If you’ve ever smoked, and tried to quit, chances are you know how much fun quitting, and quit attempts, aren’t. The cravings, the mood swings, the weight gain – ugh! What if quitting smoking was fun instead?

Game Mode: Relax

Funded by a Robert Wood Johnson Foundation’s Pioneer Program grant, Lit2Quit is a mobile game that aims to help smokers reduce or quit smoking. This promising technology is being developed and studied by a group of researchers, developers, and health professionals at Teachers College at Columbia University. I caught up recently with Azadeh Jamalian, a Ph.D student at Teachers College, and one of the lead researchers and developers on the Lit2Quit initiative. She graciously agreed to answer my many questions, and share them with Pulse + Signal readers.

BC: Lit2Quit attempts to match the effects of smoking through game play, either relaxation or receiving a “rush” – are there really only two states in which a smoker may find themselves?

AJ: Yes, research shows that smokers perceive smoking as a sedative or stimulating experience depending on their state of mind (Donovan & Marlatt, 2007). However, there may be different motives for smoking. According to Kassel, Paronis, & Stroud (2003), the most commonly reported motive is stress reduction (hence, perceived sedative effects of nicotine); other cited motives include perceived stimulant effect of smoking (specially when drinking), socialization, addiction, habit, and sensorimotor aspects of smoking (see Donovan & Marlatt, 2007).

In addition, research shows that nicotine enhances memory and focuses attention (Hahn, Ross, Yang, Kim, Huestis, & Stein, 2007; Lawrence, Ross, & Stein, 2002, Vossel, Warbrick, Mobascher, Winterer, & Fink, 2011). Although you cannot target everything in a single project, and different products may be suitable for different people, we tried to have all these motives in mind when designing Lit2Quit.

Game Mode: Rush

Mirroring the perceived stimulating and sedating effects of nicotine, Lit2Quit is designed in two modes, RUSH and RELAX. These modes use specific breath patterns and game design challenges to excite or relax the player. Depending on his/her state of mind, the player chooses which mode he/she wishes to play. For the future releases of the game, we are planning to integrate social aspects in which players could collaborate and play together, or they can invite their friends to see the world they created. In addition, we believe that since the players control both versions of the game with their breath, the gameplay mimics the behavior of smoking and help smokers to control their urge through engagement of their sensorimotor habits. Further, to enhance player’s attention and memory, the players need to memorize certain patterns to succeed in the higher levels of the game.

BC: The aim of Lit2Quit is smoking reduction through replacement of the stimulus with game play. Can you say more about how this plays out? In other words, are participants switching “cold turkey” to Lit2Quit, or is there a gradual change over time?

AJ: The aim of Lit2Quit is smoking reduction through replacement of the stimulus with game play. Since we haven’t done any field studies yet, we cannot know for sure how smoking behavior changes as the result of the gameplay. However, our hypothesis is that the game will help smokers to gradually reduce their smoking over time, as they become more expert in the gameplay, and hence can perform the advanced breath patterns in the game more successfully. Our initial studies have shown that these advanced breath patterns more closely mimics the perceived and physiological effects of nicotine.

BC: Are there preliminary data you can share with us yet?

AJ: We have compared the physiological and perceived emotional effects of gameplay to smoking through various measurements such as Self-Assessment- Manikin (SAM) survey, Electroencephalography (EEG), electrocardiography (EKG), and skin conductance (SC). Although smoking is perceived as either a stimulant or sedative, physiologically it stimulates the body. Therefore, in order to compare effects of playing the game to smoking, we analyzed both perceived and physiological effects. Overall, results show that on average subjects perceive playing either modes of the game as an enjoyable experience, and that Lit2Quit partially mimics perceived and physiological effects of smoking. We also learned that since breath is a novel game mechanic (as evidenced by the fact that in 100+ subjects, none of them had experience using their breath as a control mechanic for a mobile game), the initial difficulty levels of the game should be set low to allow players to grasp how to play the game using their breath.

At this stage of the project, we don’t have behavior change data to share. Efficacy trials are the next contemplated step for the project pending funding.

BC: After learning about the game, I wondered if the game is able to match the effects of smoking, is there any danger of addiction to the video game?

AJ: Your question reminds me of a recent article, “Saving Education Through Games Addiction.” I personally like the possibility of “saving health through game addiction!”

