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.