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   2018| December  | Volume 43 | Issue 5  
    Online since December 19, 2018

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Noncommunicable diseases among school-going adolescents: A case study on prevalence of risk factors from Sabarkantha District of Gujarat, India
Tapasvi Puwar, Deepak Saxena, Sandul Yasobant, Shital Savaliya
December 2018, 43(5):33-37
DOI:10.4103/ijcm.IJCM_117_18  PMID:30686872
Background: The increasing burden of noncommunicable diseases (NCDs) and large proportion of adolescent population in India; crafts the dynamics of NCD risk factors. Most of the NCD risk factors are behaviorally acquired which are due to change in lifestyle during adolescent age groups. Objective: This study aims to determine the prevalence of risk factors among school-going adolescents in one of district of Gujarat state, India. Subjects and Methods: This is a cross-sectional study conducted among sampled schools of Sabarkantha district of Gujarat, India, during September–December 2016. A total of 484 school-going adolescents were screened for body weight, height, blood pressure, and some information of sociodemographic, lifestyle habits, and family history were collected through a structured questionnaire in vernacular language. Data were managed with SPSS version 20. Results: This study documents that not having fruits and not doing physical activities daily are the major risk factors of NCDs among school-going adolescents of Sabarkantha district, Gujarat. In addition to this, also it has been documented that there are differential standards for body mass index (BMI) available for adolescents and have been used extensively in various studies. This study provides an insight to these three major BMI standards and their differences in measurement for the school-going adolescents. Conclusions: This study recommends promoting healthier practices for prevention of NCD lifestyle risk factors among school-going adolescents and it also recommends standardizing the BMI measurements for adolescents for India.
  21,832 199 1
Are body image issues affecting our adolescents? A cross-sectional study among college going adolescent girls
Subhashini Ganesan, SL Ravishankar, Sudha Ramalingam
December 2018, 43(5):42-46
DOI:10.4103/ijcm.IJCM_62_18  PMID:30686874
Background: Body image relates to how people think and feel about their own body. In today's society, with the growing sense of ideal body image, adolescents try to lose or gain body weight to attain that perfect body. Body image perception is still naive, and this research will try to understand these unexplored areas, where there is paucity of body image-related studies. Objectives: The objective of the study is to find out the proportion of girls dissatisfied about body image, and the association of various factors with body image dissatisfaction and to ascertain the weight control behaviors adopted by adolescent college girls. Methodology: A cross-sectional study was done among 1200 college girls in Coimbatore. A semi-structured questionnaire was used to collect data on various factors associated with body image dissatisfaction. Body mass index (BMI) of the participants was calculated. Results: Body image dissatisfaction was there among 77.6% of the girls. It was found that factors such as higher BMI, sociocultural pressure to be thin and depression were all significantly associated with body image dissatisfaction. The most commonly followed weight control behaviors were eating small meals and skipping meals. Improving the appearance and body shape were the main reasons for weight control behaviors. Conclusion: This study establishes the fact that body image dissatisfaction is no longer a western concept and affects Indian adolescent girls to a great extent. Hence, effective interventions have to be planned to increase awareness on ideal body weight and protect our young generation from pressures of negative body image.
  5,409 141 9
Depression and anxiety disorders among schoolgoing adolescents in an urban area of South India
K Jayashree, P Prasanna Mithra, MK C. Nair, Bhaskaran Unnikrishnan, Keshava Pai
December 2018, 43(5):28-32
DOI:10.4103/ijcm.IJCM_209_18  PMID:30686871
Context: Adolescence is a period of turmoil, leading to several mental health challenges including anxiety and/or depression. Aims: To study the prevalence of depression and anxiety among higher school going adolescents and their sociodemographic correlates. Settings and Design: This cross-sectional study included 201 schoolgoing adolescents. Subjects and Methods: Depression and anxiety were measured using Beck Depression Inventory and Screen for Child Anxiety Related Disorders. Statistical Analysis Used: Chi-square test and binary logistic Regression with Hosmer–Lemeshow goodness-of-fit model. Results: Overall, 82 (40.8%) showed depression (from mild mood disturbance to severe and extreme depression). Among females, it was 49.3% (vs. 35.9% among males, odds ratio [OR] 2.00; 95% confidence interval [CI]: 1.02–03.97, P = 0.046). Overall, 110 (54.7%) participants had one or the other type of anxiety. Depression among the participants having one or other type of anxiety was 60% (vs. 17.6% without anxiety, OR 7.34; 95% CI: 3.68–14.64, P < 0.0001). Conclusions: Depression and anxiety were high among the study participants. Co-existing anxiety and female gender are significantly associated with depression among them. Increasing age, socioeconomic factors, and parental education are other factors influencing depression and anxiety but were statistically not significant.
