Teens often find their sex education classes at school boring or laughable. Yet learning about sexual health is important. It gives teens the information they need to protect themselves from a variety of sexually transmitted infections as well as possible pregnancy.

So where can teens go to learn about sex? One team of researchers has taken a shot at using video games. And they're pleased with the results.

As they play, teens and tweens travel through an interactive world, facing challenges and making decisions about common social situations, decisions that may bring rewards but could also have serious consequences.

“We saw significant and sustained positive changes in terms of attitudes about sexual health and sexual health knowledge,” said the study's lead author, Lynn Fiellin, an associate professor of medicine at Yale School of Medicine.

In PlayForward: Elm City Stories, teens and tweens travel through an interactive world, facing challenges and making decisions about common social situations, decisions that may bring rewards but could also have serious consequences. The game focuses on sexual health and risk but also touches on several other risky behaviors, such as substance use, academic dishonesty and unsafe driving.

The study looked at 333 students, mostly minority, who were age 11-14, tracking them for a year. All were from afterschool, school or summer programs in the New Haven area. For a six-week period, half of the teens played PlayForward on an iPad twice a week for up to 75 minutes each session. The other half spent a similar amount of time playing a set of 12 commercial video games, including Angry Birds and Subway Surfer.

One reason teens are prone to risky behaviors is that they don't always understand that these behaviors are risky.

The students were assessed four times during the one-year study period for a range of outcomes, including sexual health knowledge and attitudes, intention to initiate sex and sexual activity. Compared to youth who played the commercial games, at the end of 12 months the teens using PlayForward demonstrated improvements in both sexual health attitudes and knowledge. For example, the PlayForward group was more likely to understand that it was true that a girl can get pregnant the first time she has sex.

The study results on knowledge applied to everyone in the study, but the findings on attitude applied only to boys, not to girls or to the older (age 13-14) participants. The reason for the gender difference could be that video games have always been a predominantly male medium, though perhaps not as much today as they once were. The authors suggest that it may be partially due to boys identifying more with their characters in PlayForward than girls did (60% to 39%).

Teens who played the game showed no difference from the other teens in terms of their intent to initiate sex or to be sexually active, but the authors still consider the results a success because this was only a proof-of-concept study to show that adolescents will engage in a game with serious content and learn things that impact the way they think and potentially what they do.

The authors plan to refine the game to influence youth behavior. They have received funding to focus on other health outcomes, including smoking and electronic or e- cigarette use and the promotion of HIV/STI testing.

The study appears in the Journal of Medical Internet Research. It is freely available.