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Effects of Smokefree Class Competition 1 year after the end of intervention: a cluster randomised controlled trial
  1. Barbara Isensee1,
  2. Matthis Morgenstern1,
  3. Mike Stoolmiller2,
  4. Karin Maruska1,
  5. James D Sargent3,
  6. Reiner Hanewinkel1
  1. 1Institute for Therapy and Health Research (IFT-Nord), Kiel, Germany
  2. 2University of Oregon, Oregon Social Learning Center, Eugene, Oregon, USA
  3. 3Cancer Control Research Program, Norris Cotton Cancer Center, Dartmouth Medical School, Lebanon, New Hampshire, USA
  1. Correspondence to Dr Barbara Isensee, Institute for Therapy and Health Research, Harmsstr 2, Kiel 24114, Germany; isensee{at}


Background The Smokefree Class Competition, a school-based smoking prevention intervention, is widely disseminated in Europe. Participating classes commit themselves to be smoke-free and self-monitor their smoking status. Classes that remain smoke-free for 6 months can win prizes. Effects of the intervention on current smoking, initiation and progression of smoking were investigated.

Methods Cluster randomised controlled trial. 84 schools (208 classes with 3490 students; mean age 12.6 years, 50.4% female) in Saxony-Anhalt, Germany, were randomly assigned to intervention or control condition. A baseline survey was conducted before the implementation of the programme, while post-test and follow-up surveys were carried out 7 (immediately after the end of the competition), 12 and 19 months after baseline. Effects of participation in the programme on current and lifetime smoking were analysed by multilevel models controlling for confounding variables.

Results Intervention students smoking occasionally at baseline smoked less frequently than students taking not part in the intervention at 7 and 12 months after baseline. Persistent beneficial programme effects were also found for lifetime smoking: intervention students were less likely to progress from experimental to established use.

Conclusion Data suggest that Smokefree Class Competition reduces the probability of progressing from occasional and experimental stages of smoking to more established forms of use.

Clinical trials registration number Trial registration ISRCTN27091233 in Current Control Trial Register.

  • Tobacco
  • school-based prevention
  • competition
  • evaluation
  • prevention PR
  • smoking RB
  • youth health

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  • Funding This study was funded by German Cancer Aid. After a positive decision on applying for study support, the German Cancer Aid did not influence the collection, analysis or interpretation of data nor the writing of the article and decision to submit it. The implementation of the Smokefree Class Competition in Germany was funded by German Cancer Aid, European Commission, Federal Centre for Health Education, German Heart Foundation, AOK-Bundesverband, German Lung Foundation and BKK-Landesverband Ost in the school year 2006/2007 and 2007/2008.

  • Competing interests IFT-Nord is responsible for both the implementation and evaluation of the competition.

  • Ethics approval Ethics approval was provided by the Saxony-Anhalt IRB (Landesverwaltungs-amt Sachsen-Anhalt, Reg.-Nr.504-50/06).

  • Provenance and peer review Not commissioned; externally peer reviewed.