Dr. Carol J. Boushey


Foods and Nutrition


Nutrition, Fitness, and Health


F&N, calcium, bone health, multi-media, computer games


Early adolescence is a critical time for skeletal development, as this is when maximal bone growth occurs (1). Development of bones mass during adolescence can help reduce the risk for childhood fractures and osteoporosis later in life. Low calcium intakes can contribute to poor bone health and can increase the risk of developing osteoporosis (2). An adequate intake of 1300 milligrams per day of calcium was set for both male and female adolescents by the Institute of Medicine (3). Unfortunately, most adolescents do not attain this recommendation. Thus, researchers have aimed to investigate various effectively reaching young people to adopt healthy behaviors, such as improving calcium intake and bone health, which is particularly challenging. Industry estimates that 45 million homes have video-game consoles and the majority of users are teenagers (4). Whereas computer games are often associated with inactivity (5), emerging research suggests that computer games may provide an avenue for providing prevention health messages for cancer, diabetes, obesity, and other health problems (6). Computer games directed to the improvement of children’s health are still in their infancy (7). Most of the multimedia-based interventions that exist today focus on fruit, vegetable, and fat intake (8). Studies on other dietary components also may be useful in improving health and preventing health risk behaviors. The role of computer-based games as learning tools for increasing awareness of bone-related health risks and improving bone health in early adolescents has not been scientifically studied. An examination of computer-based games as a learning tool is needed to evaluate whether interaction with a game directed to changing behaviors might guide adolescents to develop plans to improve their calcium intakes.

Delivering health content via multimedia and computer games has several advantages when compared to traditional teaching methods, such as lectures, textbooks, and videos.

Using Conklin 2 multimedia and computer games to deliver health content can allow for interactive learning, which has been shown to be highly effective (9). The fidelity of the messages and content of the lessons can be protected, when health education is delivered with multimedia and computer games. This is particularly important, as it can help prevent the messages and content from transitioning into misinformation or information being dropped entirely due to a teacher’s lack of confidence about a topic. Furthermore, use of these tools in school settings can reduce the burden on teachers since teachers would not need to plan lessons for subject areas outside of their specialty areas.

A systematic evaluation of the student responses to intervention programs that have incorporated games, may help illuminate whether multimedia can contribute positively to children’s comprehension of health content.

Given the emerging interest in video- and computer-games as a mode of delivering health content and information, an effort to identify features of games which may be most important for learning would be useful.

The No Bones About It multi-media intervention using video and games was developed to improve calcium and bone health of middle school students following national science and health educational standards and a behavioral model call the transtheoretical model. An important concept of the transtheoretical model is for the recipients of an intervention to articulate a plan showing willingness to make a commitment to change.

Appropriate health plans for calcium intake as promoted by No Bones About It! would support the contention that multi-media tools can provide a foundation for improving the health practices of early adolescents.

Given that a multimedia intervention would be delivered the same without accommodating potential differences between boys and girls, the purpose of this study was to compare the cognitive outcomes from No Bones About It! between boys and girls. The outcomes Conklin 3 specifically examined were: 1) the acquisition of knowledge about bone health and calcium intake; 2) the ability to articulate the game objectives which addressed how to increase calcium intake; and 3) the ability to articulate a plan of commitment to improve calcium intake.