The next viral game for the iPad may be one designed by medical researchers at Yale.

Decades of evidence in psychology has established that people often respond differently to an equivalent message framed as a gain or a loss. When researchers at the Yale School of Medicine explored how young adults responded to the framing of messages about sexual health, the team discovered that adolescents believe a combination of gain- and loss-framed messages would be most effective at reducing risky behaviors. The findings, which appeared in the journal Health Education Research on Jan. 21, have already been incorporated into a video game for the iPad called “PlayForward Elm City Stories,” that encourages youths to avoid risk behaviors.

“This study shows that, unlike previous conducted studies which show that positive framed messaging is inspiring for adults, a mixture of gain-framed and loss-framed may be more motivating for young teens when we are trying to persuade them to not initiate sexual activity,” said Deepa Camenga, a co-author of the study and instructor in pediatrics at the Yale School of Medicine.

To explore which framing methods would be most effective at delaying sexual activity among adolescents, Camenga and her team asked youth aged 10-14 years old to create posters advocating certain aspects of sexual health.

The majority of the posters and discussions contained both gain messages like “By not having sex at a young age, you are more likely to get an education,” and loss messages, including “If you go have kids, underage, you can’t do nothing anymore.”

Of the 26 posters, sixty-nine percent contained both gain and loss framed content, 19 percent contained only loss-framed content and 12 percent only gain-framed content. Most gain-framed messages focused on academic achievement and a healthy lifestyle, while most loss-framed messages concentrated on pregnancies and HIV/AIDS.

“PlayForward Elm City Stories,” which was released as a clinical trial in February 2013 and is currently available for public download, features a combination of gain and loss messages that the researchers found most preferred by the adolescents, said Lindsey Duncan, a study co-author and professor in the department of kinesiology & physical education at McGill.

Duncan said the research team decided to apply the findings to video games in particular because many adolescents naturally gravitate toward the medium.

“We hope that other groups will take some of these findings and use them to help adolescents, perhaps through other means,” she said.

For Lynn Fiellin, a Yale co-author and professor of medicine at the Yale School of Medicine, the next step in the research includes exploring how framing affects actual risk behaviors outside of the lab.

According to the Centers for Disease Control and Prevention, 39 percent of new HIV infections in 2009 came from individuals aged 13-29.