Chris Bonell

Foulkes and colleagues argue many ‘universal’ interventions to prevent mental health problems are harmful (‘inflating prevalence’ because they raise awareness of mental health problems, encouraging those without such problems to misinterpret everyday concerns as symptoms of mental health disorders, causing avoidance of stressful situations, worsening mental health), relatively ineffective (effect sizes being smaller than for targeted interventions) and/or unacceptable to students, and should be discontinued. These arguments are based on weak evidence. While their ‘prevalence inflation’ hypothesis is potentially important and plausible when applied to awareness‐raising interventions, evidence for it is currently weak and there is a tendency to overgeneralise to broader interventions. Arguments about the relative impacts of universal and targeted interventions fail to distinguish between individual and population impacts. Arguments about unacceptability are based on selected findings from a few studies, not reflecting broader evidence. These arguments could lead to erroneous decisions to discontinue universal mental health interventions in schools when they are most needed.

Objective: Dating and relationship violence and gender-based violence are common among adolescents globally and can have significant adverse long-term consequences, including widening health inequalities. There is evidence that while school-based curriculum interventions can be effective in preventing dating and relationship violence, whole-school elements are important for preventing gender-based violence. However, implementing whole-school components may be challenging in schools with limited capacity. We designed THINK AGAIN, a multi-component programme aiming to prevent dating and relationship violence and gender-based violence in schools in England. The programme comprised an assessment and report of student needs, relationships and sex education curriculum, student-staff “Action Aware Group” and staff training. Design: We conducted a non-controlled feasibility study of THINK AGAIN. Setting: State secondary schools in south-east England. The programme targeted all students in year 9 (aged 13–14) in participating schools. Method: We recruited four schools in which to pilot and assess the feasibility and acceptability of THINK AGAIN in the 2024/2025 school year. Our embedded mixed-methods process evaluation assessed the fidelity, reach and acceptability of the intervention. Results: We found that the curriculum component was delivered with fidelity across schools. However, the whole-school component was delivered with fidelity in only two of four schools. Accordingly, acceptability and reach of the curriculum component were mostly higher among both students and staff than the Action Aware Group component. Conclusion: Fidelity, reach and acceptability of the curriculum were greater than the Action Aware Group, suggesting that progression of THINK AGAIN to a phase III trial of effectiveness requires important refinements to the whole-school component.

Background/Objectives We evaluated the impact of the COVID-19 adolescent vaccination in England at two different epidemic points: the autumn (August-November) 2021, in the presence of a large Omicron epidemic wave, and the autumn (August-November) 2022, when the subsequent Omicron epidemic was at an endemic stage. Methods Using the Covasim SARS-CoV-2 model for England, under varying vaccine uptake and onset time, we evaluated the impact of a)vaccinating 18+ only versus additional 12+ vaccination from the autumn 2021; and b)the current immunisation strategy at the time versus additional 12+ vaccination from September 2022, projecting the number of new daily SARS-CoV-2 infections, hospitalisations and deaths. Results In presence of the BA.1 Omicron wave in late 2021, the expanded adolescent vaccination averted ~3,000,000 cases across all-ages, ~1,010,000 SARS-CoV-2 infections in the period 2-6 months from vaccine onset in the vaccinated cohort. During the Omicron waves in 2022, additional adolescents vaccination did not significantly reduce the COVID-19 burden in the entire population, nor within the vaccinated cohort. Conclusions Our findings highlight that adolescent vaccination impact depends on the timing/speed of implementation, other present intervention strategies, and the status of the epidemic at the time and it should not be considered as a stand-alone immunisation strategy.

