{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T14:49:26Z","timestamp":1785854966221,"version":"3.56.0"},"reference-count":65,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Serious Games"],"abstract":"\n Background<\/jats:title>\n Adolescence is a critical developmental stage that is particularly vulnerable to the initiation of tobacco use. Despite the well-documented health risks associated with tobacco use, it remains prevalent among adolescents. Games for health are a promising strategy for tobacco prevention, using experiential and social learning theories to enhance engagement and improve behavior change.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This pilot study aims to (1) compare the social game\u2013based program Storm-Heroes to a nonsocial program regarding adolescents\u2019 personal and social experiences and (2) examine how these experiences predict higher tobacco knowledge and perceived risks of vaping and conventional tobacco use.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In a cluster-randomized comparative design, 4 after-school sites (N=79 adolescents) were recruited in person and randomized in a single-blinded format to 1 of 2 interventions: the social game Storm-Heroes (44\/79, 56%) or the nonsocial program A Smoking Prevention Interactive Experience (ASPIRE; 35\/79, 44%). A study team member supervised both interventions. Data were collected at baseline, immediate follow-up, and a 1.5-month follow-up (45\/74, 61% retained). Repeated measures mixed effects models were conducted.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 45 participants continued until the 1.5-month follow-up. Participants in the Strom-Heroes group were more likely to increase their perceived risk of vaping (B=0.40; P<.001), perceived risk of conventional tobacco use (B=0.35; P=.046), and tobacco knowledge (B=1.63; P<.001) than those in the control condition. The usability level of the program was related to a higher perceived risk of vaping (B=0.16; P=.003) and conventional tobacco use (B=0.16; P=.02) by follow-up. Attention to the program was also related to higher perceived risk of vaping (B=0.12; P=.002) and conventional tobacco use (B=0.14; P<.001). Distraction was not related to either perceived risk of vaping (P=.15) or perceived risk of conventional tobacco use (P=.71). In contrast, both more attention (B=0.60; P<.001) and less distraction (B=\u20130.37; P<.001) were related to higher tobacco knowledge.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The increased perceived risk of vaping and conventional tobacco among Storm-Heroes participants aligns with the program\u2019s goals of improving participants\u2019 awareness of the risks associated with tobacco use and their tobacco knowledge. However, distraction weakened the effect of the program on tobacco knowledge, indicating that emphasis needs to be placed on minimizing distraction for better outcomes. With the results of this study, researchers can work to advance the current version of Storm-Heroes and amplify engagement in the program to improve its potential for preventing adolescents\u2019 initiation of tobacco use.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n ClinicalTrials.gov NCT02703597; https:\/\/clinicaltrials.gov\/study\/NCT02703597<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/63296","type":"journal-article","created":{"date-parts":[[2024,8,13]],"date-time":"2024-08-13T05:51:11Z","timestamp":1723528271000},"page":"e63296","source":"Crossref","is-referenced-by-count":2,"title":["Risk Perception and Knowledge Following a Social Game\u2013Based Tobacco Prevention Program for Adolescents: Pilot Randomized Comparative Trial"],"prefix":"10.2196","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2870-2365","authenticated-orcid":false,"given":"Georges","family":"Khalil","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3675-234X","authenticated-orcid":false,"given":"Erica","family":"Ramirez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2512-0700","authenticated-orcid":false,"given":"Meerah","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7354-9657","authenticated-orcid":false,"given":"Bairu","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5829-7367","authenticated-orcid":false,"given":"Nuno","family":"Ribeiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9993-7917","authenticated-orcid":false,"given":"Patrick","family":"Balian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2024,11,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7244a1"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.0218"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1037\/adb0000304"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2021.1258"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-015-2457-z"},{"key":"ref6","unstructured":"State fact sheetsCenters for Disease Control and Prevention2024-10-21https:\/\/www.cdc.gov\/tobacco\/stateandcommunity\/state-fact-sheets\/"},{"key":"ref7","unstructured":"Youth and tobacco useCenters for Disease Control and Prevention2024-10-21https:\/\/www.cdc.gov\/tobacco\/php\/data-statistics\/youth-data-tobacco\/?CDC_AAref_Val=https:\/\/www.cdc.gov\/tobacco\/data_statistics\/fact_sheets\/youth_data\/tobacco_use\/index.htm"},{"key":"ref8","author":"Singhal, A","year":"2004","journal-title":"Entertainment-Education and Social Change: History, Research, and