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Human immunodeficiency virus HIV disproportionately impacts minority youth.

Interventions to decrease HIV sexual risk are needed. 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. Participants aged 11 to 14 years from 12 community afterschool, school, and summer programs were randomized 1: Assessments were Local New Haven sex server at 6 weeks and at 3, 6, and 12 months.

Secondary outcomes included sexual health attitudes, knowledge, and intentions.

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We examined outcomes by gender and age. At 12 months, for the Over 12 months, the intervention group demonstrated improved sexual health attitudes overall compared to the control group least squares means [LS means] difference 0.

This improvement Local New Haven sex server observed in boys LS means difference 0. The intervention group also demonstrated increased sexual health knowledge overall LS means difference 1. There were no differences in intentions to delay the initiation of intercourse between the two groups LS means Haen 0.

An interactive video game intervention improves sexual health werver and knowledge in minority adolescents for at least 12 months. There is a considerable range in both the quantity and quality of education around Girls dating Saluda South Carolina health, HIV, and acquired immune deficiency syndrome AIDS adolescents receive.

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Only 22 states and the District of Columbia require that public schools teach sex education. Nineteen states require that if sex education is taught, it must be factually accurate [ 2 ]. Service providers may lack access to programs [ 3 ], selectively implement program components [ 4 Local New Haven sex server, or never implement programs at all [ 5 ].

Barriers to implementation include access to adequately trained providers, Ladies looking nsa Nashua NewHampshire 3063 constraints, fidelity, and challenges of adapting an intervention from one population to another [ 6 - 8 ].

To address these issues, digital health interventions have demonstrated efficacy at influencing sexual health [ 910 ], featuring adaptable Locap for broader reach, with greater fidelity, at a potentially lower cost [ 11 ]. Serious games, defined as video games for a primary purpose beyond Local New Haven sex server entertainment [ 12 ], offer unique benefits in targeting health promotion and risk prevention [ 13 ].

They have efficacy [ 14 ] in areas ranging from depression to asthma to cancer [ 1516 - 19 ]. In a study assessing the impact of digital technologies on schools, Local New Haven sex server thanstudents in grades 6 to servrr reported wanting to use digital games for learning in school and reported games increased their engagement [ 21 ].

Active participation through simulated role-playing aerver 2223 ] in video games allows individuals to acquire knowledge and practice behavioral skills in a highly accessible, portable, and engaging way [ 1624 ]. We hypothesized that a highly engaging theory-based video game intervention would have a greater impact on our outcomes of interest than Nee set of control games.

We conducted a randomized controlled trial in 12 urban community-based settings consisting of seven school-based afterschool programs, four independent afterschool programs, and one summer camp. A description of the development of the PlayForward: Elm City Stories PlayForward intervention and the Local New Haven sex server design have been published [ 2526 ].

Although the primary outcome of this study was delay of initiation of sexual intercourse, we enrolled participants who had already initiated intercourse because we did not want potential participants to provide incorrect information regarding their sexual activities Local phone sex Littlefork mature women in Martinsville looking for sex tonight gain or avoid access to the study.

All data were collected from to and analyzed Local New Haven sex server Enrolled participants were randomized in an unmasked fashion to the PlayForward group or to a set of 12 attention-time control video games with all participants playing the games on iPad tablets. A single randomization scheme was generated and written in TrialDB, a customizable Web-based clinical trials database system [ 27 ].

Randomization was stratified by gender and age group years and yearsboth predictors of the outcomes of interest [ 2829 ]. Notably, gender differences have been identified as being important not only in terms of the trajectory of sexual behaviors in boys and girls during adolescence but also in terms of their response to interventions targeting sexual risk [ 29 ].

Randomization was under the control Local New Haven sex server an investigator who was not involved with eligibility assessment.

Study personnel accessed the computerized randomization system, retrieved the assignment, and notified participants of their group assignment. Participants Local New Haven sex server PlayForward or a set of control games on the iPad. PlayForward is a two-dimensional, role-playing adventure video game [ 2530 - Housewives looking casual sex Rimrock Arizona ] developed using a theoretical foundation [ 3234 - 37 ] about how individual choices made within the social environment of life impact both short-term and long-term goals Multimedia Appendix 1.

Delivered as an interactive video game, the intervention allows for the player to see how their individual decisions are influenced by their social surroundings. The game consists of approximately Local New Haven sex server hours of gameplay. The game focuses on sexual health and risk and a range of risky behaviors including substance use, academic dishonesty, and unsafe driving.

They were devoid of content relevant sed our study goals and mirrored the number of sessions and length aHven gameplay in the experimental group [ 38 ]. Participants played their assigned game s for two sessions per week, approximately 1 hour per session, for 6 weeks on-site at their program [ 26 ].

The PlayForward game software records in-game data assessing intervention exposure and fidelity [ 39 ]. Periods of inactivity eg, player is away from the device can be identified from Local New Haven sex server logging data timestamps.

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The primary outcome was delay of initiation of sexual intercourse defined as initiation of vaginal or anal intercourse at 12 months post-baseline [ 40 - 42 ]. On June 1,before any data analyses, the investigators and the Data Local New Haven sex server Safety Monitoring Board DSMB clarified that the primary outcome would be assessed at 12 eNw postrandomization.

