Mode
Text Size
Log in / Sign up

Smokerface-Poster campaign shows lower increase in smoking prevalence with NNT of 93Poster campaign may curb teen smoking, but results uncertain

AI-generated summary of the cited source, checked by automated accuracy review. How we work

Key Takeaway
Note the Smokerface-Poster met clinical relevance criteria (NNT 93) despite a non-significant p-value of 0.228.

This cluster-randomized controlled trial involved 9797 grade 6/7 students in German secondary schools, where 96.0% were aged 11 to 13 years (51.4% male; 48.6% female). The study evaluated the Smokerface-Poster, a low-intensity, appearance-based school campaign promoting a photoaging app, compared against a control group over a 24-month follow-up period.

The primary outcome was the change in 30-day smoking prevalence. The intervention group showed an 18.1 percentage points increase in smoking prevalence, while the control group showed a 19.2 percentage points increase. This resulted in an adjusted ratio of odds ratios of 0.87 (95% CI 0.69 to 1.09; p=0.228). The number needed to treat was calculated at 93.

Safety data, including adverse events and tolerability, were not reported. Although the difference in smoking prevalence did not reach statistical significance, the intervention met the pre-defined threshold for clinical relevance (NNT < 100) and demonstrated a low cost of less than €50 per 100 students. These findings suggest potential utility as a low-cost school-based intervention despite the lack of statistical significance.

How this fits prior evidence

How this fits prior evidence: This study addresses a gap in school-based prevention strategies for tobacco use among adolescents. It complements existing evidence regarding regional variations in nicotine product use among Saudi adolescents and notes that while cessation-focused efforts may reduce current usage, evidence for prevention interventions is of very low certainty.

Teen smoking is a tough habit to break, and schools often try different ways to prevent it. A new study tested a simple, low-cost approach: posters that show how smoking ages your face. The idea is to use appearance as a motivator, not fear of lung cancer or heart disease.

Researchers in Germany recruited nearly 10,000 students in grades 6 and 7, most aged 11 to 13. Half of the schools got the posters, which promoted a photoaging app, while the other half didn't. After 24 months, they compared how many kids had started smoking in the past 30 days.

Both groups saw an increase in smoking, which is common at this age. But the increase was slightly smaller in the schools with the posters: 18.1 percentage points versus 19.2 percentage points. That difference wasn't statistically significant, meaning it could be due to chance. However, the campaign did meet a pre-defined threshold for clinical relevance, and it costs less than 50 euros per 100 students.

This is an early, low-intensity intervention, and the results are not definitive. The study didn't report any side effects or adverse events, but it also didn't look at long-term effects. If you're a parent or educator, this might be a promising, affordable option, but more research is needed to confirm if it really works.

What this means for you:
A cheap poster campaign might slightly slow teen smoking, but the effect wasn't statistically significant.

Common questions

What did the study find about the poster campaign and teen smoking?

The study found that schools using the Smokerface posters saw a smaller increase in 30-day smoking prevalence (18.1 percentage points) compared to control schools (19.2 percentage points). However, this difference was not statistically significant, meaning it could be due to chance. The campaign did meet a pre-defined threshold for clinical relevance.

How much does the Smokerface poster campaign cost?

The campaign is low-cost, at less than 50 euros per 100 students. This makes it an affordable option for schools, but the study's results are not definitive, so schools should weigh the evidence carefully.

What are the side effects of the poster campaign?

The study did not report any adverse events or side effects related to the poster campaign. Since it's a non-invasive intervention, it's unlikely to cause harm, but the study didn't provide specific safety data.

Study Details

Study typeRct
EvidenceLevel 2
Follow-up156.0 mo
PublishedAug 2026
View Original Abstract ↓
BACKGROUND: Tobacco use remains a leading cause of preventable morbidity and mortality and is commonly initiated in adolescence. We evaluated whether Smokerface-Poster, a low-intensity, appearance-based school campaign promoting a photoaging app, could attenuate smoking uptake among early adolescents. METHODS: In this two-arm cluster-randomized controlled trial, 126 German secondary schools (9797 grade 6/7 students; 96.0% were 11-13 years old; 51.4% male; 48.6% female) were allocated to intervention or control. Intervention schools displayed two classroom posters for 24 months. Smoking behavior was assessed at baseline and 24 months. As primary outcome, we investigated the between‑group difference in the change in 30-day smoking prevalence, with a number needed to treat (NNT) of < 100 students predefined as clinically relevant per protocol. RESULTS: Baseline smoking prevalence was 7.4% in the control vs. 7.9% in the intervention group. At 24 months post-intervention, smoking prevalence increased by 19.2 %age points in control vs. 18.1 %age points in the intervention group (number needed to treat=93; adjusted ratio of odds ratios 0.87, 95% CI 0.69-1.09; p = 0.228). Favorable, non-significant patterns were also observed for anti-smoking intentions and attitudes. CONCLUSION: Although the between-group difference was not statistically significant, the intervention reached the predefined threshold for clinical relevance, with an NNT of 93. This suggests that, for every 93 students exposed to the Smokerface-Poster campaign, one fewer adolescent would be expected to smoke over the two-year follow-up. Given its low cost of < €50 per 100 students, the intervention appears to be a promising approach to supporting school-based smoking prevention.
Free Newsletter

Clinical research that matters. Delivered to your inbox.

Join thousands of clinicians and researchers. No spam, unsubscribe anytime.