Invite Only VR: Evaluation of a Vaping Prevention Game
E-cigarette use and vaping among adolescents is public health concern.
One of the top preventable risk factors for premature death among today’s adolescents is the widespread use of e-cigarettes. E-cigarette use exposes adolescents to nicotine and carcinogenic toxins and is associated with a five-fold increase in the likelihood of initiating conventional cigarette smoking, which puts youth at a higher risk for developing cancer, cardiovascular disease, and lung disease. As adolescents transition back to in-person learning within schools, experts are concerned the environment is primed for a surge in vaping rates, indicating the need to invest in vaping prevention efforts.
Funded by the National Cancer Institute, Funded by the National Cancer Institute, our team is currently optimizing Invite Only VR, a single-player, narrative-based virtual reality vaping prevention videogame intervention for 8th grade students. In the current prototype, players follow Mike, a ninth-grade student at the fictional Unity High School, over the course of three school days as he tries to find an invitation to an exclusive “Invite Only” high-school party. Along the way, the story places him in realistic school and social situations where vaping, peer pressure, stress, and relationships become part of the decisions he has to make. Vaping prevention content and coping skills are embedded throughout the narrative through conversations, health-class activities, environmental cues, and interactive mini-games.
Our team partnered with schools in Connecticut and Massachusetts to test the game with 8th grade middle school students through playtesting sessions, focus groups, and staff focus groups and interviews across schools in Connecticut and Massachusetts from Fall 2025 to Spring 2026. We are currently using the findings from this study to optimize the game for our larger evaluation and implementation cluster randomized controlled trial beginning Spring 2027 across 20 schools in Connecticut and Massachusetts.
Yale-Connecticut Principal Investigators
- Kimberly Hieftje, PhD
Associate Professor of Pediatrics (General Pediatrics) - Deepa Camenga, MD, MHS, FAAP
Associate Professor of Emergency Medicine
Massachusetts General Brigham - Massachusetts Principal Investigator
- Randi Schuster, PhD
Associate Professor of Psychology in the Department of Psychiatry
Under funding from the CT Department of Public Health, our team pilot-tested the prototype version of Invite Only VR. Our team partnered with local schools in CT to create the game based on school administration (i.e. teachers, school counselors) and adolescent feedback. In Fall 2025, we closed the study by implementing the game and collected feasibility and acceptability data from students.
Read our Community Report (2025) here!
Peer-Reviewed Publications
Camenga, D. R., Weser, V., Kurade, P., Van, S., Shaker, J., Schuster, R. M., DeTore, N. R., & Hieftje, K. (under review). From insight to impact: Novel qualitative approaches in the design of virtual reality videogames for substance use prevention. Prevention Science.
Weser, V. U., Hieftje, K., Shaker, J., Antwi, D., Singh, K. P., Schuster, R., & Camenga, D. (2026). School staff experiences with vaping disciplinary procedures in Connecticut schools: a qualitative study of middle school staff. Nicotine and Tobacco Research, 28(5), 809-816. https://academic.oup.com/ntr/article/28/5/809/8315125
Singh, K. P., Camenga, D. R., Aneni, K., & Hieftje, K. (2025). Beyond user-centered design: Designing digital health technologies for substance use prevention and treatment in children and youth. In J. L. Wells (Ed.), A clinical lens on pediatric engineering. Springer. https://doi.org/10.1007/978-3-031-84655-7_10
Weser, V. U., Duncan, L. R., Sands, B. E., Schartmann, A., Jacobo, S., François, B., & Hieftje, K. D. (2021). Evaluation of a virtual reality e-cigarette prevention game for adolescents. Addictive Behaviors, 122, 107027. https://doi.org/10.1016/j.addbeh.2021.107027
Weser, V. U., Duncan, L. R., Pendergrass, T. M., Fernandes, C. S., Fiellin, L. E., & Hieftje, K. D. (2021). A quasi-experimental test of a virtual reality game prototype for adolescent e-cigarette prevention. Addictive Behaviors, 112, 106639. https://doi.org/10.1016/j.addbeh.2020.106639
Oral Presentations
Kurade, P., Hieftje, K., Weser, V., Shaker, J., Schuster, R. M., & Camenga, D. R. (2026). Vaping to cope: Middle school students’ perceptions of the mental health impacts of nicotine and cannabis vaping. [Oral presentation]. Society for Research on Nicotine and Tobacco Annual Meeting.
Weser, V. U., Hieftje, K., Shaker, J., Schuster, R., & Camenga, D. R. (2024). Nicotine and cannabis vaping on school grounds: Perceptions of Connecticut middle school teachers, administrators, and staff. [Oral presentation]. Society for Prevention Research 32nd Annual Meeting, Washington, DC, United States.
Poster Presentations
Hieftje, K., Camenga, D. R., Weser, V., Bartush, S., & Shaker, J. (2026, May 26–29). Virtual reality for vaping prevention in middle schools: A CFIR-based assessment of implementation readiness. [Poster presentation]. Society for Prevention Research 34th Annual Meeting, Washington, DC, United States.
Kurade, P., Camenga, D. R., Weser, V. U., Shaker, J., Schuster, R. M., DeTore, N. R., & Hieftje, K. (2026, May 26–29). Evaluation and optimization of a virtual reality game for nicotine and cannabis e-cigarette prevention among middle school students. [Poster presentation]. Society for Prevention Research 34th Annual Meeting, Washington, DC, United States.
Kurade, P., Hieftje, K., Weser, V., Shaker, J., Berry, J., Van, S., Schuster, R. M., & Camenga, D. R. (2026). Evaluating a virtual-reality video game for nicotine and cannabis e-cigarette prevention in middle school students. [Poster presentation]. Society for Research on Nicotine and Tobacco Annual Meeting.
Conyers, S. G., Hieftje, K. D., Weser, V. U., Shaker, J., Kurade, P., Van, S., & Camenga, D. R. (2025). Exploring the duality of adolescent vaping discourse: A qualitative study of middle school students’ perceptions of nicotine and cannabis use in schools and communities. [Poster presentation]. Yale Pediatrics Research Forum.
Technology Demonstration
Camenga, D. R., Weser, V. U., Bartush, S., Shaker, J., Schuster, R. M., & Hieftje, K. (2026, May 26–29). Youth prevention through immersive technology: Invite Only VR. [Technology demonstration]. Society for Prevention Research 34th Annual Meeting, Washington, DC, United States.
Workshop
Camenga, D. R., Hieftje, K., & Kurade, P. (2026). Immersive technology–driven strategies to incorporate healthy coping and emotion regulation skills into cannabis and nicotine vaping prevention curricula. [Workshop]. 7th Annual Cannabis (and Other Drugs) Awareness & Prevention Conference, Halpern-Felsher REACH Lab, Stanford Medicine.