Abe Baker Butler, Contributing Photographer

Yale researchers are trying a new way to fight youth marijuana use and vaping addiction: a virtual reality video game. 

XRPeds is a Yale research group, founded in 2020, that uses virtual reality, or VR, to address pediatric health challenges. On Nov. 20 the project team announced that it is developing “ReHashed,” a new VR game that teaches students refusal skills, how to help others quit and the health consequences of marijuana vaping. The game will be implemented in three Connecticut schools in 2024. 

“I think for prevention, specifically, virtual reality is very effective because the kids are motivated to use it,” said Veronica Weser, an associate research scientist who helped design the game. “It’s really exciting for them that they get to play not only a video game, in school, but a virtual reality game. It’s so much more interesting than listening to an invited speaker giving a lecture at a school assembly.” 

The project leaders of ReHashed are Kim Hieftje, an assistant professor of pediatrics, and Deepa Camenga ’00 MED ’11, an associate professor of emergency medicine. The game was developed by Weser, Kanu Priya Singh, a postdoctoral associate at XRPeds, and Jake Shaker, a project manager at the research group.

To play the game, the player first puts on Meta Oculus headsets, which were donated by Meta. The game’s protagonist is a nerdy middle school student who is trying to get invited to an exclusive party hosted by their peers. Those peers then pressure the student to vape marijuana. According to Weser, the ReHashed narrative is a “choose your own adventure,” where students’ choices inform the story. 

All paths end with a marijuana vaping prevention outcome, and the player cannot choose to have the character vape. 

Hieftje said that the team decided to focus on marijuana vaping because they believe it is becoming an increasingly prominent and dangerous trend. While flavored e-cigarettes remain the primary driver of youth initiation, research shows that marijuana vaping poses increased health risks and is linked to increased use of other substances. Hieftje spotted the advent of Juul and nicotine e-cigarettes early. Around 2016, she began to study vaping, which she saw as a rising trend in tobacco addiction. 

According to Weser, the team originally designed “ReHashed” for eighth-grade students, but teachers and principals told the team that eighth-grade was too late. They wanted the team to reach students who had not already been exposed to marijuana vaping. 

“The goal of this game is prevention not cessation,” Weser said. “Kids are starting vaping as early as sixth grade. If we are trying to prevent them from vaping, we need to get them before they have started.”

Hieftje and Weser both emphasized that they are incorporating feedback from teachers, school resource officers counselors and students to ensure the game’s language and scenarios are realistic. The team also works with youth actors, who voice the avatars in the game, and they are also recruiting a formal Youth Advisory Board of local high school students to offer feedback. 

ReHashed builds upon Weser’s and Hieftje’s prior work with Invite Only VR, a nicotine vaping game with a similar premise that was tested in Milford public schools from 2019-2020 and published as part of a study in 2021. The results of that study showed high knowledge gain and student engagement, with some positive vaping behavioral change relative to controls. The game, published for free on the Meta store, was one of the Forbes Top 50 VR Games of 2019. 

Using funding from the Connecticut Department of Public Health, ReHashed will be implemented in health classes across three different southern Connecticut schools at no cost to schools. According to Hieftje, the team intentionally chose schools with different levels of socioeconomic status and urbanity to get an accurate data sample. Additionally, they plan to collect acceptability data from students and feasibility data from teachers through surveys. 

ReHashed’s state funding comes from Connecticut’s portion of the 2021 American Rescue Plan Act. Hieftje said that Connecticut State Senator James Maroney helped mobilize other senators to secure funding for the program. In an interview with the News, Maroney said he was happy to help, calling the project “a great use” of funds for prevention.

“I’m excited because it’s an innovative program — it’s a way to reach students not necessarily in their own idiom but in a way that’s fun for them,” Maroney said. “[It is] a way that they’re used to interacting through games and to use that to develop positive outcomes.”

Still, the team said that there are obstacles to implementing VR in the classroom. For example, because the team intends for students to play the game over three 45-minute sessions, each student has to have the same headset each time they resume the game. Additionally, the team has to disable the internet and remove all other applications from every headset. 

Hieftje also said she was worried about whether students were excited about the game due to the novelty of VR, rather than the game’s content. 

Justin Berry, the creative producer and project director at XRPeds who did not work on the ReHashed game, said he believes VR technology is inherently powerful because it enables users to experience phenomena without facing their actual consequences.

If the middle school results are successful, Hieftje said that the team hopes to expand its reach and adapt the game for non-English speakers, students with disabilities and those who can not use VR headsets. 

“Our goal is to make [ReHashed] accessible to all schools and every child within Connecticut,” Hieftje said.

Hieftje said that XRPeds is the only research group running VR-based youth vaping prevention projects. The News had the opportunity to try out the game in full VR at XRPeds’ new space, the Yale Center for Immersive Technologies in Pediatrics, which opened in August. The Center invites interested members of the Yale community to contact them to play the game and engage with XRPeds.

In 2022, 21 percent of 12th graders reported vaping marijuana in the past year, an increase from 9.5 percent in 2017.