de Buisonjé, D. R., Brosig, F., Breeman, L. D., Bloom, E. L., Reijnders, T., Janssen, V. R., Kraaijenhagen, R. A., Kemps, H. M. C., & Evers, A. W. M. (2023). Put your money where your feet are: The real-world effects of StepBet gamified deposit contracts for physical activity. Internet Interventions, 31, 100610.

From the abstract: In a real-world setting, and among a large and diverse sample, participating in a gamified deposit contract challenge was associated with a large increase in step counts. A majority of challenges were successful and succeeding in a challenge was associated with a large and clinically relevant increase in step counts.

Bloom, E. L., Japuntich, S. J., Pierro, A., Dallery, J., Leahey, T. M., & Rosen, J. (2022). Pilot trial of QuitBet: A digital social game that pays you to stop smoking. Experimental and Clinical Psychopharmacology, 30(5), 642–652.

From the abstract: Among the 50 players, 34% were winners. Thirty-seven participants (74%) responded to a post-QuitBet survey, of whom 95% said they would be interested in playing another QuitBet and would recommend QuitBet to others. Overall, feedback was positive with some suggestions for improvement. In conclusion, a digital social game for smoking cessation with a deposit contract was feasible and acceptable. Next steps include conducting a randomized trial to establish efficacy and a sustainable business model.

Leahey, T., & Rosen, J. (2014). DietBet: A web-based program that uses social gaming and financial incentives to promote weight loss. JMIR Serious Games, 2(1), e2.

From the abstract: DietBet, a social gaming website, reached nearly 40,000 individuals in just 7 months and produced excellent 4-week weight loss results.

Hirt-Schierbaum, L., & Ivets, M. (2020). You can win by losing! Using self-betting as a commitment device: Evidence from a weight loss program (Ruhr Economic Papers No. 881). RWI – Leibniz-Institut für Wirtschaftsforschung.

From the abstract: Our empirical results suggest that financial incentives incorporated into the self-bet mechanism encourage commitment and weight loss. More specifically, by placing higher wagers on themselves and participating in games with larger pots, agents can increase their chances of successful commitment and lose more weight.

Bloom, E.L., Waring, J., Japuntich, S. J., Dallery, J., Leahey, T. M., Dunsiger, S., & Rosen, J. (2025, March). I bet I can quit: NIH SBIR-funded randomized trial of a gamified smoking cessation app with a deposit contract. Poster presented at the annual meeting of the Society of Behavioral Medicine, San Francisco, CA.

Winner of the 2025 SBM Digital Health Tech Madness Champion Award!

Abstract:

Significance: Contingency management (CM), which uses financial incentives to motivate behavior change, is among the most effective non-pharmacological treatments for cigarette smoking cessation in academic research settings. Two promising strategies for facilitating real-world application of CM are delivering it via smartphone apps and funding the incentives via deposit contracts, in which participants pay a deposit of their own money up front that they can only recoup by quitting smoking. Methods: We conducted a randomized trial of a smoking cessation app that was structured as a 28-day “game” with a $30 deposit (their “bet”). All “players” were provided with a Bluetooth-enabled breath carbon monoxide (CO) monitor, included with their $30 deposit. Players were instructed to quit by day 2. All players who abstained from smoking between day 3-28, verified by daily breath testing with up to 2 lapse days allowed, were declared “winners.” Winners split the total sum of deposits equally, such that their $30 deposit was refunded plus they received extra profit from the forfeited deposits of players who did not submit the required breath tests. U.S. adults (N = 245, Mage = 44.9) who smoked at least 5 cigarettes per day (M = 13.5) were recruited nationwide (47 states) in 14 cohorts (M = 18 participants, range 4-34). Each cohort was randomized to play the “Group” or “Individual” version of the game. The Group version included the deposit contract, a social feed where players could communicate with each other and a host who provided smoking cessation education, and a game board that displayed players’ progress. The Individual version only included the deposit contract (no social feed or game board). Participants completed follow-up assessments at 1 (i.e., post-game), 2, 3, and 6 months after the game start date. Results: The win rate was not significantly different in the Group (43.1%) vs. Individual (37.5%) version (p=.59 in model adjusting for clustering and covariates). However, a longitudinal model comparing self-reported 7-day point prevalence abstinence showed significant differences at 1 month favoring the Group version (OR=1.86, 95% CI: 1.04-3.24) and trends in the same direction at 2, 3, and 6 months (ORs=1.20-1.59). Conclusion: Incorporating social interaction and education enhanced the short-term effects of a deposit contract for smoking cessation delivered via an app. These findings will guide future app development and commercialization efforts.

