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Smokefree Class Competition

Evidence level:
Best PracticePromising PracticeEmergent Practice
 
Evidence of Effectiveness:
?-0+++
Transferability:
?-0+
Enduring Impact:
?-0+
Review criteria and process

Policy category

Facilitating Positive Transitions to Adulthood

Countries that have implemented practice

Netherlands, Finland, Czech Republic, Switzerland, Italy, Norway

Age Groups

Teenagers (age 13 to 19), Middle Childhood (age 6 to 12)

Years in Operation

1989  - still operating

Type of Organization Implementing Practice

Other Private Organization, National Government, International government

Practice Overview

The Smokefree Class Competition program began in Finland in 1989 and has been initiated in 22 European countries between 1997 and 2008.  The program gives classes of pupils aged 11-14 years old the choice to become a ‘nonsmoking class’ for six months, in return for being entered in a lottery to win a class trip if at least 90% of the class remains smoke-free in each month of the competition period.  The students monitor and report their own participation on a weekly basis.  In some of the countries they also receive health education lessons about the effects of smoking.  The rules and prizes of the competition vary slightly by country but are generally similar.  The intervention is intended to reduce the number of adolescents who currently smoke or will ever smoke and delay the age at which adolescents become smokers by applying positive reinforcement to nonsmoking, making nonsmoking a popular behavior and adjusting social norms within peer groups.

Sustainability

The effects of the program have not been evaluated beyond 1 year after the conclusion of competition participation, and several studies have found that the effects diminish over time.  A cost-effectiveness study has been carried out by Hoeflmayr & Hanewinkel (2007) using data from the Wiborg & Hanewinkel (2002) evaluation (Evaluation 2a above) and cost data from the administration of the Smokefree Class Competition program in Germany.  The study calculated that the program would prevent 2.04% of participants from ever becoming regular smokers, with an estimate of the cost of the program at 39 Euro per student.

Transferability

Smokefree Class Competition has been implemented in up to 22 European countries.  Well-designed evaluations have been carried out in Finland, Norway, and Germany with similar results.  The majority of the evaluations including two randomized trials found that the program decreased the number of children smoking during the intervention or reduced their progression toward daily smoking but that the positive effect diminished over time after participation in the program ended.

Evidence of Effectiveness

Evaluation 1  

Crone, M., Reijneveld, S., Willemsen, M., van Leerdam, F., Spruijt, R. and Hira Sing, R., Prevention of smoking in adolescents with lower education: a school based intervention study, J Epidemiol Community Health 2003; 57:675-680.

This randomized controlled study randomized at the school level; however the control and intervention groups were significantly different in gender balance.

Summary of Results for Evaluation 1

 

 

Outcome

Treatment Group

Control Group

Outcomes improved (statistically significant)

 

 

The odds that students in the control group report smoking at the post-test measurement are 1.61 times higher than the odds for students in the treatment group.

The odds that students in the control group report smoking for the first time between the pre-test and post-test measurement times are 1.64 times higher than the odds for students in the treatment group. Percentage of smokers at post-test

 

 

 

 

 

 

19.9%

 

 

 

 

 

 

25.8%

Outcomes with no effect

 

 

Percentage of smokers at follow-up

23.9%

26.7%

 

Evaluation 2a 

 

Wiborg, G. and Hanewinkel, R., Effectiveness of the “Smoke-Free Class Competition” in Delaying the Onset of Smoking in Adolescence, Preventive Medicine 2002; 35:241-249.

 

This quasi-experimental study evaluated the program in three cities in Berlin, assigning classes to the intervention and control group by city while matching on grade level and school type between the groups.

Summary of Results for Evaluation 2a

 

Outcome

Outcomes improved (statistically significant)

 The odds that students in the control group report smoking in the four weeks prior to the post-test measurement are 2.19 times higher than the odds for students in the treatment group.

The odds that students in the control group report smoking daily at the time of the post-test measurement are 2.23 times higher than the odds for students in the treatment group.

 

The odds that students in the control group report smoking daily at the time of the follow-up measurement are 1.52 times higher than the odds for students in the treatment group.

