JMIR Publications

ABSTRACT

Background:

The majority of smokers express an interest in quitting and about half make an attempt to quit, but about 90% of these attempts fail. Videogame-based interventions have the potential to address common barriers to evidence-based smoking cessation treatment including cost, lack of access to healthcare settings, and low engagement.

Objective:

The purpose of this study was to evaluate the feasibility and acceptability of a videogame-based smoking cessation intervention called InspiredTM.

Methods:

U.S. adults (n=48) were recruited online to use InspiredTM on their smartphone for 7 weeks (the final 6 of which had a goal of smoking abstinence for all participants). The object of the game was to grow and defend one healing tree per level against attackers. In each level, players allocated different colored gems from their bank to activate either healing or defensive structures. Levels of the game were unlocked twice daily when participants reported the number of cigarettes they smoked since the previous entry. Completion of the levels awarded players in-game currency, which was used to strategically strengthen their structures. Participants received additional in-game rewards from either submitting smoking self-reports (i.e., submission contingent) or for submitting self-reports indicating smoking abstinence (i.e., abstinent contingent), consisting of gem prisms (used to power their structures for longer) and larger amounts of in-game currency. Additionally, participants completed an online survey at intake, week 4, week 7, and during the 30-day follow-up.

Results:

Participants were 56.3% female, 8.3% Hispanic, 77.1% white, 56.2% employed, 54.2% earning less than $40,000 a year, and had an average age of 39.79 (SD=10.72). Geographically, 29.2% of the sample lived in non-urban areas (e.g., rural, suburban). There were no significant differences between groups, so all outcome data are combined. Participants reached a mean highest level of 10.71 in the game (SD=8.43), though there was a high degree of variability. Participants reported abstinence on 31.36% (SD=38.16%) of all cessation phase reports and averaged 5.40 samples of continuous abstinence (SD=9.78). For every one-standard deviation increase in highest level achieved, there was a 27% increase in the percentage of abstinent samples reported and a 405% increase in longest period of continuous abstinence. During the abstinence phase, 52.10% of participants submitted at least one abstinent report. On an 11-point scale, participants rated the intervention moderately favorably: if they had to do it again, they would use Inspired to help them quit (M=6.43, SD=3.44) and InspiredTM was helpful in this current attempt to quit (M=5.37, SD=3.57).

Conclusions:

These results support acceptability a videogame-based smoking cessation intervention for a geographically diverse population. Though high rates of dropout prevent conclusions on the intervention’s feasibility (possibly due to the game being imbalanced), a subset of the participants responded favorably to the intervention. Scalable and accessible smoking cessation interventions could be the key to addressing the number one cause of preventable morbidity and mortality in the U.S. Clinical Trial: ClinicalTrials.gov NCT03929003