Abstract
Because exposure to UV radiation early in life is an important risk factor for melanoma development, reducing UV exposure in children and adolescents is of paramount importance. New interventions are urgently required. To determine the effect of the free face-aging mobile app Sunface on the skin cancer protection behavior of adolescents. This cluster-randomized clinical trial included a single intervention and a 6-month follow-up from February 1 to November 30, 2018. Randomization was performed on the class level in 52 school classes within 8 public secondary schools (grades 9-12) in Itauna, Southeast Brazil. Data were analyzed from May 1 to October 10, 2019. In a classroom seminar delivered by medical students, adolescents' selfies were altered by the app to show UV effects on their future faces and were shown in front of their class, accompanied by information about UV protection. Information about relevant parameters was collected via anonymous questionnaires before and 3 and 6 months after the intervention. The primary end point of the study was the difference in daily sunscreen use at 6 months of follow-up. Secondary end points included the difference in daily sunscreen use at 3 months of follow-up, at least 1 skin self-examination within 6 months, and at least 1 tanning session in the preceding 30 days. All analyses were predefined and based on intention to treat. Cluster effects were taken into account. Participants included 1573 pupils (812 girls [51.6%] and 761 boys [48.4%]; mean [SD] age, 15.9 [1.3] years) from 52 school classes. Daily sunscreen use increased from 110 of 734 pupils (15.0%) to 139 of 607 (22.9%; P < .001) at the 6-month follow-up in the intervention group. The proportion of pupils performing at least 1 skin self-examination in the intervention group rose from 184 of 734 (25.1%) to 300 of 607 (49.4%; P < .001). Use of tanning decreased from 138 of 734 pupils (18.8%) to 92 of 607 (15.2%; P = .04). No significant changes were observed in the control group. The intervention was more effective for female students (number needed to treat for the primary end point: 8 for girls and 31 for boys). These findings suggest that interventions based on face-aging apps may increase skin cancer protection behavior in Brazilian adolescents. Further studies are required to maximize the effect and to investigate the generalizability of the effects. ClinicalTrials.gov Identifier: NCT03178240.
Highlights
DESIGN, SETTING, AND PARTICIPANTS This cluster-randomized clinical trial included a single intervention and a 6-month follow-up from February 1 to November 30, 2018
Randomization was performed on the class level in 52 school classes within 8 public secondary schools in Itauna, Southeast Brazil
The intervention was more effective for female students. These findings suggest that interventions based on face-aging apps may increase skin cancer protection behavior in Brazilian adolescents
Summary
Patient Selection and Study Design The Sunface trial was a randomized clinical superiority trial with 2 parallel groups. Details are found in the peer-reviewed study protocol, which adhered to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) reporting guidelines and was published before we implemented the present trial.[29] The present study protocol is found in Supplement 1. The study received ethics board approval by the University of Itauna, Itauna, Brazil. All pupils assented to participation, and the ethics board waived the need for written informed consent because no biochemical intervention was involved and data were deidentified. The study was conducted from February 1 through November 30, 2018. Eight public secondary schools in Itauna were recruited via email, telephone, and personal appointment (in most cases with the principal), and 52 school classes were included in the study
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
