Game-based contingency management for smoking cessation

描述（由申请人提供）：在美国，吸烟仍然是可预防的发病率和死亡率的头号原因。人们注意到，许多障碍阻碍了戒烟干预措施的实施，例如缺乏临床医生培训，实施治疗所需的时间承诺，以及与治疗相关的费用。因此，制定更有效的干预措施并使吸烟者以相对较低的成本获得干预措施至关重要。我们最近开发了一种基于互联网的应急管理（CM）干预方法，参与者在呼气时向CO监测器提交网络摄像头录制的视频，他们通过戒烟来赚钱。尽管提供基于戒烟的金钱激励的相关成本可能低于与吸烟引起的医疗并发症相关的成本，但激励的成本通常被认为是CM的障碍。因此，本提案的目标是显著降低成本，提高这种高度可访问的基于互联网的戒烟管理的可持续性。在专家团队的帮助下，通过迭代开发过程，将为Facebook开发一款有趣且具有吸引力的社交策略电子游戏（“Quitters, Incorporated”）。寻求治疗的吸烟者将能够获得奖励，条件是满足网络摄像头验证的与戒烟一致的CO值。三项强有力的、以证据为基础的激励措施将被用于这一CM干预。激励机制将包括：(1)个人附带条件，可用于改善游戏玩法；(2)社会附带条件，如积极反馈和虚拟奖励，可给予其他玩家，以承认他们在戒断方面的成功，并改善他们的游戏玩法；(3)团体附带条件，要求团体所有成员达到戒断目标，以解锁某些游戏功能。在游戏开发后，我们将评估基于视频游戏的戒烟CM的可行性、可接受性、吸引力和初步疗效。一项为期7周的试点研究将涉及随机分配参与者（N=100）：(1)戒烟组，奖励将根据戒烟情况而提供；(2)提交组，奖励将根据提交视频而提供，但与戒烟无关。试点研究的结果将影响未来基于视频游戏的CM干预吸烟、酒精和其他药物使用的研究，以及糖尿病、哮喘和其他疾病的药物依从性。基于游戏的健康管理将促进以相对较低的成本广泛获得这种创新、有趣和可持续的干预措施（游戏将免费提供），从而提供对公共卫生产生重大影响的潜力。

DESCRIPTION (provided by applicant): Cigarette smoking remains the number one cause of preventable morbidity and mortality in the U.S. A number of barriers have been noted that prevent access to smoking cessation interventions, such as lack of clinician training, the time commitment required to implement treatments, and the costs associated with treatment. Thus, it is critically important that more effective interventions be developed, and be made accessible at a relatively low cost, to smokers. We recently developed an Internet-based Contingency Management (CM) intervention, where participants submit web-camera recorded videos as they exhale into a CO monitor, and they earn money for abstinence. Although the costs associated with providing monetary incentives contingent on smoking abstinence are likely to be less than the costs associated with medical complications caused by smoking, the cost of incentives is often cited as a barrier to CM. Thus, the goals of the present proposal are to markedly decrease costs and increase sustainability of this highly accessible Internet-based CM for smoking cessation. Using an iterative development process with the help of a team of experts, a social strategy video game intended to be fun and engaging will be developed for Facebook ("Quitters, Incorporated"). Treatment- seeking smokers will be able to earn incentives contingent on meeting web-camera verified CO values consistent with smoking abstinence. Three powerful, evidence-based incentives will be harnessed in this CM intervention. The incentives will consist of: (1) individual contingencies that can be used to improve game play, (2) social contingencies, such as positive feedback and virtual rewards, that can be given to other players to acknowledge their success with abstinence and improve their game play, and (3) group contingencies that will require all members of a group to meet abstinence goals in order to unlock access to certain game features. After game development, we will assess the feasibility, acceptability, appeal, and preliminary efficacy of video- game-based CM for smoking cessation. A 7-week pilot study will involve randomly assigning participants (N=100) to either: (1) abstinent contingent, where incentives will be delivered contingent on quitting smoking, or (2) submission contingent, where incentives will be delivered contingent on submitting videos, but independent of quitting smoking. The outcomes of the pilot study will impact future research in the development of video-game-based CM interventions for smoking, as well as for alcohol and other drug use, and medication compliance in diabetes, asthma, and other conditions. Game-based CM will promote widespread access to this innovative, fun, sustainable intervention at a relatively low cost (the game will be available to play for free), thereby offering the potential t have a substantial public health impact.