Understanding specific needs in health and socialo care Essay
INTRODUCTIONThe World Health Organization has already informed of increasing Non-communicable diseases (NCDs) among adolescents as a major public health problem. These age groups are important and also lie in the fact that many serious diseases in adulthood have their roots in adolescence. For these reasons, we research to assess the proportion of lifestyle risk factors for NCDs and habits among the adolescence in Victoria University College (VUC).
Non-communicable disease (NCD) is also known as the chronic disease. NCD cannot transmit from person to person. NCDs have four types such as Diabetes, Cardiovascular diseases, Cancers and chronic respiratory diseases. Most of the NCDs are long duration and they can effect on slow progression. NCDs are most hazardous disease during these centuries. These diseases are more affected in developed and developing countries. Especially, most of the NCDS occur before the age of 60. So, the people die with prematurity in low and middle countries.
NCDs are also impact on socioeconomic factors. Vulnerable and socially disadvantaged people get sicker and die sooner than the people of higher social position because they are at greater risk of being exposed to harmful products such as tobacco or unhealthy food. Thus, NCDs are quickly becoming a major disease around the world.
According to our based trends, 60% of people are died because of non-communicable disease in 1999. For 2020, NCDs are expected to account for 73% of deaths.NCDs deaths are really rising nowadays. So, we need to control and prevention of non-communicable diseases. Lower income countries have lower capacity for control and prevention. High-income countries can give NCD services covered by health insurance. The important ways to reduce NCDs are needed all sectors which include health, finance, education, planning and others. We should mainly reduce risk factors such as unhealthy diet (obesity and underweight), alcohol, Tobacco use, high blood pressure, physical inactivity and decreased vegetables and fruits intake.
These factors are caused because of our unhealthy life style. Modifiable Behavioural risk factorsObesity is caused by unhealthy diet, physical inactivity in this way we were cause most NCDs. In every year, 6 million of people deaths with tobacco use (over 600,000 deaths from exposure to second-hand smoke). Furthermore, 1.7 million deaths are attributable to low fruit and vegetables consumption. Half of the 2.32 million annual deaths from harmful alcohol drinking. Metabolic and Physiological risk factorsRaised blood pressure, Obesity, hyperglycemia (high blood glucose levels) and hyperlipidemia (high levels of fat in blood) are the four ways that increases the prevalence of NCD.
All over the world, high blood pressure attribute 16.5% of global deaths. Second, tobacco use is followed with 9%, physical inactivity (6%), obesity and overweight is 5% each.LITERATURE REVIEWNon-communicable diseaseNowadays, double burden of disease is challenging our global health care in various aspects- social, economic, occupation and so on. Decreasing number of communicable diseases is balanced out or overwhelmed by growing matter of non-communicable diseases burden. Non-communicable disease is the illness or health condition cannot be transmitted from one person to another one.
NCD is chronic in nature and it impair body structure and function which deteriorate the person’s normal life and life expectancy. Because of permanently persisting nature, creating disability, and needing long term care, NCD is regarded as a burden to the society, country and family.NCD mortality rate will be contributed 73% of all death in 2020 which will be 60% of disease burden. The uprising trend of NCD epidemic is closely related to multiple risk factors which can be preventable.Common NCDs in Myanmar1. Cardio-vascular disease (Coronary heart disease, Hypertension, Stroke) 2. Malignancies3.
Diabetes4. Nutritional disorder (Protein Energy Malnutrition, Iron deficiencyanaemia, specific vitamin deficiency) 5. Accidents and injuries6. ObesityThe major issue of boosting the prevalence of NCD is unhealthy lifestyles; smoking, alcohol drinking, obesity, lack of physical activities and consumption of fruit and vegetables.
Person’s lifestyle is established since childhood and so modifying hazardous lifestyle focusing on adolescents is the key factors to oppose the existing danger of NCD. Some non-communicable diseases also act as the precipitating factors for various health problems.ObesityObesity is a medical condition which is the abnormal collection of body fat which can effect on health. So the life expectancy will be lower and it can increase the health problem.
Obesity can be expressed by mean of BMI and waist circumference. BMI is calculated by the following formula.Classification of BMIClassificationBMI (kg/m2)Risk of comorbiditiesUnderweight40.00Very severeWaist CircumferenceWaist circumference refers to a numerical measurement of our waist. If fat is mainly accumulated around our waist than other area: hips or thighs, we will face health problems. Waist circumference of more than 35 inches in women and 40 inches in men is marked as high risk of developing obesity and health problems like diabetes, blood pressure and heart disease. Although we can measure the obesity by BMI, waist circumference is also the major concerned factors.
We use the waist circumference as a risk indicator when the patients are normal or overweight by BMI measurement.Health effectsThe body fat measurement BMI and the waist circumference are not perfect identifying obesity but it’s very useful in clinical and epidemiologic research. Obesity increases the risk of getting various diseases like heart disease, type 2 diabetes and cancer. Obesity is one of the leading preventable causes of death worldwide. There are many factors that effect on health like psychosocial effects, social effect and the effect on society. The health effects of obesity are 1. Coronary heart disease2.
Type 2 diabetes3. Cancers in endometrial, breast, and colon4. Hypertension5. Dyslipidemia6. Stroke7. Liver and Gallbladder disease8. Sleep apnea and respiratory problems9.
Osteoarthritis10. Gynecological problemsCausesThe obesity is commonly caused by a combination of excessive food intake, lack of physical exercise, genetic factors, endocrine disorders, medication or psychiatric illness. And other is because of accessible and palatable diet and increased reliance on cars, and mechanized manufacturing. According to 2006 report, other ten factors that can cause obesity are 1. Insufficient sleep2. endocrine disorder3. decreased variability in ambient temperature4. decreased rates of smoking because smoking reduce the hunger 5.
increased use of medications that can cause weight gain6. Proportional increases in ethnic and age groups which tend to be heavier 7. pregnancy at a later age8. natural selection for higher BMI9. assertive mating leading to increased concentration of obesity risk factor Being overweight is also changed according to the time like in about 1970 the average person eat about 3654 calories and and in about 2003 it increased to 3734 per person.
And this calorie has been related to obesity.PreventionObesity can be prevented by changing healthy lifestyle habits, including healthy eating and physical activity which can lower the risk of becoming obese and developing related diseases. Families, Communities, Schools, Child care settings, Medical care providers, Faith-based institutions, Government agencies, the media, and the food and beverage industries and entertainment industries influenced the dietary and physical activity behaviours of children and adolescents. The school plays an important and critical role because its establishment of safe and supportive environment with policies and it practices which support healthy behaviors since childhood. In school the children can learn how to eat healthy and how to keep fit. Some obese people eat little yet gain weight due to a slower metabolism than average people have. The best way to treat obese people is controlling diet and doing exercise. There are other methods of combating obesity in developed countries.