 

 The odds that students in the control group who were initially non-smokers report smoking in the four weeks prior to the post-test measurement are 1.98 times higher than the odds for students in the treatment group who were initially non-smokers.

The odds that students in the control group who were initially non-smokers report smoking in the four weeks prior to the follow-up measurement are 1.36 times higher than the odds for students in the treatment group who were initially non-smokers.

 

 The odds that students in the control group who were initially non-smokers to smoke daily at the time of the post-test measurement are 3.58 times higher than the odds for students in the treatment group who were initially non-smokers.

 

The odds that students in the control group who were initially non-smokers report smoking daily at the time of the follow-up measurement are 1.65 times higher than the odds for students in the treatment group who were initially non-smokers.

Outcomes with no effect

 The odds that students in the control group report smoking in the four weeks prior to the follow-up measurement are 1.19 times higher than the odds for students in the treatment group who were initially non-smokers.

 

Evaluation 2b

Hanewinkel, R. and Wiborg, G., Primary and Secondary Prevention of Smoking in Adolescents: Results of the Campaign “Be Smart - Don’t Start”, Gesundheitswesen 2002; 64: 492-498.

This evaluation used the same sample as Wiborg & Hanewinkel, 2002, with the same data collection stages.

Summary of Results for Evaluation 2b

Outcome

Treatment Group

Control Group

Outcomes improved (statistically significant)

 

 

Percentage of students smoking at follow-up

Percentage of students initially non-smokers who remained non-smokers at follow-up

25.5%

82.5%

 

32.9%

77.6%

 

Outcomes with no effect

 

 

Percentage of students initially smoking who quit during the study period

30%

21%

 

 

 

 

Evaluation 3  

Isensee, B. and Hanewinkel, R., Effects of a repeated participation in the non-smoking competition “Be Smart - Don’t Start”, Sucht. German Journal of Addiction Research and Practice 2007, 53(6):328-334.

This post-test-only evaluation compared the effects of the Smokefree Class Competition on current year participants (CY) to the previous year’s participants (PY) and those who participated in the competition in both years (BY). Effectively this measured the attenuation of the program’s effects over a year (CY vs. PY) and the value of continuing the program over multiple years (BY vs. PY).

Summary of Results for Evaluation 3

 

Outcome

Outcomes improved (statistically significant)

The odds that students who received the treatment in both years report never having smoked at the time of the post-test measurement are 1.46 times higher than the odds for students in the control group.

 

The odds that students in the control group report smoking 1-100 cigarettes and smoking at least once in the four weeks prior to the post-test measurement are 1.39 times higher than the odds for students in the treatment group.

Outcomes with no effect

The odds that students who received the treatment only in the current year report never having smoked at the time of the post-test measurement are 1.32 times higher than the odds for students in the control group.

 

The odds that students who received the treatment only in the current year report smoking 1-100 cigarettes and smoking at least once in the four weeks prior to the post-test measurement are 1.14 times higher than the odds for students in the control group.

 

The odds that students in the control group reported smoking more than 100 cigarettes and smoking at least once in the four weeks prior to the post-test measurement are 1.42 times higher than the odds for students who received the treatment in both years and 1.18 times higher than the odds for students who received the treatment only in the current year.

 

Evaluation 4

Isensee, B., Morgenstern, M., Stoolmiller, M., Maruska, K. and Hanewinkel, R., Evaluation des Nichtraucherwettbewerbs Be Smart - Don’t Start an Schulen des Landes Sachsen-Anhalt, Institut fuer Therapie- und Gesundheitsforschung, 12/2008.

This is the original publication of the data analysed and presented in more detail in Hanewinkel, et al., (2010) and Isensee, et al., (2012). The cluster-randomized controlled trial examined smoking and bullying behaviour in classes participating in the Smokefree Class Competition (renamed ‘Be Smart, Don’t Start’) in Sachsen-Anhalt, Germany.

