and 23.9%, respectively). More African American children aged 12 to 17 years are exposed to people who are
15 high or drunk (55.7%) than children of other ethnic groups.29 The percentage of children reporting that obtaining illicit drugs is fairly or very easy is higher among African American and Hispanic youth (25).
4.4 Obesity and overweight
According to the research Patel, 2010 Obesity and overweight have become a worldwide epidemic, and there is an urgent need to examine childhood obesity and overweight across countries using a standardized international standard. In investigation the prevalence of obesity and overweight and their association with socioeconomic status (SES) and the risk factors like diet, physical activity like exercise, sports, sleeping habit in afternoon, eating habits like junk food, chocolate, eating outside at weekend, family history of diabetes and obesity this study. Age-adjusted prevalence of overweight was found to be 14.3% among boys and 9.2% among girls whereas the prevalence of obesity was 2.9% in boys and 1.5% in girls. The prevalence of overweight among children was higher in middle SES as compared to high SES group in both boys and girls whereas the prevalence of obesity was higher in high SES group as compared to middle SES group. The prevalence of
16 obesity as well as overweight in low SES group was the lowest as compared to other group. Eating habit like junk food, chocolate, eating outside at weekend and physical activity like exercise, sports, sleeping habit in afternoon having remarkable effect on prevalence on overweight and obesity among middle to high SES group. Prevalence of overweight and obesity in Indian adolescent school going children: its relationship with socioeconomic status and associated lifestyle factors (26). According to this article child is overweight or obese, they have an increased risk of developing various health problems. They are also more likely to become an overweight or obese adult. If overweight and obesity are treated in childhood, some of these health problems may be reversed, or even prevented. Your child is also more likely to grow into an adult with a healthy weight. A child who is overweight or obese also has an increased risk of:
● Joint problems, including wear and tear (osteoarthritis) and separation of the ball of the hip joint from the upper end of the thigh bone slipped capital femoral epiphysis. Obese children are also more likely to develop bow legs and are more likely to have fractures of bones. ● Going through puberty early.
● Breathing problems, including worsening of asthma, difficulties with your child's breathing whilst they are asleep (obstructive sleep apnoea) and feeling out of breath easily when they are exercising.
● Developing iron deficiency and vitamin D deficiency.
● Being overweight or obese as an adult (more than half of children who are obese will grow up to be obese as adults).
● Developing heart problems as an adult.
Being overweight or obese does run in families. It is thought that 5 out of 10 children who have one parent who is obese will become obese themselves. And 8 out of 10 children who have two parents who are obese will also become obese themselves. It is recommended that all children should do at least 60 minutes of moderate physical activity every day. Some suggest that children who are overweight or obese should even do more than this. This 60 minutes does not have to be done all at once and can be broken up into 10- or 15-minute blocks. Try to find activities that your child enjoys, rather than something they don't want to do. This way they are more likely to continue with it. Also, you should encourage your child to become generally less inactive (sedentary). The amount of time that they spend doing sedentary activities, such as watching television, using a computer, or playing video games, should be less than two hours each day.
As parents and carers, there are some ways that you can encourage your child to become more physically active. For example:
17 ● Encourage active play for your child, including games that involve moving around a lot, such
as skipping, dancing, running or ball games.
● Encourage your child to spend less time sitting doing sedentary activities.
● Build physical activity into your child's life in general. Try to be more active as a family. For example, walking or cycling to school and the shops, going swimming or to the park together. Again, remember that as a parent or carer, you act as a role model.
● Help children to take part regularly in structured physical activities that they enjoy. This may include dancing, football or other sports or swimming (27).
4.5 Risking taking behaviour –alcohol and smoking
Moore and Gullone (1996) described risk-taking as behaviour that involves moderate to high short-term gain, followed by the potential for greater long-term loss. Risk is perceived by some to be synonymous with excitement and sensation-seeking (Plant and Plant, 1992), but this relationship is likely only to be coincidental; there are different levels of risk, some being inherently far more dangerous than others. People are influenced not necessarily by the reality of a risk, but by what they perceive that risk to be. Impulsive (and deleterious) activities and thrill-seeking activities are used frequently as examples of risky behaviour.
Risk-taking is synonymous with lifestyle, with risk having both positive and negative aspects. Risk-taking behaviour may be described as ‘those behaviours, undertaken volitionally. Risky drinking, including early and frequent drinking and drunkenness, is associated with adverse psychological, social and physical health consequences, including academic failure, violence, accidents, injury, use of other substances and unprotected sexual intercourse According to the survey, beer, wine and distilled spirits are the most common bought in or consumed amongst international students, due to their affordability and availability(28).This study reported that, for the first time in 6 years, marijuana and other illicit drug use was unchanged among eighth-graders; in addition, there was a concurrent increase in disapproval of marijuana use among these students. Binge drinking, defined as 5 or more drinks on one occasion, remains problematic, occurring in 15%, 25%, and 31% of the 8th-, 10th-, and 12th-graders, respectively. Addiction develops from a complex interplay between the individual, the agent (drugs and alcohol), and the environment. The initiation of first drug use is determined by interactions between social, cognitive, cultural, attitudinal, personality, and developmental factors. The earliest influences to smoke drink alcohol, or use drugs may come from the family. Factors that are related to drug use during adolescence
18 include poor self-image, low religiosity, poor school performance, parental rejection, family dysfunction, abuse, under- or over-controlling by parents (29).
