Assessment of NCD risk factors in Indonesian adolescents

There has been a significant global shift in the pattern of disease, with non-communicable diseases (NCDs) such as diabetes, cardiovascular disease and mental disorder now the prevailing cause of death and disability in most countries, including Indonesia. Adolescents represent an important population group in terms of responding to NCDs for two reasons. Firstly, many of the risk factors for adult NCDs (such as tobacco use, physical inactivity and poor diet) arise and are potentially modifiable during adolescence. Secondly, adolescents experience a significant burden of preventable NCD, including mental disorder, asthma and chronic pain. As such, NCDs have implications for the health and wellbeing of adolescents, their longer term health, and the health of the next generation. However, current global data collection systems (such as DHS and MICS) primarily focus on sexual and reproductive health risks and outcomes, without measuring the range of NCD risk factors and outcomes in adolescents. Where NCD data are collected (for example, the RISKESDAS survey in Indonesia), measures are often not specific to adolescent risk behaviour or outcome. A further challenge is that data for adolescents are typically collected from schools or home-based samples, and may therefore exclude young people who are at greatest risk of NCD – those who are disconnected from home or school. In many countries, such as Indonesia, the absence of these data contribute to a policy and practice gap.

This study aimed to fill key data gaps by measuring the prevalence of key NCD risk factors and outcomes amongst both school- and community-based adolescents in Indonesia. Additionally, it aimed to document the determinants that underpin NCD risks and outcomes, and explore how young people themselves perceive NCDs. To date, these have both been poorly explored, yet are critical to informing effective preventive and treatment interventions. Additionally, the study aimed to assess the prevalence of poor mental health (a key NCD outcome) and high body mass index (a key metabolic risk).

The study employed a sequential mixed methods design. It included a formative qualitative phase comprising 16 focus group discussions (FGDs), followed by a quantitative component that included a cross-sectional survey, anthropometric measurements (height and weight) and biomarker assessment (including venous blood sampling to measure lipids, anaemia and blood pressure measurements). We also validated the assessment of mental health using survey scales by including a psychiatric interview for a sub-sample in Jakarta.

The study was carried out in two purposively selected provinces in Indonesia. Jakarta was selected as it represents the most developed and populous province in Indonesia, while South Sulawesi (in the mountainous region on the western southern peninsula of Sulawesi island) was selected in order to sample adolescents living in more peri-urban and remote parts of Indonesia.

Findings and recommendations

This is a large and complex study, but one that will serve as a rich platform to further advance our understanding of NCDs amongst adolescents in Indonesia. To date we have finalised all data collection, completed analysis of the qualitative data and commenced quantitative data analysis. We have focused our immediate efforts on the qualitative data analysis and interpretation, given this is critical to contextualising the quantitative analysis. The findings of this analysis also privilege the voice of young people (often not heard), and stand to make an important contribution to policy and practice in their own right. From these analyses, the research was able to arrive at the following recommendations:

• Given the burden and perceived severity of poor mental health and overweight/obesity among young people, there is a critical need to address these issues within Indonesia.
• Young people have a sophisticated understanding of the risk and protective factors associated with both mental health and high BMI, and should, therefore, be part of the solution.
• Given the substantial stigma associated with mental health and what appears to be low levels of mental health literacy, a multi-sectoral approach that includes the educational, health and community sectors is recommended.
• Mental health specialists need to work with religious leaders and communities to develop initiatives that reduce stigma and discrimination associated with mental illness and mental health help-seeking.
• Initiatives aiming to reduce the risk of high BMI among Indonesian adolescents need to focus on addressing access to fresh food for young people, creating safe and accessible spaces for physical activity within urban settings, and making use of existing spaces within rural settings by implementing community-based physical activity programs.