Long-term effects of a school-based prevention program

Aims: With the aim to influence social norms, school classes participating in the non-smoking competition "Be Smart - Don't Start" commit themselves to abstain from smoking for six months. The aim of the study was to investigate the long-term effectiveness of this preventive measure. Methods: In 2006 a total of 3,490 7th graders from 84 schools of the German State Saxony-Anhalt took part in a cluster-randomized study to test the effectiveness of the competition. This sample was contacted again in 2015, nine years after baseline, and surveyed about their smoking behavior. The endpoints of the study were never smoking, daily smoking, initiation of smoking, and smoking cessation. Results: Fifty-eight schools (69.0% of the initial sample) were willing to participate in the follow-up, resulting in 688 (19.7%) student questionnaires that could be matched with baseline data (mean age in 2015: 21.2 years). Participants with a low risk for smoking had a higher likelihood to be reached at follow-up. Furthermore, participants from Gymnasium schools were more frequently reached in the control group. In almost all analyses, there was a numerical difference in favor of the intervention group in terms of smoking behavior; for the quit date this difference was statistically significant. Conclusions: Due to the small sample size and the selective attrition, general conclusions about the long-term effects of the participation in the competition can only be drawn with great caution.