Alcohol use. Literature review reports shows 90.2% of students (88.5% males and 91.7%
females) have had at least one drink in their lifetime. 30.3% of those surveyed overall, 32.2% males and 28.5% females reported drinking on 40 or more occasions, which would indicate more frequent drinking habits. 62.4% (59.2% males and 65.7% females) reported having a drink within the last 30 days and regarded as current drinkers. According to WHO report Alcohol adopted in December 1995, called on all Member States to draw up a comprehensive alcohol policy and outlined 5 ethical principles and goals and 10 health promotion strategies as guidelines. “Drinking among young people to a large extent reflects the attitudes and practices of the wider adult society” (World Health Organisation 2001)” In February 2001 who planned the Ministerial Conference on Young People and Alcohol issued a Declaration, which aimed to protect young people from the pressure to drink and to minimise the harm done to them directly or indirectly by alcohol. In 2006 they planned to reduce substantially the number of young people who start to consume alcohol; to delay the age of onset of drinking; to reduce substantially the occurrence and the frequency of high-risk drinking; One in four deaths in young men aged 14-29 in Europe is attributable to alcohol. In this study alcohol consumption was causal in 4% of breast cancers in the developed world. The relative risk of breast cancer increased by 7.1% for each extra unit or drink of alcohol (10g of alcohol) consumed on a daily basis. Whilst smoking and drinking can be interrelated behaviours, this study confirms that tobacco consumption has little or no contribution to breast cancer but alcohol consumption does (Hamajima, Hirose et al. 2002) review (32).
19
Drug use. Drug use has been a consistent feature of the urban environment for the past
century, despite sustained and costly efforts at prevention. 7000-8000 acute drug-related deaths are reported annually in the European Union. Cannabis continues to be the most commonly used illegal substance in all EU countries. The economic, health, and social costs associated with drug use are enormous. In the past two decades, injection drug use has been one of the two most common routes for the spread of HIV infection worldwide (30). Drugs in the age group 15-39 years showed an increase in all health boards except the eastern health board region. The analysis of the 10th annual survey of 147077 students by the National Parents' Resource Institute for Drug Education for the 1996-1997 school year showed an increase in the monthly use of marijuana, cocaine, stimulants, sedatives, hallucinogens, and heroin among sixth- to eighth-graders when compared with the previous academic year. in this studies they said Peer influence plays a pivotal role in the initiation of tobacco and drug usage. Peer pressure may be a factor not only in drug use but also in drug abstinence. Peer cross-pressure, that is, the opposing influences on individuals exerted by the choices they make or by their socioeconomic standing or social group membership, may play a role in initiation of drug use. The study by Robin and Johnson on peer cross-pressure found adolescents believed their peers' general attitude was against drug use. With the exception of alcohol, there was
20 a direct relationship between peer cross-pressure and subsequent drug use; the lower the acceptance of drug use, the less frequent the drug use. The higher the perceived risk, the lower the drug use.
Other studies suggest that children predisposed to use drugs may seek out others with similar inclinations. Adolescents, whose drug use is influenced by peer pressure, in the absence of psychological dysfunction, are more likely to stop using drugs (31).
Smoking. Smoking harms nearly every organ of the body. Cigarette smoking causes 87
percent of lung cancer deaths. It is also responsible for many other cancers and health problems. These include lung disease, heart and blood vessel disease, stroke and cataracts. According to the survey reports shows 61.3% of the students surveyed have smoked at least once in their lifetime. More females (64.0%) than males (57.7%) have smoked in their Lifetime. Research findings show that having parents, siblings and friends who smoke increase the chances of teenagers becoming smoker themselves. Peer smoking is, however, possibly a more direct influence on whether a teenager will smoke. How first cigarette was obtained they answered as following:
- My friend gave it to me 61.4 - Don’t remember 15.6
- Took it from my parent’s house 7.6 - I bought it from a shop* 7.2
- Given by a family member 3.6 (32).
