Azzopardi Peter S, Willenberg Lisa, Wulan Nisaa, Devaera Yoga, Medise Bernie, Riyanti Aida, Ansariadi Ansariadi, Sawyer Susan, Wiguna Tjhin, Kaligis Fransiska, Fisher Jane, Tran Thach, Agius Paul A, Borschmann Rohan, Brown Alex, Cini Karly, Clifford Susan, Kennedy Elissa C, Pedrana Alisa, Pham Minh D, Wake Melissa, Zimmet Paul, Durrant Kelly, Wiweko Budi, Luchters Stanley
Global Adolescent Health Group, Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.
Department of Paediatrics, Royal Children's Hospital, The University of Melbourne, Melbourne, Australia.
Glob Health Action. 2020;13(1):1732665. doi: 10.1080/16549716.2020.1732665.
Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality globally, with the burden largely borne by people living in low- and middle-income countries. Adolescents are central to NCD control through the potential to modify risks and alter the trajectory of these diseases across the life-course. However, an absence of epidemiological data has contributed to the relative exclusion of adolescents from policies and responses. This paper documents the design of a study to measure the burden of metabolic syndrome (a key risk for NCDs) and poor mental health (a key outcome) amongst Indonesian adolescents. Using a mixed-method design, we sampled 16-18-year-old adolescents from schools and community-based settings across Jakarta and South Sulawesi. Initial formative qualitative enquiry used focus group discussions to understand how young people conceptualise mental health and body weight (separately); what they perceive as determinants of these NCDs; and what responses to these NCDs should involve. These findings informed the design of a quantitative survey that adolescents self-completed electronically. Mental health was measured using the Centre for Epidemiologic Studies Depression Scale-Revised (CESD-R) and Kessler-10 (both validated against formal psychiatric interview in a subsample), with the metabolic syndrome measured using biomarkers and anthropometry. The survey also included scales relating to victimisation, connectedness, self-efficacy, body image and quality of life. Adolescents were sampled from schools using a multistage cluster design, and from the community using respondent-driven sampling (RDS). This study will substantially advance the field of NCD measurement amongst adolescents, especially in settings like Indonesia. It demonstrates that high quality, objective measurement is acceptable and feasible, including the collection of biomarkers in a school-based setting. It demonstrates how comparable data can be collected across both in-school and out of school adolescents, allowing a more comprehensive measure of NCD burden, risk and correlates.
非传染性疾病（NCDs）是全球发病和死亡的主要原因，其负担主要由低收入和中等收入国家的人们承担。青少年对于非传染性疾病的控制至关重要，因为他们有潜力改变风险，并在整个生命过程中改变这些疾病的发展轨迹。然而，缺乏流行病学数据导致青少年在政策制定和应对措施中相对被忽视。本文记录了一项研究的设计，该研究旨在测量印度尼西亚青少年中代谢综合征（非传染性疾病的关键风险因素）和心理健康不佳（关键结果）的负担。我们采用混合方法设计，从雅加达和南苏拉威西岛的学校和社区环境中抽取了16至18岁的青少年作为样本。最初的形成性定性调查使用焦点小组讨论，以了解年轻人如何分别概念化心理健康和体重；他们认为这些非传染性疾病的决定因素是什么；以及对这些非传染性疾病的应对措施应该包括什么。这些发现为青少年自行电子完成的定量调查的设计提供了依据。心理健康使用流行病学研究中心抑郁量表修订版（CESD-R）和凯斯勒10量表（两者均在一个子样本中与正式的精神病学访谈进行了验证）进行测量，代谢综合征则使用生物标志物和人体测量学进行测量。该调查还包括与受害、联系、自我效能感、身体形象和生活质量相关的量表。青少年从学校采用多阶段整群抽样设计进行抽样，从社区采用应答驱动抽样（RDS）进行抽样。这项研究将极大地推动青少年非传染性疾病测量领域的发展，特别是在印度尼西亚这样的环境中。它表明高质量、客观的测量是可以接受和可行的，包括在学校环境中收集生物标志物。它展示了如何在在校和校外青少年中收集可比数据，从而更全面地衡量非传染性疾病的负担、风险和相关因素。
