The methods.

A study was conducted with 327 high school teachers in 40 states to assess the effectiveness of the program. The study used a quasi-experimental design with an experimental and control groups. The experimental group completed the At-Risk training and then responded to the questionnaire while the control group only completed the questionnaire.

The results.

The results were statistically significant at p<0.01 levels in all independent variables that were measured. Teachers who completed the training reported statistically significant increases in their ability to identify, approach, and refer at-risk students. Teachers also reported an increase in the likelihood that they would approach and refer an at-risk student. Here are some of the particularly interesting figures:

1. 97% of teachers recognize that part of their role is to identify and refer at-risk students.
2. 97% of participants who received the training indicated they were likely or very likely to approach and refer an at-risk student.
3. 96% of participants reported that engaging in simulated conversations with at-risk students was helpful in preparing them for similar conversations in real life.
4. 89% rated the course as Very Good or Excellent.

The future.

At-Risk is one of the few mental health games that deals with suicide prevention. Other examples include Beyond the Front for the U.S. Army and Reach Out Central created by Inspire Foundation, Australia.  The results of this new At-Risk study show that mental health game technology can be a powerful tool in school settings–where most at-risk youth spend the majority of their day. You can read more about Kognito Interactive’s research by visiting their website at http://www.kognito.com/atrisk/research.html. Congratulations to the Kognito Interactive team!

American Journal of Preventative Medicine, Elsevier: San Diego, CA, December 7, 2010 – Obesity in youngsters has risen dramatically in recent decades. Fruit and vegetable (FV) consumption and increased water intake can lower the risk of obesity, as can increased physical activity, but it is not always easy to convince children to eat better and exercise more. In a new study published in the January 2011 issue of the American Journal of Preventive Medicine, researchers found that video games designed to encourage these behaviors were effective.

About the games

“Escape from Diab” (Diab) and “Nanoswarm: Invasion from Inner Space” (Nanoswarm) are epic video games specifically designed to lower risks of type 2 diabetes and obesity by changing youth diet and physical activity behaviors. Designed by Archimage, Inc., and funded by a Small Business Initiative Research Grant from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, Diab and Nanoswarm are based on social cognitive, self-determination, and persuasion theories.

“Diab and Nanoswarm were designed as epic video game adventures, comparable to commercial quality video games. These games incorporated a broad diversity of behavior change procedures woven in and around engrossing stories. The games motivated players to substantially improve diet behaviors,” according to lead investigator Tom Baranowski, PhD, Professor of Pediatrics, U.S. Department of Agriculture/Agricultural Research Service supported Children’s Nutrition Research Center, Baylor College of Medicine. “Serious video games hold promise, but their effectiveness and mechanisms of change among youth need to be more thoroughly investigated.”

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The study and results

Children playing these video games increased FV consumption by about 2/3 serving per day, but did not increase water consumption or moderate to vigorous physical activity, or improve body composition. Despite the increase, FV and water consumption and physical activity remained below the minimum recommendations.

In this randomized clinical trial, 153 children ages 10 to 12 years, were divided into a treatment group (103 children) and a control group (50). Complete data were obtained on 133 subjects. The treatment group first played Diab and then Nanoswarm. The control group played diet and physical-activity knowledge-based games on popular websites. Each group was assessed at the start of the trial, immediately after Diab, immediately after Nanoswarm, and again two months later. Height, weight, waist size, and triceps skin-fold thickness were measured. Physical activity was monitored for at least 4 days by accelerometer-based data from each child at each assessment. Food consumption was measured using 24 hour dietary recalls conducted by registered dietitians.

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The article is “Video Game Play, Child Diet, and Physical Activity Behavior Change – A Randomized Clinical Trial” by Tom Baranowski, PhD, Janice Baranowski, MPH, RD, Debbe Thompson, PhD, Richard Buday, FAIA, Russ Jago, PhD, Melissa Juliano Griffith, MPH, Noemi Islam, MPH, Nga Nguyen, MS, and Kathleen B. Watson, PhD. It appears in the American Journal of Preventive Medicine, Volume 40, Issue 1 (January 2011) published by Elsevier. doi: 10.1016/j.amepre.2010.09.029

According to Dr. Fiellin:

The goal of our project is to provide young teens the opportunity to practice and acquire skills in order to avoid or reduce their risk behavior. The hope is that this reduction in risk would then translate to preventing new cases of HIV.

From the rest of the interview, I picked up on some key points about health games as they relate to diseases such as HIV/AIDS:

• Young teens are already engaged in game play
• Games allow for repeated practice and play
• Highly engaging (if designed well)
• Portability – can be applied to various mobile platforms
• Opportunities to improve knowledge, prevention efforts and increase adherence
• Global application increasing

Although we don’t have an official name for the game just yet, I’m looking forward to seeing what the folks over at Yale come up with as far as design. Last year, we highlighted a game called +Click that looked at helping HIV positive teenagers make positive choices. Hopefully this will motivate other groups to think outside the box with this disease.

The hidden 1200 kcal !

Since that time many efforts have already been made to try to change the slope of the overweight and obesity curves. Although it is believed that daily caloric intake should be around 2,500 kcal for moderately active men and high active women, it has been estimated that the average American ingests 3,748 kcal per day.

In fact, this excessive portion intake  in the American population might come from eating more because the environment is offering more than necessary. According to the National Heart, Lung and Blood Institute and its Obesity Education Initiative this “portion distortion” has grown in size and energy in the last twenty years at a horrific trend. The size of a bagel has doubled and the weight of French fries portion has tripled!

If you add up all these distortions, it is no surprise that this additional 1,200 kcal would be quite hard to eliminate by physical activity since it corresponds to about 4 hours of cycling …. and result in gaining weight and all the complications that are associated.

Don’t blame it on me !

Indeed, the American Institute for Cancer Research (AICR) has issued in 2007 the revised version of the American Plate that includes more low calories food and a significant reduction of animal proteins. Not to mention what unnatural molecules are found in meat and other food products, the reduction of portion was not accompanied by a recommendation of reduction in dish sizes resulting in the same visual perception of a plate and what size and height it should have.

In a scientific study published in the Obesity Research Journal in that same year (2007), Clemson and Penn State University scientists have studied who establishes restaurant portion sizes and factors that influence these decisions and examined this in a survey that included 300 chefs their opinions regarding portion size. Executive chefs were identified as being primarily responsible for establishing portion sizes served in restaurants and 76% of them thought that they served “regular” portions, the actual portions of steak and pasta they reported serving were 2 to 4 times larger than serving sizes recommended by the U.S government.

It’s not so easy to just blame overweight and obese people when there are numerous accomplices in this nutritional crime.

Play the plate

I believe education can make a huge difference in our portion size problem, especially for children, by creating health games and educational activities that might help better consider regular or normal proportions and use the corresponding dishware to achieve good and balanced intake. In fact, some quizzes or recommendations are available on the Net to draw attention on the portion distortion effects.

On the games side, many are found to address the right food balance but few if any were found to specifically address the problem of size portion and to educate kids on the space and time dimension of portion.

Considering the above-mentioned scientific articles, there is room for such computer and video games that can address specifically the visual perception of a normal or adapted food portion and certainly the duration aspects of eating.

Small is beautiful

In conclusion, instead of only focusing on the public to manage its problems with the help of social and healthcare community, strong incentives could also be issued toward the food industry and dishware industrials to change their habits and products, and participate to this worldwide challenge of war against obesity.

For example, a reduction of the dinner plate size would normally result in :

• lowering the price of menu and make it accessible to more people
• lowering the amount of leftover food that has to be thrown way
• lowering the price of house dishware
• lowering the generated pollution on non-used and discarded material
• changing the size perception of portions

Young adults in danger

While they represent only 9% of the French population,  22% of those killed in 2008 by road accidents were 18-24 year olds [3].

In 2008, an online survey was conducted on young drivers in 8 European countries, ordered by the French Road Safety Association and the French Association of Insurance Companies. This survey revealed that if the young Swedish, Polish and English are the biggest drinkers of alcohol during parties, the French, with their Latin neighbours (Spaniards and Italians), take more risks driving: during their last evening party, 1 in 4 young Frenchmen drove after drinking alcohol and 1 in 10 drank more than 2 glasses.

Happy Night : A Serious Game to support advertised campaigns

After the death by drowning of an intoxicated 23 year old man who was exiting a disco, the municipality of Nantes (France) decided to create a serious game.  Its objective: to built adventure video games with messages on the prevention of risk behaviors related to binge drinking. This action contributes to a general approach towards awareness and prevention of young audiences and aims to publicize the risks of binge drinking, the limitation of these risks and the need for responsible behaviour for oneself and for others.

This serious game called Secret Happy Night has reached its 3rd episode and is available both in French and English. In this game, you are Pan European security agent “Jacques Baveur” trying to arrest a dangerous guy.

Remind you of something ? Yes ! Jack Bauer, the hero of the American TV show “24″. In a humorous way, the game immerses you in the night life, where you will be confronted with people who have consumed too much alcohol. You will also have to make choices that may keep you sober and fit for the mission, or put you on the floor … Eventually, the game helps the player wonder about his or her drinking habits and those of others.

To launch this health game, the creators used an innovative teasing strategy using social media. In April 2009 they announced, through targeted groups on Facebook and town university student associations, that they were opening an actual night club similar to that in the game.  To get a sneak peek they offered free tickets to discover it on-line.  According to M. Jean-Noel Février, the Communication Manager of Nantes Municipality, that very day, they had 2,800 connections and after six months, they reached almost 10,000 visitors.

It’s still too early for feedback and significant data from road traffic and hospital emergency admissions on what kind of impact Secret Happy Night may have had on binge drinking. However, one might consider that this original strategy has helped the city of Nantes to take the lead in innovation for this prevention campaign, investing in an unusual territory for a community service.

[1] : WHO Road Safety Status country Profile for France
[2] : WHO Road Safety Status country Profile for UK
[3] : French Association for Road Safety

Battle the Sperminator.

Adventures in Sex City is an online health game designed to teach teens about birth control, relationships, sexually transmitted infections (STIs), pregnancy, and general sexual health.  Teens must go up against Sperminator, a former superhero who’s infected by a STI and doesn’t seek treatment.  Please note this game is for teens and adults only.  The artwork is definitely not for little kids.

In the dark of the night, Sex City is in a panic because of the terrible Sperminator whose sole mission is to infect all citizens with various sexually transmitted infections.  Who do you call?  The Sex Squad!  An elite team of superheroes dedicated to keeping the citizens of Sex city safe from STIs.  It’s up to you to help the Sex Squad stop the Sperminator and save Sex City.

The goal of the game is to answer a series of sex-based questions using one of the Sex Squad super heroes.  Teens can go up against the sinister Sperminator using one of four characters:

1. Wonder Vag – a pro-abstinence virgin
2. Willy The Kid – a short guy that joined the squad to prove size doesn’t matter
3. Power Pap – a sexually active girl that’s already had a close encounter with a STI
4. Captain Condom – a scientist whose condom-perfecting experiment went awry resulting in his half man half condom appearance.

Get a trivia question correct and you can deflect the Sperminator’s infected  sperm with your rubber condom shield.  Get it wrong and be prepared to be shot by the Sperminator’s sexual projectile arms. You won’t find the game mechanic revolutionary, but I found the comic book style to be compelling, the characters amusing, and the questions informative.

And if that doesn’t amuse you…

If you need a really good laugh, may I suggest checking out some of the MLHU’s collection of condom commercials.  This is definitely better than reading a pamphlet.  Congratulations to MLHU for their creative efforts to deliver sexual health information to teens!

“It surprises most people to learn that pneumonia kills more children than any other disease – taking more than 2 million young lives annually,” writes former U.S. Senate Majority Leader and Save the Children Board member Bill Frist, MD. [Reuters]

Save the Children, a leading organization focused on improving the lives of children around the world, recently launched their Survive to 5 campaign. This campaign highlights the pressing needs of children around the world who do not survive past their 5th year of life because of the factors that affect their health.

On November 2nd, Save the Children launched the Mission Pneumonia online quiz game to help people get the facts on childhood pneumonia. “Although childhood pneumonia is a serious issue, we wanted to create a fun and interactive way through Mission: Pneumonia for people of all ages to get involved and make a difference,” says Mary Beth Powers – Chief of the Survive to 5 campaign.

The quiz game consists of 7 different levels, each with a number of questions related to pneumonia. As players progress through the levels and answer questions correctly, they are offered opportunities to take action such as sharing what they learn with friends/family through Twitter and Facebook or even  by signing a petition to Congress in support of legislation to expand life-saving health measures to more mothers and children in poor countries.

I think this is a big draw to the future of these types of games where the main goal is to impart knowledge to the player about a specific issue. The tie-in of actionable links is a smart move because you already have the user there on the screen – as they become more aware of the issue, they may be more inclined to move forward with an activity that engages real world constituents.