4.6 Healthy nutrition in children
Healthy diet helps children grow and development. It also helps prevent obesity and weight-related diseases, such as diabetes. To give your child a nutritious diet. As a teenager, they go through many changes. Body is on its way to becoming its adult size. You may notice that you can't fit into your old shoes or that your jeans are now 3 inches too short. Along with these changes, you are probably becoming more independent and making more of your own choices. Some of the biggest choices you face are about your health. Healthy habits, including eating a healthy diet and being physically active, can help you feel good, look good, and do your best in school, work, or sports. They might also prevent diseases such as diabetes, high blood pressure, heart disease, osteoporosis, stroke, and some cancers when you are older.
Healthy diet helps children grow and development. It also helps prevent obesity and weight related diseases, such as diabetes. To give your child a nutritious diet. As a teenager, they go through many changes. Body is on its way to becoming its adult size. You may notice that you
21 can't fit into your old shoes or that your jeans are now 3 inches too short. Along with these changes, you are probably becoming more independent and making more of your own choices. Some of the biggest choices you face are about your health. Healthy habits, including eating a healthy diet and being physically active, can help you feel good, look good, and do your best in school, work, or sports. They might also prevent diseases such as diabetes, high blood pressure, heart disease, osteoporosis, stroke, and some cancers when you are older (33).
4.7 Importance of physical activity in children
According to this studies Population surveys show that many young people are not meeting the guidelines. Although about 80% of adolescents are estimated to spend at least 30 minutes being active, probably less than half are active at least 60 minutes they said About two-thirds of adolescent boys and one-quarter of adolescent girls report doing 20 min of sustained moderate to vigorous physical activity three times per week. Studies using self-report measures usually find more physical activity than those using objective measures physical activity is good for fitness and their body development physical activity can prevent from many unwanted diseases like obesity overweight are common among. Because physical activity has important health benefits in youth and many young people are not meeting established guidelines, improving the physical activity levels of youth is an important public health challenge.so students should do exercise in their schools like yoga swimming walking running cycling etc. (34,35).
4.8 Social determinants of health in children
According to the World Health Organization (WHO), health and illness follow a social gradient: the lower the socioeconomic status (SES), the worse the health. In other words, health is influenced by many social factors, such as education, income, work or living environments, unemployment, access to health services. The social determinants of health consist of various factors that determine health and wellbeing, for instance, socio-economic factors, genders, cultures and education (McMurray, 2010). Some groups of people are healthier than others (36).
Family. Family affluence is a robust determinant of adolescent health. A socioeconomic
gradient in health in which health and wellbeing improve as affluence rises is found in many cultures throughout the life-course Parental communication is one of the key portals through which the family functions as a protective health asset, equipping young people to deal with stressful situations and buffering them against adverse influences. Ease of communication between
22 adolescents and their mother is particularly important for life satisfaction. A growing body of research demonstrates similarities between parents’ and children’s food acceptance and preferences, intake, and willingness to try new foods. Mothers and children show similar patterns of food acceptance and food preferences. Children’s intake of fruit and vegetables was positively related to parents’ intake of fruit and vegetables, and parents’ modelling of healthful dietary behaviours was associated with low-fat eating patterns and lower dietary fat intake.
Peers relations. Developing positive peer relationships and friendships is crucial in helping
adolescents deal with developmental tasks such as forming identity, developing social skills and self-esteem, and establishing autonomy According to this study parents provide the strongest influence on children’s health beliefs and behaviours, they are not the only people to model eating behaviours. Children and adolescents alike are also influenced by what their peers eat. In a study of preschool children, Birch found that when children saw other children choosing and eating vegetables the observing children did not like, preferences for and intake of disliked vegetables increased. Peers are considered to be particularly influential in adolescent eating behaviour. In a study of adolescents, Feunekes and colleagues found that, on food frequencies, 19% of foods consumed by adolescents were similar to those consumed by their friends.
The unequal distribution of wealth and income has a profound impact on the health of the poor. This is because they lack the necessary resources, such as food, shelter, and clean water, to survive. ices, and social exclusion. Collectively, these factors are known as social determinants of health. Living and working in adverse conditions can cause chronic stress. Examples of chronic stress include high blood pressure, diabetes, pain, and depression obesity, CVD. These adverse conditions can negatively influence a person's health behaviour, too. Maintaining a healthy diet may be difficult for a person who is unemployed and cannot afford nutritious food (39).
School environment. Experiences in school can be crucial to the development of self-esteem,
self-perception and health behaviour. HBSC findings show that those who perceive their school as supportive are more likely to engage in positive health behaviours and have better health outcomes, including good self-rated health, high levels of life satisfaction, few health complaints. These suggest that schools have an important role in supporting young people’s well-being and in acting as buffers against negative health behaviours and outcomes (40).
