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Background  The respiratory infectious diseases (RID) threaten the health and life quality of school students. However, previous related studies were insufficient in research design and method applied. This study aimed to evaluate the effect of health education on the knowledge and behavior of students toward RID through difference-in-difference (DID) analysis in Gansu, China.    Methods  In 2015–2016, a one-year health education program in Gansu, China was conducted. The intervention group contained 1064 students before and 1001 students after the health education (2015 and 2016, respectively). The control group contained 1018 and 1001 students, respectively. The health education, including playing promotional cartoons, developing lectures, giving out handbook copies and making hand copy and blackboard newspapers, and publicity columns on RID, were conducted monthly from 2015 to 2016 in intervention group. The data were collected before and after the health education program with a questionnaire on the students’ knowledge and preventive behaviors regarding RID. The  ×   2   and  t  tests were performed to compare the accuracy rate and scores for RID knowledge and behavior of the two groups. DID estimation was conducted to evaluate the effect of health education on RID knowledge and behavior while controlling the non- equilibrium variables.    Results  After the health education program, the accuracy rate and scores of most items in the intervention group were significantly higher than those in the control group ( P < 0.05 ) except for item k9 “What methods can prevent flu?”. The DID results wherein the demographics- age, nationality, and household register were controlled showed that health education significantly improved the accuracy rate of RID knowledge by 5.2–63.9% for most items, although the accuracy rates of items k2 “What’s the transmission way of the mumps?” and k9 were significantly decreased by 36.8 and 12.0%. The health education significantly improved the score of knowledge by 155.2% ( P < 0.001 ) and the accuracy rate of all items of RID behavior by 2.9–51.5% except for item b3 “If you have phlegm, how do you usually deal with it?”. In addition, the health education also significantly improved the score of behavior toward RID of the sampled students by 138.2% ( P < 0.001 ).    Conclusion  The results of this study show that health education seemed to increase the RID knowledge and behavior of students. It is recommended that the health education should be enhanced and popularized in schools of China, and RID transmission routes and prevention methods should attract more attention.

bmc public health

The effect of health education on knowledge and behavior toward respiratory infectious diseases among students in Gansu, China: a quasi-natural experiment