BC: What else should we know about the Lit2Quit research?

AJ: We have successfully finished the first stage of the project and are publishing our results in tandem with providing peer review opportunities at presentations at notable gaming and health care conferences. Our plan is to enrich the design of the game by adding a layer of social and community aspects to the game as well as explore platform agnosticism and body sensor networking for input monitoring. Most critical to the game’s success and impact are new collaboration and partnership opportunities with developers,
nonprofit foundations, educational institutions and industry. In particular, we are in the process of designing efficacy trials to study short-term and long-term patterns of smoking behavior change as the result of gameplay intervention. You could follow our progress and contact us via our Facebook page or www.Lit2Quit.com.

BC: Do you think Lit2Quit could be played for any other purposes aside from smoking reduction?

AJ: Yes! The game is fun to play and in fact anyone could enjoy playing the game without even knowing that it’s a smoking reduction game. In addition, since there is no direct reference to smoking in the game, the Relax mode in particular could be played for any type of stress reduction. if you gain expertise in the “Relax” version of the game you could train yourself to self-relax through meditative breathing patterns, and therefore self-monitor your stress through breathing slower than your usual rate. The game has other health benefits. It could be used in clinics for treating asthma and chronic inflammatory diseases of the airways.

–

To learn more about Lit2Quit watch this video:

Lit2Quit Video by Advance from Dan Rabinowitz on Vimeo.

Bridgette

Bridgette Collado, MA, RD, is a health communication consultant and registered dietitian, and a contributor to Pulse + Signal. Follow Bridgette on Twitter: www.twitter.com/bcollado.

References:
Donovan, D.M. & Marlatt, G.A. (Eds.). (2007). Assessment of addictive behavior (2nd ed.), The Guilford Press.

Hahn, B., Ross, T.J., Yang, Y., Kim, I., Huestis, M.A, Stein, E.A. (2007). Nicotine enhances visuospatial attention by deactivating areas of the resting brain default network. Journal of  Neuroscience, 27, 3477?3489.

Kassel, J.D., Stroud, L.R., & Paronis, C.A. (2003). Smoking, stress, and negative affect: Correlation, causation, and context across stages of smoking. Psychological Bulletin, 129(2), 270-304.

Lawrence, N.S., Ross, T.J., Stein, E.A., (2002). Cognitive mechanisms of nicotine on visual attention. Neuron, 36 (3), 24, 539?548.

Vossel, S., Warbrick, T., Mobascher, A. Winterer, G. , & Fink, G.R. (2011). Spatial and sustained attention in relation to smoking status: behavioural performance and brain activation patterns, Journal of Psychopharmacology, 25(11) 1485?1495.

My news feeds have been much abuzz with talk of the newly announced journal, Games for Health: Research Development, and Clinical Applications. Gaming for health is a topic we’ve been covering here at Pulse + Signal, so when we heard the news, we caught up with the journal’s Editor-in-Chief, Bill Ferguson, for a Q & A.

Mary Ann Liebert, Inc., the publishers of the anticipated journal, hope to bring greater cohesion to the field of health games with its launch in early 2012. In addition to peer-reviewed articles, the journal will feature product news and reviews, as well as reports from the field. Read on for more detail…

BC: Why launch an academic journal for games for health?

BF: Health games are perhaps the most powerful new tools for the prevention and treatment of health issues.  I was asked by Mary Ann Liebert, the founder of our company, to attend the most recent games for health conference in Boston this past May to see if the field of health related games had matured to the point where the researchers, game developers, therapists, end users and so on would benefit from a dedicated journal.  I was very impressed by the depth and breadth of research going on in universities as well as the many very practical uses of games to improve the well-being of people with many different challenges.  Many of the key people I met including Debra Lieberman of the University of California at Santa Barbara, Paul Tarini of the Robert Wood Johnson Foundation and Ben Sawyer, the organizer of the conference, enthusiastically supported the idea of a journal dedicated to games for health.

BF: Robert Wood Johnson Foundation has been a powerful force in health games research. At present, they have no official role in the journal although many of their grantees are on our editorial board.

BC: Who’s brain child is the new journal?

