Video games might soon have a place in classrooms around the country as tools to help educate adolescents about public health issues, such as HIV, substance abuse, alcohol and smoking.

Seven years ago, Lynn Fiellin MED ’96, founder and director of the play2PREVENT Lab at the Yale Center for Health & Learning Games and associate professor of medicine, received funding from the National Institutes of Health to study how interactive video games might effectively combat public health issues among New Haven youth.

“Our goal is [to develop] a portfolio of games, each with a different focus, and to work on a system to get these games into the hands of kids everywhere,” Fiellin told the News.

Play2PREVENT’s inaugural interactive video game, PlayForward: Elm City Stories, was developed over the course of five years and aims to provide at-risk youth with knowledge and skills related to sexual health by simulating realistic scenarios. More specifically, PlayForward targets HIV risk in minority youth.

Play2PREVENT first formed focus groups composed of New Haven teenagers to determine how best to proceed with the development of PlayForward. After this initial planning phase, the lab conducted a 24-month-long study from 2013 to 2015 to research the game’s impact on sexual-health attitudes and behaviors. The study surveyed 333 New Haven teens aged 11 to 14, half of whom were instructed to play control games, such as Subway Surfer and Angry Birds, and half of whom were given PlayForward. The study’s results published earlier this month in the Journal of Medical Internet Research showed that PlayForward was effective in improving positive attitudes and increasing knowledge about sexual health for up to a year after the initial tests.

Over a 12-month period following the initial tests, participants in the PlayForward group demonstrated improved attitudes about sexual health and sexual-health knowledge compared to the control group, according to the study’s findings.

Fiellin had also hoped PlayForward would make participants more likely to delay the initiation of sexual intercourse, but the study’s results demonstrated no such impact. Still, Fiellin noted, a change in attitude and knowledge could lead to a “difference in behavior” in the future.

Fiellin said she and her team realized that video games could be an effective tool to combat public health issues once they became aware of the lack of standardized HIV prevention programs and the near ubiquitous usage and accessibility of video games.

“Serious video games as digital health interventions offer the unique opportunity to increase the accessibility and reach of theory-driven and tested interventions,” Fiellin concluded in the study.

Kimberly Hieftje, the deputy director of play2PREVENT, said video games are a natural way to engage youth. They allow adolescents to see the consequences of their actions in a safe, albeit virtual space, while still maintaining a level of control. For that reason, she added, video games offer the “perfect platform.”

Fiellin’s team has begun developing ways to market PlayForward to a larger audience through a web-based version and a smartphone app.

Hieftje, who is working to distribute play2PREVENT’s educational video games to a larger population, said she hopes that PlayForward will augment rather than replace traditional methods of sex education.

“What is to be seen is how — not if but how — video games are best used because there may not just be one model. There may be several models in terms of how you can use this type of digital intervention to connect with kids,” Fiellin said.

In an interview with the News, Tyra Pendergrass FES ’10, associate director and community liaison of play2PREVENT, attributed video games’ effectiveness in large part to their low risk potential. Pendergrass, who distributed PlayForward to New Haven school programs, said that the majority of schools and parents were enthusiastic once they realized that the game carried low risk and could teach their children about sexual health and safety.

Pendergrass hopes to one day extend this collaboration between schools and the lab to lawmakers and researchers, but she acknowledged that facilitating this partnership will be an “uphill battle.”

PlayForward’s success has generated momentum for the promotion of other serious games, such as smokeSCREEN, which targets smoking prevention. Play2PREVENT has partnered with national pharmacy chain CVS and Stanford University School of Medicine to distribute smokeSCREEN to upwards of 200,000 adolescents across the United States.

According to the study authors, their research on PlayForward is the first randomized controlled trial to demonstrate a sexual-health video game’s ability to influence sexual attitudes and knowledge.

Chloe Glass | chloe.glass@yale.edu