To evaluate the effectiveness of cellular telephone text messaging as a reminder tool for improving adherence to sunscreen application.Design: We conducted a randomized, controlled trial of the effect of an electronic text-message reminder system on adherence to sunscreen application. Adherence to daily sunscreen use was evaluated using a novel electronic monitoring device.Setting: Participants were recruited from the general community.Participants: Seventy participants constituted a volunteer sample from the general community. The inclusion criteria required participants to be 18 years or older, to own a cellular telephone with text-message features, and to know how to retrieve text messages.Intervention: Half of the participants received daily textmessage reminders via cellular telephone for 6 weeks, and the other half did not receive reminders. The textmessage reminders consisted of 2 components: a "hook" text detailing daily local weather information and a "prompt" text reminding users to apply sunscreen.Main Outcome Measure: The primary end point of the study was adherence to sunscreen application measured by the number of days participants applied sunscreen during the 6-week study period.Results: All 70 participants completed the 6-week study. There were no statistically significant differences in baseline characteristics between the 2 study groups. At the end of the study period, the 35 participants who did not receive reminders had a mean daily adherence rate of 30.0% (95% confidence interval, 23.1%-36.9%). In comparison, the 35 participants who received daily textmessage reminders had a mean daily adherence rate of 56.1% (95% confidence interval, 48.1%-64.1%) (PϽ.001). Among the participants in the reminder group, 24 (69%) reported that they would keep using the text-message reminders after the study, and 31 (89%) reported that they would recommend the text-message reminder system to others. Subgroup analysis did not reveal any significant demographic factors that predicted adherence.Conclusions: Despite awareness of the benefits of sunscreen, adherence is low, even in this population, for whom adherence was knowingly monitored. Shortterm data demonstrate that using existing cellular telephone text-message technology offers an innovative, lowcost, and effective method of improving adherence to sunscreen application. The use of ubiquitous communications technology, such as text messaging, may have implications for large-scale public health initiatives.
The aim of this study was to examine the incidence and mortality of cutaneous melanoma (CM) in Hong Kong. The epidemiology, clinical, and pathological features of melanoma in Asians are different from those in the European population, yet there is little in the literature that describes about melanoma in Asians. Data from the Hong Kong Cancer Registry from 1983 to 2002 were collected and reviewed. Population-based data were analyzed, focusing on the mortality and incidence rates over this 20-year period. The mean Hong Kong CM incidence rate between 1983 and 2002 was 0.8/100 000 for men and 0.6/100 000 for women. There was an overall decrease in the incidence of CM in Hong Kong between 1983 and 2002 (P<0.001). The crude mortality rate of melanoma varied from year-to-year in Hong Kong between 1983 and 2002, showing an overall increase within this period (P <0.001). Unlike most parts of the world, the overall incidence in Hong Kong is shown to trend downward between 1983 and 2002. Various factors including ethnic shifts within the Hong Kong population and the organization of the health care system may play a role in this observation. In addition, the mortality of melanoma increased between 1940 and 1990 in most parts of the world, but in Hong Kong, the mortality rate in the past 20 years reveals a modest upward trend. Its significance requires further investigation.
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