Increasing anti-tobacco attitudes among youth through an educational interactive game

Background: Games are emerging as a novel and engaging method for increasing youth health learning and subsequent adoption of positive health behaviors. Previous anti-tobacco initiatives have used tactics for invoking critical attitudes towards tobacco companies as an effective strategy for reducing youth’s intentions to use tobacco. Smoke Stacks is an educational board game designed to engage youth in critically examining the exploitative practices of tobacco companies and the harmful effects of tobacco.

Objective: This study examines how Smoke Stacks contributes to shifts in youths’ attitudes towards tobacco companies and behavioral intentions to use tobacco.

Methods: A total of 67 youth ages 14-18 years participated in the study. Participants were assessed using a pre-/post- evaluation design. Pre- and post-gameplay, participants completed questionnaires assessing tobacco knowledge, attitudes, and behavioral intentions to use tobacco products. Paired t-tests and Chi-square tests were used to examine changes in knowledge, attitudes, and behavioral intentions regarding tobacco.

Results: Overall participants reported increased knowledge regarding the health effects of tobacco (p<.001). Participants were more likely to agree that tobacco companies try to get young people to start smoking (p=.02) and deny that cigarettes cause cancer and other diseases (p=.002). Participants reported being less likely to engage in tobacco use soon (p=.02) or over the next year (p=.01) compared to pre-gameplay assessment.

Discussion: Health-focused games are a promising means of public health education. Findings from the current study demonstrate that Smoke Stacks, an anti-tobacco educational board game, may contribute to shifts in attitudes and behavioral intentions regarding tobacco use.