Can incentives encourage children and teens to resist smoking?

The other side of the smoking coin is, of course, prevention, with children and young people being a key target for initiatives designed to stop people becoming smokers. The second new review looked at whether incentives are effective in preventing children and adolescents from starting to smoke.

Seven trials were included, six evaluating the Smoke free Class Competition (SFC), which has been widely used throughout Europe, including here in the UK. This is a schools-based programme in which classes of children, generally between the ages of 11 and 14, commit to not smoking and report regularly on their smoking status.  Classes with at least 90% of students being non-smokers at the end of six months are put forward into a competition to win prizes, usually through a lottery system. All the included studies were cluster trials, in which schools were the ‘clusters’ allocated to receive the intervention or not. Five trials of SFC, with 6362 people, had results that could be combined.

What did they find?

  • No statistically significant effect of SFC on preventing smoking uptake

How good is the evidence?

Not very good. There were not many studies suitable for inclusion in the review and there were a number of problems in the design, conduct and reporting of the trials. Here are some of the problems highlighted by the authors:

  • Interventions varied widely in the incentives offered, which may influence their effectiveness. Incentives described ranged from ice cream vouchers to cash prizes of up to 450 euros
  • Most studies were at risk of multiple biases, including the only study of SFC reporting a significant effect of the competition
  • There was a lot of missing data in the final analyses
  • It was not possible to get relevant data from the one trial that did not study the SFC
  • There are gaps in the evidence. For example, incomplete data and the small number of studies meant that it was not possible to assess whether the amount or type of incentive affected smoking prevention

The bottom line?

Incentive programmes have not been shown to prevent children and adolescents from starting smoking, but there is a lack of high quality evidence so their impact remains unknown.


Johnston V, Liberato S, Thomas D. Incentives for preventing smoking in children and adolescents. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD008645. DOI: 10.1002/14651858.CD008645.pub2. The Cochrane summary of this review is available here:

You might also be interested in… This new systematic review, funded by the National Institute for Health Research’s Health Technology Assessment Programme, on telehealth for smoking cessation:

Chen Y, Madan J, Welton N, Yahaya I, Aveyard P, Bauld L, et al. Effectiveness and cost-effectiveness of computer and other electronic aids for smoking cessation: a systematic review and network meta-analysis. Health Technology Assessment 2012;16(38)

This new Public Health Guidance by the National Institute for Clinical Health and Excellence (NICE) on smokeless tobacco cessation in South Asian communities in the UK: National Institute for Clinical Health and Excellence.Smokeless tobacco cessation: South Asian communities.NICE Public Health Guidance 39.London: NICE, September 2012.

This guidance has also been incorporated into a NICE Pathway available here:

To coincide with ‘Stoptober’, The Centre for Reviews and Dissemination (CRD) has highlighted some key systematic reviews and additional NICE guidance on smoking cessation, including five other Cochrane reviews, on its website:

1 thought on “Can incentives encourage children and teens to resist smoking?

  1. Preventing kids from starting smoking has to be the ultimate aim. Once children start smoking it is difficult to convert them into non smokers until they have been smoking for many years. The more we can do early, the better for all surely.

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