23
4.9 Lifestyle of children in Punjab and other countries.
According to studies done by, Mandeep Singh and Sukhdev Singh, KanwarMandeep Singh PhD, Assistant Director of Physical Education, compare the physical fitness of the rural and urban children from Punjab. Total 360 children (180 rural and 180 urban) of age between 12 to 17 years were selected to participate in the study. All the subjects were measured for various physical fitness components. The differences in growth, body dimensions, body composition and fitness levels of children due to urban and rural environmental disparities have come into centre of attention during the last few years. The environmental factors lead to changes in the physical fitness level among children. The impact of socioeconomic status, ethnicity and area of residence (urban or rural) has been reported on the level of physical fitness among children; On the other hand, changes in lifestyle due to living in urban settings may also affect physical fitness. Environmental and social changes related to living in urban areas such as crowding, changing neighbourhood, safety worries and inadequate grounds for play may possibly contribute to lower level of physical fitness among children (41). In Punjab rural area children diets are different and urban area school children diet are different. mostly student in rural area don’t eat proper breakfast or fruits intake and exercise daily mostly boys daily exercise and girls 4 days a week only in school they leisure time spent on computer games mobiles etc. and other hands urban they have proper healthy plans and school organised proper yoga physical activity school activity Young people aged between 11 and 15 years face many pressures and challenges, including growing academic expectations, changing social relationships with family and peers and the physical and emotional changes associated with maturation classes for children they eat healthy food.
According to the HBSC survey conducted by 2012-2014 Young people aged between 11 and 15 years face many pressures and challenges, including growing academic expectations, changing social relationships with family and peers and the physical and emotional changes associated with maturation affecting issues such as mental health, the development of health complaints, tobacco use, diet, physical activity level and alcohol use. The WHO Commission on Social Determinants of Health claims that the vast majority of inequalities in health between and within countries are avoidable; they continue to be experienced by young people across Europe and North America. young people in the WHO European Region enjoy better health and development than ever before, but are failing to achieve their full health potential.in Europe countries Young people’s health choices, including eating habits, physical activity and substance use, change during adolescence. Health inequalities emerge or worsen during this developmental
24 phase and translate into continuing health problems and inequalities in the adult years. HBSC reports have presented findings for boys and girls separately, providing clear evidence of gender differences in health that have persisted or changed over time. Boys in general engage more in externalizing or expressive forms of health behaviours, such as drinking or fighting, while girls tend to deal with health issues in a more emotional or internalizing way, often manifesting as psychosomatic symptoms or mental health problems. the frequency of drunkenness increased by an average of 40% in all participating eastern European countries; at the same time, drunkenness declined by an average of 25% in 13 of 16 western European and North American countries (42).
4.10 Interventions to change health behaviour
Health behaviours are shaped through a complex interplay of determinants at different levels. For example, physical activity is influenced by self-efficacy at the individual level, social support from family and friends at the interpersonal level, and perceptions of crime and safety at the community level. Most successful public health programs and initiatives are based on an understanding of health behaviours. To improve health behaviour can be best designed with an understanding of relevant theories of behaviour change and the ability to use them skilfully. It is also important for children to get regular health screenings with their health care provider. These visits are a chance to check your child's development. They are also a good time to catch or prevent problems. Health screenings for school-age children should be seen for following:
● Significant weight gain or loss
● Sleep problems or change in behaviour ● Fever higher than 102 F
● Rashes or skin infections ● Frequent sore throats ● Breathing problem
Health problems healthy habits, including eating a healthy diet and being physically active, can help you feel good, look good, and do your best in school, work, or sports. They might also prevent diseases such as diabetes, high blood pressure, heart disease, osteoporosis, stroke, and some cancers when you are older. Recommendations are as following:
Make half of what is on your child's plate fruits and vegetables
Choose healthy sources of protein, such as lean meat, nuts, and eggs
25
Broil, grill, or steam foods instead of frying them
Limit fast food and junk food
Offer water or milk instead of sugary fruit drinks and sodas (43).
Main way to treat a child who is overweight or obese is to look at changes that can be made to their lifestyle. Changes that involve the whole family are best. The two main lifestyle changes that are advised are for your child to eat more healthily and do plenty of physical activity.
Overweight children should be encouraged to eat more healthily and to reduce the total number of calories that they eat. In most cases, as a parent, will need to take responsibility for making changes to your child's diet, especially if child is under the age of 10 to 12. According to this studies sometimes changes a referral to a dietician may be suggested. This is recommended for children by professional are as following:
● Aim for a balanced and varied diet for the whole family.
● Encourage your child to eat meals at regular times and to watch how often they are eating. They should avoid snacking as much as possible.
● Try to eat meals in a sociable atmosphere as a family, without distractions. For example, do not eat in front of the television.
● If snacks are eaten it should be healthy snacks (for example, fruit) instead of sweets, chocolates, crisps, nuts, biscuits and cakes.
● Low-calorie drinks are better than sugary drinks (water is best). ● Snacks or food should not be used as a reward.
● Encourage your child to watch the portion sizes of the food that they are eating.
