Advancing Adolescent and Young Adult Health in the COVID-19 Pandemic: Responses and Adaptations
Foney: Good afternoon. My name is Dr. Dana Foney, and I serve as a health scientist and project officer in the division of research within the Office of Epidemiology and Research At Maternal and Child Health Bureau Health Resources and Services Administration. The division of research provides ongoing support for maternal and child health for MCH, extramural research activities, including the engaging research innovations and challenges, or the EnRICH webinar series.
You are joining a community of more than 100 participants with an interest in advancing MCH research. The EnRICH webinar series provides technical assistance and methodological updates aimed at stimulating interest an applied and translational MCH research. Today's webinar is entitled "Advancing Adolescent and Young Adult Health in the COVID-19 Pandemic: Responses and Adaptations." This presentation is the second of the three COVID-19-related EnRICH webinars. Before we start, I would like to briefly introduce our main speakers for the afternoon -- Drs. Elizabeth Ozer, James Lester, and Alison Cohen.
Dr. Elizabeth Ozer is a professor of pediatrics and the director of research for the Office of Diversity and Outreach at the University of California, San Francisco. She serves as principal investigator of the MCHB-funded Adolescent and Young Adult Health Research Network. Dr. Ozer's training has spanned the areas of health, social, and clinical psychology. Dr. James Lester is a distinguished
university professor of computer science and director of the Center for Educational Informatics at North Carolina State University. He is a fellow of the Association for the Advancement of Artificial Intelligence. His research centers on transforming education with artificial intelligence.
Dr. Alison Cohen is a social epidemiologist. Her research explores social and environmental determinants of health inequities with an eye towards doing community-driven, policy-relevant applied epidemiology research to systematically document health inequities and identify interventions beyond the health sector that could reduce inequities health and well-being. So, next, we'd like to briefly gauge the audience's prior knowledge on adolescent and young adult health during the COVID-19 pandemic. So, on your screen, you will see a poll question. We would like for you to rate your current knowledge of the topic, one being limited and five being high.
Please go ahead and answer the question. Okay, so it looks like we have folks that have very high-level of knowledge in the area, and others who are looking forward to learning something more from the program today. So thank you for your participation. And now I will turn the program over to Drs. Ozer, Lester, and Cohen.
Ozer: Great. Thanks for that introduction. Good afternoon, I am Elizabeth Ozer, and I am pleased to be able to present a brief overview of the Adolescent and Young Adult Health Research Network and then have the opportunity to share two research network projects that have been developed or modified in response to the COVID-19 pandemic. And, Dr. Charles Irwin, the co-PI, will also be available, in the question-and-answer session at the end. I want to acknowledge the support from HRSA, as well as our Maternal and Child Health Bureau project officers.
So, the main goal of the research network is to develop and maintain a transdisciplinary research network that will accelerate the translation of developmental science into maternal and child health, adolescent and young adult practice, promote scientific collaboration, and develop additional research capacity in the adolescent-young adult health field. Now, the network is based -- the project is based at University of California, San Francisco, with partners in the MCHB-funded Leadership Education in Adolescent Health Program, LEAH Program, The Society for Adolescent Health and Medicine, or SAHM, and the Center for the Developing Adolescent at UC Berkeley. And, collectively, this team represents leaders in in transdisciplinary research, addressing different settings and service populations.
With SAHM, that's the major convening of practitioners and researchers in adolescent and young adult health. And it also represents over 100 clinics serving diverse adolescents and young adults, as well as educating and supporting new leaders in the field. And, collectively, since 2014, there have been 27 research projects affiliated with the network, 31 articles, we've mentored 21 new investigators through these projects and articles, and reached nearly 1,700 practitioners and researchers.
Now, we have several major focus areas for the network. One is developmental science. Another is clinical preventive services. And the third is the integration of care. And, in order to be responsive in an ongoing manner to emerging health issues of adolescents and young adults, we have this fourth broad area called emerging issues. And across these areas, really a cross-cutting theme has been wearing the lens of health equity, and reducing disparities.
