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Purpose: The teaching of cooking is an important aspect of school-based efforts to promote healthy diets among children, and is frequently done by external agencies. Within a limited evidence base relating to cooking interventions in schools, there are important questions about how interventions are integrated within school settings. The purpose of this paper is to examine how a mobile classroom (Cooking Bus) sought to strengthen connections between schools and cooking, and drawing on the concept of the sociotechnical network, theorise the interactions between the Bus and school contexts. Design/methodology/approach: Methods comprised a postal questionnaire to 76 schools which had received a Bus visit, and case studies of the Bus' work in five schools, including a range of school sizes and urban/rural locations. Case studies comprised observation of Cooking Bus sessions, and interviews with school staff. Findings: The Cooking Bus forged connections with schools through aligning intervention and schools' goals, focussing on pupils' cooking skills, training teachers and contributing to schools' existing cooking-related activities. The Bus expanded its sociotechnical network through post-visit integration of cooking activities within schools, particularly teachers' use of intervention cooking kits. Research limitations/implications: The paper highlights the need for research on the long-term impacts of school cooking interventions, and better understanding of the interaction between interventions and school contexts. Originality/value: This paper adds to the limited evidence base on school-based cooking interventions by theorising how cooking interventions relate to school settings, and how they may achieve integration.

The objective of the study was to develop and evaluate an effective whole-community approach to identifying a diverse group of influential young people to effectively diffuse health promotion messages among their peers. A peer nomination questionnaire, developed through extensive piloting work, was completed by 10 730 Year 8 students (aged 12-13 years) in 59 schools (30 intervention, 29 control) as part of a cluster randomized controlled trial. Influential students identified in 30 intervention schools were trained to disseminate smoke-free health promotion messages through informal contacts with peers. This approach successfully identified, recruited and retained a diverse group of students, broadly representative of their year group, to undertake the role of "peer supporter". Although students and staff expressed doubts about the suitability of some young people recruited as peer supporters, the intervention achieved a 22% reduction in the odds of being a regular smoker in intervention compared with control schools [odds ratio 0.78 (95% CI 0.64-0.96)]. Carefully designed and developed peer-led interventions have potential for delivering effective smoking prevention among adolescents. Paying close attention to the way in which peer educators are identified, and involving young people themselves in this process, may be the key to increasing the effectiveness of peer education.

Objective: The complexity and scale of health promotion interventions present challenges for the standardization of delivery. Furthermore, health promotion practice favours adapting interventions according to perceived client need. This paper examines the fidelity of intervention delivery within A Stop Smoking in Schools Trial (ASSIST), identifying if and why variations occurred, the consequences of these variations for the integrity of the intervention, and the broader implications for the delivery of evidence-based health promotion in schools. Design: The ASSIST intervention involved influential Year 8 students being trained to encourage their peers, through informal conversations, to be smoke-free. Its effectiveness was evaluated by a pragmatic randomized controlled trial with an integral process evaluation to examine the context, implementation and receipt of the intervention. Setting: Thirty secondary schools in South Wales and the west of England. Method: A variety of methods, including interviews, questionnaires and observation, were used to obtain data from key participants. Qualitative data were analysed using the constant comparative method. Results: Whilst overall fidelity was high, some variations were observed. Despite this variation, the intervention was largely delivered successfully and appropriately across a range of schools. Lessons learned from ASSIST enabled us to develop a model to categorize variations in intervention delivery. Conclusion: The model developed can inform the design of health promotion interventions and identify the level of fidelity which should be expected outside of a trial. We believe that this model can contribute to good practice in the implementation of evidence-based health promotion in schools. (Contains 8 tables and 1 figure.)

