31.12.39 Health Behavior of School-Aged Children in Sialkot

Original Article

 

Health Behavior of School Children

Health Behavior of School-Aged Children in Sialkot

Usman Nasir1, Rabea Nasir3, Ghazala Khalid2, Rashid Siddique4, Nimra Ikram1 and Akmal Khurshid Bhatti1

ABSTRACT

Objective: To determine Health Behavior of School-Aged Children in Sialkot.

Study Design: Observational Study

Place and Duration of Study: This study was conducted at the Sialkot Medical College Sialkot during Jan 2019 to Dec 2019.

Materials and Methods: Health Behavior in School aged Children (HBSC) questionnaire was used in this study. Questionnaire survey was carried out in 2 schools of Sialkot. One school was private and one school was public. There were 300 participants and majority of them were 14 and 15 years old. Health behavior was measured with questions concerning adolescent’s nutritional habits (breakfast, fresh fruit and vegetable, sweets, fast food and soft drinks with sugar consumption), health-risk behavior (cigarette use, injuries) and physical activity. Statistical data was analyzed using the statistic package SPSS 15.0 for Windows

Results: Two thirds (78.5%) of respondents thought they are in good health and just 4% claimed having excellent health. Results of this work showed, that forty one percent students of school exercise two-three times a week and seven point three percent less than once a month. It was determined that more than half of Sialkot teen agers eat morning food every day on end of the week, but on end of the week less than one third have morning food at home. One third of respondents stated, that eat fresh vegetable and 20.1% of then eat fresh fruit every day. Unhealthy diet products such as sweets, soft-drinks with sugar, fast food adolescents consumed (from 0% till 24.6%) every day or 4-6 times a week. Current study indicates that girls were less habitual to use carbonated drinks and junk foods as compared to opposite sex. They ingest more balanced diet.  The results showed that 12.1% of adolescents reported smoking once a week. Statically significant differences were found among respondent gender and injuries. Young Girls were harmed more often than boys in the past twelve month. Teenagers in Sialkot thought they are in excellent health less frequent than teenagers in Lithuania. Study result showed that statistically significant differences were found between breakfast consumption on weekends, nutritional habits, smoking of adolescents in Sialkot.

Conclusion: Adolescents in general experience good health in Sialkot. Physical activity of the majority adolescents did not meet the global WHO recommendations for school-aged children. Children above twelve years of age are used to intake raw vegetables frequently than the raw fruits. Majority of adolescent’s unhealthy diet products consumed rarely. Less beneficial foods is being more frequently ingested by males as compared to females. Teenagers in Lithuania enjoy very good health more often than teenagers in Sialkot. Health behavior of teenagers were different in Sialkot.                                                                   

Key Words: Health habits, Children above 12 years, nutritional habits, health risk behavior

Citation of article: Nasir U, Nasir R, Khalid G, Siddique R, Ikram N, Bhatti AK. Health Behavior of School-Aged Children in Sialkot. Med Forum 2020;31(12):166-170.

 

 

INTRODUCTION

 

 

1. Department of Community Medicine / Medicine2, Sialkot Medical College, Sialkot.

3. Department of Physiology, Mohammad Islam Medical College, Gujranwala.

4. Department of Operative Dentistry, IMC, Sialkot.

 

 

Correspondence: Dr. Usman Nasir, Senior Demonstrator Community Medicine Sialkot Medical College Sialkot.

Contact No: 03338717806

Email: usmannasir5@hotmail.com

 

 

Received:    May, 2020

Accepted:    September, 2020

Printed:        December, 2020

 

 

Health behavior is one of the most important determinants of health. These are labors being adopted by persons regardless of their own condition of health in order to propagate, shield and perpetuate health.  It may either effect positively or negatively. Multiple studies are needed to get data about health of babies and adolescents. These studies should encompass various activities related to health in order to collect data for health education. World health organization has defined health as well being physically, socially, and emotionally1.

Thus, work into children’s health requires to consider the positive characteristic of health, as well as danger factors for future ailment and disease. Positive or health promoting behavior needs to be studied, as well as health-damaging or risk behavior.

