A sustainability of a multi-component education program (ABC of Healthy Eating) after three months and nine months: the socioeconomic context in improving nutrition knowledge in Polish teenagers

Abstract Background: Nutrition knowledge, through its direct influence on dietary behaviours, can be considered as an important factor that indirectly influences human health. Dietary behaviours are formed in childhood, and many of them are relatively stable over time. It follows that changing dietary behaviours and developing nutrition knowledge should take place before undesirable dietary habits become established. The study aimed to evaluate the sustainability of a multi-component education (ABC-HEat) program related to healthy nutrition and lifestyle after three months and nine months and to assess the socioeconomic context in improving teenage nutrition knowledge.Methods: The study was designed as a clustered, controlled, education-based intervention. A sample was chosen and allocated into either an educated group (under intervention) or a control group (outside of intervention). The study covered 464 students 11-12-year-old (educated/control 319/145) from primary schools in locations covering the entire territory of Poland. In the educated group, data were collected three times: before education, after three months and after nine months to measure the short- and the long-term effect of education, respectively. In the control group, data were collected in parallel. Changes in nutrition knowledge score (NKS, points) by sex, residence, family affluence scale (FAS) were the main outcome measures. Logistic regression models were used to evaluate chance of no increase in the NKS with two reference categories: any increase or an increase by ≥ 4 points.Results: The increase in the NKS was significantly higher in the educated group than in the control group – three months after education on average by 1.4 to 2.7 points (all P < 0.001) in the total sample and all subgroups (girls, boys, rural residence, urban residence, low FAS, higher FAS), and nine months after education in rural residents by 2.2 points (P < 0.001) and in the total sample by 0.4 (P < 0.05). In the educated group, the chance of no increase in the NKS was higher in urban than rural residents after three months and nine months (adjusted odds ratios [OR] and 95% Confidence Intervals [95% CI]: 3.63, 1.80-7.31 and 2.99, 1.60-5.59, respectively, both P < 0.001) using the increase in the NKS by ≥ 4 points as a reference.Conclusions: The multi-component education program improved the nutrition knowledge of teenagers in the short-term regardless of socioeconomic variables, but in the long-term this effect was visible only in rural residents. It suggests that a special path of nutrition education addressed to urban teens may be required.