● Make up a third of most of your child's meals with starch-based foods (such as cereals, bread, potatoes, rice, and pasta). Wholegrain starch-based foods should be eaten when possible.
● Make sure that your child eats plenty of foods high in fibre. Foods rich in fibre include wholegrain bread, brown rice and pasta, oats, peas, lentils, grain, beans, fruit, vegetables and seeds. Amongst other things, foods high in fibre will help to fill your child up.
● Aim for at least five portions, or ideally 7-9 portions, of a variety of fruit and vegetables per day for your child.
● Children need some fat in their diet but aim to grill, boil or bake rather than fry foods (35).
In conclusion, we could say that the health of children is a product of complex, dynamic processes produced by the interaction of external influences, such as children’s family, social, and physical environments, and their genes, biology, and behaviours. Because children are rapidly changing and
26 developing in response to these interactions, this systematic review confirm that physical activity is associated with numerous health benefits in school-aged children and youth. The dose-response relations between physical activity and health that were observed in several observational studies suggest that the more physical activity, the greater the health benefit. However, the results from several experimental studies suggested that even modest amounts of physical activity can have tremendous health benefits in high-risk youngsters (e.g., obese, high blood pressure). To achieve substantive health benefits, the physical activity should be of at least a moderate intensity, and it should be recognized that vigorous intensity activities may provide an even greater benefit. Aerobic-based activities that stress the cardiovascular and respiratory systems have the greatest health benefit, other than for bone health, in which case high-impact weight bearing activities are required However; bone health was more favourably affected by modest amounts of resistance training and other high-impact activities (jumping) that were performed on at least 2 or 3 days of the week. Thus, this recommendation indicates that a small amount of bone strengthening activities should be incorporated. It is believed that a multi-level, multi-sectoral approach is required for this to be successful resolving the problem of inactivity requires a sustained change in individual daily activity and sedentary patterns. From a public health perspective, a reduction in sedentary behaviour may be easier than increasing physical activity with negative health outcomes in both boys and girls; this was true across all study designs with the majority of studies (85.8%) reporting similar relationships. The majority of current work has focused on television viewing and body composition and suggests that children and youth should watch less than 2 hours of TV per day during their discretionary time. Furthermore, children and youth should try to minimize the time they spend engaging in other sedentary pursuits throughout the day (e.g. playing video games, using the computer for non-school work or prolonged sitting). This work can be used to inform the development of evidence-based sedentary behaviour recommendations for children and youth.
27
5. MATERIAL AND METHODS
Survey procedures and sampling. The data on health behaviour analysed below were
collected in a school-based, cross-sectional, anonymous survey conducted during December 2016 in 2 different schools in Punjab (India). The sample of students covered6 to 10 grade students (5 classes) in one public school in the rural area (n=150) and in one private school (n=150) in urban area. In total 300 students aged 13 to 17 years took part in the survey. Questionnaire forms were distributed by the author of this research to students in each classroom. It was explained shortly to respondent’s methodology of filling in the questionnaire forms. Written informed consent was obtained from the students after explaining the study objectives. Subjects were questioned after being given a full explanation of the purpose of the study by the researcher and after having agreed to participate in the study. One-two schooling periods (45 minutes each) were provided as the time frame for filling out the questionnaires. Eligible participants could freely choose to participate or not in the survey. Measures of anonymity and confidentiality were ensured. The response rate in the total sample was 90%.
Questionnaire instrument and variables. Questionnaire comprised 45 questions
regarding respondents the main demographical data (gender, age, place of residence) and health behaviours – perceived health, illness and health complaints, unhealthy behaviours (smoking, alcohol) eating habits, physical activity, leisure time, injury behaviour, relations with family and peers, school related behaviour.
Statistical analysis. After the completion of the questionnaire survey, the data were entered
to data base and prepared for further data analysis. Statistical data analyse was performed by using SPSS/version 20 (statistical package) for social sciences for data accumulation and analyses. Data were analyzed by descriptive statistics with frequency distribution, cross-tub calculation, and correlation by mean values. Relation between variables were considered to be statistical significant when the p-value were < 0.05.
Ethical statement. Ethics approval for the study was provided by the Centre of Bioethics
of Lithuanian University of Health Sciences. The study conformed to the principles outlined in the World Medical Association’s Declaration of Helsinki. The study was also endorsed by the local educational authorities in Punjab and by the school principals. Additionally, written informed consent for participation in the questionnaire survey was obtained from school students.
28
6. RESULTS AND DISCUSSION
6.1 Demographical characteristics of the studied sample of school children.
The sample of respondent students consisted of 300 school students. Demographical characteristics of this group are presented in Table 1.