  4,740 232 3
Challenges for adolescent health programs: What is needed?
Jayantilal Satia
December 2018, 43(5):1-5
DOI:10.4103/ijcm.IJCM_331_18  PMID:30686866
  3,573 265 3
A systematic review on effect of electronic media among children and adolescents on substance abuse
Mahalaqua Nazli Khatib, Anju Sinha, Abhay M Gaidhane, Padam Simkhada, Prakash B Behere, Deepak Saxena, Bhaskaran Unnikrishnan, Afroz Khatib, Mahjabeen Ahmed, Zahiruddin Quazi Syed
December 2018, 43(5):66-72
DOI:10.4103/ijcm.IJCM_116_18  PMID:30686878
Background: Substance abuse is one of the most significant global public health issues among youths. Electronic media has become a part of day-to-day life for all. This systematic review is undertaken to comprehensively explore the effect of electronic media on substance abuse among children and adolescents. Methodology: Two review authors independently searched various electronic databases and other sources. Selection Criteria: Randomized control trials that assessed the effect of exposure of electronic media (defined as television, internet, gaming, mobile phones/phones, and radio) among participants in the age range of 5–19 years on substance abuse were included in the review. Data Collection and Analysis: Two reviewers independently extracted data. We used an approach proposed by the Cochrane Collaboration. We used GRADE profiler to assess the overall quality of the evidence. Main Results: We retrieved 6003 studies and found 15 studies that fulfilled our inclusion criteria. Since included studies differed in the type of intervention and reporting of outcomes, we did not undertake meta-analysis and choose to describe studies narratively. Quality of evidence was rated as “very low” due to too little information or too few data to be able to reach any conclusions. Authors' Conclusions: Clinicians, policymakers, and educators to partner with caregivers and youth to support electronic media use that promotes positive outcome in these areas. Registration of Systematic Review: This systematic review has been registered at PROSPERO International prospective register of systematic reviews (Registration number: PROSPERO 2018 CRD42018086935) available at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID = 86935.
  2,699 109 1
Convergence and outreach for successful implementation of Rashtriya Kishor Swasthya Karyakram
Khushi Kansara, Deepak Saxena, Tapasvi Puwar, Sandul Yasobant, Poonam Trivedi, Shital Savaliya, Manish Fancy
December 2018, 43(5):18-22
DOI:10.4103/ijcm.IJCM_226_18  PMID:30686869
Background: Adolescents (10–19 years of age) constitute about one-fifth of India's population. The Ministry of Health and Family Welfare, Government of India, has launched Rashtriya Kishor Swasthya Karyakram (RKSK) in 2014 to improve health of adolescents. Adolescent Health Day (AHD) is an important intervention of RKSK for outreach and to secure convergence among relevant departments. Objectives: The objective of this study is to design and document methodology for effective implementation of AHD. Materials and Methods: This study was conducted in Talod block of Sabarkantha district of Gujarat. The methodology was developed using ABCDE approach – assess, build, create, deliver, and evaluate. Results: During assess phase, experts identified convergence an important component for successful implementation of RKSK. Formative research reaffirm that convergence played an important role in effective implementation of RKSK. Findings from these two phases led to the creation of a methodology which was used to deliver AHDs. This was further evaluated using interviews with key stakeholders in health and education department. It is now being used to organize AHDs in the district. Conclusion: ABCDE approach can be used to develop a better health interventions for National Health Programs.
