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 (χ (2) 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). 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).