Effect of a single one-hour teaching session about environmental pollutants and climate change on the understanding and behavioral choices of adolescents: The BREATHE pilot randomized controlled trial

BACKGROUND: Despite the wealth of scientific information on the health effects of air pollution, the adult public’s lifestyle continues to be largely detrimental towards the environment. OBJECTIVE: The purpose of the study was to determine whether a short interactive teaching session on air pollution could shift reported behavioral choices of adolescents towards environmentally friendlier options. METHODS: We performed a pilot randomized control trial in which eighth-grade students were randomized to receive a one-hour script-based teaching on either the effects of air pollution on lung health (intervention group) or the role of vaccination in public health (active control group). The enrolled students completed a survey (15 multiple-choice questions; five targeting understanding (score range 5 to 20); ten targeting behavioral choices (score range 10 to 38) newly designed for this study to evaluate their understanding and predict their future behavior towards air pollution immediately before, immediately after, and one month after the teaching sessions. RESULTS: Seventy-seven students (age = 13.5±0.6 years; 50.4% female; median annual family income = $25K-$50K with 70.1% <$50K; 39 assigned to intervention group) were enrolled in the study. The teaching sessions did not result in any significant change in the participants’ understanding domain scores in either the intervention or the control groups. However, the intervention (air pollution) teaching session resulted in a statistically significant increase in behavior domain score from baseline to immediately post-teaching, which continued to be present at one-month follow-up (mean ± standard deviation of score change immediately after = 1.7±3.3; score change 1-month after = 2.5±3.2; P<0.001; minimally important difference = 1.0). DISCUSSION: This pilot study highlights the potential of a short one-time teaching session in promoting environmentally friendly behavior choices among adolescents.