Young Children's Mathematical Learning From Intelligent Characters.

Children's math learning (N = 217; Mage  = 4.87 years; 63% European American, 96% college-educated families) from an intelligent character game was examined via social meaningfulness (parasocial relationships [PSRs]) and social contingency (parasocial interactions, e.g., math talk). In three studies (data collected in the DC area: 12/2015-10/2017), children's parasocial relationships and math talk with the intelligent character predicted quicker, more accurate math responses during virtual game play. Children performed better on a math transfer task with physical objects when exposed to an embodied character (Study 2), and when the character used socially contingent replies, which was mediated by math talk (Study 3). Results suggest that children's parasocial relationships and parasocial interactions with intelligent characters provide new frontiers for 21st century learning.

The Influence of Active Gaming on Cardiorespiratory Fitness in Black and Hispanic Youth.

BACKGROUND: Youth in the United States have low levels of cardiorespiratory fitness, a risk factor for childhood obesity. Lower levels of physical fitness for black and Hispanic youth contribute to health disparities. In this feasibility study, we examined active video games (AVGs) as a tool to improve fitness and attitudes toward physical activity during early adolescence. METHOD: A 6-week AVG program took place in a youth development program in a high-poverty neighborhood in New York City. Youth aged 10 to 15 years (50% overweight or obese) participated in 2 fitness tests and completed surveys that captured barriers to physical activity pre- and postintervention. Each week, participants played Wii Fit games for 30 minutes. RESULTS: Participants improved the number of sit-ups and step-ups they completed from pre- to postintervention (p < .05). Participants also increased their self-efficacy, intention to exercise and perceived social support to exercise (p < .05). Youth reported a high level of enjoyment and perceived Wii Fit as ways to increase physical fitness and increase their physical activity. CONCLUSION: AVGs may be a viable alternative exercise program to increase physical activity for black and Hispanic youth living in poverty-impacted neighborhoods.

Character Apps for Children's Snacks: Effects of Character Awareness on Snack Selection and Consumption Patterns.

OBJECTIVE: Media characters are used to market snacks that are typically of poor nutritional value, which has been linked to childhood obesity. This study examines whether children's snack selections and consumption patterns are influenced by an app depicting a popular children's media character, as well as the role that children's awareness of the character plays. The results can increase our understanding of how to encourage healthier snack selection and consumption in newer game-based marketing venues, such as apps. MATERIALS AND METHODS: Four- and 5-year-old children (N = 132) played a bowling game on an iPad with no character or with a character holding either healthier or unhealthy snacks. After app-play, children selected and consumed healthier or unhealthy snacks. Children's awareness of the character was measured by children's verbalizations of the character's name during or after app-play. RESULTS: An ordered logistic regression found no significant effect of treatment conditions compared with the control group. Within treatment conditions, awareness of the character led to selection and consumption of more healthy snacks in the healthier condition (odds ratio ß = 10.340, P = 0.008), and of unhealthy snacks in the unhealthy condition (odds ratio ß = 0.228, P = 0.033), but children were unaware that the character influenced their decisions. CONCLUSIONS: Results suggest that young children will choose and consume healthier, not just unhealthy, products when they are aware that a popular character in an app is associated with the snack, potentially leading to healthier eating patterns.

Influence of a Character-Based App on Children's Learning of Nutritional Information: Should Apps Be Served with a Side of Media Characters?

