INTRODUCTION

Modern science through improved sanitation, vaccination, antibiotics and medical attention has eliminated the threat of death from most infectious diseases. But now, too many people are dying relatively young from noncommunicable diseases like heart diseases and cancer. The main contributing factor for this epidemiological transition is change in our lifestyle toward the unhealthy continuum, e.g., tobacco use, excessive alcohol consumption, unhealthy dietary habits and physical inactivity. This means that death from lifestyle diseases like hypertension, diabetes and cancer are now the primary causes of death.

Lifestyle is the way a person lives. This includes patterns of social relations, consumption, entertainment and dress. The term lifestyle also reflects an individual's attitudes, beliefs and, essentially, the way the person is perceived by himself/herself and, at times, also how he/she is perceived by others.

This rapidly growing epidemic of noncommunicable diseases is responsible for 60% of the world's deaths.[1] At least 50% of the deaths in the US each year are due to unhealthy lifestyle.[2] In India also, the situation of lifestyle diseases is quite alarming. The disease profile is changing rapidly. The World Health Organization (WHO) has identified India as one of the nations that is going to have most of the lifestyle disorders in the near future. Nowadays, not only are lifestyle disorders becoming more common but they are also affecting the younger population. Hence, the population at risk shifts from 40+ to maybe 30+ or even younger. Already considered the diabetes capital of the world, India now appears headed toward gaining another dubious distinction of becoming the lifestyle-related disease capital as well. A study conducted jointly by the All India Institute of Medical Sciences and the Max Hospital shows that the incidence of hypertension, obesity and heart disease is increasing at an alarming rate, especially in the young, urban population.

In most of these lifestyle diseases, the onset is insidious and is usually after the age of 30 years. By the time interventions are planned and implemented, the damage to health has already occurred.

Adolescents are a unique population with specific health concerns and needs. Adolescence is the peak age of onset for serious mental illness like depression and psychosis. Physical, emotional, social and sexual change makes adolescents overloaded with stress, which can result in anxiety, withdrawal, aggression, poor coping skills and actual physical illness. Adolescents constitute about 22.8% of the population of India.

It is well documented that behaviors developed during this period influence health in adulthood.[3] Several health-compromising behaviors (e.g., smoking, alcohol) as well as health-enhancing behaviors (e.g., physical exercise, nutrition) are adopted in adolescence, and they often persist into adulthood. The WHO estimates that 70% of premature deaths among adults are due to behavior (smoking, illicit drug use, reckless driving) initiated during adolescence.[4] Therefore, helping adolescents establish healthy lifestyles and avoid developing health risk behaviors is crucial and should be started before these behaviors are firmly established. The demands on young people are new and unprecedented; their parents could not have predicted many of the pressures they face. How we help adolescents meet these demands and equip them with the kind of education, skills and outlook they will need in a changing environment will depend on how well we understand their world.

There is a definite need to investigate the health behavior of adolescents rather than focus on adults since it will be far more difficult for adults to change their unhealthy habits adopted in their youth. Many studies have demonstrated a positive relationship between health-promoting lifestyle and quality of life. McDaniel[5] found a positive correlation between health-promoting lifestyle and quality of life in 91 older adults, aged 60-92 years. It was also demonstrated that there exists a relationship between positive health outcomes and such behaviors as regular exercise,[6] not smoking,[7] maintaining ideal weight,[8] eating a well-balanced diet[9] and managing stress.[10] It was planned to undertake a lifestyle intervention project among the college students of Chandigarh. Hence, the present pilot study was performed to create an elementary baseline data about the prevalence of lifestyle-associated risk factors among the college students of Chandigarh.

OBJECTIVES

To ascertain the health-promoting behavior and lifestyle of adolescents of Chandigarh.

METHODS

The present cross-sectional study was conducted in Chandigarh during 2009 among University graduates of Chandigarh aged 17-20 years. An estimated sample size of around 50 students was taken. One college under the university was randomly selected from Chandigarh. A class of graduate students was selected randomly from that college and all the students of the class were included after taking written consent for participation. Students pursuing their graduation (regular) course were eligible for participation in the study. Students who were doing their graduation through correspondence (distant learning) or during the evening study hours were excluded from the studies.

A semi-structured, pretested questionnaire comprising of 28 items regarding activities like diet, physical exercise, spirituality and philanthropy was used in the study. All items are scored on a scale from 1 to 4; 1 = never, 2 = sometimes, 3 = often, 4 = routinely, except items of philanthropy that had only two scores. Six items were negatively stated. These were reversed before the total score was computed. A composite score was obtained, which ranged from 28 to 106. In analyzing health-promoting behavior, only those who reported often (score = 3) or routinely (score = 4) in each item were considered as health-promoting behavior. To calculate the mean of the lifestyle profile, the scores for all items were summed and then divided by the numbers of items. Higher mean scores denoted positive health-promoting lifestyle or behaviors.

Height, weight, waist and hip circumference of the respondents were measured using standardized equipments and procedures.

