Improving adolescents’ dietary behavior through teacher-delivered cancer prevention education: A school-based cluster randomized intervention trial in urban Rajasthan

Abstract

Abstract Background Dietary practices are one of the most common modifiable risk factors for cancers. Foods rich in dietary fibres are considered protective, and fast & junk foods are risk for common cancers. Adolescence period is marked by habit formation and is thus suited for delivering behavioral intervention. Schools offer an optimal setting for planning and executing these interventions to a large number of adolescents. Objective To assess the effectiveness of a classroom-based teacher delivered cancer prevention education in improving dietary behaviors among school going urban adolescents. Methods A cluster randomized trial was conducted in government secondary and senior secondary schools with schools as clusters. A sample of 1024 students was estimated from 16 schools with 1:1 allocation in control and intervention group. Student’s self-reported dietary behaviors for eating healthy and avoiding unhealthy foods, and their determinants as per theory of planned behavior framework were recorded. Two teachers from each of 8 intervention schools were trained to deliver cancer prevention education to students within regular school curriculum with focus on dietary behaviors. Results A total of 1096 students from 8 intervention and 8 control group schools completed the study. The study recorded significant improvement in scores of students from intervention group (IG) compared to control group (CG) for their attitude, subjective norms, perceived behavioral control and intention towards consuming healthy and avoiding unhealthy foods. The intervention was found effective in significantly improving the proportion of students for limiting fried food, fast food, packed food and sugar sweetened beverages (OR:1.65, 95%CI:1.10,1.47, p:0.015), and consuming fruits and vegetables daily (OR:1.72, 95%CI:1.19,2.50, p:0.004). Conclusion Classroom-based cancer prevention education delivered through teachers during regular working hours is effective in improving dietary behaviors and its determinants among adolescent students. Thus, we recommend integrating a section focusing on role of diet towards cancer prevention and other life-style diseases in existing school curriculum. Trial Registration: The trial was registered under Clinical Trial Registry-India with registration number CTRI/2018/12/016586.