Health Outcomes In Later Life Research Articles

Abstract P129: Age at Menarche Associated With Cardiovascular Disease Risk Factors and History Among African American Women: The Jackson Heart Study

Menarche is the onset of menstruation and is a definitive indication of female puberty. The average age at menarche has steadily declined worldwide over the past century. While many cardiovascular conditions have their start during youth, age at menarche may also play a role in predicting the risk for cardiovascular disease (CVD). Of particular importance is the disproportionately high number of CVDs that affect African Americans, which contributes greatly to the disparities in life expectancy between African Americans and Whites. This study aims to address a gap in knowledge about African American women’s health by examining the association between age at menarche and CVD. We assessed the hypothesis that an earlier age at menarche is associated with increased odds of CVD risk factors and history for women in the Jackson Heart Study. This study was a secondary analysis of baseline data from 2,458 females in the Jackson Heart Study, a longitudinal cohort study of African Americans in the Jackson, MS metropolitan area. Early menarche was defined as menarche occurring at less than 12 years of age. Cardiovascular disease risk factors included hypertension, diabetes, obesity, and abdominal obesity (waist circumference >88cm). Cardiovascular disease history included coronary heart disease, heart attack, and stroke. The association between early menarche and CVD risk factors and history was examined using multivariable logistic regression models, controlling for physical activity, nutrition, smoking, alcohol use, education, income, and oral contraceptive use. The prevalence of CVD risk factors and CVD history was higher for women with an early age at menarche (<12 years) than for other women. After adjusting for covariates, early age at menarche was associated with greater odds of hypertension (OR, 1.47 [95% CI, 1.17-1.84]), obesity (OR, 1.77 [95% CI, 1.43, 2.19]), abdominal obesity (OR, 1.87 [95% CI, 1.44, 2.41)], history of coronary heart disease (OR, 1.98 [95% CI, 1.33, 2.94]), and history of heart attack (OR, 1.76 [95% CI, 1.09, 2.84]). Early age at menarche was not significantly associated with diabetes or stroke history. In conclusion, in this large sample of African American women in the Jackson Heart Study, we observed that menarche before 12 years of age was associated with increased odds of CVD risk factors and CVD history compared to those with menarche after 12 years of age. These findings highlight the importance of exposures during youth and childhood which may contribute to poor health outcomes in later life.

Atypical maternal interaction is associated with elevated levels of hair cortisol in children.

The quality of maternal caregiving is an important factor in the healthy development of a child. One consequence of prolonged insensitive and atypical maternal interaction behavior (e.g., withdrawing from interactions with the child and role-reversal, i.e., the takeover of the parental role or parts of it by the child) in mother-child-dyads can cause alteration of the child's stress response system. Higher salivary cortisol concentrations were reported in infants and toddlers directly after negative interactions with their parents. However, no study to date has examined the association between atypical maternal interaction behavior and hair cortisol concentrations (HCC) in infants. Here, we studied the association of maternal interaction behavior with HCC of the child. Mother-child dyads (N = 112) participated in the longitudinal study My Childhood-Your Childhood. The AMBIANCE scale and its subscales were used to assess atypical maternal interaction behavior during the Strange Situation Procedure. Chronic stress levels in the child were assessed by HCC of 3 cm hair strands at the age of 12 months. Maternal educational level (operationalized in highest education level) served as a control variable. Robust multiple linear regression analyses revealed that role/boundary confusion was associated with HCC, i.e., the higher atypical interaction behavior of the mother the higher the HCC in the children. By measuring hair cortisol in this study, it is possible to determine the average long-term activity of the child's stress response system.Thus, atypical maternal interaction behavior could be a risk factor for persistent stress in children, contributing to a higher risk for negative health outcomes in later life. The results of this study highlight the importance of early intervention programs that focus on the relationship between mother and child.

Epigenetics and the Exposome: DNA Methylation as a Proxy for Health Impacts of Prenatal Environmental Exposures.

