Aims: To evaluate the effectiveness and cost-effectiveness of alcohol screening and brief intervention for adolescents delivered within the school setting. Method: Multi-centre, pragmatic, prospective randomised controlled trial conducted across different regions of England. We evaluated the effectiveness and cost-effectiveness of an Alcohol Screening and Brief Intervention (ASBI) in addition to Personal Health and Social Education (PHSE) compared to PHSE alone for adolescents aged 15 years in school. Our primary outcome was quantity of alcohol consumed at 12-months, assessed in units of alcohol. We also assessed alcohol-related problems, drinking motives and health and wellbeing. The trial was registered with current controlled trials (ISRCTN45691494). Results: While 60% of the study population had reduced their alcohol consumption at month 12, we found no difference in effectiveness between ASBI and PHSE for any of our outcome measures. The ASBI was not found to be cost-effective compared to PHSE. Conclusions: The results of the study suggest that it is not worthwhile implementing ASBI in a school setting. This concurs with other recent evidence of the effectiveness of ASBI for adolescent populations.

The United Kingdom has seen a decrease in the number of young people drinking alcohol. However, the UK prevalence of underage drinking still ranks amongst the highest in Western Europe. Whilst there is a wealth of evidence reporting on the effectiveness of both primary, and secondary interventions, there is little evidence reporting the experiences of young people who receive them. The present study reports the results of interviews with 33 young people who were involved in an alcohol screening and brief intervention randomised controlled trial in England. All interviews were analysed using inductive applied thematic analysis. Three major themes emerged following the analysis process: drinking identities and awareness of risk; 2) access to support and advice in relation to alcohol use; and 3) appraisal of the intervention and potential impact on alcohol use. There appeared to be a reluctance from participants to describe themselves as someone who drinks alcohol. Furthermore, those who did drink alcohol often did so with parental permission. There was variation amongst participants as to how comfortable they felt talking about alcohol issues with school staff. Overall participants felt the intervention was useful, but would be better suited to 'heavier' drinkers.

Background: Adverse effects from young people's alcohol consumption manifest in a range of physical and psychosocial factors, including neurological issues, cognitive impairment and risk-taking behaviours. The SIPS JR-HIGH pilot trial showed alcohol screening and brief intervention (ASBI) to be acceptable to young people and schools in the north-east of England. Objectives: To conduct a two-arm, individually randomised controlled trial to evaluate the effectiveness and cost-effectiveness of ASBI for risky drinking in young people aged 14–15 years in the school setting, to monitor the fidelity of ASBI and to explore the barriers to, and facilitators of, implementation with staff, young people and parents. Design: A baseline survey with a 12-month follow-up. Interviews with 30 school staff, 21 learning mentors and nine teachers, and 33 young people and two parents. Setting: Thirty state schools in four areas of England: north-east, north-west, Kent and London. Participants: Year 10 school pupils who consented to the study (aged 14–15 years, recruited between November 2015 and June 2016), school-based staff and parents of the young people who took part in the study. Interventions: Young people who screened positively on a single alcohol screening question and consented were randomised to the intervention or control arm (blinded). The intervention was a 30-minute one-to-one structured brief intervention with a trained learning mentor and an alcohol leaflet. The control group received a healthy lifestyle leaflet (no alcohol information). Main outcome measures: The primary outcome measure was total alcohol consumed in the last 28 days. Secondary outcomes related to risky drinking, general psychological health, sexual risk-taking, energy drink consumption, age of first smoking, quality of life, quality-adjusted life-years, service utilisation and demographic information. Results: A total of 4523 young people completed the baseline survey, with 1064 screening positively (24%) and 443 being eligible to take part in the trial. Of those 443, 233 (53%) were randomised to the control arm and 210 were randomised to the intervention arm. Of the 443, 374 (84%) were successfully followed up at 12 months (intervention, n = 178; control, n = 196). The results were that the intervention showed no evidence of benefit for any alcohol-related measure when compared with the control arm. At 12 months we found a reduction from 61.9% to 43.3% using the Alcohol Use Disorders Identification Test cut-off point of 8 and cut-off point of 4 (69.0% to 60.7%). These results were not significant. A cost-effectiveness analysis showed that the average net cost saving of the brief intervention was £2865 (95% confidence interval –£11,272 to £2707) per year compared with usual practice, with the intervention showing a 76% probability of being cost saving compared with usual practice. The interview findings showed that school was an acceptable setting to carry out ASBI among staff and young people. Limitations: Recruitment of parents to take part in interviews was poor. Only 18 ASBI sessions were recorded, making it difficult to assess internal validity. Conclusions: Although the intervention was ineffective in reducing risky drinking in young people aged 14–15 years, it was well received by the young people and school staff who participated.

