{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:36:31Z","timestamp":1792604191574,"version":"4.5.0"},"reference-count":93,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Serious Games"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Opioid misuse and mental disorders are highly comorbid conditions. The ongoing substance misuse and mental health crises among adolescents in the United States underscores the importance of widely scalable substance misuse preventive interventions that also address mental health risks. Serious video games offer an engaging, widely scalable method for delivering and implementing preventive interventions. However, there are no video game interventions that focus on preventing opioid misuse among older adolescents, and there are limited existing video game interventions that address mental health.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to develop and conduct a formative evaluation of a video game intervention to prevent opioid misuse and promote mental health among adolescents aged 16-19 years (PlaySmart). We conducted formative work in preparation for a subsequent randomized controlled trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted development and formative evaluation of PlaySmart in 3 phases (development, playtesting, and preimplementation) through individual interviews and focus groups with multiple stakeholders (adolescents: n=103; school-based health care providers: n=51; and addiction treatment providers: n=6). PlaySmart content development was informed by the health belief model, the theory of planned behavior, and social cognitive theory. User-centered design principles informed the approach to development and play testing. The Exploration, Preparation, Implementation, and Sustainability framework informed preimplementation activities. Thematic analysis was used to identify themes from interviews and focus groups that informed PlaySmart game content and approaches to future implementation of PlaySmart.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We developed a novel video game PlaySmart for older adolescents that addresses the risk and protective factors for opioid misuse and mental health. Nine themes emerged from the focus groups that provided information regarding game content. Playtesting revealed areas of the game that required improvement, which were modified for the final game. Preimplementation focus groups identified potential barriers and facilitators for implementing PlaySmart in school settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PlaySmart offers a promising digital intervention to address the current opioid and mental health crises among adolescents in a scalable manner.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/46912","type":"journal-article","created":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T10:02:07Z","timestamp":1699005727000},"page":"e46912","source":"Crossref","is-referenced-by-count":15,"title":["A Video Game Intervention to Prevent Opioid Misuse Among Older Adolescents: Development and Preimplementation Study"],"prefix":"10.2196","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5792-3605","authenticated-orcid":false,"given":"Kammarauche","family":"Aneni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4513-5526","authenticated-orcid":false,"given":"Claudia-Santi F","family":"Fernandes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2794-9481","authenticated-orcid":false,"given":"Lily A","family":"Hoerner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6723-2744","authenticated-orcid":false,"given":"Claire","family":"Szapary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2750-2321","authenticated-orcid":false,"given":"Tyra M","family":"Pendergrass Boomer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0160-6613","authenticated-orcid":false,"given":"Lynn E","family":"Fiellin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2023,11,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.2847"},{"key":"ref2","unstructured":"Key substance use and mental health indicators in the United States: results from the 2020 national survey on drug use and healthSubstance Abuse and Mental Health Services Administration2021102022-01-09https:\/\/www.samhsa.gov\/data\/sites\/default\/files\/reports\/rpt35325\/NSDUHFFRPDFWHTMLFiles2020\/2020NSDUHFFR1PDFW102121.pdf"},{"key":"ref3","unstructured":"Substance use disorder defined by NIDA and SAMHSAWyoming Legislative Interim Committee2022112023-01-09https:\/\/wyoleg.gov\/InterimCommittee\/2020\/10-20201105Handoutfor6JtMHSACraig11.4.20.pdf"},{"key":"ref4","year":"2008","journal-title":"Drug Misuse: Psychosocial