Abstract

Introduction

Alcohol, vaping, and other drug (AOD) prevention for youth remains a pivotal public health concern, particularly in countries with high rates of underage substance use. In Australia, underage alcohol consumption declined significantly from the early 2000s to the late 2010s, with a notable increase in the proportion of teenage abstainers. However, since 2019, this trend has plateaued, and rates of underage drinking have begun to rise again. Currently, approximately one-third of Australian adolescents aged 14–17 report consuming alcohol in the past year (Australian Institute of Health and Welfare 2024b). Parallel to this, the use of e-cigarettes among young Australians has increased substantially. In 2023, 9.3% of individuals aged 18–24 reported daily e-cigarette use, highlighting the growing prevalence of vaping among younger demographics (Australian Institute of Health and Welfare 2024a). Emerging nicotine products, such as nicotine pouches, are also gaining popularity among Australian youth, further complicating efforts to address substance use (Jongenelis et al. 2024, Watts et al. 2024). Compounding these challenges, recent research shows that young people are frequently exposed to online marketing of nicotine products, despite advertising restrictions in many Western countries. Misinformation about health and wellbeing is also increasingly circulated by social media influencers, whose content is often viewed as credible due to high engagement and parasocial relationships. Mulcahy et al. (2025) demonstrate that high-virality influencer posts can lower perceived deception and facilitate the spread of misinformation, especially when accompanied by supportive user comments. These dynamics create a digital environment in which adolescents are vulnerable to misleading substance-related content, highlighting the need for forward-looking, media-literate interventions that strengthen critical thinking and digital discernment. McGlinchy et al. (2025) similarly found that children as young as 11 frequently encounter vape and tobacco marketing online, where traditional advertising restrictions are often ineffective. Buchanan et al. (2018) further show that digital marketing negatively shapes young people’s attitudes and behaviours towards unhealthy products, with peer-endorsed content blurring boundaries between advertising and social interaction. In parallel, adolescents today are growing up in a digital-first environment that strongly influences their health behaviours and perceptions. As Raeside (2025) explains, adolescent health promotion must evolve alongside young people’s digital engagement habits by using community-based and digital-only platforms that reflect their lived experiences and expectations. This involves prioritizing youth voice, digital safety, and participatory design to avoid reinforcing inequities and to address emerging digital determinants of health. In a world-first effort to limit young people’s exposure to harmful online environments, Australia has restricted social media use to individuals aged 16 and over, highlighting growing concern about risks in unregulated digital spaces.

Amid these developments, schools continue to play a central role in universal AOD prevention by providing structured opportunities to shape young people’s attitudes and behaviours before risky substance use patterns emerge. Schools are uniquely positioned for this work because they reach most children and adolescents during key developmental years. The literature shows that social and emotional factors, including peer influence, social norms, and perceived acceptance within family and school environments, are important drivers of adolescent AOD behaviours (Biles et al. 2025). The school environment has long been central to public health and educational interventions. Traditional school-based AOD programmes, such as didactic seminars, health education units, and expert-led presentations, aim to delay initiation and reduce substance use by increasing knowledge, shifting attitudes and norms, and enhancing self-efficacy. Yet these approaches often suffer from low engagement, limited personalization, and poor translation of knowledge into practice (Liu et al. 2022, Gardner et al. 2024). In contrast, emerging approaches such as immersive virtual reality (VR) offer a new vehicle to engage young people through dynamic and experiential learning. VR allows students to actively participate in simulated environments that replicate real-life social scenarios, making abstract concepts more concrete and emotionally resonant (AlGerafi et al. 2023, Marougkas et al. 2024). By embedding decision-making moments within engaging narratives and real-world 360° footage, VR can support adolescents in critically reflecting on substance use, rehearsing resistance strategies, and building confidence in navigating risky situations. However, despite growing interest, few AOD programmes have integrated or rigorously evaluated VR interventions targeting adolescent substance use, largely due to technological barriers such as cost, equipment requirements, and setup complexity. While VR is known to be engaging (Jiang et al. 2026), its potential remains underexplored, as existing studies often rely on limited outcome measures, leaving a critical evidence gap. Building on this knowledge base, this paper examines the implementation of a VR intervention component of a larger AOD programme aimed at high school students. It builds and expands the existing evidence base and explores how VR can influence a range of psychological, emotional, experiential, and behavioural factors such as engagement, immersion, emotional responses, peer resistance, critical thinking, problem-solving, and overall satisfaction. By supporting harm minimization approaches and strengthening practical decision-making and refusal skills, VR offers a promising tool for prevention particularly in the face of growing digital influences on young people’s perceptions and behaviours.

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Source: https://academic.oup.com/heapro/article/41/1/daag002/8441976