[Prevention of hepatitis B in juveniles. Effect of a medical health education lesson in school]

Abstract

Background: In recent years, a dramatic rise in the incidence of sexually transmitted hepatitis B in youth and adolescence has been observed, with a doubling of the incidence during the 1990s; in particular, young females have a fourfold increased risk of infection, compared with the general population. The responsible mechanisms in this age group include a general change of sexual behavior as well as insufficient knowledge, and thus underestimation, of the disease. Improved primary prevention requires a more effective and broader health education, but reliable data on extent and duration of such educational interventions are lacking.

Methods: In a prospective, randomized, controlled trial of 1,911 children (6th grade, n = 881) und adolescents (9th grade, n = 1,030), the increment in the specific knowledge of hepatitis B (intervention group; n = 1,123) persisting for 14 days, as effected with a single, medical, focused health education lesson given by physicians, in comparison with a control group (n = 788; without health education lesson) was investigated. The questions included basic facts on crucial mechanisms of hepatitis B transmission. In parallel, the participants evaluated the subjectively perceived relevance and acceptance of the topic. Interventions were integrated in routine class lessons.

Results: Prior to intervention, both groups had an identical rate of correct answers (34-60% and 32-66%, respectively). The rates remained unchanged in the control group over the 2-week observation period. By contrast, in the intervention group the proportion of correct answers increased (to 68-88%; p < 0.0001). In parallel, subjective relevance and acceptance increased significantly. Moreover, lesson acceptance rates and objective knowledge increments were significantly correlated (p < 0.0001).

Conclusion: These results demonstrate for the first time the effect of a focused, medical health education lesson in juvenile age groups prior to, and in, a period of life with an increased risk for hepatitis B infection. A preventive impact can be expected not only due to a markedly improved specific knowledge, but also due to a significant increase in the acceptance of the topic, including the importance of hepatitis B vaccination programs.