I just wanted to briefly tell you about some of the areas under our emerging issues bucket that we focused on over the last several years, included mental health, healthy functioning and sleep, substance use, gender identity and care for transgender youth, and we've had an ongoing emphasis on supporting parents and caregivers of adolescents. Today, I want to briefly focus on some of our projects in the area of technology, as well as the interaction between the use of technology and the response to the COVID-19 pandemic. So, network collaborators have been developing digital health tools for primary care. This includes both an adolescent and young adult emotional behavioral health screening tool that can actually be integrated into the electronic health record. As well as parent education and an engagement tool. The network group had three different papers published in a supplement in the "Journal of Adolescent Health" that focused on innovative digital technologies to improve adolescent and young adult health.
We had no idea when we began writing these articles that they would be published in the midst of the COVID-19 pandemic and be more of a response to emerging issues than we could have ever anticipated. Particularly at this time, when digital technologies have been called upon to rapidly transform the way that we provide clinical care, deliver public health messages, and educate the next generation of health professionals. And, most very importantly, is how we frame this discussion to include equity and inclusivity for young people. And in another area which we hadn't anticipated would be quite as relevant, although it is always relevant, we have also been, as a follow-up, really, to the Bright Futures Guidelines, exploring rates of clinician screening and discussion about adolescent technology use in primary care. And then, in an area which likely deserves a webinar on its own, network collaborators have focused on the rapid implementation of telemedicine at the onset of the COVID-19 pandemic.
Now, today, I'd like to now move on to our speakers who will be, under the umbrella, really responding to the COVID-19 pandemic, technology-based research, and implementation. And the first presentation is on young adult college students' health and well-being during the COVID-19 pandemic. This will be presented by Dr. Cohen. And as you'll hear more about, this was a very fast response to a focus on the health and well-being of college students employing Instagram as a tool.
And then, the next presentation, HealthQuest: Engaging Adolescents in Health Careers with Game-based Learning, Dr. Lester will describe the modifications in response to COVID-19 to an already established research project. Thank you. Cohen: Great, thanks, Elizabeth. So, excited to be here. I'm Alison Cohen. I'm assistant professor of epidemiology and biostatistics.
I'm presenting this on behalf of my co-lead, as well, who is also here in the session. Lindsay Hoyt, who's an assistant professor of psychology at Fordham. And...
There we go. So, college students have been in the news a fair amount. As many of you may be familiar, we are particularly interested, too, in the experiences of young adults and studying their experiences longitudinally.
Before we get started, I want to recognize and acknowledge a really wonderful and large research team that's include lots of students and trainees in those projects. Many of whom are leading or participating. in the manuscripts that are emerging from our study. And so this emerged -- Lindsay and I brought kind of complementary expertise, as a social epidemiologist and a developmental psychologist, to really comprehensively understand young adult health, and so this research has been supported by the Adolescent and Young Adult Health Research Network at UCSF. As well as various support from the University of San Francisco and from Fordham.
And so, our goal here -- this was now almost a year ago, which feels crazy -- lot of the first studies that were coming out were often based on convenience samples. We wanted to create a national perspective, and get closer to a population-based sampling. Whilst still doing it remotely and rapidly and inexpensively. And so we recruited participants over Instagram. We used these ads to recruit young adult full-time college students across the country who were 18 to 22 years old. And we used Instagram because, as of fall 2019, so pre-pandemic, more than 80% of college students were on Instagram.
And we expect that that proportion is even higher due to the pandemic. And so the way people entered into our sample was they saw these ads on Instagram. They could click on a link to get to our screener survey, basically just to confirm that they were eligible and to provide consent. And then, had the opportunity to enroll in our survey. Which our first survey was done in late April of 2020.
