BackgroundIllicit drug use increases the risk of poor physical and mental health. There are few effective drug prevention interventions.ObjectiveTo assess the acceptability of implementing and trialling two school-based peer-led drug prevention interventions.DesignStage 1 – adapt ASSIST, an effective peer-led smoking prevention intervention to deliver information from the UK national drug education website [see www.talktofrank.com (accessed 29 August 2017)]. Stage 2 – deliver the two interventions, ASSIST + FRANK (+FRANK) and FRANK friends, examine implementation and refine content. Stage 3 – four-arm pilot cluster randomised control trial (cRCT) of +FRANK, FRANK friends, ASSIST and usual practice, including a process evaluation and an economic assessment.SettingFourteen secondary schools (two in stage 2) in South Wales, UK.ParticipantsUK Year 8 students aged 12–13 years at baseline.Interventions+FRANK is a UK informal peer-led smoking prevention intervention provided in Year 8 followed by a drug prevention adjunct provided in Year 9. FRANK friends is a standalone informal peer-led drug prevention intervention provided in Year 9. These interventions are designed to prevent illicit drug use through training influential students to disseminate information on the risks associated with drugs and minimising harms using content from www.talktofrank.com. Training is provided off site and follow-up visits are made in school.OutcomesStage 1 – +FRANK and FRANK friends intervention manuals and resources. Stage 2 – information on the acceptability and fidelity of delivery of the interventions for refining manuals and resources. Stage 3 – (a) acceptability of the interventions according to prespecified criteria; (b) qualitative data from students, staff, parents and intervention teams on implementation and receipt of the interventions; (c) comparison of the interventions; and (d) recruitment and retention rates, completeness of primary, secondary and intermediate outcome measures and estimation of costs.Results+FRANK and FRANK friends were developed with stakeholders [young people, teachers (school management team and other roles), parents, ASSIST trainers, drug agency staff and a public health commissioner] over an 18-month period. In the stage 2 delivery of +FRANK, 12 out of the 14 peer supporters attended the in-person follow-ups but only one completed the electronic follow-ups. In the pilot cRCT, 12 schools were recruited, randomised and retained. The student response rate at the 18-month follow-up was 93% (1460/1567 students). Over 80% of peer supporters invited were trained and reported conversations on drug use and contact with trainers. +FRANK was perceived less positively than FRANK friends. The prevalence of lifetime illicit drug use was 4.1% at baseline and 11.6% at follow-up, with low numbers of missing data for all outcomes. The estimated cost per school was £1942 for +FRANK and £3041 for FRANK friends. All progression criteria were met.ConclusionsBoth interventions were acceptable to students, teachers and parents, but FRANK friends was preferred to +FRANK. A limitation of the study was that qualitative data were collected on a self-selecting sample. Future work recommendations include progression to a Phase III effectiveness trial of FRANK friends.Trial registrationCurrent Controlled Trials ISRCTN14415936.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 5, No. 7. See the NIHR Journals Library website for further project information. The work was undertaken with the support of the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer). Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UK CRC, is gratefully acknowledged.

Background. Implementing health improvement is often perceived as diverting resource away from schools’ core business, reflecting an assumption of a “zero-sum game” between health and education. There is some evidence that health behaviors may affect young people’s educational outcomes. However, associations between implementation of school health improvement and educational outcomes remains underinvestigated. Methods. The study linked school-level data on free school meal (FSM) entitlement, educational outcomes, and school attendance, obtained from government websites, with data from the School Environment Questionnaire (SEQ) on health improvement activity collected in Wales (2015/2016). Spearman’s rank correlation coefficients and linear regression models tested the extent of association between health improvement activity and attendance and educational outcomes. Results. SEQ data were provided by 100/115 network schools (87%), of whom data on educational performance were obtained from 97. The percentage of pupils entitled to FSM predicted most of the between-school variance in achievement and attendance. Linear regression models demonstrated significant positive associations of all measures of health improvement activity with attainment at Key Stage (KS) 3, apart from mental health education in the curriculum and organizational commitment to health. Student and parent involvement in planning health activities were associated with improved school attendance. There were no significant associations between health improvement and KS4 attainment. Conclusion. Implementing health improvement activity does not have a detrimental effect on schools’ educational performance. There is tentative evidence of the reverse, with better educational outcomes in schools with more extensive health improvement policies and practices. Further research should investigate processes by which this occurs and variations by socioeconomic status.