Incitti, J., Bloom, E., Hasan, R., & Mitchell, J. (2025, March). Examining engagement amongst mobile health app users: A 6-month latest class analysis study. Poster presented at the annual meeting of the Society of Behavioral Medicine, San Francisco, CA.

Abstract:

BACKGROUND: Mobile health application (mHealth app) effectiveness may be limited by low engagement. Increasing understanding of factors influencing engagement may help. mHealth app subscription and renewal are two metrics of interest to commercial app publishers. PURPOSE: To identify homogenous user subgroups (i.e., behavioural phenotypes) within a paid mHealth app context and examine associations with subscription and renewal. METHODS: A 6-month latent class analysis (LCA) study was conducted with new users of the WayBetter app, an mHealth app with financial incentives. Users completing a 7-day free trial between November 2, 2023 and January 3, 2024 were included. LCA produced phenotypes using (1) purpose-built survey responses (e.g., socio-demographics, previous health behaviours, personality traits), (2) device assessed health data (e.g., daily step count), and (3) 7-day trial period engagement data (e.g., number of app opens). Odds ratios (OR; p<0.05) assessed associations between phenotypes and 6-month subscription (i.e., $69 USD) and 6-month renewal (i.e., additional $69 USD). RESULTS: The total sample included 934 users (Age [SD]=42.00 [9.65] years; % women=91.10%). Based on key LCA fit indices (e.g., Vuong-Lo-Mendell-Rubin likelihood test=467.16, p=0.032), and theoretical interpretability, five distinct phenotypes were formed: (1) Highly Engaged Subscribers, (2) Subscribers with Multimorbidity, (3) Healthy Subscribers, (4) Non-subscribers with Multimorbidity, and (5) Healthy Non-Subscribers. Phenotypes 1, 2, and 3 had greater odds of subscribing (OR=21.31, [8.56,53.06]; OR=7.11, [4.04,12.50]; OR=8.28, [4.26,16.08], respectively) than phenotype 4 (OR=0.82, [0.48,1.41]), compared to phenotype 5, the reference. As well, the odds phenotypes 1, 2, 3 and 4 renewed were OR=1.06, [0.62,1.81]; OR=0.900, [0.54,1.49]; OR=0.99, [1.0,1.8], OR=0.5, [0.3,0.7], respectively (compared to the reference class phenotype 5). CONCLUSION: Behavioural phenotypes likely or not to subscribe were identified using data collected during the 7-day free trial period. These may be targeted with future intervention.

Hasan, R., Mitchell, M., Bloom, E., Incitti, J., & Van Reisen, J. (2024, March). Examining engagement predictors of health and fitness app uptake in the general population: A 24-week prospective cohort study. Poster presented at the annual meeting of the Society of Behavioral Medicine, Philadelphia, PA.

Abstract:

Introduction: Low mobile health (mHealth) app engagement, leading to little or no effect, is typical. Financial incentives may be a solution but can be costly. Examinations of more efficient incentive models, such as “deposit contracts”, where individuals wager their own money and can earn it back contingent on behaviour, are needed. Objective: To examine predictors of initial six-month subscription with the deposit contract-based WayBetter Health app. The secondary objective is to characterize app engagement over six months of app use. Methods: A six month prospective cohort study is being conducted in partnership with WayBetter between November 2023 and May 2024. The sample is restricted to new app users engaged in a 7-day free trial. WayBetter is sending new users an email on trial day 5 inviting them to complete a 25-item survey regarding socio-demographics (e.g., household income), health behaviours (e.g., physical activity, weight-loss history), determinants health app use (e.g., social influence), and personality traits (i.e., risk-taking). Survey items were selected using the Capability, Opportunity, Motivation-Behaviour (COM-B) model for behaviour change. Once 300 WayBetter users complete the survey, their responses will be linked to app subscription and engagement (e.g., weekly app opens) data to accomplish the primary and secondary study objectives. Specifically, latent class analyses will be used to identify homogeneous subgroups of users (e.g., ‘older risk-taking women’) who opt, or not, for a six-month subscription and who continue to engage, or not, over six months. Results: One hundred and twenty-six WayBetter users have completed the survey thus far (87.3% women; mean age=42±10.62 years; % low income=7.14). Only about one-quarter self-reported meeting physical activity guidelines (24.60%) while more than a third (37.30%) report experiencing weight-related discrimination at least once. Additionally, 43.65% report a high willingness to take risks. Study recruitment and data collection will be complete by December 2023 and May 2024, respectively. Discussion: Study recruitment is progressing well, with early evidence suggesting traditionally hard-to-reach populations (e.g., lower income adults) are participating in the survey. We expect findings may inform the design of interventions targeting user groups more or less likely to subscribe and engage with deposit contract-based mHealth apps like Waybetter.