Another aspect of the game that makes it even more personal is that at the end of each level, players are introduced to real community health workers that are making a difference in their communities after being trained by Save the Children to diagnose pneumonia in children.

Definitely looking forward to more interactive ways to increase education around health issues as well as to spur real world action!

Recently, we came across another game that focuses on influenza – this time giving you the ability to control how an outbreak is treated. The game is simply entitled: The Great Flu.

Basically you have the option of five different outbreak scenarios with accompanying virus names (the ‘Gamers Flu’ sounds particularly nasty!). Each scenario has an increasing level of difficulty. The goal of the game is to prevent a pandemic from happening – pretty much what happened this year with H1N1. You have a limited budget to add to the reality.

What I like about this type of game is that it really gives individuals a sense of what public health officials do to prevent this type of crisis from happening. The first flu game we highlighted gave you an idea of prevention on a micro level – The Great Flu gives you a very macro level view of outbreak prevention.

Under the “Learn More” tab, you get a scientific introduction and tutorial about the influenza virus and how a primarily animal-based virus can sometimes leap species and affect humans.

We had a lot of fun with this game and plan on trying out each difficulty setting. How well do YOU prevent worldwide outbreak?

Nanoswarm

Invasion From Inner…

By Mary Ann Pendino …

Book Preview

Why publish?

Archimage, developers of Nanoswarm: Invasion From Inner Space, decided to release the book for publication so the story can be enjoyed while the public awaits the clinical trial results from researchers at the Children’s Nutrition Research Center at Baylor College of Medicine.  Data is scheduled to be released by the end of 2009.

The book was originally written to help the developers fully understand the backstory and characters appearing in the game.  It turned out to be such a good story that co-author Richard Buday felt it shouldn’t gather electronic dust on some hard drive.  It needed to be in print.

The story.

The book sells for $12.95 and will soon include an educational workbook. Here’s what to expect from the novel:

Life in the year 2030 was almost perfect.  War, crime and hunger were history.  Microscopic robots had eradicated pollution.  Scientists were on the verge of curing disease.  Then, one day, people all over the world started getting sick. And no one knew why.  That’s when you, a 12-year-old Trainee Second Class, joined the world’s leading research team. Wings, this is your story.  How will you choose?

This is no good folks. Especially for our young people who are continually being exposed to sexually explicit material on and offline. It is vital that we continue to raise the bar on how we educate them on making intelligent decisions about their lifestyles that will not only protect them from HIV/AIDS but will encourage them to evaluate other choices. In the health gaming world, interactivity is key and today I was pleased to come across news of a game in the works that addresses HIV/AIDS among teens.

The reality is, there are young people already infected with HIV but that doesn’t mean the education stops for them – in fact, it’s all the more important. Last week, news surfaced about +CLICK, an interactive game aimed at HIV positive teenagers to help them make smart decisions and help manage their condition.

The game was created from a research study from the folks over at the University of Texas School of Public Health. The study participants were 32 young people; mean age was 17.8; 62.5 percent were females; 68.8 percent were black; 28.1 percent were Hispanic; 56.2 percent acquired HIV perinatally; 43.8 percent were infected through behavior; and 68.8 percent were sexually experienced.

“We wanted to create +CLICK so that we could help educate youth on the importance of making proper, healthy decisions to protect their relationships and themselves as well as help to reduce transmission of [HIV],” said Christine Markham, PhD, lead investigator and an assistant professor of behavioral sciences at the University of Texas School of Public Health.

+CLICK is in the final stages of development and according to the article, should be available to the public in about 6 months. I’m pretty excited about this namely because I haven’t heard of anything that could have the potential of positive impact for youth with HIV. This is quite an innovative way to begin tackling a need that has been around for a while.  The results of the pilot study are available in the May 2009 edition of AIDS Care.

Another interesting game, that you can check out right now, was developed by UNICEF and their Voices of Youth program. What Would You Do? is a basic text/Flash based online game that allows young people to involve themselves in a scenario that most likely would happen as they interact with their peers. The game focuses on prevention messages and giving the young person the ability to think about the consequences of social activities as it applies to HIV/AIDS.

Here at healthGAMERS we are all about the serious and important impact that games can and will have on our society’s health. Stay tuned as we await the launch of +CLICK – you know we will be covering it!

For more information on how the Web is being used to fight against HIV/AIDS, do yourself a favor and check out the AIDS.gov blog for great case studies and initiatives.