OBJECTIVE: Childhood obesity is a health issue in the United States, associated with marketing practices in which media characters are often used to sell unhealthy products. This study examined exposure to a socially contingent touch-screen gaming app, which replied immediately, reliably, and accurately to children's actions. Children's recall of nutritional content and their liking of the character were assessed. MATERIALS AND METHODS: Four- and five-year-old children (N = 114) received no-exposure, single-exposure, or repeated-exposure to a character-based iPad app rewarding healthy and penalizing unhealthy behaviors. Children reported how much they liked the character and recalled healthy and unhealthy items from the app. An ordinary least squares regression was conducted on how much children liked the character by condition. Poisson regressions were conducted on the number of items recalled by condition alone, and in an interacted model of treatment condition by liking the character. RESULTS: Children liked the character more in the repeated app-exposure condition than in the control group (P = 0.018). Children in the repeated and single app-exposure conditions recalled more healthy (P < 0.001) and unhealthy (P < 0.001) items than the control group. Within treatment conditions, liking the character increased recall of healthy items in the single app-exposure compared to the repeated app-exposure condition (P = 0.005). CONCLUSIONS: Results revealed that repeated exposure increased children's learning of nutritional information and liking of the character. The results contribute to our understanding of how to deliver effective nutrition information to young children in a new venue, a gaming app.

Screen Media Exposure and Obesity in Children and Adolescents.

Obesity is one of the best-documented outcomes of screen media exposure. Many observational studies find relationships between screen media exposure and increased risks of obesity. Randomized controlled trials of reducing screen time in community settings have reduced weight gain in children, demonstrating a cause and effect relationship. Current evidence suggests that screen media exposure leads to obesity in children and adolescents through increased eating while viewing; exposure to high-calorie, low-nutrient food and beverage marketing that influences children's preferences, purchase requests, consumption habits; and reduced sleep duration. Some evidence also suggests promise for using interactive media to improve eating and physical activity behaviors to prevent or reduce obesity. Future interdisciplinary research is needed to examine the effects of newer mobile and other digital media exposures on obesity; to examine the effectiveness of additional interventions to mitigate the adverse effects of media exposures on obesity and possible moderators and mediators of intervention effects; to effectively use digital media interventions to prevent and reduce obesity; and to uncover the mechanisms underlying the causal relationships and interactions between obesity-related outcomes and media content, characteristics, and context.

The American Psychological Association Task Force assessment of violent video games: Science in the service of public interest.

A task force of experts was convened by the American Psychological Association (APA) to update the knowledge and policy about the impact of violent video game use on potential adverse outcomes. This APA Task Force on Media Violence examined the existing literature, including the meta-analyses in the field, since the last APA report on media violence in 2005. Because the most recent meta-analyses were published in 2010 and reflected work through 2009, the task force conducted a search of the published studies from 2009-2013. These recently published articles were scored and assessed by a systematic evidentiary review, followed by a meta-analysis of the high utility studies, as documented in the evidentiary review. Consistent with the literature that we reviewed, we found that violent video game exposure was associated with: an increased composite aggression score; increased aggressive behavior; increased aggressive cognitions; increased aggressive affect, increased desensitization, and decreased empathy; and increased physiological arousal. The size of the effects was similar to that in prior meta-analyses, suggesting a stable result. Our task force concluded that violent video game use is a risk factor for adverse outcomes, but found insufficient studies to examine any potential link between violent video game use and delinquency or criminal behavior. Our technical report is the basis of this article. (PsycINFO Database Record

Toddler learning from video: Effect of matched pedagogical cues.

Toddlers learn about their social world by following visual and verbal cues from adults, but they have difficulty transferring what they see in one context to another (e.g., from a screen to real life). Therefore, it is important to understand how the use of matched pedagogical cues, specifically adult eye gaze and language, influence toddlers' imitation from live and digital presentations. Fifteen- and 18-month-old toddlers (N=123) were randomly assigned to one of four experimental conditions or a baseline control condition. The four experimental conditions differed as a function of the interactive cues (audience gaze with interactive language or object gaze with non-interactive language) and presentation type (live or video). Results indicate that toddlers' successfully imitate a task when eye gaze was directed at the object or at the audience and equally well when the task was demonstrated live or via video. All four experimental conditions performed significantly better than the baseline control, indicating learned behavior. Additionally, results demonstrate that girls attended more to the demonstrations and outperformed the boys on the imitation task. In sum, this study demonstrates that young toddlers can learn from video when the models use matched eye gaze and verbal cues, providing additional evidence for ways in which the transfer deficit effect can be ameliorated.