  2,527 150 -
Improving adolescent health services across high priority districts in 6 states of India: Learnings from an integrated reproductive maternal newborn child and adolescent health project
Rajni Wadhwa, Nidhi Chaudhary, Nitin Bisht, Anil Gupta, Narayan Behera, Anupam Kumar Verma, Mona Chopra, Manish Jain, Geeta Verma, Sachin Gupta, Gunjan Taneja, Rajeev Gera
December 2018, 43(5):6-11
DOI:10.4103/ijcm.IJCM_38_18  PMID:30686867
Background: India has been at the forefront of designing adolescent health (AH) policies. The National Adolescent Reproductive and Sexual Health policy (2006), the Reproductive, Maternal, Newborn Child, and AH strategy (2013), and the “Rashtriya Kishor Swasthya Karyakram (RKSK)” (2014) have been the critical milestones in this direction. However, despite policies being available, the AH outcomes need improvement through operationalization of focused and need-based AH interventions. Objectives: The objectives of this study were to improve services for RKSK interventions across select geographies of India. Materials and Methods: USAID's VRIDDHI Project has been providing technical support at the national level and in six focus states to improve uptake of evidence-based high-impact reproductive, maternal, newborn, child, and AH interventions. To improve AH services and outcomes, two approaches were implemented, namely (a) strengthen the functioning of adolescent-friendly health clinics in 95 high caseload health facilities in 26 high priority districts across six states and (b) demonstrate other operational strategies outlined in RKSK program including strengthening of district committees on AH, undertaking formative research for developing adolescent-focused communication strategy, and operationalizing weekly iron and folic acid supplementation program. Results: As a result of ongoing technical support over 2-year period (January 2016–December 2017), improvements were noted across multiple AH indicators. In addition, evidence-based learnings were also generated from the demonstration models for potential scale up to other geographies. Conclusion: The project was successful in improving AH services in the intervention facilities through an integrated approach which is replicable, sustainable, and scalable for driving the AH program in India.
  2,024 179 -
Improving adolescent health: Learnings from an interventional study in Gujarat, India
Pallavi Patel, Tapasvi Puwar, Neeta Shah, Deepak Saxena, Poonam Trivedi, Krupali Patel, Sandul Yasobant, Manish Fancy, Hema Matela, Shital Savaliya, Pachillu Kalpana, Ritu Rana
December 2018, 43(5):12-17
DOI:10.4103/ijcm.IJCM_286_18  PMID:30686868
Background: There are multiple risk factors during adolescence, which become precursors of various diseases and injuries inflicting high morbidity, mortality, and disability. There are several gaps in adolescent health research in India; one among them is that programs targeting adolescent health are constrained by the absence of rigorous interventional research informing interventions for improving adolescent health. This study aims to document the effectiveness of intervention on adolescent health and knowledge change on the risk factors among adolescents in one of the selected districts in Gujarat, India. Methods: This was an interventional study with quasi-experimental design executed in one of the blocks of Gujarat. Baseline was conducted in 2013–2014 followed by intervention and the end line during 2016–2017. A structured validated questionnaire after pilot testing was executed to collect information on sociodemographic profile, nutrition status, menstrual hygiene practices, reproductive and sexual health, substance abuse, program awareness and utilization, and empowerment through life skills of adolescents in baseline and end line survey. Data analysis was carried out using IBM SPSS Statistics for Windows, Version 20.0. (Armonk, NY: IBM Corp). Results: This study documented increased awareness regarding anemia, knowledge about STD and HIV/AIDS, reduced addiction to tobacco, improved practices during menstrual hygiene and engagement with adolescent services/schemes in the intervention site. Conclusion: This study concludes that evidence-based interventions lead to increase in knowledge and practices; however, some improvements have also been documented in the nonintervention site. Therefore, changes due to interventions could not be attributed completely for improving adolescent health. Further long term interventional studies are required to develop a robust evidence on improving health of adolescents in India.