The accumulation of every day exposures can impact health across the life course, but our understanding of such exposures is impeded by our ability to delineate the relationship between an individual's early life exposome and later life health effects. Measuring the exposome is challenging. Exposure assessed at a given time point captures a snapshot of the exposome but does not represent the full spectrum of exposures across the life course. In addition, the assessment of early life exposures and their effects is often further challenged by lack of relevant samples and the time gap between exposures and related health outcomes in later life. Epigenetics, specifically DNA methylation, has the potential to overcome these barriers as environmental epigenetic perturbances can be retained through time. In this review, we describe how DNA methylation can be framed in the world of the exposome. We offer three compelling examples of common environmental exposures, including cigarette smoke, the endocrine active compound bisphenol A (BPA), and the metal lead (Pb), to illustrate the application of DNA methylation as a proxy to measure the exposome. We discuss areas for future explorations and current limitations of this approach. Epigenetic profiling is a promising and rapidly developing tool and field of study, offering us a unique and powerful way to assess the early life exposome and its effects across different life stages.

Resting metabolic rate in relation to incident disability and mobility decline among older adults: the modifying role of frailty.

Alterations in resting metabolic rate (RMR), the largest component of daily total energy expenditure, with aging have been shown in various studies. However, little is known about the associations between RMR and health outcomes in later life. To analyze whether RMR is associated with incident disability and mobility decline in a 10-year longitudinal study, as well as the moderating role of frailty in these associations. Data from 298 older adults aged 70 and over from the Frailty and Dependence in Albacete (FRADEA) study in Spain were used, including a baseline measurement in 2007-2009 and a follow-up measurement 10years later. RMR was measured by indirect calorimetry. Outcomes were incident disability in basic activities of daily living (BADL, Barthel Index), incident disability in instrumental ADL (IADL, Lawton index), and mobility decline (Functional Ambulation Categories scores). Fried's frailty phenotype was used as an indicator of frailty. Logistic regression analyses were conducted. Fully adjusted and stratified analyses revealed that only in the pre-frail/frail group, a higher RMR was associated with a lower risk of incident BADL disability (OR = 0.47, 95% CI = 0.23-0.96, p = 0.037), incident IADL disability (OR = 0.39, 95% CI = 0.18-0.84, p = 0.017), and mobility decline (OR = 0.30, 95% CI = 0.14-0.64, p = 0.002). To our knowledge, this is the first study looking at the associations between RMR and functional health using a longitudinal research design. The results suggest that RMR could be used as an early identifier of a specific resilient group within the pre-frail and frail older population, with a lower risk of further health decline.

IS THE HEALTH OF OLDER AMERICANS WITH A GED EQUIVALENT TO THEIR PEERS WITH A HIGH SCHOOL DIPLOMA?

Abstract Previous research has found higher levels of educational attainment to be strongly associated with better health outcomes in later life, such as better cognitive functioning and fewer functional and sensory impairments. However, most studies have grouped General Educational Development (GED) recipients with high school graduates, neglecting potential differences in socioeconomic status, health behaviours, and health outcomes among these two groups. The aim of the current study is to identify differences in the age-sex-race-poverty adjusted prevalence and odds of cognitive impairment, hearing impairment, vision impairment, limitations in activities of daily living (ADLs), and ambulation limitations among three groups of older American adults: high school dropouts, GED recipients, and high school graduates with no post-secondary education. The present study uses secondary analysis of the 2017 American Community Survey, a nationally representative survey of community-dwelling and institutionalized older adults aged 65 years and older, of whom 20,489 were GED recipients, 154,892 had a high school diploma and 49,912 had finished grade 8 but had not completed high school. Our findings indicate that there is a gradient in health outcomes among Americans aged 65-84, with the highest prevalence and odds of cognitive impairment, hearing impairment, vision impairment, ADL limitations, and ambulation limitations occurring among high school dropouts, followed by GED recipients, and the lowest prevalence among high school graduates. These findings suggestion that although GED recipients have better health outcomes than high school dropouts, there is still a significant disparity in health status between GED recipients and high school graduates.

