Gamified Physical-Digital Smoking Cessation Intervention for Young Adults: Mixed Methods Development and Usability Study (Preprint)

<sec> <title>BACKGROUND</title> Smoking remains a leading cause of death worldwide, with young adults particularly at risk due to the lack of targeted cessation initiatives. While mobile apps show promise in supporting smoking cessation, they primarily target smokers already motivated enough to install them, highlighting the need for interventions that reach those who are not yet ready to take that step. </sec> <sec> <title>OBJECTIVE</title> This paper focuses on designing and evaluating Smokwit, a digital smoking cessation intervention aimed at young adults during the act of smoking. Smokwit seeks to investigate the early stages of smoking cessation (precontemplation and contemplation) that are important yet rarely investigated. </sec> <sec> <title>METHODS</title> The paper is based on the design science research methodology where a digital intervention—Smokwit—was designed and evaluated in the wild using a mixed method approach combining quantitative results of a quasi-experiment with qualitative insights from users and experts. More specifically, Smokwit is a novel gamified ambient intervention that integrates a connected ashtray with a mobile app. The ashtray aims to trigger processes of change, in particular consciousness raising and social liberation (as part of the transtheoretical model of change) by provoking curiosity, self-reflection, and ad-hoc peer discussions among smokers. The linked mobile app is designed to reinforce this goal by providing smoking cessation self-help material and coaching possibilities. We evaluated the effectiveness of this intervention through a 3-month field study designed as a quasi-experiment with a treatment and control group (n=46). A qualitative analysis with users (n=10) and smoking cessation experts (n=7) provides insights into the type of interactions that happened within and outside the system as well as practical implications for smoking cessation organizations. </sec> <sec> <title>RESULTS</title> The qualitative findings revealed that the intervention promoted smokers’ self-reflection, peer discussions, and mobile app interactions. Furthermore, the quantitative analysis uncovered a possible trend toward increased readiness to quit among smokers in the treatment group compared to the control group; however, this did not reach conventional levels of statistical significance (b=1.33; &lt;i&gt;z&lt;/i&gt;=1.91; &lt;i&gt;P&lt;/i&gt;=.06). </sec> <sec> <title>CONCLUSIONS</title> Smokwit provides encouraging insights into how to design a bottom-up digital intervention that targets young adults at an opportune moment to support them on their smoking cessation journey. </sec> <sec> <title>CLINICALTRIAL</title> <p/> </sec>