Objective: Although current UK policy argues that schools have a key role in raising health standards, emphasis on the core curriculum restricts teachers' opportunities to undertake health promotion activities. The challenge is to design effective health promotion interventions that minimize pressures on teaching staff and curriculum space. Here we consider teachers' perspectives of an effective peer-led, school-based smoking intervention, implemented by external trainers. Design: The intervention, during which influential Year 8 students identified through a whole-year peer nomination process were trained to reduce smoking uptake through informal interactions with students in their year group, was evaluated by a pragmatic randomized controlled trial (ASSIST: A Stop Smoking In Schools Trial). An integral process evaluation examined the context, implementation and receipt of the intervention. Setting: Thirty secondary schools in south-east Wales and the west of England. Methods: Teachers in all intervention schools completed questionnaires at key stages of the intervention. Semi-structured interviews were undertaken in four schools at baseline and immediately post-intervention. The method of constant comparison, derived from grounded theory, was used throughout the analysis. Results: The intervention was successfully implemented in a wide range of schools; recruitment and retention rates were good; and outcome data showed a reduction in smoking levels. Some teachers expressed concern about the participation of challenging students, external trainers setting standards of discipline, and communication over timetabling. Conclusion: Overall, teachers showed commitment to the ASSIST intervention and felt it was compatible with the Year 8 curriculum. If implemented more widely, the importance of peer nomination should be stressed. (Contains 5 tables and 2 figures.)

It is increasingly argued that the effectiveness of health promotion interventions should be measured to inform policy and practice. The randomized controlled trial (RCT) continues to be regarded as the "gold standard" of health services research but health promotion practitioners have raised concerns about the RCT's appropriateness for evaluating their work. A preferred model is currently the pragmatic trial, measuring effectiveness under "routine" conditions, incorporating a process evaluation to examine context, implementation and receipt. This model was chosen by A Stop Smoking in Schools Trial (ASSIST) to evaluate an intervention in which influential Year 8 students (12-13 years old) were trained to encourage non-smoking behaviour through informal conversations with their peers. Outcome data show that the intervention was effective in reducing smoking levels in intervention schools compared with control schools. In this paper we describe the extensive process evaluation embedded within the trial and, rather than focusing on resultant data, we consider the potential for such detailed examination of process to affect the intervention's delivery, receipt and outcome evaluation. We describe how some acknowledged challenges were addressed within ASSIST, which have relevance for future similar trials: Hawthorne effects, overlapping roles within the team and distinguishing between the intervention and its evaluation.

UK Biobank is an intensively characterised prospective cohort of 500,000 adults aged 40-69 years when recruited between 2006 and 2010. The study was established to enable researchersworldwide to undertake health-related research in the public interest. The existence of such a large, detailed prospective cohort with a high degree of participant engagement enabled its rapid repurposing for coronavirus disease-2019 (COVID-19) research. In response to the pandemic, the frequency of updates on hospitalisations and deaths among participants was immediately increased, and new data linkages were established to national severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) testing and primary care health records to facilitate research into the determinants of severe COVID-19. UK Biobank also instigated several sub-studies on COVID-19. In 2020, monthly blood samples were collected from approximately 20,000 individuals to investigate the distribution and determinants of SARS-CoV-2 infection, and to assess the persistence of antibodies following infection with another blood sample collected after 12 months. UK Biobank also performed repeat imaging of approximately 2,000 participants (half of whom had evidence of previous SARS-CoV-2 infection and half did not) to investigate the impact of the virus on changes in measures of internal organ structure and function. In addition, approximately 200,000 UK Biobank participants took part in a self-test SARS-CoV-2 antibody sub-study (between February and November 2021) to collect objective data on previous SARS-CoV-2 infection. These studies are enabling unique research into the genetic, lifestyle and environmental determinants of SARSCoV-2 infection and severe COVID-19, as well as their long-term health effects. UK Biobank's contribution to the national and international response to the pandemic represents a case study for its broader value, now and in the future, to precision medicine research. [ABSTRACT FROM AUTHOR]

