Conceived and created by members of the Health Informatics and Implementation Science Division in the Department of Quantitative Health Sciences (QHS), Crave Out! is a component of the Quality Improvement in Tobacco-Provider Referrals and Internet-delivered Microsystem Optimization (QUIT-PRIMO) grant from the National Cancer Institute, led by principal investigator Thomas Houston II, MD, MPH, professor of quantitative health sciences and medicine. “Our overall goal is to advance science related to the use and impact of the Internet in health services delivery of tobacco control,” said Dr. Houston.
The game app is one of a number of smoking cessation tools available on the website developed by QUIT-PRIMO, www.decide2quit.org, where primary care providers can register patients who smoke, are trying to quit, or have already quit. Employing a popular technological medium like video games is a contemporary approach to creating smoking cessation tools that consumers can easily access and use. “We are recruiting individuals who register at the site to test the smoking cessation tools it offers,” said Kathryn Delaughter, research project director for QHS. “Thinking about helping relapse prevention led to development of Crave Out! for individuals who have already quit smoking and are trying to stay that way.”
Influenced by already popular games like Angry Birds and Simon, Crave Out! uses a system of increasingly difficult levels of play designed to keep players engaged long enough—in the case of ex-smokers—for a nicotine craving to pass. The game challenges players with progressively longer and varied sequences of different colored fruits to be caught in a bucket that players move under a cascade of falling fruits. “We used input from ex-smokers to help create the look of game,” noted Wayne Chan, lead game engineer. “They didn’t want anything that reminds them of cigarettes, so we switched from our original white cylinders and eggs, to the colored fruit concept.”
Users who successfully remember the sequence of target fruits can strategize how to catch them—certain fruits tend to bounce off the edges of the bucket, while others get snatched by the bucket. When users successfully complete a sequence, they are rewarded with a “sticker,” displayed first on a summary page after each level, and then behind the fruits as play continues. But unlike stickers for kids, these stickers remind ex-smokers of reasons to quit smoking.
Crave Out! in its current fruity form is based on a prototype game initially developed for use on personal computers by a teenaged summer intern, Matthew Schmidt, and tested for usability with adult smokers referred to the study by the UMMS Tobacco Consultation Service. The investigators also sought the advice of their family, including the children of Houston, Delaughter and Chan. Feedback indicated that making Crave Out! for use on mobile devices so that the game can be played on the go was the next logical step. Development of an Android version is currently underway.
More than 500 users have downloaded Crave Out! since it became available in December 2011 at the online iPhone App Store. QHS expertise will come into play in continuing phases of the QUIT-PRIMO grant, including testing the efficacy of a mobile game intervention like Crave Out! in helping ex-smokers continue to resist the urge to smoke. Early, informal feedback is encouraging so far. One customer reviewer wrote, “Love the stickers! Very addicting, like Angry Birds.” The developers in QHS hope users of Crave Out! are better off being addicted to a video game than to cigarettes.
View the video clip below for a glimpse at how engaging, fun—and reinforcing for ex-smokers—Crave Out! can be.
Related links:Smoke-free: Three Years and CountingTeaching the tricks of the tobacco tradeWorcester Community Smoking Cessation Resource GuideTobacco Cessation Assistance