Effectiveness of multipronged intervention on knowledge and attitude regarding health risk behaviors and prevention among Indian adolescents: A cluster randomized controlled trial

Adolescence is a critical window for the emergence of lifestyle-related health risk behaviours that contribute substantially to the global burden of disease. This study examined the effectiveness of a multipronged, school-based intervention in improving knowledge and attitudes regarding health risk behaviours among adolescents. A cluster-randomized design was used to recruit 338 first-year pre-university students (170 intervention; 168 control).Baseline data on sociodemographic characteristics, knowledge, and attitudes were collected using validated self-administered tools. The intervention comprised an interactive awareness session and roleplay focusing on causes, prevention, and management of health risk behaviours. Participants were predominantly 16 years old and female across both groups. Substance use among family members was reported by 19.8% (intervention) and 18.2% (control). Significant improvements in knowledge were observed both within the intervention group over time [F(2336)=3.13, p < 0.004] and between the intervention and control groups [F(1336)=79.8, p < 0.001]. Attitude scores also showed significant positive changes over time within the intervention group [F(2336)=14.51, p < 0.001]. The multipronged intervention effectively enhanced adolescents' knowledge and fostered more favourable attitudes towards health risk behaviour prevention. School based public health strategies that integrate education and skill building represent a practical, scalable approach for reducing multiple risk behaviours among adolescents.