  1,967 162 -
Preparedness of young girls for prevention of cervical cancer and strategy to introduce the HPV vaccine
Dharitri Swain, Swayam Prangya Parida
December 2018, 43(5):38-41
DOI:10.4103/ijcm.IJCM_14_18  PMID:30686873
Objective: Cervical cancer incidence and mortality rates remain high in developing country due to low levels of awareness on preventive measures. The main study objective was to sensitize the young girls on the prevention of cervical cancer. Study Design: Quasi-experimental pretest and posttest design was used. Methods: A total of 240 young girls enrolled and 60 were selected randomly for the sensitization program. The preparedness for prevention of cervical cancer was assessed through structured preparedness criteria and perception toward vaccination was ascertained through rating scale. Results: Changes in knowledge level and intention to be vaccinated and for developing positive attitude to be screened in future were assessed using paired t-tests and found to be statistically significant. There is been an improvement in knowledge score noticed from pretest to posttest. The greatest improvements were observed in responses to questions on knowledge on symptoms (60%) and prevention (88%) that is maximum responded vaginal bleeding is the most common symptoms of cervical cancer and avoiding early sexual intercourse is the preventive measures of cancer cervix. Out of the 60 girls, 52 (86%) shown their agreement for human papillomavirus (HPV) vaccination, 35 (58.33%) took the HPV vaccine as a preventive measure. Conclusion: Study concludes that periodical sensitization through educational intervention may act as a cascade for girls and help them to be more aware about the preventive aspects of cervical cancer.
  1,946 148 -
Intervention study for reducing schoolbag weights in two rural schools in Maharashtra
Shyam Vinayak Ashtekar, Shekhar Bhikaji Padhyegurjar, Jagdish Dhondiba Powar, Aqsa Siddiqui
December 2018, 43(5):52-55
DOI:10.4103/ijcm.IJCM_299_17  PMID:30686876
Context: Heavy schoolbags are reported worldwide including India. The prescribed safe upper limit was 10% of student bodyweight. Aims: This intervention study explored (a) impact of awareness measures among stakeholders and (b) any systemic constraints for reducing bag loads. Settings and Design: This is a two-stage intervention study following a 2016–2017 baseline study of schoolbag weights in two rural schools. Subjects and Methods: The study involved 175 students (male: 79 and female: 96) from 8th to 9th standards. The intervention consisted of sharing the baseline findings of schoolbag weight, guidelines, and necessary measures for the same. The first intervention involved creating awareness among teachers regarding the harmful effects and the second intervention involved students. Bag weights were recorded on digital luggage scale in prelunch sessions in the following weeks after the intervention. Statistical Analysis: The impact of interventions was tested with (a) Paired t-test for mean bag weights and (b) Chi-square test for the proportion of heavy schoolbags. Results: The mean baseline bag weight of 3.77 kg declined statistically significantly after successive interventions to 3.4 and 3.2 kg. The baseline proportion of 51% of heavy bags (>10% of body weight) declined to 38% and 29%. Despite interventions, 19% students in 8th carried heavier bags than the 3.4 kg cap set by Government guidelines. Subjects taught in 8th standard were above 6/day. Conclusions: Awareness programs for stakeholders only partially succeeded in reducing bag weights. Hence, reducing the daily subject load is necessary.
  1,808 94 2
A systematic review on effect of electronic media on diet, exercise, and sexual activity among adolescents
Abhay M Gaidhane, Anju Sinha, Mahalaqua Nazli Khatib, Padam Simkhada, Prakash B Behere, Deepak Saxena, Bhaskaran Unnikrishnan, Mahafroz Khatib, Mahjabeen Ahmed, Zahiruddin Quazi Syed
December 2018, 43(5):56-65
DOI:10.4103/ijcm.IJCM_143_18  PMID:30686877
Context: Electronic media has become a part of day-to-day life for all, and particularly more so for children and adolescents. Exposure to electronic media may be beneficial as well as harmful. Aim: The aim of the study is to systematically synthesize existing published and non-published empirical evidence on the effect of exposure to electronic media on diet, exercise, and sexual activity. Methodology: Two reviewers independently searched online databases such as MEDLINE, CENTRAL, and EMBASE. We applied no language, date, or publication restrictions. Selection Criteria: We included randomized control trials that assessed the effect of exposure of electronic media on diet, exercise, and sexual activity in participants between 5 and 19 years. Study Selection, Data Extraction: Two reviewers independently screened studies identified in electronic search and independently extracted data and assessed the risk of bias of included studies. Data Analysis: We had planned to use the risk ratio or odds ratio for dichotomous data, and mean difference (MD) or standardized MD for continuous data. However, as included studied differed in types of intervention and reporting of outcomes, we did not undertake meta-analysis. Main Results: All included trials were parallel randomized controlled trials except for one that was a crossover trial. Eight studies reported the effect of electronic media on diet and exercise, two on diet, two on exercise, and one on sexual activity. Quality of evidence was rated as “very low” for all outcomes due to too little information or too few data to be able to reach to any conclusions. Conclusions: There is a little body of evidence that limits conclusions. We need to comprehend as to how to swap undesirable effects of electronic media and make it more desirable. Registration of Systematic Review: This systematic review has been registered at PROSPERO International prospective register of systematic reviews (Registration number: PROSPERO 2018 CRD42018086935) available at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=86935.
