• Titus J Brinker, Julia Holzapfel, Tanja G Baudson, Katharina Sies, Lena Jakob, Hannah Maria Baumert, Marlene Heckl, Ana Cirac, Janina L Suhre, Verena Mathes, Fabian N Fries, Hannah Spielmann, Nancy Rigotti, Werner Seeger, Felix Herth, David A Groneberg, Tobias Raupach, Henning Gall, Claudia Bauer, Pat Marek, Anil Batra, Chase H Harrison, Lava Taha, Andreas Owczarek, Felix J Hofmann, Roger Thomas, Ute Mons, and Michael Kreuter.
• Universities of Gießen and Marburg Lung Center (UGMLC); Member of the German Center for Lung Research (DZL), Justus-Liebig-University of Gießen, Gießen, Germany.
• BMJ Open. 2016 Nov 7; 6 (11): e014288.

IntroductionSmoking is the largest cause of preventable death globally. Most smokers smoke their first cigarette in early adolescence. We took advantage of the widespread availability of mobile phones and adolescents' interest in appearance to develop a free photoaging app which is promoted via a poster campaign in secondary schools. This study aims to evaluate its effectiveness regarding smoking prevalence and students' attitudes towards smoking.Methods And AnalysisA randomised controlled trial is conducted with 9851 students of both genders with an average age of 12 years in grades 6 and 7 of 126 secondary schools in Germany. At present, cigarette smoking prevalence in our sample is 4.7%, with 4.6% of the students currently using e-cigarettes (1.6% use both). The prospective experimental study design includes measurements at baseline and at 6, 12 and 24 months postintervention via a questionnaire plus a random cotinine saliva sample at 24 months postintervention. The study groups consist of randomised schools receiving the Smokerface poster campaign and control schools with comparable baseline data (no intervention). The primary end point is the difference of change in smoking prevalence in the intervention group versus the difference in the control group at 24 months follow-up. Longitudinal changes in smoking-related attitudes, the number of new smokers and quitters and the change in the number of never-smokers will be compared between the two groups as secondary outcomes.Ethics And DisseminationEthical approval was obtained from the ethics committee of the University of Gießen and the ministries of cultural affairs, both in Germany. Results will be disseminated at conferences, in peer-reviewed journals, on our websites and throughout the multinational Education Against Tobacco network.Trial Registration NumberNCT02544360, Pre-results.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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