Introduction: The school environment influences adolescent health through both individual experiences, such as one’s own engagement with school, and broader school-level factors, such as aggregate student levels of engagement, affecting all students. For mental-health outcomes, existing evidence more consistently supports individual-level influences than school-level effects. In relation to depression, negative student-level educational experiences have been associated with increased symptoms, while evidence for school-level associations remains limited and often methodologically weak. We aimed to address this gap through a secondary analysis of longitudinal data from a trial involving 49 English secondary schools. Methods: Student-reported educational experiences (school belonging, educational commitment, participation at school, relationships with teachers and expectation of university) as well as family affluence were measured at baseline (ages 12–13) and depressive symptoms were assessed at follow-up (ages 15–16). Associations were examined at both the individual student and aggregate school level of educational experiences. Results: Forty-five schools were retained at endline and 4,601 students comprised our analytical sample. At the student level, greater school belonging (beta coefficient = −0.24; 95% confidence interval = −0.29, −0.19) and educational commitment (beta coefficient = −0.19; 95% confidence interval = −0.29, −0.08) were associated with lower risk of depressive symptoms in fully adjusted models. At the school level, only overall educational commitment was associated with reduced depressive symptoms in a partially but not fully adjusted model (beta coefficient = −1.02; 95% confidence interval = −1.86, −0.18). Discussion: These findings suggest that educational experiences influence depressive symptoms primarily through individual-level mechanisms, for example involving students’ sense of belonging, engagement, participation and relationships) but the general level of educational commitment within a school may also play a meaningful role. (249 words).

Background: Population-level engagement with public health interventions is needed to achieve impact. Recently, however, there has been evidence of increasing resistance to government-led public health interventions in areas such as vaccination, climate change mitigation, sexual and reproductive healthcare, and non-pharmaceutical-based infection control measures. The rise in populist attitudes that has taken place in many countries over the last two decades may be one potential explanation for this phenomenon, given the importance placed on individual freedom and national sovereignty, and a distrust of scientific, government and other elites within much populist discourse. Methods: To understand how populist-aligned views might subsequently influence the receipt of public health interventions, we systematically reviewed quantitative, longitudinal evidence across thirteen bibliographic databases and relevant websites, published between 2008 and 2024. All studies were set in Organisation for Economic Co-operation and Development (OECD) countries and results were synthesised narratively. Results: Across 16 included studies, much of the evidence focused on COVID-19. We found evidence that prior populist-aligned attitudes have a negative impact on subsequent receipt of public health interventions, such as the COVID-19 vaccine and non-pharmaceutical-based prevention measures against COVID-19 (i.e., engaging in masking and social distancing) through both existing and increasing distrust in elite institutions and actors over time. We also found preliminary evidence about the potentially negative role of populist-aligned attitudes on the receipt of other vaccinations before and during the COVID-19 pandemic. Conclusions: From a policy perspective, the findings from this review suggest the need for proactive efforts by political, scientific and medical establishments to build and maintain trust, thereby strengthening the reputation of both the public health leaders and institutions that engage with those more likely to be resistant to public health interventions to increase overall acceptance and uptake. Trial registration: PROSPERO registration number CRD4202451312.

Objective: Dating and relationship violence (DRV) and gender-based violence (GBV) are reported to be common among adolescents internationally and can have significant adverse long-term consequences, including widening gender inequalities in health outcomes. There is evidence that while school-based curriculum programmes can be effective in preventing DRV, whole-school elements such as student/staff action groups are important for preventing GBV. However, the processes of implementing whole-school components may be challenging in schools with limited capacity. We designed THINK AGAIN, a multi-component programme aiming to prevent DRV and GBV in English secondary schools. Design: Non-controlled feasibility study of THINK AGAIN. Setting: State secondary schools in south-east England. The programme targeted all students in year 9 (aged 13–14) in participating schools. Method: We recruited four schools to assess the feasibility and acceptability of THINK AGAIN in the 2024–25 school year. Our embedded process evaluation assessed programme feasibility, processes of implementation and how context influenced these. We conducted 16 interviews with school staff and analysed the data informed by the General Theory of Implementation. Results: We found that the curriculum component was feasible and prioritised for delivery by schools. However, the whole-school component faced challenges to implementation in terms of both workability and context. Conclusion: Study findings support the progression of THINK AGAIN to a phase III trial of effectiveness, pending full assessment of progression criteria and important refinements to the whole-school component.