IS THE HEALTH OF OLDER AMERICANS WITH A GED EQUIVALENT TO THEIR PEERS WITH A HIGH SCHOOL DIPLOMA?

Abstract Previous research has found higher levels of educational attainment to be strongly associated with better health outcomes in later life, such as better cognitive functioning and fewer functional and sensory impairments. However, most studies have grouped General Educational Development (GED) recipients with high school graduates, neglecting potential differences in socioeconomic status, health behaviours, and health outcomes among these two groups. The aim of the current study is to identify differences in the age-sex-race-poverty adjusted prevalence and odds of cognitive impairment, hearing impairment, vision impairment, limitations in activities of daily living (ADLs), and ambulation limitations among three groups of older American adults: high school dropouts, GED recipients, and high school graduates with no post-secondary education. The present study uses secondary analysis of the 2017 American Community Survey, a nationally representative survey of community-dwelling and institutionalized older adults aged 65 years and older, of whom 20,489 were GED recipients, 154,892 had a high school diploma and 49,912 had finished grade 8 but had not completed high school. Our findings indicate that there is a gradient in health outcomes among Americans aged 65-84, with the highest prevalence and odds of cognitive impairment, hearing impairment, vision impairment, ADL limitations, and ambulation limitations occurring among high school dropouts, followed by GED recipients, and the lowest prevalence among high school graduates. These findings suggestion that although GED recipients have better health outcomes than high school dropouts, there is still a significant disparity in health status between GED recipients and high school graduates.

SEQUENCING OF PLANNED AND UNPLANNED BIRTHS AND IMPLICATIONS FOR MID- AND LATER-LIFE HEALTH AMONG NLSY79 WOMEN

Abstract Existing studies demonstrate that unplanned births (e.g., unwanted, mistimed) are associated with worse health for mothers in the short-term and—according to some preliminary evidence—in mid- and later-life. Yet as life course and reproductive career frameworks highlight, childbearing experiences often unfold over a number of years, with a considerable amount of diversity in pregnancy and birth experiences even for the same individual. For example, a person may have an unplanned birth in late adolescence followed by only planned births in early adulthood. In order to provide a more holistic understanding of how birthing experiences births are associated with midlife health, we use Sequence Analysis (SA) on the 1979 National Longitudinal Survey of Youth (NLSY79; N=3,992) to examine how patterning of planned and unplanned births is associated with physical and mental health at ages 50 and 60 (SF-12). Preliminary analysis indicates that compared to respondents with only planned births, respondents with unplanned birth(s) followed by planned birth(s) have worse physical and mental health at midlife, but there is no difference in health for respondents with only planned births, only unplanned births, and planned birth(s) followed by unplanned birth(s). Future analysis with SA will consider how more detailed sequences (e.g., timing, number and type, ordering, spacing) are associated with these mid- and later-life health outcomes, taking into account selection factors such as childhood SES and educational attainment. This project demonstrates the need for life course perspectives on the long-term health implications of unplanned births, recognizing diversity within and between individuals.

