BackgroundUnhealthy behaviors are associated with mental health problems and violence in adolescents, yet their combined association has been understudied. Using the Global School Health Survey, this study examined the association between combined unhealthy behaviors (including fast food, soft drink, smoking, other tobacco products and physical inactivity) and anxiety, suicidal ideation and involvement in physical fight among Pakistani adolescents.MethodsData were obtained from the Global School Health Survey conducted in Pakistan (2009). The study population consisted of school going adolescents aged 13 to 15 years. Association of combined unhealthy behaviors with anxiety, suicidal ideation and involvement in physical fight were studied through secondary analysis. We used univariate and multivariate logistic regression analysis by complex sample method, accounting for cluster sampling technique used for data collection.ResultsOf the total 4583 students, weighted percentage and unweighted count for one, two, three and four or more unhealthy behaviors was 39.4% (n = 1770), 22.1% (n = 963), 5.9% (n = 274) and 1.2% (n = 62) respectively. The weighted prevalence for anxiety, suicidal ideation and involvement in physical fight were 8.4%, 7.3% and 37.4% respectively. The results of multivariate logistic regression analysis after adjustment showed that students who had four or more unhealthy behaviors had higher odds of; being anxious (OR 2.45, 95%CI 1.31-4.59, p value 0.004), suicide ideation (OR 4.56, 95%CI 2.58-8.07, p value <0.001) and being involved in physical fight (OR 3.15, 95% CI 1.63–6.08, p value <0.001) as compared to those who had not adopted any unhealthy behaviors.ConclusionsThis study suggests that the co-occurrence of unhealthy behaviors is associated with anxiety, suicidal ideation and physical fight among adolescents. These findings should be considered when developing interventions to combat detrimental outcomes of unhealthy behaviors during adolescence.

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Malnutrition is a primary cause of child morbidity and mortality. The effects of maternal depressive symptoms on children's health, especially their nutritional status, have received less attention in developing countries but needs to be evaluated to understand the public health implications of maternal depression. The aim of the current study was to investigate the association between maternal depressive symptoms and children's nutritional status using data from low socioeconomic community in Pakistan. Maternal depressive symptoms defined as Aga Khan University Anxiety and Depression Scale score of 20 or greater was assessed for mothers with children under two years of age. Logistic regression models estimated the association between maternal depressive symptoms and stunting and underweight. Of 325 mothers, 40% scored positive on the depressive scale. The prevalence of stunting and underweight in children under two years was 36.6% and 35.4%, respectively. Maternal depressive symptoms were significantly associated with children being stunted and underweight. Mothers with depressive symptoms were more than three times likely to have stunted (odds ratio (OR) 3.15, 95% confidence interval (CI) 1.91-5.18, p value < .001) and underweight (OR 3.26, 95% CI 1.99-5.34, p value < .001) children compared to non-depressed mothers. Maternal-related factors such as poor education, unemployment, and low household income were found to be significantly associated with higher odds of children's short stature and underweight.

Background: Bullying and violence are problems of aggression in adolescents. Healthy lifestyle practices are common health promotion approaches in school settings; however, their association with aggressive behaviours in school-going adolescents is less explored. Aims: This study examined the associations of healthy lifestyle behaviours including good hygiene, physical activity, recommended diet and refrainment from tobacco use with bully victimization and violence among adolescents. Methods: Data were obtained from the Global School Health Survey conducted in Pakistan (2009). The study population consisted of school-going adolescents aged 13 to 15 years. We constructed our final dataset using information from 4102 participants. Association of healthy lifestyle behaviours with bully victimization and violence experience were assessed using multivariate logistic regression. Results: Results indicate lower odds of being bullied (good hygiene:

ObjectivesAreca nut is widely consumed in many parts of the world, especially in South and Southeast Asia, where cardiovascular disease (CVD) is also a huge burden. Among the forms of CVD, acute coronary syndrome (ACS) is a major cause of mortality and morbidity. Research has shown areca nut chewing to be associated with diabetes, hypertension, oropharyngeal and esophageal cancers, and CVD, but little is known about mortality and re-hospitalization secondary to ACS among areca nut users and non-users. MethodsA prospective cohort was studied to quantify the effect of areca nut chewing on patients with newly diagnosed ACS by categorizing the study population into exposed and non-exposed groups according to baseline chewing status. Cox proportional hazards models were used to examine the associations of areca nut chewing with the risk of re-hospitalization and 30-day mortality secondary to ACS. ResultsOf the 384 ACS patients, 49.5% (n=190) were areca users. During 1-month of follow-up, 20.3% (n=78) deaths and 25.1% (n=96) re-hospitalizations occurred. A higher risk of re-hospitalization was found (adjusted hazard ratio [aHR], 2.05; 95% confidence interval [CI], 1.29 to 3.27; p=0.002) in areca users than in non-users. Moreover, patients with severe disease were at a significantly higher risk of 30-day mortality (aHR, 2.77; 95% CI, 1.67 to 4.59; p<0.001) and re-hospitalization (aHR, 2.72; 95% CI, 1.73 to 4.26; p<0.001). ConclusionsThe 30-day re-hospitalization rate among ACS patients was found to be significantly higher in areca users and individuals with severe disease. These findings suggest that screening for a history of areca nut chewing may help to identify patients at a high risk for re-hospitalization due to secondary events.

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Objective: To explore the association of gender with risk factors for cardiovascular diseases among adolescents. Method: The cross-sectional study was conducted 2016-2019 in low-income schools in Karachi after approval from the ethics review board of Dow University of Health Sciences, and comprised adolescents of both genders aged 11-17 years. Anthropometric measurements and lifestyle behaviours were used to generate risk profile for cardiovascular diseases. Data was analysed using SPSS 16. Results: Of the 1195 subjects, 468(39.2%) were boys and 727(60.8%) were girls. The mean age was 13.9±1.6 years. Mean family size was 5.9±3.64. Overall, 989(91.3%) participants consumed soft drinks, 44(4%) were smokers, 340(48.4%) consumed betel nut, 215(32.9%) Pan, 125(21.2%) Gutka and 9(1.7%) Bidi. Of the total, 867(83.3%) participants were physically less active than recommended, and daily screen time was >2 hours among 513(45.7%) participants. Body mass index and body fat percentage were significantly higher among girls (p<0.05). Higher rates of diastolic and systolic blood pressure and hand grip strength were observed in boys compared to girls (p<0.05). Conclusion: Interventional programmes in schools should emphasise the need for healthy lifestyle behaviours, increased physical activity, good eating habits and smoking cessation. Key Words: CVD risk factors, Adolescents, Lifestyle behaviours, Micronutrients, Pakistan.

Objectives Substantial mortality and morbidity due to cardiometabolic diseases (CMD's) has significantly increased in low resource settings, including Pakistan. Ageing and unhealthy lifestyle practices (smoking, an unhealthy diet and physical inactivity) upsurge the risk, resulting in double burden on health care system. In this study, we determined the prevalence of CMD's and the associated risk factors using data from a large community survey. Methods A large community survey was conducted in Gulshan-e-Iqbal town, Karachi, Pakistan, using multi-stage sampling technique. Medical camps were set up accordingly to collect data. Data collection was based on socio-demographics, clinical diagnosis and self-reported history of the diseases. Hypertension, stroke, adiposity, dyslipidemia and diabetes were defined using standardized, cut-off values. Cardiometabolic disease was defined as the presence of at least one of the listed illnesses. Chi-square test and logistic regression was used to identify the risk factors for cardio metabolic diseases. Odd's ratio and 95% confidence interval were used to report the findings. Results Of the total 2968 participants, 51.8% adults were found with cardio-metabolic diseases. Of all, 39.7% had hypertension followed by 29.7% obesity, 23.1% diabetes and 11.9% dyslipidemia, respectively. A significant increasing trend was observed for age and body mass index (BMI) with the risk of CMD. Older respondents aged 50–59 years (OR = 2.18, 95% CI [1.77–2.70]), 60–69 years (OR = 3.0, 95% CI [2.28–3.96]) and > 70 years (OR = 3.04, 95% CI [2.06–4.48]) were significantly more likely to have CMD as compared to younger adults. Similarly, participants being overweight (OR = 1.39, 95% CI [1.16–1.67]), obese (OR = 1.70, 95% CI [1.41–2.05]) and married (OR = 1.41, 95% CI [1.07–1.86]) had higher of odds of developing cardiometabolic diseases. Moreover, physical activity was found to have a protective effect on CMD. Conclusions An apparent profile of cardiometabolic disease emerges as BMI and age increases; however a protective behavior was observed with physical activity. Understanding these findings, suggest multidisciplinary programs and policies for early detection of multiple chronic illnesses, additionally with behavioral guidelines to prevent further disease progression and complications. Funding Sources No funding was available.