Discussion
We developed a one-hour teaching session about air pollution and climate change targeted towards adolescents along with a questionnaire to quantitatively assess adolescents’ understanding and behavioral choices regarding air pollution and environment. We then conducted a randomized controlled trial using the teaching session and the questionnaire to see whether this one-time short teaching session about air pollution and climate change, versus the control session about vaccines, could have lasting effects on understanding of air pollution and climate change issues and behavior of adolescents in choosing environmentally friendlier approaches in their daily living. We found that our air pollution teaching session did not affect how the adolescents scored on the questionnaire understanding domain. However, we found that the air pollution teaching session did improve the behavioral choices of the adolescents as measured by the questionnaire, both immediately and about one month after the administration of the teaching session. The changes in the behavioral domain score were larger than the estimated MID of the questionnaire, suggesting a statistical and clinically significant improvement lasting over a month with a single one-hour teaching session about environment and health. To our knowledge, this is the first study to show that a one-time teaching session on air pollution pollutants, climate change, and environmental health in adolescents could cause a shift in their choices towards environmentally friendlier behavior.There are few studies that have examined the benefits of environmental education in youth, but most have been descriptive and cross-sectional in nature, looking at the association of environmental knowledge and environmentally friendly behavior. In 2011, Naquin and colleagues designed a questionnaire to investigate environmental health knowledge, attitudes, and practices of 115 children enrolled in grades four through eight at a university laboratory school in southeast Louisiana, and reported the differences in those domains by students’ grade levels [A few other studies have reported examining the effect of environmental education in form of an intervention and examining its effects on youth; however, these studies were usually of a much longer duration teaching, were administered to older youth in the high school through college age range, were not evaluating specific environmentally-relevant behavioral changes, and/or lacked appropriate control arm [Interestingly, in our study, both adolescents who received the intervention (air pollution) teaching session and those who received the control (vaccine) teaching session showed a statistically significant improvement on the questionnaire in their behavior domain scores at about one-month follow-up, with the intervention group having a larger, though not any longer statistically significant, increase in their score. The finding that even the control group that had a teaching session unrelated to air pollution or climate change (vaccine) also showed an improvement in their one-month follow-up behavioral choice score towards environmentally friendlier options is surprising but could be potentially explained as a case of a “spillover effect” [