Interventions"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm675152e1"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-030601"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2015.04.010"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2013.12.033"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1007\/s10935-020-00578-0"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2016.12.018"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2017.17040413"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1037\/a0035488"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1192\/bja.2020.64"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.psych.60.110707.163456"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2019.6235"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcl.2019.08.005"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.8148"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1080\/08897077.2019.1691128"},{"key":"ref19","unstructured":"National Center for Education StatisticsRacial\/ethnic enrollment in public schoolsUS Department of Education, Institute of Education Sciences2022-09-19https:\/\/nces.ed.gov\/programs\/coe\/indicator\/cge\/racial-ethnic-enrollment"},{"key":"ref20","unstructured":"School enrollment in the United States: October 2020 - detailed tablesUS Census Bureau20202022-11-20https:\/\/www.census.gov\/data\/tables\/2020\/demo\/school-enrollment\/2020-cps.html"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.2196\/18487"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2021.106523"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1037\/a0025756"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2014.01.029"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2012.301209"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.5093\/in2011v20n1a6"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1037\/0022-006X.75.6.914"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2018.11.016"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.21037\/mhealth.2020.01.05"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1089\/g4h.2021.0118"},{"key":"ref31","unstructured":"Mobile phone ownershipPew Research Center201701112020-01-29https:\/\/www.pewresearch.org\/internet\/chart\/mobile-phone-ownership\/"},{"key":"ref32","unstructured":"HeathSKey barriers limiting patient access to mental healthcareTechTarget: Patient Engagement HIT2023-01-09https:\/\/patientengagementhit.com\/news\/key-barriers-limiting-patient-access-to-mental-healthcare"},{"key":"ref33","author":"Abt, CC","year":"2002","journal-title":"Serious Games"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.2196\/39086"},{"key":"ref35","unstructured":"Teens, video games and civicsPew Research Center200809162022-03-19https:\/\/www.pewresearch.org\/internet\/2008\/09\/16\/teens-video-games-and-civics\/"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1177\/003172170508700205"},{"key":"ref37","first-page":"103","author":"Lieberman, D","year":"1997","journal-title":"Health Promotion and Interactive Technology: Theoretical Applications and Future Directions"},{"key":"ref38","first-page":"1","author":"Street, RL Jr","year":"1997","journal-title":"Health Promotion and Interactive Technology: Theoretical Applications and Future Directions"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.1126\/science.1146930"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.1016\/j.aap.2008.03.005"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.1097\/NNR.0b013e31822cc87d"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.1177\/1740774516637871"},{"issue":"2","key":"ref43","first-page":"342","volume":"18","author":"Marsch, LA","year":"2007","journal-title":"Adolesc Med State Art Rev"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2013.1095"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.1097\/00004479-200101000-00004"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.3109\/14639239709089835"},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e2598"},{"key":"ref48","doi-asserted-by":"publisher","DOI":"10.1080\/10410230802676490"},{"key":"ref49","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2007-3134"},{"key":"ref50","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.4377"},{"key":"ref51","doi-asserted-by":"publisher","DOI":"10.1089\/g4h.2021.0243"},{"key":"ref52","doi-asserted-by":"publisher","DOI":"10.2196\/33975"},{"key":"ref53","doi-asserted-by":"publisher","DOI":"10.1007\/s13142-013-0246-8"},{"key":"ref54","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2018.03.021"},{"key":"ref55","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/B978-0-12-809269-9.00006-2","author":"Laranjo, L","year":"2016","journal-title":"Participatory Health Through Social Media"},{"key":"ref56","doi-asserted-by":"publisher","DOI":"10.1300\/j029v03n04_04"},{"key":"ref57","unstructured":"LaMorteWWThe health belief modelBoston University School of Public Health2022-11-20https:\/\/sphweb.bumc.bu.edu\/otlt\/mph-modules\/sb\/behavioralchangetheories\/behavioralchangetheories2.html"},{"key":"ref58","first-page":"45","author":"Champion, VL","year":"2008","journal-title":"Health Behavior and Health Education: Theory, Research, and Practice. 