Despite recent reductions in the smoking rate, tobacco smoking is still the leading cause of preventable death and disease in America. Public health interventions have successfully spread the notion that smokers should quit smoking; nearly 70% of smokers have tried to quit, and 40% have tried within the last year. However, most attempts at quitting are unsuccessful.

Why do smokers find it hard to quit? The Lit2Quit project proposes that it is because people’s motivational states change over time. Sometimes, would-be quitters are in a telic state. They are motivated by long-term plans and rational calculations. In this state, it is relatively easy to resist the urge to smoke. However, people can also be in a paratelic state. This means that they are motivated by excitement, pleasure, and short-term rewards, not by big-picture goals and desires. Because the benefits of quitting are far away, the urge to smoke becomes much harder to resist!

We propose that a game-based intervention is the perfect approach for helping quitters while they’re in a paratelic state. The game substitutes for the cigarette on not one but two levels. First, the game serves as an immediately pleasurable alternative activity. Second, the game is designed to reduce the player’s urge to smoke, so that at the end of a play session the player is less likely to pick up a cigarette.

The game reduces players’ urge to smoke by using the proven technique of breath therapy. Breath therapy uses biofeedback to induce physiological and emotional sensations that mirror the effects of smoking. Unfortunately, smokers generally find breath therapy boring, and have low participation rates outside the laboratory. By integrating breath therapy into the design of the game, we serve the dual goals of making our game a better smoking-reduction intervention and making breath therapy more usable and fun.

The game uses other game design techniques to amplify the physiological and emotional effects of breath therapy. These techniques include the choice of sound, color, and visual style, the speed and amplitude of physical gestures required to play, the pace of game-play, the nature and difficulty of in-game challenges, the game narrative, and more.

Finally, the game is designed for mobile play. Smokers experience the urge for tobacco in many different places and contexts; a successful intervention must always be accessible. Smartphones travel everywhere with their owners, particularly in the under-40 age group we target. That means that Lit2Quit can be available for would-be quitters anytime and anywhere.

Our first round of studies investigate whether the game succeeds at inducing physiological and emotional changes similar to those produced by smoking. We measured players’ state of arousal using skin conductance and heart rate for the physical aspects, and the SAM scale for the emotional side. We also looked at EEG recordings to see the impact on players’ brains. Our preliminary findings are positive, but we are currently analyzing a larger data set for greater confidence.

Once our data is fully analyzed, we intend to seek additional funding to conduct field trials. Laboratory success is an important first step, but we need to see how our intervention holds up in the real-world environment it was designed for!

The Lit2Quit project was funded by a Robert Wood Johnson Foundation Health Games Research grant.

The project site can be found here.

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