Youth violence: What we know and what we need to know.

School shootings tear the fabric of society. In the wake of a school shooting, parents, pediatricians, policymakers, politicians, and the public search for "the" cause of the shooting. But there is no single cause. The causes of school shootings are extremely complex. After the Sandy Hook Elementary School rampage shooting in Newtown, Connecticut, we wrote a report for the National Science Foundation on what is known and not known about youth violence. This article summarizes and updates that report. After distinguishing violent behavior from aggressive behavior, we describe the prevalence of gun violence in the United States and age-related risks for violence. We delineate important differences between violence in the context of rare rampage school shootings, and much more common urban street violence. Acts of violence are influenced by multiple factors, often acting together. We summarize evidence on some major risk factors and protective factors for youth violence, highlighting individual and contextual factors, which often interact. We consider new quantitative "data mining" procedures that can be used to predict youth violence perpetrated by groups and individuals, recognizing critical issues of privacy and ethical concerns that arise in the prediction of violence. We also discuss implications of the current evidence for reducing youth violence, and we offer suggestions for future research. We conclude by arguing that the prevention of youth violence should be a national priority. (PsycINFO Database Record

2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE): a randomised trial.

BACKGROUND: No consensus exists for the best way to monitor and when to trigger delivery in mothers of babies with fetal growth restriction. We aimed to assess whether changes in the fetal ductus venosus Doppler waveform (DV) could be used as indications for delivery instead of cardiotocography short-term variation (STV). METHODS: In this prospective, European multicentre, unblinded, randomised study, we included women with singleton fetuses at 26-32 weeks of gestation who had very preterm fetal growth restriction (ie, low abdominal circumference [<10th percentile] and a high umbilical artery Doppler pulsatility index [>95th percentile]). We randomly allocated women 1:1:1, with randomly sized blocks and stratified by participating centre and gestational age (<29 weeks vs ≥29 weeks), to three timing of delivery plans, which differed according to antenatal monitoring strategies: reduced cardiotocograph fetal heart rate STV (CTG STV), early DV changes (pulsatility index >95th percentile; DV p95), or late DV changes (A wave [the deflection within the venous waveform signifying atrial contraction] at or below baseline; DV no A). The primary outcome was survival without cerebral palsy or neurosensory impairment, or a Bayley III developmental score of less than 85, at 2 years of age. We assessed outcomes in surviving infants with known outcomes at 2 years. We did an intention to treat study for all participants for whom we had data. Safety outcomes were deaths in utero and neonatal deaths and were assessed in all randomly allocated women. This study is registered with ISRCTN, number 56204499. FINDINGS: Between Jan 1, 2005 and Oct 1, 2010, 503 of 542 eligible women were randomly allocated to monitoring groups (166 to CTG STV, 167 to DV p95, and 170 to DV no A). The median gestational age at delivery was 30·7 weeks (IQR 29·1-32·1) and mean birthweight was 1019 g (SD 322). The proportion of infants surviving without neuroimpairment did not differ between the CTG STV (111 [77%] of 144 infants with known outcome), DV p95 (119 [84%] of 142), and DV no A (133 [85%] of 157) groups (ptrend=0·09). 12 fetuses (2%) died in utero and 27 (6%) neonatal deaths occurred. Of survivors, more infants where women were randomly assigned to delivery according to late ductus changes (133 [95%] of 140, 95%, 95% CI 90-98) were free of neuroimpairment when compared with those randomly assigned to CTG (111 [85%] of 131, 95% CI 78-90; p=0.005), but this was accompanied by a non-significant increase in perinatal and infant mortality. INTERPRETATION: Although the difference in the proportion of infants surviving without neuroimpairment was non-significant at the primary endpoint, timing of delivery based on the study protocol using late changes in the DV waveform might produce an improvement in developmental outcomes at 2 years of age. FUNDING: ZonMw, The Netherlands and Dr Hans Ludwig Geisenhofer Foundation, Germany.

