Indian Adolescents Research Articles

Relationship between adolescent anemia and school attendance observed during a nationally representative survey in India

BackgroundAnemia has been suggested to be related with schooling outcomes in India. Less is known, however, about whether the observed relationship persists after accounting for all household-level factors which may confound the association between anemia and schooling.MethodsNationally representative data on adolescents aged 15–18 years with data on measured hemoglobin level and school attendance were extracted from India’s National Family Health Surveys conducted between 2005 and 2021. We compared school attendance between adolescents living in the same household but with varying levels of hemoglobin concentration, while controlling for age and period effects. We assessed heterogeneity in the relationship between anemia and school attendance across anemia severity groups and socio-demographic characteristics.ResultsThe proportion of adolescents with any anemia is 55.2% (95% CI: 55.0–55.5) among young women and 31.0% (95% CI: 30.6–31.5) among young men. In conventional (between-household) regression models, having any anemia is associated with a 2.5 percentage point reduction (95% CI: 2.1–2.8) in school attendance; however, in household fixed-effects models, anemia has qualitatively small and non-significant effects on school attendance. Our results are consistent using alternative model specifications as well as across anemia severity groups, genders, types of relationship to the household head, household wealth quintiles, and states and union territories in India.ConclusionsThis within-household analysis finds little evidence that anemia is associated with school attendance among adolescents in India. Observational studies likely overstate the connection between anemia and school attendance due to household factors that have not been accounted for.

Resting Metabolic Rate in Indian Adolescents and Youth with Type 1 Diabetes Mellitus: A Case Controlled Study

Abstract Introduction: Energy metabolism in type 1 diabetes (T1D) is known to be different. Resting metabolic rate (RMR) accounts for the largest portion of total energy needs. The objective of our study was to assess resting metabolic rate and its determinants in adolescents and young adults with T1D in comparison with age- and gender-matched healthy controls. Methods: This cross-sectional study included 97 children and young adults (10–19 years) with type 1 diabetes having a disease duration of at least 1 year. For the control population, 95 age- and gender-matched healthy adolescents were enrolled. Clinical examination and biochemical evaluation of parameters pertaining to diabetes and body composition were estimated, and RMR was measured using indirect calorimetry for both cases and controls. Results: Adolescents with T1D were significantly shorter, and had significantly lower calorie intake, higher RMR and volume of oxygen consumed (VO2) as compared to the healthy controls (P < 0.05). RMR adjusted for weight showed a significant positive correlation with lean body mass (LBM) percentage, and energy intake and a negative correlation with disease duration. Those with a T1D duration of less than 5 years demonstrated a significantly higher RMR, lower body fat percentage, higher LBM percentage, carbohydrate and energy intake/kg body weight and higher calculated insulin sensitivity (IS) as compared to those with greater disease duration. Muscle mass percentage and higher energy intake were found to be significant positive predictors and advancing age/diabetes duration was a negative predictor of weight-adjusted RMR (P < 0.05), whereas IS and male gender tended towards significant negative association (P = 0.06). Conclusion: Indian children with type 1 diabetes had a higher resting metabolic rate as compared to healthy children. Muscle mass, energy intake and diabetes duration were observed to be important predictors of RMR in T1D. Reduction in RMR with advancing age/disease duration may predispose to weight gain and subsequent double diabetes in T1D.

Sleep Problems and Health Outcomes Among Urban American Indian and Alaska Native Adolescents

