Objective: To systematically review systematic reviews of school-based sexual-health and relationship Education (SHRE) programmes and, thereby, identify interventions and intervention components that promote reductions in risky sexual behaviour among young people. Methods: Electronic bibliographies were searched systematically to identify systematic reviews of school-based interventions targeting sexual-health. Results were summarised using a narrative synthesis. Results: Thirty-seven systematic reviews (summarising 224 primary randomised controlled trials) met our inclusion and quality assessment criteria. In general, these reviews analysed distinct sets of primary studies, and no comprehensive review of available primary studies was identified. Interventions were categorised into five types that segment this review literature. Unfortunately, many reviews reported weak and inconsistent evidence of behaviour change. Nonetheless, integration of review findings generated a list of 32 design, content and implementation characteristics that may enhance effectiveness of school-based, sexual-health interventions. Abstinence-only interventions were found to be ineffective in promoting positive changes in sexual behaviour. By contrast, comprehensive interventions, those specifically targeting HIV prevention, and school-based clinics were found to be effective in improving knowledge and changing attitudes, behaviours and health-relevant outcomes. Conclusions: School-based interventions targeting risky sexual behaviour can be effective. Particular design, content and implementation characteristics appear to be associated with greater effectiveness. We recommend consideration of these characteristics by designers of school-based sexual-health interventions.

Background: Digital interventions offer a solution to address the high demand for mental health promotion, especially when facing physical contact restrictions or lacking accessibility. Engagement with digital interventions is critical for their effectiveness; however, retaining users’ engagement throughout the intervention is challenging. It remains unclear what strategies facilitate engagement with digital interventions that target mental health promotion. Objective: Our aim is to conduct a scoping review to investigate user engagement strategies and methods to evaluate engagement with digital interventions that target mental health promotion in adults. Methods: This scoping review adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. The search was conducted in 7 electronic databases from inception to April 2020. The inclusion criteria for studies were as follows: adult (aged ≥18 years) users of digital interventions for mental health promotion from the general population; any digital intervention for mental health promotion; and user engagement strategies described in the intervention design. We extracted the following data items: study characteristics, digital intervention (type and engagement strategy), evaluation of engagement strategy (method and result specifying whether the strategy was effective at facilitating engagement), and features of engagement (extent of use and subjective experience of users). Results: A total of 2766 studies were identified, of which 16 (0.58%) met the inclusion criteria. The 16 studies included randomized controlled trials (6/16, 37%), studies analyzing process data (5/16, 31%), observational studies (3/16, 19%), and qualitative studies (2/16, 13%). The digital interventions for mental health promotion were either web based (12/16, 75%) or mobile app based (4/16, 25%). The engagement strategies included personalized feedback about intervention content or users’ mental health status; guidance regarding content and progress through e-coaching; social forums, and interactivity with peers; content gamification; reminders; and flexibility and ease of use. These engagement strategies were deemed effective based on qualitative user feedback or responses on questionnaires or tools (4/16, 25%), usability data (5/16, 31%), or both (7/16, 44%). Most studies identified personalized support in the form of e-coaching, peer support through a social platform, personalized feedback, or joint videoconference sessions as an engaging feature. Conclusions: Personalized support during the intervention, access to social support, and personalized feedback seem to promote engagement with digital interventions for mental health promotion. These findings need to be interpreted with caution because the included studies were heterogeneous, had small sample sizes, and typically did not address engagement as the primary outcome. Despite the importance of user engagement for the effectiveness of digital interventions, this field has not yet received much attention. Further research is needed on the effectiveness of different strategies required to facilitate user engagement in digital interventions for mental health promotion.

