Trial Outcomes & Findings for Pilot Trial of a Game Embedded in a Smartphone App for Smoking Cessation (NCT NCT05227027)

NCT ID: NCT05227027

Last Updated: 2024-01-03

Results Overview

Number of times the app was opened; passively collected by the app and averaged in analysis to calculate mean number of app opens by study group over the study period. A new session is defined as use of the app after at least 30 minutes of inactivity.

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

500 participants

Primary outcome timeframe

Enrollment through 56 days after participant's selected quit date (56 to 63 days total)

Results posted on

2024-01-03

Participant Flow

Participant milestones

Participant milestones
Measure
Educational Intervention Plus Game Module
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park."
Educational Intervention Only
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance.
Overall Study
STARTED
251
249
Overall Study
COMPLETED
241
238
Overall Study
NOT COMPLETED
10
11

Reasons for withdrawal

Reasons for withdrawal
Measure
Educational Intervention Plus Game Module
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park."
Educational Intervention Only
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance.
Overall Study
Did not finish the onboarding process within the Smoke Free app prior to learning their allocation
10
11

Baseline Characteristics

Pilot Trial of a Game Embedded in a Smartphone App for Smoking Cessation

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Educational Intervention Plus Game Module
n=241 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park."
Educational Intervention Only
n=238 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance.
Total
n=479 Participants
Total of all reporting groups
Age, Continuous
38 years
n=5 Participants
35 years
n=7 Participants
36 years
n=5 Participants
Sex/Gender, Customized
Gender · Female
177 Participants
n=5 Participants
181 Participants
n=7 Participants
358 Participants
n=5 Participants
Sex/Gender, Customized
Gender · Male
59 Participants
n=5 Participants
55 Participants
n=7 Participants
114 Participants
n=5 Participants
Sex/Gender, Customized
Gender · Non-binary or other
5 Participants
n=5 Participants
2 Participants
n=7 Participants
7 Participants
n=5 Participants
Race/Ethnicity, Customized
Race and ethnicity · Non-Hispanic White
186 Participants
n=5 Participants
182 Participants
n=7 Participants
368 Participants
n=5 Participants
Race/Ethnicity, Customized
Race and ethnicity · Non-Hispanic Black
22 Participants
n=5 Participants
26 Participants
n=7 Participants
48 Participants
n=5 Participants
Race/Ethnicity, Customized
Race and ethnicity · Hispanic
19 Participants
n=5 Participants
9 Participants
n=7 Participants
28 Participants
n=5 Participants
Race/Ethnicity, Customized
Race and ethnicity · Other
14 Participants
n=5 Participants
21 Participants
n=7 Participants
35 Participants
n=5 Participants
Educational attainment
High school diploma or less
45 Participants
n=5 Participants
55 Participants
n=7 Participants
100 Participants
n=5 Participants
Educational attainment
Some college or technical school
93 Participants
n=5 Participants
84 Participants
n=7 Participants
177 Participants
n=5 Participants
Educational attainment
Bachelor's or associate degree
83 Participants
n=5 Participants
68 Participants
n=7 Participants
151 Participants
n=5 Participants
Educational attainment
Graduate degree
20 Participants
n=5 Participants
31 Participants
n=7 Participants
51 Participants
n=5 Participants
Household income, categorical
Less than $20,000
35 Participants
n=5 Participants
35 Participants
n=7 Participants
70 Participants
n=5 Participants
Household income, categorical
Between $20,000 and $40,000
63 Participants
n=5 Participants
65 Participants
n=7 Participants
128 Participants
n=5 Participants
Household income, categorical
Between $40,000 and $60,000
51 Participants
n=5 Participants
51 Participants
n=7 Participants
102 Participants
n=5 Participants
Household income, categorical
Between $60,000 and $80,000
32 Participants
n=5 Participants
24 Participants
n=7 Participants
56 Participants
n=5 Participants
Household income, categorical
Between $80,000 and $100,000
21 Participants
n=5 Participants
18 Participants
n=7 Participants
39 Participants
n=5 Participants
Household income, categorical
More than $100,000
39 Participants
n=5 Participants
45 Participants
n=7 Participants
84 Participants
n=5 Participants
Cigarettes per day
15 cigarettes
n=5 Participants
15 cigarettes
n=7 Participants
15 cigarettes
n=5 Participants
Fagerström Test for Nicotine Dependence
5 units on a scale
n=5 Participants
5 units on a scale
n=7 Participants
5 units on a scale
n=5 Participants
Past quit attempts
4 attempts
n=5 Participants
4 attempts
n=7 Participants
4 attempts
n=5 Participants
Years since initiated smoking
19 years
n=5 Participants
16 years
n=7 Participants
18 years
n=5 Participants
Used electronic nicotine device systems in last 30 days
57 Participants
n=5 Participants
61 Participants
n=7 Participants
118 Participants
n=5 Participants
Used nicotine replacmeent therapy in last 30 days
56 Participants
n=5 Participants
43 Participants
n=7 Participants
99 Participants
n=5 Participants
Frequency played video games in last 6 months
Not at all
57 Participants
n=5 Participants
59 Participants
n=7 Participants
116 Participants
n=5 Participants
Frequency played video games in last 6 months
Less than once a month
36 Participants
n=5 Participants
25 Participants
n=7 Participants
61 Participants
n=5 Participants
Frequency played video games in last 6 months
At least monthly but not weekly
26 Participants
n=5 Participants
25 Participants
n=7 Participants
51 Participants
n=5 Participants
Frequency played video games in last 6 months
At least weekly but not every day
49 Participants
n=5 Participants
40 Participants
n=7 Participants
89 Participants
n=5 Participants
Frequency played video games in last 6 months
Every day
73 Participants
n=5 Participants
89 Participants
n=7 Participants
162 Participants
n=5 Participants

