If you’ve ever smoked, and tried to quit, chances are you know how much fun quitting, and quit attempts, aren’t. The cravings, the mood swings, the weight gain – ugh! What if quitting smoking was fun instead?
Funded by a Robert Wood Johnson Foundation’s Pioneer Program grant, Lit2Quit is a mobile game that aims to help smokers reduce or quit smoking. This promising technology is being developed and studied by a group of researchers, developers, and health professionals at Teachers College at Columbia University. I caught up recently with Azadeh Jamalian, a Ph.D student at Teachers College, and one of the lead researchers and developers on the Lit2Quit initiative. She graciously agreed to answer my many questions, and share them with Pulse + Signal readers.
BC: Lit2Quit attempts to match the effects of smoking through game play, either relaxation or receiving a “rush” – are there really only two states in which a smoker may find themselves?
AJ: Yes, research shows that smokers perceive smoking as a sedative or stimulating experience depending on their state of mind (Donovan & Marlatt, 2007). However, there may be different motives for smoking. According to Kassel, Paronis, & Stroud (2003), the most commonly reported motive is stress reduction (hence, perceived sedative effects of nicotine); other cited motives include perceived stimulant effect of smoking (specially when drinking), socialization, addiction, habit, and sensorimotor aspects of smoking (see Donovan & Marlatt, 2007).
In addition, research shows that nicotine enhances memory and focuses attention (Hahn, Ross, Yang, Kim, Huestis, & Stein, 2007; Lawrence, Ross, & Stein, 2002, Vossel, Warbrick, Mobascher, Winterer, & Fink, 2011). Although you cannot target everything in a single project, and different products may be suitable for different people, we tried to have all these motives in mind when designing Lit2Quit.
Mirroring the perceived stimulating and sedating effects of nicotine, Lit2Quit is designed in two modes, RUSH and RELAX. These modes use specific breath patterns and game design challenges to excite or relax the player. Depending on his/her state of mind, the player chooses which mode he/she wishes to play. For the future releases of the game, we are planning to integrate social aspects in which players could collaborate and play together, or they can invite their friends to see the world they created. In addition, we believe that since the players control both versions of the game with their breath, the gameplay mimics the behavior of smoking and help smokers to control their urge through engagement of their sensorimotor habits. Further, to enhance player’s attention and memory, the players need to memorize certain patterns to succeed in the higher levels of the game.
BC: The aim of Lit2Quit is smoking reduction through replacement of the stimulus with game play. Can you say more about how this plays out? In other words, are participants switching “cold turkey” to Lit2Quit, or is there a gradual change over time?
AJ: The aim of Lit2Quit is smoking reduction through replacement of the stimulus with game play. Since we haven’t done any field studies yet, we cannot know for sure how smoking behavior changes as the result of the gameplay. However, our hypothesis is that the game will help smokers to gradually reduce their smoking over time, as they become more expert in the gameplay, and hence can perform the advanced breath patterns in the game more successfully. Our initial studies have shown that these advanced breath patterns more closely mimics the perceived and physiological effects of nicotine.
BC: Are there preliminary data you can share with us yet?
AJ: We have compared the physiological and perceived emotional effects of gameplay to smoking through various measurements such as Self-Assessment- Manikin (SAM) survey, Electroencephalography (EEG), electrocardiography (EKG), and skin conductance (SC). Although smoking is perceived as either a stimulant or sedative, physiologically it stimulates the body. Therefore, in order to compare effects of playing the game to smoking, we analyzed both perceived and physiological effects. Overall, results show that on average subjects perceive playing either modes of the game as an enjoyable experience, and that Lit2Quit partially mimics perceived and physiological effects of smoking. We also learned that since breath is a novel game mechanic (as evidenced by the fact that in 100+ subjects, none of them had experience using their breath as a control mechanic for a mobile game), the initial difficulty levels of the game should be set low to allow players to grasp how to play the game using their breath.
At this stage of the project, we don’t have behavior change data to share. Efficacy trials are the next contemplated step for the project pending funding.
BC: After learning about the game, I wondered if the game is able to match the effects of smoking, is there any danger of addiction to the video game?
AJ: Your question reminds me of a recent article, “Saving Education Through Games Addiction.” I personally like the possibility of “saving health through game addiction!”
BC: What else should we know about the Lit2Quit research?
AJ: We have successfully finished the first stage of the project and are publishing our results in tandem with providing peer review opportunities at presentations at notable gaming and health care conferences. Our plan is to enrich the design of the game by adding a layer of social and community aspects to the game as well as explore platform agnosticism and body sensor networking for input monitoring. Most critical to the game’s success and impact are new collaboration and partnership opportunities with developers,
nonprofit foundations, educational institutions and industry. In particular, we are in the process of designing efficacy trials to study short-term and long-term patterns of smoking behavior change as the result of gameplay intervention. You could follow our progress and contact us via our Facebook page or www.Lit2Quit.com.
BC: Do you think Lit2Quit could be played for any other purposes aside from smoking reduction?
AJ: Yes! The game is fun to play and in fact anyone could enjoy playing the game without even knowing that it’s a smoking reduction game. In addition, since there is no direct reference to smoking in the game, the Relax mode in particular could be played for any type of stress reduction. if you gain expertise in the “Relax” version of the game you could train yourself to self-relax through meditative breathing patterns, and therefore self-monitor your stress through breathing slower than your usual rate. The game has other health benefits. It could be used in clinics for treating asthma and chronic inflammatory diseases of the airways.
To learn more about Lit2Quit watch this video:
Bridgette Collado, MA, RD, is a health communication consultant and registered dietitian, and a contributor to Pulse + Signal. Follow Bridgette on Twitter: www.twitter.com/bcollado.
Donovan, D.M. & Marlatt, G.A. (Eds.). (2007). Assessment of addictive behavior (2nd ed.), The Guilford Press.
Hahn, B., Ross, T.J., Yang, Y., Kim, I., Huestis, M.A, Stein, E.A. (2007). Nicotine enhances visuospatial attention by deactivating areas of the resting brain default network. Journal of Neuroscience, 27, 3477?3489.
Kassel, J.D., Stroud, L.R., & Paronis, C.A. (2003). Smoking, stress, and negative affect: Correlation, causation, and context across stages of smoking. Psychological Bulletin, 129(2), 270-304.
Lawrence, N.S., Ross, T.J., Stein, E.A., (2002). Cognitive mechanisms of nicotine on visual attention. Neuron, 36 (3), 24, 539?548.
Vossel, S., Warbrick, T., Mobascher, A. Winterer, G. , & Fink, G.R. (2011). Spatial and sustained attention in relation to smoking status: behavioural performance and brain activation patterns, Journal of Psychopharmacology, 25(11) 1485?1495.