Facial-Aging Mobile Apps for Smoking Prevention in Secondary Schools in Brazil: Appearance-Focused Interventional Study

Breno Bernardes-Souza; Francisco Patruz Ananias De Assis Pires; Gustavo Moreira Madeira; Túlio Felício Da Cunha Rodrigues; Martina Gatzka; Markus V Heppt; Albert J Omlor; Alexander H Enk; David A Groneberg; Werner Seeger; Christof von Kalle; Carola Berking; Paulo César Rodrigues Pinto Corrêa; Janina Leonie Suhre; Jonas Alfitian; Aisllan Assis; Titus Josef Brinker

doi:10.2196/10234

Facial-Aging Mobile Apps for Smoking Prevention in Secondary Schools in Brazil: Appearance-Focused Interventional Study

JMIR Public Health Surveill. 2018 Jul 17;4(3):e10234. doi: 10.2196/10234.

Authors

Breno Bernardes-Souza¹, Francisco Patruz Ananias De Assis Pires¹, Gustavo Moreira Madeira¹, Túlio Felício Da Cunha Rodrigues¹, Martina Gatzka², Markus V Heppt³, Albert J Omlor⁴, Alexander H Enk⁵, David A Groneberg⁶, Werner Seeger⁷, Christof von Kalle⁸, Carola Berking³, Paulo César Rodrigues Pinto Corrêa¹, Janina Leonie Suhre⁹, Jonas Alfitian¹⁰, Aisllan Assis¹, Titus Josef Brinker^{5

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Affiliations

¹ School of Medicine, Federal University of Ouro Preto, Ouro Preto, Brazil.
² University of Ulm, Department of Dermatology and Allergic Diseases, Ulm, Germany.
³ University Medical Center Munich, Department of Dermatology and Allergology, Munich, Germany.
⁴ Saarland University Medical Center, Department of Experimental Pneumology and Allergology, Saarland University, Homburg, Germany.
⁵ Heidelberg University Hospital, Department of Dermatology, University of Heidelberg, Heidelberg, Germany, Germany.
⁶ Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University of Frankfurt, Frankfurt, Germany.
⁷ Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL), Justus-Liebig-University, Gießen, Germany.
⁸ National Center for Tumor Diseases (NCT), Department of Translational Oncology, German Cancer Research Center, Heidelberg, Germany.
⁹ University Hospital of Bonn, Department of Pulmonary Medicine, University of Bonn, Bonn, Germany.
¹⁰ University Hospital of Cologne, Department of Cardiology, University of Cologne, Cologne, Germany.
¹¹ German Cancer Consortium (DKTK), University of Heidelberg, Heidelberg, Germany.

PMID: 30021713
PMCID: PMC6068381
DOI: 10.2196/10234

Abstract

Background: Most smokers start smoking during their early adolescence, often with the idea that smoking is glamorous. Interventions that harness the broad availability of mobile phones as well as adolescents' interest in their appearance may be a novel way to improve school-based prevention. A recent study conducted in Germany showed promising results. However, the transfer to other cultural contexts, effects on different genders, and implementability remains unknown.

Objective: In this observational study, we aimed to test the perception and implementability of facial-aging apps to prevent smoking in secondary schools in Brazil in accordance with the theory of planned behavior and with respect to different genders.

Methods: We used a free facial-aging mobile phone app ("Smokerface") in three Brazilian secondary schools via a novel method called mirroring. The students' altered three-dimensional selfies on mobile phones or tablets and images were "mirrored" via a projector in front of their whole grade. Using an anonymous questionnaire, we then measured on a 5-point Likert scale the perceptions of the intervention among 306 Brazilian secondary school students of both genders in the seventh grade (average age 12.97 years). A second questionnaire captured perceptions of medical students who conducted the intervention and its conduction per protocol.

Results: The majority of students perceived the intervention as fun (304/306, 99.3%), claimed the intervention motivated them not to smoke (289/306, 94.4%), and stated that they learned new benefits of not smoking (300/306, 98.0%). Only a minority of students disagreed or fully disagreed that they learned new benefits of nonsmoking (4/306, 1.3%) or that they themselves were motivated not to smoke (5/306, 1.6%). All of the protocol was delivered by volunteer medical students.

Conclusions: Our data indicate the potential for facial-aging interventions to reduce smoking prevalence in Brazilian secondary schools in accordance with the theory of planned behavior. Volunteer medical students enjoyed the intervention and are capable of complete implementation per protocol.

Keywords: apps; dermatology; face; photoaging; skin; smoking; tobacco; tobacco cessation; tobacco prevention.

©Breno Bernardes-Souza, Francisco Patruz Ananias De Assis Pires, Gustavo Moreira Madeira, Gustavo Moreira Madeira, Túlio Felício Da Cunha Rodrigues, Martina Gatzka, Markus V Heppt, Albert J Omlor, Alexander H Enk, David A Groneberg, Werner Seeger, Christof von Kalle, Carola Berking, Paulo César Rodrigues Pinto Corrêa, Janina Leonie Suhre, Jonas Alfitian, Aisllan Assis, Titus Josef Brinker. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 17.07.2018.