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Year : 2010  |  Volume : 47  |  Issue : 5  |  Page : 9--13

Lifestyle riskfactors of noncommunicable diseases: Awareness among school children

B Divakaran, J Muttapillymyalil, J Sreedharan, K Shalini 
 Department of Community Medicine, Academy of Medical Sciences, Pariyaram, Kannur-670 503, Kerala, India

Correspondence Address:
B Divakaran
Department of Community Medicine, Academy of Medical Sciences, Pariyaram, Kannur-670 503, Kerala


Background : Currently, the health scenario is riddled with the burden of noncommunicable diseases. Aim : The aim of this study is to assess the awareness of school children regarding the risk factors of noncommunicable diseases (NCD). Setting and Design : Three hundred and seventy-five school children, studying in classes 6 to 10, formed the study subjects. Materials and Methods : The school selected for the study was a government school, located in a rural area. The socioeconomic status of the children was mainly in the upper lower and lower class. Students from the 6 to 10 grades formed the study subjects and from among them, a random sample of 375 children were selected for the study. A close-ended questionnaire relating to 3 most commonly occurring NCDs, namely, Cancer, Cardiovascular Diseases (CVD), and Diabetes Mellitus (DM) was administered to the students. Statistical Analysis: Frequency and proportions were used to analyze the data. Results : It is found that awareness among the school children regarding lifestyle risk factors of NCDs is not satisfactory. The areas of least knowledge were found to be regarding passive smoking, early age at marriage, and reuse of cooking oil as risk factors for NCD. Conclusion : The study recommends the need for curriculum-based health education regarding the prevention aspects and motivation of the children to incorporate healthy lifestyle practices into their daily lives.

How to cite this article:
Divakaran B, Muttapillymyalil J, Sreedharan J, Shalini K. Lifestyle riskfactors of noncommunicable diseases: Awareness among school children.Indian J Cancer 2010;47:9-13

How to cite this URL:
Divakaran B, Muttapillymyalil J, Sreedharan J, Shalini K. Lifestyle riskfactors of noncommunicable diseases: Awareness among school children. Indian J Cancer [serial online] 2010 [cited 2022 Oct 2 ];47:9-13
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The current health scenario worldwide is facing the major public health challenge of Noncommunicable diseases (NCDs). Mortality, morbidity, and disability due to major NCD account for about 60% of all deaths and 47% of the global burden of disease. In South Asia, half of the disease burden is attributable to NCD. [1] India, too, is caught in the midst of transition from the burden of communicable diseases to the burden of NCDs. An estimated 9.2 million productive years of life were lost in India due to CVD in 2000, with an expected increase to 17.9 million years in 2030. [2] India has a higher number of people with diabetes than any other country, with estimates ranging from 19.4 million in 1995 to 32.7 million in 2000. [3] India is also in the fore-front with regard to the number of cancer patients. [4] NCD affects the most productive midlife period and thus negatively influences workforce productivity and economic development. The major risk factors for the NCD are associated with lifestyle and behavioral patterns, which are largely a result of practices adopted from young age itself. Thus, any attempt at reducing the incidence of NCD should include in its fold children too, as they are at an impressionable age and can be motivated to make appropriate healthy modifications and in turn they can influence the community at large. The objective of the present study is to assess the awareness of school children regarding the risk factors of NCDs. School children were selected as the study group because they are at a receptive age and are influential in determining the health of the next generation.

 Materials and Methods

The present cross-sectional study was conducted at Kannur district, Kerala state, India. A government school was selected for the study. The selection of the school was based on the proximity of the school to the Medical College. For the calculation of required sample size, as there were no previous studies undertaken in the area to assess the awareness, the proportion (p) of students having awareness was assumed to be 50%. At 5% significance level and allowable error as 10% of p, the required size was got as 400. With a nonresponse rate of around 6%, the sample actually studied comprised 375 children, who were selected randomly from among the students studying from grades 6 to 10.

After obtaining permission from the school authorities, the purpose of the study was explained to the students and then the questionnaire was distributed. The study tool was prepared in local language for easy understanding of the questions Anonymity was maintained by asking them not to write their names in the questionnaire. The filled-in questionnaire was collected back from the students on the same day.

A pre-tested, structured, close-ended, self-administered questionnaire was used for data collection. Although a number of diseases come under NCDs, we limited our questions to those relating to the 3 most commonly occurring NCDs, namely, Cancer, Cardiovascular Diseases (CVD) and Diabetes Mellitus (DM). In addition to these, the questionnaire contained the sociodemographic characteristics of the subjects.