A gastric balloon is one of the ways which can reduce weight and surgery to reduce stomach volume and reduce ability to absorb nutrients from food.SmokingSmoking refers to the breath and out breath of gases from burning tobacco in cigarettes. Dates back to the history, smoking is starting from the late 1500s. During the 19th century cigarettes were higher in demand than the cigars and pipes which had been popular among smokers until then.
Tobacco smoke contains toxic substances such as nicotine, carbon monoxide, tar and irritants, all of which affect the way of body works. It contains over 4,000 different chemicals. When we smoke, these chemicals enter our body through our mouth and throat.
Age of start smokingActually, smoking is very common in adolescents because they tried acigarette and the rise in those experimenting with smoking has been matched by an increase in regular smokers as well. And also in the US nearly a quarter of high school students smoke cigarette and another 8% experienced smokeless tobacco. Everyone has many health risk of smoking. However, the younger age they start the more problem it can cause. And there is a data about smoking is regularly collected for kids under 12, but the peak years for first trying to smoke appear to be in the sixth and seventh grades, or between the ages of 11 and 13, with a considerable number starting even earlier. In 2011, 6.
1% of eighth grade students reported having had their first cigarette by fifth grade (ages 10 to11), and 15.5% had tried smoking by eighth grade. More than half of twelfth graders who were current smokers had tried smoking by the end of ninth grade. Besides, people who start smoking before the age of 21 have the hardest time quitting.
Although some kids who become regular smokers quit before leaving high school, the majority tries to quit but fails. When the people begin smoke, their risk of contracting lung cancer, experiencing a range of risk factors and health problems in adulthood is higher. Overall, roughly one-third of all kids who become regular smokers before adulthood will eventually die from smoking. If current trends continue, more than five million of the kids under 18 who are alive today will die of tobacco-related diseases.Health effects of smokingMoreover, smoking can harm our appearance. If we smoke heavily, the teeth may become yellow and stained, the breath often smells of smoke, hair and clothes may also smell of smoke and fingers and nails may get stained by the nicotine.
On the other hand, smoking cause dead and harm nearly every organ of the body. And also compared to non-smokers, smoking is estimated to increase the health risk of 1. Coronary heart disease2. Stroke3. Lung cancer4. chronic obstructive lung diseases (such as chronic bronchitis and emphysema) And also smoking has many adverse reproductive and early childhood effects, including increased risk for 1. Infertility2. Preterm delivery3.
Still birth4. Low birth weight and5. Sudden infant death syndromeBy reducing of smoke, HPB (health promotion board) organises a variety of activities aimed at raising youth awareness about benefits of leading a tobacco free-life style. HPB adopts a targeted approach by collaborating with schools, family service centers and various youth and public organisation to hold activities to help risk youth embrace a smoke free-life style. And also there is prohibition of underage smoking. Youth below the age of 18 are prohibited by law to smoke or purchase any tobacco products. Parental smoking can result in children picking up smoking. That’s why, since 2009, HPB has stepped up programmes to encourage smoker parents to kick the habit.
These include promoting positive parental role modeling and engaging healthcare professionals to reiterate to parents the importance of being tobacco-free. HPB is always seeking to work with relevant partners to incorporate tobacco-control messages in their premises, products, programmes or events. Second-hand smokingThe danger of tobacco smoking is well known by its life destroying health condition. However, there are very few persons who noticed that the effects threat not only to smokers but also to the innocent persons who are passively receiving the poisonous smoke. So, second-hand smoke (SHS) becomes one of the global public health problems. The problem of passive smoking is the big concern in South-East Asia Region for the reasons of high smoking prevalence and low in awareness of hazards of second hand smoke.
Prevalence of second hand smoke and influencing factors of exposure The smoking prevalence of adult is significantly higher than that of the teen. Considering second hand smoke, the percentage of exposure will not be much different between them. The proportions of exposure to second hand smoke vary between different age groups according to the places of exposure. According to the STEPS survey 2009 in Myanmar, SHS exposed to over half of the respondents at home (57.
8% in females and 52% in male). Passive smoking at home has many factors to influence. Age, residence, education of thehousehold members, their occupation status, and socio-economic status are some of the factors which are inversely related to passive smoking at home. Women and young children are the main targeting group of indoor smoke because they spent more time at home. Indoor work place exposure to second-hand smoke is greater than males than females (71.
9% vs 54.7%) and it depends on the education status of the workers; the lower the education status, the higher in exposure. Prohibition of smoking in work places is just one-quarter of the total and so the law enforcement for indoor smoking policy should be encouraged. Public place is the area where younger age groups experienced more SHS than other situations. Overall exposure in public place is lower than other area (38.
8% in males vs 13.6% in female) according to the 2010 second hand smoke exposure report. Global Youth Tobacco Surveys (GYTS) reported that 34.1% of 13-15 years students exposed to SHS at home and 46.4% at public places.
Health effectsBecause of the direct and close contact to the person indoor, the challenge of SHS is very hazardous. By mean of hundreds toxic substances and over 70 carcinogenic agents involved in second hand smoke, it leads to severe health problems to all level of age group – infants to old aged.Evidences of numerous health problems caused by SHS in infants and children are well established. Respiration tract infections are one of the common diseases pronounced by passive smoking, including severe asthmatic attacks because of longer stay at home making them contact to second hand smoke at home. Another health effects attacking infants and children by indoor smoke are ear infections and sudden infant death syndrome (SIDS) which is the main cause of healthy infant mortality. Smoking during pregnancy, smoking near to the baby should be forcefully inhibited by reducing the preventable causes of infant death.
Adults also suffer various health problems caused by SHS. Risk of heart disease grows by 25-30% in nonsmokers who exposed indoor smoke at home or at work place. Center of disease control and prevention (CDC) confirmed that over 45,000 premature deaths each year in United States is triggered by SHS.Passive smoking is one of the factors causing coronary heart disease and heart attack by destroying blood vessels lining and sticking blood platelets.
SHS can also raise the risk of developing lung cancer in non-smokers by 20-30% and nearly 3400 death with lung cancer each year in United States.Control of Smoking and consumption of Tobacco Product Law, Union of MyanmarAs like in other countries, smoking tobacco control is prohibited by mean of policy and law in Myanmar to prevent both active and passive smoking hazards. In order to protect from the danger to public, non-smoking areas (smoke free areas) are created. Hospital building, medical treatment centers and clinics, stadium, playgrounds, classroom of teaching buildings, cinema, market, museum, and other public places etc are prevented from smoking by mean of law.