Table1. Demographical characteristics of students (n=300)
Variable No.(%) of students
Gender Boys Girls
106(35.4%) 194(64.6%)
Grade (year of study)
6th 53(17.7%) 7th 8th 9th 10th 21 (7.0%) 100 (33.3%) 44 (14.7%) 82 (27.3%) Urban/ rural City 34 (11.3%) Town 33 (11.0%) Village 233 (77.7%)
Average age of questioned respondents was 13.22+1.52years. Boys constituted 35.3% of respondents, and girls 64.7% respectively. Majority of respondents were students of 8th grade (33.3%), the smallest group of respondents was students of 7th grade (7.0%). More than two thirds (77.7 %) of respondents reported living in villages.
29
6.2 The profile health behaviour in school children in Punjab by gender.
Eating breakfast. Students were asked how often they eat breakfast on school days and
weekends (Fig. 2).
p<0.05, in comparison with boys and girls
Figure 2: Frequency of breakfast eating reported by students in Punjab: school survey data (%).
The analysis of data showed that “eating breakfast every school day” was common only for 7.5 % of boys and 42.8% of girls (p<0.05). Therefore, “eating 4-5 days a week” was common in 57.5 of boys and in 61.4% of girls. Only small minority of respondents (0.0 of boys and 5.7% of girls) reported that they never had breakfast.
Eating recommended food every day. It is considered that fresh fruits, vegetables should be
consumed to eat every day (or several times a day) for every person. This is why we asked students do they eat fruits and vegetables every day.
Eating fruits. Figure 3 shows that in overall, girls reported eating fruit more frequently compare
to boys (p<0.05). The analysis of data showed that “eating fruit everyday” was common only for 4.7 % of boys and 22.2% of girls (p<0.05). Therefore, “eating fruits everyday more than once a day” was common in 12.4 % of girls and in 17.9 boys (p>0.05). Only small minority of respondents (0.0 of boys and 4.1% of girls) reported that they never had fruits.
50% 7.5% 57.5% 18.6% 42.8% 61.4% Four days Five days Total Girls Boys
30 p<0.05comparison with girls and boys
Figure 3. Frequency of eat fruits reported by students in Punjab: school survey data (%).
Eating vegetables. Table 4 shows that 82.1 % of boys and 83.0 % girls were eating
vegetables every day (p>0.05). Only very small portion girls never had vegetables 4.1% and boys 0.0%.
p<0.05, in comparison boys and girls
Figure 4. Frequency how often students in Punjab eat vegetables (%).
4.70% 22.20% 17.90% 12.40% 22.60% 34.60% Boys Girls
Total everyday more than once a day Everyday ,once a day
14.95% 82.99% 97.94% 17.92% 82.08% 100% 0 0.2 0.4 0.6 0.8 1 1.2 2 to 5 days a week everyday,once a day Total Boys Girls
31
Eating sweets, chocolates. Table 5 shows that 12.9% of girls reported that they eat sweets
and chocolate once a day several times a day. Nobody from boys answered about consumption of sweets and chocolate on the everyday basis.
p<0.05, in comparison boys and girls
Figure 5: Frequency of eating sweets, chocolates reported by students in Punjab according to survey data (%)
Eating cakes, cookies every day. Figure 6 shows how often girls and boys eat cakes, biscuits,
cookies every day. Similarly, as in case of sweets, chocolates girls reported higher consumption of this kind of sweets (15.5% vs. 3.8%, p<0.05) on the daily bases in comparison with boys.
72.70% 10.80% 2.10% 85.60% 99.10% 0.00% 0.00% 99.10% 2 to 5 days a week everyday once a day everyday more than once a day Total
32 p<0.05 comparison with girls and boys
Figure 6. Frequency of eating cakes, cookies, biscuits every day by boys and girls (%).
Consumption of soft drinks every day. Such behaviour is not recommended by nutrition
experts.
p<0.05 comparison with girls and boys for everyday use of soft drinks
Figure 7. Frequency of soft drink consumption by respondent boys and girls (%)
63.0% 37.0% 15.5% 3.80% 78.5% 40.8% Girls Boys
33 It is evident from Fig. 7 that consumption of soft drinks was more common for boys: 17% of boys and only 2.1% of girls, (p<0.05) consumed soft drinks on the everyday basis.
Oral health behaviour. Tooth brushing every day is indicator of proper general care
about the personal health.
p<0.05 comparison boys and girls according tooth brush more than once a day
Figure 8. Prevalence of students who brush their teeth with toothpaste every day (%)
Surprisingly, in our study it was established that 100% of boys and girls used to brush their tooth every day. In addition, it occurred that boys were brushing their tooth more frequently more than once a day (78.3% vs. 58.2%, p<0.05).
Perceived health evaluation is important indicator of general person’s health according many
researches done among students and adults. It was established (Fig 8a) by our study that 91.5 % f boys and 77.4 % of girls reported good and excellent health (p<0.05).
