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

Abstract

BackgroundMost 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.ObjectiveIn 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.MethodsWe 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.ResultsThe 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.ConclusionsOur 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.

Mobile health interventions in developing countries: A systematic review

“…For example, Ilozumba et al 38 used the Theory of Change to determine contextual factors that affect the outcomes of mHealth intervention for pregnant women. Similarly, Bernardes-Souza et al 39 used the theory of planned behavior to examine the feasibility and user's perception of facial-aging apps that can discourage secondary school students from smoking.…”

“…All 31 studies included infrastructure-related discussion, which is the first item in the checklist. This criterion provides information about the minimum infrastructure required for each mHealth intervention and, thus, facilitates understanding of the viability, generalizability, and replicability of the mHealth 43 Afroze et al 44 Han et al 37 Islam et al 29 Lwin et al 45 Musyimi et al 46 Soto-Perez-De-Celis et al 32 Rishikesh 33 Bull et al 30 Lestantri et al 47 Guo et al 31 Borsari et al 48 Alnasser et al 49 Praveen et al 36 Ilozumba et al 38 Malik et al 50 Mishori et al 51 Li et al 52 Ginsburg et al 25 Lopez et al 26 Miah et al 53 Sobrinho et al 54 Wang et al 55 Bernardes-Souza et al 39 interventions. In regard to the second item in the checklist, technology platform, all 31 studies once again cover discussion regarding this criterion without which it is not possible to identify the constraints that might exist and inhibit the implementation and replicability of a mHealth program.…”

Telehealth interventions for substance use disorders in low- and- middle income countries: A scoping review

“…Thereafter, the number of studies increased with a total of 28 publications between 2018 and 2020. Ten publications were found in 2018 [13,[59][60][61][62][63][64][65][66][67]. The highest proportion of included literature which met the eligibility criteria for…”

“…Participants cut across individuals in the community who were dependent on psychoactive substances and indicated a willingness to quit, oil workers, night club patrons, families, and children and adolescents. Consequently, settings spanned across workplace [75], general population [16,45,46,49,52,[56][57][58][59]66,81,82], health treatment facilities [44,50,51,53,54,60,65,[67][68][69][70][71]76,77,79,80], night clubs [13,64], and schools [55,61,63,[72][73][74]78].…”

“…Studies which assessed cigarette smoking across various populations dominated our review with 25 articles [16,45,46,[49][50][51][52]54,55,[57][58][59]61,63,65,[68][69][70][71]74,75,78,79,81,82], followed by alcohol use in eight articles [13,44,56,64,72,73,76,80]. One study assessed only methamphetamine [62], one assessed any psychoactive substance use [66], and one study assessed both cigarette smoking and alcohol [77].…”