Background: 'Physical Activity 4 Everyone' (PA4E1) was an efficacious multi-component school-based physical activity (PA) program targeting adolescents. PA4E1 has seven PA practices. It is essential to scale-up, evaluate effectiveness and assess implementation of such programs. Therefore, the aim is to assess the impact of implementation support on school practice uptake of the PA4E1 program at 12 and 24 months. Methods: A cluster randomised controlled trial, utilising a type III hybrid implementation-effectiveness design, was conducted in 49 randomly selected disadvantaged Australian Government and Catholic secondary schools. A blinded statistician randomly allocated schools to a usual practice control (n = 25) or the PA4E1 program group (n = 24), with the latter receiving seven implementation support strategies to support school PA practice uptake of the seven practices retained from the efficacy trial. The primary outcome was the proportion of schools adopting at least four of the seven practices, assessed via telephone surveys with Head Physical Education Teachers and analysed using exact logistic regression modelling. This paper reports the 12-month outcomes. Results: Schools were recruited from May to November 2017. At baseline, no schools implemented four of the seven practices. At 12 months significantly more schools in the program group had implemented four of the seven practices (16/24, 66.7%) than the control group (1/25, 4%) (OR = 33.0[4.15-1556.4], p < 0.001). The program group implemented on average 3.2 (2.5-3.9) more practices than the control group (p < 0.001, mean 3.9 (SD 1.5) vs 0.7 (1.0)). Fidelity and reach of the implementation support intervention were high (both > 80%).

Alcohol sales to young customers without checking ID are common, widespread and seemingly resistant to nonpunitive interventions. The NSW Liquor Act could be modified to allow compliance testing and much more practical enforcement. While Central Coast bottle shops have a better record than other Australian areas showing some improvements with our nonpunitive industry education interventions, the results need to improve substantially to stifle primary supply.

BackgroundChildhood overweight and obesity is a significant public health issue. A key contributing factor is sugar sweetened beverages (SSBs) consumption. Evidence suggests that secondary school students are frequent consumers of SSBs, with high daily consumption. The promotion of water consumption and provision of chilled water stations can reduce SSBs consumption. The Thirsty Choose Water! study will evaluate the effectiveness of two interventions, a behavioural intervention, Thirsty? Choose Water! behavioural intervention (TCW-BI), that target students through the domains of the health promoting high schools framework, and the second intervention is the installation and promotion of chilled water stations.Methods/designThis community trial will recruit 60 secondary schools from across three Local Health Districts (LHDs) within New South Wales (NSW). A two-by-two factorial study design will be used to determine the effect of the Thirsty? Choose Water! behavioural intervention (TCW-BI), and the installation of chilled water stations. The recruited secondary schools will be randomised and non-blinded to one of four study arms receiving either the TCW-BI or chilled water stations, both interventions, or neither (control group). Baseline measures will be collected including student self-report surveys which will gather data regarding knowledge, attitudes and consumption of water and SSBs, a school profile and an environmental scan. Student surveys will be repeated post the intervention and at follow-up. Regular water meter readings will determine the water flow from the chilled water stations across the study period.DiscussionThere is an increasing body of evidence which suggests that decreasing consumption of SSBs can impact positively on childhood overweight and obesity. However, in the Australian context there are limited studies on how this may occur in the secondary school setting. This study will add to this evidence base and establish the effectiveness of TCW-BI and chilled water stations, either alone or combination on increasing water consumption in adolescents. Information about barriers and facilitators to implementation will be documented. Packages to support the implementation of the TCW-BI as a state-wide initiative will be developed.Trial registrationAustralian and New Zealand Clinical Trials Register ACTRN12618000526279 April 2018.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5685-1) contains supplementary material, which is available to authorized users.