We also did a follow-up in July, and also just finished collecting data from a third wave of follow-up. We thoroughly documented our method sections, for those of you who are more curious, in this is paper that published in "Journal of Adolescent Health." Just to give you a sense of our cohort demographics. Our participants were living in 49 states plus DC and attended over 370 different two- and four-year colleges and universities across the country. So, our sample was diverse in terms of race, ethnicity, and terms of gender. It looks a bit different than for all full-time college students across the country, but keep in mind that a lot of students are older.
So our sample isn't exactly the same as everyone else. We also had a lot of diversity in terms of socioeconomic position, and we could already start to be seeing how household income was changing just in the first few months of the pandemic. To get right into our findings -- we have limited time -- one of the interesting findings was that young adult college students were taking public health precautions seriously. And taking things seriously, and oftentimes they were acting before local governments required them to.
They started sheltering in place before local governments first required, so the first stay at home order was the San Francisco Bay area, on March 16, and you can see that a lot were sheltering in place before then. Folks also kind of stopped eating in dine-in settings before dine-in settings closed. And so this is showing that young adults are smart and are thinking about public health and are trying to do the best that they can.
That said, there are still challenges, right? We saw that people, you think about their awareness of social distancing last April. There were still challenges in remembering who with a had been within six feet of. Especially, there is some variation in terms of estimating how many times they've been within six feet of essential workers, and so you can think about that as potentially having implications for contact tracing, as well. And then, there's still also room for improvement. On both our April and July surveys, we asked people if they had had any of the symptoms that could be associated with COVID-19 and asked what they did while they were systematic to get a sense of potential for transmission.
Not everyone with those symptoms necessarily had COVID-19, but they might have. And what we found was that a relatively consistent proportion and people stayed at home exclusively when they were experiencing those symptoms. So, pre-pandemic, like January and February of last year, almost half of folks stayed home exclusively if they had any of the symptoms that are now known to be COVID-19. Those are people who almost certainly didn't have COVID-19.
That went up a bit in March and April. But then we right got back to where we were pre-pandemic. That means that there's still some substantial room for transmission and for public health intervention and that we, as public health messengers, still have a long way to go. One of the other things that we looked at -- So this was something that was in the news a lot and that our data were able to provide some insights around.
There was a lot of news coverage around college students are going to bars -- why? And so we found that, in our study, only about 10% of folks had been to a bar in the last four weeks, which was in the summer. And that wasn't actually all college students. So try to change the narrative a bit. But we still figured it was worth exploring, these folks who had been to bars repeatedly.
So what we did was we had some qualitative data that was from a different section of our survey, which just asked folks how they were thinking about COVID, and how it was affecting their lives. What we see from that are, the people who went to bars two or three times or more in that four-week period, fell into kind of these four groups. Some of them were bored or isolated. Some of them were feeling stressed. Some of them were taking COVID very seriously and taking a lot of precautions.
And some felt a bit nihilistic just in terms of everything is going wrong. "I'm getting exposed all the time. I feel like this is out of control."
And so you think about it, those kinds of groups are helpful for us to know about because it might be that we need different types of public health interventions accordingly, right? So, for folks who are feeling bored and isolated and are going to bars repeatedly, thinking about harm reduction, like creating alternative, lower-risk gathering opportunities could be helpful. For folks who are stressed, thinking about ways to reduce those sources of stress can be helpful. This group of the folks who are otherwise taking precautions, I find intellectually interesting, right? Part of it might be that we need to share more information about the risks of going to bard. Part of it might be that they said, "Okay, if the government is allowing these bars to be open, it must be safe. So maybe we need to be taking different policy precautions. Those who are nihilistic, like, yeah, I empathize.
I just don't even think about how to work on supporting those folks. So, some of the other research that we did was looking at documenting inequalities. We were documenting inequalities in stress and anxiety and finding that there were differences by gender and by sexual orientation. Women and transgender and gender diverse people had higher stress and anxiety than men, LGBTQ participants had higher stress and anxiety then heterosexual participants. This was true both at our April survey and at our July survey.
And we sought out both quantitatively and qualitatively, in terms of some of how that manifested. We also found inequalities in sleep health. So, on average, students were reporting poor sleep quality, and again, women and transgender and gender diverse students were reporting worse sleep quality than men.
And students from lower socioeconomic positions were reporting worse sleep quality than their higher-income peers. We also see some differences in responsibilities by gender. So, right, we saw those gendered inequalities in stress and anxiety and also sleep. There's been a lot of research on gender difference in the COVID-19 experiences among adult women, but we also see that the young adult college students who are women or transgender and gender diverse are appearing to have more responsibilities, including providing more childcare and schooling assistance to other members of their household than men.
This is despite having pretty similar levels of employment. We also see inequalities, in the education experience. That can be another social determinant -- oops -- of health. And so we see that the shelter in place settings that students were experiencing in spring affected their remote learning, and there were barriers to learning that were disproportionately experienced by students from marginalized background. And so, then, just to conclude, many young adults are taking the COVID-19 pandemic seriously.
They're also seriously affected by the pandemic. So we need to think about some of these things, like how policy changes can help promote healthier behavior, but also strategies, including those that may be economic or educational or social. that can be helping support them through this experience. We're also doing some future work with antibody results, as well. So, yeah.
I think, as we think about where to go from here, it is really important to be thinking about how we can reduce these inequalities and acknowledging that the pandemic has disproportionally negatively affected young adults from marginalized groups. And feel free to e-mail us, too, if we don't get to everyone's questions during the session today. Thanks. Lester: Good afternoon, I am James Lester. I'm a faculty member in computer science at NC State. I'm delighted to speak with you a bit about our project HealthQuest, which is a project that's collaborative between Elizabeth's group and my group at NC State.
We have been working together on this for something like maybe three or four years. That's part of an even longer collaboration that goes way back. HealthQuest is a fascinating project because it is really dealing with, in essence, a workforce problem. We're looking at what are some interesting ways, sort of substantively, addressing the biomedical, behavioral, and clinical workforce shortage. But doing that really early on.
We are focused, in fact, at the middle school level. So this is, as I mentioned, a collaborative project between UCSF and NC State. It's supported by SEPA, which is the Science Education Partnership Award program of NIH. HealthQuest, as you would imagine, for technology-based intervention, is the result of a team's efforts that's highly interdisciplinary. So, we've got folks from pediatrics. We've got Don Woodson from the Science Outreach and Education Center at UCSF.
Cathy Ringstaff, I believe is with us today, who's at WestEd. Randy Spain, a research psychologist. Just to pop back. We've also got our digital artists and our software engineers and the folks that they direct, as well.
So we're really looking at kind of a broad range of health careers. We're going all the way from public health to nursing to sort of basic STEM science to nutrition to mental health and to lab tech. So really looking across the spectrum from careers that require maybe a modest amount of education to those that might require a significant investment over a good number of years. And the reason we do this is that we're really trying to attract a broad range of folks to biomedical careers. And doing it in a way that is deeply engaging, as you'll see.
So the mechanism that we're using, and this is based on work that's been ongoing for about 15 years in our group, on game-based learning, is taking the technologies that have emerged in the game industry, and this is a result of enormous, enormous sums of money to create game engines that produce tremendously interesting experiences for users, and marrying those with what we know about pedagogy and how to design meaningful learning experiences that are highly engaging, highly interactive, deeply motivating, and really promote learning in a way that is perhaps a different kind of experience then students have had previously. The objective of this work is really to have a workforce impact by, in essence, hooking in kids when they're in middle school and alerting them to what are some really interesting opportunities that, otherwise, they might not be presented with. So we know that there are workforce shortages, and there is a great underrepresentation of women and racial and ethnic minorities in health science professions.
We also know that there is this fantastic opportunity in adolescence for really promoting interest and increasing self-efficacy for students to engage in these kinds of careers. What that means is, fundamentally, really promoting middle school students' interest in health science careers by taking what we think is a very kind of technology-rich approach to learning. In many ways, the best way to sort of get the flavor for this is to kind of see, in action, how a game like this might work.
