GAMES FOR HEALTH JOURNAL: Research, Development, and Clinical Applications Volume 4, Number 2, 2015 ª Mary Ann Liebert, Inc. DOI: 10.1089/g4h.2014.0141

Editorial

Sexual Health in the 21st Century Tom Baranowski, PhD

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e couldn’t be more enthused than to offer the five reports in this special issue highlighting games and sexual health. Sexually transmitted diseases (e.g., syphilis, chlamydia, gonorrhea, human immunodeficiency virus) are relatively common, and some are on the rise.1 Sexual violence and rape have increasingly caught media attention. Playing certain kinds of games might exacerbate some of these social problems. Knowing how, and wanting, to prevent or effectively cope with these diseases or behaviors requires complex nuanced skills and strong motivation, which could be the target of serious games for health. Ross Shegog assembled an expert group of games for sexual health designers and researchers and elicited their opinions on the advantages and disadvantages of games for sexual health, unique aspects of such games, what theories are needed to inform the change-promoting aspects of such games, the most useful game-related strategies or procedures to incorporate, and what is needed to establish games as a respected venue for promoting sexual health.2 The need for (a) interdisciplinary teams, (b) predicating the procedures on diverse theories relevant to different aspects of change, and (c) end-user input in design were among the many key points elucidated in this important Roundtable Discussion. DeSmet et al.3 conducted a meta-analytic review of seven published evaluations of games for sexual health. As a group, these games evidenced significant effects on determinants of the sexual behaviors, but not the behaviors themselves. Most of these games, however, did not incorporate aspects likely leading to game immersion, but emphasized primarily rewards and feedback. A next generation of games for sexual health, predicated on the principles elucidated by Shegog et al.,2 is needed to test for their effects on sexual behavior. Jozkowski and Ekbia4 developed a game prototype, ‘‘Campus Craft,’’ using many of the procedures advocated by Shegog et al.2 to prevent on-campus sexual assault. Students playing ‘‘Campus Craft’’ learned more core sexual assault prevention concepts than a control group. Future research must address whether playing this game changes players’ sexual assault-related behaviors. Driesmans et al.5 experimentally tested whether playing a videogame against a sexualized female character increased adolescents’ acceptance of rape myths and tolerance for

sexual harassment. Their findings supported these socially subversive effects, need to be replicated, and deserve attention by future entertainment game designers. B}othe et al.6 assessed factors related to online sexual pornography use. They found that respondents who used the Internet to such an extent that they ignored other aspects of their life, who were motivated to drink alcoholic beverages so they would not be social outcasts, who became immersed in excessive gameplay, and who daydreamed about playing videogames were more likely to problematically view online pornography. Future research will need to assess possible relationships between problematic online pornography viewing and inappropriate interpersonal sexual behavior and to replicate the findings of B}othe et al.6 in other countries. Also in this issue are important articles on a feasibility study of a new substance abuse relapse prevention program, ‘‘Arise,’’7 a systematic review of motor rehabilitation using Kinect (conflicting findings were discerned),8 the validity of digital posturography game balance measures of gross motor function among children with cerebral palsy (it’s valid!),9 and an assessment of a new phone-based game (with accelerometer), ‘‘MobileKids Monster Manor,’’ for encouraging physical activity among children (it worked among heavier children!).10 On a separate note, many intervention research manuscripts are submitted to Games for Health Journal (G4HJ) without a control group. Most treatments of the proper design of experimental studies are hoary treatises requiring superhuman motivation to read and Einsteinian intellect to fully understand. J A recent simple, easy-to-read article with graphics on analysis of experimental results11 provided an excellent example of how control groups in real world settings facilitate assessing what are the real effects of a healthcare policy (in our case a serious videogame) on important outcomes. I hope G4HJ readers will take a few minutes to read this informative presentation. With the onset of April showers, we hope you enjoy your downtime, reading all these interesting contributions. References

1. Centers for Disease Control and Prevention. 2012 Sexually Transmitted Diseases Surveillance. 2014 [updated March 4, 2014]. www.cdc.gov/std/stats12/default.htm (accessed December 11, 2014).

Pediatrics (Behavioral Nutrition & Physical Activity), USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas. Editor-in-Chief, Games for Health Journal.

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2. Shegog R, Brown K, Bull S, et al. Serious games for sexual health. Games Health J 2015; 4:69–77. 3. DeSmet A, Shegog R, Van Ryckeghem D, et al. A systematic review and meta-analysis of interventions for sexual health promotion involving serious digital games. Games Health J 2015; 4:78–90. 4. Jozkowski KN, Ekbia HR. ‘‘Campus Craft’’: A game for sexual assault prevention in universities. Games Health J 2015; 4:95–106. 5. Driesmans K, Vandenbosch L, Eggermont S. Playing a videogame with a sexualized female character increases adolescents’ rape myth acceptance and tolerance toward sexual harassment. Games Health J 2015; 4:91–94. 6. B}othe B, To´th-Kira´ly I, Orosz G. Clarifying the links among online gaming, Internet use, drinking motives, and online pornography use. Games Health J 2015; 4:107–122.

EDITORIAL

7. Sanchez RP, Bartel CM. The feasibility and acceptability of ‘‘Arise’’: An online substance abuse relapse prevention program. Games Health J 2015; 4:136–144. 8. Da Gama A, Fallavollita P, Teichrieb V, Navab N. Motor rehabilitation using Kinect: A systematic review. Games Health J 2015; 4:123–135. 9. Bingham PM, Calhoun B. Digital posturography games correlate with gross motor function in children with cerebral palsy. Games Health J 2015; 4:145–148. 10. Garde S, Umedaly A, Abulnaga SM, et al. Assessment of a mobile game (‘‘MobileKids Monster Manor’’) to promote physical activity among children. Games Health J 2015; 4:149–158. 11. Dimick JB, Ryan AM. Methods for evaluating changes in health care policy: The difference-in-differences approach. JAMA 2014; 312:2401–2402.

Sexual Health in the 21st Century.

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