Adolescent sleep problems are prevalent, particularly among racial and ethnic minority groups, and can increase morbidity. Despite the numerous strengths of their racial and ethnic group, urban American Indian and Alaska Native adolescents face significant health disparities but are rarely included in health research. Understanding how sleep problems are associated with health outcomes among American Indian and Alaska Native adolescents may elucidate novel targets for interventions to promote health equity. To assess whether baseline sleep problems are associated with changes in behavioral and cardiometabolic health outcomes among urban American Indian and Alaska Native adolescents 2 years later. American Indian and Alaska Native adolescents were recruited via flyers and community events for an observational cohort study in California. Baseline assessments were conducted among 142 adolescents from March 1, 2018, to March 31, 2020, and follow-ups were conducted among 114 adolescents from December 1, 2020, to June 30, 2022. Baseline actigraphy-assessed sleep duration and efficiency and self-reported sleep disturbances and social jet lag (absolute value of the difference in sleep midpoint on weekends vs weekdays; indicator of circadian misalignment). Main outcome measures included self-reported depression (measured using the Patient Health Questionnaire), anxiety (measured using the Generalized Anxiety Disorder 7-item scale), past year alcohol and cannabis use, body mass index, systolic blood pressure (SBP) and diastolic blood pressure (DBP), waist circumference, and glycosylated hemoglobin (HbA1c). Analyses examined whether baseline sleep was associated with health outcomes at follow-up, controlling for age, sex, and baseline outcome measures. The baseline sample included 142 urban American Indian and Alaska Native adolescents (mean [SD] age, 14.0 [1.4] years; 84 girls [59%]), 80% of whom (n = 114; mean [SD] age, 14.1 [1.3] years; 71 girls [62%]) completed follow-ups. Linear or logistic regressions showed significant negative associations between shorter sleep duration and depression (β = -1.21 [95% CI, -2.19 to -0.24]), anxiety (β = -0.89 [95% CI, -1.76 to -0.03]), DBP (β = -2.03 [95% CI, -3.79 to -0.28]), and HbA1c level (β = -0.15 [95% CI, -0.26 to -0.04]) and likelihood of alcohol (odds ratio [OR], 0.57 [95% CI, 0.36-0.91]) and cannabis use (full week: OR, 0.59 [95% CI, 0.35-0.99]) at follow-up. Greater social jet lag was associated with significantly higher SBP (β = 0.06 [95% CI, 0.01-0.11]) at follow-up. This cohort study found significant associations between poor sleep and adverse changes in health outcomes. Findings highlight the importance of developing culturally responsive interventions that target sleep as a key modifiable risk factor to improve the health of American Indian and Alaska Native adolescents.

Determinants of Course of Type 2 Diabetes in Indian Adolescents.

To identify determinants of the course of Type 2 diabetes in Indian adolescents. Records of 37 adolescents (24 boys; 29 post pubertal and eight pubertal) with Type 2 diabetes (initial HbA1C 10.1 ± 1.9% and BMI SDS 2.0 ± 0.8; family history of diabetes in 33, 89.2%) diagnosed at 15.2 ± 2.5 y and followed up for 3.8 ± 2.2 y till 19.1 ± 3.3 y of age, were reviewed. Initial treatment included insulin in 11 (29.7%), metformin alone in 22 (59.5%), and a combination of anti-diabetic medication in four (10.8%). Eleven subjects (29.7%) achieved remission at a median period of 5.3 mo (IQR- 17.13) after diagnosis; six of these relapsed within 0.9 ± 0.3 (range 0.4-1.3) y. The proportion of subjects requiring multiple anti-diabetic agents increased over follow-up (19% at six months, 32.5% at one year, 50% at two years, 59.1% at three, and 64.8% at four years), with the need for combination therapy after 0.9 ± 1.4 y. At the last follow-up, five were off treatment (13.5%), 10 (27%) were on metformin alone, and 22 (59.5%) were on multiple medications. The need for combination therapy at the last follow-up was lower in subjects with remission (27% against 73.1%, p = 0.02). The findings of this study suggest delayed presentation and rapid progression of Type 2 diabetes in Indian adolescents. Diagnosis on screening and achievement of remission were predictors of good outcome.

Energy and nutrient intake by 11-13-year-old young adolescents attending private schools in Delhi, India.

There are no high-quality data on dietary behaviour of adolescents in India. This study aimed to assess the intake of energy (E), macronutrients and selected micronutrients in a sample of 11-13-year-old schoolchildren in Delhi, India. Participants from private schools (n=10) recorded dietary intake using a 3-d food diary. Information was entered into the dietary assessment tool, Intake24, to ascertain portion size and convert data into nutrient intake through integrated food tables. Of the 514 consenting participants, 393 (76·4 %) (169 girls, 224 boys) aged 11·4 (±1·8) years completed the study. The median (interquartile range (IQR) daily E intake was 2580 (2139·3-2989·8) kcal (10·8 (9·0 - 12·5) MJ) for girls and 2941·5 (2466·7-3599·3) kcal (12·3 (10·3-15·2) MJ) for boys. The median (IQR) daily nutrient intakes for girls and boys respectively were protein 64·6 (54·8-79·3) g, 74·4 (61·4; 89·4) g; carbohydrate 336·5 (285·3-393·6) g, 379·6 (317·8-461·8) g; and saturated fat 45·6 (34·8-58·3) g, 54·6 (41·9-69·5) g. There were no significant between-gender differences in percentage E from protein (10·2 (9·2-11·4)), or carbohydrate (52·4 (48·7-56·7)). Girls obtained less percentage E from saturated fat (16·1 (11·0-18·2) compared with boys 16·3 (14·2-19·1) (P < 0·05). E from saturated fat was above FAO recommendations in >74 % of participants. The estimated average requirement for iron was achieved by < 40 % of girls. In conclusion, strategies to optimise the dietary intake of adolescents in India should focus on preventing excess intakes of E and saturated fat and improving iron intake in girls.

