BackgroundPreliminary evidence has suggested the role of inflammation in development and prognosis of cardiovascular diseases and cancers. Most of the prognostic studies failed to account for the effects of co-morbid conditions as these might have raised the systemic inflammation. We used neutrophil lymphocyte ratio (NLR) as a measure of systemic inflammation and investigated its association with prevalent chronic conditions.MethodsPresent study is a cross sectional study conducted on population of Karachi, Pakistan. A detailed questionnaire about the demographic details of all subjects was filled and an informed consent obtained for blood sampling. Multinomial regression analyses were carried out to investigate the relationship between NLR and prevalent chronic conditions.Results1070 apparently healthy individuals participated in the study. Proportion of individuals with hypertension was higher in middle and highest tertile of NLR as compared to the lowest tertile (18.2% & 16.1% compared to 11.8%). Individuals with hypertension were 43% (RRR = 1.43, 95% CI 0.94-2.20) and 66% (RRR = 1.69, 95% CI 1.09-2.54) more likely to be in the middle and highest tertile of NLR respectively compared to the baseline group. Similarly, individuals with diabetes mellitus were 53% (RRR = 1.53, 95% CI 0.93-2.51) and 65% (RRR = 1.65, 95% CI 1.01-2.71) more likely to be in the middle or highest tertile of NLR as compared to the baseline NLR group.ConclusionsSystemic inflammation measured by NLR has a significant association with prevalent chronic conditions. Future research is needed to investigate this relationship with longitudinal data to establish the temporal association between these variables.

BackgroundSusceptibility to smoke has been recognized as a strong predictor of smoking experimentation and taking up regular smoking habit. The identification of smoking susceptible individuals and its determinants is important in the efforts to reduce future smoking prevalence. The aims of this study are to estimate prevalence of susceptibility to smoke among adolescents, and identify factors associated with it.MethodsCross sectional data was obtained from Global Youth Tobacco Survey conducted in three cities of Pakistan in year 2004. Study population consisted of students in grades, 8th, 9th, and 10th; aged 13 to 15 years. Secondary analysis using univariate and multivariate logistic regression analyses were performed to estimate the associations between smoking susceptibility and co-variates. Descriptive statistics were reported in proportions, and adjusted odds ratios with 95% confidence interval were used to report logistic regression analyses.ResultsApproximately 12% of nonsmoking students were found susceptible to smoking. Students, who were females (OR = 1.53, 95% CI [1.24-1.89]); whose parents (OR = 1.64, 95% CI [1.35-1.99]); or close friend smoked (OR = 2.77, 95% CI [2.27- 3.40]) were more susceptible to cigarette smoking. Students who had good knowledge about harmful effects of smoking (OR = 0.54, 95% CI [0.43-0.69]); and had access to anti-smoking media (OR = 0.73, 95% CI [0.59-0.89]) were less likely to be susceptible to smoking.ConclusionStudents who were females, had smoking parents, friends or exposure to newspaper/magazines cigarette marketing, were more susceptible to cigarette smoking among Pakistani adolescents. While knowledge of harmful effects of smoking and access to anti-smoking media served as protective factors against susceptibility to smoking.

BackgroundUnhealthy behaviors are associated with mental health problems and violence in adolescents, yet their combined association has been understudied. Using the Global School Health Survey, this study examined the association between combined unhealthy behaviors (including fast food, soft drink, smoking, other tobacco products and physical inactivity) and anxiety, suicidal ideation and involvement in physical fight among Pakistani adolescents.MethodsData were obtained from the Global School Health Survey conducted in Pakistan (2009). The study population consisted of school going adolescents aged 13 to 15 years. Association of combined unhealthy behaviors with anxiety, suicidal ideation and involvement in physical fight were studied through secondary analysis. We used univariate and multivariate logistic regression analysis by complex sample method, accounting for cluster sampling technique used for data collection.ResultsOf the total 4583 students, weighted percentage and unweighted count for one, two, three and four or more unhealthy behaviors was 39.4% (n = 1770), 22.1% (n = 963), 5.9% (n = 274) and 1.2% (n = 62) respectively. The weighted prevalence for anxiety, suicidal ideation and involvement in physical fight were 8.4%, 7.3% and 37.4% respectively. The results of multivariate logistic regression analysis after adjustment showed that students who had four or more unhealthy behaviors had higher odds of; being anxious (OR 2.45, 95%CI 1.31-4.59, p value 0.004), suicide ideation (OR 4.56, 95%CI 2.58-8.07, p value <0.001) and being involved in physical fight (OR 3.15, 95% CI 1.63–6.08, p value <0.001) as compared to those who had not adopted any unhealthy behaviors.ConclusionsThis study suggests that the co-occurrence of unhealthy behaviors is associated with anxiety, suicidal ideation and physical fight among adolescents. These findings should be considered when developing interventions to combat detrimental outcomes of unhealthy behaviors during adolescence.

BackgroundCigarette smoking habit usually begins in adolescence. The developing countries in South Asia like Pakistan, India, Bangladesh, and Nepal, where the largest segment of the population is comprised of adolescents, are more susceptible to smoking epidemic and its consequences. Therefore, it is important to identify the association between anti-smoking initiatives and current smoking status in order to design effective interventions to curtail the smoking epidemic in this region.MethodsThis is a secondary analysis of national data from the Global Youth Tobacco Survey (GYTS) conducted in Pakistan (year 2003), India (year 2006), Bangladesh (year 2007), and Nepal (year 2007). GYTS is a school-based survey of students targeting adolescents of age 13–15 years. We examined the association of different ways of delivering anti-smoking messages with students’ current smoking status.ResultsA total of 19,643 schoolchildren were included in this study. The prevalence of current smoking was 5.4% with male predominance. No exposure to school teachings, family discussions regarding smoking hazards, and anti-smoking media messages was significantly associated with current smoking among male students. Participants who were deprived of family discussion regarding smoking hazards (girls: odds ratio (OR) 1.56, 95% confidence interval (CI) 0.84–2.89, p value 0.152; boys: OR 1.37, 95% CI 1.04–1.80, p value 0.025), those who had not seen media messages (girls: OR 2.89, 95% CI 1.58–5.28, p value <0.001; boys: OR 1.32, 95% CI 0.91–1.88, p value 0.134), and those who were not taught the harmful effects of smoking at school (girls: OR 2.00, 95% CI 0.95–4.21, p value 0.066; boys: OR 1.89, 95% CI 1.44–2.48, p value <0.001) had higher odds of being current smokers after multivariate adjustment.ConclusionSchool-going adolescents in South Asia (Pakistan, India, Nepal, and Bangladesh) who were not exposed to anti-tobacco media messages or were not taught about the harmful effects in school or at home had higher odds of being current smokers than their counterparts.

Background: Bullying and violence are problems of aggression in adolescents. Healthy lifestyle practices are common health promotion approaches in school settings; however, their association with aggressive behaviours in school-going adolescents is less explored. Aims: This study examined the associations of healthy lifestyle behaviours including good hygiene, physical activity, recommended diet and refrainment from tobacco use with bully victimization and violence among adolescents. Methods: Data were obtained from the Global School Health Survey conducted in Pakistan (2009). The study population consisted of school-going adolescents aged 13 to 15 years. We constructed our final dataset using information from 4102 participants. Association of healthy lifestyle behaviours with bully victimization and violence experience were assessed using multivariate logistic regression. Results: Results indicate lower odds of being bullied (good hygiene: