Designing and Testing a Game Intervention to Help Youth Quit Smoking

Project Lead Category Project status
Hanneke Scholten Substance Abuse Completed

Smoking is one of the leading public health problems in the world. Currently, there is no evidence-based intervention program available to help youth quit smoking. Besides the lack of high-quality research, recruitment and retention of youth are two of the most challenging aspects of the implementation and evaluation of smoking cessation interventions. We argue that limitations in current smoking cessation interventions for youth can be maximally addressed by using games as interventions. In the current project a game intervention was designed and tested to help youth quit smoking.

Project team


Smoking is one of the leading public health problems in the world, killing each year about eight million people worldwide1. In the Netherlands, approximately 20,000 people die each year as a direct consequence of smoking2. The most common smoking-related diseases are cancer, cardiovascular diseases, asthma and chronic obstructive pulmonary disease (COPD)1,2. As a consequence of the amount of smoking-related diseases, smoking is responsible for nearly three billion health care costs in the Netherlands per year2. Most recent numbers show that 23% of the Dutch population aged 12 years and older smokes occasionally; 18% smokes daily3. Among youth aged 10 to 19 years of age, 16% smoked in the last four weeks and 9% are daily smokers4. Despite these high numbers, there is no evidence-based intervention program available to help youth and young adults quit smoking in the Netherlands5. Besides the lack of high-quality research, recruitment and retention of youth and young adults are two of the most challenging aspects of the implementation and evaluation of smoking cessation interventions6-10. We argue that limitations in current smoking cessation interventions for youth and young adults can be maximally addressed by using video games as interventions 9,11-13.

There are several important causal factors related to smoking onset and persistence that serve as potential key targets for intervention. Smoking among youth and young adults is clearly a social phenomenon that is largely tied to networks of peers, therefore it seems important to incorporate mechanisms that target social competence and influence in an intervention14,15. Another important determinant of the onset and maintenance of youth and young adults smoking is impulsivity16. Two core distinctive components of impulsivity exist, which are both implicated in smoking behavior16. First, the emergence and maintenance of adolescent substance dependence, such as smoking, may be explained by deficits in inhibitory control17,18. The inability to quit smoking regardless of negative consequences may be the result of deficits in inhibitory control17,18. The second component of impulsivity is an exacerbation of impulsive decision making, also known as delay discounting. Delay discounting refers to the preference for immediate rewards19. Smokers tend to have a preference for immediate small rewards over larger delayed rewards20.

In the current project a video game will be developed as an intervention to help youth and young adults quit smoking. This video game will be based on evidence-based mechanisms that are expected to have a positive effect on the smoking behavior of individuals. By using a video game format we hope to increase the attractiveness of the intervention and motivation to participate in general. After development, we will test this video game on its effectiveness and examine mechanisms of change to help youth and young adults quit smoking.


of youth between the ages of 16 and 25 smoke daily


There are no evidence-based interventions in the Netherlands that can help youth quit smoking.


of people having seen me play board games do not recognize me anymore - overly fanatic


First two studies have been conducted, data have to be analyzed and reported on. Third study is in preparation, with the aimed N=150 of youth between 16 and 26 that smoke and are motivated to quit smoking. 


Project team

Hanneke Scholten title=
Hanneke Scholten

Researcher, multidisciplinary work and collaboration, wants to understand the how's and why's, loves her high heels and coffee in the morning, walks and talks too fast.




E-mail Hanneke

Maartje Luijten title=
Maartje Luijten


Assistant Professor


E-mail Maartje

Isabela Granic title=
Isabela Granic

Professor and Chair of the Developmental Psychopathology department in the Behavioural Science Institute; writer; voracious podcast consumer; mother of two upstanding little gamers


Director of GEMH Lab


E-mail Isabela

Ken Koontz title=
Ken Koontz

In house game designer, artist, producer and lover of games. I bring diversity, design experience and the NOISE!!!!


Creative Director


E-mail Ken

Anouk Poppelaars title=
Anouk Poppelaars

PhD candidate interested in using social regulation of emotion and multidisciplinary game design to promote mental health in youth. Disheveled multi-tasker and provider of snacks.




E-mail Anouk


All sources
  1. World Health Organization (WHO). (2019). Fact sheet Tobacco 2019. Retrieved from

  2. Rijksinstituut voor Volksgezondheid en Milieu (RIVM) (2016a). Sterfte door roken. Retrieved from!node-sterfte-en-verloren-levensjaren-door-roken.