Mental Health Issues Among School Children and Adolescents in India: A Systematic Review.

Childhood and adolescence are critical developmental stages for mental health, and the environment in which they grow has an impact on their well-being and growth. This study aims to assess mental health issues among school children and adolescents in India. A systematic search was conducted on the literature published between January 2013 and August 2023 in PubMed, Scopus, Cochrane Library, and Eric database. Thirty-one studies with a sample size of 30,970 were included in the final quantitative synthesis, of which 14,381 were male. The overall mean age of the school children and adolescents was 14.58 years, with a standard deviation of 1.35. A diverse range of mental health concerns have been documented in school children and adolescents, exhibiting differing degrees of severity and frequency. The analysis showed that depression was the most prevalent mental health issue among children, followed by social, behavioral, and emotional problems, anxiety, psychological distress, internet technology addiction, stress, social phobia, sexual and emotional abuse, violence, and attention deficit hyperactive disorder. The study concludes that school mental health research in India is critical for personalizing interventions to the specific requirements of the diverse student population, decreasing stigma, and enhancing overall student well-being within the cultural and educational context of the country.

Evaluating Within-Network and Between-Network Construct Validity of the Hindi Version of the Grit-Short Scale Among Indian Adolescents

The Grit-short scale measures consistency and perseverance for long-term goals. In the present study, we translated and adapted the Grit-short scale into Hindi (Grit-SH) and examined its within-network and between-network construct validity among Indian adolescents. The participants were 534 senior secondary school students aged 14 – 18 years recruited from five schools across two samples. Grit-SH, along with the brief inventory of thriving and student satisfaction scale, was administered in sample 1 ( N 1 = 310), whereas in sample 2 ( N 2 = 224), the English version of the Grit-short scale was used. Regarding within-network construct validity, the two-dimensional structure of Grit-SH demonstrated an acceptable fit to the data, partially strict invariance against its English version, and good internal consistency reliability. In terms of between-network construct validity, grit demonstrated a significantly positive correlation with student satisfaction and well-being. Overall, findings indicated that the Grit-SH is a valid and reliable measure of grit that researchers and practitioners can use to assess grit among Indian adolescents.

Normative data for insulin-like growth factor-1 (IGF-1) in healthy children and adolescents from India.

Serum IGF-1 is an important biochemical tool to diagnose and monitor GH-related disorders. However, ethnic-specific Indian data following consensus criteria for the establishment of normative data, are not available. Our objective was to generate chronological age (CA)-, bone age (BA)- and Tanner stage-specific normative data for IGF-1 in healthy Indian children and adolescents. A cross-sectional epidemiological study was conducted in schools and the community, which enrolled apparently healthy children and adolescents with robust exclusion criteria. The outcome measure was serum IGF-1 assessed using an electro-chemiluminescence immunoassay (ECLIA). The 2.5th, 5th, 10th, 25th, 50th (median), 75th, 90th, 95th, and 97.5th centiles for IGF-1 were estimated using generalized additive models. We recruited 2226 apparently healthy participants and following exclusion, 1948 (1006 boys, 942 girls) were included in the final analysis. Girls had median IGF-1 peak at CA of 13 years (321.7 ng/mL), BA of 14 years (350.2 ng/mL) and Tanner stage IV (345 ng/mL), while boys had median IGF-1 peak at CA of 15 years (318.9 ng/mL) BA of 15 years (340.6 ng/mL) and Tanner stage III (304.8 ng/mL). Girls had earlier rise, peak and higher IGF-1 values. The reference interval (2.5th-97.5th percentile) was broader during peri-pubertal ages, indicating a higher physiological variability. This study provides ethnicity-specific normative data on serum IGF-1 and will improve the diagnostic utility of IGF-1 in the evaluation and management of growth disorders in Indian children and adolescents.

