Women smokers' experiences of an age-appearance anti-smoking intervention: a qualitative study

UK women smokers' experiences of an age-progression smoking cessation intervention: Thematic analysis of accounts

Objectives

Appearance-related interventions to promote healthy behaviour have been found effective to communicate health risks. The current study aimed to explore women smokers' experiences of age-progression software showing the effects of smoking on the face.

Methods

A qualitative design was implemented, utilizing both individual interviews and focus groups within a critical realist framework. Fifteen, 19-52 year-old women smokers were administered an age-progression intervention. All participants responded to the intervention, engaged in semi-structured interviews, and were invited back to attend one of three focus groups. Data were analysed using inductive thematic analysis.

Results

Four main themes were identified: Health versus Appearance, Shock Reaction, Perceived Susceptibility, and Intention to Quit. Participants found the intervention useful, voicing need for a comprehensive approach that includes both appearance and health. Despite increases in appearance-based apps which could diminish impact, women's accounts of shock induced by the aged smoking-morphed images were similar to previous work conducted more than ten years previously.

Conclusions

The study provides novel insights in how women smokers currently perceive, and react to, an age-progression intervention for smoking cessation.

Innovation

Findings emphasise the implementation of this intervention type accompanied by health information in a range of patient settings.

A Photoaging Intervention Delivered to Adolescents in Secondary Schools: A Feasibility Study

Excessive exposure to ultraviolet radiation during adolescence can have a lasting effect on long-term skin cancer risk. Skin cancer prevention interventions for adolescents have been less commonly investigated than those for children and adults. The study objectives were to develop and evaluate the feasibility of a secondary school-based appearance focused intervention, including the development and testing of protocols and instruments, as a resource module that could be efficiently integrated into the secondary school science curriculum. This longitudinal study was conducted with a convenience sample of 38 13–14 year-old students attending one New Zealand (NZ) urban secondary school. The recruitment rate was excellent with only one student not participating because of parental concern. In terms of the implementation practicality, the intervention, as it stands, was extremely resource intensive, involving four research staff to deliver. This will not work if delivered in a classroom setting by a single teacher. However, the intervention was well received by students, so it shows promise if a less resource intensive version could be produced. The acceptability of the intervention with the students was good with the majority (61%) having no suggestions for improvements. Suggested improvements were minor and could be easily addressed.

Students' experiences of a facial morphing intervention designed to encourage safer drinking

Objective: The study was designed to investigate women's experiences of an age-appearance, facial-ageing, morphing intervention to show the effect of alcohol consumption on their skin. Design: Seventeen women aged 19-32 took part in the study, using individual sessions where they viewed the intervention. Main Outcome Measures: Participants were recorded during their viewing of the facial-ageing software, and the recordings of the sessions were then transcribed. Results: Transcripts were analysed using inductive thematic analysis. The women were shocked about the possible impact of alcohol consumption on their skin and appearance, and all of the women stated that the intervention had made them think about changing their alcohol consumption behaviours in the future, after viewing the images of themselves which were morphed to show the effects of both moderate and excessive alcohol consumption. Conclusion: The results are discussed in relation to suggestions for interventions aimed at women. It is concluded that appearance-based interventions do have a role to play with regards to alcohol consumption interventions.

A randomised trial of the effect of appearance versus health-framed messages on engagement with an online brief screening and alcohol reduction intervention

Objectives: To compare the impact of appearance versus health-framed messages on engagement in a brief web-based risk screening and alcohol reduction intervention. Design: Randomised trial delivered via Drinkaware's website. Visitors were exposed to appearance (n = 51,588) or health-framed messages (n = 52,639) directing them towards an AUDIT-C risk screening questionnaire. Users completing this questionnaire were given feedback on their risk level and extended frame-congruent information. Outcomes: The primary outcome is completion of the AUDIT-C questionnaire. The secondary outcome is whether the participant accessed any of four further resources. Results: The appearance-framed message led to a small but significant increase in the number of users completing the AUDIT-C compared to the health-framed message (n = 3,537, 6.86% versus n = 3,355, 6.37%, p < 0.01). Conversely, following subsequent risk feedback, users exposed to extended health-framed information were more likely to access further resources (n = 1,146, 2.17% versus n = 942, 1.83%, p < 0.01). Conclusions: Physical appearance-framed messages increased the likelihood of engagement with an online alcohol screening and brief intervention tool, whereas health-framed messages increased the likelihood of accessing further resources. This highlights the potential for the use of multi-level approaches in alcohol reduction interventions.

