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Background: UK schools increasingly have to respond to anxiety, depression, and conduct disorder as key causes of morbidity in children and young people (CYP).Objective: To assess the comparative effectiveness of educational setting-based interventions for the prevention of anxiety, depression, and conduct disorder in CYP.Design: Systematic review, network meta-analysis (NMA), economic evaluation.Data sources: MEDLINE, EMBASE, PsycINFO and CENTRAL searches to 4 April 2018 and NHS EED on 22 May 2019 for economic evaluations. No language or date filters applied.Main Outcomes: Post-intervention self-reported anxiety, depression or conduct disorder symptoms.Review methods: We included randomised/quasi-randomised trials of universal or targeted interventions for prevention of anxiety, depression or conduct disorder in CYP aged 4–18 years. Interventions were based on Cognitive Behavioural Therapy (CBT), mindfulness/relaxation, CBT+Interpersonal Therapy (IPT), third-wave, exercise, biofeedback, behavioural, IPT, bias modification and occupational therapy. Screening was conducted independently by two reviewers. Data extraction was conducted by one reviewer and checked by a second. Intervention and component-level NMA were conducted in OpenBUGS. A review of the economic literature and a cost-consequence analysis were conducted.Results: 142 studies were included in the review, and 109 contributed to the NMA. 57/109 were at unclear risk of bias for random sequence generation and allocation concealment. Heterogeneity was moderate. In universal secondary school settings, mindfulness/relaxation interventions (Standardised Mean Difference (SMD) -0.65, [95%CrI -1.14 to -0.19]) and CBT (SMD -0.15 [95%CrI -0.34 to 0.04]) may be effective for anxiety. CBT interventions containing a psychoeducation component may be effective (SMD -0.30, [-0.59 to -0.01]) at preventing anxiety post-intervention. For anxiety in targeted secondary settings there was evidence exercise was effective (SMD -0.47, [95%CrI -0.86 to -0.09]). There was weak evidence in universal (SMD -0.07, [95%CrI -0.23 to 0.05]) and targeted (SMD -0.38, [95%CrI -0.84 to 0.07]) primary settings, that CBT may prevent anxiety. For preventing depression in universal secondary settings, there was weak evidence that CBT (SMD -0.04, [-0.16 to 0.07]) and CBT+IPT (SMD -0.18, [-0.46 to 0.08]) may be effective. Third wave (SMD -0.35, [-0.70 to 0.00]) and CBT interventions (SMD -0.11, [-0.28 to 0.05]) containing a psychoeducation component may be effective at preventing depression post-intervention. There was no evidence of intervention effectiveness in targeted secondary, targeted primary, or universal primary settings post-intervention. Results for university settings were unreliable due to inconsistency in the NMA. A narrative summary was reported for five conduct disorder prevention studies, all in primary school settings. None reported the primary outcome at post-intervention. The economic evidence review reported heterogeneous findings from six studies. Taking the perspective of a single school budget and based on CBT intervention costs in universal secondary settings, the cost-consequence analysis estimated an intervention cost of £43 per student.Limitations: The emphasis on disorder-specific prevention excluded broader mental health interventions and restricted the number of eligible conduct disorder prevention studies. Restricting to interventions based in the educational setting limited the number of eligible university-level interventions.Conclusions: There was weak evidence of the effectiveness of school-based, disorder-specific prevention interventions, although effects were modest and the evidence not robust. CBT-based interventions may be more effective if they include a psychoeducation component.Future work: Future trials for prevention of anxiety and depression should evaluate CBT with and without a psychoeducation component, and include mindfulness/relaxation or exercise comparators, with sufficient follow-up. Cost implications must be adequately measured.

Poor quality urban environments substantially increase non-communicable disease. Responsibility for associated decision-making is dispersed across multiple agents and systems: fast growing urban authorities are the primary gatekeepers of new development and change in the UK, yet the driving forces are remote private sector interests supported by a political economy focused on short-termism and consumption-based growth. Economic valuation of externalities is widely thought to be fundamental, yet evidence on how to value and integrate it into urban development decision-making is limited, and it forms only a part of the decision-making landscape. Researchers must find new ways of integrating socio-environmental costs at numerous key leverage points across multiple complex systems. This mixed-methods study comprises of six highly integrated work packages. It aims to develop and test a multi-action intervention in two urban areas: one on large-scale mixed-use development, the other on major transport. The core intervention is the co-production with key stakeholders through interviews, workshops, and participatory action research, of three areas of evidence: economic valuations of changed health outcomes; community-led media on health inequalities; and routes to potential impact mapped through co-production with key decision-makers, advisors and the lay public. This will be achieved by: mapping system of actors and processes involved in each case study; developing, testing and refining the combined intervention; evaluating the extent to which policy and practice changes amongst our target users, and the likelihood of impact on non-communicable diseases (NCDs) downstream. The integration of such diverse disciplines and sectors presents multiple practical/operational issues. The programme is testing new approaches to research, notably with regards practitioner-researcher integration and transdisciplinary research co-leadership. Other critical risks relate to urban development timescales, uncertainties in upstream-downstream causality, and the demonstration of impact.

Additional file 1.