PRIMARY outcome

Timeframe: Enrollment through 56 days after participant's selected quit date (56 to 63 days total)

Number of times the app was opened; passively collected by the app and averaged in analysis to calculate mean number of app opens by study group over the study period. A new session is defined as use of the app after at least 30 minutes of inactivity.

Outcome measures

Outcome measures
Measure
Educational Intervention Plus Game Module
n=241 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park."
Educational Intervention Only
n=238 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance.
Number of Unique App Sessions
29.6 number of sessions
Standard Deviation 36.5
24.3 number of sessions
Standard Deviation 37.9

PRIMARY outcome

Timeframe: Enrollment through 56 days after participant's selected quit date (56 to 63 days total)

Passively collected by the app and averaged in analysis among those with a session to calculate mean number of minutes of usage per session by study group.

Outcome measures

Outcome measures
Measure
Educational Intervention Plus Game Module
n=241 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park."
Educational Intervention Only
n=238 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance.
Minutes of App Usage Per Session
6.9 minutes per session
Standard Deviation 5.4
6.1 minutes per session
Standard Deviation 5.2

SECONDARY outcome

Timeframe: Enrollment through 56 days after participant's selected quit date (56 to 63 days total)

Number of unique days with at least one app session, passively collected by the app and averaged by study group.

Outcome measures

Outcome measures
Measure
Educational Intervention Plus Game Module
n=241 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park."
Educational Intervention Only
n=238 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance.
Unique Days With at Least One App Session
14.3 days with a session
Standard Deviation 15.3
11.9 days with a session
Standard Deviation 13.3

SECONDARY outcome

Timeframe: 56 days after participant's selected quit date (56 to 63 days after enrollment)

Proportion of participants who self-report having abstained for the prior 7 days during the 2-month follow-up assessment, assuming missing = smoking.

Outcome measures

Outcome measures
Measure
Educational Intervention Plus Game Module
n=241 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park."
Educational Intervention Only
n=238 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance.
Self-reported 7-day Point-prevalence Abstinence at 2 Months
94 Participants
101 Participants

SECONDARY outcome

Timeframe: 56 days after participant's selected quit date (56 to 63 days after enrollment)

Proportion of participants who who self-report having abstained for the prior 30 days during the 2-month follow-up assessment, assuming missing = smoking.

Outcome measures

Outcome measures
Measure
Educational Intervention Plus Game Module
n=241 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park."
Educational Intervention Only
n=238 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance.
Self-reported 30-day Point-prevalence Abstinence at 2 Months
54 Participants
50 Participants

SECONDARY outcome

Timeframe: 56 days after participant's selected quit date (56 to 63 days after enrollment)

Population: Only those participants who completed the follow-up questionnaire are included in the analysis population.

Rating of satisfaction with assigned app on a 5-point Likert scale from "Not at all" (1) to "Extremely" (5), assessed in the 2-month follow-up questionnaire. The measure is averaged by study group.

