The FDA has lately taken a hard stance on tobacco companies targeting children and teens (thanks in some part to departing FDA Commissioner Dr. Scott Gottlieb), and it certainly seems as if the agency is exploring every avenue in its public awareness campaign — including free-to-play video games.

Earlier this month the agency and its partner, marketing communications firm FCB New York, stealthily launched One Leaves, a short horror game that draws attention to the health impacts of cigarettes and tobacco products.

Leaning into the statistic that three in four teenagers who smoke cigarettes in high school will continue into adulthood, it pits players against three other computer-controlled characters hoping to escape a labyrinth of school halls, hospital rooms, sewers and morgues. Throughout the 20-minute-or-so experience, they’ll encounter imagery and roadblocks intended to evoke the side effects of smoking — disorienting smog-filled hallways, tar-covered floors, bloated organs and their own character’s winded breath. All the while, a voice projected over the facility’s PA system urges players to escape while they still are able, and laments their fate should they become one of the three left to their fate.

"This game is part high school, part hospital and part hell," said Gary Resch, EVP at FCB New York EVP and the game’s executive creative director, said in a statement. "Our mission, alongside FDA, was to deliver the potent '3 out of 4' addiction statistic in a truly provocative and experiential way."

One Leaves is part of “The Real Cost,” an anti-smoking ad campaigned developed by FCB in 2014. It’s available on Xbox One and PC, and also features a found footage-style trailer from director Darren Aronofsky.

WHAT’S THE IMPACT

While scathing user reviews and footage of the game itself suggest that it might not be up to AAA standards, One Leaves is free to download and packaged well enough that it’s likely to attract a number of curious downloads — especially since FCB was able to secure video game streaming sensation Ninja for a featured play through on his multi-million subscriber Youtube channel. Getting the message across to young players at increasing risk of tobacco usage can still be seen as a win for the agency (although there is some evidence that unsavvy ad campaigns can have the opposite of their intended effect).

WHAT’S THE TREND

Teen-focused smoking cessation has long proven a tricky beast for public health, and the game faces the age-old challenge of public health campaigns harnessing popular media. In the past, efforts like these and the Truth Initiative’s BecomeAnEX social network-based cessation intervention have found the most success when not only prioritizing high levels of engagement among their target audience, but positive and meaningful connections.

“There’s sort of an assumption that more engagement is better … but not all engagement is really created equal,” Molly Waring, assistant professor and director of methodology core at the University of Connecticut’s Center for mHealth and Social Media, said last year at Mad*Pow's Health Experience Design (HXD) Conference. “In one study, we actually incentivized a handful of participants to engage more to get everyone else to engage more in their group. We found that was successful in … increasing overall engagement in that group. However, the people we incentivized to participate more and the people they [encouraged] did not lose more weight. In fact, they didn’t lose an impressive amount of weight at all — many other people lost much more weight than they did. So it’s not a simple story.”

While the FDA’s direct involvement in One Leaves is noteworthy, it’s not the only instance in which games have been used as a health tool. Others include mobile games designed to educate patients about their conditions or promote physical activity and healthy lifestyles.

ON THE RECORD

"For many teens, cigarette addiction is something that happens to older smokers. The power of 'One Leaves' is that it reframes addiction in a way that's more immediate and relatable to those teens. If you play with cigarettes, you will get trapped," Suzanne Santiago, FCB New York EVP and group management director, said in a statement.