Background: Childhood obesity is a significant public health issue. Sugar-sweetened beverage (SSB) consumption contributes to this and adolescents are high consumers.This paper provides a descriptive overview of a school-based intervention to address this. Methods: 61 secondary schools in New South Wales were randomised to receive a behavioural intervention (BI), a chilled water station (CWS), both interventions or neither (control). The BI was delivered through classroom lessons, school-based promotion and vaccination clinic. The CWS intervention included the installation of one CWS per school. Intervention effectiveness over time was assessed via student surveys at baseline, post-intervention and follow-up (individual-level outcomes), feedback from teachers and vaccination nurses, a school information survey, and remotely monitored CWS water usage (school-level outcomes).Results: Teachers reported the BI was useful in teaching students about drinking water and negative consequences of SSBs. Nurses considered the post-vaccination waiting period a good opportunity to deliver health promotion messages. Students in this group showed statistically significant changes in knowledge about SSBs, dehydration effects and changes in daily SSB consumption (T1 23.18%; T3 18.20%).Positive feedback regarding CWSs was received with an increase in water consumption reported for students in this group (T1 86.15% to T3 89.66%) and a statistically significant increase in students carrying a water bottle to school and filling it observed. Conclusions: Both interventions were readily implemented with high levels of acceptability and impact on students' knowledge and SSB consumption. The study demonstrates how to promote water consumption in schools utilising two different interventions.So what?: Evidence regarding how to decrease SSB consumption amongst secondary school students has been strengthened.

Issue addressed Childhood obesity is a serious public health challenge. Consumption of sugar‐sweetened beverages (SSBs) is one contributing factor, with adolescents being the highest consumers. Methods This study used a randomised controlled trial and two‐by‐two factorial design to determine the effectiveness of a school‐based behavioural intervention (including education/promotional messages) and/or environmental intervention (chilled water station), on encouraging adolescents to choose water instead of SSBs. Sixty‐one secondary schools (n = 8992 eligible students year 7 student) were recruited and randomly allocated to one of four study groups, the behavioural intervention, the environmental intervention, both interventions or neither. Results The primary outcome was increased water consumption; secondary outcomes included changes in students' knowledge and attitudes about water and SSBs and changes in SSB consumption. For students who received at least one intervention there was an increased odds (though not statistically significant) of higher water consumption compared to those that received no intervention. There was a decrease in SSB consumption for students who received both interventions combined (OR: 0.67; 95% confidence interval: 0.55‐0.082; P < .01). Conclusions The combined intervention had a greater effect on decreasing SSBs consumption. This is noteworthy given SSBs are a key contributor to overweight and obesity. So what? To our knowledge this is the first Australian study examining combined school‐based interventions to specifically promote the consumption of water and decrease the consumption of SSBs in adolescents. The study findings add to the evidence regarding the benefits of delivering multicomponent school‐based interventions which add value to existing interventions that address the complex public health issue of overweight and obesity.

Issue AddressedSelling alcohol to a minor is a serious offence in the New South Wales Liquor Act. However, minors report they can purchase alcohol easily. This study used an intersectoral partnership between the Central Coast Local Health District (CCLHD) Health Promotion Service, and Liquor & Gaming NSW (L&GNSW) Compliance Operations to test a site visit intervention to increase ID checks at packaged liquor outlets (PLOs).MethodsAs the current legislative framework does not allow minors to attempt to purchase alcohol from PLOs, even under compliance operations, this study employed pseudo‐minors aged 18–19 years. Pseudo‐minors visited all PLOs on the Central Coast, NSW in four survey rounds, attempting to purchase alcohol without ID. If a PLO sold alcohol to the pseudo‐minor, they received a visit from a Health Promotion Officer and L&GNSW Inspector to inform them of the sale and that they are at risk of selling alcohol to a minor.ResultsSite visits were an effective intervention to increase the rates of ID checking. Alcohol sales to pseudo‐minors without ID decreased from 34% in Round 1 to 7% in Round 4. Young sales staff and independent stores were less likely to check ID.ConclusionsThis intervention was associated with some of the lowest rates of underage alcohol purchasing reported to date. However, it may not be sustainable in the long term. It is recommended that: future studies randomise site visits to investigate their contribution to the observed reduction, cost effectiveness of the intervention is explored and legislative change to allow controlled purchase operations for alcohol is considered.So What?Young people under 18 years of age should not be able to purchase alcohol from liquor licence outlets, and strong laws apply if a sale is detected. However, despite these rules, young people still report they can access alcohol in this manner. Whilst our intervention of site visits with the regulatory body saw decreases in sales to our pseudo‐minors, we advocate for controlled purchase operations (similar to tobacco control) as a more sustainable and effective intervention to reduce sales to minors ‐ while this is not yet legislated for packaged liquor outlets in Australia, it is deemed best practice in other countries.

