Background: Text messaging has successfully supported smoking cessation. This study compares a mobile application with text messaging to support smoking cessation. Materials and Methods: Young adult smokers 18-30 years old (n = 102) participated in a randomized pretest-posttest trial. Smokers received a smartphone application (REQ-Mobile) with short messages and interactive tools or a text messaging system (onQ), managed by an expert system. Selfreported usability of REQ-Mobile and quitting behavior (quit attempts, point-prevalence, 30-day point-prevalence, and continued abstinence) were assessed in posttests. Results: Overall, 60% of smokers used mobile services (REQ-Mobile, 61%, mean of 128.5 messages received; onQ, 59%, mean of 107.8 messages), and 75% evaluated REQ-Mobile as user-friendly. A majority of smokers reported being abstinent at posttest (6 weeks, 53% of completers; 12 weeks, 66% of completers [44% of all cases]). Also, 37% (25%of all cases) reported 30-day point-prevalence abstinence, and 32% (22% of all cases) reported continuous abstinence at 12 weeks. OnQ produced more abstinence (p < 0.05) than REQ-Mobile. Use of both services predicted increased 30-day abstinence at 12 weeks (used, 47%; not used, 20%; p = 0.03). Conclusions: REQ-Mobile was feasible for delivering cessation support but appeared to not move smokers to quit as quickly as text messaging. Text messaging may work better because it is simple, well known, and delivered to a primary inbox. These advantages may disappear as smokers become more experienced with new handsets. Mobile phones may be promising delivery platforms for cessation services using either smartphone applications or text messaging.

Importance Mobile smart phones are rapidly emerging as an effective means of communicating with many Americans. Using mobile applications, they can access remote databases, track time and location, and integrate user input to provide tailored health information. Objective A smart phone mobile application providing personalized, real-time sun protection advice was evaluated in a randomized trial. Design The trial was conducted in 2012 and had a randomized pretest-posttest controlled design with a 10-week follow-up. Setting Data was collected from a nationwide population-based survey panel. Participants The trial enrolled a sample of n=604 non-Hispanic and Hispanic adults from the Knowledge Panel® aged 18 or older who owned an Android smart phone. Intervention The mobile application provided advice on sun protection (i.e., protection practices and risk of sunburn) and alerts (to apply/reapply sunscreen and get out of the sun), hourly UV Index, and vitamin D production based on the forecast UV Index, phone's time and location, and user input. Main Outcomes and Measures Percent of days using sun protection and time spent outdoors (days and minutes) in the midday sun and number of sunburns in the past 3 months were collected. Results Individuals in the treatment group reported more shade use but less sunscreen use than controls. Those who used the mobile app reported spending less time in the sun and using all protection behaviors combined more. Conclusions and Relevance The mobile application improved some sun protection. Use of the mobile application was lower than expected but associated with increased sun protection. Providing personalized advice when and where people are in the sun may help reduce sun exposure.

Importance Mobile apps on smart phones can communicate a large amount of personalized, real-time health information, including advice on skin cancer prevention, but their effectiveness may be affected by whether Americans can be convinced to use them. Objective A smart phone mobile application delivering real-time sun protection advice was evaluated for a second time in a randomized trial. Design The trial conducted in 2013 utilized a randomized pretest-posttest controlled design. Screening procedures and a 3-week run-in period were added to increase use of the mobile app. Also, follow-ups at 3- and 8-weeks after randomization were conducted to examine immediate and longer-term effects. Setting Data was collected from participants recruited nationwide through online promotions. Participants A volunteer sample of adults aged 18 or older who owned an Android or iPhone smart phones. Intervention The mobile application gave feedback on sun protection (i.e., sun safety practices and sunburn risk) and alerted users to apply/reapply sunscreen and get out of the sun. Also, it displayed the hourly UV Index and vitamin D production based on the forecast UV Index, time, and location. Main Outcomes and Measures Percent of days using sun protection and days and minutes outdoors in the midday sun and number of sunburns in the past 3 months were assesed. Results Treatment group participants used wide-brimmed hats more at 7-weeks than controls. Women who used Solar Cell reported using all sun protection combined more than men but men and older individuals used sunscreen and hats less. Conclusions and Relevance The mobile application appeared to weakly improve sun protection initially. Use of the mobile application was higher than in a previous trial and associated with greater sun protection especially by women. Strategies to increase use are needed if the mobile app is to be effective deployed to the general adult population.

Smart phones are changing health communication for Americans. User-centered production of a mobile application for sun protection is reported. Focus groups (n=16 adults) provided input on the mobile application concept. Four rounds of usability testing were conducted with 22 adults to develop the interface. An iterative programming procedure moved from a specification document to the final mobile application, named Solar Cell. Adults desired a variety of sun protection advice, identified few barriers to use and were willing to input personal data. The Solar Cell prototype was improved from round 1 (seven of 12 tasks completed) to round 2 (11 of 12 task completed) of usability testing and was interoperable across handsets and networks. The fully produced version was revised during testing. Adults rated Solar Cell as highly user friendly (mean=5.06). The user-centered process produced a mobile application that should help many adults manage sun safety.

Developing innovative delivery approaches for evidenced-based interventions are promising to increase intervention sustainability and participant access and engagement. It is critical that these adaptations are systematic and developed with expert consultation and community input.

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