A Skin Cancer Prevention Facial-Aging Mobile App for Secondary Schools in Brazil: Appearance-Focused Interventional Study

Abstract

BackgroundThe incidence of melanoma is increasing faster than any other major cancer both in Brazil and worldwide. Southeast Brazil has especially high incidences of melanoma, and early detection is low. Exposure to ultraviolet (UV) radiation is a primary risk factor for developing melanoma. Increasing attractiveness is a major motivation among adolescents for tanning. A medical student-delivered intervention that takes advantage of the broad availability of mobile phones and adolescents’ interest in their appearance indicated effectiveness in a recent study from Germany. However, the effect in a high-UV index country with a high melanoma prevalence and the capability of medical students to implement such an intervention remain unknown.ObjectiveIn this pilot study, our objective was to investigate the preliminary success and implementability of a photoaging intervention to prevent skin cancer in Brazilian adolescents.MethodsWe implemented a free photoaging mobile phone app (Sunface) in 15 secondary school classes in southeast Brazil. Medical students “mirrored” the pupils’ altered 3-dimensional (3D) selfies reacting to touch on tablets via a projector in front of their whole grade accompanied by a brief discussion of means of UV protection. An anonymous questionnaire capturing sociodemographic data and risk factors for melanoma measured the perceptions of the intervention on 5-point Likert scales among 356 pupils of both sexes (13-19 years old; median age 16 years) in grades 8 to 12 of 2 secondary schools in Brazil.ResultsWe measured more than 90% agreement in both items that measured motivation to reduce UV exposure and only 5.6% disagreement: 322 (90.5%) agreed or strongly agreed that their 3D selfie motivated them to avoid using a tanning bed, and 321 (90.2%) that it motivated them to improve their sun protection; 20 pupils (5.6%) disagreed with both items. The perceived effect on motivation was higher in female pupils in both tanning bed avoidance (n=198, 92.6% agreement in females vs n=123, 87.2% agreement in males) and increased use of sun protection (n=197, 92.1% agreement in females vs n=123, 87.2% agreement in males) and independent of age or skin type. All medical students involved filled in a process evaluation revealing that they all perceived the intervention as effective and unproblematic, and that all pupils tried the app in their presence.ConclusionsThe photoaging intervention was effective in changing behavioral predictors for UV protection in Brazilian adolescents. The predictors measured indicated an even higher prospective effectiveness in southeast Brazil than in Germany (>90% agreement in Brazil vs >60% agreement in Germany to both items that measured motivation to reduce UV exposure) in accordance with the theory of planned behavior. Medical students are capable of complete implementation. A randomized controlled trial measuring prospective effects in Brazil is planned as a result of this study.

Secondary prevention of UV-induced skin cancer: development and pilot testing of an educational patient counseling approach for individual sun protection as standard procedure of patient care

“…the use of mobile apps that show the photoaging effects of solar UVR on the participant's face) has so far been tested mainly on younger target groups (e.g. students) (Brinker et al 2017(Brinker et al , 2018a. Little is known about the use in older people (Brinker et al 2018a, b).…”

Testing Wearable UV Sensors to Improve Sun Protection in Young Adults at an Outdoor Festival: Field Study

“…The desire for tanned skin has been reported as a significant barrier to using sun protection in adolescents, with a tan associated with providing a sense of confidence, achievement, attractiveness, and the ability to fit in with their peers [ 8 ]. A photoaging app, called Sunface, which predicts the effects of sun damage to the face (such as wrinkles or aging) was tested in adolescents and was found to be effective in changing tanning and sun safe behaviors [ 33 ]. During 2010-2014, the nationwide campaign The dark side of tanning targeted young Australians’ attitudes toward tanning and was shown to be effective at reducing positive attitudes toward tanning [ 34 ].…”

Technological Applications in Skin Cancer Prevention

“…The perceived effect on motivation was higher in female pupils in both tanning bed avoidance (n=198, 92.6% agreement in female's vs n=123, 87.2% agreement in males) and increased use of sun protection (n=197, 92.1% agreement in female's vs n=123, 87.2% agreement in males) and independent of age or skin type. All medical students involved filled in a process evaluation revealing that they all perceived the intervention as effective and unproblematic, and that all pupils tried the app in their presence [16]. New medical apps are released all the time without the consumer consideration of where their private being sent.…”