Outcome measures

Outcome measures
Measure
Educational Intervention Plus Game Module
n=144 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park."
Educational Intervention Only
n=127 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance.
Satisfaction With App
3.7 units on a scale
Standard Deviation 1.0
3.7 units on a scale
Standard Deviation 1.1

SECONDARY outcome

Timeframe: 56 days after participant's selected quit date (56 to 63 days after enrollment)

Population: Only those participants in the intervention group who completed the follow-up questionnaire are included in the analysis population.

Rating of satisfaction with the game on a 5-point Likert scale from "Not at all" (1) to "Extremely" (5), assessed in the 2-month follow-up questionnaire. The measure is averaged for the intervention group.

Outcome measures

Outcome measures
Measure
Educational Intervention Plus Game Module
n=84 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park."
Educational Intervention Only
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance.
Satisfaction With Game (Intervention Group Only)
3.3 units on a scale
Standard Deviation 1.4

OTHER_PRE_SPECIFIED outcome

Timeframe: 56 days after participant's selected quit date (56 to 63 days after enrollment)

Proportion of participants who who self-report having abstained for the prior 7 days during the 2-month follow-up assessment, verified by saliva cotinine test, assuming missing = smoking. Averaged by study group. Recoded to 0 if the person reported having smoked during the same 7-day window during repeated measurement of daily smoking in the app.

Outcome measures

Outcome measures
Measure
Educational Intervention Plus Game Module
n=241 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park."
Educational Intervention Only
n=238 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance.
Biochemically Verified 7-day Point-prevalence Abstinence at 2 Months
27 Participants
37 Participants

OTHER_PRE_SPECIFIED outcome

Timeframe: 56 days after participant's selected quit date (56 to 63 days after enrollment)

Proportion of participants who who self-report having abstained for the prior 30 days during the 2-month follow-up assessment, verified by saliva cotinine test, assuming missing = smoking. Averaged by study group. Recoded to 0 if the person reported having smoked during the same 30-day window during repeated measurement of daily smoking in the app.

Outcome measures

Outcome measures
Measure
Educational Intervention Plus Game Module
n=241 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park."
Educational Intervention Only
n=238 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance.
Biochemically Verified 30-day Point-prevalence Abstinence at 2 Months
19 Participants
31 Participants

OTHER_PRE_SPECIFIED outcome

Timeframe: During the 56 days after participant's selected quit date

Proportion of days in which participants self-report having abstained in the last 24 hours, collected via a pop-up box that appears the first time each day a participant opens the app. Averaged by study group.

Outcome measures

Outcome measures
Measure
Educational Intervention Plus Game Module
n=241 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park."
Educational Intervention Only
n=238 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance.
Repeated 1-day Point-prevalence Smoking Abstinence
17.3 percentage of days
Standard Deviation 25.6
12.4 percentage of days
Standard Deviation 21.3

OTHER_PRE_SPECIFIED outcome

Timeframe: Enrollment through 56 days after participant's selected quit date (56 to 63 days total)

Number of non-game (core app) activities completed in the app by activity type: passively collected by the app to assess number of times the participant completed the following activity types: reported a craving, recorded a diary, completed a mission, read a tip, used the chatbot.

Outcome measures

Outcome measures
Measure
Educational Intervention Plus Game Module
n=241 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park."
Educational Intervention Only
n=238 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance.
Program Adherence (Index of Core Feature Use)
19.0 number of core features used
Standard Deviation 28.2
15.6 number of core features used
Standard Deviation 29.1

OTHER_PRE_SPECIFIED outcome

Timeframe: Enrollment through 56 days after participant's selected quit date (56 to 63 days total)

Population: In-game gifts available for intervention group only.

Number of in-game gifts unlocked during the study period (intervention group only); a summary measure of intensity of engagement (dose of treatment) of the app; passively collected by the app.

Outcome measures

Outcome measures
Measure
Educational Intervention Plus Game Module
n=241 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park."
Educational Intervention Only
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance.
Gifts Unlocked (Intervention Group Only)
3.3 number of gifts unlocked
Standard Deviation 6.9

OTHER_PRE_SPECIFIED outcome

Timeframe: Enrollment through 56 days after participant's selected quit date (56 to 63 days total)

Population: Applicable to intervention group only.

Number of game activities completed in the app by activity type; passively collected by the app to assess number of times the participant completed the following activity types: navigated to the game dashboard, completed each pet care activity (breathing exercise, feeding, washing, memory mini-game), visited the park, entered the dragon guide.