BACKGROUND: Health and education are intrinsically linked, while both are significantly patterned by socioeconomic status throughout the life course. Nevertheless, the impact of promoting health via schools on education is seen by some as a ''zero-sum game''; ie, focusing resources on health improvement activity distracts schools from their core business of educating pupils, potentially compromising educational attainment. There is emerging evidence that school health improvement interventions may beneficially influence both health and attainment. However, few studies have examined the relationship between school health improvement activity and socioeconomic inequalities in educational attainment. METHODS:Wales-wide, school-level survey data on school health policies and practices was linked with routinely collected data on academic attainment. Primary outcomes included attendance and academic attainment at age 14 (Key Stage 3) and 16 (Key Stage 4). Linear regression models were constructed separately for high and low Free School Meal (FSM) schools, adjusting for confounders. Interaction terms were fitted to test whether there was an interaction between FSM, health improvement activity, and outcomes. RESULTS:There were positive associations between almost all school health variables and KS3 attainment among high, but not low FSM schools. Similarly, for attendance, there were positive associations of several health variables among high but not low FSM schools. There were no associations for KS4 attainment. CONCLUSIONS:Our findings did not support the ''zero-sum game'' hypothesis; in fact, among more deprived schools there was a tendency for better attendance and attainment at age 14 in schools with more embedded health improvement action. T hroughout the life-course, health and education are intrinsically linked, 1 with a synergistic interaction between the two. 2 Better health a Research Associate, (longs7@cardiff.ac.uk), DECIPHer, .04 (−0.14, 0.06) 0.10 (−0.07, 0.27) 0.23 (−0.05, 0.51) 0.43 (0.02, 0.84) 0.29 (0.10, 0.48) 0.44 (0.26, 0.62) FSM 2016 −0.45 (−0.80, −0.11) −0.46 (−0.67, −0.25) −0.70 (−1.48, 0.08) −0.39 (−0.86, 0.08) −0.09 (−0.16, −0.03) −0.04 (−0.08, −0.01) Organizational commitment −0.41 (−1.15, 0.32) 1.41 (0.21, 2.61) −0.76 (−2.19, 0.67) 0.76 (−1.56, 3.08) −0.15 (−0.28, −0.02) 0.30 (0.12, 0.48) Interaction 0.10 (0.02, 0.17) 0.06 (−0.08, 0.20) 0.02 (0.01, 0.03) Significant values are indicated in bold.

In three experiments, rats were trained to discriminate between 20 and five (Exps. 1 and 2), or between 40 and five (Exp. 3), black squares. The squares were randomly distributed in the center of a white background and displayed on a computer screen. For one group, the patterns containing the higher quantity of squares signaled the delivery of sucrose (+), whilst patterns with the lower quantity of squares did not (-). For the second group, sucrose was signaled by the lower, but not by the higher, quantity of squares. In Experiment 1, the intertrial interval (ITI) was a white screen, and the 20+/5-discrimination was acquired more readily than the 5+/20-discrimination. For Experiment 2, the ITI was made up of 80 black squares on a white background. In this instance, the 5+/20-discrimination was acquired more successfully than the 20+/5-discrimination. In Experiment 3, two groups were trained with a 40+/5-discrimination, and two with a 5+/40-discrimination. For one group from each of these pairs, the training trials were separated by a white ITI, and the 40+/5-discrimination was acquired more readily than the 5+/40-discrimination. For the remaining two groups, the training trials were not separated by an ITI, and the two groups acquired the task at approximately the same rate. The results indicate that the cues present during the ITI play a role in the asymmetrical acquisition of magnitude discriminations based on quantity.

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