U.S. Gives Yale Researcher $3.9-Million in Tax Dollars to Develop ‘Avatar’ Sex-Ed Video Game for Kids

February 5, 2010 - 3:12 AM
The federal government is giving an assistant professor at the Yale School of Medicine $3.9 million to develop a video game to teach "sex, drug and alcohol negotiation" skills to children 9-14 years of age.

Sterling Memorial Library, Yale University (Wikimedia Commons photo)

(CNSNews.com) - The National Institute of Child Health and Human Development (NICHD), a division of the National Institutes of Health, is giving Dr. Lynn Fiellin, an assistant professor at the Yale School of Medicine, $3.9 million over five years to develop a video game to teach “sex, drug and alcohol negotiation and refusal skills" to children 9-14 years of age.
 
The game will feature “virtual characters or avatars” that are guided by the children playing the game to make decisions about whether to engage in behaviors that put them at risk of being infected with HIV.
 
The game’s effectiveness in training children to avoid HIV-transmitting behaviors will be tested by having children as young as 9 play the game two days a week for a month—either after school or on weekends—at a New Haven, Conn., community center.
 
A press release about Dr. Fiellin’s $3.9-million grant put out by the Yale University Office of Public Affairs on Sept. 24, 2009 said that the children in the study will be “between 11 and 14 years old.” However, both the official NICHD grant abstract and the summary of the project posted on the Web site of Yale’s Center for Interdisciplinary Research on AIDS, say the children in the study will be “ages 9-14.”

Additionally, Peggy McCardle, chief of the NICHD’s Child Development and Behavior Branch told CNSNews.com the game is being designed for "preadolescents," and specifically responded to a question about why children as young as 9-14—rather than older children--were being used in the study.
 
“According to the U.S. Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance Survey: 7.1 percent of high school students say they have had sexual intercourse before the age of 13,” said McCardle. “That figure is higher for certain groups, with 26.2 percent of black males and 11.9 percent of Hispanic male students reporting having had intercourse before age 13. Similarly, rates for other risky behaviors are also high, with 23.8 percent of high school students saying they had drunk alcohol and 8.3 percent saying they had tried marijuana before age 13. The rationale for the current project is to teach younger children the negotiation and refusal skills that they will need to resist pressures for risky behaviors, before those behaviors become established, or before they even begin.”
 
After they have played the game for four weeks, the children in the study will be periodically surveyed to see if they are refraining from activity—including “vaginal or anal intercourse”—that puts them at risk of HIV infection.
 
“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,” says the official NICHD abstract for the grant.
 
“Subjects will play two sessions/week of their assigned game for four weeks,” says the abstract. “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.”
 
McCardle stressed that the “primary outcome” of vaginal or anal intercourse mentioned here is not something that will take place in the video game itself, but are behaviors that will be statistically measured among the participating children to see if the game is having the desired impact on their lives.
 
“This project seeks to teach preadolescents the negotiation and refusal skills they will later need in adolescence to resist risky activities such as early sex and substance use,” said McCardle. “The researchers are designing a video game in which players will take part in role playing, to learn to avoid risky behaviors. It may be helpful to explain that ‘primary outcome’ which you mention, is a statistical term, referring to the measure or observation which is directly relevant to determining if the intervention is effective. So, in this case, the objective is to determine whether mastering the video game leads to improved skills for avoiding risky behavior. So, from 1 month to several months after the participants have mastered the game, the participants will complete questionnaires asking whether they have engaged in these behaviors (the primary outcome). If the research is successful, participants taking part in the video game sessions will have been less likely to engage in high risk activity than will youth in the comparison group—those who played a conventional video game.”
 
The NICHD abstract says the game will be designed to teach children “sex, drug and alcohol negotiation and refusal skills.”
 
“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,” says the abstract. “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 itself will make it possible for 9- to 14-year-olds to role-play through “avatars” on a computer screen who make decisions about whether to engage in risky activities as directed by the child playing the 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,” says the abstract.

NIH campus in Bethesda, Md. (NIH photo)

McCardle told CNSNews.com that the “avatars” in the video game will not actually engage in sexual or other high-risk activity on the child’s computer screen.
 
“The avatars engage in role playing, having conversations in which they refuse to engage in risky behaviors,” said McCardle in written responses to questions from CNSNews.com. “They do not engage in risky behaviors.”
 
CNSNews.com asked how the game could develop critical thinking skills if the players were not allowed the option of making both choices---either to engage in risky behavior or not engage in it—leaving aside the issue of whether that behavior was actually graphically illustrated by the actions of the avatar on the computer screen.
 