Although peer education has enjoyed considerable popularity as a health promotion approach with young people, there is mixed evidence about its effectiveness. Furthermore, accounts of what young people actually do as peer educators are scarce, especially in informal settings. In this paper, we examine the activities of the young people recruited as 'peer supporters' for A Stop Smoking in Schools Trial (ASSIST) which involved 10,730 students at baseline in 59 secondary schools in south-east Wales and the west of England. Influential Year 8 students, nominated by their peers, were trained to intervene informally to reduce smoking levels in their year group. The ASSIST peer nomination procedure was successful in recruiting and retaining peer supporters of both genders with a wide range of abilities. Outcome data at 1-year follow-up indicate that the risk of students who were occasional or experimental smokers at baseline going on to report weekly smoking at 1-year follow-up was 18.2% lower in intervention schools. This promising result was supported by analysis of salivary cotinine. Qualitative data from the process evaluation indicate that the majority of peer supporters adopted a pragmatic approach, concentrating their attentions on friends and peers whom they felt could be persuaded not to take up smoking, rather than those they considered to be already 'addicted' or who were members of smoking cliques. ASSIST demonstrated that a variety of school-based peer educators, who are asked to work informally rather than under the supervision of teaching staff, will engage with the task they have been asked to undertake and can be effective in diffusing health-promotion messages. Given the serious concerns about young people's smoking behaviour, we argue that this approach is worth pursuing and could be adapted for other health promotion messages. Keywords: Peer education; Smoking; Adolescents; Process evaluation; Friendship groups; Health promotion; UK

Abstract Background Smoke-free legislation was introduced in Wales in April 2007. In response to concerns regarding potential displacement of smoking into the home following legislation, this study assessed changes in secondhand smoke (SHS) exposure amongst non-smoking children. Methods Approximately 1,750 year 6 (aged 10-11) children from 75 Welsh primary schools were included in cross-sectional surveys immediately pre-legislation and one year later. Participants completed self-report questionnaires and provided saliva samples for cotinine assay. Regression analyses assessed the impact of legislation on children's SHS exposure at the population level, and amongst subgroups defined by parental figures who smoke within the home. Results Geometric mean salivary cotinine concentrations were 0.17 ng/ml (95% CI 0.15,0.20) pre-legislation and 0.15 ng/ml (95% CI 0.13,0.17), post-legislation, although this change was not statistically significant. Significant movement was however observed from the middle (0.10-0.50 ng/ml) to lower tertile, though not from the higher end (>0.51 ng/ml) to the middle. Reported exposure to SHS was greatest within the home. Home-based exposure did not change significantly post-legislation. Reported exposure in cafés or restaurants, buses and trains, and indoor leisure facilities fell significantly. The proportion of children reporting that parent figures smoked in the home declined (P = 0.03), with children with no parent figures who smoke in the home significantly more likely to provide saliva with cotinine concentrations of Amongst children with no parent figures who smoke in the home, the likelihood of 'not knowing' or 'never' being in a place where people were smoking increased post-legislation. Conclusion Smoke-free legislation in Wales did not increase SHS exposure in homes of children aged 10-11. Reported SHS exposure in public places fell significantly. The home remained the main source of children's SHS exposure. The legislation was associated with an unexpected reduction in cotinine levels among children with lower SHS exposure pre-legislation. The findings indicate positive rather than harmful effects of legislation on children's SHS exposure, but highlight the need for further action to protect those children most exposed to SHS.