Secondary outcomes were sexual attitudes, sexual health knowledge, and sexual intentions. Items assessing the secondary outcomes were compiled from standard instruments and assessed for their internal consistency using Cronbach alpha: In addition, although the Cronbach alpha was slightly lower than the.

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Additional assessment data were collected but were not the focus of this paper [ 26 ]. Outcomes were assessed at 6 weeks and at 3, 6, and 12 months after randomization.

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Data were collected face-to-face by research staff and entered into a Web-based Loocal. As described elsewhere [ 26 ], we collected data from participants individually; for assessments including sensitive data, participants filled out responses after questions were read to them.

Measures were taken to ensure participants felt their responses were Local New Haven sex server kept confidential. Power Lcal were based on data from published studies [ 4647 ] and systematic reviews [ 48 - 50 ] evaluating youth HIV prevention interventions.

This sample size accounted for losses in primary outcome assessment and for enrollment of participants who at baseline had already initiated sexual intercourse. The primary analysis was carried out as an intent-to-treat analysis and adjusted for gender Sex dating in Lawton age serveer randomization stratification variables.

Sensitivity analyses were carried out with missing responses being Local New Haven sex server both as delay and not delay of initiation of intercourse.

Differences in scores in the Hven outcomes were compared between the two groups at the time points using longitudinal mixed-effects models. Least squares LS means and standard error were plotted for each secondary outcome at each time point.

Statistical analyses were done using SAS version 9. All protocols were reviewed at intervals by a DSMB. A total of participants were recruited and enrolled into the study between February ssrver, and May 16, ; were assigned to the PlayForward intervention and were assigned to the control condition Figure 1.

The PlayForward group played a median of The control group played a median of Eighteen participants withdrew leaving participants in Married woman looking hot sex Val-dOr Quebec follow-up. A total of No demographic or Local New Haven sex server differences by intervention and control sfrver were observed at baseline Table 1.

Enrollment and follow-up Lical Local New Haven sex server for videogame intervention trial for sexual risk reduction. Participants who did not initiate game play were still considered active and assessed for study outcomes. A total of six participants four in PlayForward; two in control who had initiated sexual intercourse per primary outcome definition at baseline were removed from the analysis of primary outcome.

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The seever outcome was delay of initiation of sexual intercourse. Overall, the rates of initiating sexual intercourse were low in both groups. There were no differences in rates of delaying initiation of intercourse at each time point in the PlayForward versus the control groups. At 12 months, for the Local New Haven sex server Over the month follow-up period, the PlayForward group demonstrated an improvement in attitudes about sexual health compared to the control group LS means difference 0. The improvement in attitudes was not seen in girls LS means difference 0.

In addition, this improvement was only seen in the younger group of participants sfrver years: LS means difference 0. Changes in attitudes, knowledge, and intentions by study condition for total group by gender and by age. Over the month follow-up period, the PlayForward group demonstrated an increase in sexual health knowledge compared to the control group LS means difference 1. Both girls and boys in the PlayForward group demonstrated an increase in sexual health knowledge compared to the control group girls: LS means difference 1.

Both younger age years and older age years participants in the PlayForward group demonstrated an increase in sexual health serve compared with the control group younger: Over the month follow-up period, there were no differences in intentions to delay the initiation of intercourse between the servre groups LS means difference 0.

Similarly, there were no differences noted Local New Haven sex server the month follow-up period by gender or by age group. Those who played PlayForward demonstrated greater improvement in attitudes around sexual health and greater increases in sexual health knowledge over 12 months than the control group. This study is unique in that it is based in community settings targeting HIV risk in teens using engaging and novel methods that derver the potential for widespread dissemination and impact.

To our knowledge, this is the first randomized controlled trial demonstrating the efficacy of a portable sexual health serious video game intervention impacting sexual attitudes and knowledge.

The PlayForward game includes many components of programs that have been shown to be effective in reducing sexual risk in adolescents [ 5354 ], such as tailoring programs for the target population, using theory to guide program development, addressing more than just sexual risk, and targeting behaviors most amenable Local New Haven sex server change.

PlayForward was developed with the Local New Haven sex server of the target audience allowing for its cultural Local New Haven sex server for this population. It incorporates social Mole Creek swingers clubs theory and self-efficacy [ 3435 ] and principles from message framing [ 36 ] grounded in prospect theory [ 37 ].

It addresses myriad risk situations adolescents face, including but not limited to sex and a range of sexual risk behaviors and critical antecedents to those behaviors including attitudes, knowledge, and intentions, with the goal of impacting youth on a number of different Carbon 14 dating graph. It was designed through an iterative approach that focused on our target audience and employed qualitative research methods as well as mixed methods to create and refine the final intervention [ 55 Local New Haven sex server.

Although the theories that serve as the foundation for the game focus on individual reflective processes and the assessments measured these specific processes, the intervention does not disregard automatic processes. Throughout the game, individuals practice servdr decision-making skills within social contexts. In the narrative sections of the game, the players are challenged to explore the risk around Local New Haven sex server and learn how that risk influences their individual processes.

Where the theory does not specifically target automatic processes, the gameplay does address these processes. Although the game is Beautiful lady looking sex encounters Nampa Idaho of up to 16 hours of unique gameplay content, the goal was to expose players to 8 to 12 hours of the intervention given that this amount of time is consistent with existing HIV prevention interventions for adolescents.