Videogame-based Incentives for Smoking Cessation

Cigarette smoking remains the number one cause of preventable morbidity and mortality in the
U.S. A number of barriers have been noted that prevent access to smoking cessation
interventions, such as lack of clinician training, the time commitment required to implement
treatments, and the costs associated with treatment. Thus, it is critically important that
more effective interventions be developed, and be made accessible at a relatively low cost,
to smokers. We recently developed an Internet-based Contingency Management Intervention
(CM),, where participants submit web-camera recorded videos as they exhale into a CO monitor,
and they earn money for abstinence. Although the costs associated with providing monetary
incentives contingent on smoking abstinence are likely to be less than the costs associated
with medical complications caused by smoking, the cost of incentives is often cited as a
barrier to CM. Thus, the goals of the present proposal are to markedly decrease costs and
increase sustainability of this highly accessible Internet-based CM for smoking cessation.

Using an iterative development process with the help of a team of experts, a social strategy
video game intended to be fun and engaging will be developed for Facebook ("Quitters,
Incorporated"). Treatment-seeking smokers will be able to earn incentives contingent on
meeting web-camera verified CO values consistent with smoking abstinence. Three powerful,
evidence-based incentives will be harnessed in this CM. The incentives will consist of: (1)
individual contingencies that can be used to improve game play, (2) social contingencies,
such as positive feedback and virtual rewards, that can be given to other players to
acknowledge their success with abstinence and improve their game play, and (3) group
contingencies that will require all members of a group to meet abstinence goals in order to
unlock access to certain game features. After game development, we will assess the
feasibility, acceptability, enjoyability, and preliminary efficacy of video-game-based CM for
smoking cessation. A 7-week pilot study will involve randomly assigning participants (N=100)
to either: (1) abstinent contingent, where incentives will be delivered contingent on
quitting smoking, or (2) submission contingent, where incentives will be delivered contingent
on submitting videos, but independent of quitting smoking.

The outcomes of the pilot study will impact future research in the development of
video-game-based CM interventions for smoking, as well as for alcohol and other drug use, and
medication compliance in diabetes, asthma, and other conditions. Game-based CM will promote
widespread access to this innovative, fun, sustainable intervention at a relatively low cost
(the game will be available to play for free), thereby offering the potential to have a
substantial public health impact.

Inclusion Criteria:

- 18 years or older

- smoking 10+ cigarettes per day

- smoking for 2+ years

- currently wishes to quit smoking

- has a computer at home with Internet access

- U.S. citizen

- literate

Exclusion Criteria:

- smoking other substances (e.g., marijuana, cigars) > 2 times per month

- unstable medical or psychiatric condition that might interfere with the program

- living with someone who smokes in the home

- a job that exposes the person to excessive ambient carbon monoxide