Summary of Results for Evaluation 4

 

 

Outcome

Time elapsed since beginning of 6 month competition

Outcomes improved (statistically significant)

7 months

12 months

19 months

Coefficient of interaction term representing individuals who had initially been occasional smokers in the no-participation and control group

(Larger indicates that individuals who initially smoked occasionally smoke more frequently at post-test than their counterparts in the treatment group)

Frequency of:

Active bullying

 

 

Passive bullying

 

 

Isolation

 (Lack of significance indicates that program is not a significant cause of bullying)

0.36

 

 

 

 

 

 

(P/d/n/C)*

(1.92/1.99/

1.92/1.94)

 

(2.02/2.01/

2.09/2.00)

 

(1.23/1.33/

1.28/1.28)

 

0.55

 

 

 

 

 

 

(P/d/n/C)

(1.77/1.78/

1.70/1.80)

 

(2.03/1.92/

2.01/1.99)

 

(1.19/1.23/

1.20/1.20)

 

 

 

 

 

 

 

 

(P/d/n/C)

(1.74/1.74/

1.82/1.71)

 

(1.98/2.10/

2.11/2.03)

 

(1.25/1.25/

1.22/1.19)

 

Outcomes with no effect

 

 

Coefficient of interaction term representing individuals who had initially been occasional smokers in a particular group

(Larger indicates that individuals who initially smoked occasionally smoke more frequently at post-test than their counterparts in the treatment group)

Coefficient of interaction term representing individuals who had initially been regular smokers in the no-treatment group

(Larger indicates that individuals who initially smoked regularly smoke more frequently at post-test than their counterparts in the treatment group)

 

 

 

 

 

 

 

0.16

 

 

 

 

 

 

 

 

 

 

 

 

-0.28

 

 

 

 

 

 

 

0.16

 

 

 

 

-0.12

 

 

 

 

 

*(P/d/n/C)=Participation/Dropped out of competition/No participation/Control group

 

Evaluation 4a 

Hanewinkel, R., Isensee, B., Maruska, K., Sargent, J. and Morgenstern, M., Denormalising smoking in the classroom: does it cause bullying? J Epidemiol Community Health 2010; 64: 202-208.

This cluster-randomized controlled trial focused on identifying bullying or a lack thereof in relation to implementation of the Smokefree Class Competition. A lack of statistically significant outcomes (except for isolation) was interpreted as an indication that the intervention did not cause bullying.

Summary of Results for Evaluation 4a

Outcome

Outcomes improved (statistically significant) at the time of post-test

The odds that students in the control group report recent feelings of isolation are 1.30 times higher than students in the successful participation group.

The odds that students in the no participation group report having bullied recently are 1.19 times higher than students in the control group.

 

Outcomes with no effect at the time of post-test

The odds that students in the control group report having been bullied recently are 1.05 times higher than students in the no participation group, 1.08 times higher than students in the successful participation group and 1.04 times higher than students in the unsuccessful participation group.

 

The odds that students in the successful participation group report having bullied recently are 1.06 times higher than students in the control group.  The odds that students in the unsuccessful participation group report having bullied recently are the same as the odds for students in the control group.

 

The odds that students in the no participation group report recent feelings of isolation are 1.02 times higher than students in the control group. 

 

The odds that students in the control group report recent feelings of isolation are 1.02 times higher than students in the unsuccessful participation group.

 

 

Evaluation 4b

Isensee, B., Morgenstern, M., Stoolmiller, M., Maruska, K., Sargent, J. and Hanewinkel, R., Effects of Smokefree Class Competition 1 year after the end of intervention: a cluster randomized controlled trial, J Epidemiol Community Health 2012; 66:334-341.

In this cluster-randomized trial, children reported their smoking behaviour at pre-test, at post-test a month after the conclusion of the program, a year after beginning the program, and a year after the post-test.

Summary of Results for Evaluation 4b

Outcome

Outcomes improved (statistically significant)

 

 The odds that students who were initially experimental smokers in the control group report becoming a regular smoker are 1.45 times higher than students who were initially experimental smokers in the participating group.

 

 

Outcomes with no effect

 

Coefficient of membership in participating treatment group in linear regression on smoking status

7 months (Post-test)

12 months

19 months

 

 

 

0.01

0.06

0.07

 

 

Evaluation 5  

Schmid, H., Smokefree Class Competition in Switzerland: Does it work with negative peer pressure? Tobacco Prevention Foundation, 2006.

