An Interactive Video Game for HIV Prevention in At-Risk Adolescents

描述（由申请人提供）：电子游戏无处不在，可以改善健康行为，但尚未被评估为促进少数民族早期青少年预防艾滋病毒传播的工具。少数民族青少年预防艾滋病毒的一个主要挑战是在他们的环境中捕捉个体——在“他们生活的地方”与个体会面。目前的应用程序结合了行之有效的艾滋病毒预防策略和交互式视频游戏平台，该平台结合了虚拟环境和智能熟悉的虚拟角色来应对这一挑战。研究表明，在电子游戏中获得新知识、技能和态度，并在游戏中练习这些技能的青少年，更有可能在现实生活中表现得类似。因此，这个应用程序的目标是改编现有的软件来开发和改进一个交互式视频游戏，旨在通过教授少数民族青少年性、毒品和酒精的谈判和拒绝技巧来降低艾滋病毒的风险。该游戏将根据少数民族青少年以及在积极青年发展、社会认知理论和自我效能、前景理论和信息框架、软件和人工智能开发以及商业游戏设计方面具有专业知识的合作者的意见进行改编。我们将通过对330名9-14岁的少数民族青少年进行随机临床试验来评估游戏的功效，这些青少年参加了课后和/或周末青少年项目，他们将被随机分配玩互动式艾滋病毒预防电子游戏“Retro-Warriors”，或玩商业“现成”电子游戏。受试者将在四周内每周玩两次指定的游戏。主要结果将是性活动的开始，定义为阴道或肛门性交的开始。次要结局包括艾滋病毒风险行为知识、社会能力、自我效能、药物/酒精使用行为和整体冒险行为。我们假设实验组在1个月、6个月、12个月和24个月时的性行为开始率较低，知识得分较高。我们还将探讨所选择的基线特征是否与交互式视频游戏中嵌入的谈判技巧训练干预的改进反应有关。这种干预的独特之处将包括使用可以口头回应并与玩家互动的虚拟角色或化身，逼真的虚拟城市环境，使用性，药物/酒精“风险挑战”，受试者可以反复练习，根据前景理论使用信息框架，鼓励重复参与的有趣且引人入胜的干预，以及追踪玩家在游戏中的选择和行为的能力。这个应用程序的成功实施将代表着一种范式的转变，为互动游戏在少数族裔青少年中预防艾滋病的作用提供了证据。视频游戏技术有可能将现有的艾滋病毒预防手段扩大到越来越多的电子游戏平台，包括互联网、个人数字助理和移动电话，从而为公共卫生干预创造新的途径。

DESCRIPTION (provided by applicant): Video games are ubiquitous, can improve health behavior, but have not been evaluated as a tool to promote protection from HIV transmission in minority early adolescents. A major challenge in HIV prevention for minority adolescents is capturing individuals in their environment - meeting individuals "where they live". The current application combines proven HIV prevention strategies and an interactive video game platform that incorporates virtual environments and intelligent conversant virtual characters to address this challenge. Research demonstrates that adolescents who acquire new knowledge, skills and attitudes in a video game, and practice these skills in the game, are more likely to behave similarly in real life. Therefore, the goal of this application is to adapt existing software to develop and refine an interactive video game designed to decrease HIV risk by teaching minority adolescents sex, drug and alcohol negotiation and refusal skills. The game will be adapted with input from minority adolescents, and collaborators with expertise in positive youth development, social cognitive theory and self-efficacy, prospect theory and message framing, software and artificial intelligence development, and commercial game design. We will evaluate the efficacy of the game by conducting a randomized clinical trial in 330 minority youths, ages 9-14 years, attending an after-school and/or weekend youth program, who will be randomly assigned to play the interactive HIV prevention video game, "Retro-Warriors", or to play a commercial "off-the-shelf" video game. Subjects will play two sessions/week of their assigned game for four weeks. The primary outcome will be initiation of sexual activity, defined as the initiation of either vaginal or anal intercourse. Secondary outcomes include HIV risk behavior knowledge, social competency, self-efficacy, drug/alcohol use behaviors and overall risk-taking behaviors. We hypothesize that the experimental group will have lower rates of initiation of sexual activity and have higher knowledge scores at 1, 6, 12, and 24 months compared with the control group. We will also explore if selected baseline characteristics are associated with an improved response to the negotiation skills training intervention embedded in the interactive video game. Unique features of this intervention will include the use of virtual characters or avatars who can verbally respond to and interact with the player, a realistic virtual urban setting, the use of sex, drug/alcohol "risk challenges" that the subjects can practice repeatedly, the use of message framing according to prospect theory, a fun and engaging intervention that encourages repeated involvement, and the ability to track the players' choices and behaviors in the game. The successful implementation of this application will represent a paradigm shift, providing evidence for the role of interactive games as HIV/AIDS prevention in minority adolescents. Video game technology has the potential to expand the available vehicles for HIV prevention to the increasing number of electronic gaming platforms including the internet, personal digital assistants, and cell phones, thereby creating a new avenue for public health interventions. PUBLIC HEALTH RELEVANCE: This research is designed to develop and test a video game that will teach minority adolescents how to avoid sex, drug and alcohol risk behaviors that can lead to HIV infection. The research goes beyond the use of a game for education and proposes to create an interactive world in which the game players can engage in "role-playing" to learn to avoid risky behaviors. This application has far-reaching implications including the potential for this technology to "travel" with the player, i.e., the player ultimately can do sessions from home, on a console, a cell phone, or a personal digital assistant. There are international implications given that access to the internet is growing in developing countries and these technologies could be transferred to adolescents in countries experiencing a growing HIV epidemic but who have limited access to targeted risk reduction strategies. If successful, the results of this research will be video game technology that can improve individual and public health and decrease HIV transmission.