Background: Adolescence is a critical developmental stage when young people make lifestyle choices that have the potential to impact on their current and future health and social wellbeing. The relationship between substance use and criminal activity is complex but there is clear evidence that the prevalence of problematic substance use is far higher among adolescent offenders than the general adolescent population. Adolescent offenders are a marginalized and vulnerable population who are significantly more likely to experience health and social inequalities in later life than their non-offending peers. There is a paucity of evidence on effective interventions to address substance use and risk-taking behaviours in adolescent offender populations but it is clear that preventative or abstinence orientated interventions are not effective. RISKIT-CJS is an intervention developed in collaboration with young people taking account of the current best evidence. Feasibility and pilot studies have found the intervention addresses the needs of adolescents, is acceptable and has demonstrated potential in reducing substance use and risk-taking behavior. Methods: The study is a mixed method, two-armed, prospective, pragmatic randomized controlled trial with individual randomisation to either treatment as usual alone or the RISKIT-CJS intervention in addition to treatment as usual. Adolescents, aged 13 to 17 years inclusive, engaged with the criminal justice system who are identified as having problematic substance use are eligible to participate. The study will be conducted across three geographical areas; South and South East England, London and North East England between March 2017 and February 2019. Discussion: The study represents an ambitious programme of work to address an area of need for a marginalized and vulnerable population.

Introduction: Drinking has adverse impacts on health, well-being, education and social outcomes for adolescents. Adolescents in England are among the heaviest drinkers in Europe. Recently, the proportion of adolescents who drink alcohol has fallen, although consumption among those who do drink has actually increased. This trial seeks to investigate how effective and efficient an alcohol brief intervention is with 11–15?years olds to encourage lower alcohol consumption. Methods and analysis: This is an individually randomised two-armed trial incorporating a control arm of usual school-based practice and a leaflet on a healthy lifestyle (excl. alcohol), and an intervention arm that combines usual practice with a 30?min brief intervention delivered by school learning mentors and a leaflet on alcohol. At least 30 schools will be recruited from four regions in England (North East, North West, London, Kent and Medway) to follow-up 235 per arm. The primary outcome is total alcohol consumed in the last 28?days, using the 28?day Timeline Follow Back questionnaire measured at the 12-month follow-up. The analysis of the intervention will consider effectiveness and cost-effectiveness. A qualitative study will explore, via 1:1 in-depth interviews with (n=80) parents, young people and school staff, intervention experience, intervention fidelity and acceptability issues, using thematic narrative synthesis to report qualitative data. Ethics and dissemination: Ethical approval was granted by Teesside University. Dissemination plans include academic publications, conference presentations, disseminating to local and national education departments and the wider public health community, including via Fuse, and engaging with school staff and young people to comment on whether and how the project can be improved.

Background - RISKIT-CJS was a cluster randomised trial of a multi-component risk reduction programme for adolescents (aged 13-17), involved with the criminal justice system in England. Its main quantitative finding was acceptance of the null hypothesis of no effect on alcohol and substance use. Here we report on the realist, qualitative evaluation of the RISKIT-CJS programme to explore what can be learnt about how such programmes may not produce effects for their target group. Methods - the qualitative evaluation used: records of meetings and focus groups (purposive sample), practitioner interviews and observational fieldnotes of programme delivery. Data were abductively coded, using a realist framework to identify the configurations of context, mechanisms, moderators and outcomes through which the programme worked in practice. Results - This paper presents that refined realist programme theory. Relevant contexts included: geographical and institutional setting of the intervention sites (organising group work, staff ability, motivation and capacity), and the individual participant contexts (complex needs, maturity, motivation and risk profile). The intended mechanisms included: motivation to change; learning consequences; educational engagement; better communication; improved self-efficacy; and positive peer influence. The triggering of these mechanisms was affected by positive moderators (strong local programme champions, ageing out of crime for older participants) and negative moderators (disorganised, understaffed setting, and ageing into crime for younger participants). Potential negative mechanisms, included: negative peer effects and treatment fatigue. Different combinations of contexts, mechanisms and moderators led to different outcomes for different participants which are not adequately explained by an interpretation of the null quantitative result that the programme had 'no effect'. Conclusion - The paper demonstrates how realist, qualitative research can provide useful learning for policy and practice, even when the overall, quantitative result of a trial of a preventive intervention is null.

