Virtual Reality for the Prevention and Cessation of Nicotine Vaping in Youths: Protocol for a Randomized Controlled Trial.

Abstract

Background: Only a few trials target high school-aged teens with vaping interventions, typically focusing on prevention rather than cessation, with content limited to vaping harms and refusal skills. Given the co-occurrence and increasing incidence of vaping and mental health issues in teens, both must be simultaneously addressed by vaping interventions.

Objective: This randomized controlled trial aimed to evaluate the feasibility and preliminary efficacy of a virtual reality (VR) intervention for teens that targets both determinants of vaping (eg, mood and stress) and vaping prevention and cessation skills.

Methods: The participants are 150 students attending 1 of 2 racially and ethnically diverse Boston-area high schools. Health classes are randomly assigned to VR or control (assessment only). Students are eligible if not opted out by their parents, provided assent, and did not have health issues that preclude participation. While control classes (and ineligible students within them) have their regular classroom activity, VR classes are provided with Oculus Meta Quest 2 headsets and engage with the intervention during 3 class periods, once per week. Players solve a mystery with a vaping subplot and play a series of minigames to teach emotional regulation, coping strategies, and building resilience. A mobile app connects to the VR game, providing a home-based experience to reinforce skills learned. VR and control classes complete baseline and postintervention surveys on the same schedule. Primary outcome measures include feasibility, satisfaction and engagement with game play, and vaping awareness, knowledge, attitudes, and intentions to avoid or quit vaping. Secondary outcomes include vaping quit attempts, 7- and 30-day point prevalence abstinence, motivation and self-efficacy to quit or avoid vaping, positive and negative affect, emotional regulation and coping, and motion sickness.

Results: The project was approved by the institutional review board on April 2, 2024, and data collection began in April 2024 and concluded in June 2024, and 150 participants were recruited (98 intervention and 52 control). Although freshmen and sophomore classes were targeted in this study, there were several juniors and seniors (n=5) in these classes due to school transfers and the need for them to take the mandatory curriculum. Data cleaning has been completed, and analyses are ongoing. The results are expected to be submitted for publication in August of 2025.

Conclusions: As VR is visual, auditory, and tactile, it is ideal for practicing skills, facilitating memory, and increasing the likelihood of transfer to real-world settings. The immersion of VR promotes engagement with the intervention, rather than external digital temptations. Our study is innovative due to the cluster-randomized design, focus on both prevention and cessation, integration of mood management, and implementation among racially and ethnically diverse teens. Incorporation into school-based health curricula allows for proactive reach.

Trial registration: ClinicalTrials.gov NCT06003439; https://clinicaltrials.gov/study/NCT06003439.

International registered report identifier (irrid): DERR1-10.2196/71961.