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| ID | Type | Description | Link |
|---|---|---|---|
| NCI-2021-07004 | Registry Identifier | CTRP (Clinical Trial Reporting Program) | |
| P30AG012839 | U.S. NIH Grant/Contract | View source | |
| R21CA238301 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| National Cancer Institute (NCI) | NIH |
| National Institute on Aging (NIA) | NIH |
| University of California, Berkeley | OTHER |
| Johns Hopkins University |
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This study evaluates the effects of a video game embedded in a commercially available mobile application (app) for smoking cessation. Smokers are increasingly turning to mobile health apps for assistance with quitting smoking, and there is a critical need for strategies to engage app users to increase retention and efficacy. Video games are designed to increase users' motivation and engagement, which in turn may increase their exposure and adherence to a smoking cessation program. The hypothesis is that the game increases engagement, retention, and smoking abstinence rates compared with a core version of the app without the game. A two-arm individually randomized pilot trial of 500 adult smokers will test this hypothesis, comparing outcomes for participants randomized to receive the core app plus embedded game with participants randomized to receive the core app only. Primary outcomes relate to user engagement with the app. Secondary outcomes relate to user engagement, efficacy (smoking abstinence), and user satisfaction.
PRIMARY OBJECTIVES:
I. Augment an existing smartphone cessation app for smoking cessation with a video game to increase user engagement.
II. Test the feasibility, engagement, and early efficacy of the 'gamified' app, compared to one without gamification.
OUTLINE:
Participants are recruited through the Smoke Free smartphone app and randomized to 1 of 2 arms.
ARM I: Participants receive an educational intervention through the Smoke Free application (core app) with the embedded video game module. Participants complete questionnaires and may undergo saliva sample collection, if they report being smoke-free on follow-up.
ARM II: Participants receive an educational intervention through the Smoke Free application without the video game module (core app only). Participants complete questionnaires and may undergo saliva sample collection, if they report being smoke-free on follow-up.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Education plus game module | Experimental | Participants receive an educational intervention through the Smoke Free application with the embedded game module. Participants complete questionnaires and may undergo saliva sample collection, if they report being smoke-free on follow-up. |
|
| Education module only | Active Comparator | Participants receive an educational intervention through the Smoke Free application only (core app only). Participants complete questionnaires and may undergo saliva sample collection, if they report being smoke-free on follow-up. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Game Module | Behavioral | Receive access to the the game module through the free, 'Smoke Free' smartphone application |
|
| Measure | Description | Time Frame |
|---|---|---|
| Number of Unique App Sessions | Number of times the app was opened; passively collected by the app and averaged in analysis to calculate mean number of app opens by study group over the study period. A new session is defined as use of the app after at least 30 minutes of inactivity. | Enrollment through 56 days after participant's selected quit date (56 to 63 days total) |
| Minutes of App Usage Per Session | Passively collected by the app and averaged in analysis among those with a session to calculate mean number of minutes of usage per session by study group. | Enrollment through 56 days after participant's selected quit date (56 to 63 days total) |
| Measure | Description | Time Frame |
|---|---|---|
| Unique Days With at Least One App Session | Number of unique days with at least one app session, passively collected by the app and averaged by study group. | Enrollment through 56 days after participant's selected quit date (56 to 63 days total) |
| Self-reported 7-day Point-prevalence Abstinence at 2 Months |
| Measure | Description | Time Frame |
|---|---|---|
| Biochemically Verified 7-day Point-prevalence Abstinence at 2 Months | Proportion of participants who who self-report having abstained for the prior 7 days during the 2-month follow-up assessment, verified by saliva cotinine test, assuming missing = smoking. Averaged by study group. Recoded to 0 if the person reported having smoked during the same 7-day window during repeated measurement of daily smoking in the app. |