  1,723 115 4
Are school-going adolescents mentally healthy? Case study from Sabarkantha, Gujarat, India
Tapasvi Puwar, Sandul Yasobant, Deepak Saxena
December 2018, 43(5):23-27
DOI:10.4103/ijcm.IJCM_56_18  PMID:30686870
Background: Mental health issues becoming the global public health challenge, especially among the youth (12–24 years of age), although they are often detected later in life. In India, the adolescent population constitutes a quarter of the country's population and burden of disease varies from 9.5 to 102/1000 population. Most of the mental health disorders remain unidentified due to negligence and ignorance of multiple factors. Keeping this in mind and lack of population-based studies with good quality for guiding the mental health policies, this study aims to document the prevalence of emotional and behavioral difficulties among adolescents in Sabarkantha district of Gujarat, India. Methods: This is a school-based cross-sectional study conducted among 11–19 years of school-going adolescents during August–September 2016. About 477 adolescents who gave consent to participate were selected from 20 randomly primary and secondary schools. A prevalidated questionnaire for sociodemographic information including global validated standard questionnaire for mental health scoring known as Strengths and Difficulties Questionnaire (SDQ) were administered and self-reported responses were documented. Statistical analysis was conducted through SPSS version 20. Results: Mean age of the study population was 14.2 ± 1.4 years. About 14.6% boys and 12.6% of girls had abnormal total SDQ score, while 15.3% boys and 21.9% of girls had borderline SDQ score. Thus, 70.1% of boys compared to 65.6% girls had normal SDQ score. The difference between mean (higher mean score among girls) of total SDQ score of boys and girls was statically significant at the level of P < 0.05. Major risk factors for self-reported mental health issues were illiterate mother, occupation of parents, which make them away from family during daytime, nuclear family, severe addiction to alcohol in the family, financial problem in the family, and adolescent getting daily physical punishment. One-seventh adolescents are vulnerable for mental health problems found in this study. About one-fifth adolescents have internalizing (emotional) and about one-sixth have externalizing (conduct) manifestations. Conclusion: There is an urgent need to address the emotional and conduct manifestation among school-going adolescents. Rashtriya Kishor Swasthya Karyakram framework needs to address these issues on priority.
  1,646 142 -
Adolescent's perception about the introduction of new cigarette packaging and plain packaging of cigarette packs: A qualitative study
Archana Bhat, KB Shilpashree, Archana Krishnamurthy, C Manjunath, R Shwetha, S Madhusudhan
December 2018, 43(5):47-51
DOI:10.4103/ijcm.IJCM_97_18  PMID:30686875
Introduction: Larger health warning labels on cigarette packages were introduced in India in 2016 to more clearly inform consumers about the health risks associated with tobacco use. The aim of this study was to know the adolescent's perception on the introduction of new cigarette packaging and plain packaging of cigarette packs. Methodology: A qualitative study was carried out among adolescents aged 16–19 years. Eighteen participants were selected using purposive sampling technique. Three focus group discussions with the first group consisting of 6 smokers and the second and third groups consisted of 6 quit smokers and 6 nonsmokers were conducted. The data were later transcribed and analyzed using grounded theory approach. Results: Nearly all participants were aware of tobacco products, brand names, colors, and pictorial warnings on tobacco products. While the nonsmokers perceived fear was greater regarding warning and the pictorial messages, the current smoker's perceptions were unaffected by fear appeals. Almost all participants reported that new cigarette warning labels were more visible, informative, and scarier than the older ones. Conclusion: Positive impact of warning labels was seen among nonsmokers and few quit smokers whereas the current smoker's perceptions were unaffected.
  1,661 94 -
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