So if the folks could roll the video here, that would be great. ♪♪ ♪♪ ♪♪ ♪♪ ♪♪ ♪♪ ♪♪ ♪♪ ♪♪ ♪♪ ♪♪ "Crystal Island" is the basis for the HealthQuest intervention. "Crystal Island" is an interesting experience, both from a learner's perspective, but also from a researcher's perspective. So this is a game-based learning environment, that has undergone many, many iterations over many years. It's been often -- Folks think it's very difficult to design either a game or a learning environment, and of course, designing them both together to work in concert is even more challenging. And it does take many many iterations to get an experience that really is effective but also engaging.
We found that it's essential to provide tools that can address cognitive load kinds of issues. And for HealthQuest in particular, we are really interested in having the students experientially learn what it's like to take on the role of health career folks. And what that means is, in this case, for public health, solving a mystery by collecting data, by interviewing characters, by forming hypotheses, ruling out potential hypothesis because they don't present the data, and so forth. And what COVID has presented us with is a particularly interesting opportunity because we would like to, in essence, invent COVID into the game. So that means incorporating new symptoms that the virtual characters might experience. It means introducing new causes into the diagnosis worksheet.
And even new ways for collecting data, for example, on surfaces and objects. It also entails expanding the dialogue significantly so that the characters will discuss not only new symptoms, but how they are experiencing these. So it's been kind of an unexpected experience to create this COVID version because it really makes a difference to kind of ubiquitously embed in the game information about COVID. There are virtual posters that are around the learning environment. There are many textbook entries. I should have mentioned that the game itself is NGSS-aligned and also includes literacy for complex informational text.
And some of that language is in pamphlets about COVID. And we have, of course, been working very closely with medical experts, to ensure the accuracy of the information in the game, which, of course, is a bit of a moving target. We've also been adapting the technology behind the scenes.
So one of the most significant effects of COVID from a learning perspective is having this need to be able to deliver learning experiences like this, not in the classroom, for which it was originally designed, but actually in the home. And what that means is having a real ability to cope with the kinds of lower-cost devices that we find in homes, especially Chromebooks and tablets. So we've been working on not only delivery on those platforms, but also new cloud architecture that can support very large simultaneous implementations of the learning environment. We're limited in time today, but I also want to mention that there are two other components that are somatically tightly integrated into the HealthQuest experience, as well. One of these is the collection of the career adventure episodes that are really featuring, we think of it as kind of mini games that students can become involved with for each of the health professions and career explainer videos that provide in-depth information grade-appropriate for middle schoolers, to introduce students to these kinds of activities.
And complementing all of this are a set of really beautifully produced videos from folks that are just beginning, or maybe early on in their career paths, that's then produced at UCSF, and those are really going to be a plus for this project, I think. So we have, like the rest of the world, development modified implication plans for pilot testing. So we are eagerly awaiting the ability to pilot this in North Carolina and California. Broad dissemination, as I mentioned, both during and post-COVID. And also have been developing teacher resources, for the HealthQuest web site.
So, thanks so much for your attention. And we look forward to your questions. Foney: Great. So, thank you all so much for an informative and interesting presentation. We really appreciate you taking the time to share your expertise and innovations with the MCH community. So now we're ready for the question-and-answer period.
So we have a question for Dr. Cohen and Dr. Hoyt. You reported that 20% of the respondents in your survey were Asian or Pacific Islander. So, considering the prejudice towards Asians during the COVID pandemic, I'm curious whether they experienced more stress and anxiety during the pandemic than other groups.
Cohen: Yeah, great question. So, we looked at that actually in a few different ways. One of the things was that, based on the anecdotal observations that were starting to come in, we actually asked about discrimination. In our April survey, to see who was experiencing discrimination, those results are in our first "Journal of Adolescent Health" paper that's available as a link. What we found there was that relatively few of our participants had experienced discrimination, which is lucky, but most of the people who had experienced discrimination related to COVID, at that point in time, were Asian. We also did look at, when we were looking at the racial and ethnic differences in stress and anxiety, most of the findings weren't statistically significant.