SEQUENCING OF PLANNED AND UNPLANNED BIRTHS AND IMPLICATIONS FOR MID- AND LATER-LIFE HEALTH AMONG NLSY79 WOMEN

Abstract Existing studies demonstrate that unplanned births (e.g., unwanted, mistimed) are associated with worse health for mothers in the short-term and—according to some preliminary evidence—in mid- and later-life. Yet as life course and reproductive career frameworks highlight, childbearing experiences often unfold over a number of years, with a considerable amount of diversity in pregnancy and birth experiences even for the same individual. For example, a person may have an unplanned birth in late adolescence followed by only planned births in early adulthood. In order to provide a more holistic understanding of how birthing experiences births are associated with midlife health, we use Sequence Analysis (SA) on the 1979 National Longitudinal Survey of Youth (NLSY79; N=3,992) to examine how patterning of planned and unplanned births is associated with physical and mental health at ages 50 and 60 (SF-12). Preliminary analysis indicates that compared to respondents with only planned births, respondents with unplanned birth(s) followed by planned birth(s) have worse physical and mental health at midlife, but there is no difference in health for respondents with only planned births, only unplanned births, and planned birth(s) followed by unplanned birth(s). Future analysis with SA will consider how more detailed sequences (e.g., timing, number and type, ordering, spacing) are associated with these mid- and later-life health outcomes, taking into account selection factors such as childhood SES and educational attainment. This project demonstrates the need for life course perspectives on the long-term health implications of unplanned births, recognizing diversity within and between individuals.

CONTEXTS OF COGNITIVE DECLINE: MAPPING NEIGHBORHOOD OPPORTUNITIES AND BARRIERS FOR HEALTHY AGING IN PLACE

Abstract Stark geographic variation in later-life health outcomes suggests that local built and social environments are critical in shaping disease and disability, physical and cognitive function, and engagement in everyday life among older adults. This paper presents a community-engaged mapping project aiming to depict the uneven distribution of hazards and amenities relevant to cognitive aging across the United States. Living in neighborhoods with opportunities for social interaction (e.g., coffee shops, senior centers), intellectual stimulation (e.g., museums, libraries) and physical activity (e.g., parks, walkable streets) may slow rates of cognitive decline and reduce risk for Alzheimer’s disease. We assembled a community advisory board to translate research findings into a pilot website and interactive map that assesses neighborhoods for cognitive aging resources and amenities. The objective is to increase public awareness and inform public health and policy efforts to ameliorate community barriers and create more equitable opportunities to promote healthy aging in place.

RISKS FOR LATER-LIFE COGNITIVE IMPAIRMENT: DISENTANGLING CHILDHOOD AND EARLY FAMILY-LIFE PREDICTORS

Abstract Observing later-life health outcomes using a life-course model uncovers critical periods of influence. We investigated the relationship between five multi-component measures of childhood disadvantage (determined by Morton et al., 2022) and risk of cognitive impairment (determined by the Langa-Weir Classification) in later life. Data from the Health and Retirement Study (n= 9,509) were used. We conducted a multivariable parametric survival analysis to examine the relationships between the early life predictors of low socioeconomic status (SES), childhood impairments, risky adolescent behaviors, risky parental behaviors, and childhood chronic illness and the risk of developing later-life cognitive impairment between 2006 and 2016. We found that each additional indicator of low SES, risky adolescent behavior, and impairment in childhood increased the risk of developing cognitive impairment over the 10 years studied (HR=1.14, p < .05; HR=1.15, p < .05; HR=1.19, p < .05). Additional indicators of risky parental behaviors, however, were related to a smaller risk of developing cognitive impairment over time (HR=0.96, p < .05). Childhood chronic illness was not significantly associated with the risk of developing cognitive impairment. These results show that early-life factors might have long-term implications for the development of cognitive impairment in later life and display differential relationships with risk when parsed into competing categories. Measures of disadvantage indicating smaller risk may point to the resilience and plasticity of the brain in early life and highlight the need for the study of multiple life stages in order to track predictors of cognitive impairment throughout the life course.

Cumulative risk exposure and child cellular aging in a Dutch low-risk community sample.

One of the proposed mechanisms linking childhood stressor exposure to negative mental and physical health outcomes in later life is cellular aging. In this prospective, longitudinal, and pre-registered study, we examined the association between a cumulative pattern of childhood risk exposure from age 6 to age 10 (i.e., poor maternal mental health, parental relationship problems, family/friend death, bullying victimization, poor quality friendships) and change in two biomarkers of cellular aging (i.e., telomere length, epigenetic age) from age 6 to age 10 in a Dutch low-risk community sample (n=193). We further examined the moderating effect of cortisol reactivity at age 6. Ordinary Least Squares regression analyses revealed no significant main effects of childhood risk exposure on change in cellular aging, nor a moderation effect of child cortisol reactivity. Secondary findings showed a positive correlation between telomere length and cortisol reactivity at age 6, warranting further investigation. More research in similar communities is needed before drawing strong conclusions based on the null results.

