The current review revealed that electronic media interventions have been developed and examined for an array of conditions that are potentially highly relevant and important to the care of youth. Of the 19 studies included in the current review, 17 reported a statistically significant change in health or safety behavior. These results, however, should be interpreted with caution given that the quality assessment of these studies found most of them to be of poor quality. Of the five studies18,19,25–27
that were of excellent quality, four18,19,25,26
found statistically significant differences in the treatment group as compared with the control group. While the current review provides support for the use of electronic media for behavior change in youth, it also highlights, based on the quality assessments, that few scientifically rigorous evaluations of electronic media for targeted behavior change in this age group have been conducted.
Although electronic media-based interventions have the potential to promote health and safety behaviors in youth, there may be some potential limitations for accessing these types of interventions outside of school. Because youth from lower income environments are slightly less likely than youth from higher income environments to go online or to report owning a computer,43
they may have limited access to internet and computer -based interventions. Videogames, however, occupy a prominent position in American life and appear to cross demographic lines with ixty percent of blacks, 61% of whites, and 55% of Hispanics report interactive game playing.44
Video game playing extends across economic lines as well and is reported by 58% of those with household incomes under $35,000.3
Our review has several important limitations. The limited number of randomized controlled trials and heterogeneity of interventions, settings, and behavior change outcomes make it difficult to draw comprehensive conclusions. We were also limited by the variability in the quality of the studies in terms of our ability to determine the efficacy of the different interventions. The primary concerns about study quality centered around external validity, such as failure to report the description of randomization or withdrawals and dropouts. Notably, none of the studies included in this review were blinded, which also reduced their quality rating. Finally, the majority of the data collected specific to behavior change outcomes is based on self-report of the study subjects.
In summary, our study highlights several key gaps in the existing literature. Given their potentially broad applicability, higher quality evaluations of existing electronic-media-based interventions are needed. Of the five studies that received an excellent quality rating, four studies18,19,25,26
reported a statistically significant change in asthma or sexual risk related behavior. These studies provide excellent models of electronic media-based interventions that created behavior change in youth. Specifically, these interventions showed improvement in self-management and risk reduction behaviors in young adolescents, which may be an age group that is most amenable to adopting positive health and safety behaviors. We identified a paucity of studies focusing on unintentional injury prevention and promoting decreased alcohol and drug use among youth, despite their significant morbidity and mortality among this demographic. Our review demonstrates a need to assess the effectiveness of using electronic-media-based interventions in different settings. Given their promise for promoting improved health and safety behavior change among youth in various settings, future research should focus on developing, rigorously evaluating, and implementing electronic-media-based interventions.