Breathe Free: Smartphone Videogame-based Incentives for Smoking Cessation

Funding Source: National Institute on Drug Abuse (Small Business Innovation Research); R44DA036252

Project Period: 2014-2016

Principal Investigators: Bethany Raiff, PhD; Multi-PI Darion Rapoza, PhD

Other Project Staff: Nicholas Fortungno (Playmatics, Inc); Madeline Carrig (Duke University); Daniel Scherlis (Entertainment Science)

Project Summary:
Cigarette smoking remains the number one cause of preventable morbidity and mortality in the U.S. Each year, one third to one half of smokers attempt to quit at least once; however, approximately 94% of quit attempts fail. A number of interventions have been developed to help smokers initiate and maintain abstinence. Unfortunately, even though most smokers express a desire to quit, relapse is the most likely outcome. Thus, it is not only critically important that more effective interventions be developed to reduce relapse, but it isalso a primary public health goal to ensure that evidence-based smoking cessation interventions be made widely available, and at a low cost, to smokers. One of the most powerful, evidence-based behavioral interventions for smoking cessation is contingency management (CM). CM for smoking cessation consists of delivering incentives (typically money) contingent on objectiveevidence of smoking abstinence (e.g., carbon monoxide [CO] levels in the exhaled breath). However, the cost of providing incentives, the time it takes to administer the program, and the distance that must be traveled to participate in supervised monitoring procedures are often cited as barriers to CM. This SBIR Fast-Track project seeks to develop a mobile videogame-basedcontingency management intervention for smoking cessation. The goals of the present project are to markedly decrease costs, improve sustainability, and further increase accessibility of CM interventions for smoking cessation. To increase access, all aspects of the intervention will be available via Android or iOS smartphones used in conjunction with a matchbox-sized peripheral device for monitoring breath CO. To decrease costs and improve sustainability, themobile game we will develop will allow us to replace the monetary incentives typically used in CM interventions with in-game "virtual rewards" that can immediately be used to help players meet game objectives, as well as with social reinforcement, prompted and incentivized in the context of the game. In Phase I, an iterative design and formative evaluation process will be used to create a game design and storyboard for the mobile game to be developed in Phase II, the CO data collection software will be produced and integrated with the CO Monitor, and a demo of the videogame will be developed. The demo created will be presented to 20 treatment-seeking smokers owning the targetplatform devices, who will then complete a survey & prospective evaluation of the planned intervention. In Phase II the development of the videogame, capable of supporting 7 weeks of play, will be completed, and a 7 week randomized control trial outcome evaluation will be conducted with 114 subjects to assess the feasibility, acceptability, appeal, and efficacy of the smoking cessation intervention.

Public Health Relevance: 
We plan to develop and evaluate a mobile videogame-based smoking cessation intervention that will overcome barriers to treatment using such as cost, sustainability, participation time and travel burdens, and program appeal. This videogame will be the first of its kind, is based on an evidence-based intervention shown to promote smoking abstinence, and we anticipate it will be highly effective for helping smokers who wish to quitstop smoking. The findings from this research will be of great public health significance because of the unprecedented reach and relatively low cost, aswell as the potential for similar interventions to be developed for other health problems, such as alcohol or drug abuse and medication adherence forchronic illnesses.


Jacob Borodovsky, BA

PhD Student, Dartmouth Psychiatric Research Center

Buprenorphine; Opioid, Behavioral Health Technology; Co-Occurring Disorders

borodovsky smallJacob Borodovsky is currently a Health Policy and Clinical Practice PhD student at The Dartmouth Institute in the Geisel School of Medicine. He graduated from Tufts University with a B.A. in Clinical Psychology. Before coming to the Center for Technology and Behavioral Health he worked as a research coordinator for WestBridge Community Services and Cambridge Health Alliance in Boston. Jacob’s research is focused primarily on exploring the role that technological interventions can play in enhancing behavioral health and the treatment of Co-Occurring disorders. Jacob is particularly interested in developing technologically based models of buprenorphine treatment that may help increase rates of medication adherence and reduce diversion. He is currently conducting this research under the supervision of Dr. Lisa Marsch and Dr. Alan Budney. In his spare time he enjoys rock climbing.


Selected Publications:

Schuman-Olivier, Z., Weiss, R. D., Hoeppner, B. B., Borodovsky, J., & Albanese, M. J. (2014). Emerging adult age status predicts poor buprenorphine treatment retention. Journal of Substance Abuse Treatment, 47(3), 202-212. doi: 10.1016/j.jsat.2014.04.006

Schuman-Olivier, Z., Hoeppner, B. B., Weiss, R. D., Borodovsky, J., Shaffer, H. J., & Albanese, M. J. (2013). Benzodiazepine use during buprenorphine treatment for opioid dependence: Clinical and safety outcomes. Drug Alcohol Depend, 132(3), 580-586.

Schuman-Olivier, Z., Connery, H., Griffin, M. L., Wyatt, S. A., Wartenberg, A. A., Borodovsky, J., . . . Weiss, R. D. (2013). Clinician beliefs and attitudes about buprenorphine/naloxone diversion. Am J Addict, 22(6), 574-580. 