Burn injuries caused by e-cigarette explosions: A systematic review of published cases

INTRODUCTION

E-cigarettes have the potential to cause burns from batteries that explode. Although e-cigarette explosion burns have been reported by the media (e.g. local online news, blogs), there is a need for a comprehensive review of published medical case reports regarding these injuries.

METHODS

CINAHL and PubMed were systematically searched using common terms regarding e-cigarettes (electronic cigarette, e-cigarette, vape, vaping, electronic nicotine delivery systems) in every combination with the term ‘explosion’. Peer-reviewed articles were included if they: were written in English, described case reports of burn injuries caused by e-cigarette explosions, and were published in any year. Cases were categorized by demographics, location of the e-cigarette explosion, burned body areas, types of burns, total body surface area of burns, the need for skin grafting, and the length of hospital stay.

RESULTS

Thirty-one articles were included in the review and described 164 cases. Most patients (90%) were male and between 20 to 29 years old. In the majority of cases (65%), e-cigarettes exploded in pockets, compared to exploding in the face or hand. Common burned areas included the thigh, hand, genitals, and face. Burn severity was typically second-degree burns (35%) or a combination of second-degree and third-degree burns (20%). In all, 48 patients required skin grafting, with 19 reporting a median hospital stay of 5 days.

CONCLUSIONS

This review has several implications, including the need for regulation of batteries, education regarding battery safety, and leveraging images of the severity of e-cigarette explosion burns to discourage the use of e-cigarettes.

A brief facial morphing intervention to reduce skin cancer risk behaviors: Results from a randomized controlled trial

The current study was designed to test the efficacy of an appearance-based facial morphing program to reduce intentional UV exposure among individuals at risk for skin cancer. A three-arm randomized controlled trial was employed (N = 219) comparing facial morphing + health information to: (1) mindfulness + health information; and (2) health information only. Participants were young adults with a history of recent intentional tanning and future intentions to tan. Primary outcomes were indoor and outdoor tanning frequency and tanning intentions, with secondary outcomes of tanning attitudes, body image, and affect. Facial morphing participants reported less frequent tanning, compared to mindfulness and control participants at 1-month follow-up. Facial morphing participants also generally reported lower intentions to tan at immediate follow-up, although the magnitude of these effects weakened at 1-month follow-up. Facial morphing programs may offer a brief, efficacious, and scalable augmentation to standard of care in reducing intentional UV exposure. This trial is registered with clinicaltrials.gov (NCT03237013).

Male smokers' experiences of an appearance-focused facial-ageing intervention

This study investigated 30 male smokers' experiences of an appearance-focused, facial-ageing intervention. Individual interviews ( n = 21) and three focus groups ( n = 9) were conducted. Transcripts were analysed using thematic analysis. Male smokers explained that viewing the impacts of smoking on their own faces was the most effective part of the intervention and 22 men (73%) said that they intended quitting smoking or reducing number of cigarettes smoked post-intervention. It is recommended that designers of appearance-focused interventions target men in the future as the current findings demonstrated that the majority of men engaged well with the intervention.

Gaining pounds by losing pounds: preferences for lifestyle interventions to reduce obesity

While there is evidence that weight-loss interventions reduce morbidity, indications of their acceptability are limited. Understanding preferences for lifestyle interventions will help policymakers design interventions. We used a discrete choice experiment to investigate preferences for lifestyle interventions to reduce adult obesity. Attributes focused on: the components of the programme; weight change; short-term and longer-term health gains; time spent on the intervention and financial costs incurred. Data were collected through a web-based questionnaire, with 504 UK adults responding. Despite evidence that dietary interventions are the most effective way to lose weight, respondents preferred lifestyle interventions involving physical activity. While the evidence suggests that behaviour change support improves effectiveness of interventions, its value to participants was limited. A general preference to maintain current lifestyles, together with the sensitivity of take up to financial costs, suggests financial incentives could be used to help maximise uptake of healthy lifestyle interventions. An important target group for change, men, required more compensation to take up healthier lifestyles. Those of normal weight, who will increase in weight over time if they do not change their lifestyle, required the highest compensation. Policymakers face challenges in inducing people to change their behaviour and adopt healthy lifestyles.