The Role of Adverse Childhood Experiences in Multidimensional Nature of Subjective Age.

Age stereotypes and expectations about one's own aging commence in childhood, while most research focuses on predictive associations with midlife cognition and health outcomes in later life. This study instead aims to examine adverse childhood experiences (ACEs) contributing to multiple measures of subjective age (SA) among Chinese older adults and test whether these relationships differ by household registration (hukou). In a representative sample of Chinese older adults aged 60 and older from the 2018 China Longitudinal Aging and Social Survey (n = 7,815), ordinary least squares is used to examine the associations between ACEs and 3 facets of SA: felt age, look age, and self-defined aging standard. Childhood starvation experience and limited health care access predict older felt age and look age, while parental death is associated with lower self-defined aging standard. Zooming in on hukou-specific associations shows that the dose-response relationship on older adults with rural hukou is particularly pronounced. Findings provide empirical support for views of aging from a life-course perspective and highlight the enduring impact of ACEs for late-adulthood SA, as well as their differential influence on multiple indicators of SA. Interventions that focus on promoting health and development in childhood could potentially have effects beyond the childhood phase, and benefit for their positive aging attitude in later life.

Attachment insecurity moderates emotion responses to mindfulness and loving-kindness meditation in adults raised in low socioeconomic status households.

Research on attachment theory holds that insecure attachment influences people's daily social and emotional experiences. Mindfulness meditation and loving-kindness meditation have been associated with improvements in physical and mental well-being often through their influence on emotion experience and regulation. Yet, little research has examined how emotional well-being may be improved in insecurely attached individuals through meditation practice. We suspected that the emotion profiles of anxious and avoidant attachment may shift with meditation training, both across time and on a particular day. Improving emotional well-being may be especially consequential for those most at risk for negative health outcomes in late life. A diverse community sample of midlife adults raised in low-SES homes (N = 113; 55% white, 87.5% female) completed daily emotion reports for 10 weeks, during which they received 6 weeks of meditation training, randomized to either loving-kindness or mindfulness meditation practice. Results from growth curve analyses revealed that individuals with greater attachment anxiety and randomized to mindfulness meditation reported significant increases over time in positive emotions alongside decreases in negative emotions. Those high in attachment avoidance reported significant decreases in negative emotions in both meditation groups. On the daily level, within-person dose-response analyses revealed that individuals with greater attachment anxiety showed the most consistent dose-response relations between the duration of either meditation practice and same-day increases in positive emotions and decreases in negative emotions. These findings highlight how meditation interventions can shift emotion profiles of insecurely attached midlife adults who are at heightened risk for late life chronic illnesses. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Gender differences in rural-urban migration and its impact on depression in later life.

Although rural-to-urban migration has been well researched, how gender shapes processes and outcomes, including later-life health outcomes, has not been thoroughly investigated. Guided by a life course perspective, this study explores gender differences in rural-urban migration patterns and its association with depression in later life among Chinese older adults. Exploiting rich life history data from the China Health and Retirement Longitudinal Study, we employ sequence analysis to identify the typical migration trajectories of Chinese older adults. Moderated mediation analysis is then used to examine gender-specific health pathways linking migration trajectories and later-life depression. The results indicate that: rural migrants who settled in urban regions have lower level of depression in later life than 'return migrants' who moved back to rural areas or those who were rural non-migrants; the gender gap in depression is marginally smaller among early urban settlers than rural non-migrants; and household income in later life has stronger mediation effects for migrant men than for migrant women. The study therefore highlights the importance of considering the role of gender when designing policies aiming to improve the health and wellbeing of migrants in later life.