This post-test-only quasi-experimental study in Switzerland collected data on smoking and violence by participation status in Smokefree Class Competition as part of the World Health Organization’s Health Behaviour in School-Aged Children Study.

Summary of Results for Evaluation 5

 

 

Outcome

Outcomes improved (statistically significant)

 

 

Coefficient in linear regression of daily smoking

Participating class

Coefficient in linear regression of weekly smoking

Participating class

Coefficient in structural equation modelling of classroom climate

Participating class

 

-0.52

 

-0.58

 

 

0.12

 

Outcomes with no effect

 

 

Coefficient in linear regression of daily smoking

Participating class that dropped out

Coefficient in linear regression of weekly smoking

Participating class that dropped out

Coefficient in structural modelling of classroom climate

Participating class that dropped out

Coefficient in structural modelling of passive violence

Participating class

Participating class that dropped out

Coefficient in structural modelling of active violence

Participating class

Participating class that dropped out

 

 

-0.11

 

-0.16

 

0.009

 

0.02

0.04

 

0.02

-0.01

 

 

Evaluation 6  

Schulze, A., Mons, U., Edler, L. and Potschke-Langer, M., Lack of sustainable prevention effect of the “Smoke-Free Class Competition” on German pupils, Preventive Medicine 2006; 42:33-39.

This study used a matched randomized trial design but did not report data at post-test. Surveys were given at pre-test and at an 18-month follow-up. Additionally, attrition was very high due to limited ability to match individuals’ pre-test and post-test surveys.

Summary of Results for Evaluation 6

Outcome

Outcomes improved (statistically significant)

None

Outcomes with no effect

The odds that students in the treatment group report never having smoked at both the pre-test and 18 month follow-up are 1.02 times higher than students in the control group.

 

The odds that students in the treatment group report both having quit smoking at pre-test and remaining a non-smoker until the 18 month follow-up are 1.07 times higher than students in the control group.

 

 

Evaluation 7  

Svoen, N. and Schei, E., Adolescent smoking prevention – primary health care in cooperation with local schools: A controlled intervention study, Scand J Prim Health Care 1999; 17:54-58.

This study took data from several cohorts of students over the period 1992-1996. Post-test results were measured in an exit survey given to cohorts that finished the ninth grade during the study period. This means that despite the duration of the study, it did not include a follow-up measurement beyond the post-test. There was no randomization because the study groups included all secondary school students in the municipality selected for that group by the study authors.

Summary of Results for Evaluation 7

 

 

Outcome

Treatment Group

Control Group

Outcomes improved (statistically significant)

 

 

Daily smokers at conclusion of study period

Number of cigarettes smoked by the average daily smoker

2.9%

3.4

 

7.9%

9.0

 

Outcomes with no effect

 

 

Number of occasional smokers at conclusion of study period

Girls

Boys

 

 

14%

6%

 

 

14%

6%

 

Evaluation 8  

Vartiainen, E., Saukko, A., Paavola, M. and Vertio, H., ‘No Smoking Class’ competitions in Finland: their value in delaying the onset of smoking in adolescence, Health Promotion International 1996; 11(3).

This study evaluated the original form of the Smokefree Class Competition, which made no allowance for 10% or fewer smokers in participating classes as detailed in the rules of the international version of the program. It also awarded cash prizes to winning classes instead of class trips.

Summary of Results for Evaluation 8

 

 

Outcome

Outcomes improved (statistically significant)

The odds that students in the control group report smoking at the time of the post-test measurement are 1.55 times higher than students in the treatment group.

 

Outcomes with no effect

The odds that students in the control group report smoking at the time of the one year follow-up measurement are 1.25 times higher than students in the control group.