Moreover, fine or imprisonment is subjected to some offences concerning tobacco advertisement by setting up signboard, distribution pamphlet, advertising in multimedia, sponsoring service to hold athletic game, exhibition or any welfare activities. To prevent youth smoking, selling cigar within 100 yards from school compound, selling to under 18 years old aged and selling cigarette singly or package less than 20 are prohibited according to the law. The law also enforces the cigarette manufacturing company to mention the toxic effect on health caused by smoking clearly on the package. AlcoholAlcohol is classed as a depressant, meaning that it slows down the vital functions resulting in slurred speech, unsteady movement, disturbed perceptions and an inability to react quickly. Alcohol is one of the most popular mood-changing leisure time drugs.
Nowadays we can see the people over the age 18 and younger than 18 are in bottles shops, pubs, clubs and bars. Types of alcohol(1) Beer – it’s prepared by brewing and fermenting grains, then flavoring the mixture with hops. The alcohol content of beer usually ranges from 4% to 6% alcohol by volume. (2) Wine – it’s made using fermented fruits (usually grapes).
Wine is completely fermented and has a long ageing process, which leads it to having an alcohol content of around 9% to 16%. (3) Spirits – aproduct of both fermentation and distillation. Spirits are stronger alcohols and can have an alcohol content of above 20% (20% – 70%)Age of limitationJust about everyone knows that the legal drinking age throughout the United States is 21. However, according to the National Center on Addiction and Substance Abuse, almost 80% of high school students have tried alcohol. Reasons of alcohol drinkingSome people drink occasionally, but can also unwind or enjoy social events without drinking. However, other people regularly drink above recommended limits (one drink per day for women and older people, two drinks per day for men) or may feel like they need alcohol in order to relax, have a good time, or feel better. If you find yourself needing to drink, you may have an alcohol problem. Drinking too much can cause problems with their relationship at home and at work, lead to poor judgment and dangerous behavior, and sometimes cause legal issues.
Driving and doing other activities while drunk may lead to hurt or kill yourself or others. Some Veterans turn to alcohol as a way to try to deal with problems in their daily lives and use it for recreation, to calm down, or to fall asleep. Retirement, the death of a spouse or good friend, leaving your home, losing your job, and being diagnosed with a disease all can trigger emotions that lead some people to abuse alcohol. Alcohol abuse and dependence can start at any age, and there are no good predictors of when it may start, though a family history or current family alcohol or drug abuse problems may influence the start of personal drinking problems. Some people have been heavy drinkers for many years, but others develop a drinking problem later in life. Sometimes the onset is triggered by major life changes that cause depression, isolation, boredom, and loneliness. Health effects of alcoholWhen people drink alcohol, it’s absorbed into bloodstream. From there, it affects the central nervous system (the brain and spinal cord), which controls virtually all body functions.
According to the figure, there have 13 health effects; Brain damage addiction and stroke, blurred vision, slurred speech, bleeding throat, stop breathing, heart disease and irregular heart beat, Stomach ulcers, liver disease and liver failure, muscle weakness, intestinal cancer, intestinal ulcers, importance (man) and infertility (woman), osteoporosis.Alcohol is the depressant, which means it slows the function of the central nervous system. Alcohol actually blocks some of the messages trying to get to the brain. This alters a person’s perceptions, emotions, movement, vision, and hearing. Drink a lot in a short space of time and the amount of alcohol in the blood can discontinue the body from working properly. It can slow down your brain functions so you lose your sense of balance, irritate the stomach which causes vomiting and it stops your gag reflex from working properly – you can choke on, or inhale, your own vomit into your lungs, affect the nerves that control your breathing and heartbeat, it can stop both, dehydrate you, which can cause permanent brain damage, lower the body’s temperature, which can lead to hypothermia and then lower your blood sugar levels. And then drinking much alcohol can cause the mantel health such as increase stress, depression and affecting your temper.
Drinking heavily can also affect your relationships with your partner, family and friends. It can impact on your performance at work. These issues can also contribute to depression.
If you use drink to try and improve your mood or mask your depression, you may be starting a vicious cycle.But mostly Myanmar women are no drinking alcohol because in Myanmar there have many cultures and norms for women and men too.Nowadays, the average age in Myanmar teenage has their first drink is 15. And then many other countries, underage drinking is a widespread problem with often serious consequences. Young people who drink are more likely to be the wound of vicious crime, to be involved in alcohol related traffic accidents, and to have depression and anxiety. Other risky behaviors are also linked to early drinking. Drinking at a young age greatly increases the risk of developing alcohol problems later in life and problems in brain developing. .
Because experts now know that the human brain is stilldeveloping during our teens, scientists are researching the effects drinking alcohol can have on the teen brain. Experimentation with alcohol during the teen years is common.Some reasons that teens use alcohol and other drugs are curiosity, to feel good, reduce stress, and relax, to fit in and to feel older. From a very young age, kids see advertising messages showing beautiful people enjoying life and alcohol. And because many parents and other adults use alcohol socially having beer or wine with dinner, for example alcohol seems harmless to many teens. Alcohol and teenage problemsThe consequences of underage drinking are school problems, such as higher absence and poor or failing grades, social problems, such as fighting and lack of participation in youth activities, legal problems, such as arrest for driving or physically hurting someone while drunk, physical problems, such as hangovers or illnesses, unwanted, unplanned, and undefended sexual activity, trouble of normal growth and sexual development, physical and sexual assault and higher risk for suicide and homicide. Alcohol-related car crashes and other unintentional injuries, such as burns, falls, and drowning, memory problems, abuse of other drugs, changes in brain development that may have life-long effects and death from alcohol poisoning.So we need to reduce and prevent drinking by mean of family activities, drinking juices and playing or doing exercises.
And then prevention of teenage or underage drinking will need community based efforts to observe the activities of youth and decrease youth access to alcohol. So we need to issue the laws such as enforcement of minimum legal drinking age laws, national media campaigns targeting youth and adults, increasing alcohol excise taxes, reducing youth exposure to alcohol advertising, and development of comprehensive community-based programs. These elements are requiring for the prevention of teenage drinking.
Physical activityPhysical activity means movement of the body using energywhich helps our body to keep fit and healthy. It includes walking, gardening, cycling, dancing, golf, swimming and competitive sports like football and tennis.Doing regular physical activity can help us in lots of benefits. For example , it can reduces the risk of heart disease, stroke, diabetes, high blood pressure, obesity, some cancer and strengthen our bone and muscle .
For those people who are obesity, doing physical activity will help them keep fit and. It can also reduce our stress and can control our weight. It can also increase our chances of living longer. We can take only about 30 minutes a day to do physical activity like walking.Any ages can do physical activity daily. Type and duration of physical exercise varies according to age group. Children and adolescentThose children and adolescent should do about 60 minutes (1 hour) or more of physical activity each day. They should do 3 types of physical activity.
