Community-level women's education and undernutrition among Indian adolescents: A multilevel analysis of a national survey.

<h4>Background</h4>Little research has explored the influence of social context on health of Indian adolescents. We conceptualized community-level women's education (proxy for value placed on women's wellbeing) as exerting contextual influence on adolescent hemoglobin level and...

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Autores principales:	Ankita R Shah, Malavika A Subramanyam
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/3656448aeabc477f84f4f01c2289718b
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spelling	oai:doaj.org-article:3656448aeabc477f84f4f01c2289718b2021-11-25T06:23:46ZCommunity-level women's education and undernutrition among Indian adolescents: A multilevel analysis of a national survey.1932-620310.1371/journal.pone.0251427https://doaj.org/article/3656448aeabc477f84f4f01c2289718b2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0251427https://doaj.org/toc/1932-6203<h4>Background</h4>Little research has explored the influence of social context on health of Indian adolescents. We conceptualized community-level women's education (proxy for value placed on women's wellbeing) as exerting contextual influence on adolescent hemoglobin level and body mass index (BMI).<h4>Methods</h4>We derived our sample of more than 62,000 adolescent aged 15 through 17 years from the Indian National Family Health Survey 2015-16. The sample consisted of a total of 62648 adolescents (54232 girls and 8416 boys) for the hemoglobin, and 62846 adolescents (54383 girls and 8463 boys) for the BMI analysis. We fitted multilevel random intercepts linear regression models to test the association of village- and urban-ward-level-women's education with hemoglobin level and BMI of adolescents, accounting for their own and their mother's education; as well as relevant covariates.<h4>Findings</h4>Our fully adjusted model estimated that if the 52% of communities with less than 20 percent of women having a tenth-grade education in our sample were to achieve 100 percent tenth-grade completion in women, hemoglobin would be 0·2 g/dl higher (p<0·001) and BMI would be 0·62 kg/m2 higher on average among all adolescents in such communities. Unexplained variance estimates at the contextual level remained statistically significant, indicating the importance of context on adolescent undernutrition.<h4>Interpretations</h4>Adolescents are deeply embedded in their context, influenced by contextual factors affecting health. Promoting adolescent health therefore implies altering social norms related to adolescent health and health behaviors; along with structural changes creating a health-promoting environment. Integrating our empirical findings with theoretically plausible pathways connecting community-level women's education with adolescent undernutrition, we suggest that enhancing community-level women's education beyond high school is necessary to facilitate these processes.<h4>Implications</h4>Addressing contextual determinants of adolescent undernutrition might be the missing link in India's adolescent anemia and undernutrition prevention efforts, which are currently focused heavily on individual-level biomedical determinants of the problem.Ankita R ShahMalavika A SubramanyamPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 5, p e0251427 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Ankita R Shah Malavika A Subramanyam Community-level women's education and undernutrition among Indian adolescents: A multilevel analysis of a national survey.
description	<h4>Background</h4>Little research has explored the influence of social context on health of Indian adolescents. We conceptualized community-level women's education (proxy for value placed on women's wellbeing) as exerting contextual influence on adolescent hemoglobin level and body mass index (BMI).<h4>Methods</h4>We derived our sample of more than 62,000 adolescent aged 15 through 17 years from the Indian National Family Health Survey 2015-16. The sample consisted of a total of 62648 adolescents (54232 girls and 8416 boys) for the hemoglobin, and 62846 adolescents (54383 girls and 8463 boys) for the BMI analysis. We fitted multilevel random intercepts linear regression models to test the association of village- and urban-ward-level-women's education with hemoglobin level and BMI of adolescents, accounting for their own and their mother's education; as well as relevant covariates.<h4>Findings</h4>Our fully adjusted model estimated that if the 52% of communities with less than 20 percent of women having a tenth-grade education in our sample were to achieve 100 percent tenth-grade completion in women, hemoglobin would be 0·2 g/dl higher (p<0·001) and BMI would be 0·62 kg/m2 higher on average among all adolescents in such communities. Unexplained variance estimates at the contextual level remained statistically significant, indicating the importance of context on adolescent undernutrition.<h4>Interpretations</h4>Adolescents are deeply embedded in their context, influenced by contextual factors affecting health. Promoting adolescent health therefore implies altering social norms related to adolescent health and health behaviors; along with structural changes creating a health-promoting environment. Integrating our empirical findings with theoretically plausible pathways connecting community-level women's education with adolescent undernutrition, we suggest that enhancing community-level women's education beyond high school is necessary to facilitate these processes.<h4>Implications</h4>Addressing contextual determinants of adolescent undernutrition might be the missing link in India's adolescent anemia and undernutrition prevention efforts, which are currently focused heavily on individual-level biomedical determinants of the problem.
format	article
author	Ankita R Shah Malavika A Subramanyam
author_facet	Ankita R Shah Malavika A Subramanyam
author_sort	Ankita R Shah
title	Community-level women's education and undernutrition among Indian adolescents: A multilevel analysis of a national survey.
title_short	Community-level women's education and undernutrition among Indian adolescents: A multilevel analysis of a national survey.
title_full	Community-level women's education and undernutrition among Indian adolescents: A multilevel analysis of a national survey.
title_fullStr	Community-level women's education and undernutrition among Indian adolescents: A multilevel analysis of a national survey.
title_full_unstemmed	Community-level women's education and undernutrition among Indian adolescents: A multilevel analysis of a national survey.
title_sort	community-level women's education and undernutrition among indian adolescents: a multilevel analysis of a national survey.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/3656448aeabc477f84f4f01c2289718b
work_keys_str_mv	AT ankitarshah communitylevelwomenseducationandundernutritionamongindianadolescentsamultilevelanalysisofanationalsurvey AT malavikaasubramanyam communitylevelwomenseducationandundernutritionamongindianadolescentsamultilevelanalysisofanationalsurvey
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Community-level women's education and undernutrition among Indian adolescents: A multilevel analysis of a national survey.

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