Game-based contingency management for smoking cessation

描述（由申请人提供）：吸烟仍然是美国可预防的发病和死亡的头号原因。人们注意到许多阻碍获得戒烟干预措施的障碍，例如缺乏临床医生培训、实施治疗所需的时间投入以及与治疗相关的费用。因此，制定更有效的干预措施并以相对较低的成本向吸烟者提供服务至关重要。 我们最近开发了一种基于互联网的应急管理（CM）干预措施，参与者将他们呼气时的网络摄像头录制的视频提交到一氧化碳监视器中，并通过禁欲赚钱。尽管与提供戒烟相关的金钱激励相关的成本可能低于与吸烟引起的医疗并发症相关的成本，但激励成本常常被认为是 CM 的障碍。因此，本提案的目标是显着降低成本并提高这种易于访问的基于互联网的戒烟CM的可持续性。 在专家团队的帮助下，采用迭代开发流程，将为 Facebook（“Quitters, Incorporated”）开发一款有趣且引人入胜的社交策略视频游戏。寻求治疗的吸烟者将能够根据网络摄像头验证的与戒烟一致的二氧化碳值获得奖励。此次 CM 干预措施将利用三种强有力的、基于证据的激励措施。激励措施将包括：（1）可用于改善游戏玩法的个人意外事件，（2）社交意外事件，例如积极反馈和虚拟奖励，可给予其他玩家以承认他们禁欲的成功并改善他们的游戏玩法，以及（3）团体意外事件，要求小组的所有成员达到禁欲目标才能解锁某些游戏功能。游戏开发完成后，我们将评估基于视频游戏的戒烟CM的可行性、可接受性、吸引力和初步效果。一项为期 7 周的试点研究将涉及将参与者 (N=100) 随机分配到：(1) 戒烟组，其中奖励将根据戒烟而提供，或 (2) 提交组，其中奖励将根据提交视频而提供，但与戒烟无关。 该试点研究的结果将影响未来针对吸烟、酗酒和其他药物使用以及糖尿病、哮喘和其他疾病的药物依从性开发基于视频游戏的 CM 干预措施的研究。基于游戏的 CM 将以相对较低的成本促进这种创新、有趣、可持续的干预措施的广泛普及（该游戏将免费玩），从而有可能对公共卫生产生重大影响。

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.