Smokers Not Ready to Quit Respond to Cessation Game

By Lisa Rapaport

March 02, 2022

(Reuters Health) - Playing a smoking cessation smartphone game may make it easier for smokers to achieve cessation even when they're not yet ready to quit, a clinical trial suggests.

The trial included 433 current smokers who reported that they were reluctant to quit, of whom 213 were randomized to participate in a three-week mobile-health game experience prior to the initiation of nicotine replacement therapy. All the participants were given nicotine replacement therapy.

People who participated in the "Take a Break" smoking cessation mobile health game received motivational text messages, quizzes, and gift cards to encourage them to stop smoking. The games were designed around social cognitive theory with mechanics designed to promote behavior change.

After three months, 35% of people who played the game and 23% of those in the control group that only received nicotine replacement therapy succeeded in having at least one quit attempt, defined as 24 hours of abstinence (hazard ratio 1.68).

At six months, participants who used the game were significantly more likely to report smoking cessation (OR 2.47) and to achieve smoking cessation as verified by carbon monoxide tests (OR 1.92) compared with those in the control group.

"New approaches are needed to engage these individuals who are not yet ready to quit smokers and motivate them to quit smoking," said senior study author Rajani Sadasivam, a professor of population and quantitative health sciences at the University of Massachusetts Medical School, in Worcester.

"In Take a Break (TAB), we approached the challenge of engagement using several strategies," Sadasivam said by email. "The key innovation of TAB was combining concepts from behavioral theory and gamification strategies."

During the three weeks when some participants were participating in the TAB program, researchers found that those getting the intervention were significantly more likely to experience at least one 24-hour period of abstinence from smoking than controls (OR 2.01). People who did the TAB program had a higher mean number of 24-hour abstinence periods (1.20) than participants in the control group (0.60).

One limitation of the study is that many individuals contacted to enroll in the trial declined to participate, an outcome that may have contributed to selection bias and skewed the results toward better cessation outcomes. Another limitation is that the trial had a 24% attrition rate.

Researchers also excluded individuals with active mental health symptoms from participating in the trial, a selection criterion that may mean the results are not generalizable to all smokers, the study team notes in JAMA Internal Medicine.

Even so, the results underscore that clinicians shouldn't rule out conversations around smoking cessation just because patients say they're not yet ready to consider quitting, Sadasivam said.

"We can encourage behavioral practice to develop knowledge and skills so that future quit-smoking attempts are most successful," Sadasivam said. "Behavioral practice means practice quit attempts when people can reflect on their smoking behaviors, learn to manage cravings, and enhance their confidence they can quit in the future."

SOURCE: JAMA Internal Medicine, online January 24, 2022.