Inclusion criteria:
Exclusion criteria: None
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| Name | Affiliation | Role |
|---|---|---|
| Justin White, PhD | University of California, San Francisco | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of California San Francisco | San Francisco | California | 94143 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 37566442 | Background | White JS, Salem MK, Toussaert S, Westmaas JL, Raiff BR, Crane D, Warrender E, Lyles C, Abroms L, Thrul J. Developing a Game (Inner Dragon) Within a Leading Smartphone App for Smoking Cessation: Design and Feasibility Evaluation Study. JMIR Serious Games. 2023 Aug 11;11:e46602. doi: 10.2196/46602. | |
| 39475840 | Derived | White JS, Toussaert S, Raiff BR, Salem MK, Chiang AY, Crane D, Warrender E, Lyles CR, Abroms LC, Westmaas JL, Thrul J. Evaluating the Impact of a Game (Inner Dragon) on User Engagement Within a Leading Smartphone App for Smoking Cessation: Randomized Controlled Trial. J Med Internet Res. 2024 Oct 30;26:e57839. doi: 10.2196/57839. |
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| ID | Title | Description |
|---|---|---|
| FG000 | Educational Intervention Plus Game Module | Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park." |
| FG001 | Educational Intervention Only | Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Educational Intervention Plus Game Module | Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park." |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Median |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Number of Unique App Sessions | Number of times the app was opened; passively collected by the app and averaged in analysis to calculate mean number of app opens by study group over the study period. A new session is defined as use of the app after at least 30 minutes of inactivity. | Posted | Mean | Standard Deviation | number of sessions | Enrollment through 56 days after participant's selected quit date (56 to 63 days total) |
|
63 days after enrollment
Adverse events were reported based on survey responses to "Did you experience any negative, unpleasant, unwanted, or otherwise unexpected side effects as a result of participating in this trial?"
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Educational Intervention Plus Game Module | Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application, as well as the integrated game module. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. Game module: Receive free access to the the Inner Dragon game module integrated into the Smoke Free smartphone application. In the Inner Dragon game, users care for a customizable pet dragon. that "evolves" in tandem with the user's progress in quitting smoking. The game includes several key features: 1) the dragon hatches on the user's quit day and evolves every 7 days to unlock new attributes and powers; 2) users earn experience points by using selected core app features; 3) users maintain "care meters" that change when the dragon is fed or pet; 4) the game provides tools for the user to better cope with the challenges of withdrawal, such as a breathing exercise to provide calmness and a memory minigame as a distraction; and 5) users can asynchronously interact with other users' dragons in a "dragon park." |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Anxious or depressed | Psychiatric disorders | Systematic Assessment | Reported being anxious or depressed |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Justin White, Associate Professor | University of California, San Francisco | 415-476-8045 | justin.white@ucsf.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Feb 4, 2022 | Nov 13, 2023 | Prot_SAP_001.pdf |
| ICF | No | No | Yes | Informed Consent Form | Jan 6, 2022 | Jul 27, 2023 | ICF_000.pdf |
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| ID | Term |
|---|---|
| D018479 | Early Intervention, Educational |
| ID | Term |
|---|---|
| D002662 | Child Health Services |
| D003153 | Community Health Services |
| D006296 | Health Services |
| D005159 | Health Care Facilities Workforce and Services |
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| OTHER |
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| Smoke Free smartphone application | Behavioral | Receive educational intervention through the free 'Smoke Free' smartphone application (core version of the app) |
|
|
Proportion of participants who self-report having abstained for the prior 7 days during the 2-month follow-up assessment, assuming missing = smoking. |
| 56 days after participant's selected quit date (56 to 63 days after enrollment) |
