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Background Assessment of the US Truth campaign showed that mass media campaigns informing children about tobacco industry practices are effective in preventing smoking uptake. The aim of this study was to assess the potential effectiveness of a school-based intervention, based on the premise of Truth, in reducing ever smoking and susceptibility to smoking among children in the UK. Methods Data come from a pilot study intended to test the acceptability of the intervention and ease of delivery, and to provide preliminary evidence of effectiveness before further assessment in a randomised trial. 445 students in two schools in the East Midlands, UK, completed anonymous questionnaires in Year 7 (ie, aged 11–12 years) and Year 8 (12–13), before and after receiving the Operation Smoke Storm intervention. This intervention consisted of three teacher-led sessions that combined interactive paper-based and audio-visual components in Year 7 and one booster session in Year 8. We used multilevel logistic regression (students nested within schools), adjusted for confounders, to compare the odds of smoking and susceptibility at follow-up in students who received Operation Smoke Storm with 1692 students in eight local schools who were asked identical questions about smoking behaviour as part of another survey but who did not receive the intervention. The study was approved by the University of Nottingham Medical School Research Ethics Committee (reference C13122012 CHS EPH Smoking). Findings Prevalence of ever smoking or susceptibility to smoking was similar in intervention and control schools in Year 7. In Year 8, 34 students (7·6%) who received Operation Smoke Storm reported ever smoking and 111 (24·9%) reported susceptibility to smoking; 175 students (10·3%) who did not receive Operation Smoke Storm reported ever smoking and 329 (19·4%) reported susceptibility. There was no significant difference in the odds of a combined outcome of ever smoking or susceptibility to smoking in students who received the intervention compared with controls (adjusted odds ratio 1·28, 95% CI 0·83–1·97; p=0·263), and no difference in odds of ever smoking (0·82, 0·42–1·58; p=0·549). Interpretation Operation Smoke Storm does not seem to have reduced smoking and susceptibility to smoking among students aged 12–13 years in two UK schools. Qualitative analysis is ongoing to explore students' and teachers' perceptions of Operation Smoke Storm and potential reasons to explain the apparent lack of effectiveness. Funding The National Institute for Health Research Public Health Research Programme (NIHR PHRP) (project number 11/3010/02). The funder had no role in the writing of the abstract or the decision to submit.

Background 40% of smokers become addicted before age 16 years and those who start at an early age are less likely to quit and more likely to die from their habit than are those who start later. Evidence from the US truth campaign suggests that interventions focusing on the tactics of the tobacco industry can be effective in preventing smoking uptake by children. Operation Smoke Storm is the first UK intervention based on this premise and we report an evaluation of its acceptability and effectiveness. This resource comprises three classroom sessions in which students act as secret agents uncovering tobacco industry tactics through videos, quizzes, discussions, and presentations. Methods Eight focus groups were conducted with 80 students in year 7 (aged 11–12 years) who had participated in Operation Smoke Storm at two schools in the East Midlands, UK. 18 interviews were conducted with teachers who delivered the intervention. The focus groups and interviews were digitally audiorecorded, transcribed verbatim, and analysed with the Framework method. The study was approved by the University of Nottingham's medical school research ethics committee (reference C13122012 CHS EPH Smoking). Findings Students enjoyed the secret agent scenario and reported acquiring new knowledge about smoking and the tobacco industry, which seemed to strengthen their aversion to smoking. Most teachers felt confident about delivering the resource, but would have welcomed more background information about the topic and guidance on how to steer discussions. Teachers highlighted a need for the resource to be flexible and not dependent on lesson length, teacher confidence, or expertise. Students and teachers endorsed the idea of developing a booster component for year 8 students (12–13 years), though stressed practical considerations including computer access. Participants also supported the development of printed information complementing the resource to encourage parents to support their child to not experiment with tobacco. Interpretation Although data were only collected from two schools, this rigorously conducted study highlights that Operation Smoke Storm can be delivered by teachers to raise awareness about smoking-related issues. These promising findings are relevant for anyone looking to deliver a novel anti-smoking message to young people and for health policy makers aiming to reduce uptake of smoking. The ideas and issues raised by students and teachers are now being used to improve and extend the resource for further evaluation. Funding National Institute for Health Research Public Health Research Programme (project number 11/3010/02). The funder had no role in the writing of this abstract or the decision to submit.

Background Childhood obesity is about 2% above the national average in Birmingham. In 2011, Birmingham's public health team customised national guidance into Startwell, a childhood obesity prevention programme, consisting of discrete physical activity (PA) and nutrition elements, targeting early years settings in which obesity prevalence is highest. A 3-month independent formative assessment was commissioned during the programme's second year. Practices in intervention and control settings were compared to assess whether Startwell effected behaviour change and to recommend improvements. Methods 12 Startwell nutrition, 12 Startwell PA interventions, and 12 non-Startwell control settings were randomly selected from lists provided by Birmingham Community Healthcare NHS. Two to three staff (manager, early years workers) and two parents at each setting were invited to participate in focus groups or semistructured face-to-face interviews, or both. Participants provided written informed consent. Tape-recorded discussions followed topic guides to capture knowledge, attitudes, and perceptions of the nutrition or PA aspects emphasised in Startwell. Two people independently identified themes and reached consensus. Transcripts were thematically analysed with NVivo-10 software and again consensus was reached. Knowledge was assessed against national guidelines, as were meal plans. Startwell records of pre-training and post-training self-assessment scores for knowledge of healthy eating, healthy eating activities, and weaning were verified against observations at site visits. Findings Compared with controls, intervention staff had better understanding of the PA guidelines, more confidence, and the skills to deliver PA within their settings. However, many felt training could better match needs. PA at intervention settings focused more purposively and consistently on fundamental movement skills and included more indoor activities compared with controls. Action plans to motivate staff to implement Startwell PA were generally short term. Pre-training and post-training scores of intervened staff showed knowledge of healthy eating and related messages increased by 16% (95% CI 11·8–20·5). Training reportedly increased skills, confidence, and motivation to promote healthy nutrition to children and parents. Controls, committed to promoting healthy nutrition, did so irregularly, without confidence, knowledge, skills, and support. Compared with controls, intervention settings offered more nutritionally balanced meal plans, provided more appropriate drinks for different ages, were more positive role models for healthy lifestyles, and implemented more health promotion activities. Some parents in the nutrition intervention settings valued the health promotion information and activities, suggesting some success in information dissemination. Staff confidently stated that they regularly raised parents' awareness in both nutrition and PA intervention settings, which some parents did not confirm: none recalled Startwell PA messages, showing poor recognition of the brand. All staff valued the follow-up support from Startwell for development and implementation of action plans. Despite challenges (funding, staff motivation) there was optimism about benefit to the community if Startwell is sustained. Interpretation Startwell helps promotion of good nutrition in early years settings and enables healthy eating and PA in respective settings. Startwell's sustainability and success hinge on supporting staff in settings to engage parents, building self-reliance and peer support into the programme as it extends across the city so that local and national ambitions to curb overweight and obesity can be met. The strengths of this assessment were random sampling of intervention and non-intervention settings, comparison with control settings, all interviews being co-facilitated, and verified coding. Time precluded collection of quantitative data and limited the number of interviews with parents. Startwell builds capacity, takes a life-course approach, and accords with evidence that multiple components are better than one. Funding Birmingham Community Healthcare NHS Trust.