Certain behavior is initiated in the adolescent years, while some patterns of behavior, such as eating patterns, become established in earlier childhood. Taking a social as opposed to a purely biomedical research perspective means studying the social, environmental and psychological influences or determinants of child and adolescent health and health behavior2.

This study was carried out in relation to health, taking food, tobacco and exercises.

Adolescence is defined as the period from the onset of puberty to the termination of physical growth and attainment of final adult height and characteristics that occurs during the second decade of life. It can be known by abrupt physical growth, remarkable physical and psychological changes, and unfolding personal relationships. Children above 12 years and abrupt changes linked with it may have major effects on the health of individuals, and, conversely, variations in health may significantly affect the transitions of adolescence.3,4

MATERIALS AND METHODS

The survey was conducted during Jan 2019 to Dec 2019 in 2 different types (one private and one public) of schools in Sialkot. Class was chosen as a sampling unit. The data was collected from 9th grade primary school students. The participants were 300 (200 boys and 100 girls). One hundred boys and fifty girls were from public school and hundred boys and fifty girls were from private school. Majority of respondents were 14 and 15 years old and just 3% of participant were 16 years old. More than 90% of participants lived in urban areas (cities, towns) and 5.5% in countryside.

Health Behavior in School aged Children (HBSC) questionnaire was used in this study. Health Behavior in School aged Children (HBSC), a world health organization (WHO) coordinated transnational work, collects data on 11-, 13- and 15-year-old boys’ and girls’ health and comfort, sociocultural context and combination of knowledge, practices, and attitudes that together contribute to motivate the actions we take regarding health, repeated after four years. This study used questions regarding health behaviors of adolescents. Data concerned, combination of knowledge, practices, and attitudes that together contribute to motivate the actions we take regarding health was collected with the help of survey questioning about measured with questions concerning adolescent’s the way a person or group eats various food items, Diseases causing habits like cigarette smoking and habits of doing exercise.

Adolescents were asked to fill in the questionnaire in school classroom during ordinary school hours. Written informed consent was obtained from the students after explaining the study objectives. The students were free to withdraw at any time without giving any reason. Complete secrecy was observed during the process of data collection, entry and analysis. All attempts were made in this research to complete the ethical considerations in accordance with the ‘Ethical principles for medical research involving human subjects’ of Helsinki Declaration. The response rate was 100 percent.

RESULTS

The incidence of adolescent from City was maximum 204 (68.3%) and Minimum 16(5.5%) from Village as shown in table no 1.

Table No 1: Distribution of adolescent place of residence

Sr. No.

Place of residence

No of cases

age%

1

City

204

68.3%

2

Town

80

26.7%

3

Village

16

5.5%

Total

300

100%

The incidence of adolescent male was 200 (66.66%) and 100 (33.33%) in female as shown in table no 2.

Table No 2: Gender Distribution of Adolescent

Sr. No.

Gender

No of cases

age%

1

Male

200

66.66%

2

Female

100

33.33%

Total

300

100 %

Fresh fruit and vegetable consumption is very important determinant regarding healthy lifestyle. Longitudinal studies suggest that fruit and vegetable consumption tracks into adulthood which points at the importance of establishing healthy eating behavior among children and adolescent5.

One third (32.6%) of respondents stated, that eat fresh vegetable and 20.1% of then eat fresh fruit every day. This suggests that, fresh vegetables are more popular than fruits among adolescents. It was determined that no significant differences were found among gender and fresh fruit, vegetable consumption (Table 3). Other studies in Europe confirm opposite results, that vegetable intake was in general lower than fruit intake and boys consumed less fruit and vegetables than
girls did6.

