Objective To assess the type and quality of the studies evaluating the effects of electronic media-based interventions on health and safety behavior change. Data Sources Studies were identified from searches in MEDLINE (1950 to September 2010) a and PsycINFO (1967 to September 2010). Study Selection Included were published studies of interventions that used electronic media and focused on health/safety behavior change in children aged 18 years or younger. Intervention Electronic media-based intervention. Main Outcome Measure Health or safety behavior change. Results Nineteen studies met criteria and focused on at least one behavior change outcome. Of these studies, 7 employed interventions related to physical activity and/or nutrition, 6 focused on asthma, 3 focused on safety behaviors, 2 focused on sexual risk behaviors, and 1 targeted diabetes. Seventeen studies reported at least one statistically significant effect on behavior change outcomes, including an increase in fruit, juice, or vegetable consumption, an increase in physical activity, improved asthma self-management, acquisition of street and fire safety skills, and sexual abstinence. Only five of the 19 studies were rated as being of excellent quality. Conclusions Our systematic review suggests that interventions using electronic media can improve health/safety behaviors in young people. However, there is a need for higher quality, rigorous interventions that promote behavior change.

BackgroundHuman immunodeficiency virus (HIV) disproportionately impacts minority youth. Interventions to decrease HIV sexual risk are needed.ObjectiveWe hypothesized that an engaging theory-based digital health intervention in the form of an interactive video game would improve sexual health outcomes in adolescents.MethodsParticipants aged 11 to 14 years from 12 community afterschool, school, and summer programs were randomized 1:1 to play up to 16 hours of an experimental video game or control video games over 6 weeks. Assessments were conducted at 6 weeks and at 3, 6, and 12 months. Primary outcome was delay of initiation of vaginal/anal intercourse. Secondary outcomes included sexual health attitudes, knowledge, and intentions. We examined outcomes by gender and age.ResultsA total of 333 participants were randomized to play the intervention (n=166) or control games (n=167): 295 (88.6%) were racial/ethnic minorities, 177 (53.2%) were boys, and the mean age was 12.9 (1.1) years. At 12 months, for the 258 (84.6%) participants with available data, 94.6% (122/129) in the intervention group versus 95.4% (123/129) in the control group delayed initiation of intercourse (relative risk=0.99, 95% CI 0.94-1.05, P=.77). Over 12 months, the intervention group demonstrated improved sexual health attitudes overall compared to the control group (least squares means [LS means] difference 0.37, 95% CI 0.01-0.72, P=.04). This improvement was observed in boys (LS means difference 0.67, P=.008), but not girls (LS means difference 0.06, P=.81), and in younger (LS means difference 0.71, P=.005), but not older participants (LS means difference 0.03, P=.92). The intervention group also demonstrated increased sexual health knowledge overall (LS means difference 1.13, 95% CI 0.64-1.61, P<.001), in girls (LS means difference 1.16, P=.001), boys (LS means difference 1.10, P=.001), younger (LS means difference 1.18, P=.001), and older (LS means difference=1.08, P=.002) participants. There were no differences in intentions to delay the initiation of intercourse between the two groups (LS means difference 0.10, P=.56).ConclusionsAn interactive video game intervention improves sexual health attitudes and knowledge in minority adolescents for at least 12 months.Trial RegistrationClinicaltrials.gov NCT01666496; https://clinicaltrials.gov/ct2/show/NCT01666496 (Archived by WebCite at http://www.webcitation.org/6syumc9C0).

As mobile technologies and videogaming platforms are becoming increasingly prevalent in the realm of health and healthcare, so are the opportunities to use these resources to conduct behavioral interventions. The creation and empirical testing of game style interventions, however, is challenged by the requisite collaboration of multidisciplinary teams, including researchers and game developers who have different cultures, terminologies, and standards of evidence. Thus, traditional intervention development tools such as logic models and intervention manuals may need to be augmented by creating what we have termed "Game Playbooks" which are intervention guidebooks that are created by, understood by, and acceptable to all members of the multidisciplinary game development team. The purpose of this paper is to describe the importance and content of a Game Playbook created to aide in the development of a videogame intervention designed specifically for health behavior change in young teens as well as the process for creating such a tool. We draw on the experience of our research and game design team to describe the critical components of the Game Playbook and the necessity of creating such a tool.

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Purpose: This pilot study evaluated the short-term effects of an interactive videogame on changing adolescent knowledge, beliefs and risk perceptions, and intentions to use e-cigarettes, cigarettes, and other tobacco products. A secondary aim was to evaluate players’ game experience. Methods: Participants (N=80 11–14 year olds) were recruited from 7 community-based afterschool programs in Los Angeles, California and New Haven, Connecticut. The design was a single group pre-post design with replication. A pre-test survey was administered that included demographic variables and knowledge, risk perceptions, beliefs, and intentions to use e-cigarettes, cigarettes, and other tobacco products. An interactive videogame focusing on risky tobacco use situations was subsequently played in four 60-minute sessions over a four-week period, followed by a post-test survey. Analyses included paired t-tests of pre-post videogame change, regression analyses, and path analyses testing mediational effects of beliefs and risk perceptions on the relationship between knowledge and intentions. Results: The videogame changed knowledge of e-cigarettes and other tobacco products (p’s<.001), risk perceptions of cigarettes and e-cigarettes (p<.01 and p<.001, respectively), and beliefs about e-cigarettes and other tobacco products (p’s<.05), but not intentions Older adolescents reported greater e-cigarette knowledge and risk perceptions (p’s<.05), and females reported greater risk perception of cigarettes (p < .05). Beliefs mediated the relationship between knowledge and intentions to use e-cigarettes (indirect effect p <.05). Conclusion: Results suggest that brief exposure (4 hours over 4 weeks) to videogames focused on changing knowledge and attitudes towards tobacco products may have a promising effect on preventing risk for early adolescent tobacco product use, particularly for e-cigarettes.