The only statistically significant finding that we had on that front actually was that Asian participants had lower anxiety than white students. So, no, we didn't end up seeing that, but we also -- 20% of Asians is a relatively large proportion of our population. So we did have statistical power, but I think it's certainly also going to be worth continuing to replicate in future studies, as well. Foney: Perfect.
Cohen: Yeah. Replicate the testing. Not necessarily replicate the findings. Foney: Right.
Okay. This question is just for all of the speakers or any of the speakers. So, what are some lessons learned or best practices that might apply beyond COVID-19 in terms of the delivery of clinical care to adolescents and young adults? Cohen: I'm happy to start answering the question. I think one of the things that we have been reflecting on is that it seems like some of the impacts that we are documenting now are potentially going to live with people for a while. And, so, thinking about how we address these inequalities and some of the long-ranging sequelae that we don't yet know what they are, 'cause not enough time has passed, is going to be really important to think about.
But that's one of the things that we've been thinking about. is kind of sharing this with the idea that it's worth acknowledging that these inequalities are taking place and thinking about some personalized solutions at the clinical level to try to address the population level inequalities in addition to thinking about some of these public health interventions and social policy interventions that might be able to help reduce these inequalities on a larger scale. But it does really feel like it's going to need to be and all-hands-on-deck effort. Ozer: Hi, I can also respond to that question.
It's Elizabeth Ozer. I think it really speaks to, you know, we've focused on the specifics -- and I noted that there was our collaborators, and if Dr. Irwin's on, you might want to talk about this a little bit more -- but in terms of telemedicine and adjusting to telemedicine very quickly. But I think that what has been raised is just so many of the ways that we deliver care, and while there certainly will be some in-person visits, I think we're really rethinking so much of how we integrate what we do in terms of delivery of health service. And in terms of my background, I'm thinking about clinical preventive services, how do we integrate that? Are there different ways to do that? Healthy check, which is something we've been working on to integrate screening into care, that was originally being done in the waiting room. Now we're modifying that so that can be done before a visit.
The parent engagement tool, which I'd mentioned that we were developing, was originally developed when a parent came in to a primary care office. And, so, we're now really rethinking that. And in fact, one of the things I didn't talk about in the presentation, but we realized we had to hear a lot more, also, from parents about what they were interested in now and were able to actually add a few questions to the CDC survey of adolescents and parents, in which we're going to be asking parents more about how they'd like to receive information, and what they'd like to receive from providers, and how they'd like to receive information in other ways. So I just think, on sort of every level in which we are delivering care, I think this is making us rethink. Foney: And I see one question.
What was the sample size in the Cohen study? It looks like that is 707. Cohen: Correct. Yes, sorry. I think I replied privately. So, 707 for the baseline. Then we had about a 544. Although I think sometimes our sample size was 543 -- there was one person who didn't respond to all of the questions -- for our July survey. But all of the numbers are in the second paper, too.
Foney: Wonderful. Okay, so, I'm not seeing any additional questions come in. Ozer: Can I just have a -- Sorry, could I just do a follow-up -- this is Elizabeth -- to Alison. And one thing that she just mentioned very briefly at the end but talked about the follow-up. It just reminded me with this question about the sample.
of the antibody testing. And I think it might be great if you could just talk a little bit about the follow-up that's also going to be happening with the sample. Cohen: Sure. So, yes, what I didn't talk about in the 10 minutes that we had was we were just kind of featuring some of the data that we had collected. We also did interviews of the subsample of participants over the summer.
We've also done photo/voice data collection with participants. We also did a third survey that just wrapped up, third survey wave. But what Elizabeth was mentioning is that we also -- all participants had the opportunity to provide us with an antibody sample. And so, that was a dried blood spot. And that was in collaboration with some colleagues at Northwestern. And so, we are -- The postdoc is about to start analyzing those data right now.