Table No 3: Correlation between gender and exercise hour a week

Exercise hour a week

Boys

 %(n)

Girls

%(n)

Total

%(n)

None

1,5 (3)

0

1 (3)

1/2 hours

12,5 (25)

16 (16)

13,7 (41)

1 hours

38 (76)

40 (40)

38,7(116)

2-3 hours

37 (74)

33 (33)

35,7(107)

4-6 hours

11 (22)

11 (11)

11 (33)

χ2 = 2,466; df = 4; p> 0,05

Table No 4: Correlation between gender and breakfast consumption on weekdays and weekends

Breakfast consumption on weekdays

Boys

 %(n)

Girls

%(n)

Total

%(n)

Every day

57,9 (110)

46 (46)

53,8 (156)

Less than every day

42,1 (80)

54 (54)

46,2 (134)

Never

0

0

0

χ2 = 3.729; df = 1; p> 0,05

Breakfast consumption on weekends

Boys

%(n)

Girls

%(n)

Total

%(n)

Every day

32,2 (64)

20 (20)

28,1 (84)

Less than every day

53,3 (106)

67 (67)

57,9 (173)

Never

14,6 (29)

13 (13)

14 (42)

χ2 = 5,790; df = 2; p< 0,05

         

Table No 5: Correlation between gender and fresh fruit, vegetable consumption

Fresh fruits consumption

Boys

 %(n)

Girls

%(n)

Total

%(n)

Every day and 4-6 times a week

18,6 (37)

23 (23)

20,1 (60)

1-3 times a week and never

81,4 (162)

77 (77)

79,9 (239)

χ2 = 1,235; df = 1; p> 0,05

Fresh vegetables consumption

Boys

%(n)

Girls

%(n)

Total

%(n)

Every day and 4-6 times a week

34,8 (69)

28 (28)

32,6 (97)

1-3 times a week and never

65,2 (129)

72 (72)

67,4 (201)

χ2 = 0,558; df = 1; p> 0,05

Unhealthy diet products such as sweets, soft-drinks with sugar, fast food adolescents consumed (from 0% till 24.6%) every day or 4-6 times a week. It was determined that significant differences were found among gender and soft-drinks with sugar and fast food consumption – girls consumed unhealthy diet products less frequent than boys. No significant differences were found among gender and sweets consumption (Table 4).

Other studies confirmed that consumption of sugar-sweetened beverages, including soft drinks, has risen across the globe, accompanied by an increase in the prevalence of overweight and obesity7.

In summary every second 9th grade student has breakfast every day in Sialkot. Fresh vegetables are more popular than fruits among adolescents. Unhealthy diet products such as sweets, soft-drinks with sugar, fast food are more popular between boys than girls.

Table No 6: Correlation between gender and unhealthy diet products consumption

Sweets consumption

Boys

%(n)

Girls

%(n)

Total

%(n)

Every day and 4-6 times a week

3,5 (7)

0

2,3 (7)

1-3 times a week and never

96,5 (192)

100 (100)

97,7 (292)

χ2 = 6,348; df = 1; p> 0,05

Soft- drinks with sugar consumption

Boys

%(n)

Girls

%(n)

Total

%(n)

Every day and 4-6 times a week

24,6* (49)

9 (9)

19,4 (58)

1-3 times a week and never

75,4 (150)

91 (91)

80,6 (241)

χ2 = 3,765; df = 1; p< 0,05

Fast food consumption

Boys

%(n)

Girls

%(n)

Total

%(n)

Every day and 4-6 times a week

7* (14)

0

4,7 (14)

1-3 times a week and never

93 (185)

100 (100)

95,3 (285)

χ2 = 1,758; df = 1; p< 0,05

Table No 7: Correlation between adolescents self-rated health in Sialkot

Adolescents self-rated health

Sialkot

%(n)

Excellent

4 (12)

Good

78,6 (234)

Poor

17,4 (52)

Total %(n)

100 (298)

χ2 = 91,2; df = 3; p< 0,05

Study result showed that statistically significant differences were found between breakfast consumption on weekends in Sialkot and Lithuania. On weekends, adolescents in Lithuania eat breakfast every day more frequent than children in Sialkot (Table 6). The obtained results lead to the conclusion that adolescents in Lithuanian are more supervised by their parents than in Sialkot.