Jakob R, Lepper N, Fleisch E, Kowatsch T. Predicting early user churn in a public digital weight loss intervention. In Proceedings of the CHI Conference on Human Factors in Computing Systems (CHI ’24), May 11–16, 2024, Honolulu, HI, USA. ACM, New York, NY, USA

From the abstract:

Digital health interventions (DHIs) offer promising solutions to the rising global challenges of noncommunicable diseases by promoting behavior change, improving health outcomes, and reducing healthcare costs. However, high churn rates are a concern with DHIs, with many users disengaging before achieving desired outcomes. Churn prediction can help DHI providers identify and retain at-risk users, enhancing the efficacy of DHIs. We analyzed churn prediction models for a weight loss app using various machine learning algorithms on data from 1,283 users and 310,845 event logs. The best-performing model, a random forest model that only used daily login counts, achieved an F1 score of 0.87 on day 7 and identified an average of 93% of churned users during the week-long trial. Notably, higher-dimensional models performed better at low false positive rate thresholds. Our findings suggest that user churn can be forecasted using engagement data, aiding in timely personalized strategies and better health results.

de Buisonjé, D. R., Brosig, F., Breeman, L. D., Bloom, E. L., Reijnders, T., Janssen, V. R., Kraaijenhagen, R. A., Kemps, H. M. C., & Evers, A. W. M. (2023, August). Put your money where your feet are: The real-world effects of StepBet gamified deposit contracts for physical activity. Paper presented at the 17th International Congress of Behavioral Medicine, Vancouver, British Columbia, Canada.

Abstract:

Background: Gamification and deposit contracts (a financial incentive in which participants pledge their own money) can enhance effectiveness of mobile behavior change interventions. However, to assess their potential for improving population health, research should investigate implementation of gamified deposit contracts outside the research setting. We performed a naturalistic evaluation of gamified deposit contracts offered in the StepBet smartphone app. We explored for whom they work best, and under which conditions they are most effective to help increase physical activity.

Methods: The modal StepBet challenge consisted of a $40 deposit made prior to a 6-week challenge period during which participants reached daily and weekly step goals in order to regain their deposit (and additional earnings). Step goals were tailored on a historic step count retrieval that was also used as baseline comparison. Primary outcomes were increase in step count (continuous) and challenge success (dichotomous).

Results: Overall, average daily step counts increased by 31.2% (2,423 steps, SD = 3,462) from 7,774 steps (SD = 3,112) at baseline to 10,197 steps (SD = 4,162) during the challenge. The average challenge success rate was 73%. Those who succeeded in their challenge (n = 53,281) increased their step count by 44.0% (3,465 steps, SD = 3,013), while those who failed their challenge (n = 19,693) decreased their step count by -5.3% (-398 steps, SD = 3,013). Challenges started as a New Year’s resolution were slightly more successful (77.7%) than those started during the rest of the year (72.6%).

Discussion and conclusion: Participating in gamified deposit contracts was associated with a large and clinically relevant increase in step counts. We recommend implementing gamified deposit contracts for physical activity where possible. Future research should explore possible setback effects among people who fail a challenge, and how setbacks can be mitigated.

Pre-registration: Open Science Framework (https://doi.org/10.17605/OSF.IO/D237C)

de Buisonjé, D. R., Brosig, F., Breeman, L. D., Bloom, E. L., Reijnders, T., Janssen, V. R., Kraaijenhagen, R. A., Kemps, H. M. C., & Evers, A. W. M. (2023, March). Put your money where your feet are: The real-world effects of StepBet gamified deposit contracts for physical activity. Paper presented at the 12th Annual Meeting of the Association for Researchers in Psychology and Health, The Netherlands.

