Introduction: In India, deaths from non – communicable diseases are projected to almost double to about 8 million a year by the year 2020 from about 4 million in 1990. A major part of this change in the disease profiles can be attributed to a shift in the lifestyle and behavioral risk factors in the population. Majority of these diseases (specifically cardiovascular diseases, diabetes, cancer and stroke) show a common risk factor profile: physical inactivity, increased consumption of high calorie food, decreased consumption of fruits and vegetables, and tobacco consumption. All these risk factors are modifiable and are related to health behavior. Studies have shown that behavioral modifications are more successful if implemented at an early age. Schools have long been recognized as potentially effective settings for public health initiatives as they access a large population of children and youth across broad ethnic and socioeconomic strata.

Objectives: 1) To develop, implement and evaluate healthy school guidelines regarding diet, physical activity & tobacco in schools of rural Ballabgarh.2) To assess the change in knowledge and practices of middle school children about diet, physical activity & tobacco after one year of a school based intervention in rural Ballabgarh.3) To assess the role of schools in health promotion at the community level.4) To estimate the cost of the above formulated school-based intervention.

Methods: A cluster randomized controlled trial was carried out from Jan 2009 to Feb 2010, in 40 middle schools of intensive field practice area of rural Ballabgarh, Haryana. Data was collected from 2348 students on their knowledge and practices regarding major risk factors of non-communicable diseases viz  physical activity, diet and tobacco before starting the intervention to assess the baseline characteristics of the schools and students.  An intervention package consisting of teachers training, school action plan and IEC (Information, education and communication) material was delivered to the intervention group schools. After the intervention, the survey was repeated in the same schools.

Results: Significant no of schools adapted the ‘No Tobacco policy’ but could not prevent shops from selling tobacco products within 100 metres.Schools adapted the policy of encouraging students to bring fruits & vegetables but the availability of  salted snacks within the school environment did not come down. Periods on physical activity significantly increased & also the IEC material on display, this correlates well with the increased physical activity of the students. Number of students attending PT classes increased significantly along with the knowledge about beneficial effects of physical activity. The total time spent on watching TV also came down significantly in the IG (decreased by 14min/day) & increased by 1.5min/day in the CG). Consumption of fruits and vegetables increased and that of deep fried food decreased but no positive impact observed in consumption of salted snacks. Habit of purchasing eatables from outside did not improve in our study. The knowledge about harmful effects of second hand smoke improved significantly. Prevalence of current smoking as well as smokeless tobacco came down significantly.