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Background: In India, stress levels are increasing steadily among youth. We aimed to explore the factors that contribute to psychological stress and coping strategies among adolescents in Mysore, India to inform the development of an intervention. Methods: We recruited 16 volunteers in Mysore, India including 6 younger (12-15 years; 3 girls) and 10 older adolescents/ young adults (17-25 years; 5 girls) using a purposive sampling technique. Older adolescents were recruited from ongoing birth cohort study, and the younger adolescents by word-of-mouth from the community. Individual in-depth interviews were carried out based on a semi-structured interview guide comprising open-ended questions. The interviews were analysed to derive themes and emerging constructs related to stress and coping strategies. Results: Adolescents generally perceived stress in their daily lives. Family conflicts and academic pressures were the main triggers for increased stress. Issues around peer relationships, and social position were also important contributors. Adolescents reported that they had robust coping strategies. These included stress release through rationalising and acceptance of the situation, distraction activities, spirituality, and self-comforting methods. However, they felt the need for further support from their family, and the society in general. In particular they expressed the need for a space to share their concerns and obtain guidance through healthy discussions with adults. Conclusions: Our study indicates that adolescents in India are exposed to a wide range of stressors in their daily lives. The conflict between ‘traditional’ society’s opinions of what adolescents should do and the new age adolescents’ aspirations for autonomy to find ‘informed’ solutions for their issues may hinder the stress management efforts. Moving forward, we propose to develop a culturally acceptable intervention tool that accommodates adolescents’ perspectives and psychosocial context.

Background: Early life nutrition may affect individuals’ susceptibility to adult non-communicable diseases (NCD). Psychological stress is a well-recognised NCD risk factor. Recent evidence suggests that impaired foetal nutrition alters neuro-endocrine pathways, and hypothalamic-pituitary-adrenal axis feedback systems, resulting in abnormal stress responses, and NCD risk. This study aims to examine adolescent cortisol and cardiovascular stress responses in relation to maternal nutrition and contemporaneous NCD risk markers. Methods: The study sample will be drawn from three well-established birth cohorts in India; the Parthenon cohort, Mysore (N=550, age~20y), the SARAS KIDS prenatal intervention cohort, Mumbai (N=300, age~10-12y) and the Pune Rural Intervention in Young Adults/ PRIYA cohort, Pune (N=100, age~22y). We will perform the ‘Trier Social Stress Test (TSST)’, a well-accepted stress-test module which involves participants performing 5-minutes each of public speaking and mental arithmetic tasks in front of unfamiliar ‘judges’ (stressor). Repeated measures of salivary cortisol and autonomic cardiovascular outcomes relative to the stressor will be assessed. Measures of psychological stress, cognitive function, blood pressure, glucose-insulin metabolism and depression will be carried out. Mechanistic studies including DNA methylation in gluco-corticoid receptor (NR3C1) and 11β-HSD2 gene loci and neuroimaging will be carried out in a subsample. Qualitative interviews and focus group discussions in a subsample of the Parthenon cohort will explore the perception of stress and stressors among the youth. We will convert repeated measures into time-weighted averages before analysis. We will carry out multivariable regression analysis to test the associations. We will further refine the analyses using the mixed-model regression and conditional analyses for the association with repeated measures. Ethics and dissemination: This study has been approved by the research ethics committee of CSI Holdsworth Memorial Hospital, Mysore. The findings will be disseminated locally and at international meetings, and reports will be submitted to open access peer reviewed journals.