BF: If you take a moment to look at the history of Mary Ann Liebert, Inc. you will see that she and our colleagues have been the pioneer publishers in some seventy health and human wellness fields including Diabetes Technology and Therapeutics in which we have worked closely with Sanofi.  Our peer reviewed journals often precede public awareness of emerging health sciences as is the case with Games for Health:  Research, Development, and Clinical Applications.

BC: Published articles will be peer reviewed, is that correct? With the diverse mix of developers, clinicians and researchers working in the field, how will reviewers be chosen? 

BF: Yes, in addition to field reports, product reviews and news from the field, our content will feature peer reviewed research papers.  Two of our key editorial board members, Dr. Lieberman, whom I mentioned, and Tom Baranowski, PhD of Baylor University will help me to determine and enlist appropriate reviewers for each submitted paper.  We are currently putting together our website and I will be issuing a call for papers very soon.

BC: Are there plans to make the journal open source? If not, how can we gain access?

BF: The journal will be available by subscription in print and online.  The Games for Health:  Research, Development, and Clinical Applications website www.liebertpub.com/g4h will feature complimentary sample issues and articles and clear instructions on how to submit articles and information of interest.

BC: How often will the journal be published?

BF: Initially, we will print bi-monthly with the hope that the volume of papers, news, activities and demand will drive us to monthly publication.

BC: Is there anything else you’d like our readers to know about the journal?

BF: I’d like your readers to know that they now have a forum to share their advancements, developments and interests in the field of games for health as well as a single source for leading edge news.  It is our goal to be a powerful vehicle for sharing and shaping this important new field.  Your contributions are welcome in Games for Health:  Research, Development, and Clinical Applications.

–
Bridgette Collado for Pulse + Signal

Follow Bridgette at twitter.com/bcollado

When Pulse + Signal was covering the Games for Health confence in Boston recently, we had the chance to highlight the Monumental game, created by Bill Sabram of MeYou Health.

Recently Bill let us know that version 2.0 is now out for the interactive stair-climbing game! Currently the game is only available on the iPhone and is available for free in the iTunes store. Maybe an Android version is in the works?

If you have an iPhone, I’d encourage you to check it out and let us know what you think!

The following is a guest post from Kristi Miller Durazo, conference attendee & health innovation advocate. Read more about Kristi after the post.

[Image: Games for Change]

Games are the “Hot Ticket”, right!? Everything is a game. Just add a game to that and we have a solution…or, do we? As I consider the intersection of my experiences at Games for Health and then last week at Games for Change, I note some common patterns emerging, but some major evolutionary differences in the spaces. Both are excellent venues for exploring the progress, status and the future of games that share a societal benefit. While that “benefit” may be personal (which is the premise of almost all “health games”), increasingly it is social and far more reaching in its potential in terms of broad policy and in societal change. I don’t think, especially in traditional health, we’ve taken the next steps in how we view games. Here are my personal observations:

• Games aren’t new. Games are embedded in our past, our present, our future. Card games, board games, real world games like tag and capture the flag have been around forever. Now, however, we have three generations who have played electronic games, interactive games, now mobile games. Gaming isn’t new. The technology, the scalability and the intersection with other media and social forms is advancing.
• Games are a part of a bigger whole. Games can serve as a platform for awareness, engagement and action, but not in isolation. As one speaker at Games for Change noted, you can’t just throw content at kids (or grownups, I add). Games can be a “scaffold” from which content can hang. Find the Future is an example highlighted this week that takes the “content” message from the NYC Library and meshes it with a game as part of a “bigger whole”.
• Games tell stories. Games that truly have the objective of “change” have a narrative. As Ken Eklund (@writerguygames) shared his in story about stories… “where beautiful fiction and reality resonate there is “suspension of disbelief” in which we become engaged in the experience” ELUDE from MIT has been highlighted at a number of conferences as an immersive story experience within traditional video game dynamics. Pulse + Signal also covered Elude during the Games for Health conference. Even in mainstream, mass market games, stories are key. Speakers pointed out that many kids are learning more history in “Call of Duty” than they are in school. EVOKE uses a graphic novel as the channel for telling its story. But the storyline, regardless of channel is critical.
• Games are about experiences. Increasingly, games are part of a greater “transmedia experience” that immerses the players through film, art, narrative, play and social interaction. ITVS has long been a leader in the transmedia space. Their new initiative around Women and Girls 2016 (photo via @devonsmith) incorporates a wide range of media, including games into their work. America 2049 also uses design, storytelling, games and transmedia to engage players on multiple levels, taking “Facebook Game” to an entirely new place. Community management is critical at keeping the experience alive and evergreen.
• Games can be simply executed. Simple mobile platforms make game play ubiquitous regardless of technology. In the developing world where more people have phones than running water, simple interfaces like IM, SMS and IVR are the channels of choice. However, the power of the story and the social interaction remain critical to success.
• Games are social and dynamic. Increasingly, games will be more… active, mobile, global, collaborative, networked, interdisciplinary. In remarks by @natronbaxter regarding lessons learned in EVOKE: “In the future, games will be designed for mobile platforms with access points for the web vs. the other way around.” But that doesn’t necessarily mean “there’s an app for that.” It’s less about being on 24/7. It’s about being “just in time” available when and where I want it. In EVOKE, players even went outside the game to “riff” on the experience. From creating wikis to embedded librarians who provided deeper resources into the game play, the social interface outside the game developed on its own.
• Games for change needs networked expertise. As @DouglasCrets commented during the conference, “the big lesson right now is that it’s not important to be THE expert. It’s important to be the person with a network of experts.” Devon Smith extends that thought: “Nobody has the expertise across game design, funding and social impact, so partnerships are abundant.”

