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Stress is a widespread phenomenon and young people especially are experiencing high levels of stress. School-related factors are the most frequently self-reported stressors among adolescents, but few interventions have targeted the school environment. This study evaluated the effectiveness of the Healthy High School (HHS) intervention on stress at a 9-month follow-up. The study included 5201 first-year high school students (~16 years) in Denmark. Participating schools were randomized into the HHS intervention (N = 15) or control group (N = 15). Baseline measurements were conducted in August 2016 and the follow-up was conducted in May 2017. The intervention was designed to promote well-being (primary outcome) by focusing on physical activity, meals, sleep, sense of security, and stress (secondary outcomes). The intervention comprised: structural initiatives at the school level; a teaching material; peer-led innovation workshops; and a smartphone app. The 10-item Perceived Stress Scale was used to measure stress. Intervention effects on perceived stress were estimated using an intention-to-treat approach with multiple imputations of missing data and multilevel general linear regression modelling. A total of 4577 students answered the baseline questionnaire. No statistically significant difference was found in stress between students at intervention and control schools at the follow-up (mean score: 16.7 versus 16.7, adjusted b = 0.42, 95% CI: −0.16;1.00). The HHS Study is one of the first large randomized controlled trials targeting school environmental stressors. Potential implementation failures and the failures of the program theory are discussed.

Health-promoting initiatives focusing on physical activity include advice on integrating active behaviour into everyday activities pointing to a tendency to combine a health agenda with other agendas. From a public-health perspective, this might be a valuable strategy, but it calls for a conceptual awareness and exploration of the target groups’ perceptions of this broader concept of physical activity. Nested in a Danish intervention study aimed at increasing well-being among high-school students aged 16–17 through the promotion of movement, this study engages in a conceptual exploration of ‘movement in everyday lives’ related to well-being. Combining participant observation and photo-elicitation interviews, the study investigates different kinds of meaning experienced in relation to movement. Theoretically, the study is framed by existential phenomenology with a focus on corporeality, temporality and intersubjectivity. An existential theory of well-being is applied to a discussion of the relationship between bodily movement and well-being. The findings point to movement as a way for students to balance two existential modes within the dimensions of corporeality, temporality and intersubjectivity: one of activity and tenseness, and one of break and stillness. For the students, movement entails bodily experiences ranging from modes of self-forgetfulness to the body demanding attention in different ways; they experience movement as a break from everyday obligations, but also as a way of moving forward; and they experience movement as an occasion for being social and for withdrawing from the social worlds.

Peer-led interventions are highlighted as promising strategies to promote health among adolescents, but little is known about the mechanisms underlying this approach. To better understand the role of peer mentors (PMs) as implementers in school-based health promotion, we combined participant observations, focus group interviews and video recordings to explore high school students' reception of a peer-led intervention component (YoungActive). YoungActive aimed to increase well-being among first-year high school students (∼16 years of age) through the promotion of movement and sense of community and was implemented during the school year 2016-2017 in a larger school-based intervention study, the Healthy High School study in Denmark. The Healthy High School study was designed as a cluster-randomized controlled trial with 15 intervention schools and 15 control schools. At each intervention school, university students in Sports Science and Health (members of the research group) facilitated an innovation workshop aiming at inspiring all first-year students to initiate movement activities at schools. The findings illustrate potentials and challenges implied in the PM role. The peer mentors' profound commitment, as well as their response and sensibility to situational contingencies, were found to be significant for the students' reception and experience of the intervention. In conclusion, the specific job of PMs as implementers seems to consist of simultaneously following a manual and situationally adjusting in an emerging context balancing commitment and identification to the target group and the intervention project.Peer-delivery of health promotion is highlighted as a promising strategy to reach adolescents, but little is known about the mechanisms underlying this approach. To better understand the role of peer mentors (PMs) as implementers, we used qualitative methods to explore high school students’ reception of a peer-led workshop (YoungActive) in a school-based intervention in Denmark. YoungActive aimed to increase well-being among first-year high school students (∼16 years of age) through the promotion of movement and sense of community and was implemented during the school year 2016–2017. At each intervention school, university students in Sports Science and Health facilitated an innovation workshop to inspire all first-year students to initiate movement activities at schools. We found different potentials and challenges implied in the PM approach. Balancing peer mentors’ commitment and identification to the recipients and the intervention seems central.

Ensuring the sustainability of school-based public health intervention activities remains a challenge. The Young and Active (Y&amp, A) intervention used peer-led workshops to promote movement and strengthen students’ sense of community in 16 Danish high schools. Peer mentors inspired first-year students to implement movement activities. To support sustainability, we applied a three-year stepwise implementation strategy using university students as peer mentors in year 1 and senior high school students in the following two years. This study explores the sustainability potential of Y&amp, A, focusing on school coordinators’ reflections on the intervention’s fit to their schools and the student-driven approach, and we assess the three-step implementation strategy. The study is based on telephone interviews with coordinators (n = 7) from schools that participated in all three years and participant observations of four workshops (a total of approximately 250 participating students). Results were generated through an abductive analysis. Seven schools continued the intervention throughout the three years and adapted it to fit their priorities. The student-driven approach was perceived to be valuable, but few student-driven activities were initiated. Teacher support seemed crucial to support students in starting up activities and acting as peer mentors in workshops. The three-step implementation strategy proved valuable due to the peer-approach and the possibility of gradual adaptation. In future similar initiatives, it is important to address how the adequate staff support of students can be facilitated.