Video Game Intervention for Sexual Risk Reduction in Minority Adolescents: Randomized Controlled Trial

Abstract

Background: Human immunodeficiency virus (HIV) disproportionately impacts minority youth. Interventions to decrease HIV sexual risk are needed.

Objective: We hypothesized that an engaging theory-based digital health intervention in the form of an interactive video game would improve sexual health outcomes in adolescents.

Methods: Participants 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.

Results: A 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).

Conclusions: An interactive video game intervention improves sexual health attitudes and knowledge in minority adolescents for at least 12 months.

Trial registration: Clinicaltrials.gov NCT01666496; https://clinicaltrials.gov/ct2/show/NCT01666496 (Archived by WebCite at http://www.webcitation.org/6syumc9C0).

Keywords: adolescent; human immunodeficiency virus; intervention; primary prevention; randomized controlled trial; risk reduction; videogame.

Figure 1

Enrollment and follow-up flow diagram for videogame intervention trial for sexual risk reduction. Note: Assessment refers to primary outcome assessment (delay of initiation of sexual intercourse);% is of active participants. Participants who did not initiate game play were still considered active and assessed for study outcomes. A total of six participants (four in PlayForward; two in control) who had initiated sexual intercourse (per primary outcome definition) at baseline were removed from the analysis of primary outcome.

Figure 2

Changes in attitudes, knowledge, and intentions by study condition for total group by gender and by age. PF: PlayForward.