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.