Active ingredients against human epidermal aging

The decisive role of the epidermis in maintaining body homeostasis prompted studies to evaluate the changes in epidermal structure and functionality over the lifetime. This development, along with the identification of molecular mechanisms of epidermal signaling, maintenance, and differentiation, points to a need for new therapeutic alternatives to treat and prevent skin aging. In addition to recovering age- and sun-compromised functions, proper treatment of the epidermis has important esthetic implications. This study reviews active ingredients capable of counteracting symptoms of epidermal aging, organized according to the regulation of specific age-affected epidermal functions: (1) several compounds, other than retinoids and derivatives, act on the proliferation and differentiation of keratinocytes, supporting the protective barrier against mechanical and chemical insults; (2) natural lipidic compounds, as well as glycerol and urea, are described as agents for maintaining water-ion balance; (3) regulation of immunological pathogen defense can be reinforced by natural extracts and compounds, such as resveratrol; and (4) antioxidant exogenous sources enriched with flavonoids and vitamin C, for example, improve solar radiation protection and epidermal antioxidant activity. The main objective is to provide a functional classification of active ingredients as regulatory elements of epidermal homeostasis, with potential cosmetic and/or dermatological applications.

Internet-based photoaging within Australian pharmacies to promote smoking cessation: randomized controlled trial

Background

Tobacco 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.

Objective

To 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.

Methods

A 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.

Results

At 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 (χ²₁=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).

Conclusions

Demonstrating 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 Registration

Australian 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)

Impact of a facial-ageing intervention versus a health literature intervention on women's sun protection attitudes and behavioural intentions

This study was designed to investigate the impact of a facial-ageing intervention on women's sun protection attitudes and behavioural intentions, compared to a health literature intervention where participants viewed literature on the effect of ultraviolet (UV) exposure on health. Seventy women (35 in each condition) completed questionnaires at baseline and immediately post-intervention. The average age of the participants was 23.70 (SD = 5.03) years. Participants in the facial-ageing intervention condition scored significantly higher on intentions, negative attitudes and perceived sun damage susceptibility after taking part in the intervention, compared to those in the health literature intervention condition. The results are discussed in relation to suggestions for sun protection interventions aimed at women aged from 18 to 34. It is concluded that appearance-based interventions have a role to play in healthcare and educational settings with regard to UV exposure and sun protection intentions.

Men's experiences of an appearance-focussed facial-ageing sun protection intervention: a qualitative study

The study investigated men's experiences of taking part in an age-appearance-focussed intervention which involved seeing how their faces would age with and without UV exposure. Thirty-five men gave accounts of their experiences whilst taking part in the intervention, and eight men discussed their experiences retrospectively in focus groups. Transcripts were analysed using inductive thematic analysis. Men were shocked about the impact of ageing on their faces, and particularly the added impact of UV exposure, with a subgroup of men expressing lack of concern. The findings are discussed in relation to gender roles and appearance concerns in men, and comparisons are made between the thematic model produced and that produced in a similar study focussing on women's experiences of the same intervention. It is concluded that appearance-based interventions have a role to play in healthcare and educational settings with regards to UV exposure and sun protection intentions in men.

Cigarette Smoking and Facial Wrinkles: A Review of the Literature

Research studies indicate that smoking cigarettes is related to a premature development of facial wrinkles. Given that facial wrinkles may act as motivation for people to quit smoking, it is crucial that smoking cessation professionals be able to accurately inform clients about research concerning smoking and wrinkles. Therefore, the purpose of this article is to provide an updated overview of the literature which can be used by cessation clinicians as a practical reference on smoking and facial wrinkles. Databases were searched for peer-reviewed articles that study the association with smoking and wrinkles. In all, 17 articles were located and reviewed for research methods and results. Although facial wrinkles and smoking were measured inconsistently between studies, the overall literature indicates that those who smoke have a higher risk of developing premature facial wrinkles as compared to those who do not smoke. The implications of this review for smoking cessation professionals are described.

A qualitative study examining women's experiences of an appearance-focussed facial-ageing sun protection intervention

The study was designed to investigate women's experiences of an appearance-focussed, facial-ageing, morphing intervention to show the effect of UV exposure on their skin. Forty-seven women aged 18-34 took part in the intervention: 35 women in individual sessions, and 12 in four focus groups. Transcripts were analysed using inductive thematic analysis. Women were shocked about the likely effect of UV exposure on their skin. All of the women stated that they were going to make changes to their UV exposure and sun protection behaviours after viewing the images of themselves which were morphed to show the effects of UV exposure. The results are discussed in relation to suggestions for interventions aimed at women aged 18-34. It is concluded that appearance-based interventions do have a role to play in healthcare and educational settings with regards to UV exposure and sun protection intentions.