Effects of Exergame Play on EF in Children and Adolescents at a Summer Camp for Low Income Youth.

Past research has suggested exergame play improves adolescents' executive function (EF) skills. EF change in 70 African American and Hispanic/Latino 10- to 16-year-olds participating in an inner-city summer camp was assessed following five 30-minute exergame play sessions. Children's EF scores improved from pre- to posttest, and factors related to this change were examined. The number of exergame sessions the participants attended predicted posttest scores. In addition, level of achievement during game play was related to EF scores. Finally, the children's level of enjoyment was not related to EF; however, frustration and boredom during game play were negatively related to EF. The findings are discussed in terms of their implications for the relationship between exergame play and cognitive benefits for adolescent players.

Clinical prediction models for bronchopulmonary dysplasia: a systematic review and external validation study.

BACKGROUND: Bronchopulmonary dysplasia (BPD) is a common complication of preterm birth. Very different models using clinical parameters at an early postnatal age to predict BPD have been developed with little extensive quantitative validation. The objective of this study is to review and validate clinical prediction models for BPD. METHODS: We searched the main electronic databases and abstracts from annual meetings. The STROBE instrument was used to assess the methodological quality. External validation of the retrieved models was performed using an individual patient dataset of 3229 patients at risk for BPD. Receiver operating characteristic curves were used to assess discrimination for each model by calculating the area under the curve (AUC). Calibration was assessed for the best discriminating models by visually comparing predicted and observed BPD probabilities. RESULTS: We identified 26 clinical prediction models for BPD. Although the STROBE instrument judged the quality from moderate to excellent, only four models utilised external validation and none presented calibration of the predictive value. For 19 prediction models with variables matched to our dataset, the AUCs ranged from 0.50 to 0.76 for the outcome BPD. Only two of the five best discriminating models showed good calibration. CONCLUSIONS: External validation demonstrates that, except for two promising models, most existing clinical prediction models are poor to moderate predictors for BPD. To improve the predictive accuracy and identify preterm infants for future intervention studies aiming to reduce the risk of BPD, additional variables are required. Subsequently, that model should be externally validated using a proper impact analysis before its clinical implementation.

Adolescent exergame play for weight loss and psychosocial improvement: a controlled physical activity intervention.

UNLABELLED: Overweight and obese youth, who face increased risk of medical complications including heart disease and type II diabetes, can benefit from sustainable physical activity interventions that result in weight loss. OBJECTIVE: This study examined whether a 20-week exergame (i.e., videogame that requires gross motor activity) intervention can produce weight loss and improve psychosocial outcomes for 54 overweight and obese African-American adolescents. DESIGN AND METHODS: Participants were recruited from a public high school and randomly assigned to competitive exergame, cooperative exergame, or control conditions. All exergame participants were encouraged to play the Nintendo Wii Active game for 30-60 min per school day in a lunch-time or after-school program. Cooperative exergame participants worked with a peer to expend calories and earn points together, whereas competitive exergame participants competed against a peer. Control participants continued regular daily activities. Outcome measures included changes in weight, peer support, self-efficacy, and self-esteem, measured at baseline, and at ∼10 and 20 weeks. RESULTS: Growth curve analysis revealed that cooperative exergame players lost significantly more weight (mean = 1.65 kg; s.d. = 4.52) than the control group, which did not lose weight. The competitive exergame players did not differ significantly from the other conditions. Cooperative exergame players also significantly increased in self-efficacy compared to the control group, and both exergame conditions significantly increased in peer support more than the control group. CONCLUSION: Exergames, especially played cooperatively, can be an effective technological tool for weight loss among youth.

Electronic gaming and the obesity crisis.

Children and adolescents in the United States and in many countries are projected to have shorter life spans than their parents, partly because of the obesity crisis engulfing the developed world. Exposure to electronic media is often implicated in this crisis because media use, including electronic game play, may promote sedentary behavior and increase consumption of high-calorie foods and beverages that are low in nutritional value. Electronic games, however, may increase children's physical activity and expose them to healthier foods. We examine the role of electronic games in the pediatric obesity crisis and their contribution to more favorable health outcomes.