Data were analyzed using the software SPSS-16^th version. Data were analyzed using frequencies, percentages and Chi-square test.

RESULTS

The response rate for the different questions of the study varied from 80% to 90%. In this survey of 50 students, 30.6% (n = 15) of the respondents were males and 69.3% (n = 35) were females. The students were in the age group of 17-20 years. All the students belonged to the science stream. Mean score of lifestyle profile of university graduates was found to be 67.5 ± 12.1 (maximum attainable score = 106). Around one-third (n = 14) of the students were found to be overweight [Table 1]. Frequent intake of fast food (n = 12), less consumption of fruits (n = 26) and vegetables (n = 22) and skipping of breakfast (n = 19) were also reported by the students [Table 2]. Majority (n = 37) of the students exercised as part of their daily routine, but less involvement in yoga (n = 6) and outdoor games (n = 17) was noted [Table 3]. Majority (n = 48) of the students had faith in God [Table 4]. Only five students were involved in some kind of philanthropy.

Table 1. Anthropometric measurements of the respondents

Table 2. Distribution of students with habits related to diet (n=49)*

Table 3. Distribution of students with habits related to exercise (n=49)*

Table 4. Spiritual health status of students (n=49)*

DISCUSSION

Health-promoting lifestyle among adolescents has become a research focus worldwide. Life of the students in college is a transitional period, offering good opportunities for establishing health-promoting lifestyles. Most research on health-promoting behaviors has been undertaken in the US and European countries, where university students are little engaged in health-promoting behaviors, especially healthy diet and physical activity.[11, 12, 13] However, data on health-promoting lifestyles among university students in India are limited.

The results from our study provide a glimpse of the lifestyle of North Indian college students in Chandigarh. Overall, it was observed that they had a reasonably healthy lifestyle. However, about one-fourth of the students (n = 14) were overweight, more so in females. However, in a study conducted by Rao et al., more boys (72.5%) were in the overweight category.[14] This may be due to unhealthy dietary habits like frequent intake of fried foods and sweets in comparison with lesser intake of fruits and green leafy vegetables. Moreover, students like to lead a carefree life and may find it awkward to show too much concern about their health. This scenario also implies that the bombardment by health-related articles or media advertisements probably do not have much impact on health concern or behaviors of young people.

A higher frequency of eating out and having fast food was also reported. Similar findings were also found in other studies.[15, 16] This may be because majority of the students lived in hostels. They had their meals in the mess/canteen, where the food variety was limited. Fresh fruits and vegetables are seldom available in the university canteen. Skipping of meals, especially breakfast, was also observed in nearly one-third (n = 19) of the students. It was a matter of concern since skipping meals is bad for the health of students who need sufficient energy and nutritive diet, as they live an active life.

Majority of the respondents (n = 35) reported that they exercised as part of their daily routine. This may be due to the fact that adolescents of today are more conscious about their physique and appearance.[14, 17, 18] Similar results were also found in other studies.[19, 20] However, contrary results were found in a study wherein low level of physical activity was found among Iranian women.[21] However, yoga was practiced by only six students as compared with exercise (n = 35), which is similar to the findings of other studies.[16] This indicates less awareness among students about yoga and its benefits. This may also be indicative of lack of interest of yoga among students and also because yoga requires a special technique. It was also found that only one-third of the students went for outdoor games. Apparently, in the modern era of computers, Internet and mobile phones provide more choices of entertainment. The young generation, consequently, tends to lose interest in outdoor games.

The present study also revealed that majority (n = 48) of the students had faith in God. Most (n = 36) were satisfied with themselves and were clear about the purpose and importance of their life. Around two-third (n = 32) of the students had a positive attitude toward life. They were willing to accept new experiences and challenges. However, only about one-third (n = 19) made any special efforts to achieve their life goals and around half (n = 27) did not find their day interesting and challenging. This could be probably due to the fact that they were not provided with enough opportunities and had lack of support by family and college authorities. Only five students were involved in some kind of philanthropy. This could be due to the reason that the youth of today are busy in achieving their goals. They do not receive any value inculcation on these aspects, neither in the family nor in their curriculum.

CONCLUSIONS AND RECOMMENDATIONS

The present study provided a glimpse about the prevailing lifestyle of the university graduates of a modern city of North India. The result of the study showed that North Indian students had reasonably good orientations toward health behaviors with a mean score of 67.5.

Based on the findings of the study, it is recommended that topics related to diet, physical exercise, spiritual growth and philanthropy promotion should be incorporated within the curriculum of students for their all round personality development. The related information, education and communication materials should be disseminated widely in the community. Basic health workers like auxillary nurse, midwives and accredited social health activist should be empowered in assessment of risk factors of noncommunicable diseases.

LIMITATIONS

The subjects were selected from one college only. All the information collected in the study was based on self-report. Therefore, it is possible that these may be socially desirable responses, i.e., the health-promoting behaviors may not be their real or actual behaviors.