Those are aerobic activity, muscle strengthening and bone strengthening. Adults (aged 16-64 years)Those people need at least 2 hours and 30 minutes (150 minutes) every weeks. We can break it up into smaller chunks of time during the day. As long as we are doing our activity at a moderate or vigorous effort for at least 10 minutes at a time. We can do 10 minutes brisk walk, 3 times a day, 5 days a week. This can give us a total of 150 minutes of moderate intensity activity.
Older adults (aged 65 years and older )As an older adult, regular physical activity is one of the most important things we can do for our health. It can prevent many health problems that seem to come with age. It also helps our muscles grow stronger so we can keep doing our day-to-day activities without becoming dependent on others. We need 2 hours and 30 minutes (150 minutes) of aerobic activity and muscle strengthening activity for every week. Types of physical activityThere are many types of physical activity. They are –Aerobic activity – We can do aerobic activity with light, moderate, orvigorous intensity. Moderate and vigorous-intensity aerobic activity is better for our heart than light-intensity activity. However, even light-intensity activity is better than no activity at all.
People who are less fit usually have to work harder to do an activity than people who are more fit. Thus, what is light-intensity activity for one person may be moderate-intensity for another. Muscle strengthening – Muscle-strengthening activities improve the strength, power, and endurance of our muscles. Lifting weights, climbing stairs, and digging in the garden are examples of muscle-strengthening activities. Bone strengthening – Muscle-strengthening and bone-strengthening activities also can be aerobic.
Whether they are depends on whether they make our heart and lungs work harder than usual. For example, running is an aerobic activity and a bone-strengthening activity. Benefits of doing physical activityRegular exercise can help protect us from heart disease and stroke, high blood pressure, noninsulin-dependent diabetes, obesity, back pain, osteoporosis, and can improve our mood and help you to manage stress better. For the greatest overall health benefits, experts recommend that do 20 to 30 minutes of aerobic activity three or more times a week and some type of muscle strengthening activity and stretching at least twice a week. However, if we are unable to do this level of activity, we can gain substantial health benefits by accumulating 30 minutes or more of moderate-intensity physical activity a day, at least five times a week. Health benefitsHeart Disease and Stroke – Daily physical activity can help prevent heart disease and stroke by strengthening your heart muscle, lowering our blood pressure, raising our high-density lipoprotein (HDL) levels (good cholesterol) and lowering low-density lipoprotein (LDL) levels (bad cholesterol), improving blood flow, and increasing our heart’s working capacity. High Blood Pressure -Regular physical activity can reduce blood pressure in those with high blood pressure levels.
Physical activity also reduces body fatness, which is associated with high blood pressure. Obesity – Physical activity helps to reduce body fat by building or preserving muscle mass and improving the body’s ability to use calories. When physical activity is combined with proper nutrition, it can help control weight andprevent obesity, a major risk factor for many diseases. Psychological Effects – Regular physical activity can improve our mood and the way we feel about ourselves.
Researchers also have found that exercise is likely to reduce depression and anxiety and help us to better manage stress.Fruits and vegetablesFruits and vegetables are one part of the healthy diet. It can prevent from main diseases such as cardiovascular diseases, cancers, skin diseases, obesity and diabetes mellitus etc. A recently published WHO/FAO report recommends a minimum of 400g of fruits and vegetables per day for the prevention and alleviation of several micronutrient deficiencies, especially in undeveloped countries.Recommended servingStudies suggest that educated person has knowledge about consumption of fruits and vegetables. Therefore, they know that how much intake of fruits and vegetables will suitable for health. Intake of fruits and vegetables are differing in males and female which is indicated by (Wardle et al., 2000; Wang et al.
, 2002). Empirical finding describe that socio-economic status is concerned with consumption of fruits and vegetables. A study carried out by Sylvestre et al (2006) revealed that mothers consumed 2 ½ vegetable servings and 2 ½ fruit servings on average daily to reach the basic recommendation of 5 servings per day (Sylvestre et al., 2006).In the USA, the consumption of fruits and vegetables is known to contribute to an estimated intake of 91% of vitamin C, 48% of vitamin A, 30% of folate, 27% of vitamin B6, 17% of thiamine and 15% of niacin. It is also known that fruit and vegetable intake provide 16% of magnesium, 19% of iron and 9% of the calories (United States Department of Agriculture, 2000).
The United States Department of Agriculture (2000) suggested that people should eat two portions of fruits and at least three portions of vegetables per day, choose fresh and variable colors, kinds and dark-green leafy vegetables, orange fruits, vegetables and cooked dry beans and peas regularly. In some countries, consumers are encouraged to eat at least 10portions of fruits and vegetables per day. The people who consume the tomatoes and tomato products it can reduce carcinogenesis, especially of prostate cancer which is mentioned by (Giovannucci, 2002). Fruits and vegetables recommended for daily consumption consist of tomato, cucumber, green leafy vegetables, orange, mango, carrot, melon, pineapples and red grapefruit etc.The pie chart mentioned the consumption of fruits and vegetables proportion in England during 2009.Health effectAccording to the scientific evidence, eating fruits and vegetables can prevent from esophageal, stomach, pancreatic, bladder and cervical cancers and also protect 20% of various types of cancers (Crawford et al., 1994).
Moreover, fruits and vegetables consumption is influenced by gender, age, income, education and family origin. Higher intakes of cruciferous vegetables can reduce the risk of developing bladder cancer in men (Micaud et al., 1999) and higher intakes of tomato products can reduce the risk of developing prostate cancer (Giovannucci et al.
, 2002).In USA, Children and adolescent obesity have reached epidemic proportions (Muriello et al., 2006).
Obesity among children and adolescents is also increasing in South Africa and in other African countries due to western influence because they took unbalance fruits and vegetables.Several cohort studies have examined the link between fruit and vegetable intake and coronary heart disease. Daucher and co-workers (2006) carried out a meta-analysis of cohort studies and experiential that the risk of developing coronary heart disease decreased by 4% for each additional portion per day intake of fruit and vegetables and by 7% for fruit consumption, describing that fruit present a more defending effect in reducing the risk of developing coronary heart disease (CHD).Lock et al (2005) described that rising individual fruit and vegetable consumption by 600 grams per day could reduce the global burden of stroke by19% and decrease the risk of CHD by 31%.
According to the cohort study of 10, 000 adults in the USA, the people who did consume 5 portions fruits and vegetables per day, the risk of developing type-2 diabetes was lower in them as compared to those who did not consume fruits and vegetables (Ford & Mokdad, 2001).Most fruits and vegetable juices could help lower a person’s risk of developing Alzheimer’s disease. This may be related to freshly squeezed juices from fruits and vegetables are very good sources of minerals and vitamins which catalyze chemical reactions happening in the body. Fruits help to cleanse and fresh the body. Tomatoes, pineapples and citric acid such as oranges, red grapefruits and lemons are well known for their detoxifying properties (Cuthbertson, 2002).