Background: Childhood obesity is a serious public health challenge in Australia, with approximately one in four (24.9%) children aged 5-17 years being overweight or obese. Sugar sweetened beverages are one contributing factor and detrimental to health. Adolescents are the highest consumers of these, with nearly 25% of NSW children aged 12-17 years consuming sugar sweetened beverages at least 5 or more times per week. This study aims to address this by encouraging adolescents to choose water instead of sugar sweetened beverages and determine the effectiveness of two interventions (one behavioural and one environmental) alone or combined in achieving this outcome.Methods: An open-label randomised controlled trial utilising a two-by-two factorial design recruited 61 schools from across three Local Health Districts in NSW, Australia, randomising them to one of four study arms: a behavioural intervention, an environmental intervention, both or neither. Student surveys, school level surveys and water flow measurement data was collected. The primary outcome was increased water consumption, with secondary outcomes including changes in SSB consumption. To quantify the individual and joint effects of the interventions on the consumption of water and SSBs, random effects multivariable ordinal logistic regression models were derived for each outcome.Results: For students receiving at least one intervention there was an increased odds (though not statistically significant) of higher water consumption compared to those that received no intervention; whilst there was a statistically significant decrease in SSB consumption for students who received both interventions combined (OR = .67; 95% confidence interval, 0.55-.082; P<0.01).Conclusions: Evidence regarding school based obesity prevention continues to emerge, however, to our knowledge this is the first Australian study focussed on examining effective school-based interventions to specifically promote the consumption of water and decrease the consumption of SSBs in adolescents. The combination of a behavioural and an environmental intervention had a greater effect on decreasing SSB consumption. This is noteworthy given SSBs are a key contributor to overweight and obesity. The delivery of these combined interventions in schools can add value to existing interventions that address the complex public health issue of overweight and obesity.Trial Registration: Australian and New Zealand Clinical Trials Register ACTRN12618000526279 10 April 2018 http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618000526279

Objective: Adolescents are high consumers of sugar-sweetened beverages (SSBs), which contribute to overweight and obesity – a significant public health issue. Evidence suggests replacing SSBs with water and school-based interventions can reduce consumption. This study examines the acceptability of a previously trialled intervention (Thirsty? Choose Water!) in regional and remote secondary schools. Design: An open-label randomised controlled trial using a two-by-two factorial design tested the outcomes of a behavioural and/or environmental intervention on SSB and water consumption. Setting: Regional and remote secondary schools (public, catholic and independent) within the boundaries of two regional Local Health Districts within New South Wales. Participants: Twenty-four schools participated in the study. The target group was year 7 students (n=1640) - 72% of eligible students completed baseline data. The study followed students into year 8 (n=1188) - 52% of eligible students completed post intervention data. Forty teachers undertook training to deliver the intervention. Results: Interventions showed high levels of acceptability. Students demonstrated changes in knowledge, attitudes, and consumption behaviours. Multivariable ordinal logression analysis demonstrated all interventions increased the odds of students increasing their water consumption (though not statistically significant). Conversely, the combined (OR: 0.75; 95%CI: 0.59 – 0.97) or environmental intervention (OR: 0.68; 95%CI: 0.51 – 0.90) had greater odds of reducing SSB consumption and was statistically significant. Conclusions: This study builds on recent Australian evidence regarding the impact of school–based interventions on water and SSB consumption. In this study, despite a minor intervention change, and the impacts of fires, floods and COVID-19 on study implementation, the interventions were highly regarded by the school communities with positive outcomes.