 

 

Issue to consider

Four out of eight separate evaluations were run by or involved the program founder Erkki Vartiainen or the European program coordinator Reiner Hanewinkel.  According to the rules of the competition, the treatment is an opt-in program.  This meant that many of the classes chosen by various studies to be part of the intervention group decided not to participate in the intervention.  Despite the fact that participating and non-participating classes differed significantly in variables directly relevant to smoking behavior, about half the studies chose to estimate the effect of the competition program on just the classes that participated in the competition instead of estimating the effect of the competition program on all classes that were given the opportunity to participate. Another issue was that intervention and control groups were different in age, gender balance, smoking behavior or physical location at baseline in almost all evaluations, despite school type and grade matching and randomization.
The evaluation that took place in Norway examined a slightly different intervention program, although it was inspired by the Smokefree Class Competition.  The Norwegian version of the program entered individual students in the prize lottery based on their completion of the program requirements rather than requiring entire classes to participate and successfully complete the competition.  This effectively removed peer pressure as a motivation not to smoke for students participating in the competition.

Contact Information

Professor Erkki Vartiainen
Director General of Welfare and Health Promotion
The National Institute for Health and Welfare
P.O. Box 30, FI-00271 Helsinki, Finland
Phone: +358 029 524 8622
erkki.vartiainen@thl.fi

Professor Reiner Hanewinkel
SFC-Network Coordinator
Director IFT-Nord, Institute for Therapy and Health Research
Harmsstraße 2, 24114 Kiel, Germany
Phone:+49 431 570 29-0
Fax:+49 431 570 29-29
hanewinkel@ift-nord.de

 

Available Resources

http://www.smokefreeclass.info/publications.htm

Puska, P., Vartiainen, E., Laatikainen, T., Jousilahti, P., & Paavola, M. (2009). “The North Karelia Project: From North Karelia to National Action.” National Institute for Health and Welfare (THL): 204-208.

Evaluation Details

Evaluation 1

In this evaluation in the Netherlands, 26 lower education schools were recruited to the study with the help of community health services.  Schools were then randomly assigned to treatment and control with stratification on school size and participation in a concurrent drug prevention program.  13 year olds in the school year 1998-1999 participated in the study, 1444 in the intervention group and 1118 in the control group.  There were significant differences between the groups in terms of age, religion and ethnicity but particularly gender balance was skewed toward boys in the control group.

Participants completed an anonymous questionnaire about their smoking behavior, school type, class level and demographic data in October 1998 before the competition began, in June 1999 after the intervention, and again in June 2000.  Individual participant responses were tracked across time with a simple code.

Evaluations 2a and 2b

This evaluation sampled 131 secondary schools, including students between 11 and 14 years old in the study.  89 classes from Hamburg and Berlin that had already registered for the intervention were randomly selected to the intervention group (1,495 students) and 42 classes from Hanover were chosen to match the intervention group on grade level and school type (647 students).  At pre-test the control group reported a weakly significantly higher (p<0.1) prevalence of smoking on both measures, described below.

Participants completed anonymous questionnaires before beginning the intervention in October/November 1998, after the intervention completed in May 1999 and again in November 1999.  The questionnaire recorded student’s age, gender, and smoking status.  Smoking status was assessed by asking if the student had smoked in the last four weeks and whether they had smoked every day in the last seven days.  Their responses were tracked with an individual code.

Evaluation 3

This evaluation sampled students who were in 7th and 8th grade in the school years 2003-2004 and 2004-2005 in Baden-Wurttemberg, Bavaria, North Rhine Westphalia and Schleswig-Holstein.  368 students participated in the program in 2003-2004 only, 450 students participated in 2004-2005 only, and 998 students participated in the program in both years.  The groups were significantly different in age (p<0.05), gender balance (p<0.01) and school type (p<0.01).  No data are available on smoking behaviors at baseline.

Shortly after the completion of the 2005 competition, all students completed a questionnaire about socio-demographic characteristics, attitudes about smoking, frequency of smoking and knowledge about smoking.  There was no pre-test and no non-participating control group.

