Non-communicable diseases among adolescents: current status, determinants, interventions and policies

N Akseer,B Sorichetti,S Mehta,N Schwalbe,A Vandermorris,R Chera,D B Hipgrave,Z A Bhutta,Z J Brickman,J Wigle,S Al-Gashm

doi:10.1186/s12889-020-09988-5

Abstract

BackgroundAddressing non-communicable disease (NCDs) is a global priority in the Sustainable Development Goals, especially for adolescents. However, existing literature on NCD burden, risk factors and determinants, and effective interventions and policies for targeting these diseases in adolescents, is limited. This study develops an evidence-based conceptual framework, and highlights pathways between risk factors and interventions to NCD development during adolescence (ages 10–19 years) and continuing into adulthood. Additionally, the epidemiologic profile of key NCD risk factors and outcomes among adolescents and preventative NCD policies/laws/legislations are examined, and a multivariable analysis is conducted to explore the determinants of NCDs among adolescents and adults.MethodsWe reviewed literature to develop an adolescent-specific conceptual framework for NCDs. Global data repositories were searched from Jan-July 2018 for data on NCD-related risk factors, outcomes, and policy data for 194 countries from 1990 to 2016. Disability-Adjusted Life Years were used to assess disease burden. A hierarchical modeling approach and ordinary least squares regression was used to explore the basic and underlying causes of NCD burden.ResultsMental health disorders are the most common NCDs found in adolescents. Adverse behaviours and lifestyle factors, specifically smoking, alcohol and drug use, poor diet and metabolic syndrome, are key risk factors for NCD development in adolescence. Across countries, laws and policies for preventing NCD-related risk factors exist, however those targeting contraceptive use, drug harm reduction, mental health and nutrition are generally limited. Many effective interventions for NCD prevention exist but must be implemented at scale through multisectoral action utilizing diverse delivery mechanisms. Multivariable analyses showed that structural/macro, community and household factors have significant associations with NCD burden among adolescents and adults.ConclusionsMulti-sectoral efforts are needed to target NCD risk factors among adolescents to mitigate disease burden and adverse outcomes in adulthood. Findings could guide policy and programming to reduce NCD burden in the sustainable development era.

Highlights

Addressing non-communicable disease (NCDs) is a global priority in the Sustainable Development Goals, especially for adolescents
Conceptual framework Our novel evidence-based conceptual framework (Fig. 1) represents a comprehensive and integrated approach to understanding the complex pathways through which risk and protective factors contribute to NCDs among adolescents and in later life
The framework provides a depiction of four key components: i) societal determinants; ii) individual predisposing factors across the adolescent and young adulthood stages of the life course; iii) top NCD conditions among adolescents and in later adulthood; and iv) select evidence-based policies, laws and interventions for this population

Summary

Introduction

Addressing non-communicable disease (NCDs) is a global priority in the Sustainable Development Goals, especially for adolescents. It is estimated that approximately 70% of premature deaths occurring during adulthood are the result of health-related behaviours that are initiated in childhood and adolescence [3, 8]. Such risk factors, including overweight and obesity, physical inactivity, substance use and poor nutrition, substantially contribute to disease development and poor health in later life [8]. Overweight and obesity during childhood and adolescence represents a significant risk for premature mortality and physical morbidity later in life, including cardiovascular disease, asthma, and certain types of cancers [10]. The 2016 Lancet Commission on Adolescent Health and Well-being recommended investment in dominant NCD-related health behaviours among adolescents as a means of preventing future disease development [12]

Methods

Results

Discussion

Conclusion