Purpose: To think collectively and creatively about working in different ways in order to improve our response to multiple overlapping issues that lead directly and indirectly to poor health and wellbeing in young people. Context: Difficult economic conditions for many people in Europe have been created by government measures to reduce public expenditure. Large cuts to social security, a lack of earnings growth, minimal or no job security, and high housing and living costs are leading to people becoming locked in a cycle of poverty and neglect in an era of rising inequality. In efforts to survive in a time of austerity, many local councils in the UK have made cuts to children and young people's services that have taken away some of the 'lifeline' support for vulnerable children and families, as well as some of the educational and recreational opportunities for young people. Prevention services such as preventive substance misuse, teenage pregnancy services and youth offending teams have also been reduced in many areas. This summer, analysis of the Millennium Cohort Study – a multi-disciplinary research project following the lives of around 19,000 children born in the UK in 2000-01 – found that a quarter of girls and 9% of boys were depressed at age 14. A recent Children's Society survey of 11,000 14 year olds found that 22% of girls and nearly one in 10 boys had self-harmed in a year. GPs in the UK often talk about their feeling of helplessness when faced with increasing numbers of patients presenting with poor health and wellbeing caused by adverse life circumstances. Many of these issues are not medical, but they fill up the country's surgeries nonetheless. Some GPs have coined a phrase to describe the condition of these patients: 'shit-life syndrome'. It describes a situation where someone has so many things not working out for them that even an attempt to change one thing is often wiped out by the remaining factors causing them harm. Some areas with large numbers of patients in such situations have seen anti-depressant prescribing increase significantly. State of the art: In this workshop, we will briefly introduce the problem, with the help of a short video focused on a seaside town in England, and encourage participants to think about the nature of the situation. We will then describe three very different projects that CHSS are currently working on, and identify relevant learning and key challenges emerging from them. The group will then have time to think collectively about working in different ways in order to contribute to a better future for young people. There will be opportunities for small and whole group discussion and feedback, and questions to the CHSS team.

Alcohol is something that most adults use in their social life and can turn the quietest person into a party animal. Often drinking is a low risk pastime but for some it can be problematic. However, alcohol and risk management is experienced differently by young people. Today's interactive talk introduces you to RISKIT-CJS, a research project evaluating the effectiveness of an intervention that aims to equip young people involved with the criminal justice system with the skills to manage their substance use and to reduce risky behaviours. Using our tools, you will decide how risky is risky?

In an environment of growing relative poverty, rising inequalities, high housing and living costs, increases in in-work poverty and cuts to social security, education, training and young people's services, GPs in the UK are often faced with patients who present with 'low mood' caused by adverse life circumstances. Many GPs have dubbed this 'Shit-Life Syndrome'. This presentation considers the potential of three different projects being delivered or evaluated by the Centre for Health Service Studies to build understanding of the complex and dynamic ways in which these issues are interconnected. These projects include: 'RISKIT' – a 'multi-component' approach to addressing alcohol and substance use and risk-taking behaviour among young offenders; 'Go Golborne' – a 'place-based' approach to improving child health by reducing child obesity; and 'EXCEPT' – policy initiatives to help young people in Europe to overcome labour market insecurities and related risks. Together they present opportunities to reject reductionism in our approaches to dealing with complexity.

Pragmatic randomised control trials are recognised as high quality evaluative research of interventions in real-life settings. They are also recognised as complex, costly, and the recruitment process is often challenging. However, the findings and outcomes of such research can have important implications for the study population. Facilitators and barriers to recruitment can be experienced across the various trial stages, recruitment processes and within the relational networks required for multi stakeholder collaboration. The facilitators and barriers affecting recruitment can impact the trial, the site, the participant, the clinical team, flow of information, consent, and the research team. Working collaboratively with multiple stakeholders across multiple sites provides the potential for a wealth of recruitment opportunities. Relational networking provides a realistic view of the study population in context as well as an insight into stakeholders own challenges and demands when facilitating trial recruitment. When adding into the mix the trial requirements i.e. rigorous methods, ethics, respect of the research protocol and stringent data management and collection processes required for the trial, it is understandable that barriers will inevitably arise during the early recruitment process. We will illustrate how facilitators and barriers have impacted upon the early stages of the recruitment of young people in the criminal justice system using recent examples from RISKIT-CJS. We will present early recommendations based on our experience that fluidity and flexibility reduces barriers and encourages facilitating strategies