Nutritional and lifestyle risk behaviors and their association with mental health and violence among Pakistani adolescents: results from the National Survey of 4583 individuals

Saadiyah Rao, Nadia Shah, Nida Jawed, Sumera Inam, Kashif Shafique, Saadiyah Rao, Nadia Shah, Nida Jawed, Sumera Inam, Kashif Shafique

Abstract

Background: Unhealthy behaviors are associated with mental health problems and violence in adolescents, yet their combined association has been understudied. Using the Global School Health Survey, this study examined the association between combined unhealthy behaviors (including fast food, soft drink, smoking, other tobacco products and physical inactivity) and anxiety, suicidal ideation and involvement in physical fight among Pakistani adolescents.

Methods: Data were obtained from the Global School Health Survey conducted in Pakistan (2009). The study population consisted of school going adolescents aged 13 to 15 years. Association of combined unhealthy behaviors with anxiety, suicidal ideation and involvement in physical fight were studied through secondary analysis. We used univariate and multivariate logistic regression analysis by complex sample method, accounting for cluster sampling technique used for data collection.

Results: Of the total 4583 students, weighted percentage and unweighted count for one, two, three and four or more unhealthy behaviors was 39.4% (n = 1770), 22.1% (n = 963), 5.9% (n = 274) and 1.2% (n = 62) respectively. The weighted prevalence for anxiety, suicidal ideation and involvement in physical fight were 8.4%, 7.3% and 37.4% respectively. The results of multivariate logistic regression analysis after adjustment showed that students who had four or more unhealthy behaviors had higher odds of; being anxious (OR 2.45, 95%CI 1.31-4.59, p value 0.004), suicide ideation (OR 4.56, 95%CI 2.58-8.07, p value <0.001) and being involved in physical fight (OR 3.15, 95% CI 1.63-6.08, p value <0.001) as compared to those who had not adopted any unhealthy behaviors.

Conclusions: This study suggests that the co-occurrence of unhealthy behaviors is associated with anxiety, suicidal ideation and physical fight among adolescents. These findings should be considered when developing interventions to combat detrimental outcomes of unhealthy behaviors during adolescence.