Good nutrition consist the consumption of fruits and vegetables can add to the wellness and sense of well-being of people living with HIV and AIDS and may even prolong life.How it worksSufficient fruit and vegetable intake have been shown to co-ordinate with healthy lifestyle. In order to prevent or reduce the oxidative stress induced by free radicals, sufficient amounts of antioxidants need to be consumed and fruits and vegetables are known to contain a variety of antioxidant compounds such as phenolics and carotenoids which may help protect cellular systems from oxidative damage and reduce the risk of developing chronic diseases.
The combination of orange, apple, grape, and blueberry has been shown to display a synergistic effect in antioxidant activity and getting antioxidants from dietary intake by eating a wide variety of food. It is significantly important due to the fact that foods originating from plants contain many diverse types of phytochemicals in various quantities. Fruits and vegetables are rich in precursors to bicarbonate ions which supply to buffer acids in the body, that’s why if the concentration of bicarbonate ions is inadequate to maintain normal pH.OBJECTIVESGeneral objectiveTo study the health behavior and non-communicable diseases risks factors ofadolescent in Victoria University College Specific objective1. To estimate the smoking status; smoking prevalence, frequency, age of start smoking and number of cigarette smoking per day of the adolescent 2. To determine the second hand smoking prevalence of the adolescent 3. To estimate the alcohol drinking status; alcohol drinking prevalence, frequency, age of start drinking, reasons of start drinking of the adolescent 4. To study the physical activity of the adolescent5.
To estimate the average height, weight, waist circumference and BMI of the adolescent 6. To study the fruit and vegetable consumption status of the adolescentMETHODOLOGYTitle of study“Adolescent Health Behavior”Study designSchool based cross-sectional descriptive studyReference populationAdolescent in MyanmarTarget populationAdolescent in Victoria University College (VUC)Study populationStudents of both sexes in Health and Social care and Business faculty of VUC Sample populationSelected students in Health and Social care and Business of VUC Study period4th March 2013 to 11th March 2013Sample size82 students from VUC, 50 respondents from Business and 32 respondents from Health and Social Care Data collection methodThe responses were marked with blue ink on the “answer” column by respondents after getting the consent. We explained about the reasons of the study and we guaranteed that all the data and facts given by respondents is kept in privacy. When the answers are completed, we measured the height, weight, waist circumference of the respondents. Materials1.
Preceded a pre-tested structure questionnaire2. Standardized weighing scales and measuring tapeData checkingAfter coming back from survey, the data were coded and checked by the whole group and counterchecked by Dr Zin Mar Lwin to avoid error and incompleteness.Data entryData entry was done with Microsoft office Excel 2010.Data analysisData editing, data summarization, and statistical analysis was done with the aid of statistical software, STATA version 8. Tabulation and graph was done with Microsoft office Excel 2010. Final report was provided based upon finding of our survey. 1.1.
FINDING1.1. Background characteristics of respondentsTable 1Background characteristics of the respondentRespondents’ profileFrequencyPercentageMajorBusinessHealth and Social care523063.41%36.59%YearFoundationYear1 Semester1Year1 Semester2Year2 Semester1362716345.00%32.
39%75.61%The above table shows the background characteristics of the respondents. Out of 82 respondents, 63.
41% was the students from Business faculty and the rest 36.95% was from Health and Social Care faculty.The major proportion was from foundation class which constituted 45% followed by Year1 Semester1 of 32.
93% and Year1 Semester2 of 19.51%.Male and Female ratio was about 1:3 with the proportion of male and female was24.39% and 75.61% respectively. Table 2 Age distribution of respondentsRespondents’ profileBusiness(n = 52)Health and Social Care(n = 30)Total(n = 82)AgeMean SD (years)Range17.67 ± 1.
3716 – 2218.10 ± 1.7116 – 2217.83 ± 1.5116 – 22The mean age of the respondents was 17.83 years and that of students in Business faculty was a little younger than that in Health and Social Care (17.67 years vs 18.
10 years). However, Range of age distribution in both faculty was the same with minimal age 16 years and maximal age 22 years.Table 3 Race distribution of respondentsRaceFrequencyPercentageBurmaKarenChinShanRakineChineseIndianNot answer57323365369.51%3.66%2.44%3.
66%3.66%7.32%6.10%3.66%Figure 1 Race distribution of respondentsThe table and pie chart describe the race distribution of the respondents.
Among all students, Burma was the majority with the proportion of 69.51%. Chinese stood at the second place by 7.
32% and Indian was at third position with 6.10%. There were also minor ethnic groups with 3.66% each in Rakine, Shan and Karen. Chin took the smallest percentage at 2.44%.
Table 4 Religious distribution of respondentsReligionFrequencyPercentageBuddhismHinduismChristianIslamNot answer62169475.61%1.22%7.32%10.98%4.88%Figure 2 Religious distribution of respondentsAccording to the pie chart, Buddhism was the highest proportion which was about three quarter of total respondents (i.e.
75.61%). Furthermore, Islam population was 10.98% of total respondents but Hinduism was the fewest at 1.22%. 1.
2 Weight, Height, waist circumference and BMI of respondents Table 5 Summary of weight, height, BMI and waist circumference of the respondents Respondents’ profile(n = 82)Mean SDRangeWeight (kg)53.32 ± 13.3636.28 – 127Height (m)1.63 ± 0.
0741.42 – 1.83Body Mass Index (kg/m2)20.03 ± 4.
2814.87 – 43.20Waist Circumference (cm)(n = 80)71.02 ± 9.
6258.42 – 111.76The above table shows the summarization of weight, height, BMI and waist circumference. The mean weight of the respondents was 53. 32 kg with the range of 36.
28 kg to 127 kg. On the other hand, the mean height was 1.63 m (range – 1.42 – 1.83 m).Mean BMI of the respondents was 20.
03 kg/m2 and the maximum BMI is 43.20 kg/m2 and mean waist circumference was 71.02 cm.Table 6 Body Mass Index (BMI) distribution of the respondents Respondents’ profileFrequencyPercentageBMI distributionUnderweight (< 18.5 kg/m2)Normal (18.5 – 25 kg/m2)Overweight (25 – 30 kg/m2 )Obese (>30 kg/m2 )34414341.46 %50.00%4.
88%3.66%Figure 3 Body Mass Index (BMI) distribution of the respondentsIn this bar chat we can see that 50% of the respondents were in normal BMI range (18.5 – 25 kg/m2). Surprisingly there were about 41.46% are underweight but only a few proportion were over-weight and obese, 4.88% and 3.66% respectively.Table 7 Waist circumference distribution of the respondents Respondents’ profileFrequencyPercentageWaist circumferenceLow riskHigh risk (>=94cm in male, >=80cm in female)73791.
