Evaluation of a medical student-delivered smoking prevention program utilizing a face-aging mobile app for secondary schools in Germany: The Education Against Tobacco cluster-randomized controlled trial

Titus J Brinker¹, Eva I Krieghoff-Henning², Janina L Suhre³, Marc Phillipp Silchmüller⁴, Evgenia Divizieva⁵, Jilada Wilhelm⁵, Gabriel Hillebrand⁶, Ailís C Haney⁷, Aayushi Srivastava⁶, Caelán M Haney⁶, Werner Seeger⁸, Dominik Penka⁸, Henning Gall⁸, Benedikt Gaim⁹, Lazar Glisic⁹, Tobias Stark⁹, Susanne M Swoboda⁹, Sonja Baumermann¹⁰, Christian M Brieske¹¹, Lena Jakob¹², Hannah Maria Fahrner¹², Ole Anhuef¹³, Selina Marisa Schmidt¹³, Jonas Alfitian¹⁴, Lava Taha¹⁵, Hanna Beißwenger¹⁶, David A Groneberg¹⁷, Roger E Thomas¹⁸, Stefan Fröhling¹⁹, Christof von Kalle²⁰, Tanja Gabriele Baudson²¹, Fabian Buslaff²², Ute Mons²³

Affiliations

¹ Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany. Electronic address: titus.brinker@dkfz.de.
² Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany.
³ University of Bonn, Bonn, Germany.
⁴ University Hospital of Hannover, University of Hannover, Hannover, Germany.
⁵ Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany.
⁶ University of Heidelberg, Heidelberg, Germany.
⁷ Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.
⁸ Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Cardio-Pulmonary Institute (CPI), Institute for Lung Health (ILH), Justus-Liebig University, Giessen, Germany.
⁹ University of Regensburg, Regensburg, Germany.
¹⁰ Ruhr University of Bochum, Bochum, Germany.
¹¹ Department of Transfusion Medicine, University Hospital of Essen, Essen, Germany.
¹² Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany.
¹³ University Hospital of Tuebingen, University of Tuebingen, Germany.
¹⁴ Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
¹⁵ Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
¹⁶ University of Goettingen, Goettingen, Germany.
¹⁷ Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt, Germany.
¹⁸ University of Calgary, Health Sciences Centre, Calgary, Alberta, Canada.
¹⁹ Division of Translational Medical Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.
²⁰ Berlin Institute of Health at Charité - University Medicine Berlin, Clinical Study Center, Berlin, Germany.
²¹ Vinzenz Pallotti University, Department of Human Sciences, Vallendar, Germany.
²² Department of Urology and Center for Computer-assisted and Robotic Urology, Protestant Hospital of Bethel Foundation, University Hospital OWL of the University of Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany.
²³ Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Division Primary Cancer Prevention, German Cancer Research Center (DKFZ), Heidelberg, Germany; Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.

PMID: 39111207
DOI: 10.1016/j.ejca.2024.114255

Free article

Randomized Controlled Trial

Evaluation of a medical student-delivered smoking prevention program utilizing a face-aging mobile app for secondary schools in Germany: The Education Against Tobacco cluster-randomized controlled trial

Titus J Brinker et al. Eur J Cancer. 2024 Sep.

Free article

. 2024 Sep:209:114255.

doi: 10.1016/j.ejca.2024.114255. Epub 2024 Aug 2.