“The idea is that players will create avatars based on their goals and hopes for the future,” said McCardle. “Making a poor choice won’t allow players to actually participate in risky behaviors, but will take them away from their future objectives. The game is still in the design phase, so the exact scenarios haven’t been worked out yet. The researchers hope to market the game through school systems. They are acutely aware of the sensitivities involved. They don’t want to create any situations in which teens would participate in inappropriate behavior, and don’t wish to set up any scenarios that school officials and parents wouldn’t approve of.”
 
Dr. Fiellin at the Yale School of Medicine received an initial installment on the grant of $820,866 in fiscal year 2009. The five-year grant period began on August 10, 2009 and will end on July 31, 2014.
 
CNSNews.com presented questions about the grant to the NICHD. The NICHD's Child Development and Behavior Chief McCardle responded.
 
Here is a transcript of questions about the grant from CNSNews.com and answers from NICHD's McCardle:
 
Peggy McCardle, Chief of the Child Development and Behavior Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development: “Thank you for your inquiry regarding 1R01HD062080-01, ‘An Interactive Video Game for HIV Prevention in At-Risk Adolescents.’ Basic behavioral and social science research, like the study you cite below, contributes to our understanding of the complex factors that affect individuals, our communities and our environments. Research results from this field lead to new approaches for reducing risky behaviors and improving the adoption of healthy practices. Previous studies have shown that skills which adolescents learn in video games can improve health behavior.  Dr. Fiellin’s study is an attempt to use video games to help adolescents avoid the risky behaviors that can lead to HIV infection.”
 
CNSNews.com: “The abstract for the project says: ‘The primary outcome will be initiation of sexual activity, defined as the initiation of either vaginal or anal intercourse.’ ‘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.’ ‘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.’  Will the purpose of the game be for the player to have their character abstain from sex, or refrain from unsafe sex?”
 
McCardle: “This project seeks to teach preadolescents the negotiation and refusal skills they will later need in adolescence to resist risky activities such as early sex and substance use. The researchers are designing a video game in which players will take part in role playing, to learn to avoid risky behaviors. It may be helpful to explain that ‘primary outcome’ which you mention, is a statistical term, referring to the measure or observation which is directly relevant to determining if the intervention is effective. So, in this case, the objective is to determine whether mastering the video game leads to improved skills for avoiding risky behavior. So, from 1 month to several months after the participants have mastered the game, the participants will complete questionnaires asking whether they have engaged in these behaviors (the primary outcome). If the research is successful, participants taking part in the video game sessions will have been less likely to engage in high risk activity than will youth in the comparison group—those who played a conventional video game.”
 
CNSNews.com: “The abstract says: ‘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.’ Why focus on the 9-14 years age group? Why not an older group?
 
McCardle: “According to the U.S. Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance Survey: 7.1 percent of high school students say they have had sexual intercourse before the age of 13. That figure is higher for certain groups, with 26.2 percent of black males and 11.9 percent of Hispanic male students reporting having had intercourse before age 13. Similarly, rates for other risky behaviors are also high, with 23.8 percent of high school students saying they had drunk alcohol and 8.3 percent saying they had tried marijuana before age 13. The rationale for the current project is to teach younger children the negotiation and refusal skills that they will need to resist pressures for risky behaviors, before those behaviors become established, or before they even begin.”
 
CNSNews.com: “How would you respond to critics who would say people 9-14 are too young to play a video game that features “virtual characters or avatars” engaging in sexual relations?”
 
McCardle: “The avatars engage in role playing, having conversations in which they refuse to engage in risky behaviors.  They do not engage in risky behaviors.”
 
Jeffrey: “After it is developed, will this video game be commercially available?”
 
McCardle: “If the study proves successful, the video game program would be made available to school systems.”
 
Follow-up Question:
 
CNSNews.com: “In response to this question, ‘How would you respond to critics who would say people 9-14 are too young to play a video game that features “virtual characters or avatars” engaging in sexual relations?’ Dr. McCardle said: ‘The avatars engage in role playing, having conversations in which they refuse to engage in risky behaviors. They do not engage in risky behaviors.’ Question: Whether or not an avatar actually engages in risky behavior in the video presentation of the game, can a player decide to have his avatar choose to engage in that behavior? If the player is offered only one choice—the choice not to engage in risky behavior, but not the choice to engage in it—how does that develop critical thinking skills?”
 
McCardle: “The idea is that players will create avatars based on their goals and hopes for the future.  Making a poor choice won’t allow players to actually participate in risky behaviors, but will take them away from their future objectives. The game is still in the design phase, so the exact scenarios haven’t been worked out yet. The researchers hope to market the game through school systems. They are acutely aware of the sensitivities involved. They don’t want to create any situations in which teens would participate in inappropriate behavior, and don’t wish to set up any scenarios that school officials and parents wouldn’t approve of.”