May 9, 2014

Emerging Communications Technologies to Advance Prevention and Recovery

10th Annual Dartmouth Symposium on Substance Use 

Mary Brunette, MD – Associate Professor of Psychiatry, Geisel School of Medicine, Hanover, NH; Medical Director, Bureau of Behavioral Health, Department of Health and Human Services, Concord, NH

Andrew Campbell, PhD – Professor of Computer Science, Dartmouth College, Hanover, NH

Lynn Fiellin, MD – Associate Professor of Medicine, Yale University, New Haven, CT

Sarah Lord, PhD – Assistant Professor of Psychiatry and Pediatrics, Geisel School of Medicine, Hanover, NH; Director, Dissemination and Implementation Core, Center for Technology and Behavioral Health, Lebanon, NH

Lisa Marsch, PhD – Associate Professor of Psychiatry Geisel School of Medicine, Hanover, NH; Director, Center for Technology and Behavioral Health, Lebanon, NH; Director, Dartmouth Psychiatric Research Center, Lebanon, NH

Rachel Brian, MPH – Project Coordinator, Geisel School of Medicine, Hanover, NH


About the Conference:

Only a small percentage of persons with substance use disorders- or at risk for developing them- get the care they need. Communications technologies such as internet, smart phones, and interactive video games offer huge opportunities to expand prevention and treatment of substance use disorders and other mental health challenges. This symposium presents innovative initiatives that usetechnology to engage patients in addressing diverse substances challenges and phases of use - from tobacco to opioids to alcohol and across the spectrum of use from prevention to treatment to support of recovery. Speakers emphasize practical strategies for implementing use of technologies in clinical practice and attendees are given opportunities to try out many of the technology programs presented.


Integrating Evidence-Based Behavioral Health Technologies into Primary Care

Funding Source: Dartmouth SYNERGY Translational Program (Community-Based Research Core)

Project Period: July 2014-June 2016

Principal Investigator(s): Lisa Marsch, PhD; Sarah Lord, PhD; Bob Drake, MD, PhD

Other Project Staff:  Erin Corriveau, MD; Elliott Fisher, MD; Mark McGovern, PhD; Haiyi Xie, PhD; Ardis Olson, MD; Ben Crosier, PhD

Project Summary:

This project engages community and academic partners in understanding needs and priorities among rural community health care systems around shifting health care systems (e.g., in light of ACA) – with a particular focus on integrating behavioral health and medical care in rural settings.

Behavioral health problems (addictions and mental health disorders, such as depression) are highly prevalent, especially in poor and disenfranchised populations. The great majority of these people (over 90%) receive no treatment. Behavioral health problems also complicate diagnosis, treatment, and outcomes for many chronic conditions, such as diabetes, obesity, heart failure, and cancer.  A sufficient workforce to address these problems does not exist - especially in rural communities.

Incorporating new health technologies could be a cost-effective solution.  New technology tools could be used in primary care to improve access, self-care, and outcomes, and to reduce costs and health disparities.  Yet, successful implementation and sustainability of any new intervention process, including a technology-based care approach, is strengthened by attention to pre-implementation readiness of the primary care community agencies and constituent stakeholders to adopt a technology treatment innovation in their system of care. 

This two-year, 2-phased project includes mixed-methods formative research in year 1 to assess community priorities and readiness for technology-based behavioral health tools in primary care settings, followed by a demonstration implementation project of a technology-based behavioral health intervention within rural primary care settings in year 2. 

Public Health Relevance:

This work will inform strategies for optimizing implementation outcomes when embedding technology-based behavioral health tools in rural primary care settings, supported by appropriate training/technical assistance.    


Increasing HIV Testing in Urban Emergency Departments via Mobile Technology

Funding Source: National Institute on Drug Abuse (NIDA)

Project Period: 07/01/2014 – 06/30/2017

Principal Investigator: Ian David Aronson, PHD

Project Summary:

Our proposed intervention builds upon initial findings from a trial our research team conducted with patients who declined HIV testing. The brief intervention had a potent effect: a third accepted HIV testing post-intervention. While this preliminary study is highly encouraging, it revealed a number of other critical research questions. First, it remains unclear what intervention component most strongly contributed to patients’ decisions to test. Second, consistent with the literature, participants indicated that depicting a community member onscreen would increase the proportion of patients who test. Third, results suggest there is individual variation in the extent to which behavior is more strongly influenced by onscreen community members or experts (e.g. physicians). Therefore, the goal of the present study is to determine how we can refine mobile computer-based interventions to maximize HIV testing rates among patients who initially decline to test in the ED. The present study will use a pilot four-arm randomized controlled design. All participants will use mobile computers to complete a pre-test assessment. One arm will see video of a physician explaining the importance of HIV testing and modeling rapid testing (similar to the original video). The second arm will view video of a community member who explains testing importance and models testing. A third will have a choice of which of the two videos to watch. A fourth group (control) will not see any video. At the end of the computerized intervention (pre-test/video or pre-test only), onscreen text will ask patients if they would agree to an HIV test. Those who agree will be tested by ED staff. The trial will recruit patients (N=300) aged 18-64 in a high volume, urban hospital center. The study’s endpoint will be post-intervention HIV test rates. Our study will inform scalable interventions for underserved populations nationwide.

Public Health Relevance:

When hospital emergency departments (EDs) offer routine HIV testing to reach substance users and other high-risk patients, those who could benefit most frequently decline. Thus, an important health priority remains not only offering HIV testing to more patients, but developing strategies to increase test rates by working with patients who are reluctant to learn their HIV status. The proposed research will develop and evaluate the acceptability, feasibility, and preliminary efficacy of a mobile computer-based video intervention designed to increase HIV test rates among vulnerable patients in EDs and other high volume clinical settings nationwide.