Understanding the impact of fertility history on health outcomes in later life.

ObjectivesAims of this research, involving data linkage and health outcomes, is to gain a full understanding of the impact of both fertility histories and childlessness on health outcomes mid-life accounting for socio-economic background and area of residence. The research draws on and extends work on reproductive histories and life-course outcomes.
 ApproachWe aim to extend this area of research, specifically for Scotland, using Census data (1991-2011) from the Scottish Longitudinal Study (SLS) linked to health data. The Census health measures – including the 2011 Census health condition question on mental health - are the research outcomes and the explanatory information is from Census socio-economic data (captured around peak fertility for the research cohort in 1991), along with the SMR02 Maternity and SMR04 Mental Health datasets. The time-frame for available data allows 20 year follow-up from the 1991 Census to mid-life for specific female SLS birth cohorts (born 1959-1966, aged ~45-52 in 2011).
 ResultsFrom preliminary modelling we initially find, for this specific female research cohort, high birth parity to be an important factor in relation to self-reported mental health conditions at follow-up in 2011, but not once socio-economic and area-level variables are controlled for.
 ConclusionPreliminary modelling also highlights that relationship status – single, married or cohabiting – to be important over that of legal marital status as recorded at Census. For limiting long-term illness as a health outcome the findings are similar.

Immigration Experience and Cognitive Function Trajectories Among Older Chinese Immigrants.

Although a number of studies have documented cognitive health among older immigrants in the United States, little is known about how the life-course immigration experiences are associated with cognitive trajectories among older Chinese immigrants. We assess patterns of cognitive functioning and change over time and examine whether age at migration, reasons for migration, acculturation, perceived discrimination, and preferred dialects are related to cognitive trajectories. The sample comprised 2,075 participants from the Population Study of Chinese Elderly (PINE), who completed a battery of cognitive tests at four time points (2011-2019). Latent class growth analysis and multinomial logistic regression were utilized. Three latent classes of cognitive trajectories were identified: the low functioning with the fastest decline (LCF, 12%), the moderate functioning with a medium decline rate (MCF, 39%), and the high functioning with the slowest decline (HCF, 48%). Perceiving more discrimination reduced, whereas speaking Taishanese increased the odds of being in the LCF and MCF. High acculturation only distinguished MCF from HCF after controlling for the known factors of cognitive health such as age, education, and social engagement. This study identifies a group of older Chinese immigrants who are especially vulnerable to cognitive impairment and indicates that the risk of cognitive decline appears to be elevated with lower levels of acculturation and unidentified racial discrimination. More research is needed to fully understand the underlying mechanisms that link the life-course immigration experiences to cognitive health outcomes in later life.

Life course reproductive dynamics associated with menopause in Ugandan women aged 40-49.

Early menopausal onset can increase adverse health outcomes in later life; meanwhile, reproductive experiences before menopause may affect its timing. Framed by life course methodology, the study tested for independent and interdependent associations between reproductive history (contraception, age at first birth, parity, terminated pregnancy) and socioeconomic factors (education, wealth, rural-urban residence, cigarette use, marital status, age at first cohabitation) with the occurrence of early menopause. The study population was ever-married women aged 40-49 from the 2016 Demographic & Health Survey (N=2748). Analytical methods involved probability- and age-adjusted multivariate logistic regression models and predictive margins. Connections between reproductive and socioeconomic characteristics were key dynamics associated with menopause in ages 40-49. Contraception, parity, and ages at first birth and marriage were found to be independently associated with menopause in this age group. Evidence of interactions was found where no contraceptive use was associated with higher probabilities of menopause for first-time mothers aged 12-15 and for women with no education. Studying Ugandan women's reproductive histories highlighted the importance of regional knowledge about menopause. Though we hypothesized that risks would correlate in a chain, the results pointed to risks clustering around contraception, suggesting that improving contraceptive use and education for women could increase menopausal age. Furthermore, the positive association between low parity and early menopause supports the biological mechanism of faster oocyte depletion; however, high-parity populations like Uganda tend to have a younger menopausal age than low-parity populations. Declining mortality in the demographic transition could explain these inverse associations.

