Strengthening Tobacco-Free Educational Institutions Through School-Based Health Education: Implementation of Project Udaan in Vadodara, India

Background Tobacco use remains a leading preventable cause of disease in India, with initiation commonly occurring during adolescence. Schools offer an effective platform for early prevention through structured health education. Project Udaan was developed as a school-based initiative to strengthen tobacco prevention awareness and support implementation of national tobacco control policies. The primary objective of this study was to describe the implementation of Project Udaan and assess changes in students’ knowledge related to tobacco use and oral cancer prevention among students in Grades 6 to 10 using a pre-test and post-test design. Methods Project Udaan was implemented across 100 urban and rural schools in Vadodara district, Gujarat, India, among students from Grades 6 to 10. The intervention included presentations, demonstrations, interactive activities, and awareness sessions conducted by trained educators. A pre-test and post-test design was used to assess knowledge improvement. Pre-test responses were obtained from 6,017 students and post-test responses from 6,047 students. Data were analyzed using descriptive statistics. Results A comparative analysis of pre- and post-test responses demonstrated substantial improvement in students’ knowledge across tobacco use and oral cancer prevention domains. Awareness of tobacco products increased from 5172/6017 (86.0%) to 5885/6047 (97.3%), and knowledge of the tobacco-oral cancer association improved from 5295/5963 (88.8%) to 5903/6047 (97.6%). Recognition of early oral cancer symptoms rose from 4038/5983 (67.5%) to 5643/6047 (93.3%), while understanding of peer pressure as a risk factor showed the greatest increase, from 2710/5926 (45.7%) to 5377/6047 (88.9%). Awareness of the tobacco quit helpline increased from 2129/3061 (69.6%) to 5844/6047 (96.6%), and knowledge of human papillomavirus (HPV) vaccination improved from 1889/3028 (62.4%) to 5744/6047 (95.0%). Conclusion Structured school-based interventions such as Project Udaan were associated with substantial improvement in adolescents’ awareness of tobacco-related health risks and supported early prevention strategies.