So that was one of the things that was interesting, just in terms of us being able to look at antibody results alongside the pretty detailed behavioral and symptomatic data that we have from our surveys, as well as all of the sociodemographic data that we have, as well. And so, we're looking forward to understanding those who volunteered to participate in antibody testing, given that that might be increasingly of interest to colleges and universities just in terms of who is participating, you know, not just in antibody testing but potentially in voluntary COVID testing or in the first round of getting vaccines, when that becomes available to college students. Getting a sense of who volunteers for being more deeply engaged with COVID-related testing opportunities. And then, also thinking about, "Okay, so which of these people did end up actually having COVID?" Foney: There's one other question I see for the Cohen study. Did you look into stress differences based on colleges that were in person versus remote? Cohen: So, we will be able to do that with the data that we just collected.
The data that we collected in April, that was when all but a handful of colleges and universities across the country were remote. And then in July, folks weren't necessarily in school during the summer months. But, for our fall data, we will be exploring that. So I guess stay tuned for a future presentation.
Foney: And for Dr. Lester, did you want to speak any about some of your plans moving forward in your work? Lester: Sure. Yeah, so it's a really interesting kind of transition window that we're in right now, from the K-12 education perspective. So, just up the street from me right now, kids are back in school physically.
We'll see how long this lasts. But what we really expect is there will be blended learning experiences, blended in lots of different sort of nontraditional ways, than we have seen before. And learning technologies will have to adapt to that. So it's gonna be really important for these kinds of technologies to work just as well in the home as they work in school.
And then, we'll also be looking at sort of, like, outside of school, perhaps after-school kinds of experiences, too. So, it's an interesting time. But we're all, I think, making great progress. Ultimately, we're gonna come out stronger because we're gonna have more mechanisms, more avenues for introducing the students to these really interesting career paths that, before, they wouldn't been able to. Foney: How were the video games received by the users? Did they have similar interests as compared to other regular games? Lester: It's interesting.
It's completely dependent on the context. So in a school setting, it's kind of counterintuitive. So if you were to go to a middle school classroom that's using a game-based learning environment that's well-designed, that's been thoroughly tested, that's been refined over many years, what you would find is a very, very attentive classroom.
So, unexpectedly, expectations by the students are considerably, you might say, lower, than for AAA game titles. On the other hand, in the home setting, our guess, and we don't really know this yet, but expectations will be the same as they are for other games that students use. So these are really context- dependent kinds of phenomenon, and we have to figure out how to best design for this. Foney: Looks like we have another question coming in for Dr. Cohen.
So, in the follow-up survey, what questions will you ask? Do you have questions about vaccine? Just expand that a bit. Did you gage the interest of college students in getting vaccinated, given all the information and maybe some of the misinformation out there? Cohen: So, yeah, what's kind of crazy is that we actually got IRB approval for it, like, in early November, and then, like, the first week the survey was in the field was when all of the vaccination news came out. So, unfortunately, that follow-up wave, we do have some questions about vaccination. But for some of the participants, it was much more hypothetical than it is now. So hopefully we'll be able to do a follow-up, another survey wave this spring and be able to get a bit more data on that, especially as it becomes a lot more real for a lot more people. So definitely interesting and worth studying.
Foney: We have another question about the HealthQuest game. So how easy is it to be adapted for other purposes, for example adding health-related messaging? Lester: That's a great question. So, in fact, we're sort of referring to it as a single game.
But it has an interesting history. So it began strictly as microbiology. As I mentioned, NGSS-aligned, so it works great in classrooms. With funding from the Gates Foundation, we expanded to not shift away from but to actually integrate in complex informational text. So looking at questions of literacy in the context of problem-solving. After that, we began looking at salmonella questions through some funding from a different agency.
