Background and challenges to implementation:
Tobacco Free Duo is a long-term school-based intervention. It started 1993 with the aim to prevent cancer by reducing Tobacco-use. The program has developed over the years led by the Health Unit, Västerbotten County Council in Sweden, in collaboration with youth and local communities in the county. After an evaluation in 2009, the method has spread to other parts of Sweden with support from the government, and is implemented in 25% of Swedish municipalities.

Intervention or response:
The name Tobacco Free Duo originates from an idea that pupils in grade 6 are given an opportunity to team up with a tobacco free adult, and form a pair - a Duo. This is formalized by signing a mutual agreement that last until the pupil leaves secondary school, grade 9. The agreement has an annual follow up confirming being tobacco free. The programme has some key components; class-information to increase the knowledge and awareness of tobacco related issues, strengthen self-confidence, giving positive reinforcement by different awards, creating a positive non-smoking influence through social support and influence from friends, parents and local society. Groups of pupils are educated to be Tobacco Free Duo ambassadors at the schools. They are role models and plan for activities to strengthen the tobacco-free environment.

Results and lessons learnt:
Every year 80% of the pupils aged 11-12, sign the agreement and the second generation of members in Tobacco free Duo is a fact. The first evaluation of the programme showed a 50% decrease in youth smoking, and that 25 % of the adults were tobacco users quitting tobacco to become a Duo-partner. Västerbotten has the lowest prevalence of adult smoking in Sweden.

Conclusions and key recommendations:
Tobacco Free Duo has lasted, developed and spread during the past 25 years, Examples of key activities and factors of success will be presented.