A scoping review on knowledge, beliefs, and practices towards HIV/AIDS among Indian adolescents

IntroductionHIV/AIDS remains a significant global health concern among adolescents (10–19 years) with a burden of 1.65 million individuals by the year 2022; adolescents account for about 4 % of the overall HIV burden while 10 % of new adult cases are converted from the adolescent group only. In India, adolescents often lack adequate knowledge about HIV/AIDS, influenced by various factors. This scoping review aims to comprehensively synthesize and assess existing evidence on the knowledge, beliefs, and practices related to HIV/AIDS among adolescents in India. MethodLiterature searches were conducted in various databases with search limitations from January 2000 to December 2021. Ninety articles met our inclusion criteria. Data extraction was conducted, which followed a narrative summarization. A gap analysis was undertaken to highlight future research needs. A brief on government policies for creating awareness and preventing contraction among adolescents was presented for a better understanding. ResultsA total of seventy-four studies during the period of 2011–2021 were included in this analysis. More than 80% of the studies were cross-sectional (84.44%) prioritising urban settings (37.77%). Geographically, nearly one-third (26.66%) of the studies were reported from the northern region of the country. Knowledge among both the gender and the entire adolescent group was assessed by 58.9% and 15.5% of studies respectively. Key areas including knowledge regarding HIV/AIDS, sources of knowledge, attitude towards PLWH, and beliefs of adolescents regarding HIV/AIDS were prioritized. The findings indicated that males and urban adolescents exhibited higher levels of awareness about HIV/AIDS. However, several major research gaps around selected aspects of HIV/AIDS in India were identified. ConclusionThis scoping review provides a comprehensive overview of existing literature around attitude and beliefs among Indian adolescents regarding HIV/AIDS and emphasizes the importance and scope of further research. The study provides important perspectives for future policies and interventions.

Inhalant abuse among street-involved children and adolescents in India: Case for epistemic recognition and reorientation.

Contextualizing the void of research on inhalant abuse among adolescents as epistemic neglect, in this study, we use mixed-methods action research to understand inhalant abuse in a specific context in the Global South. Focusing on a large metropolitan city in Western India, we surveyed 158 street-involved children and adolescents (110 boys and 48 girls, age range from 5 to 17 years) in a group setting along with follow-up group interviews. Despite finding a high prevalence rate of inhalant abuse, our work suggests an absence of supporting structures and emphasizes the need to revisit our understanding and interpretation of substance-using behavior of street-involved youth. Instead of explaining inhalant-abusing behavior as emerging from pathological deficiencies in individuals or households, we stress the need to critically examine the exploitative environment they are embedded in. In doing so, we join efforts to decolonize conventional ways of understanding "deviant" behavior.

Protocol for process evaluation of ARTEMIS cluster randomised controlled trial: an intervention for management of depression and suicide among adolescents living in slums in India

IntroductionThere are around 250 million adolescents (10–19 years) in India. The prevalence of mental health-related morbidity among adolescents in India is approximately 7.3%. Vulnerable subpopulations among adolescents such as those...

The Associations Between Health-Related Knowledge and Health Beliefs Regarding Risk for Gestational Diabetes in American Indian and Alaska Native Female Adolescents and Young Adults at Risk for Gestational Diabetes and Their Female Caregivers: A Cross-Sectional Dyadic Analysis.