Evaluation 4

This evaluation evaluated the program’s effects on smoking behaviors and bullying in students who were between age 11 and 14 during the 2006-2007 school year in Saxony-Anhalt.  208 classes from 84 schools were randomly assigned by school to the intervention and control groups so that the intervention group contained 2,136 students and the control group contained 1,354 students.  The classes in the intervention group were then allowed to decide whether to participate in the intervention program according to the competition rules.  The participating intervention and control groups were different from the non-participating intervention group in class environment, smoking history and current smoking behavior.

Assessments took place in October of 2006 before the competition took place, in May 2007 after the competition concluded, again in October 2007 and finally in June 2008.  At each assessment stage, students completed an anonymous questionnaire about personal smoking history and current smoking behavior, family and friends smoking, knowledge and willingness to smoke, active and passive bullying, feelings of isolation and demographic characteristics.  Individual student responses were tracked over time.  In the analysis stage, the non-participating intervention classes are analyzed separately from the participating intervention classes.

Evaluation 4a

This evaluation uses data collected in Evaluation 4 for more detailed analysis of student reports of bullying, being bullied, and social isolation with respect to participation status in the Smokefree Class Competition and initial smoking status.

Evaluation 4b

This evaluation uses data collected in Evaluation 4 for more detailed description of previous analysis and further analyses of smoking behavior over the four assessment stages of the study.  Only new analyses are reported for Evaluation 4b above.

Evaluation 5

This posttest-only evaluation used survey questions from the World Health Organization’s 2001/2002 Health Behavior in School-Aged Children Study to measure smoking behavior, class climate, and violence by participation status in the Smokefree Class Competition.  Classes of children 11-14 years old were selected at random from the official register of all public school classes, such that the final sample contained 4948 students not participating in the competition, 391 students whose classes had dropped from the competition, and 1015 students who had successfully participated.

No baseline data were collected.  The questionnaire was completed by students between March and June 2002 after the conclusion of the competition for that year.  Teachers completed a separate questionnaire on related topics.  Results are reported for a wide range of analyses: please see the Schmid, et al., 2006 study appendix.

Evaluation 6

This evaluation in Germany used two data collections from the Heidelberg Children’s Panel Study in October 1998 and October 2000 to assess the effects of the Smokefree Class Competition.  The study used all seventh grade classes in Heidelberg and a stratified random sample of schools in in Mannheim and Rhine-Neckar County, from which matched pairs of schools were assigned to treatment or control groups.  All treatment group classes chose to participate in the competition, for a total of 2161 students in the treatment group and 1875 students in the control group.  The groups differed significantly in age and smoking behavior at baseline.  Student responses to the questionnaires were tracked anonymously through a student-generated code.  The questionnaires recorded students’ smoking history and current smoking behavior as well as age, gender and school information.  Data collection was not conducted at the immediate close of the competition in April 1999.

Evaluation 7

This study evaluated an intervention in Norway similar to and inspired by the Smokefree Class Competition.  The most significant difference was that the prize lottery and the contract were conducted on the basis of individual student participation instead of class participation.  The design of the study followed all students in three municipalities through grades 6, 7, 8 and 9 between 1992 and 1996.  The 187 intervention group students in the Steigen municipality could participate in the competition in all years and the 364 control group students in Hamarøy, Tysfjord and Gildeskål areas could not participate in any year.  Hamarøy and Tysfjord were added to the control group two years into the study when another anti-smoking campaign was launched in Gildeskål.  Instead of taking new baseline data, the study authors relied on national surveys of smoking in this age group from the Norwegian Council of Smoking and Health.  This record for 1989 showed that the prevalence of smoking was initially less in the control group area.  

Data were collected via questionnaire at the end of every school year for all grades except in 1996 when only 9th grade students completed the survey.  The questionnaires were completely anonymous and recorded smoking behavior, smoking knowledge, leisure, interpersonal relationships and demographic information.

Evaluation 8

In this first evaluation of the original nation-wide program in Finland, participants were randomly selected from the list of all eighth grade classes that had chosen to participate in the competition in school year 1989-1990 and from the list of all eighth grade classes that had chosen not to participate.  The final sample consisted of 65 classes (270 students) in the intervention group and 29 classes (119 students) in the control group.

Before the beginning of the competition period, after completion of the competition, and again a year after completion of the competition, children completed anonymous questionnaires about their current smoking behavior.  The responses of an individual child were not linked over time.