As we move forward in the health space, I’m struck by the words of Dr. Martin Seligman in his keynote remarks at Games for Health: well-being is so much more than the absence of disease or unhappiness. If we combine that thinking with the big thinking coming out of Games for Change, we can create a new landscape for health not only in the US, but worldwide. Where is our EVOKE, where is our America2049? To paraphrase Seligman, where do we “Flourish”?

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Kristi Miller Durazo is the Senior Strategist at the American Heart Association. In her work, she explores innovative opportunities to integrate health into the paths of people’s everyday life and examines trends that will drive our world 5, 10, 20 years from now. Her current focus areas include investigating the role design of built environments influences on health, solutions to aging in place challenges, the role of gaming and game theory in health and socialization and health. Kristi also worked with Jane McGonigal who created CryptoZoo for the American Heart Association. CryptoZoo is an alternative reality, real world urban play game and winner of the 2009 ComeOut and Play Festival’s “Best Use of Narrative” award. Her views here are expressed on her own and not those of the AHA.

You can find Kristi on Twitter at www.twitter.com/krash63 or on LinkedIn at http://www.linkedin.com/in/kristimiller63

Last week at the Games for Health 2011 conference, Dr. Doris Rusch (MIT-Singapore GAMBIT Game Lab) presented her groundbreaking game, Elude. Elude is not like most games – its intention is not to “play” but just the opposite. A beautifully designed metaphor, Elude is a  tool for people supporting others with depression.

For people who have never experienced it before, depression is difficult to understand. It is not simply sadness, as many may think; it is more akin to an all-encompassing hopelessness, a failure to connect to or derive meaning from the outside world. By tapping into the experiential aspects of the video game medium, Elude’s metaphoricalmodel for depression serves to bring awareness to the realities of depression by creating empathy with those who live with depression every day. (GAMBIT Labs)

Sitting in the dark hall, the music, scenes, and up- and downward visual pull of the game quickly sent my emotions astir. This trailer gives you a taste.

Elude is designed for the clinical setting, as part of a psycho-education package for friends and family of those living with depression. As I sat imagining this play out between clinician, client and family, my mind wandered to health literacy and realized that this type of education doesn’t fit in our current definitions. According to Healthy People health literacy is “the capacity to obtain, process, and understand basic health information and services to make appropriate health decisions.” What about the ability to empathize with others’ and their health struggles?

This has caused me to contemplate our current definitions of health literacy. Would the inclusion of empathy be too complex? Does it even make sense in the context of health literacy? As a society we certainly push for awareness of health conditions, with new awareness days/weeks/months cropping up regularly. Do we strive to understand though?

What do you think? Are we too restrictive in our definition of health literacy? Please leave me your comments and links to conversations I may have missed!

- Bridgette

Bridgette Collado is a free-lance health communication consultant and recent addition to the Pulse + Signal team. You can find her on twitter as@bcollado.