And through many, many, many projects through the National Science Foundation, in collaboration with folks around the country, we've been looking at capabilities for self-regulated learning, metacognition, looking at different grade levels. So there are Crystal Islands that have been developed for upper elementary. So, in fact, different health messaging, for example, behavior change, which is something that is near and dear to Elizabeth's heart, is something that we've thought a lot about. We have another collaborative game-based learning project currently funded by NCI that's looking at behavior change or risky behaviors for adolescents around alcohol use. That particular project has, of course, a different set of characters and a different setting.
But these games, when they are designed in kind of a modular fashion from the ground up, do lend themselves to kind of different repurposings for different domains at task and student competencies. Ozer: Wonderful. Thank you. I just wanted to -- This is Elizabeth. I just wanted to add. So I wanted to say that one of the things that James didn't get to show in this that may not have been as clear is that, actually, there are public health messages so that when we updated this to talk about COVID, one of the things that the students learned is they not only learn the symptoms, they learn about how to prevent.
And what they have to do is, when they're trying to figure out, you know, sort of, at the end, what the quizzes are, they're answering questions both about how they're trying to figure out what this outbreak might be, which, by the way, is not COVID, because we didn't want to be dealing with that, with them actually having COVID, but they're both figuring out the symptoms, but they also have to answer questions about prevention for all these various potential outbreaks, because that's part of what they're learning. So it very much was a great way to integrate public health messages to this group. And as James said, you know, one of the things clearly is those were evolving. So when we started this in the spring, there were certain messages, and then we have been constantly modifying them. And, actually, one of the questions that was differentiating from some of the other outbreaks was originally there was no vaccine.
Now, we've literally just modified this and the text that goes in these little books and in the game, you know, in the last month to reflect the vaccine. So it very much is about, you know, education and public health. And then, I think we were trying to keep this brief, and probably we could have shown it, but we also have done a very fun explainer video that talks about what it's like to be in each of these professions. And we call them explainer videos, 'cause in addition to all the games they're playing and the role models they see, that we also really have this nice, fun text that sort of has been done with an artist and cartoon to really talk about the professions. And so, we have a public health one.
And that, again, is very much about messages, about public health. And then, as James noted, this other project is a different project that's funded by NIH. But we're focusing on a game for teens on reducing risky alcohol use. And this is for high school students, in which it's all about health behavior change and modeling and integrating social cognitive theory and vicarious learning, interchanging behaviors. So, there's really lots of different ways to apply this.
Oh, and by the way, that gets linked to primary care. So the other game that's on behavior change is really linked to when a teen goes into their primary care office and is potentially using alcohol. Foney: We have another question.
Who has access to the HealthQuest game right now? Is it possible to roll out for an online app so many kids can have access to it? Lester: This is James. I can take that. Just send us an e-mail or go to the website, and you'll get the current version of the Crystal Island learning environment. And we're becoming very close on a couple of different fronts. One I mentioned, I think, that there is a significant push for the back end, to support kind of broadscale implementation.
And the second is that we're narrowing in on getting the current COVID information into the game, as Elizabeth mentioned. But just send us a note or go to the website, and we'll get you set up. We would love for you and your kids and your kids' schools to use Crystal Island and HealthQuest.
And we'd be very pleased if you contacted us. Foney: All right. Thank you. Okay. So, we will pause there. And if folks have additional questions, please continue to submit them, and we will gather them and circulate them among the presenters for follow-up.
So we'd just like to thank each of you again for such a great presentation and for taking the time to share your expertise. So, we're nearing the end of the program. After the webinar, each participant will receive a request to complete an evaluation. We hope you'll fill this out and provide the NSCH Division of Research with feedback on today's event. Your responses will really help us plan future webinars in the EnRICH series. Thank you again for your attendance and participation.
I also want to thank Kara Wise, Holly Doggett, and Meghann Cash at Altarum for helping organize this event. An archive of today's webinar will be available on the Division of Research website in several weeks. Thank you, and have a wonderful afternoon, everyone.