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.Grant R01HD062080 from the Eunice Kennedy Shriver National Institute of Child Health and Human
Development.http://www.jmir.orgam2017Psycholog