25%8.75%Figure 4 Waist circumference distribution of the respondentsThe above pie chart illustrated the proportion of waist circumference status. There were 8.
75% of the respondents who was under the category of high risk which mean waist circumference more than 94 cm in male and more than 80 cm in female. Majority of the respondents were in low risk group (i.e. 91.25%)1.3 Smoking status of the respondentsTable 8 Smoking history and frequency of smoking of the respondents Smoking statusFrequencyPercentageSmoking history (n = 82)YesNoNot answer1170113.
41 %85.37%1.22%Frequency of smoking(n = 11)Daily smokerOccasional smokerNot at all44336.36%36.
36%27.27%Figure 5 Smoking history and frequency of smoking of the respondentsThe above pie chart shows the history of smoking of the respondents and the bar chart describes the frequency of smoking among smokers. Majority of the respondents had not exposed to smoking at their life time with the percentage of 85.
37%. There are 13.41% who had smoked and among them some continued smoking and some had stopped.Out of 11 smokers (13.41%), 27.
27% did not continue smoking but the rest proportion were divided by daily smokers and occasional smoker equally (36.36% each).Table 9 Age of start smoking and number of cigarette smoking per day of the smokers Smoking statusMean SDRangeAge of start smoking (year)(n = 11)15.18 ± 2.2310 – 18No of cigarette per day(n = 9)6.
89 ± 7.981 – 20The mean age of initiate smoking was 15.18 years and the youngest age was 10 years. Average daily smoking of cigarette was 6.89 and the maximum number was 20.
Table 10 Passive smoking status of the respondentsPassive smoking statusFrequencyPercentagePassive smoking in past yearYesNoNot answer4232851.22 %39.02%9.
76%Passive smoking at home in past yearYesNoNot answer21461525.61%56.10%18.
29%Passive smoking in a car or private vehicle in past yearYesNoNot answer40281448.78%34.15%17.07%Passive smoking in public places in past yearYesNoNot answer44241453.66%29.27%17.07%Passive smoking at friends or relative place in past yearYesNoNot answer31371437.80%45.
12%17.07%continuePassive smoking statusFrequencyPercentagePassive smoking in school environment in past yearYesNoNot answer33351440.24%42.68%17.07%Figure 6 Passive smoking status of the respondentsThe above bar chart demonstrates the distribution of second hand smoke exposure to respondents in last year. Overall passive smoking status was over half of the respondents (i.e. 51.
2%). The highest proportion of exposing second hand smoke occurred in public places and the proportion showed 53.66% which is over double to the proportion of second hand smoke at home and it was 25.
61%. Moreover, over 40% of the students responded that they had experienced passive smoking in school environment.1.4 Alcohol consumption status of the respondentsTable 11 Alcohol consumption status of the respondentsAlcohol consumption statusFrequencyPercentageAlcohol consumption history (n = 82)YesNoNot answer25461130.49 %56.
10%13.41%Reasons of starting consumption alcohol (n = 25)Peer pressureCuriosityBecause you felt like itInfluence of an adultOtherNot answer2357628.00 %12.00%20.00%28.00 %24.00%8.
00%Alcohol consumption statusMean SDRangeAge of start alcohol consumption (year)(n = 23)14.70 ± 3.214 – 18Figure 7 Alcohol consumption history and reasons of starting alcohol consumption of the respondentsThe above pie chart demonstrates the alcohol drinking status of the respondents. Among 82 students, below one-third of total respondents experienced in alcohol drinking in their life time (i.e.
30.49%) and there was 13% who did not give proper answer about alcohol drinking history.The chart on the right shows the various reasons why the students initiated drinking alcohol. The main reason of starting alcohol in respondents was influence of an adult who encouraged them to drink and the percentage was 28% which was followed by other reasons (24%) and the reason of their own pleasure (20%).According to our survey, the mean age of start drinking alcohol among respondents was 14.70 years and the youngest age of tasting alcohol was 4 years old.Table 12 Distribution of frequency of alcohol consumption of the respondents Alcohol consumption statusFrequencyPercentageFrequency of alcohol consumption (n = 25)Everyday3-5 times a weekOnce a weekOnly on weekendsOn special occasionOtherNot answer111511514.
00%Figure 8 Distribution of alcohol drinking frequencyThe above bar chart shows the frequency of drinking alcohol of the respondents. According to this chart 44% drank on special occasion, only on weekends and other were 20% each. 1.
5 Physical activity status of the respondentsTable 13 Physical activity status vs gender of the respondents Physical activityMale(n = 20)Female(n = 62)Total(n = 82)Number (%)Number (%)Number (%)AdequateInadequateNot answer10 (50.00)8 (40.00)2 (10.00)5 (8.
06)51 (82.26)6 (9.68)15 (18.29)59 (71.95)8 (9.76)Adequate (>30 minutes a day for at least 5 days a week)Figure 9 Physical activity status vs gender of the respondentsThe above pie charts compare the proportion of physical activity in male and female students. Among all the students, 71.
95% of students were inadequate in the physical activity. Half of the male students did adequate physical activity whereas only 8.06% of female students had adequate physical activity. 1.
6 Fruit and vegetable consumption status of the respondents Table 14 Fruit and vegetable consumption status of the respondents Fruit and vegetable consumption statusFrequencyPercentageAdequateInadequateNot answer2654131.71 %65.85%2.
