Increasing Anti-Tobacco Industry Attitudes Among Youth: A Pilot Study of a Multiplayer Educational Board Game

Games Health J. 2019 Feb;8(1):49-54. doi: 10.1089/g4h.2017.0186. Epub 2018 Aug 29.


Objective: An anti-tobacco educational board game, Smoke Stacks, was designed to engage youth in critical thinking regarding marketing practices of tobacco companies and tobacco's harmful effects. A pilot study was conducted to examine whether playing this theoretically informed that board game increased knowledge about tobacco use and negative attitudes toward tobacco companies, and decreased behavioral intentions to use tobacco.

Materials and methods: Sixty-seven teenagers aged 14-18 participated in the game assessment. Pre-/postevaluation methods were used to assess change in participant attitudes, knowledge, and intentions following gameplay.

Results: Compared to baseline, participants reported substantially increased self-perceived knowledge of the health effects of tobacco (P = 0.001) and were significantly more likely to agree that tobacco companies encourage young people to start smoking (P = 0.001), and that tobacco companies deny that cigarettes cause cancer and other diseases (P = 0.002).

Conclusion: This pilot study demonstrates that youth who played Smoke Stacks gained perceived knowledge and increased negative attitudes toward tobacco company tactics for encouraging smoking and discounting potential health risks of cigarettes.

Keywords: Denormalization; Embedded design; Theory of planned behavior; Tobacco.

MeSH terms

  • Adolescent
  • Attitude to Health*
  • Female
  • Games, Recreational* / psychology
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Male
  • Pilot Projects
  • Tobacco Industry*
  • Tobacco Use / prevention & control*
  • Tobacco Use / psychology