The 7th annual Games for Health conference began today in Boston. This conference is one of several going on now as part of Games Beyond Entertainment Week, organized by Digitalmill, Inc. and is supported by the Pioneer Portfolio of the Robert Wood Johnson Foundation. Today’s pre-conference line-up did not disappoint – I’m only sorry that I couldn’t attend every presentation! From accessibility to sensors, prevention to rehabilitation, medical education to research, the day was packed with awesome speakers, great design and a whole lot of inspiration. Here are just a few of today’s take-aways…

1. Gaming has the potential for application in a long list of healthcare topics.

Continua Health Alliance talked about the many health gaming opportunities, including integrative health activities, simple secondary input, chronic disease care and diagnostic gaming.

2. Incentives work.

Incentivizing gaming was a practice and recommendation across the board. Continua Health Alliance provided that competitions are the greatest motivators (the speaker referenced Partners Healthcare data not available in the public domain). Group competitions were also a hot topic – they are not only highly motivating but add a social dynamic different from head-to-head rivalry. Creativity and supplying options were also mentioned as important factors in considering incentives, for example, allowing one to apply credit to a cause, or trade it in for mobile minutes, may be more motivating than cash for some.

3. Users who share their success do better.

Bill Sabram of MeYou Health talked to this point, touting the power of connection. In Monumental, MeYou Health’s free iPhone app that “takes you to the top of virtual monuments as you climb real stairs,” users can share results with other users through social plug-ins, and these users are more successful.

Tomorrow looks just as promising! So, look for more conference coverage tomorrow on Pulse + Signal and follow the hashtag #G4H11 for live news.

–

Bridgette (a.k.a. @bcollado)

Here at Pulse + Signal, I’m always really excited about the new ideas and initiatives that come from great organizations focused on making a difference for the public’s health. One of those organizations that I’ve been familiar with since taking a visit to the 2008 Health 2.0 conference in San Francisco, is HopeLab – they definitely fit the description of innovative and concerned for our nation’s health.

Yesterday I saw a tweet from them pointing to a blog post highlighting their culture. It immediately put a smile on my face and caught the attention of my good friend Fran Melmed who pretty much captured my same sentiment:

Fun, positive and making real impact. To grab some text from their site, here is what they are all about:

Today we’re working to harness the power and appeal of technology to improve kids’ health. Our work with Re-Mission demonstrated that specially designed technology can be both fun and effective in driving positive health behavior in young people.

Our nonprofit mission is to combine rigorous research with innovative solutions to improve the health and quality of life of young people with chronic illness. We work closely with young people to understand their needs and to incorporate their critical and ongoing input into our product development, and we are committed to the scientific study of our products to ensure that they are effective.

We focus our efforts on diseases in which there is significant unmet need among young people and where we believe there is potential for HopeLab to have great impact:

•    Cancer
•    Obesity
•    Sickle cell disease
•    Autism
•    Major depressive disorder

I really think this is a great way to indirectly tell your organization’s story. Not only does it give interested parties a chance to understand more about what you do, it adds character. Personality. Substance. All of this completes your brand and how people feel about what your mission is accomplishing. Sure, funding is always something that many nonprofits wish to always be taken care of and that’s why there is a donate button on the front page.

But allowing us to take a peek into what makes them an innovative place where people actually want to contribute ideas and hard work – that is a form of storytelling that creates a win win situation for all parties involved. It certainly continues to make me a fan.

Here are some other great links highlighting the company:

From ShapingYouth blog: HopeLab Raises a Ruckus to Get Kids Moving

From healthGAMERS blog:  Videogames and Exercise for Kids: Closing the Loop

Fast Company article: Video Games for Health

Remember what I mentioned regarding the importance of competition for health innovation? Well the good folks over at Humana are definitely aware of this and have recently unveiled a new competition focused on healthy gaming. No strangers to the health games arena, the Humana and their Insert Coin challenge are asking you: “Got a GREAT idea for a healthy game?”

The contest started last Thursday (June 11) but don’t fret – you have until September 9th to get entries in! Keep in mind, the games to be submitted can range from those geared toward little kids to those focused on the elderly – so the canvas for creativity is huge!

Speaking of creativity, my buddy Naimul (one of the awesome people at Humana) turned his swag on with this hilarious rap music video promoting the Insert Coin challenge as well as giving tribute to his love for 8-bit video games.

You can also peek into the minds of some pretty innovative folks from Humana at the Crumple It Up blog.

Photo credit: Patrick Frost