44%Adequate – ? 5 portions of fruit and vegetables a dayFigure 10 Fruit and vegetable consumption status of the respondentsThe above pie chart described the proportion of fruit and vegetable consumption status. We can see that proportion of inadequate fruit and vegetable status was more than adequate consumption among the respondents. Inadequate proportion is the highest fruit and vegetable consumption status with the percentage of 65.85%. At the second position there was adequate intake and there were 2.44% who did not give the answer.Table 15 Summarization of fruit and vegetable consumption of the respondents Fruit and vegetable consumption statusMean SDRangeFruit and vegetable consumption (n = 80)3.91 ± 2.310 – 14Fruit consumption (n = 80)1.88 ± 1.120 – 5Vegetable consumption (n = 80)2.04 ± 1.380 – 9Means of fruit and vegetable consumption was 3.91 portions in 80 respondents. The means of vegetable consumption was higher than that of fruit consumption. The maximum consumption of fruit and vegetable was 14 portions and also there were some students who do not eat fruit and vegetable at all.DiscussionThe major race and religion of the Republic of the Union of Myanmar isBurma, Buddhist and it coincides with our finding that about 70% were Burma and 75% were Buddhism. Our study based on adolescent and so our study group’s mean age was 17.83 years.Nutritional status of the respondents is estimated by mean of BMI and waist circumference. Most of the people had healthy life style but about 41.46 were underweight because of food fad and lack of physical activity. Nearly 8% were high risk of obesity related diseases and it may be due to improper and binge eating habit and lack of physical activities. Because of changing in life style and advance of electronic device, some of the students spend most of their time in front of computer, playing computer game and studying.Compare to United States study which showed that nearly 25% of high school students smoked cigarette, our finding of smoking history was quite fewer (i.e. 13.41%). According to our culture, cigarette smoking in young age and female was not accepted socially. Moreover, cigarette selling to underage is prohibited by Tobacco Law. Out of 11 smokers, 27.27% already stopped smoking and it is the good point. Stopped smoking at early age is important because the risk of getting Carcinoma Lung can reduce back to the level of normal person if they stop smoking for more than 10 years. There were some smokers who smokes 20 cigarettes per day which means heavy smokers and it can lead to severe health problems in short time.According to the passive smoking status of the respondents, we noticed that public places like cinema, departmental store, and restaurant and food shops are the major places of exposing to second hand smoke. The percentage was 2 times higher than that of the exposure at home. Because of the higher education and socio-economic status in urban area, the percentage of second hand smoke at home was lowest among other public place. Smoking near school environment is hazard to the students and it accounted for nearly 40%. We noticed that there were about 18% of the respondents who did not give any answer about the question. It showed that some of the students did not have full participation in our survey even though we warrantied that the information are kept in privacy and it may be due to the fact that the students are not used to the practice of conduction survey like otherdeveloped countries.The proportion of alcohol drinking among respondents was about 30% and the figure was significantly lower than the proportion in United State high school students which expressed 80%. The main reasons of starting alcohol in adolescent was adult influence and so the youngest age of start drinking 4 years old may be due to the reason. Drinking is not socially acceptable behavior in Myanmar. However, some adult relatives encourage their junior to drink small amount of beer at a social occasion and it may be the starting point of drinking alcohol. Among the drinkers, only 4% drunk daily and 44% drunk only on special occasion when they meet their relatives, friends and family.Our study showed that only 18.29% had adequate physical activities; 50% of male and 8.06% of female. Adequate physical exercise maintains boy weight and keeps fit. Similarly to obesity, lack of physical activity or inadequate physical activity is due to the transforming pattern of lifestyle and extra using of modernized electronic things than previous time. Furthermore, facility of doing physical exercise like fitness center, playground, athletic field are fewer than the needed amount and also not accessible to everyone. Boys participated in physical exercise much higher than girls because most parents want to stay them under their protection and do not want their daughters go out too frequently.Compared to the survey conducting in England, 2009, the proportion of adequate fruit intake (more than 5 portions per day) of our respondents (i.e 31.71%) is approximately similar to their finding (i.e. 29%). We found that there were some students who did not take fruit and vegetable which may be due to food fad and little knowledge about fruit and vegetable.RecommendationAll know that obesity is related to various health problems like hypertension, diabetes mellitus, and heart disease. Not only obesity but also underweight is also risk factor for welcoming diseases. To reduce the underweight we need to give health education like how to eat healthy andthey need to eat with proper ratio. And for the overweight and obese we should encourage them to eat low fat food and do daily exercise.Nowadays, smoking is the biggest killer around the world. If we canno reduce the smoking prevalence considerably, we will face many health problems such as lung cancer, coronary heart diseases and their disease burden. Most of the students think that smoking is one of the fashions. But it can take many lives as well as our earth. To reduce smoking, we need to give health education to the students, teachers and parents. Another important thing is to enforce the shops at school or around the school not to sell cigarette to underage students and also not to sell out of package.Public place smoking is prohibited by national tobacco law but there are still many people who smoked there. So law enforcement should be increased to reduce the nuisance scene of smoking at public place. Smoking is not allowed at school but students are trying to smoke at the compound which still effect to the surrounding persons. There should be fine or proper punishment to the persons who break the rule.There were only less than one-third of the students who consumed fruit and vegetable adequately (i.e at least 5 portions per day). Because of the health protective effects of fruit and vegetable, we should encourage the respondents to take adequate amount daily. Furthermore, there should be food shops which sell fresh and wholesome fruit and vegetable in school to make them available easily. Health education is needed not only to adequate intake but also to proper choosing of fresh fruits and vegetables and cleansing and washing before eating.Teenage alcohol drinking is one of the major problems in recent time. Because of the social and health consequence of drinking alcohol, alcohol drinking in adolescent should be discouraged. Early alcohol addiction can lead to destroy their judgment and their effort for their career as youth is the future of our community. Starting small amount of addictive is the way of getting the bad habit and lifestyle which can give them only trouble.According to our study, there were very few percentage joined physical activities adequately. Physical activity is needed to control overweight as well as can keep the person. Giving health education and encouraging the students to do physical activities is one way to promote healthy life style. Moreover, providing proper facilities like playground, athletic filed, gym and fitness center to the students are also important. The school provides sport game occasionally and it can encourage the students to participate and enjoy the extra school activities. However, compulsory involvement in one of the sports to students may help them get adequate physical exercise.There were only less than one-third of the students who consumed fruit and vegetable adequately (i.e at least 5 portions per day). Because of the health protective effects of fruit and vegetable, we should encourage the respondents to take adequate amount daily. Furthermore, there should be food shops which sell fresh and wholesome fruit and vegetable in school to make them available easily. Health education is needed not only to adequate intake but also to proper choosing of fresh fruits and vegetables and cleansing and washing before