34 p<0.05 comparing boys and girls according good and expellant health evaluation
Figure 8a. Perceived health evaluation (percentage of answers) by student respondents (%). Physical activity. Physical activity was evaluated asking the question “how many days you were
active physically for at least 60 minutes per day’. Data showed that boys were more active than girls: 38.5% of boys and only 15.5% were doing exercise 60 minutes a day for 6-7 days a week.
p<0.05, in comparison boys and girls were active physically for 60 minutes
Figure 9. Percentage of students who were physically active for at least 60 minutes per day (%). 62.00% 40% 43.40% 100% 37.90% 60% 56.60% 0%
4days physical acitivity 5 days physical activity 6 days physical acitivity 7 days physical acitivity for 60 mis
35
Smoking. This behaviour (Fig. 10) was uncommon among school students in Punjab. Only
0.9% of boys and surprisingly, 2,1% of girls reported smoking every week or more often (p>0.05).
p<0.05, in comparison boys and girls
Figure10. Prevalence of smoking among school children (boys and girls) in Punjab (%). Alcohol drinking. Drinking alcohol is not considered as proper behaviour in school students
in Punjab. Probably this is why very few school students about alcohol use. Surprisingly nobody responded about use of beer or wine. Only low percentage of girls (2.1%) reported use of sparkling vine “rarely”.
p<0.05, in comparison boys and girls
Figure. 11 Prevalence of students who reported sparkling wine drinking (%).
2.1% 0.0% 97.9% 100% 0% 0.9% 99.1% 100% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% 120.0% Everyday
Atleast once a week I dont smoke Total Boys Girls 0% 2.1% 100% 98% Boys Girls Never Rarely
36
6.3 Comparison of health behaviour of urban and rural students in Punjab
p<0.05, in comparison city and village
Figure 12. Comparison of breakfast eating behaviour with Rural and Urban in Punjab
The analysis of data showed that “eating breakfast in urban and rural children” was common for 71.6% of city children and 85.8% of Rural children (p<0.05). Therefore, “eating 2-5 days a week” was common in 22.4% of Urban and in 14,20% Rural.
p<0.05, in comparison village and city
Figure 13. Comparison of rural and urban school aged children how often children eat fruits every day (%). 22.40% 71.60% 94% 14.20% 85.80% 100% 2 to 5 days a week everyday total village City 29.9% 58.2% 88.1% 77.7% 22.3% 100% 2 to 5 days a week Everyday Total village city
37 Figure 13 shows that in overall, rural students reported eating fruit more frequently compare to city students (p<0.05). The analysis of data showed that “eating fruit everyday” was common only for 55.20% of urban and 22.30% rural children (p<0.05). Therefore, “eating fruits 2 to 5 days a week” was common in 77.70% of rural and in 29.90% of urban(p>0.05).overall majority of respondents (100% of rural and 94% of urban) reported that they had fruit
p<0.05, in comparison village and city
Figure 14. Comparison of rural and urban school aged children how often rural and urban children eat vegetables (%).
Eating vegetables. Table 4 shows that 85.8 % of rural and 71.60 % urban were eating vegetables
every day (p>0.05). Only small portion had 2 to 5 a week vegetables 22.4% urban and 14.2% rural.
38 p<0.05, in comparison village and city
Figure.15 Comparison of rural and urban school aged children how often children eat sweets, chocolates in Rural and Urban Comparison of rural and urban school aged children.
Eating sweets, chocolates. Figure 16 shows that 94.1% of urban children reported that they eat
sweets and chocolate once a day several times a day.9% of rural and 6% of urban children answered about consumption of sweets and chocolate on the everyday basis.
p<0.05, in comparison Urban and Rural
Figure16. Comparison of rural and urban school aged children how often they eat cakes, biscuits, cookies in city and villages (%).
88.1% 6.0% 94.1% 80.3% 9.0% 89.3% 2 to 5 days a week Everyday Total village city 68.7% 25.4% 94.1% 77.7% 7.3% 85% 2 to 5 days a week everyday Total Village City
39
Eating cakes, cookies every day. Figure 17 shows how often urban and rural students eat
cakes, biscuits, cookies every day. Similarly, as in case of sweets, rural students reported higher consumption of this kind of sweets (77.7% vs. 68.7% city, p<0.05) on the daily bases. On the everyday basis very small amount of respondent eating sweets 25.4% of city and 7.30% village. Intake of soft drinks among adolescents is a matter of concern and is higher than in other age groups of 11 to 15 years old. It is associated with a greater risk of weight gain obesity and chronic diseases and directly affects dental health by providing excessive amounts of sugars, carbohydrates etc. In school aged children soft drinks gives high energy intake in liquid form that increasing the carbohydrate contents of the diet and reducing other nutrients in the body. Drink less soft drink.