Outcome measures

Outcome measures
Measure
Educational Intervention Plus Game Module
n=241 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park."
Educational Intervention Only
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance.
Game Activities (Intervention Group Only)
123.1 number of game features used
Standard Deviation 285.0

OTHER_PRE_SPECIFIED outcome

Timeframe: 56 days after participant's selected quit date (56 to 63 days after enrollment)

Population: Only those participants who completed the follow-up questionnaire are included in the analysis population.

Rating of whether would recommend assigned app to a friend on a 5-point Likert scale from "Not at all" (1) to "Extremely" (5), assessed in the 2-month follow-up questionnaire. The measure is averaged by study group.

Outcome measures

Outcome measures
Measure
Educational Intervention Plus Game Module
n=144 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park."
Educational Intervention Only
n=127 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance.
Recommends App to Friend
3.8 units on a scale
Standard Deviation 1.1
4.0 units on a scale
Standard Deviation 1.1

OTHER_PRE_SPECIFIED outcome

Timeframe: 56 days after participant's selected quit date (56 to 63 days after enrollment)

Population: Only those participants who completed the question in the follow-up questionnaire are included in the analysis population. A programming error led to missing data for most respondents who reported having continued to smoke.

Motivation to quit, reported on a 10-point scale from not at all motivated (0) to very unmotivated (10) and assessed in the 2-month follow-up.

Outcome measures

Outcome measures
Measure
Educational Intervention Plus Game Module
n=73 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park."
Educational Intervention Only
n=71 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance.
Motivation to Quit
9.3 units on a scale
Standard Deviation 1.3
9.4 units on a scale
Standard Deviation 1.5

OTHER_PRE_SPECIFIED outcome

Timeframe: 56 days after participant's selected quit date (56 to 63 days after enrollment)

Population: Only those participants who completed the questions in the follow-up questionnaire are included in the analysis population.

The measure includes items from the Bonding and Confidence subscales from the Mobile Agnew Relationship Measure, a scale of digital therapeutic alliance. Two items from each of the Bonding and Confidence subscales were included. Each item was asked on a 4-point Likert scale from strongly disagree (1) to strongly agree (4). The subscale items were combined to give a total possible score of 16 and a range of 4 (low alliance) to 16 (high alliance). The measure is averaged by study group. Assessed in the 2-month follow-up.

Outcome measures

Outcome measures
Measure
Educational Intervention Plus Game Module
n=150 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park."
Educational Intervention Only
n=129 Participants
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance.
Digital Therapeutic Alliance
12.7 units on a scale
Standard Deviation 2.2
12.8 units on a scale
Standard Deviation 2.5

Adverse Events

Educational Intervention Plus Game Module

Serious events: 0 serious events
Other events: 3 other events
Deaths: 0 deaths

Educational Intervention Only

Serious events: 0 serious events
Other events: 7 other events
Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Other adverse events
Measure
Educational Intervention Plus Game Module
n=241 participants at risk
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park."
Educational Intervention Only
n=239 participants at risk;n=238 participants at risk
Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance.
Psychiatric disorders
Anxious or depressed
0.41%
1/241 • 63 days after enrollment
Adverse events were reported based on survey responses to "Did you experience any negative, unpleasant, unwanted, or otherwise unexpected side effects as a result of participating in this trial?"
1.3%
3/239 • 63 days after enrollment
Adverse events were reported based on survey responses to "Did you experience any negative, unpleasant, unwanted, or otherwise unexpected side effects as a result of participating in this trial?"
Psychiatric disorders
Feelings of withdrawal, craving, or irritability
0.41%
1/241 • 63 days after enrollment
Adverse events were reported based on survey responses to "Did you experience any negative, unpleasant, unwanted, or otherwise unexpected side effects as a result of participating in this trial?"
1.7%
4/239 • 63 days after enrollment
Adverse events were reported based on survey responses to "Did you experience any negative, unpleasant, unwanted, or otherwise unexpected side effects as a result of participating in this trial?"
Gastrointestinal disorders
Constipation
0.41%
1/241 • 63 days after enrollment
Adverse events were reported based on survey responses to "Did you experience any negative, unpleasant, unwanted, or otherwise unexpected side effects as a result of participating in this trial?"
0.00%
0/239 • 63 days after enrollment
Adverse events were reported based on survey responses to "Did you experience any negative, unpleasant, unwanted, or otherwise unexpected side effects as a result of participating in this trial?"

Additional Information

Dr. Justin White, Associate Professor

University of California, San Francisco

Phone: 415-476-8045

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place