Additional file 1. Supplementary Material, Description of data: The supplementary material contains additional information concerning: 1. Risk thresholds; 2. Confounder measures and their derivation; 3.Deriving the adolescent cumulative risk exposure measure; 4. Deriving the latent classes; 5. Deriving the sample; 6. Comparison of imputation sample and those excluded from the analysis by key demographic variables; 7.Risk profiles for adolescence, percentage of sample and cumulative risk score for complete case and imputed samples; 8. Latent class trajectories; 9. Cross tabulations of cumulative risk score quartiles and proportion belonging to each of the latent classes; and 10. Associations between the adolescent cancer risk measure and socioeconomic status (SES) measures.

Additional file 3. Data sources. Description of data: contains both a table showing the sources of ALSPAC questionnaire and clinic data used in research and links to each questionnaire or data source.

Additional file 2. STROBE Statement—Checklist of items that should be included in reports of cohort studies, Description of data: a table providing information regarding where each of the components of the report are located in the document.

Additional file 1

Background: Improving children and young people’s provision for mental health is a current health priority in England. Secondary school teachers have worse mental health outcomes than the general working population, which the Wellbeing in Secondary Education (WISE) cluster randomised controlled trial aimed to improve. The WISE intervention comprised a Mental Health First Aid (MHFA) training package to at least 16 percent of staff, a short mental health awareness session to all teachers, and development of a staff peer-support service. Twenty-five schools were randomised to intervention or control arms. This paper reports findings regarding the extent of uptake and fidelity of the intervention. Methods: Mixed methods data collection comprised researcher observations of training delivery, training participant evaluation forms, trainer and peer supporter interviews, peer supporter feedback meetings, logs of support provided, and teacher questionnaires. Quantitative data were summarised descriptively, while thematic analysis was applied to the qualitative data. Results: In the 12 schools assigned to the intervention arm, 113 (8.6%) staff completed the two-day standard MHFA training course, and a further 146 (11.1%) staff completed the one-day MHFA for Schools and Colleges training. In seven (58.3%) schools the required eight percent of staff completed the MHFA training packages. A one-hour mental health awareness raising session was attended by 666 (54.5%) staff. Delivery of the MHFA training package was achieved with high levels of fidelity and quality across schools. All schools set up the peer-support service following training, with a majority adhering to most of the operational guidelines developed from the pilot study at the outset. Teachers reported limited use of the peer support service during follow-up. At the one year follow up, only three (25.0%) schools indicated they had readvertised the service and there was evidence of a reduction in support from senior leadership. Conclusion: The MHFA training package was delivered with reasonably high fidelity, and a staff peer support service was established with general, but not complete, adherence to guidelines. In some schools insufficient staff received MHFA training and levels of delivery of the peer support service compromised intervention dose and reach.

OBJECTIVES: Few contemporary studies have examined peer and social drivers of alcohol use during mid-adolescence. We sought to explore young people's perspectives on socio-cultural influences relating to alcohol use behaviour during this period.DESIGN: Qualitative research study.METHODS: Semi-structured one-to-one (n=25), paired (n=4) or triad (n=1) interviews and one focus group (n=6) were conducted with 30 young people aged 14 to 15 (13 males, 17 females) recruited from 4 schools, and 12 participants (aged 14 to 18, 8 males, 4 females) recruited from two youth groups in an urban centre in the West of England. Nineteen participants abstained from alcohol use, 9 were occasional or moderate drinkers and 14 drank alcohol more regularly. Interviews were audio-recorded, transcribed verbatim and analysed thematically using NVivo V.10, through a lens of social influence and social norms theories.RESULTS: Alcohol consumption was associated with being cool, mature and popular, while enabling escape from reality and boosting confidence and enjoyment. Positive expectancies, alongside opportunity, contributed to motivating initiation, but social influences were paramount, with participants describing a need to 'fit in' with friends to avoid social exclusion. Such influences positioned drinking at parties as a normative social practice, providing opportunities for social learning and the strengthening of peer norms. Social media presented young people with positive alcohol-associated depictions of social status, enjoyment and maturity. This intersection of influences and norms generated a pressurised environment and a sense of unease around resisting pressures, which could elicit stigmatising insults.CONCLUSIONS: Cultural norms, social influences and social media intersect to create a pressurised environment around alcohol use during mid-adolescence, driving the escalation in the prevalence of excessive consumption at this stage. New interventions need to address normative influences to enable the prevention of excessive alcohol use during adolescence.

Additional file 5. Extent of implementation of the WISE intervention at school-level. Table indicating whether domains of fidelity, reach and dosage were achieved by intervention schools.

Additional file 3. Guidelines for peer supporters. Guidelines for peer supporters to set up a peer support service in the school as part of the WISE intervention.

Additional file 1 : Table S1. Details on the derivation of the risk behaviours. Table S2. Polychoric correlations between 12 risk behaviours (males below and females above main diagonal). Table S3. Model fit statistics for 10-item Latent Class models across three alternative samples. Figure S1. Prevalence of each risk behaviour (complete case sample, n = 1195 males / 1735 females). Figure S2. Class-specific MRB profiles – Males. Figure S3. Class-specific MRB profiles – Females. Figure S4. Bivariate residuals for 3 and 4-class males’ models (complete case sample (S1)). Figure S5. Bivariate residuals for 3 and 4-class females’ models (complete case sample (S1))

Additional file 1. Baseline school variables (for academic year just completed – 2015-2016, pre intervention). Table of characteristics.

Additional file 2. Sample for case study schools. Characteristics of case study schools.