Objective To undertake a systematic review and meta-analysis to establish the effectiveness of handwashing in reducing absence and/or the spread of respiratory tract (RT) and/or gastrointestinal (GI) infection among school-aged children and/or staff in educational settings. Design Randomised-controlled trials (RCTs). Setting Schools and other settings with a formal educational component in any country. Patients Children aged 3–11 years, and/or staff working with them. Intervention Interventions with a hand hygiene component. Main outcome measures Incidence of RT or GI infections or symptoms related to such infections; absenteeism; laboratory results of RT and/or GI infections. Results Eighteen cluster RCTs were identified; 13 school-based, 5 in child day care facilities or preschools. Studies were heterogeneous and had significant quality issues including small numbers of clusters and participants and inadequate randomisation. Individual study results suggest interventions may reduce children's absence, RT infection incidence and symptoms, and laboratory confirmed influenza-like illness. Evidence of impact on GI infection or symptoms was equivocal. Conclusions Studies are generally not well executed or reported. Despite updating existing systematic reviews and identifying new studies, evidence of the effect of hand hygiene interventions on infection incidence in educational settings is mostly equivocal but they may decrease RT infection among children. These results update and add to knowledge about this crucial public health issue in key settings with a vulnerable population. More robust, well reported cluster RCTs which learn from existing studies, are required.

Background: Digital health interventions have the potential to improve health at a large scale globally by improving access to healthcare services and health-related information, but they tend to benefit more affluent and privileged groups more than those less privileged.

Summary: Hepatitis C virus (HCV) antiviral treatment for people who inject drugs (PWID) could prevent onwards transmission and reduce chronic prevalence. We assessed currentPWIDtreatment rates in sevenUKsettings and projected the potential impact of current and scaled‐up treatment onHCVchronic prevalence. Data on number ofPWIDtreated and sustained viral response rates (SVR) were collected from sevenUKsettings: Bristol (37–48%HCVchronic prevalence amongPWID), East London (37–48%), Manchester (48–56%), Nottingham (37–44%), Plymouth (30–37%), Dundee (20–27%) and North Wales (27–33%). A model ofHCVtransmission amongPWIDprojected the 10‐year impact of (i) current treatment rates andSVR(ii) scale‐up with interferon‐free direct acting antivirals (IFN‐freeDAAs) with 90%SVR. Treatment rates varied from <5 to over 25 per 1000PWID. Pooled intention‐to‐treatSVRforPWIDwere 45% genotypes 1/4 [95%CI33–57%] and 61% genotypes 2/3 [95%CI47–76%]. Projections of chronicHCVprevalence amongPWIDafter 10 years of current levels of treatment overlapped substantially with currentHCVprevalence estimates. Scaling‐up treatment to 26/1000PWIDannually (achieved already in two sites) withIFN‐freeDAAs could achieve an observable absolute reduction inHCVchronic prevalence of at least 15% amongPWIDin all sites and greater than a halving in chronicHCVin Plymouth, Dundee and North Wales within a decade. Current treatment rates amongPWIDare unlikely to achieve observable reductions inHCVchronic prevalence over the next 10 years. Achievable scale‐up, however, could lead to substantial reductions inHCVchronic prevalence.

Tobacco and cannabis use, alcohol consumption and inactivity are health risk behaviors (HRB) of crucial importance for health and wellbeing. The impact of the COVID-19 pandemic on university students’ engagement in HRB has yet received limited attention. We investigated whether HRB changed during the COVID-19 pandemic, assessed factors associated with change and profiles of HRB changes in university students. A web-based survey was conducted in May 2020, including 5021 students of four German universities (69% female, the mean age of 24.4 years (SD = 5.1)). Sixty-one percent of students reported consuming alcohol, 45.8% binge drinking, 44% inactivity, 19.4% smoking and 10.8% cannabis use. While smoking and cannabis use remained unchanged during the COVID-19 pandemic, 24.4% reported a decrease in binge drinking while 5.4% reported an increase. Changes to physical activity were most frequently reported, with 30.6% reporting an increase and 19.3% reporting a decrease in vigorous physical activity. Being female, younger age, being bored, not having a trusted person and depressive symptoms were factors associated with a change in HRB. Five substance use behavior profiles were identified, which also remained fairly unchanged. Efforts to promote student health and wellbeing continue to be required, also in times of the COVID-19 pandemic.