Intake of soft drinks among adolescents is a matter of concern (44,45) and is higher than
in other age groups of 11 to 15 years old (46,47). It is associated with a greater risk of weight gain obesity (48) and chronic diseases (49) and directly affects dental health by providing excessive amounts of sugars (50,51), carbohydrates etc. In school aged children soft drinks gives high energy intake in liquid form that (52) increasing the carbohydrate contents of the diet and reducing other
nutrients in the body. Drink less soft drinks (53,54).
p<0.05, in comparison rural and urban
Figure17. Comparison of rural and urban school aged children by frequency how often they drink coke and other soft drinks (%).
It is evident from Fig. 18 that consumption of soft drinks was more common for rural children: 65.7%% of rural and only 53.7% city, (p<0.05) consumed soft drinks on the 2 to 5 days a
53.7% 7.5% 61.2% 65.7% 7.3% 73% 2 to 5 days a week everyday Total Village City
40 week. In city 38.8% never had soft drinks and 27.0% rural students. Very small portion of urban 7.5% and 7.3% of rural students drinking soft drinks on the daily basis
p<0.05, in comparison urban and rural respondents
Figure18. Comparison of rural and urban school aged children by perceived health rating (%).
Perceived health evaluation is important indicator of general person’s health according many researches done among students. It was established by our study that 85.6 % of urban and 77.4 % of rural reported good and excellent health (p<0.05). And 83.6% urban and 70.4% rural reported Good health. Very less respondents had excellent health in rural 7.0% and 2.0%.
2.0% 83.6% 85.6% 7.0% 70.4% 77.4% excellent Good Total village City
41 p<0.05, in comparison city and village
Figure19. Comparison of rural and urban school aged children by how often they brush the teeth (%).
Surprisingly, in our study it was established that overall 100% rural student and 99.2% of urban students used to brush their tooth. And 66.5% of rural and 61.2% of urban brush their tooth more than once a day In addition, it occurred that urban students were brushing their tooth more frequently everyday once a day (38.80% vs. 33.50%, p<0.05).
p<0.05, in comparison village and city
Figure.20. Comparison of rural and urban school aged children how often you do physical exercise at least for 60 minutes (%).
61.20% 38.80% 99.20% 66.50% 33.50% 100%
more than once a day once a day Total
42 This Data showed that rural were more active than urban: 24.03 % of rural and only 9.8% were doing exercise 60 minutes a day for 6 days a week. and very small respondents 8.5% vs. 2.0 % were doing physical activity a day for 7 days
p<0.05, in comparison village and city
Figure 21. Comparison of rural and urban school aged children how often they smoke.
This behaviour (Fig. 21) was uncommon among school students in Punjab. Only 6.0% of city students were smoke everyday and surprisingly, 0.4% reported smoking every week or more often (p>0.05).
6.4. Comparison of lifestyle of students in Punjab and seven reference HBSC countries (%).
94% 0.4%
6.00%
99.6% I don't smoke
At least once a week but not everyday Everyday Village City 71 52 52 56 67 43 53 80.4 82 67 62 70 75 61 68 100 Spain Italy Lithuania Canada Sweden Wales Scotland Punjab Girls Boys
43 p<0.05, in comparison boys and girls
Figure. 22. Percentage of boys and girls who have breakfast everyday in Punjab and reference HBSC countries (%).
Fig.22 shows comparison with other HBSC network countries the survey has done 2014 according to HBSC research data. School aged children eat breakfast every day in Punjab 80.4 % girls 100 of boys(p<0.05) eat every days and in Scotland girls 53% and 68% of boys.
p<0.05, in comparison boys and girls
Figure 23. Comparison between Punjab school students and HBSC reference countries, how often they eat fruits everyday (%).
Research shows that in Canada 46% of girls and 55 % of boys eating fruit everyday basis. As compare to Punjab 32% of girls and 35.8% boys eating fruits daily. Results shows in Canada consumption of fruits more than Punjab.
. 34 32 36 55 26 31 39 32 34 39 28 46 23 31 35 35.8 Spain Italy Lithuania Canada Sweden Wales Scotland Punjab Girls Boys
44 p<0.05, in comparison boys and girls
Figure 24. Prevalence of consumption of soft drinks everyday in students of Punjab HBSC reference countries (%).
In this table Punjab school girls use soft drinks 23.2% of girls and boys are 29.2%. Scotland school aged children were 20 % of girls and 29% of boys use less soft drink compare to Punjab children. In overall review is girls use less soft drink than boys.
p<0.05, in comparison boys and girl
Figure 25. Percent of respondents in Punjab and HBSC countries who rated their health as good and excellent (%).
25 21 15 10 6 24 29 29.2 21 13 8 7 4 25 20 23.2 Spain Italy Lithuania Canada Sweden Wales Scotland Punjab Girls Boys 85 73 75 83 80 76 84 77.4 89 90 86 91 89 88 90 91.5 Spain Italy Lithuania Canada Sweden Wales Scotland Punjab Boys Girls