Research on associations between knowledge and health beliefs for women at risk for gestational diabetes mellitus (GDM) has focused on adults at risk for or having GDM. Gaps also exist in examining interpersonal associations with family members or peers. We examined dyadic associations between knowledge and health beliefs about the risk for GDM between and within American Indian and Alaska Native (AIAN) female adolescents and young adults (FAYAs) at risk for GDM and their mothers or adult female caregivers (FCs). Grounded in the Expanded Health Belief Model, we employed a cross-sectional design using baseline data from 147 dyads of AIAN FAYAs at risk for GDM and their FCs who participated in the Stopping GDM in Daughters and Mothers trial. FAYAs were 12.0 to 24.5 years of age, and 89.1% were students. FCs had a mean (SD) age of 44.0 (9.3) years, 87.0% were AIAN, 44.9% were college educated, 19.7% had ever had GDM, and 81.0% were the FAYA's mother. FAYAs and FCs completed surveys about knowledge and health beliefs (benefits, barriers, severity, susceptibility) regarding GDM risk and prevention. Bivariate correlational analyses were performed to examine associations between and within dyad members. Dyadic associations were investigated using actor-partner interdependence modeling (APIM) assuming distinguishable dyad members. Compared with their FCs, FAYAs had lower health-related knowledge and perceived benefits of GDM prevention and susceptibility regarding GDM risk. APIM revealed actor and partner effects of health-related knowledge on health beliefs for dyads. In particular, positive actor effects were found for FAYAs and FCs for GDM-related knowledge with perceived benefits (P <.001), and positive partner effects of GDM-related knowledge for FCs were related to perceived susceptibility and severity for FAYAs (P <.05). As shown in these AIAN dyads, FAYAs and their FCs, as members of one another's social network, may influence each other's health beliefs regarding GDM risk and prevention.

Cultural Connection and Well-being for American Indian Adolescents.

American Indian and Alaska Native (AI/AN) adolescents face health disparities resulting from historical traumas. There is a paucity of research focusing on mental health in AI/AN adolescents or the relationship between cultural connection and health. This project assesses the relationship between cultural identity and markers of mental health and well-being for AI/AN adolescents. Adolescents 12 to 18 years old from the Lumbee Tribe of North Carolina participated in this mixed-methods study. Phase 1, discussed in this manuscript, involved surveys using validated instruments to assess cultural connection and markers of mental health and well-being. Characteristics of the 122 AI/AN youth who completed the survey included: mean age 14.9 years (SD = 2.0); 61% (n = 75) assigned female at birth; 56% (n = 70) identified as female; and 4.1% (n = 5) identified as non-binary. Mean tribal affiliation (TA) and ethnic identity (EI) scores suggest strong cultural connection (TA: M = 3.1/5, SD = 0.6; EI: M = 3.4/5, SD = 0.9). Sleep quality (M = 2.63/5) and positive stress management (M = 2.06/5) were low. Bivariate and logistic regression demonstrated moderate positive correlations between EI and friendship, EI and emotional support, TA and friendship, and TA and emotional support. AI/AN adolescents in this sample have a moderate-strong connection with Native culture, marked by ethnic identity and tribal affiliation, and positive markers of mental health and well-being. Data from this study may be used for policy formulation to promote increased funding and programming addressing mental health for AI/AN youth.

An analysis of knowledge, awareness, and attitude about cervical cancer and its prevention among urban Indian adolescents: A cross-sectional study

An analysis of knowledge, awareness, and attitude about cervical cancer and its prevention among urban Indian adolescents: A cross-sectional study

A Sexual Health Education for Adolescents in India

Teenagers are predominant in the adolescent period. It is a period of transition from childhood to adulthood. (Montessori, 2014). Adolescents feel curious and embarrassed about the changes that occur during this period and they find themselves drawn to the members of the opposite sex and may feel self-conscious, excited, and nervous, these teenagers try to experiment with their desires out of social and ethical norms to fulfill their sexual desires. In Indian society, sex is morally permitted only after marriage (sodhi,2004) and sex relation outside marriage is morally condemned by society(Jessica ,2015). Ethically it is clear that any kind of exploitation of sex is undesirable. But in pandemic situations like in Covid 19, teenagers spend most of their time with laptops, mobile phones, and tabs with an internet connection, the pictures lured by the youth are very much influenced by them. Due to the impact of media and peer group pressure, and they sometimes rebel against their parents and elders and seek the approval and companionship of their peers. In addition to that technological awareness and advancements in development have forced this youth to move one step toward the abolition of family customs and traditions. In this context, sexual health education is very important for teenagers to create awareness about the harmful effects of improper sexual relationships (Swayam , 2021).

Psychotherapy for Families with Adolescent Children: Clinical Practice Guidelines

Family therapy is often indicated in the treatment of adolescents with mental health difficulties. The family context is often seen as a predisposing, precipitating, perpetuating, or a protective factor for a wide range of child and adolescent mental health concerns. Several approaches to family therapy are now recognized as evidence-based treatments for different psychiatric presentations. In this article, we hope to describe the relevance of family therapy for families with adolescents in India, present case illustrations on commonly used approaches to family therapy, and propose clinical practice guidelines.

