Abstract
BackgroundLittle research has explored the influence of social context on health of Indian adolescents. We conceptualized community-level women’s education (proxy for value placed on women’s wellbeing) as exerting contextual influence on adolescent hemoglobin level and body mass index (BMI).MethodsWe derived our sample of more than 62,000 adolescent aged 15 through 17 years from the Indian National Family Health Survey 2015–16. The sample consisted of a total of 62648 adolescents (54232 girls and 8416 boys) for the hemoglobin, and 62846 adolescents (54383 girls and 8463 boys) for the BMI analysis. We fitted multilevel random intercepts linear regression models to test the association of village- and urban-ward-level-women’s education with hemoglobin level and BMI of adolescents, accounting for their own and their mother’s education; as well as relevant covariates.FindingsOur fully adjusted model estimated that if the 52% of communities with less than 20 percent of women having a tenth-grade education in our sample were to achieve 100 percent tenth-grade completion in women, hemoglobin would be 0·2 g/dl higher (p<0·001) and BMI would be 0·62 kg/m2 higher on average among all adolescents in such communities. Unexplained variance estimates at the contextual level remained statistically significant, indicating the importance of context on adolescent undernutrition.InterpretationsAdolescents are deeply embedded in their context, influenced by contextual factors affecting health. Promoting adolescent health therefore implies altering social norms related to adolescent health and health behaviors; along with structural changes creating a health-promoting environment. Integrating our empirical findings with theoretically plausible pathways connecting community-level women’s education with adolescent undernutrition, we suggest that enhancing community-level women’s education beyond high school is necessary to facilitate these processes.ImplicationsAddressing contextual determinants of adolescent undernutrition might be the missing link in India’s adolescent anemia and undernutrition prevention efforts, which are currently focused heavily on individual-level biomedical determinants of the problem.
Highlights
Adolescence (10 to 19 years) is a period of rapid physical growth in human development, substantially increasing nutritional demand [1]
There is a paucity of research on undernutrition, including low hemoglobin levels and underweight, in Indian adolescents, that focuses on the influence of determinants beyond the individual level [5]
We conceptualize that living in neighborhoods that support the sociocultural norms valuing women’s well-being would promote adolescent health. We investigate this by quantifying the association of community-level women’s education with adolescent hemoglobin level, and body mass index (BMI), above and beyond the role of their mother’s education
Summary
Adolescence (10 to 19 years) is a period of rapid physical growth in human development, substantially increasing nutritional demand [1]. Anemia and other forms of undernutrition severely curb growth and cognitive development, adversely affect productivity, and increase the risk of poor pregnancy outcomes among adolescent mothers, perpetuating the intergenerational cycle of undernutrition [5]. Despite such severe impacts, there is a paucity of research on undernutrition, including low hemoglobin levels and underweight, in Indian adolescents, that focuses on the influence of determinants beyond the individual level [5]. We conceptualized community-level women’s education (proxy for value placed on women’s wellbeing) as exerting contextual influence on adolescent hemoglobin level and body mass index (BMI)
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