| Self-reported 30-day Point-prevalence Abstinence at 2 Months | Proportion of participants who who self-report having abstained for the prior 30 days during the 2-month follow-up assessment, assuming missing = smoking. | 56 days after participant's selected quit date (56 to 63 days after enrollment) |
| Satisfaction With App | Rating of satisfaction with assigned app on a 5-point Likert scale from "Not at all" (1) to "Extremely" (5), assessed in the 2-month follow-up questionnaire. The measure is averaged by study group. | 56 days after participant's selected quit date (56 to 63 days after enrollment) |
| Satisfaction With Game (Intervention Group Only) | Rating of satisfaction with the game on a 5-point Likert scale from "Not at all" (1) to "Extremely" (5), assessed in the 2-month follow-up questionnaire. The measure is averaged for the intervention group. | 56 days after participant's selected quit date (56 to 63 days after enrollment) |
| 56 days after participant's selected quit date (56 to 63 days after enrollment) |
| Biochemically Verified 30-day Point-prevalence Abstinence at 2 Months | Proportion of participants who who self-report having abstained for the prior 30 days during the 2-month follow-up assessment, verified by saliva cotinine test, assuming missing = smoking. Averaged by study group. Recoded to 0 if the person reported having smoked during the same 30-day window during repeated measurement of daily smoking in the app. | 56 days after participant's selected quit date (56 to 63 days after enrollment) |
| Repeated 1-day Point-prevalence Smoking Abstinence | Proportion of days in which participants self-report having abstained in the last 24 hours, collected via a pop-up box that appears the first time each day a participant opens the app. Averaged by study group. | During the 56 days after participant's selected quit date |
| Program Adherence (Index of Core Feature Use) | Number of non-game (core app) activities completed in the app by activity type: passively collected by the app to assess number of times the participant completed the following activity types: reported a craving, recorded a diary, completed a mission, read a tip, used the chatbot. | Enrollment through 56 days after participant's selected quit date (56 to 63 days total) |
| Gifts Unlocked (Intervention Group Only) | Number of in-game gifts unlocked during the study period (intervention group only); a summary measure of intensity of engagement (dose of treatment) of the app; passively collected by the app. | Enrollment through 56 days after participant's selected quit date (56 to 63 days total) |
| Game Activities (Intervention Group Only) | Number of game activities completed in the app by activity type; passively collected by the app to assess number of times the participant completed the following activity types: navigated to the game dashboard, completed each pet care activity (breathing exercise, feeding, washing, memory mini-game), visited the park, entered the dragon guide. | Enrollment through 56 days after participant's selected quit date (56 to 63 days total) |
| Recommends App to Friend | Rating of whether would recommend assigned app to a friend on a 5-point Likert scale from "Not at all" (1) to "Extremely" (5), assessed in the 2-month follow-up questionnaire. The measure is averaged by study group. | 56 days after participant's selected quit date (56 to 63 days after enrollment) |
| Motivation to Quit | Motivation to quit, reported on a 10-point scale from not at all motivated (0) to very unmotivated (10) and assessed in the 2-month follow-up. | 56 days after participant's selected quit date (56 to 63 days after enrollment) |
| Digital Therapeutic Alliance | The measure includes items from the Bonding and Confidence subscales from the Mobile Agnew Relationship Measure, a scale of digital therapeutic alliance. Two items from each of the Bonding and Confidence subscales were included. Each item was asked on a 4-point Likert scale from strongly disagree (1) to strongly agree (4). The subscale items were combined to give a total possible score of 16 and a range of 4 (low alliance) to 16 (high alliance). The measure is averaged by study group. Assessed in the 2-month follow-up. | 56 days after participant's selected quit date (56 to 63 days after enrollment) |
| BG001 | Educational Intervention Only | Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex/Gender, Customized | Count of Participants | Participants |
|
| Race/Ethnicity, Customized | Count of Participants | Participants |
|
| Educational attainment | Count of Participants | Participants |
|
| Household income, categorical | Count of Participants | Participants |
|
| Cigarettes per day | Median | Inter-Quartile Range | cigarettes |
|