Abstract:

Background: Gamification and deposit contracts (a financial incentive in which participants pledge their own money) can enhance effectiveness of mobile behavior change interventions. However, to assess their potential for improving population health, research should investigate implementation of gamified deposit contracts outside the research setting. We performed a naturalistic evaluation of gamified deposit contracts offered in the StepBet smartphone app. We explored for whom they work best, and under which conditions they are most effective to help increase physical activity.

Methods: The modal StepBet challenge consisted of a $40 deposit made prior to a 6-week challenge period during which participants reached daily and weekly step goals in order to regain their deposit (and additional earnings). Step goals were tailored on a historic step count retrieval that was also used as baseline comparison. Primary outcomes were increase in step count (continuous) and challenge success (dichotomous).

Results: Overall, average daily step counts increased by 31.2% (2,423 steps, SD = 3,462) from 7,774 steps (SD = 3,112) at baseline to 10,197 steps (SD = 4,162) during the challenge. The average challenge success rate was 73%. Those who succeeded in their challenge (n = 53,281) increased their step count by 44.0% (3,465 steps, SD = 3,013), while those who failed their challenge (n = 19,693) decreased their step count by -5.3% (-398 steps, SD = 3,013). Challenges started as a New Year’s resolution were slightly more successful (77.7%) than those started during the rest of the year (72.6%).

Discussion and conclusion: Participating in gamified deposit contracts was associated with a large and clinically relevant increase in step counts. We recommend implementing gamified deposit contracts for physical activity where possible. Future research should explore possible setback effects among people who fail a challenge, and how setbacks can be mitigated.

Pre-registration: Open Science Framework (https://doi.org/10.17605/OSF.IO/D237C)

Bloom, E. L., Japuntich, S. J., Tsuei, J., Alivi Fili, A., Dallery, J., Leahey, T., & Rosen, J. (2023, March). Academia-industry collaboration to develop a digital social game for cigarette smoking cessation. In E. L. Bloom (Chair), Development, dissemination, and commercialization of digital smoking and vaping cessation and prevention programs. Symposium presented at the annual meeting of the Society for Research on Nicotine and Tobacco, San Antonio, TX.

Abstract:

The NIH SBIR/STTR grant mechanism provides funding to small businesses to support research and development of commercializable products and services. We will provide an overview of this grant mechanism, explain how it can facilitate collaborations between academia and industry and influence career journeys, and describe our work on a digital social game for smoking cessation that is supported by a NIDA SBIR Fast Track award. Contingency management involves providing financial incentives for behavior change and is among the most effective non-pharmacological treatments for cigarette smoking cessation when tested in academic research settings. However,concerns about feasibility, acceptability, and relapse after incentives are discontinued have limited dissemination and commercialization of contingency management programs. The digital smoking cessation game we are developing includes a deposit contract, which is a self-sustaining, scalable form of contingency management, and other social gaming elements. The game is delivered via a smartphone application. Participants verify smoking abstinence using remote carbon monoxide breath testing with video-based identify verification. We will review the game development process including initial ideation and testing an early prototype on social media, developing a minimum viable product (MVP) version of a smartphone application, and testing this MVP in a pilot trial. During the pilot trial, which has already been published (Bloom et al., 2021), we collected quantitative and qualitative data that was used to inform revisions to the app and the design of an ongoing randomized trial. We will present the protocol for this trial, including the rationale for game and study design changes informed by the pilot trial, and early data on recruitment processes and challenges. Finally, we will discuss future plans and options for achieving successful commercialization of this product.

Bloom, E.L., Japuntich, S. J., Pierro, A., Dallery, J., Leahey, T. M., & Rosen, J. (2020, May). Pilot trial of QuitBet – A digital social game that pays you to stop smoking. Video poster presented at the UConn Center for mHealth and Social Media 4th Annual Conference: Building an Evidence Base for Commercially Available Technology, Storrs, CT (virtual conference).

