Effects of tobacco game

A powerful team has been assembled to perform on this project. The PI, Tom Plocher, is a researcher with three decades of experience conducting human factors research. Klassen is an experienced educational software developer who has created over 60 educational software products.

Consulting with Mr. Plocher and Dr. Klassen will be Dr. Carole A. Bagley, PhD. She will be organizing the evaluation with the schools to test the feasibility of the phase I version of your game. She will also consult on the presenting educational content during the phase I game development. This is true regardless of their age or how long they have been smoking. Visit the Benefits of Quitting page for more information about how quitting smoking can improve your health.

Department of Health and Human Services. Atlanta: U. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report 08 ; Actual Causes of Death in the United States. Rockville MD : U. A Report of the Surgeon General external icon. For Further Information. Fact Sheets. What's this.

Related CDC Sites. Social Media. Links with this icon indicate that you are leaving the CDC website. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Cravings a Questionnaire of Smoking Urge-Brief; scale ]low to higher cravings].

Self-efficacy a Smoking Abstinence Self-Efficacy, scale [not at all tempted to extremely temped to extremely tempted]. Coping skills a Condiotte and Lichtenstein Confidence Questionnaire; scale [no confidence to high confidence]. The intervention group smoked less cigarettes at follow-up [at 1, 2, and 6 mo postintervention].

At 6 mo postintervention, the intervention group had a mean of smoked cigarettes of 0. At all follow-up time points, the intervention group had greater confidence to avoid smoking than the control group.

Self-efficacy to refuse offers scale [not sure at all to definitely sure]. Intentions to use cigarettes scale [not at all likely to definitely likely]. The intervention reduced nicotine addiction, and crushing cigarettes in VR had a better impact than grasping balls.

Self-efficacy to quit smoking a Condiotte and Lichtenstein Confidence Questionnaire; scale [no confidence to high confidence]. The number of cigarettes smoked per day decreased from baseline 17 to follow-up at 30 d 12 and at 90 d.

Confidence in quitting decreased from baseline 3. Intention to quit smoking a [scale not at all to absolutely ].

Attitude to smoking prohibition in hospitals [scale unacceptable to completely justifiable ]. Self-efficacy a Smoking Self-Efficacy Questionaire; scale [not at all sure to absolutely sure to refrain from smoking when facing stimuli]. Attitudes toward smoking scale a scale [totally disagree to fully agree]. Attitudes toward Nicotine Replacement Therapy scale a scale [totally disagree to fully agree]. Smokers in the intervention groups were more likely to be in stage 2 contemplation, preparation, and action rather than stage 1 precontemplation compared with participants in the control group.

Tobacco substance users had a mean self-efficacy score of 4. While participants had a relatively high behavioral intention to quit or reduce their substance use, these scores decreased from baseline to follow-up. Average scores on attitude were at baseline 3. It was found that participants that reported tobacco use as their problem substance had an average score on self-efficacy, attitude, and intended behavior of 3.

The mean pre- and postintervention ratings for all 3 groups ranged from 1. There was no main effect on group or item level, yet improvements were found in 2 items.

The mean pre- and postintervention ratings for all 3 groups ranged from ranged from 1. Anti-smoking self-efficacy scale a scale [lowest to highest level of self-efficacy]. Attitudes toward tobacco use [scale most negative to most positive attitude ]. Tobacco-use motives a scale [lowest to highest motives to smoke].

Motivation to decline tobacco use in the future scale [highest to lowest motivation]. Within the other groups and between groups, no differences were found. Smoking status a Bedfont Smokerlyzer; scale 1 [nonsmoker] to 7 [heavy smoker].

The effects of playing a serious game on smoking status and cessation were assessed in 7 studies. Four studies found statistically significant, positive effects on smoking status, 19 , 25 , 27 , 33 and 1 study found positive effects that were significant at one time point but insignificant at another time point. Six studies assessed the effects of serious games on behavioral determinants of smoking cessation among adult smokers. Of these determinants, 6 had statistically significant positive effects ie, attitude, self-efficacy, intention, self-expansion, and coping skills.

One study found statistically significant, positive effects on attitude toward smoking. Three studies evaluated a serious game that was delivered in combination with another intervention. Two studies reported statistically significant, positive effects on smoking cessation.

The outcome measures used in the studies were all validated, 20 , 22 , 24 partly validated, 25—27 , 30 , 33 or none of the measures were validated. Owing to the heterogeneity of the included studies, it was impossible to perform a pooled meta-analysis.

This systematic review aimed to gain insight into the composition and effects of serious games on smoking-related outcomes. We found that serious games included multiple game elements of different categories. The evidence from a number of studies suggests that games may have positive effects on smoking-related outcomes, particularly on smoking cessation. Six studies on smoking prevention together assessed 20 determinants and found statistically significant positive effects for 8 determinants ie, attitude, knowledge, perceived risk, perceived susceptibility, intention, and perceptions.