| Fagerström Test for Nicotine Dependence | Fagerström Test for Nicotine Dependence is a 6-item measure of nicotine dependence. It has a scale range from 0 (low dependence) to 10 (high dependence). The total score is reported. | Median | Inter-Quartile Range | units on a scale |
|
| Past quit attempts | Median | Inter-Quartile Range | attempts |
|
| Years since initiated smoking | Median | Inter-Quartile Range | years |
|
| Used electronic nicotine device systems in last 30 days | Count of Participants | Participants |
|
| Used nicotine replacmeent therapy in last 30 days | Count of Participants | Participants |
|
| Frequency played video games in last 6 months | Count of Participants | Participants |
|
| OG001 | Educational Intervention Only | Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. |
|
|
| Primary | Minutes of App Usage Per Session | Passively collected by the app and averaged in analysis among those with a session to calculate mean number of minutes of usage per session by study group. | Posted | Mean | Standard Deviation | minutes per session | Enrollment through 56 days after participant's selected quit date (56 to 63 days total) |
|
|
|
| Secondary | Unique Days With at Least One App Session | Number of unique days with at least one app session, passively collected by the app and averaged by study group. | Posted | Mean | Standard Deviation | days with a session | Enrollment through 56 days after participant's selected quit date (56 to 63 days total) |
|
|
|
| Secondary | Self-reported 7-day Point-prevalence Abstinence at 2 Months | Proportion of participants who self-report having abstained for the prior 7 days during the 2-month follow-up assessment, assuming missing = smoking. | Posted | Count of Participants | Participants | 56 days after participant's selected quit date (56 to 63 days after enrollment) |
|
|
|
| Secondary | Self-reported 30-day Point-prevalence Abstinence at 2 Months | Proportion of participants who who self-report having abstained for the prior 30 days during the 2-month follow-up assessment, assuming missing = smoking. | Posted | Count of Participants | Participants | 56 days after participant's selected quit date (56 to 63 days after enrollment) |
|
|
|
| Secondary | Satisfaction With App | Rating of satisfaction with assigned app on a 5-point Likert scale from "Not at all" (1) to "Extremely" (5), assessed in the 2-month follow-up questionnaire. The measure is averaged by study group. | Only those participants who completed the follow-up questionnaire are included in the analysis population. | Posted | Mean | Standard Deviation | units on a scale | 56 days after participant's selected quit date (56 to 63 days after enrollment) |
|
|
|
| Secondary | Satisfaction With Game (Intervention Group Only) | Rating of satisfaction with the game on a 5-point Likert scale from "Not at all" (1) to "Extremely" (5), assessed in the 2-month follow-up questionnaire. The measure is averaged for the intervention group. | Only those participants in the intervention group who completed the follow-up questionnaire are included in the analysis population. | Posted | Mean | Standard Deviation | units on a scale | 56 days after participant's selected quit date (56 to 63 days after enrollment) |
|
|
|
| Other Pre-specified | Biochemically Verified 7-day Point-prevalence Abstinence at 2 Months | Proportion of participants who who self-report having abstained for the prior 7 days during the 2-month follow-up assessment, verified by saliva cotinine test, assuming missing = smoking. Averaged by study group. Recoded to 0 if the person reported having smoked during the same 7-day window during repeated measurement of daily smoking in the app. | Posted | Count of Participants | Participants | 56 days after participant's selected quit date (56 to 63 days after enrollment) |
|
|
|
| Other Pre-specified | Biochemically Verified 30-day Point-prevalence Abstinence at 2 Months | Proportion of participants who who self-report having abstained for the prior 30 days during the 2-month follow-up assessment, verified by saliva cotinine test, assuming missing = smoking. Averaged by study group. Recoded to 0 if the person reported having smoked during the same 30-day window during repeated measurement of daily smoking in the app. | Posted | Count of Participants | Participants | 56 days after participant's selected quit date (56 to 63 days after enrollment) |
|
|
|
| Other Pre-specified | Repeated 1-day Point-prevalence Smoking Abstinence | Proportion of days in which participants self-report having abstained in the last 24 hours, collected via a pop-up box that appears the first time each day a participant opens the app. Averaged by study group. | Posted | Mean | Standard Deviation | percentage of days | During the 56 days after participant's selected quit date |
