Hesketh,, Therese; (2001) Health, nutritional and behavioural indicators in adolescents in urban and rural China. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Objectives: to determine differences in health, nutritional and behavioural indicators in adolescents in urban and rural Zhejiang Province, and to make recommendations for the development of adolescent health services and health education in eastern China. Setting: Twelve secondary schools in three distinct socio-economic and geographic areas: Hangzhou (urban), Xiaoshan (wealthy rural) and Chunan (poor, mountainous rural) in Zhejiang Province, eastern China. Methods: A two stage cross-sectional survey was carried-out. The first stage was carried out in six middle and high schools and involved the development, testing and administration of a questionnaire covering a range of health and lifestyle issues. Areas of importance highlighted in Stage One informed the content of Stage Two which consisted of anthropometry, haemoglobin measurement, and a further questionnaire focusing particularly on nutritional status and psychological morbidity. Results: There were 4197 respondents aged predominantly 12-18 in Stage One and 1577 respondents aged 12-16 in Stage 2. Key findings included significant differences in socio-demographic patterns in the three areas: 90% of Hangzhounese were only children, compared with 55% in Xiaoshan and 8% in Chunan. Regular smoking was very rare (0.3%) and non-existent in girls. Underweight was far more prevalent than overweight 18% and 3.6% (P<0.001). The strongest predictor of overweight was urban residence OR 9.1(95% CI 3.7,23). Over half of all girls (51%) were anaemic, with significantly more in Chunan.(P<0.001). Anxiety and depression were common in both sexes and in both urban and rural areas, but very few sufferers had sought professional help. Much of the psychological morbidity was related to academic pressure. Conclusions: As a result of the study, the first of its kind in the Province, changes have been made to the health education curriculum for secondary schools in Zhejiang and there are plans to introduce counselling services into schools.

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