Table No 8: Correlation between breakfast consumption of adolescents on weekends in Sialkot

Breakfast consumption on weekends

Sialkot

%(n)

Every day

28,1 (84)

Less than every day

57,9 (173)

Never

14 (42)

Total %(n)

100 (298)

χ2 = 529,8; df = 2; p< 0,05

Fresh fruits and vegetables consumption reflects not only nutritional habits of adolescents, but also indicates family’s health literacy rates. In this survey were established that adolescents in Lithuanian eat more fresh fruits and vegetables than teenagers in Sialkot (Table 7).

Table No 9: Correlation between fresh fruit and vegetable consumption of adolescents in Sialkot

Fresh fruits consumption

Sialkot

%(n)

Every day and 4-6 times a week

20,1 (60)

1-3 times a week and never

79,9 (239)

Total %(n)

100 (299)

χ2 = 39,9; df = 1; p< 0,05

Fresh vegetables consumption

Sialkot

%(n)

Every day and 4-6 times a week

32,6 (97)

1-3 times a week and never

67,4 (201)

Total %(n)

100 (298)

χ2 = 11,53; df = 1; p<0,05

 

DISCUSSION

Physical activity is an important lifestyle factor that is associated with a wide range of health benefits8. Participation in regular physical activity in childhood and adolescence has also been reported to positively influence physical activity levels in adulthood9.

Study results showed, that 41% of school students exercise 2-3 times a week and 7.3% less than once a month. No significant differences were observed between gender and student physical activity. In the survey information were collected regarding the time used to perform exercise. It was established that 11% of boys and girls spend 4-6 hours a week being physically active (Table 1). Which means, that small part of adolescents meet the global recommendations for school-aged children physical activity (participate in at least 60 minutes, and up to several hours, of at least moderate physical activity on a daily basis)10. Nutritional habits of adolescents in Sialkot the habitual decisions of individuals or group of people regarding what foods they eat are important relating to the activity undertaken by people for the purpose of maintaining or enhancing their health,. Epidemiological research claims that youth breakfast consumption is very important part of young people future health11. Regular breakfast consumption is associated with higher intakes of micronutrients, a better diet that includes fruit and vegetables and less frequent use of soft drinks12. Despite the potential importance of breakfast consumption, the prevalence rates of breakfast skipping among children and adolescents have increased in the past few decades13.

The study result showed that more than half (53.8%) of Sialkot adolescents eat breakfast every day on weekdays, but on weekends less than one third (28.1%) have breakfast at home. It was known, that there were gross variances between breakfast consumption on weekends and gender – girls eat breakfast less frequent then boys (Table 2). It should be noted, that 14% of despondences reported, never eat breakfast on weekends.

A recently published WHO/HBSC international report confirmed these study findings, determining that girls eat breakfast less frequent than boys14.

Adolescents in Lithuania consume sweets more frequent than school children in Sialkot, opposite findings were determined in soft-drinks with sugar consumption – adolescents in Lithuania consume soft-drinks with sugar less frequent than teenagers in Sialkot.

*p<0.05 – z test compared adolescents in Sialkot

Fast foods are very popular with adolescents, who are at a stage in life in which they experience increased autonomy, both in terms of availability of meals outside the home and discretionary income15.

*p<0.05 – z test compared adolescents in Sialkot

Frequent consumption of fast food has adverse effects on nutrition because of excessive content of energy and fat and low nutritional value16.

Study results showed that significant differences were found between fast food consumption of adolescents in Sialkot. Adolescents in Lithuania consume fast food more frequent than school children in Sialkot. The obtained results lead to the conclusion that adolescents in Lithuanian may have greater accessibility to fast food restaurant than teenagers in Sialkot.

*p<0.05 – z test compared adolescents in Sialkot

Analyzing relationship between adolescent’s smoking in Sialkot and Lithuania were found statistically significant differences. It was determined that frequency of smoking every day was significantly higher in Lithuania than in Sialkot.

*p<0.05 – z test compared adolescents in Sialkot.

CONCLUSION

Adolescents in general thought they are good health in Sialkot. Physical activity of the majority of adolescents did not meet the global WHO recommendations for school-aged children. No statistically significant differences were found between the gender and physical activity. Every second 9th grade student had breakfast every day in Sialkot. Fresh vegetables were more popular than fresh fruits among adolescents. Boys and girls consumed fresh fruits and vegetables equally often.

2. Majority of adolescent’s unhealthy diet products such as sweets, soft-drinks with sugar, fast food consumed rarely (1-3 times a week or never). Unhealthy diet products were more popular between boys than girls in Sialkot.

3. The percentage rate of teenagers, who smoked daily, were small, girls smoke cigarette less frequent than boys. Adolescents smoking were related to self-rated poor health.

 

Author’s Contribution:

Concept & Design of Study:

Usman Nasir

Drafting:

Rabea Nasir, Ghazala Khalid

Data Analysis:

Rashid Siddique, Nimra Ikram, Akmal Khurshid Bhatti

Revisiting Critically:

Usman Nasir, Rabea Nasir

Final Approval of version:

Usman Nasir

Conflict of Interest: The study has no conflict of interest to declare by any author.

REFERENCES

1.      Annesi JJ. Relations of physical self-concept and self-efficacy with frequency of voluntary physical activity in preadolescents: Implications for after-school care programming. J Psychosomatic Res 2006; 61:515-520.

2.      Affenito SG. Breakfast: a missed opportunity. J Am Diet Assoc 2007;107: 565–569.

3.      Andersen LB, Riddoch C, Kriemler S, Hills A. Physical activity and cardiovascular risk factors in children.Br J Sports Med 2011;45:871–876.

4.      Aslam, Monazza. The quality of school provision in Sialkot: Are girls worse off?” GPRG working paper no 066, University of Oxford; 2007.

5.      Haug E, Rasmussen M, Samdal O, Iannotti R, Kelly C, et al. Overweight in school-aged children and its relation with demographic and lifestyle factors: results from the WHO-Collaborative Health Behaviour in School-aged Children (HBSC) Study. Int J Public Health 2009;54(S2): 167–179.

6.      Precioso  J, Samorinha C, Macedo M, Antunes H. Smoking prevalence in Portuguese school-aged adolescents by gender: Can we be optimistic? Rev PortPneumol2012.http://dx.doi.org/10.1016/j.rppneu.2012.03.001.

7.      Kokkevi A, Richardson C, Florescu S, Kuzman M, Stergar E. Psychosocial correlates of substance use in adolescence: A cross-national study in six European countries. Drug and Alcohol Dependence 2007;86:67-74.

8.      Anderson C, Burn MD. Patterns of adolescent smoking initiation rates by ethnicity and sex. Tob Control 2009;2000; 9 (Suppl 2).

9.      Birndorf S, Ryan S, Auinger P, Aten M. High self-esteem among adolescents: Longitudinal trends, sex differences, and protective factors. J Adolescent Health 2005;37:194–201.

10.  Currie C, et al. Inequalities in young people’s health: international report from the HBSC 2006/06 survey. WHO Policy Series: Health policy for children and adolescents Issue 5, WHO Regional Office for Europe, Copenhagen, 2008.

11.  Curry LA, Youngblade LM. Negative affect, risk perception, and adolescent risk behavior. J Applied Develop Psychol 2006;27:468-485.

12.  Currie C, Roberts C, Morgan A. Smith R, Settertobulte W, Samdal O, editors. Young people’s health in context. Health behavior in School-aged Children (HBSC) study: international report from the 2001/2002 survey. Health Policy for Children and Adolescents; 2004.

13.  Das, Jishnu, Pandey P, Zanoj T. Learning levels and gaps in Sialkot, World Bank Discussion; 2006.p.4067.

14.  Hallal PC, Victora CG, Azevedo MR, Wells JCK. Adolescent physical activity and health: a systematic review. Sports Med 2006;36:1019–1030.

15.  Richter M, Erhart M, Vereecken CA, Zambon A, Boyce W, Gabhain SN. The role of behavioral factors in explaining socio-economic differences in adolescent health: A multilevel study in 33 countries. Social Sci Med 2009;69:396-403.

16.  Salonna F, van Dijk JP, Madarasova Geckova A, Sleskova M, Groothoff JW, et al. Social inequalities in changes in health-related behavior among Slovak adolescents aged between 15 and 19. BMC Public Health 2008;8:57.