Background: In Germany there is a high prevalence of smoking especially among young people. A comprehensive tobacco control programme combining several single measures is necessary. One of these measures should be health education programmes, including programmes for primary prevention of smoking. One recently developed primary smoking prevention programme is the competition "Be Smart - Don't Start". This programme has been implemented in Germany since the school year 1997/1998. The aim of this study is to describe the diffusion of the programme between 1997 and 2003.
Methods: The diffusion of the programme over a six-year period in Germany is described. School classes were clustered according to grade and region (German "Bundesländer"). The estimated number of participating pupils is compared to population data.
Results: Between 1997 and 2003 the number of participating classes has grown by the factor 18.2: from 462 school classes in the school year 1997/1998 to 8,402 school classes in the school year 2002/2003. In the school year 2002/2003, 218,452 pupils participated in the competition, which equals 5.64 % of the total population of the 11- to 14-year olds. The number of pupils participating in the programme varies to a high degree in Germany. Between 1.07 % and 12.2 % of the target group is reached via the programme. In some grades and regions of Germany up to 19 % of the target group participate in the competition.
Conclusion: The competition "Be Smart - Don't Start" has been successfully implemented in Germany. To our present knowledge the programme is the biggest primary smoking prevention programme in Germany.