|
|
|
| Other Pre-specified | Program Adherence (Index of Core Feature Use) | Number of non-game (core app) activities completed in the app by activity type: passively collected by the app to assess number of times the participant completed the following activity types: reported a craving, recorded a diary, completed a mission, read a tip, used the chatbot. | Posted | Mean | Standard Deviation | number of core features used | Enrollment through 56 days after participant's selected quit date (56 to 63 days total) |
|
|
|
| Other Pre-specified | Gifts Unlocked (Intervention Group Only) | Number of in-game gifts unlocked during the study period (intervention group only); a summary measure of intensity of engagement (dose of treatment) of the app; passively collected by the app. | In-game gifts available for intervention group only. | Posted | Mean | Standard Deviation | number of gifts unlocked | Enrollment through 56 days after participant's selected quit date (56 to 63 days total) |
|
|
|
| Other Pre-specified | Game Activities (Intervention Group Only) | Number of game activities completed in the app by activity type; passively collected by the app to assess number of times the participant completed the following activity types: navigated to the game dashboard, completed each pet care activity (breathing exercise, feeding, washing, memory mini-game), visited the park, entered the dragon guide. | Applicable to intervention group only. | Posted | Mean | Standard Deviation | number of game features used | Enrollment through 56 days after participant's selected quit date (56 to 63 days total) |
|
|
|
| Other Pre-specified | Recommends App to Friend | Rating of whether would recommend assigned app to a friend on a 5-point Likert scale from "Not at all" (1) to "Extremely" (5), assessed in the 2-month follow-up questionnaire. The measure is averaged by study group. | Only those participants who completed the follow-up questionnaire are included in the analysis population. | Posted | Mean | Standard Deviation | units on a scale | 56 days after participant's selected quit date (56 to 63 days after enrollment) |
|
|
|
| Other Pre-specified | Motivation to Quit | Motivation to quit, reported on a 10-point scale from not at all motivated (0) to very unmotivated (10) and assessed in the 2-month follow-up. | Only those participants who completed the question in the follow-up questionnaire are included in the analysis population. A programming error led to missing data for most respondents who reported having continued to smoke. | Posted | Mean | Standard Deviation | units on a scale | 56 days after participant's selected quit date (56 to 63 days after enrollment) |
|
|
|
| Other Pre-specified | Digital Therapeutic Alliance | The measure includes items from the Bonding and Confidence subscales from the Mobile Agnew Relationship Measure, a scale of digital therapeutic alliance. Two items from each of the Bonding and Confidence subscales were included. Each item was asked on a 4-point Likert scale from strongly disagree (1) to strongly agree (4). The subscale items were combined to give a total possible score of 16 and a range of 4 (low alliance) to 16 (high alliance). The measure is averaged by study group. Assessed in the 2-month follow-up. | Only those participants who completed the questions in the follow-up questionnaire are included in the analysis population. | Posted | Mean | Standard Deviation | units on a scale | 56 days after participant's selected quit date (56 to 63 days after enrollment) |
|
|
|
| 0 |
| 241 |
| 0 |
| 241 |
| 3 |
| 241 |
| EG001 | Educational Intervention Only | Participants receive free access to an educational intervention consisting of the core features of the Smoke Free application only. Participants complete questionnaires and are invited to completed remote saliva sample collection if they report being smoke-free at follow-up. Smoke Free educational intervention: Receive free access to core features of the Smoke Free smartphone application, including a calculator that tracks time elapsed since quitting smoking, progress indicators regarding predicted health improvements, daily tasks to avoid and resist urges to smoke, and a text-based chatbot that delivers smoking cessation guidance. | 0 | 238 | 0 | 238 | 7 | 239 |
|
| Feelings of withdrawal, craving, or irritability | Psychiatric disorders | Systematic Assessment | Reported feelings of withdrawal, craving, or irritability |
|
| Constipation | Gastrointestinal disorders | Systematic Assessment | Reported constipation |
|
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| D011314 | Preventive Health Services |