References

    1. Mulder M, Ranchor AV, Sanderman R, Bouma J, van den Heuvel WJ. The stability of lifestyle behaviour. Int J Epidemiol. 1998;27(2):199–207. doi: 10.1093/ije/27.2.199.
    1. Geckova A, Tuinstra J, Pudelsky M, Kovarova M, van Dijk JP, Groothoff JW, et al. Self-reported health problems of Slovak adolescents. J Adolesc. 2001;24(5):635–645. doi: 10.1006/jado.2001.0422.
    1. The State of the World’s Children 2011: Adolescence an age of opportunity [] [accessed on April 28 2014]
    1. Mushtaq MU, Gull S, Mushtaq K, Shahid U, Shad MA, Akram J. Dietary behaviors, physical activity and sedentary lifestyle associated with overweight and obesity, and their socio-demographic correlates, among Pakistani primary school children. Int J Behav Nutr Phys Act. 2011;8(1):130. doi: 10.1186/1479-5868-8-130.
    1. World Health Organization . WHO report on the global tobacco epidemic, 2013 country profile Pakistan. Geneva: WHO; 2013.
    1. Ishaque A, Ahmad F, Zehra N, Amin H. Frequency of and factors leading to obesity and overweight in school children. J Ayub Med Coll Abbottabad. 2012;24(2):34–38.
    1. Mirza I, Jenkins R. Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: systematic review. BMJ. 2004;328(7443):794. doi: 10.1136/bmj.328.7443.794.
    1. Sabir I, Zaman M. Youth Violence in Pakistan: The Social Structure and Culture of Violence. Profilaktyka Społeczna i Resocjalizacja. 2013;21:7–24.
    1. Verger P, Lions C, Ventelou B. Is depression associated with health risk-related behaviour clusters in adults? Eur J Public Health. 2009;19(6):618–624. doi: 10.1093/eurpub/ckp057.
    1. Singh AK, Maheshwari A, Sharma N, Anand K. Lifestyle associated risk factors in adolescents. Indian J Pediatr. 2006;73(10):901–906. doi: 10.1007/BF02859283.
    1. Johnson JG, Cohen P, Pine DS, Klein DF, Kasen S, Brook JS. Association between cigarette smoking and anxiety disorders during adolescence and early adulthood. JAMA. 2000;284(18):2348–2351. doi: 10.1001/jama.284.18.2348.
    1. Ströhle A. Physical activity, exercise, depression and anxiety disorders. J Neural Transm. 2009;116(6):777–784. doi: 10.1007/s00702-008-0092-x.
    1. McGee R, Williams S, Nada-Raja S. Is cigarette smoking associated with suicidal ideation among young people? Am J Psychiatr. 2005;162(3):619–620. doi: 10.1176/appi.ajp.162.3.619.
    1. Rudatsikira E, Siziya S, Kazembe L, Muula A. Prevalence and associated factors of physical fighting among school-going adolescents in Namibia. Ann Gen Psychiatry. 2007;6:18. doi: 10.1186/1744-859X-6-18.
    1. Solnick SJ, Hemenway D. Soft drinks, aggression and suicidal behaviour in US high school students. Int J Inj Contr Saf Promot. 2013;21(3):1–8.
    1. Hasumi T, Ahsan F, Couper CM, Aguayo JL, Jacobsen KH. Parental involvement and mental well-being of Indian adolescents. Indian Pediatr. 2012;49(11):915–918. doi: 10.1007/s13312-012-0218-y.
    1. Margolese SK, Markiewicz D, Doyle AB. Attachment to parents, best friend, and romantic partner: Predicting different pathways to depression in adolescence. J Youth Adolesc. 2005;34(6):637–650. doi: 10.1007/s10964-005-8952-2.
    1. Cheng Y, Tao M, Riley L, Kann L, Ye L, Tian X, et al. Protective factors relating to decreased risks of adolescent suicidal behaviour. Child Care Health Dev. 2009;35(3):313–322. doi: 10.1111/j.1365-2214.2009.00955.x.
    1. Conry MC, Morgan K, Curry P, McGee H, Harrington J, Ward M, et al. The clustering of health behaviours in Ireland and their relationship with mental health, self-rated health and quality of life. BMC Public Health. 2011;11(1):692–701. doi: 10.1186/1471-2458-11-692.
    1. Kvaavik E, Batty GD, Ursin G, Huxley R, Gale CR. Influence of individual and combined health behaviors on total and cause-specific mortality in men and women: the United Kingdom health and lifestyle survey. Arch Intern Med. 2010;170(8):711–718. doi: 10.1001/archinternmed.2010.76.
    1. World Bank: World Development Indicators: Participation in Education. [] [accessed on May 05 2014]
    1. The Global School and Health Survey background [] [accessed on May 05 2014]
    1. GSHS Global School-Based Student Health Survey Information for the Local Ethical Review Committee [] [accessed on May 05 2014]
    1. Rudatsikira E, Muula A, Siziya S. Variables associated with physical fighting among US high-school students. Clin Pract Epidemiol Ment Health. 2008;4(1):16. doi: 10.1186/1745-0179-4-16.
    1. The Global School and Health Survey Codebook []
    1. Samanta A, Mukherjee S, Ghosh S, Dasgupta A. Mental health, protective factors and violence among male adolescents: A comparison between urban and rural school students in West Bengal. Indian J Public Health. 2012;56(2):155. doi: 10.4103/0019-557X.99916.
    1. Rodrigo C, Welgama S, Gurusinghe J, Wijeratne T, Jayananda G, Rajapakse S. Symptoms of anxiety and depression in adolescent students; a perspective from Sri Lanka. Child Adolesc Psychiatry Ment Health. 2010;4(1):10. doi: 10.1186/1753-2000-4-10.
    1. Spring B, Moller AC, Coons MJ. Multiple health behaviours: overview and implications. J Public Health (Oxf) 2012;34(1):i3–10. doi: 10.1093/pubmed/fdr111.
    1. Sharma R, Grover VL, Chaturvedi S. Risk behaviors related to inter-personal violence among school and college-going adolescents in south Delhi. Indian J Community Med. 2008;33(2):85. doi: 10.4103/0970-0218.40874.
    1. Bott S, Jejeebhoy S, Shah I, Puri C. Towards adulthood: exploring the sexual and reproductive health of adolescents in South Asia: World Health Organization; 2003.
    1. Towe VL, Ul Hasan S, Zafar ST, Sherman SG. Street life and drug risk behaviors associated with exchanging sex among male street children in Lahore, Pakistan. J Adolesc Health. 2009;44(3):222–228. doi: 10.1016/j.jadohealth.2008.09.003.

Source: PubMed

3
Sottoscrivi