Aims: To investigate whether effects of the ASSIST (A Stop Smoking In Schools Trial) school‐based smoking prevention intervention diffused from students to the people they lived with. Design Secondary analysis of a cluster‐randomized control trial (cRCT). Setting: England and Wales. Participants: A total of 10 730 students aged 12–13 years in 59 schools assigned using stratified block randomization to the control (29 schools, 5372 students) or intervention (30 schools, 5358 students) condition. Intervention and comparator: The ASSIST intervention involves 2 days of off‐site training of influential students to encourage their peers not to smoke during a 10‐week period. The control group continued with their usual education. Measurements The outcomes were the proportion of students who self‐reported living with a smoker and the smoking status of each resident family member/caregiver. Follow‐up assessments were immediately after the intervention and at 1 and 2 years post‐intervention. Findings The odds ratio (OR) for living with a smoker in the intervention compared with the control groups was 0.86 [95% confidence interval (CI) = 0.72, 1.03] immediately after the intervention, OR = 0.84 (95% CI = 0.72, 0.97) at a 1‐year follow‐up and OR = 0.86 (95% CI = 0.75, 0.99) at 2‐year follow‐up. In a three‐tier multi‐level model with data from all three follow‐ups, student‐reported smoking by fathers (OR = 0.90, 95% CI = 0.80, 1.00), brothers (OR = 0.78, 95% CI = 0.67, 0.92) and sisters (OR = 0.80, 95% CI = 0.69, 0.92) was lower in the intervention compared with control group. Subgroup analyses by baseline smoking status suggested that these effects were more consistent with prevention of uptake than prompting cessation. Conclusions: A Stop Smoking In Schools Trial (ASSIST) school‐based smoking prevention intervention may have reduced the prevalence of smoking in people who lived with ASSIST‐trained students. This indirect transmission is consistent with the predictions of diffusion of innovations theory which underpins the design of ASSIST. [ABSTRACT FROM AUTHOR]

Methods used to select opinion leaders for informal behavior change interventions vary, affecting the role they adopt and the outcomes of interventions. The development of successful identification methods requires evidence that these methods achieve their aims. This study explored whether the "whole community" nomination process used in the ASSIST smoking prevention program successfully identified "peer supporters" who were well placed within their school social networks to diffuse an antismoking message to their peers. Data were collected in the United Kingdom during A Stop Smoking in Schools Trial. Behavioral data were provided at baseline and post intervention by all students. Social network data were provided post intervention by students in four control and six intervention schools. Centrality measures calculated using UCINET demonstrate that the ASSIST nomination process successfully identified peer supporters who were more socially connected than others in their year and who had social connections across the entire year group including the program's target group. The results indicate that three simple questions can identify individuals who are held in high esteem by their year group and who also have the interpersonal networks required of opinion leaders to successfully disseminate smoke-free messages through their social networks. This approach could be used in other informal health promotion initiatives. [ABSTRACT FROM AUTHOR]

Objectives: To examine the prevalence of electronic(e)-cigarette use, prevalence of e-cigarette and tobacco use by age, and associations of e-cigarette use with sociodemographic characteristics, tobacco and cannabis use among young people in Wales. Design: Data from two nationally-representative cross-sectional surveys undertaken in 2013-2014. Logistic regression analyses, adjusting for school-level clustering, examined sociodemographic characteristics of e-cigarette use, and associations between e-cigarette use and smoking. Setting: Primary and secondary schools in Wales. Participants: Primary-school children aged 10-11 (n=1601) and secondary-school students aged 11-16 (n=9055). Results: Primary-school children were more likely to have used e-cigarettes (5.8%) than tobacco (1.6%). Ever use of e-cigarettes remained more prevalent than ever use of tobacco until age 14-15. Overall, 12.3% of secondary-school students (aged 11-16) reported ever using e-cigarettes, with no differences according to gender, ethnicity or family affluence. The percentage of 'never smokers' reporting having used e-cigarettes was 5.3% at age 10-11 to 8.0% at age 15-16. The proportion of children who had ever used an e-cigarette and reported currently smoking increased from 6.9% among 10-11 year olds to 39.2% in 15-16 year olds. Only 1.5% (n=125) of 11-16 year-olds, including 0.3% of never smokers, reported regular e-cigarette use (use at least once a month). Current weekly smokers were 100 times more likely than non-smokers to report regular e-cigarette use (relative risk ratio (RRR=121.15; 95% CI 57.56 to 254.97). Regular e-cigarette use was also more likely among those who had smoked cannabis (RRR 53.03; 95% CI 38.87 to 80.65). Conclusions: Many young people (including never-smokers) have tried e-cigarettes. However, regular use is less common, and is associated with tobacco cigarette use. Longitudinal research is needed to understand age-related trajectories of e-cigarette use and to understand the temporal nature of relationships between e-cigarette and tobacco use. [ABSTRACT FROM AUTHOR]