Bibliography

Crone, M., Reijneveld, S., Willemsen, M., van Leerdam, F., Spruijt, R. and Hira Sing, R., Prevention of smoking in adolescents with lower education: a school based intervention study, J Epidemiol Community Health 2003; 57:675-680.
Hanewinkel, R., Isensee, B., Maruska, K., Sargent, J. and Morgenstern, M., Denormalising smoking in the classroom: does it cause bullying? J Epidemiol Community Health 2010; 64: 202-208.
Hanewinkel, R. and Wiborg, G., Primary and Secondary Prevention of Smoking in Adolescents: Results of the Campaign “Be Smart - Don’t Start”, Gesundheitswesen 2002; 64: 492-498.
Hoeflmayr, D. and Hanewinkel, R., Do school-based tobacco prevention programmes pay off? The cost-effectiveness of the ‘Smoke-free Class Competition’, Public Health, 2007; 122: 34-41.
Isensee, B. and Hanewinkel, R., Effects of a repeated participation in the non-smoking competition “Be Smart - Don’t Start”, Sucht. German Journal of Addiction Research and Practice 2007, 53(6):328-334.
Isensee, B., Morgenstern, M., Stoolmiller, M., Maruska, K. and Hanewinkel, R., Evaluation des Nichtraucherwettbewerbs Be Smart - Don’t Start an Schulen des Landes Sachsen-Anhalt, Institut fuer Therapie- und Gesundheitsforschung, 12/2008.
Isensee, B., Morgenstern, M., Stoolmiller, M., Maruska, K., Sargent, J. and Hanewinkel, R., Effects of Smokefree Class Competition 1 year after the end of intervention: a cluster randomized controlled trial, J Epidemiol Community Health 2012; 66:334-341.
Schmid, H., Smokefree Class Competition in Switzerland: Does it work with negative peer pressure? Tobacco Prevention Foundation, 2006.
Schulze, A., Mons, U., Edler, L. and Potschke-Langer, M., Lack of sustainable prevention effect of the “Smoke-Free Class Competition” on German pupils, Preventive Medicine 2006; 42:33-39.
Svoen, N. and Schei, E., Adolescent smoking prevention – primary health care in cooperation with local schools: A controlled intervention study, Scand J Prim Health Care 1999; 17:54-58.
Vartiainen, E., Saukko, A., Paavola, M. and Vertio, H., ‘No Smoking Class’ competitions in Finland: their value in delaying the onset of smoking in adolescence, Health Promotion International 1996; 11(3).
Wiborg, G. and Hanewinkel, R., Effectiveness of the “Smoke-Free Class Competition” in Delaying the Onset of Smoking in Adolescence,
Preventive Medicine 2002; 35:241-249.
Also see:
Flay, B., The promise of long-term effectiveness of school-based smoking prevention programs: a critical review of reviews, Tobacco Induced Diseases 2009; 5:7.
Hanewinkel, R., “Smoke-free Class Competition”: Far-reaching conclusions based on weak data, Preventive Medicine 2006; 43: 150-153.
Hanewinkel, R., “Be Smart – Don’t Start.” Results of a Non-Smoking Competition in Germany 1997-2007, Gesundheitswesen 2007; 69:38-44.
Hruba, D., Zachovalova, V., Matejova, H. and Dankova, I., “Our class does not smoke”; The Czech version of the “Smoke-free Class Competition” programme, Cent Eur J Public Health 2007; 15(4): 163-166.
Isensee, B., Hanewinkel, R., Meta-Analysis on the Effects of the Smoke-Free Class Competition on Smoking Prevention in Adolescents, European Addiction Research 2012; 18: 110-115.
Tamang, E., Pilati, G., Latini, R. and Pettino, A., Smoke Free Class Competition, Official Journal of the Italian Society of Tobaccology 2003; 3:13-17.

Last Updated

January 2014

Country

The program has been evaluated in Finland, Norway, the Netherlands, the Czech Republic, Germany, Italy and Switzerland but it operates in up to 22 European countries.