Respiratory morbidity at follow-up of small-for-gestational-age infants born very prematurely.

BACKGROUND: The aim of this study was to determine whether small-for-gestational-age (SGA) infants born very prematurely had increased respiratory morbidity in the neonatal period and at follow-up. METHODS: Data were examined from infants recruited into the United Kingdom Oscillation Study (UKOS). Of the 797 infants who were born at <29 wk of gestational age, 174 infants were SGA. Overall, 92% were exposed to antenatal corticosteroids and 97% received surfactant; follow-up data at 22-28 mo were available for 367 infants. RESULTS: After adjustment for gestational age and sex, SGA infants had higher rates of supplementary oxygen dependency at 36 wk postmenstrual age (odds ratio (OR): 3.23; 95% confidence interval: 2.03, 5.13), pulmonary hemorrhage (OR: 3.07; 95% CI: 1.82, 5.18), death (OR: 3.32; 95% CI: 2.13, 5.17), and postnatal corticosteroid requirement (OR: 2.09; 95% CI: 1.35, 3.23). After adjustment for infant and respiratory morbidity risk factors, a lower mean birth weight z-score was associated with a higher prevalence of respiratory admissions (OR: 1.40; 95% CI: 1.03, 1.88 for 1 SD change in z-score), cough (OR: 1.28; 95% CI: 1.00, 1.65), and use of chest medicines (OR: 1.32; 95% CI: 1.01, 1.73). CONCLUSION: SGA infants who were born very prematurely, despite routine use of antenatal corticosteroids and postnatal surfactant, had increased respiratory morbidity at follow-up, which was not due to poor neonatal outcome.

Dietary Digital Diaries: Documenting Adolescents' Obesogenic Environment.

Obesogenic built environments may contribute to excessive eating and obesity. Twenty-three 12- to 17-year-old low-income African American adolescents created digital diaries by photographing their lunchtime food environment in a summer academic program. Digitally depicted foods were classified as appearing on the platescape (student's or others' plate) or the tablescape (food buffet). Height, weight, BMI percentile, and waist-to-hip ratio were calculated at baseline and week 4. Adolescents digitally depicted high caloric, high fat foods on the platescape and tablescape, particularly adolescents with a higher waist-to-hip ratio. Weight gain during the 4-week program was significantly predicted by the number of calories and the amount of fat content depicted on the student's plates. Digital diaries, then, can document adolescents' perspectives of their food environments that promote their overconsumption of high caloric and high fat foods that contribute to weight gain and put them at risk for obesity.

Motivating effects of cooperative exergame play for overweight and obese adolescents.

BACKGROUND: Exergames (i.e., video games that require gross motor activity) may provide intrinsically motivating experiences that engage youth in sustained physical activity. METHOD: Thirty-one low-income 15- to 19-year-old overweight and obese African American adolescents were randomly assigned to a competitive exergame (n = 17) or a cooperative exergame (n = 14) condition. Participants played a preassigned Wii Active exergame routine that took between 30 and 60 min each school day, and sessions occurred during lunch time or an after-school program over a 6 month period. Participation was voluntary, so students decided whether to come or not on a given day. Cooperative exergame players worked together with a peer to expend calories and earn points, while competitive exergame players competed individually against a peer to expend calories and earn points. Motivation was measured through surveys and interviews at the end of the intervention, and energy expenditure was measured by accelerometry during game play. RESULTS: Compared with the competitive group, the cooperative players were significantly more intrinsically motivated to play (p = .034, partial eta-squared = 0.366) and more psychologically attracted to the design of the exergame (p = .034, partial eta-squared = 0.320). Intrinsic motivation was significantly positively correlated with energy expenditure during game play: individuals who were motivated by control/choice had higher energy expenditure (p = .026), and those who were more goal motivated (p = .004) and more immersed in game play (p = .024) had lower energy expenditure during game play. CONCLUSIONS: Cooperative exergame play produced higher intrinsic motivation to play the exergame than competitive exergame play did. Intrinsic motivation that came from a desire for control/choice was related to higher energy expenditure during game play. Cooperative exergame play holds promise as a method for engaging overweight and obese youth in physical activity.

