A Metaverse Program to Prevent E-Cigarette Use Among Adolescents: Pilot Mixed Methods Study

Abstract

Abstract Background E-cigarette use among adolescents presents challenges distinct from traditional smoking issues. The perception that e-cigarettes are less harmful and their distinctive appeal as a means of sensation seeking among adolescents suggest that traditional smoking prevention programs may not guarantee effectiveness in preventing e-cigarette use. Therefore, there is an urgent need for educational interventions to prevent adolescents from using e-cigarettes. Objective This pilot study aimed to assess the potential of the Meta Nodam program, a novel metaverse-based educational initiative to enhance adolescents’ resistance to e-cigarette use and increase their engagement in preventive education. Methods The Meta Nodam program was developed on the Roblox platform, designed to promote autonomous engagement and health-related decision-making among adolescents. The study included 120 participants in a 2-session intervention over 2 weeks, each session lasting 45 minutes. Changes in key cognitive outcomes (e-cigarette use intentions, attitudes, norms, self-efficacy, and interest development) were examined using pre- and postintervention surveys. In addition, focus group interviews with 10 participants were conducted to gain deeper insights into participants’ experiences. Results Quantitative analysis showed a significant within-group increase in e-cigarette–related self-efficacy (=–3.171;=.002), whereas no statistically significant pretest-posttest differences were observed in intentions (=–0.846;=.40) or attitudes (=−0.080;=.94). Qualitative findings explained and expanded these results by indicating that immersive metaverse experiences made e-cigarette–related risks more tangible, encouraged peer discussion, and promoted reflection on e-cigarette–related decision-making. Participants also described the program as engaging and reported interest in further exploring information about the health risks of e-cigarette use. Conclusions Owing to the short duration of the metaverse experience, limited to 2 sessions over 2 weeks, the program did not measurably alter adolescents’ attitudes or intentions regarding e-cigarette use. However, it was associated with enhanced e-cigarette–related self-efficacy and demonstrated the applicability, usefulness, and attractiveness of the metaverse program. This study highlights the potential of digital platforms such as the metaverse for health education, emphasizing user engagement, interaction, and experiential learning in preventive education. Future research should consider broader participant demographics and more robust experimental designs to more rigorously evaluate the potential of such interventions.