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

Akseer et al. BMC Public Health (2020) 20:1908 https://doi.org/10.1186/s12889-020-09988-5 RESEARCH ARTICLE Open Access Non-communicable diseases among adolescents: current status, determinants, interventions and policies N. Akseer1,2* , S. Mehta1, J. Wigle1,2, R. Chera1, Z. J. Brickman1, S. Al-Gashm1, B. Sorichetti1,2, A. Vandermorris1,3, D. B. Hipgrave4, N. Schwalbe5 and Z. A. Bhutta1,2,6 Abstract Background: Addressing 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. Methods: We 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. Results: Mental 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. Conclusions: Multi-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. Keywords: Adolescents, Non-communicable diseases, Determinants, Policies, Risk factors * Correspondence: 1 Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada 2 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Akseer et al. BMC Public Health (2020) 20:1908 Background The global burden of non-communicable diseases (NCDs) is a growing public health crisis that requires attention and action from the international community [1]. As the leading cause of mortality, this class of diseases is responsible for 38 million of 57 million annual deaths, with 85% of these deaths occurring in low- and middle-income countries (LMICs) [2]. However, the discussion on efforts to address NCDs to-date has focused on the adult population, with adolescents largely overlooked [3]. Since NCDs are often considered ‘lifestyle illnesses’ and the youth population is commonly thought of as healthy, modest efforts have been made to assess their health, disease prevention and lifestyle modification. Yet, adolescents experience a substantial share of the global NCD burden [4, 5]. Extensive research has shown that NCDs are primarily attributed to underlying and modifiable risk factors that often emerge during these earlier years [5–7]. 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]. For example, the prevalence of overweight and obesity increases drastically during mid-adolescence and into adulthood [9]. 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]. Drug and substance use also represent a threat for multiple health outcomes, including poor mental health [11]. Since health behaviours and risk exposures that emerge during adolescence underpin health and well-being across the life-course and also affect pregnancy outcomes, investments must be made in the health of current and future generations. In fact, 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]. Addressing NCDs has emerged as a global priority in the Sustainable Development Goals (target 3.4) [13] and the focus of a third UN high-level meeting [14], and includes the establishment and promotion of cost-effective interventions to prevent and address NCDs [15]. However, existing literature provides patchy insight into the current state of NCD-related lifestyle and behavioral risk factors among young people. In fact, to-date, there is no systematic assessment of the NCD burden, risk factors and determinants of NCDs, and effective interventions and policies for targeting t (...truncated)