The 'Take a Break' game: Randomized trial protocol for a technology-assisted brief abstinence experience designed to engage lower-motivated smokers

Abstract

Background: While smoking continues to be the most preventable cause of mortality in the United States, most current smokers remain not ready to quit at any given time. Engaging these 'motivation phase' smokers with brief experiences to build confidence and practice skills related to cessation could lead to sooner and more successful quit attempts. Increasingly available mobile technology and gamification can be used to provide smokers with accessible and engaging support.

Methods: We describe our protocol for conducting a randomized controlled trial evaluating Take a Break, an mHealth-based smoking pre-cessation challenge designed for smokers not ready to quit. Participants in the intervention receive 1) Motivational Messages, 2) text message Challenge Quizzes, 3) Goal-setting with tobacco treatment specialist, 4) Coping Mini-Games apps, and 5) Recognition and Rewards for participation during a 3-week challenge. Access to coping mini-games and motivational messaging continues for 6-months. Both intervention and comparison group participants receive brief Nicotine Replacement Therapy (NRT) sampling and daily smoking assessment text messages for three weeks. Primary outcomes include number of days abstinent during the challenge, change in patient-reported self-efficacy after the challenge, time to first quit attempt following the challenge, and 7-day point prevalent smoking cessation at six months.

Conclusion: Take a Break is an innovative approach to engage those not prepared for a quit attempt. Take a Break provides motivation phase smokers with tools and a brief experience to prepare them for a quit attempt, filling a gap in tobacco cessation support and current research.

Keywords: Cessation induction; Gamification; Tobacco cessation; mHealth.

Copyright © 2020 Elsevier Inc. All rights reserved.

Figures

Figure 1:

Study Workflow Diagram

Figure 2:. The Take a Break Three-Week Experience with Five Behavior Support Components

Week 1 is the training week. In this week, the experience focuses on: 1. Motivational Messages: tailored for smokers not ready to quit 2. Challenge Quizzes: to assess habits (cravings and urges) and daily abstinence assessments (number of cigarettes smoked in past 24 hours) with positive feedback. At the end of Week 1: 3. Goal-setting call: a brief 20–30-minute call with the week 1 training experience reviewed and smokers asked if they wish to set an abstinence goal. Weeks 2 and 3 are the “The Challenge” where smokers work toward their abstinence goal: During The Challenge, Motivational Messages and daily abstinence assessments with positive feedback continue. The challenge focuses on achieving the abstinence goal and includes: 4. Coping mini-games: apps encouraged to use for distraction and/or relaxation to cope with cravings - see also Figure 3. 5. Recognition and Rewards: throughout the three weeks smokers receive points for responding to Challenge quizzes and medals/rewards at the 3-week follow-up visit. *Note that all participants receive NRT sampling (Seventy-two Nicorette lozenges provided so smokers may use them during the challenge).

Figure 3.. The Six Coping Mini Games Provided to Manage Cravings with Distraction and Relaxation during the The Take a Break Challenge

We pilot tested a series of games freely available for common smart phone operating systems with current smokers. All six apps included in the Take a Break are frequently downloaded, highly rated by users, free to download, and available on both iOS and Android platforms. Note that the Take a Break team did not develop these Apps nor do we have any competing interest associated with their use.