Abstract
BackgroundTobacco smoking leads to death or disability and a drain on national resources. The literature suggests that cigarette smoking continues to be a major modifiable risk factor for a variety of diseases and that smokers aged 18-30 years are relatively resistant to antismoking messages due to their widely held belief that they will not be lifelong smokers.ObjectiveTo conduct a randomized controlled trial (RCT) of a computer-generated photoaging intervention to promote smoking cessation among young adult smokers within a community pharmacy setting.MethodsA trial was designed with 80% power based on the effect size observed in a published pilot study; 160 subjects were recruited (80 allocated to the control group and 80 to the intervention group) from 8 metropolitan community pharmacies located around Perth city center in Western Australia. All participants received standardized smoking cessation advice. The intervention group participants were also digitally photoaged by using the Internet-based APRIL Face Aging software so they could preview images of themselves as a lifelong smoker and as a nonsmoker. Due to the nature of the intervention, the participants and researcher could not be blinded to the study. The main outcome measure was quit attempts at 6-month follow-up, both self-reported and biochemically validated through testing for carbon monoxide (CO), and nicotine dependence assessed via the Fagerström scale.ResultsAt 6-month follow-up, 5 of 80 control group participants (6.3%) suggested they had quit smoking, but only 1 of 80 control group participants (1.3%) consented to, and was confirmed by, CO validation. In the intervention group, 22 of 80 participants (27.5%) reported quitting, with 11 of 80 participants (13.8%) confirmed by CO testing. This difference in biochemically confirmed quit attempts was statistically significant (χ2 1=9.0, P=.003). A repeated measures analysis suggested the average intervention group smoking dependence score had also significantly dropped compared to control participants (P<.001). These differences remained statistically significant after adjustment for small differences in gender distribution and nicotine dependence between the groups. The mean cost of implementing the intervention was estimated at AU $5.79 per participant. The incremental cost-effectiveness ratio was AU $46 per additional quitter. The mean cost that participants indicated they were willing to pay for the digital aging service was AU $20.25 (SD 15.32).ConclusionsDemonstrating the detrimental effects on facial physical appearance by using a computer-generated simulation may be both effective and cost-effective at persuading young adult smokers to quit.Trial RegistrationAustralian New Zealand Clinical Trials Registry: ACTRN12609000885291; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12609000885291 (Archived by WebCite at http://www.webcitation.org/6F2kMt3kC)
Highlights
Tobacco smoking leads to premature death or morbidity and places a drain on national resources
Study design and population: Customers were screened for eligibility to the RCT from eight community pharmacies (Figure 4): Figure 4: Profile of the randomised controlled trial
Summary of findings: The impact of the photo-ageing innovation on confirmed quit attempts by the young people recruited to this study was highly significant (P=.003, Chi-square test)
Summary
Tobacco smoking leads to premature death or morbidity and places a drain on national resources. Smoking reduces life expectancy by approximately seven years, with significant morbidity in the final years of a shortened life [4,5] Even those who consume between one and four cigarettes per day triple their long-term risk of dying from cardiovascular disease or lung cancer [6]. A number of previous studies have investigated the potential of personalised, computer-generated, facial ageing software to prompt quit attempts in young adult smokers. These have generally found facial ageing interventions to have some impact [11,12,13,14]. The literature suggests that cigarette smoking continues to be a major modifiable risk factor for a variety of diseases and that smokers aged 18 – 30 years are relatively resistant to anti-smoking messages due to their widely held belief that they will not be lifelong smokers
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