4th edition"},{"key":"ref59","author":"Ajzen, I","year":"2005","journal-title":"Attitudes, Personality and Behavior. 2nd edition"},{"key":"ref60","doi-asserted-by":"publisher","DOI":"10.15288\/jsad.2011.72.322"},{"key":"ref61","first-page":"67","author":"Monta\u00f1o, DE","year":"2008","journal-title":"Health Behavior and Health Education. 4th edition"},{"key":"ref62","doi-asserted-by":"publisher","DOI":"10.3109\/10826084.2014.984847"},{"key":"ref63","unstructured":"LaMorteWWThe social cognitive theoryBoston University School of Public Health2022-11-20https:\/\/sphweb.bumc.bu.edu\/otlt\/mph-modules\/sb\/behavioralchangetheories\/behavioralchangetheories5.html"},{"key":"ref64","author":"Pagulayan, R","year":"2002","journal-title":"Human Computer Interaction Handbook: Fundamentals, Evolving Technologies, and Emerging Applications"},{"key":"ref65","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2007.09.027"},{"key":"ref66","doi-asserted-by":"publisher","DOI":"10.2196\/13695"},{"key":"ref67","doi-asserted-by":"publisher","DOI":"10.2196\/games.9231"},{"key":"ref68","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2018.07.007"},{"key":"ref69","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2016.08.025"},{"key":"ref70","doi-asserted-by":"publisher","DOI":"10.1007\/s11121-008-0095-8"},{"key":"ref71","doi-asserted-by":"publisher","DOI":"10.2345\/0899-8205-46.s2.49"},{"key":"ref72","doi-asserted-by":"publisher","DOI":"10.1111\/cpsp.12154"},{"key":"ref73","doi-asserted-by":"publisher","DOI":"10.2196\/games.8881"},{"key":"ref74","doi-asserted-by":"publisher","DOI":"10.2196\/24112"},{"key":"ref75","doi-asserted-by":"publisher","DOI":"10.2196\/36068"},{"key":"ref76","doi-asserted-by":"publisher","DOI":"10.1007\/s10488-010-0327-7"},{"key":"ref77","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-018-0842-6"},{"key":"ref78","unstructured":"JohnstonLDMiechRAO'MalleyPMBachmanJGSchulenbergJEPatrickMEMonitoring the future national survey results on drug use, 1975-2019: overview, key findings on adolescent drug useInstitute for Social Research, The University of Michigan2021-07-21https:\/\/eric.ed.gov\/?id=ED604018"},{"key":"ref79","doi-asserted-by":"publisher","DOI":"10.1080\/14780887.2020.1769238"},{"key":"ref80","doi-asserted-by":"publisher","DOI":"10.1177\/1049732320921835"},{"key":"ref81","doi-asserted-by":"publisher","DOI":"10.2196\/12389"},{"key":"ref82","author":"Schell, J","year":"2019","journal-title":"The Art of Game Design: A Book of Lenses. 3rd edition"},{"key":"ref83","doi-asserted-by":"publisher","DOI":"10.1089\/g4h.2012.0025"},{"key":"ref84","doi-asserted-by":"publisher","DOI":"10.1177\/1524839914521211"},{"key":"ref85","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.2011.06201.x"},{"key":"ref86","doi-asserted-by":"publisher","DOI":"10.1016\/j.cbpra.2019.12.002"},{"key":"ref87","unstructured":"BanksJBowmanNDClose intimate playthings? Understanding player-avatar relationships as a function of attachment, agency, and intimacyAoIR Selected Papers of Internet Research20132022-09-29https:\/\/journals.uic.edu\/ojs\/index.php\/spir\/article\/view\/8498"},{"key":"ref88","doi-asserted-by":"publisher","DOI":"10.1109\/cgames.2013.6632611"},{"key":"ref89","unstructured":"PlaySmart game overviewPlay2PREVENT Lab Youtube20222022-09-29https:\/\/www.youtube.com\/watch?v=CFc77scYP64"},{"key":"ref90","unstructured":"Secondary school teachersDataUSA2023-09-20https:\/\/datausa.io\/profile\/soc\/secondary-school-teachers#demographics"},{"key":"ref91","unstructured":"Teacher characteristics and trendsNational Center for Education Statistics2023-09-20https:\/\/nces.ed.gov\/fastfacts\/display.asp?id=28"},{"key":"ref92","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.3789"},{"key":"ref93","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.2013.301608"}],"container-title":["JMIR Serious Games"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/games.jmir.org\/2023\/1\/e46912","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:54:07Z","timestamp":1782842047000},"score":1,"resource":{"primary":{"URL":"https:\/\/games.jmir.org\/2023\/1\/e46912"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,3]]},"references-count":93,"URL":"https:\/\/doi.org\/10.2196\/46912","relation":{"has-preprint":[{"id-type":"doi","id":"10.2196\/preprints.46912","asserted-by":"object"}]},"ISSN":["2291-9279"],"issn-type":[{"value":"2291-9279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,3]]}}}