Video Games Aim To Reduce Risky Behavior Among Teens, Young Adults

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Women’s health is the next frontier for a team of medical researchers at Yale who believe video games can be powerful tools in the fight against HIV and other serious diseases.

For the last several years, Yale’s Play2Prevent lab has been a hub of collaboration between doctors and computer programmers testing the capacity of games to educate users and, perhaps, even change risky behavior. Their work is part of a fast-growing movement in public health to better understand how virtual gaming environments can improve players’ lives in the real world.

The lab’s latest project aims to reduce HIV infections among young African American women.  Using a grant from the Women’s Health Research at Yale Pilot Program, the team will spend this year working with groups of black teens and 20-somethings to design a game that’s relevant, entertaining and, hopefully, a model for future public health projects.

“This is a really new field,” said Kimberly Hieftje, who holds a PhD in health behavior and is a member of the Play2Prevent team. “There’s not a lot out there. We’re making this up as we go. We’re learning what works and what doesn’t.”

Teens and young adults have higher rates of new HIV infections than older age groups, according to the U.S. Centers for Disease Control. In the U.S., people ages 13-29 represented 39 percent of all new infections in 2009; African American women are at higher risk than their Caucasian peers.

In Connecticut, people younger than 30 have become increasingly more likely to be diagnosed with HIV. In 2002, they accounted for just 13 percent of new infections. In 2012, that age group represented roughly 30 percent.  That same year, African Americans represented just over 40 percent of newly diagnosed HIV patients in all age groups.

PlayForward: Elm City Stories game asks users to consider the risks.

PlayForward: Elm City Stories game asks users to consider the risks.

The work at Yale is part of a technological genre called “serious games” covering myriad topics like global warming, geopolitical strife and healthy eating. There’s even a game that uses a zombie invasion to motivate players to go jogging. Such games are designed to be fun, but they address vexing problems like obesity, war and, in the case of Yale’s recent work, HIV.

The statistics are why the lab team is focusing on a game for young, black women. This will be the lab’s second game aimed at HIV prevention. The first, called PlayForward: Elm City Stories, helps teenagers make better decisions about sexual activity to avoid unwanted pregnancy and STDs. Creating a game that’s both fun and effective takes lots of work and time. The team started work on Elm City Stories in 2009 and finished production at the end of 2012.

Elm City Stories is designed to do more than just teach about the perils of unprotected sex. Ben Sawyer, co-founder of the game design firm Digitalmill and a member of the lab, says the goal is to create interactive narratives about living a healthy life.

“Instead of saying this is a game about HIV, we created a game that says here’s what risk looks like,” he said.

Since its debut, Elm City Stories has undergone the same kind of rigorous testing typically applied to a new prescription drug. Hundreds of teenagers in New Haven, Hamden and Bridgeport are now enrolled in a clinical trial to test the game’s affects on decision-making.  Because the participants are in a clinical trial their names are confidential.  If research shows that the game can, indeed, change behaviors for the better, it will be made available for use in schools across the country.

The team is months away from being able to quantify the impact of Elm City Stories, but Hieftje said the teens’ preliminary responses have been positive.

Kimberly Hieftje

Kimberly Hieftje

“It’s hands on, it’s personal, it’s their own game,” she said. “They love that it’s on the iPad. We don’t hide from the kids that this is about sexual risk… but that doesn’t mean it’s not engaging and fun.”

Some participants are students at the New Haven LEAP program where Youth Development Coordinator Erica Pretty agrees the game is having positive effects.

“For them to actually sit down and really engage for that period of time has really surprised me,” she said. “ It’s something they can relate to.”

Everyone involved in Elm City Stories is excited about the prospect of designing a game just for women, and they’re taking the lessons they’ve learned over the last few years and applying them to this project.

One of their biggest successes came from involving potential players in the early development process. The team spent hours working with teenagers to develop the look, feel and vocabulary of the Elm City game, something Sawyer says made the finished product more relevant to the kids’ lives.

“There were terms they knew about sex that I’d never heard of,” Sawyer said.

Engaging women in the upcoming design process will be equally crucial, and not just in terms of how the game looks and sounds. Women tend to prefer narrative games to competitive scenarios, and they may be more receptive to social components that male players.

The young women won’t be writing computer code, but they will play a big role in sketching out the overall structure of the new game, called PlayitSafe. They’ll help researchers decided if the game should be played on mobile phones or some other kind of device and if it should have social media components. They’ll test paper prototypes and – if things go as planned – the lab will have a solid game design by the end of this year.

“Girls and boys tend to have different types of games they like,” said Hieftje. “Being able to talk to the women and find out the kinds of games they do and don’t like has been helpful.”

View Elm City Stories here.

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