Content Analysis of Anti-Tobacco Videogames: Characteristics, Content, and Qualities

Objective: Although the prevalence of adolescent smoking has declined over the past two decades, the rate of decline has slowed. Electronic videogames show promise as an effective tool for health behavior change; however, the current state of tobacco prevention and cessation games has not been previously reviewed or evaluated. Methods and Materials: Currently available tobacco-related videogames were identified through online searches and in smartphone application stores. In total, 88 games were systematically coded for characteristics, content, and quality using a reliable and valid coding instrument developed for this research. Results: The majority of games included at least two components of interactivity (75.0 percent) and at least one mechanism for rewarding (69.3 percent). However, most games lacked a story line (97.7 percent) and components for sense of control (25.0 percent). There were an average of 3.54 (standard deviation = 2.20) theoretical constructs in the games, with attitudes (83.0 percent), knowledge (78.4 percent), and perceived severity (55.7 percent) being the most common. The most common educational approach used was the affective education model (83.0 percent). Most games included at least one tobacco message (90.9 percent), with a majority of messages being loss-framed (63.6 percent) and/or one-sided (75.0 percent). Conclusions: Although today's anti-tobacco videogames contain many effective features, numerous qualities and best practices for changing behaviors through games are not present. Future games should seek to address these best practices in their development and evaluation to increase the likelihood they will be effective.