  3. Centraal Bureau voor de Statistiek (CBS) (2013). Gezondheidsenquête. Retrieved from:,26-38&D3=0&D4=l&HDR=T&STB=G1,G2,G3&VW=T
  4. Nationaal Expertisecentrum Tabaksontmoediging (2013). Roken jeugd monitor 2013. Utrecht, NL: Trimbos Instituut.
  5. Nationaal Expertisecentrum Tabaksontmoediging (2013). Interventies stoppen met roken voor jongeren. Utrecht, NL: Trimbos Instituut.
  6. Backinger, C. L., Michaels, C. N., Jefferson, A. M., Fagan, P., Hurd, A. L., & Grana, R. (2008). Factors associated with recruitment and retention of youth into smoking cessation intervention studies— review of the literature. Health Education Research, 23, 359-368. doi: 10.1093/her/cym053
  7. Kealey, K. A., Ludman, E. J., Mann, S. L., Marek, P. M., Phares, M. M., Riggs, K. R., & Peterson, A. V. (2007). Overcoming barriers to recruitment and retention in adolescent smoking cessation. Nicotine & Tobacco Research, 9, 257-270. doi: 10.1080/14622200601080315
  8. Sussman, S., & Sun, P. (2009). Youth tobacco use cessation: 2008 update. Tobacco Induced Diseases, 5-15. doi: 10.1186/1617-9625-5-3
  9. Balch, G. I., Tworek, C., Barker, D. C., Sasso, B., Mermelstein, R. J., & Giovino, G. A. (2004). Opportunities for youth smoking cessation: Findings from a national focus group study. Nicotine & Tobacco Research, 6, 9–17. doi: 10.1080/1462200310001650812
  10. Leatherdale, S. T., & McDonald, P. W. (2007). Youth smokers’ beliefs about different cessation approaches: Are we providing cessation interventions they never intend to use? Cancer Causes & Control, 18, 783-791. doi: 10.1007/s10552-007-9022-8
  11. Lenhart, A., Kahne, J., Middaugh, E., Macgill, A. R., Evans, C., & Vitak, J. (2008). Teens, video games, and civics. Pew Internet & American Life Project. Retrieved from:
  12. Civljak, M., Sheikh, A., Stead, L. F., & Car, J. (2010). Internet-based interventions for smoking cessation. Cochrane Database of Systematic Reviews, 9, 1-48. doi: 10.1002/14651858.CD007078.pub3
  13. Hutton, H. E., Wilson, L. M., Apelberg, B. J., Tang, E. A., Odelola, O., Bass, E. B., & Chander, G. (2011). A systematic review of randomized controlled trials: Web-based interventions for smoking cessation among adolescents, college students, and adults. Nicotine & Tobacco Research, 13, 227-238. doi: 10.1093/ntr/ntq252
  14. Mermelstein, R. (2003). Teen smoking cessation. Tobacco Control, 12, i25-i34. doi: 10.1136/tc.12.suppl_1.i25
  15. Thomas, R. E., McLellan, J., & Perera, R. (2013). School-based programmes for preventing smoking. Cochrane Database of Systematic Reviews 2013, 4, 1-422. doi: 10.1002/14651858.CD001293.pub3.
  16. de Wit, H. (2009). Impulsivity as a determinant and consequence of drug use: A review of underlying processes. Addiction Biology, 14, 22-31. doi: 10.1111/j.1369-1600.2008.00129.x.
  17. Goldstein, R. Z., & Volkow, N. D. (2011). Dysfunction of the prefrontal cortex in addiction: Neuroimaging findings and clinical implications. Nature Reviews Neuroscience, 12, 652-669. doi: 10.1176/appi.ajp.159.10.1642
  18. Field, M., & Cox, W. M. (2008). Attentional bias in addictive behaviors: A review of its development, causes, and consequences. Drug and Alcohol Dependence, 97, 1-20. doi: 10.1016/j.drugalcdep.2008.03.030
  19. Stanger, C., Budney, A. J., & Bickel, W. K. (2013). A developmental perspective on neuroeconomic mechanisms of contingency management. Psychology of Addictive Behaviors, 27, 403–415. doi: 10.1037/a0028748
  20. Amlung, M., & MacKillop, J. (2014). Clarifying the relationship between impulsive delay discounting and nicotine dependence. Psychology of Addictive Behaviors, 28, 761-768. doi: 10.1037/a0036726

Want to keep up-to-date with our research?