Authors

Affiliations

¹ Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany. Electronic address: titus.brinker@dkfz.de.
² Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany.
³ University of Bonn, Bonn, Germany.
⁴ University Hospital of Hannover, University of Hannover, Hannover, Germany.
⁵ Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany.
⁶ University of Heidelberg, Heidelberg, Germany.
⁷ Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.
⁸ Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Cardio-Pulmonary Institute (CPI), Institute for Lung Health (ILH), Justus-Liebig University, Giessen, Germany.
⁹ University of Regensburg, Regensburg, Germany.
¹⁰ Ruhr University of Bochum, Bochum, Germany.
¹¹ Department of Transfusion Medicine, University Hospital of Essen, Essen, Germany.
¹² Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany.
¹³ University Hospital of Tuebingen, University of Tuebingen, Germany.
¹⁴ Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
¹⁵ Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
¹⁶ University of Goettingen, Goettingen, Germany.
¹⁷ Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt, Germany.
¹⁸ University of Calgary, Health Sciences Centre, Calgary, Alberta, Canada.
¹⁹ Division of Translational Medical Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.
²⁰ Berlin Institute of Health at Charité - University Medicine Berlin, Clinical Study Center, Berlin, Germany.
²¹ Vinzenz Pallotti University, Department of Human Sciences, Vallendar, Germany.
²² Department of Urology and Center for Computer-assisted and Robotic Urology, Protestant Hospital of Bethel Foundation, University Hospital OWL of the University of Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany.
²³ Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Division Primary Cancer Prevention, German Cancer Research Center (DKFZ), Heidelberg, Germany; Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.

PMID: 39111207
DOI: 10.1016/j.ejca.2024.114255

Abstract

Background: To reduce smoking uptake in adolescents, the medical students' network Education Against Tobacco (EAT) has developed a school-based intervention involving a face-aging mobile app (Smokerface).

Methods: A two-arm cluster-randomized controlled trial was conducted, evaluating the 2016 EAT intervention, which employed the mobile app Smokerface and which was delivered by medical students. Schools were randomized to intervention or control group. Surveys were conducted at baseline (pre-intervention) and at 9, 16, and 24 months post-intervention via paper & pencil questionnaires. The primary outcome was the difference in within-group changes in smoking prevalence between intervention and control group at 24 months.

Results: Overall, 144 German secondary schools comprising 11,286 pupils participated in the baseline survey, of which 100 schools participated in the baseline and at least one of the follow-up surveys, yielding 7437 pupils in the analysis sample. After 24 months, smoking prevalence was numerically lower in the intervention group compared to control group (12.9 % vs. 14.3 %); however, between-group differences in change in smoking prevalence between baseline and 24-months follow-up (OR=0.83, 95 %-CI: 0.64-1.09) were not statistically significant (p = 0.176). Intention to start smoking among baseline non-smokers declined non-significantly in the intervention group (p = 0.064), and remained essentially unchanged in the control group, but between-group differences in changes at the 24-months follow-up (OR=0.88, 0.64-1.21) were not statistically significant (p = 0.417).

Conclusion: While a trend towards beneficial effects of the intervention regarding smoking prevalence as well as intention to start smoking among baseline non-smokers was observed, our smoking prevention trial demonstrated no significant effect of the intervention.

Keywords: Prevention; Schools; Smoking; Smoking prevention; Tobacco prevention.

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Conflict of interest statement

Declaration of Competing Interest TJB programmed the Smokerface App and is therefore formally the owner/rights holder. In 2017, he was offered and accepted 500 Euro per year from another German tobacco prevention charity (ginko Stiftung für Prävention, Germany) to license the Smokerface App for their school-based prevention efforts,with no influence to this study. TJB is also the owner of Smart Health Heidelberg GmbH, a software company which develops digital utehealth apps. Werner Seeger received consulting fees from United Therapeutics, Tiakis Biotech AG, Liquidia, Pieris Pharmaceuticals, Abivax, Pfizer, Medspray BV, outside the submitted work. The other authors declare no conflict of interest.

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Evaluation of a medical student-delivered smoking prevention program utilizing a face-aging mobile app for secondary schools in Germany: The Education Against Tobacco cluster-randomized controlled trial

Affiliations

Evaluation of a medical student-delivered smoking prevention program utilizing a face-aging mobile app for secondary schools in Germany: The Education Against Tobacco cluster-randomized controlled trial

Authors

Affiliations

Abstract

Conflict of interest statement

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MeSH terms

LinkOut - more resources

Full Text Sources