Interactive multimedia programs have been demonstrated to produce substantial change in
children's dietary behaviors. This SBIR-Phase 2 protocol will evaluate the two video game
interventions designed to change diabetes related behaviors, including diet and physical
activity: Escape from Diab! and Nanoswarm that were developed in Phase 1. The primary
hypotheses for this SBIR-Phase 2 protocol are:
1. The two video games will result in greater dietary and physical activity change than a
knowledge based control group.
2. The effects of the video games will be mediated by changes in child preferences for FV
and PA, self-efficacy to change FV intake and PA, and intrinsic motivation to eat FV
We will test these hypotheses by evaluating the two video games in a randomized experiment.
To minimize costs, we will evaluate the impact of the games on behavior (diet and PA), BMI
and related psychosocial variables, but not blood values. Our long-term goal is reducing the
incidence of Type 2 diabetes and related health problems in youth.
Increasing numbers of minority youth are at risk for developing Type 2 Diabetes (T2D)
because of family history and overweight. While precise incidence and prevalence rates for
T2D among children are not available, the prevalence has increased substantially in the last
ten years, likely due to parallel increases in obesity among children. These cases are
expected to progress to end organ damage at an early age, with the resultant increased
personal and societal costs. Probable risk factors for T2DM include ethnicity (African
American, Hispanic, Native American), family history of diabetes, and obesity. Prevention is
key to reducing risks for T2D. The only modifiable risk factor is weight, which reflects
dietary and physical activity practices. A diet high in fruit and vegetables, and
appropriate in total calories and low in dietary fat are likely protective against both
obesity and T2D. Although national data suggest the percentage of kilocalories (kcal) from
fat consumed by children aged 2-17 decreased between 1989 and 1995 (now at 33% of total
kcal), actual fat intakes did not decrease. Kcal intake, however, increased. Children's
current intake of fruit and vegetables is less than one-half of the 5-A-Day goal. Changing
the diet and physical activity practices to impact adiposity among children 10 to 12 years
old before the onset of obesity or early in obesity holds great promise of preventing T2D.
Furthermore, it is approximately this age that children assume more responsibility for their
diet and physical activity, and thereby the intervention can be expected to have a greater
impact on behavior. Children at the 50%tile or higher BMI are those most likely to progress
to obesity, and thereby provide an important target group for obesity prevention.
Video games focused on promoting T2D-related changes in diet and physical activity, based on
the most current theories of health behavior, hold the promise of preventing T2D among
children, and thereby reducing lifelong disease burden. Unlike traditional media-based
interventions (print, graphic, audio/visual, television broadcast), computer technology
provides opportunities to influence behavior change through direct, personalized interactive
As part of a SBIR-Phase I, we created two video games: Escape from Diab! and Nanoswarm -
Invasion from Inner Space. These intervention video games propose to increase fruit and
vegetable intake to reduce total calories by displacing high fat, high calorie foods;
increase water intake to decrease sweetened beverage consumption and total calories;
increase physical activity; and decrease inactivity (e.g., TV watching, playing commercial
video games). The behavioral and educational objectives address national behavior change
- Three to five servings of fruit (F) or 100% fruit juice (J) per day and Four to seven
servings of vegetables (V) per day (based on child recommended calorie intake for age
- Five to eight glasses of water (W) per day,
- Moderate to vigorous Physical Activity (PA) of at least 60 min/day, and
- Physical Inactivity (PI) (TV, e-games, telephone) of no more than 2 hours per day.
Both games use an adventure storyline to capture the children's interest and attention, and
thereby enhance their desire to keep coming back to the game across multiple sessions
(between which behavior change goals are attempted). The storylines provide messages that
reinforce the diet and physical activity change objectives. Seamlessly woven into each
adventure session are programmed procedures for promoting behavior change (goal setting,
goal review), which were tailored to characteristics of the child obtained through self
report. Behavior change knowledge games, seamlessly woven into the storyline, are used to
provide the basis for effective goal setting; and energy balance games, also seamlessly
woven into the storyline, are used to provide the knowledge necessary to effectively self
control caloric intake and output.
1. Healthy 10-12 year old African-American, Hispanic-American, Anglo or Asian children.
2. Able to fluently speak, read and write English.
3. Able to play computer video games.
4. DSL or high-speed internet connection at home.
5. No dietary restrictions that limit their intake of fruit & vegetables or water.
6. No medical, physical handicaps or other reasons that would limit their physical
7. Greater than 50% BMI, but less than 95% BMI.
1. Children who are not in the target age range of 10-12 years old.
2. Not able to fluently speak, read and write English.
3. Not able to play computer video games.
4. No DSL or high-speed internet connection at home.
5. Dietary restrictions that limit their intake of fruit & vegetables or water.
6. Medical, physical handicaps or other reasons that would limit their physical
7. Less than 50% BMI or greater than 95% BMI.
8. History of epileptic seizures.