Nine studies were aimed at smoking cessation, of which 7 assessed smoking status or cessation. Of these studies, 4 found statistically significant, positive effects on smoking status, and 3 studies assessed the effect on the number of smoked cigarettes with all finding positive, statistically significant effects.

Six studies assessed the effects of serious games on 12 determinants of smoking cessation, 7 of which found statistically significant positive effects ie, self-efficacy, self-expansion, attitude, coping skills, and intention.

This review analyzed which game elements are included in serious games aimed at smoking prevention and cessation. Social features, which include support networks, appear thus underrepresented in serious games for smoking initiation prevention and cessation. This underrepresentation suggests that there is a window of opportunity to incorporate these features in these serious games, which could contribute to their effectiveness to prevent or stop smoking.

This is because serious games with social features included in this systematic review all reported positive significant effects on smoking cessation and determinants. Our finding that a number of studies suggested that games may have positive effects on smoking-related outcomes is in line with other reviews on serious health games. Sexual health games positively affected behavioral determinants eg, intention , yet no effect on behavior was found eg, delayed sexual initiation.

Considering the effects of serious games on smoking initiation prevention, the results were more ambiguous and will likely require a timespan covering years rather than weeks. Also, some studies may have lacked power to detect statically significant effects. Our review exposes various limitations in the included studies and raises serious questions.

The heterogeneity of studies, intervention characteristics, and outcomes inhibits an unambiguously, conclusive evaluation of the effects of serious games on smoking-related outcomes.

Moreover, the reporting of the studies did not allow an analysis of the effects of specific or combinations of game elements on smoking-related outcomes. Further, many studies were classified as poor or fair methodological quality, raising questions about the validity of results.

One of the main issues was unreported information. This prevents a distinction between studies that reported incompletely but may have in fact good methodological quality and studies that actually had poor methodological quality. Moreover, about a quarter of the studies did not report any theoretical basis of their game or intervention; however, this is crucial for effectiveness of serious games on behavioral determinants.

As it is known that most smokers have multiple quit attempts before achieving maintained smoking cessation, long-term results are of great importance to assess whether serious games have lasting effects on smoking on smoking-related outcomes. To illustrate, 1 study showed that at follow-up the positive effects on self-efficacy and intention to change health behavior can substantially be reduced. In addition, smoking status was only in 2 studies assessed by carbon monoxide; other studies used self-reports.

Self-reports tend to underestimate smoking behavior. Last, the fixed playtime of the serious games is a limitation. The amount of playtime ie, frequency and duration of serious games and settings of studies varied greatly among studies in our review, and only 2 studies allowed free usage. Effects assessed based on free usage are likely to reflect effects close to real-life effects in contrast to fixed play sessions.

The fixed play of most serious games might thus generate effects that are not fully generalizable to real-life settings.

Our systematic review might be affected by publication bias, which may have resulted in an overestimation of the potentially positive effects of serious games on smoking-related outcomes.

Another limitation of our review is the quality appraisal of included studies. Despite the independent appraisal by 2 reviewers and the use of quality appraisal tools, there was room for subjectivity in the appraisal.

Another limitation is that we were dependent on the descriptions of a game in the included articles for the extraction of game elements, which were often not detailed. Therefore, we might have misclassified game elements. Last, the results of this review might be influenced by the taxonomy of King et al, 17 which we used for extraction of game elements. Although we used the most relevant taxonomy according to our assessment of 3 taxonomies, game elements might have been missed due to the specific taxonomy used.

In this review, we gained insight into the composition and effects of serious games on smoking-related outcomes. As a next step, it would be valuable to assess the contribution of single or combinations of game elements on the effects of these serious games on prevention and cessation of smoking. Based on the results of our review, we suggest to include game elements with reward and social features and subsequently assess their contribution to effects.

These features are the most and least included game elements, respectively, and a contribution assessment would show whether this is justified. They should evaluate these games on their effectiveness, with standardized, valid evaluation measures and measurements.

Furthermore, we urge future evaluations to be based on voluntary playtime and to assess long-term results at least 6 months postintervention.

Still, the intended intensity of interaction ie, intermittent interaction or time-intervals between the player and the game should be taking into account when determining the length of the follow-up period. Moreover, we highly recommend that future evaluations of serious games be more methodologically homogenous and of high quality. To conclude, serious games included multiple game elements of different categories and seemed to positively affect smoking-related outcomes, particularly smoking cessation.

However, owing to the various limitations of the literature, we cannot be conclusive about the effects of serious games on smoking prevention, cessation, or behavioral determinants.

At this point, we have insufficient knowledge on the effects and working mechanisms of serious games to make well-founded recommendations to game designers.

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