For the Smokefree Class Competition (SFC), classes compete to maintain 90% smoking abstinence over six months of follow‐up, reporting rates on a monthly basis; then, classes maintaining 90% abstinence compete for rewards such as monetary prizes, class trips, or special activities.

Reviewers found that the SFC intervention failed to reduce smoking uptake relative to usual drug prevention/education programs or no intervention in children and adolescents (aged 11 to 14 years), but evidence was of very low to low quality. Rates of unintended behaviors did not differ between SFC and control groups at any follow‐up intervals, although one study reported that children receiving SFC may have made more false claims about their smoking status to increase their chances of winning. None of the included trials reported adverse effects.

Reviewers found no trials of incentive interventions other than SFC for smoking prevention among children and teens that reported on the key outcome of smoking uptake rates.