eating.According to our survey, we noticed that there were some students who did not give proper answer. Because of our education system, middle and high school students have not done any survey at their school and so they are not aware of the importance of research and survey. We should encourage them to fully participate in any survey as well as give them chance to involve.ConclusionAccording to our finding, majority were Myanmar Buddhist, 69.51% and 75.61% respectively. Male and female ratio was 1:3. The highest number of students were in foundation class at 45%. The mean age of the respondents was 17.83 years.In our data, only 3.66% were obese and 41.46% were underweight. Mean BMI was 20.03 kg/m2 and mean waist circumference was 71.02 cm. 8.75% of the respondents were considered as high risk person according to their waist circumference.Regarding smoking status, 13.41% of the students had smoked and out of them, 36.36% were daily smoker and another 36.36% were occasional smoker. The rest 27.27% already stopped smoking. Mean age of start smoking was 15.18 years and mean number of cigarette smoke per day was 6.89 with the maximum of 20.Passive smoking is also the major problems to deterioate health. Our finding showed that public places like restraurants, shopping center, food courts, recreation center are the major place to expose second hand smoke (i.e. 53.66%). Home exposure to SHS is very important because of close proximity but it was only 25.61%. School SHS exposure was 40.24%.Concerning alcohol drinking, 30.49% had drunk alcohol and 28% started drinking due to the influence of adult. Mean age of alchol drinking was 14.70 years and the minimal age was 4 years. Most of them (44%) drunk only on special occasion and there were 4% who drunk daily.Our finding indicated that only 18.29% had adequate physical exercise which means at least 30 minutes a day moderate physical activity for 5 days a week. 50% of male students did adequate physical exercise but only 8.06% of female students did exercise adequately. Fruit and vegetable consumption status expressed that under one-third of the respondents (31.71%) consumped fruit and vegetable adequately (more than or equal to 5 portions of fruit and vegeables a day). Reference1. “ The WHO Global NCD Risk Factor Surveillance” available at http://www.who.int/ncd_surveillance/strategy 2. Public health risk assessment and interventions available at http://www.ifrc.org/en/what-we-do/health/diseases/noncommunicable-disease/ 3. “Non-communicable disease” can be seen in http://www.who.int/mediacentre/factsheets 4. “Obesity classification” can be seen in http://en.m.wikipedia.org/wiki/Obesity 5. “History of smoking” can be seen in http://en.wikipedia.org/wiki/History_of_smoking 6. “Prevalence of adolescent smoking” available at http://www.tobaccofreekids.org/research/factsheets/pdf/0127.pdf 7. “Heatheffect of smoking” can be seen in http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/ 8. “Tobacco Control Law, Myanmar” available at www.tobaccocontrollaws.org/legislation/country/myanmar? 9. “Exposure to second-hand tobacco smoke among adults in Myanmar” available from:http://www.indianjcancer.com/text.asp?2012/49/4/410/10774910. “Prevalence of underage drinking” available at http://www.camy.org/factsheets/sheets/prevalence_of_underage_drinking.html 11. “Underage drinking” available from http://www.cdc.gov/alcohol/fact-sheets/underage-drinking.html 12. “Health effects of alcohol” can be seen in https://www.drinkaware.co.uk/check-the-facts/health-effects-of-alcohol 13. “Health effects of alcohol” can be seen in https://www.drinkaware.co.uk/check-the-facts/health-effects-of-alcohol/mental-health/alcohol-and-mental-health 14. “Teenage and alcohol” available at http://m.kidshealth.org/teen/drug_alcohol/alcohol/alcohol.html 15. “Early Age Alcohol Use” http://www.helpguide.org/harvard/alcohol_teens.html 16. “Physical Activity For Health” can be seen in http://www.patient.co.uk/health/Physical-Activity-For-Health.html 17. “Promoting fruit and vegetable consumption around the world” available from http://www.who.int/dietphysicalactivity/fruit/en/ Questionnaire for Health and Lifestyle SurveyWe conduct a survey investigating health and lifestyle of students in VUC. This survey is anonymous and we would be grateful if you would complete the following survey. Code No.Section 1: Characteristics; Socio – Demographic1.1What is your name?1.2How old are you?_________ years1.3What is your gender?1. Male 2. Female1.4What is your race?__________1.5What is your religious?__________1.6Which subject are you studying now?1. Enginnering2. Computing3. Business4. Health and social care1.7Which class are you in?1. Foundation2. Year 1 Semester13. Year 1 Semester24. Year2 Semester15. Year2 Semester21.8What is your current highest qualification (the highest qualification you attained before VUC)?________________________Section 2: BMI measurement2.1What is your current weight?Use a scale if possible to get your current weight. Adjust your scale to zero Remove your shoes and wear light clothing________ Pound(or) _________ kg2.2How tall are you?Remove your shoes, stand straight with your back and heels against a wall Lay a book flat on top of your head and make a mark on the wall_____feet _____ inches(or) ______ cm2.3What does your waist size measure?Stand up straight in front of a mirror to position the measuring tap correctly Measure one inch above your navel or “belly button”_______ inches(or) ______ cmSection 3: Smoking3.1Have you ever smoked a cigarette, cigar or other tobacco product? 1. Yes 2. No(if No, go to section 4)3.2Have you ever smoked a whole cigarette?1. Yes 2. No3.3At what age did you smoke your first whole cigarette?_______ years3.4At the present time, how frequent do you smoke?1. Daily (at least one cigarette every day for the past 30 days) 2. Occasionally (at least one cigarette in the past 30 days, but not every day) 3. Not at all ( you did not smoke at all in the past 30 days)3.5How many cigarettes do you smoke every day now?_______________ cigarettesSection 4: Second hand smoking (Passive smoking)4.1In the past year, were you exposed to second hand smoke on most days? 1. Yes 2. No(if No, go to section 5)4.2In the past year, were you exposed to second hand smoke at home? 1. Yes 2. No4.3In the past year, were you exposed to second hand smoke in a car or other private vehicle? 1. Yes 2. No4.4In the past year, were you exposed to second hand smoke in public places (restaurants, shopping malls, cinema)? 1. Yes 2. No4.5In the past year, were you exposed to second hand smoke when visiting friendsor relatives? 1. Yes 2. No4.6In the past year, were you exposed to second hand smoke in the school environment? 1. Yes 2. NoSection 5: Alcohol drinking5.1Have you ever consumed alcohol?1. Yes 2. No(if No, go to section 5)5.2At what age did you start consuming alcohol?________ years5.3Why did you start consuming alcohol?1. Peer pressure2. Curiosity3. Because you “felt like it”4. Influence of an adult5. Other (explain) _______________5.4How often do you drink?1. Every day2. 3-5 times a week3. Once a week4. Only on weekends5. On special occasions6. Other (explain)___________Section 6: Physical activity6.1Do you do vigorous-intensity activity that causes large increases in breathing or heart rate (vigorous-intensity sports, fitness or recreational activities—running or football) for at least 10 minutes continuously? 1. Yes 2. No(if No ?go to 6.4)6.2In a typical week, on how many days do you do vigorous intensity activities? _______ days per week6.3How much time do you spend doing vigorous-intensity activities on a typical day? ______ Hours _____ minutes6.4Do you do moderate-intensity activity that causes small increases in breathing or heart rate (such as brisk walking, cycling, or swimming) for at least 10 minutes continuously? 1. Yes 2. No(if No ?go to 6.7)6.5In a typical week, on how many days do you do moderate intensity activities? _______ days per week6.6How much time do you spend doing moderate-intensity activities on a typical day? ______ Hours _____ minutes6.7How much time do you usually spend sitting or reclining on a typical day? (sitting or reclining at school, at home, getting to and from places, or with friends including time spent sitting at a desk, sitting with friends, travelling in a car, bus, reading, playing cards or watching television or using computer. Do not include time spent sleeping) ______ Hours _____minutesSection 7: Fruits and vegetables7.1On average, how many portions of FRUIT do you eat a day?(Eg: a handful of grapes, an orange, a glass of fruit juice, a handful of dried fruits)_______ portions per day7.2On average, how many portions of VEGETABLES do you eat a day? (Eg: 3 heaped tablespoons of carrots, a side salad, 2 spears of broccoli_______ portions per dayChecked by _________ Date ________