Maternal Depression and Family Media Use: A Questionnaire and Diary Analysis.

We describe the association between postpartum depression and the quantity and content of infant media use. Households with depressed mothers viewed twice as much television as households with non-depressed mothers did, and depressed mothers appeared to derive comparatively greater pleasure from television viewing. Maternal depression was associated with an increased exposure to child-directed content by 6-9-month-old infants, although it was not associated with an increased exposure to adult-directed programming. Depressed mothers also reported being less likely to sit and talk with their children during television use or to consult outside sources of information about media. This increase in television exposure without corresponding parental involvement could negatively affect developmental outcomes.

Digital Gaming and Pediatric Obesity: At the Intersection of Science and Social Policy.

Children and adolescents in developed countries are heavily immersed in digital media, creating an inexpensive, far-reaching marketing opportunity for the food industry and the gaming industry. However, exposure to nonnutritious food and beverage advertisements combined with the use of stationary media create a conflict between entertainment and public health. Using the popular digital gaming platforms advergames (online games that market branded products) and exergames (video games that involves gross motor activity for play) as exemplars, the following article provides an analysis of the negative and positive health impacts of digital gaming as they relate specifically to overweight and obesity outcomes for children and adolescents. Theoretical explanations including the food marketing defense model, persuasion knowledge model, and social cognitive theory are used to explain the influence of gaming on young players' health. Throughout the article, we discuss the role of public policy to encourage the development and use of health-promoting digital games as an innovative, effective tool to combat the pediatric obesity crisis.

Competitive versus cooperative exergame play for African American adolescents' executive function skills: short-term effects in a long-term training intervention.

Exergames are videogames that require gross motor activity, thereby combining gaming with physical activity. This study examined the role of competitive versus cooperative exergame play on short-term changes in executive function skills, following a 10-week exergame training intervention. Fifty-four low-income overweight and obese African American adolescents were randomly assigned to a competitive exergame condition, a cooperative exergame condition, or a no-play control group. Youths in the competitive exergame condition improved in executive function skills more than did those in the cooperative exergame condition and the no-play control group. Weight loss during the intervention was also significantly positively correlated with improved executive function skills. The findings link competitive exergame play to beneficial cognitive outcomes for at-risk ethnic minority adolescents.

Neonatal and infant outcome in boys and girls born very prematurely.

INTRODUCTION: Although important new strategies have improved outcomes for very preterm infants, males have greater mortality/morbidity than females. We investigated whether the excess of adverse later effects in males operated through poorer neonatal profile or if there was an intrinsic male effect. RESULTS: Male sex was significantly associated with higher birth weight, death or oxygen dependency (72% vs. 61%, boys vs. girls), hospital stay (97 vs. 86 days), pulmonary hemorrhage (15% vs. 10%), postnatal steroids (37% vs. 21%), and major cranial ultrasound abnormality (20% vs. 12%). Differences remained significant after adjusting for birth weight and gestation. At follow-up, disability, cognitive delay, and use of inhalers remained significant after further adjustment. DISCUSSION: We conclude that in very preterm infants, male sex is an important risk factor for poor neonatal outcome and poor neurological and respiratory outcome at follow-up. The increased risks at follow-up are not explained by neonatal factors and lend support to the concept of male vulnerability following preterm birth. METHODS: Data came from the United Kingdom Oscillation Study, with 797 infants (428 boys) born at 23-28 wk gestational age. Thirteen maternal factors, 8 infant factors, 11 acute outcomes, and neurological and respiratory outcomes at follow-up were analyzed. Follow-up outcomes were adjusted for birth and neonatal factors sequentially to explore mechanisms for differences by sex.