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Crave-Out: A Distraction/Motivation Mobile Game to Assist in Smoking Cessation
Open Access Articles
  • Kathryn Delaughter, University of Massachusetts Medical School
  • Rajani S. Sadasivam, University of Massachusetts Medical School
  • Ariana Kamberi, University of Massachusetts Medical School
  • Thomas M. English, University of Massachusetts Medical School
  • Gregory Seward, University of Massachusetts Medical School
  • S. Wayne Chan, University of Massachusetts Medical School
  • Julie E. Volkman, University of Massachusetts Medical School
  • Daniel J. Amante, University of Massachusetts Medical School
  • Thomas K. Houston, University of Massachusetts Medical School
UMMS Affiliation
Department of Quantitative Health Sciences; Department of Psychiatry
Publication Date
Document Type
BACKGROUND: Smoking is still the number one preventable cause of death. Cravings-an intense desire or longing for a cigarette-are a major contributor to quit attempt failure. New tools to help smokers' manage their cravings are needed. OBJECTIVE: To present a case study of the development process and testing of a distraction/motivation game (Crave-Out) to help manage cravings. METHODS: We used a phased approach: in Phase 1 (alpha testing), we tested and refined the game concept, using a Web-based prototype. In Phase 2 (beta testing), we evaluated the distraction/motivation potential of the mobile game prototype, using a prepost design. After varying duration of abstinence, smokers completed the Questionnaire of Smoking Urge-Brief (QSU-Brief) measurement before and after playing Crave-Out. Paired t tests were used to compare pregame and postgame QSU-Brief levels. To test dissemination potential, we released the game on the Apple iTunes App Store and tracked downloads between December 22, 2011, and May 5, 2014. RESULTS: Our concept refinement resulted in a multilevel, pattern memory challenge game, with each level increasing in difficulty. Smokers could play the game as long as they wanted. At the end of each level, smokers were provided clear goals for the next level and rewards (positive reinforcement using motivational tokens that represented a benefit of quitting smoking). Negative reinforcement was removed in alpha testing as smokers felt it reminded them of smoking. Measurement of QSU-Brief (N=30) resulted in a pregame mean of 3.24 (SD 1.65) and postgame mean of 2.99 (SD 1.40) with an overall decrease of 0.25 in cravings (not statistically significant). In a subset analysis, the QSU-Brief decrease was significant for smokers abstinent for more than 48 hours (N=5) with a pregame mean of 2.84 (SD 1.16) and a postgame mean of 2.0 (SD 0.94; change=0.84; P =.03). Between December 22, 2011, and May 29, 2014, the game was downloaded 3372 times from the App-Store, with 1526 smokers visiting the online resource linked to the game. CONCLUSIONS: Overall, playing the game resulted in small, but nonsignificant decreases in cravings, with changes greater for those had already quit for more than 48 hours. Lessons learned can inform further development. Future research could incorporate mHealth games in multicomponent cessation interventions. TRIAL REGISTRATION: NCT00797628; (Archived by WebCite at
  • Internet,
  • health behavior,
  • secondary prevention,
  • smoking cessation
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This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Serious Games, is properly cited.
DOI of Published Version
JMIR Serious Games. 2016 May 26;4(1):e3. doi: 10.2196/games.4566. Link to article on publisher's site
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Citation Information
Kathryn Delaughter, Rajani S. Sadasivam, Ariana Kamberi, Thomas M. English, et al.. "Crave-Out: A Distraction/Motivation Mobile Game to Assist in Smoking Cessation" Vol. 4 Iss. 1 (2016) ISSN: 2291-9279 (Electronic)
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