The awareness level of the students was judged based on the lifestyle risk factors of NCDs included in the questionnaire. This included obesity, excessive anxiety, excess salt intake, lack of exercise, early age at marriage, lack of sexual hygiene, passive smoking, fatty diet, use of soft drinks, fast food consumption, reuse of cooking oil, and addictions, such as smoking and chewing tobacco, as well as the use of alcohol. The correct responses given by each student was converted into percentages, with 100% denoting the correct responses to all the questions. Based on the proportion of correct responses, the students were classified into 3 groups denoting their different levels of awareness. High awareness group comprised students scoring more than 60%, medium awareness group comprised those students who scored between 30% and 60%, whereas low awareness group students scored less

than 30%.

The data collected were entered into an excel spread sheet and transformed to PASW 17 for analysis. The frequency and proportions were used for data analysis.


A total of 375 students comprised the study subjects; and 51.5% of them were males and the remaining were females. Religion-wise composition showed Hindus 36.8%, Muslims 34.9%, and Christians 28.3%. Regarding family history of these diseases, 13.1% reported to have a family history of DM, 2.9% to have a family history of CVD, and 2.1% to have a family history of Cancer.

The awareness level of all the study subjects is shown in [Table 1]. It can be seen that a majority (84.8%) of the students have a very low awareness regarding lifestyle risk factors of NCDs and only 0.8% of students were having a good level of knowledge regarding the lifestyle risk factors.

[Table 2] displays the trend in physical activity among the study group. It can be seen that only a small number of children engage themselves in daily activities of exercise and games.

[Figure 1] shows the knowledge status of the children regarding the diseases, that is, whether they have heard about it and whether they think these diseases to be public health problems. It shows that the students were not aware of the seriousness of these diseases. Only 23 students (6.1%) thought all the three diseases to be public health problems.

[Figure 2] shows the awareness of the school children regarding NCDs with respect to their preventable aspect. A majority (47.5%) felt that among the 3 NCDs, DM could be prevented. Some students had the misconception that the NCDs were communicable in nature.

[Figure 3] shows the major dietary habits of the study group. It can be seen that the daily consumption of fruits and vegetables is very low but more number of students have soft drinks daily. This trend may be due to the fact that in Kerala, even the rural population tries to imbibe some aspects of the urban culture, as more and more of agricultural land is given up for construction purposes. Also, the influence of the media is seen on the younger generation, even if they cannot afford the costly brands of soft drinks shown in the advertisements, they fall for local products, which appear similar in looks to the advertised products. The younger generation finds it more appealing to have these soft drinks instead of tender coconut water, which is readily available in the natural form and is healthy. The number of students having fast foods is least, which may be due to the fact that the school being located in a rural area, and they did not have easy access to such foods, which may be a blessing in disguise. Fast foods include parotta (similar to parathas, but they are made from maida flour and also a lot of saturated fats in the form of oils are used in its preparation), meat (chicken, beef, and others)-based preparations, which use a lot of oil and spices, as well as bakery items, such as puffs, which are also made from maida flour and vanaspati.


Similar studies conducted at different places show the following. A study, conducted in Pune, India, among school children from classes 9 to 12, regarding awareness of risk factors showed that the level of knowledge was very low among them. [5] The Persian Gulf healthy heart project, conducted in Iran, was a school-based intervention study. It found that the classroom-based cardiovascular health promotion had a significant effect on the heart health knowledge. [6] In a study conducted among school-going children in New Delhi, India, it was estimated that 15-25% of the urban school children in India are at risk of developing type 2 diabetes at an early age. [7] This may be partly attributed to the media, especially television, which is the most influential source of dietary changes and information, for example, the food advertisements enticing young children with colorful sweets and chocolate products. This influences the food choices, leading to family preferences for "junk food" or fast food. Another important aspect to be taken note of is the fact that nowadays schools put more emphasis on good test scores, and this takes a toll among the children as schools have less focus on physical education. The curriculum should include games and sports as an integral part. An Indian study showed a high prevalence of metabolic and dietetic coronary risk factors among the adolescents of the middle and upper class of India. [8] The Indian Diabetes Prevention Program, a prospective randomized controlled trial in urban Asian Indian subjects with persistent Impaired Glucose Tolerance (IGT) showed that lifestyle modification was effective in the prevention of diabetes. [9] All the above studies point to the utmost necessity of imparting awareness to school children regarding the lifestyle modifications to be adopted by them in order to be healthy citizens of the future.


Our study concludes that the awareness among school children regarding lifestyle risk factors of NCDs is not satisfactory. It recommends the need for curriculum-based education that includes healthy lifestyle training and motivation of the children to incorporate these practices into their daily lives to build the foundation for a healthy generation tomorrow.


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