Practice"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1089\/g4h.2012.0017"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-658-02897-8_3"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1089\/g4h.2015.0096"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.2196\/games.5793"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.2196\/38493"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.2196\/56037"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.2196\/47807"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2018.11.016"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocaa013"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.2196\/28037"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2021.107027"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1080\/08897077.2019.1691128"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0289319"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.5210\/ojphi.v4i3.4321"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.6.3.e34"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.1923"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0296503"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.2196\/mhealth.9405"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1080\/14659891.2021.2019328"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.engappai.2004.08.024"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1109\/tlt.2019.2927914"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.3109\/10826080903038050"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.19030\/jber.v8i5.725"},{"key":"ref32","author":"Bandura, A","year":"1977","journal-title":"Social Learning Theory"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g1687"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.7174"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1080\/14622200802323183"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.4278\/0890-1171-12.1.38"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2017.02.018"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.1176\/foc.1.2.213"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.2196\/25618"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.1177\/1461444812439552"},{"key":"ref41","unstructured":"BrunetJForest-BoucherAFredetteMBrand placement in virtual environments: impact of flow on brand recognition and recallLes Cahiers du GERAD2008112024-09-21https:\/\/www.researchgate.net\/publication\/237746158_Brand_Placement_in_Virtual_Environments_Impact_of_Flow_on_Brand_Recognition_and_Recall"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.1037\/t58113-000"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.1177\/0018720816669646"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1002\/ejsp.2420200502"},{"key":"ref45","unstructured":"CollinsRLEberhartNKEstrada-DarleyIRothEEvaluation of Los Angeles County's fall 2020 WhyWeRise mental health campaign and WeRise 2021RAND20223102024-09-21https:\/\/www.rand.org\/pubs\/research_reports\/RRA875-2.html"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.5683"},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0144827"},{"key":"ref48","doi-asserted-by":"publisher","DOI":"10.4103\/ijpvm.ijpvm_264_16"},{"key":"ref49","doi-asserted-by":"publisher","DOI":"10.2196\/13031"},{"key":"ref50","doi-asserted-by":"publisher","DOI":"10.1108\/he-09-2020-0092"},{"key":"ref51","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2007.04.006"},{"key":"ref52","doi-asserted-by":"publisher","DOI":"10.1093\/her\/cyt106"},{"key":"ref53","unstructured":"HickeyAMAn adolescents peer-led motivational interviewing intervention conducted in low socio-economic community youth organisations to change health risk behaviours (smoking, alcohol and sedentary behaviours)Trinity College Dublin20242024-09-21https:\/\/www.tara.tcd.ie\/handle\/2262\/108280?show=full"},{"key":"ref54","doi-asserted-by":"publisher","DOI":"10.1016\/j.abrep.2020.100335"},{"key":"ref55","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2015.12.004"},{"key":"ref56","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-2466.2011.01551.x"},{"key":"ref57","doi-asserted-by":"publisher","DOI":"10.1080\/10810730290001774"},{"key":"ref58","doi-asserted-by":"publisher","DOI":"10.4278\/ajhp.110302-QUAN-95"},{"key":"ref59","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-2466.2000.tb02862.x"},{"key":"ref60","doi-asserted-by":"publisher","DOI":"10.1080\/08923640902857713"},{"key":"ref61","author":"Murray, FB","year":"1983","journal-title":"Piaget and the Foundations of Knowledge"},{"key":"ref62","doi-asserted-by":"publisher","DOI":"10.1016\/j.edurev.2021.100393"},{"key":"ref63","doi-asserted-by":"publisher","DOI":"10.34119\/bjhrv3n6-160"},{"key":"ref64","doi-asserted-by":"publisher","DOI":"10.3390\/info14020105"},{"key":"ref65","doi-asserted-by":"publisher","DOI":"10.2196\/games.5678"}],"container-title":["JMIR Serious Games"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/games.jmir.org\/2024\/1\/e63296","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T13:56:01Z","timestamp":1785851761000},"score":1,"resource":{"primary":{"URL":"https:\/\/games.jmir.org\/2024\/1\/e63296"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,5]]},"references-count":65,"URL":"https:\/\/doi.org\/10.2196\/63296","relation":{"has-preprint":[{"id-type":"doi","id":"10.2196\/preprints.63296","asserted-by":"object"}]},"ISSN":["2291-9279"],"issn-type":[{"value":"2291-9279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,5]]}}}