Adverse Childhood Experiences, Positive Childhood Experiences, and Adult Health

Objective: This study investigates the associations between positive childhood experiences and adult well-being, examining the moderating role of childhood social support in the relationship between adverse childhood experiences (ACEs) and adult health outcomes. Method: Data were from the 2015 Wisconsin Behavioral Risk Factor Surveillance System survey. The sample included 4,849 individuals ages ≥18 years who were asked about their ACEs, childhood social support, and a range of health outcomes. We used logistic regression and subgroup moderation tests to predict health outcomes. Results: Adults with high ACE scores and lower levels of childhood social support had worse health outcomes than those with low ACE scores and higher levels of childhood social support. In addition, adults with lower ACE scores and lower levels of childhood social support had worse health outcomes than the reference group, indicating that inadequate childhood social support itself may contribute to negative health outcomes in later life. Conclusions: Both ACEs and childhood social support were independently associated with adult health problems, and the combination of high levels of ACEs and low childhood social support was the most significant predictor of adverse health outcomes in adulthood, controlling for adult sociodemographic indicators. Building and enhancing supportive relationships in childhood may buffer the negative effects of early adversities on adult well-being.

In utero exposure to natural disasters and later-life mortality: Evidence from earthquakes in the early twentieth century

A growing body of research explores the effects of prenatal insults caused by natural disasters on life-cycle outcomes. This paper joins the literature by exploring the long-run effects of prenatal exposure to earthquakes on adulthood and old-age mortality. Using Social Security Administration death records (1975–2005) linked with the full-count 1940 US census and implementing a difference-in-difference methodology, I show that exposure during the first trimester is associated with 1.8 months lower longevity, conditional on survival up to age 34. This effect is equivalent to 22 percent of the white-nonwhite gap in the outcome. The results implicate the relevance of the in-utero period and specifically the onset of pregnancy for later-life health outcomes.

Descriptive study to identify the barriers of healthy diet among children in selected school of Kashmir with a view to develop a lifestyle modification programme

Globally, around 16 million babies are born to adolescent girls between the ages of 15 and 19 years. Although rates of births among adolescent girls have declined in all regions since 1990 but still remain high in Africa, Asia, Latin America, and Caribbean. Nearly 50% of all women aged 20–24 years in Asia and Africa are married by the age of 18 years, placing them at a higher risk for early pregnancy, maternal disability, and death. Adolescence is a critical age group as this is a period to develop specific expertise and hone individual skills to enter the mainstream workforce and contribute to the economic productivity. It is also a period when major changes in health and health-related behaviours such as smoking and substance abuse, unsafe sexual practices, poor eating, and lack of exercise occur, which may substantially impact health outcomes in later life. Due to the success of child survival initiatives over the last few decades, there has been a dramatic rise in the population of adolescents especially in low- and middle-income countries. There is an unacceptable rate of mortality among adolescents, as an estimated 1.3 million adolescents died in 2012; 70% of these deaths occurred in Africa and Southeast Asia. Based on the problem selected and objectives of the study, descriptive research design was selected to identify the barriers of healthy diet among school going children in a selected school of Kashmir with a view to develop a lifestyle modification programme. Sixty subjects were selected in selected area of Kashmir by non-probability sampling technique for this study. Self-structured checklist was used for data collection and was analysed by descriptive and inferential statistics using chi-square and t-test. The findings also revealed that statistically significant association was found between barriers to healthy diet with these variables (educational status and Fathers education) whereas no significant association was found between barriers to healthy diet with these variables (age, area of residence and mothers education) at (p