On a typical day at East Shore Middle School in Milford, the library is where students spend time using the computers, working on projects and checking out books.
But on a recent Monday morning, about a dozen students sat at tables, each with a virtual reality headset strapped onto their faces and a controller in one hand. Instead of seeing each other, Tino Pavlat and his friends interacted with people at a virtual high school and played Space Cats, a shooter minigame.
“I liked that, like, it was real voices instead of like a robot,” he said. “Space Cats was fun. We want Space Cats to be its own game.”
Pavlat, 12, is among 300 seventh and eighth grade students in the Milford Public School District who are part of a randomized, controlled trial run by the play4REAL Lab at the Yale Center for Health and Learning Games.
Researchers developed a virtual reality game on vaping prevention and are looking at how effective it may be in reducing the rising rates of e-cigarette use by teens.
Data from the Connecticut School Health Survey showed that nearly 15% of students have tried vaping, up from 2.4% in 2011. Nationally, about 1 in 4 high school students used an e-cigarette product this year, according to the U.S. Food and Drug Administration.
Veronica Weser, a postdoctoral research associate at the play4REAL Lab, is on the team that helped create “Invite Only,” a free game that includes educational activities and the Space Cats minigame.
Made for Oculus Go, a virtual reality company and store, student players become characters in a high school environment -- they’re put in situations where they get offered vaping products at school or a party, and they have friends whom they’re trying to help quit.
“We really hope that this game is going to arm kids with the facts and information, and make them feel empowered to talk to their friends who may be vaping or who may be thinking about vaping,” Weser said.
The game was released at a time when local and national legislators and public health officials are looking for ways to more strictly regulate e-cigarette products in order to prevent teen use and limit health risks for illnesses like vaping-related lung injury.
The Yale project was funded by Oculus and created with New Haven-based game developer PreviewLabs Inc. The game includes recorded voices from local actors, and the virtual school is modeled after Jonathan Law High School in Milford.
About half of the 300 students will serve as a control group -- they won’t play the game, but they will complete questionnaires throughout the year using information they’ve learned in health classes and other school-based campaigns. The experimental group contains students who are playing the game.
Weser and her colleagues Kimberly Hieftje, play4REAL Lab director, and Brandon Sands, postgraduate research associate, will follow up with the kids in three and six months to learn what educational information sticks with the students and where teens remain confused.
“So we’ll be able to see, did most of the kids miss the ‘Juul is not a cigarette’ question, which is something really common,” Weser said, “or was it mostly kids thinking that, ‘It’s not an aerosol, but water,’ which is part of the marketing campaign of a lot of these e-cigarette companies.”
Riley Simons, a seventh grader at East Shore Middle School, sat among classmates in the library as she played the game. She ran through a dialogue exercise aloud with two characters in the game, Mike and Yumi.
“How about using a free texting app program? Just text quit to 47848,” Simons said.
“That’s a good start, but what else can I do?” asked Yumi, a virtual high school student who is trying to quit vaping. “It seems like this is going to be harder than it seems.”
Simons picked a response from the offered options in the game and asked, “How about talking to someone you trust, like your doctor or your mom?”
Although she doesn’t personally know anyone who vapes, Simons said she knows there are kids her age who do it.
“It’s a middle school, a lot of times people make some bad decisions, but I really learned a lot more about it through the game,” she said. “I didn’t know what a Juul pod was before, but I actually know what that is now.”
Federal data show that the most common reasons students use e-cigarettes include use by a family member or friend, the availability of flavored products, and a belief that they are less harmful than other forms of nicotine like cigarettes.
Simons said the game helps sort out some of that misinformation.
“Because if you don’t learn, you’re going to get addicted to it and it’s so, so bad for you,” she said. “And it’s really important that people our age are learning and knowing about it because we can’t fall into peer pressure, we have to learn.”
Similar games and educational tools already exist, but Weser said virtual reality is a platform that uses sensory immersion, which can be attractive to a generation of kids who no longer consider things like computers, smart tablets and phones to be novel.
Accessibility to the vaping prevention game, however, is limited -- it can be played only with Oculus virtual reality headsets and controllers, which cost about $150 or more. But Sands said schools and educators are making early investments in the technology, eager for new tools they can use to address vaping.
He anticipates that the controlled trial will produce scientific data that will show how effective the game is toward changing students’ beliefs, knowledge and intentions regarding e-cigarettes and vaping. Sands also hopes the game has far-reaching prevention outcomes.
“If we reach one person and they reach three people, then the potential for that kind of domino effect is, it’s a very real opportunity there,” he said.
Yale researchers hope to have final data results from the trial by next year.