Bloom, E.L., Japuntich, S. J., Pierro, A., Dallery, J., Leahey, T. M., & Rosen, J. (2020, March). Pilot trial of QuitBet – A digital social game that pays you to stop smoking. Poster presented at the annual meeting of the Society for Research on Nicotine and Tobacco, New Orleans, LA (e-poster presented virtually).

Abstract:

Significance: Providing financial incentives for abstinence is among the most effective behavioral intervention approaches for smoking cessation but has rarely been implemented in real-world settings. We developed and pilot tested QuitBet, a commercial, digital social game for smoking cessation administered via a smartphone application. Game players earned financial incentives for abstinence verified via remote breath carbon monoxide (CO) testing. Methods: QuitBet was modeled on the company’s established games targeting weight loss and physical activity. All games include: 1) an activity board with social media features (players can post and respond to messages, photos, and videos) and 2) entirely player-funded financial incentives in the form of a deposit contract (the “bet”). QuitBet had a bet of $30 and lasted for 28 days. After a week for preparation, the quit day was day 8. Between day 9-28 (a 20-day period), players earned back $1 of their $30 bet for each day of CO-verified abstinence. Remaining bet money was pooled into a “grand prize” pot. Players who were abstinent on at least 19 of the 20 days (1 lapse day allowed) were declared “winners” and split the grand prize pot equally. A game host posted daily messages containing education about smoking cessation and behavior change strategies (e.g., coping with cravings) and moderated the discussion. Results: Players (N = 50 U.S. adults who smoked at least 10 cigarettes per day, 78% female, Mage = 40.4) were recruited online in Oct-Nov 2019. The online screening survey was completed 687 times, of which 235 were eligible; 106 signed the online consent form; 77 completed the baseline survey; and 50 paid their bet and joined a game (23 players in Game 1; 27 players in Game 2). Twenty-eight (28) players (56%) were abstinent on day 9 and 21 (42%) were abstinent for at least 7 consecutive days. Conclusion: These results suggest that QuitBet is feasible and has potential for significant positive impact on public health. Next steps include conducting a randomized trial to establish efficacy and a sustainable business model and to determine if playing multiple consecutive games is effective for preventing relapse.

Bloom, E. L., Pierro, A., & Rosen, J. (2019, March). A social game that pays you to stop smoking: Outcomes of a commercial digital smoking cessation program. Poster presented at the annual meeting of the Society of Behavioral Medicine, Washington, DC.

Abstract:

Significance: Contingency management (CM), in which smoking abstinence is reinforced with financial incentives, is one of the most effective intervention approaches for cigarette smoking cessation. Exhaled breath carbon monoxide (CO) testing is used for objective verification of self-reported abstinence. However, traditional clinic-based CM has not been widely implemented in community settings due to concerns about CO testing cost and frequency and obtaining funding for the incentives. Recently, the first low cost, smartphone-enabled CO testing device became available for sale directly to consumers. We report the outcomes from the first offering of a commercial, digital smoking cessation program in which participants used this device to receive financial incentives for abstinence. Methods: This analysis was exempted from review by the Institutional Review Board at Rhode Island Hospital. The program was modeled on the company’s established programs (called “games”) for weight loss, which have had over 600,000 “players.” All games include: 1) a digital game activity board with social media features (players can post and respond to messages, photos, and videos) and 2) self-sustaining, entirely player-funded financial incentives in the form of a deposit contract. Players must deposit a specified amount of money to join a game. In this quit smoking game, the deposit was $30, which included the CO testing device (paid for by the company). The game lasted for 28 days. The official quit date was on day 8. Between day 9–28 (a 20-day period), players (N = 32 adult U.S. smokers) earned back $1 of their $30 deposit for each day of CO-verified abstinence. Remaining deposit money was pooled into a “grand prize” pot. Players who were abstinent on at least 19 of the 20 days were declared “winners” and split the grand prize pot equally. Players posted their CO test results on the activity board. A game host (ELB) posted a daily educational message or discussion topic. Results: Fifteen (15) of the 32 players (47%) were winners, of whom 5 had the allowed lapse. After the game, players were surveyed anonymously to obtain their feedback, which was very positive. Conclusion: The next steps are to establish the game’s effectiveness and a sustainable business model. By playing multiple consecutive games, players could extend incentive availability indefinitely to prevent relapse. This game has potential for significant positive impact on public health.