Department of Dermatology, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany.
School of Medicine, University of Itauna, Itauna, Brazil.
JAMA Dermatol. 2020 Jul 1;156(7):737-745. doi: 10.1001/jamadermatol.2020.0511.
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.
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 (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.
由于生命早期接触紫外线辐射是黑色素瘤发展的一个重要危险因素，因此减少儿童和青少年的紫外线暴露至关重要。迫切需要新的干预措施。
确定免费的面部老化手机应用程序 Sunface 对面部皮肤癌保护行为的影响。
设计、设置和参与者：这是一项在巴西东南部伊图阿纳的 8 所公立中学（9-12 年级）的 52 个班级中进行的单干预和 6 个月随访的随机对照临床试验。在 52 个班级的层面上进行了随机分组。数据于 2019 年 5 月 1 日至 10 月 10 日进行分析。
在由医学生进行的课堂研讨会上，应用程序会改变青少年的自拍照，以显示紫外线对他们未来面部的影响，并在他们的班级面前展示，同时提供有关紫外线保护的信息。在干预前和干预后 3 个月和 6 个月，通过匿名问卷收集了有关相关参数的信息。
该研究的主要终点是在 6 个月随访时每日使用防晒霜的差异。次要终点包括在 3 个月随访时每日使用防晒霜的差异、在 6 个月内至少进行 1 次皮肤自我检查以及在过去 30 天内至少进行 1 次晒黑。所有分析均基于意向治疗进行预设。考虑了集群效应。
参与者包括来自 52 个班级的 1573 名学生（812 名女生[51.6%]和 761 名男生[48.4%]；平均[标准差]年龄为 15.9[1.3]岁）。在干预组中，每日使用防晒霜的人数从 734 名学生中的 110 名（15.0%）增加到 607 名学生中的 139 名（22.9%；P<0.001）。在干预组中，至少进行 1 次皮肤自我检查的学生比例从 734 名学生中的 184 名（25.1%）上升到 607 名学生中的 300 名（49.4%；P<0.001）。使用晒黑产品的人数从 734 名学生中的 138 名（18.8%）减少到 607 名学生中的 92 名（15.2%；P=0.04）。对照组未观察到显著变化。该干预措施对女生更有效（主要终点的治疗人数：女生 8 人，男生 31 人）。
这些发现表明，基于面部老化应用程序的干预措施可能会增加巴西青少年的皮肤癌保护行为。需要进一步研究以最大限度地提高效果，并研究效果的普遍性。
ClinicalTrials.gov 标识符：NCT03178240。