Mobile Distractions among Adolescents: Impact on Learning in the Aftermath of COVID-19 in India

The advent of mobile technology has brought numerous benefits, but it has also introduced distractions, especially among adolescents. The COVID- 19 pandemic further exacerbated this issue, as remote learning became the norm. This paper explores the impact of mobile distractions on the learning outcomes of adolescents in India post-COVID-19. Through a review of existing literature and empirical evidence, this paper aims to shed light on the prevalence of mobile distractions, their effects on academic performance, and potential strategies to mitigate them.

Investigating key latent factors influencing alcohol consumption among the tribal male adolescents in Dooars region, West Bengal

Background Alcohol consumption among tribal male adolescents in India is a significant social concern. Tribal adolescents are particularly vulnerable and tend to lean toward alcohol addiction. Therefore, it is crucial to introduce some necessary footsteps to reduce alcohol consumption. The primary objective of this study is to investigate the association of various latent factors with the alcohol-drinking behavior of tribal adolescents. Methods The study collected data from 600 tribal adolescents from the Dooars region, with 241 of them reported consuming alcohol. The study aimed to confirm the theoretical development of hypotheses regarding peer pressure, parental discord, stress, attitude toward alcohol, and food insecurity as exogenous latent factors influencing the alcohol-drinking behavior of tribal adolescents. In this context, the study adopted both measurement and structural models using Partial Least Squares-Structural Equation Modeling (PLS-SEM). Results The findings revealed a significant path relationship between alcohol drinking behavior and various exogenous factors like peer pressure (β = 0.214, p = .000), parental discord (β = 0.121, p = .009), stress (β = 0.170, p = .000), attitude toward alcohol (β = 0.110, p = .004), and food insecurity (β = 0.510, p = .000). This study developed a reflective measurement model, and the evaluation of reflective measurement models was conducted, assessing internal consistency, convergent validity, and discriminant validity, yielding satisfactory results. Conclusion To tackle alcohol issues among tribal adolescents in the Dooars region, effective strategies should be employed. These include educating in schools, highlighting tribal role models, aiding peers with alcohol dependence, providing life skills training, and addressing parental discord and food insecurity through awareness campaigns, workshops, and better infrastructure.

Validating Tools to Measure Life Skills Among Adolescents in India

Life skill education is critical for developing various competencies among the adolescent population, especially in India, given the recent shift in policy focus. This article examines the reliability, factor structure, and the validity of scales measuring gender attitudes, perceived self-efficacy, resilience, and problem-solving developed to assess the effectiveness of a life skill program among Indian adolescents. Baseline data, before a life skill intervention program by Magic Bus India Foundation, were collected from over 16000 Indian adolescents between 11 and 15 years on different measures. Results from principal component analyses with promax rotation indicated a one-factor solution for all the scales. Further, confirmatory factor analyses indicated an excellent model fit using the diagonally weighted least squares method of estimation for the above-mentioned scales. The models for each scale were gender invariant, indicating that gender attitudes, perceived self-efficacy, resilience, and problem solving were assessed similarly between boys and girls. Additionally, correlation analysis indicated a positive relationship between gender attitudes and self-efficacy, a negative relation between gender attitudes and resilience, and a negative association between self-efficacy and resilience. Implications are discussed.

Uplifting and Uncanny Conversations Around Death and Dying: Qualitative Study Among Indian Adolescents and Emerging Adults

This study explores perspectives of adolescents and emerging adults on having conversations around death and dying, if there is a value in discussing death early in life, and to explore the views on likelihood of introducing death education in Indian curriculum. Using constructivist grounded theory of qualitative research, the study inquired the perspectives of adolescents and emerging adults employing semi-structured interviews. All participants showed interest in discussing the topic; they actively participated in sharing their views, something that they heard, and inquiring about cultural practices. In analyzing the interview data, mainly three themes emerged: 1. Understanding death in relation to shadow and spirit stories; 2. Existential view on death and managing grief and anxiety; 3. Social and cultural narratives into death education. This study sets out to address a gap in research among adolescents and emerging adult attitudes and opinions toward death. However, there is a need to understand barriers in normalizing conversations around death and dying in wider communities in India and further research is essential.