Table 1 Study characteristics and findings for 43 studies

Web-based interventions

  Bertholet, 2015 [61]

Switzerland

Alcohol

Alcooquizz

Elicited normative feedback on alcohol consumption and consequences per occasion; risk indication, alcohol and health info, recommendations

Young men (n = 737) with unhealthy alcohol use; mean age 20.75 (SD: 1.13)

Brief intervention; Personalized normative feedback

2 parallel-group RCT:

-greater reduction in drinks/wk. for intervention group vs. controls at 6 mo.; favorable intervention effect on AUDIT group vs. controls

  Brunette, 2018 [62]

USA

Tobacco

Let’s Talk about Smoking

Brief, interactive, web-based, motivational intervention; info on smoking risks, exercises for self-efficacy, treatment, and treatment cessation; guided, 3-module program; personalized report

Young adults who smoke with severe mental illnesses (n = 81); mean age 24.8 (SD:3.6), range 18–30

Motivational decision support

Randomized pilot study:

-more intervention users had biologically verified abstinence at 14 wks. vs. comparison subjects

  Champion, 2016 [63]*

Australia

Alcohol/

Cannabis

Climate Schools Alcohol and Cannabis course

12 lessons, 6/term offered at 6-month intervals; interactive online cartoons, teacher-delivered activities; info on minimizing harms of alcohol/cannabis use; aims to challenge perceptions of peer drug use, build resistance

Secondary school students (n = 1,103); mean age 13.25 (SD: 0.47), range 13–14

Social Influence; Harm Minimization approach

Cluster RCT:

-sig. greater alcohol/cannabis knowledge at post-intervention, less alcohol consumption, and less intention to use alcohol in future for intervention group vs. controls

  Newton, 2018 [64]*

Australia

Alcohol /Cannabis

CAP (Climate and Preventure) program

Two 90-min. group sessions delivered by clinical Psychologist; education; negative coping behaviors identified and challenged; coping and goal setting; analysis of physical, cognitive and behavioral responses

High school students (n = 1,712); mean age 13.3 (SD: 0.48)

Cognitive Behavioral approach; Psychoeducation

Cluster RCT; 3 intervention groups, 1 control:

Universal Climate and combined programs increased cannabis-related knowledge up to 2 years; no sig. differences intervention vs. controls for cannabis harms and cannabis use

  Teesson, 2020 [65]*

Australia

Alcohol /Cannabis

Climate Schools Combined Intervention

Six 40-min lessons on reducing anxiety and depression; same format as substance use course; incorporates skill acquisition, psychoeducation, management of psychological and cognitive symptoms and behaviors

Secondary school students (n = 6,386), mean age 13.5 (SD: 0.6), range 13–14

CBT; skills acquisition; Psychoeducation; Climate schools approach

Multicenter, cluster RCT:

Combined intervention group increased knowledge re alcohol and cannabis, mental health; reduced odds of drinking, heavy episodic drinking, less increase in anxiety vs. controls

  Davies, 2017 [66]**

UK

Alcohol

Two interventions: “OneTooMany”: a social embarrassment questionnaire and “Drinks Meter”: a personalized feedback app about personal drinking habits in relation to those of others

Young adults who drink currently (n = 488); mean age 21.70 (SD: 3.28), age range 18–30

Comparative behavior change techniques; Personalized normative feedback

RCT:

Insufficient power to detect group differences

  Deady, 2016[67]

Australia

Alcohol

DEAL Project

Automated, web-based self-help intervention for problematic alcohol use and depressive symptoms; 4 one-hour modules completed over 4 weeks; attention-control condition (Health Watch)

Young adults engaging in hazardous drinking (n = 104); age range 18–25

CBT, Motivational interviewing

Randomized trial:

Sig. improvement on depression symptoms, symptom severity and reduced alcohol use, maintained at 6-mo. follow-up (H1 confirmed)

  Geisner, 2015 [68]

USA

Alcohol

Risky alcohol use intervention

Brief, personalized, web-based feedback intervention for college students with both elevated alcohol use and depressed mood; customized programming with intervention material based on responses to screening and baseline surveys; info on referral

College students with AUDIT scores ≥ 8; and BDI-II scores ≥ 14 (n = 311); mean age: 20.14 (SD: 1.34); age range 18–24

Personalized normative feedback (Social norms approach); Psychoeducation; Skills/protective

strategies

Randomized trial:

No sig. main effects; moderation effects: participants in alcohol and integrated conditions with lower depressed mood or alcohol problems at baseline had greater reduction in alcohol-related problems at follow-up vs. controls

  Marsch, 2021 [69]

USA

Opioids

POP4Teens

P4T: digital, interactive, activity-oriented program, unique in integrating knowledge about risk factors; education and skills training; JTT (Just Think Twice): active control condition

Adolescents (n = 406); age range 12–17

Psychoeducation; Social influence; Skills training

RCT:

Sig. sustained improvements in intention to use prescription opioids (PO), increased perceived risk, and improved PO refusal skills for both programs. Sig. greater increased PO knowledge for P4T than for JTT

  Miller, 2016 [70]

USA

Alcohol

Personalized Feedback Interventions. 3 interventions: PFI-Norms group (Feedback on perceptions of peer drinking vs. actual patterns, and percentile rankings of drinking quantity on campus); PFI Enhanced group: same feedback + info on costs of alcohol consumption and behavioral strategies to limit risk); PFI-Choice group: choice of 2 (of 9) supplementary feedback components, also an assessment only (AO) group

College students, weekly alcohol use (n = 376);

mean age 19.79 (SD: 2.17)

Personalized normative feedback

Exploratory RCT:

The 3 PFI groups had greater decreases in alcohol use, peak blood and alcohol concentration (BAC), related problems and perceptions of typical students’ drinking vs. AO, but no differences among the PFI groups

  Schuckit, 2015 [71]

USA

Alcohol

Two sets of 4 educational videos, one set based on low LR to alcohol (Low LR-based (LRB) group) and the other incorporating more generic state-of-the-art (SOTA) info with no emphasis on model of risk; LRB included info on environmental mediators and attitudes, while SOTA focused on negative affect and impulsivity as additional risk factors. Drinking outcomes over 8 weeks were compared

College freshmen, past-month alcohol use (n = 454); age: NA

Motivational interviewing, Brief Intervention (with feedback)

Randomized trial:

Both LR groups decreased drinking in both education groups, but more decrease in low LR group with the LRB educational protocol; high LR group demonstrated slightly better outcomes with SOTA protocol; small to medium effect sizes

  Schwinn, 2018 [72]*

USA

Any substance

RealTeen

Intervention sessions guided by older, animated narrator; focus on goal setting, decision making, puberty, body image, coping, drug knowledge, refusal skills (two sessions), and a review

Girls, general population (n = 788); age range 11–15

Psychoeducation; Skills training; Goal setting; Social learning theory; Resiliency framework

Randomized trial:

Intervention group smoked fewer cigarettes, less binge drinking and higher alcohol, cigarette, and marijuana refusal skills than controls, and less peer drug use vs. controls

  Schwinn, 2019 [73]*

USA

Any substance

See above

See above

See above

Randomized trial

At 2-yr. follow-up, for intervention group less past-month cigarette, marijuana, and “other” drug use; lower peer drug use, increased scores on drug refusal skills vs. controls; at 3-yr. follow-up, for intervention group less past-mo. cigarette and e-cigarette use, lower peer drug use, increased drug refusal skills vs. controls

  Tuliao, 2019 [74]

USA

Alcohol

Brief online feedback intervention for risk of alcohol use. Intervention provides participants with their alcohol risk levels and offers info on professional help to those with problematic alcohol use

College students (n = 721); mean age 20.81 (SD: 2.49)

Brief feedback intervention

Mixed method study: Feedback group sig. less likely to view info on services vs. no-feedback group. Sig. feedback group x stigma interaction effect – those with average/high stigma re substance use scores less likely to view feedback information

  Vargas-Martínez, 2019 [75]

Spain

Alcohol

ALERTA ALCOHOL

Feedback intervention, consisting of preventive messages and personalized info

High school students (n = 1,247); age range 15–19

I-Change Model; Feedback intervention

2-arm cluster RCT:

Reduced binge drinking (BD) at 4-mo. follow-up; higher perceived HRQoL associated with reduced BD, controlling for several socio-demographic variables

  Vogel, 2020 [76]

USA

Tobacco

Put It Out Project

Intervention included daily posts, image and text, and a question eliciting comments; live sessions on smoking cessation (’The Doctor is In’) with a commenting feature. Q/A format for info and support

Young adults who smoke (sexual/gender minorities) (n = 165);

mean age 21.4 (SD: 2.3)

US clinical guidelines; Transtheoretical models of behavior change

Pilot RCT:

POP more likely than TSP-SGM to report smoking abstinence at 3- and 6-mo. and reduced smoking at 3- mo.; reduced abstinence at 3- and 6-mo. and reduced smoking at 3- mo. for POP vs. those referred from Smokefree.gov

  Walukevich-Dienst, 2019 [77]

USA

Cannabis

Personalized feedback intervention

The PFI included PNF and feedback on: (1) risk related to cannabis use; (2) norms related to cannabis use and (3) risk for CUD

Undergraduate students with problematic cannabis use (n = 204); mean age 19.83 (SD: 1.43)

Personalized normative feedback

RCT:

Gender moderated the relationship between condition and one-mo. follow-up problems, with fewer cannabis-related problems for women in PFI condition at follow-up vs. women in PNF-only condition. No sig. differences for men

Game-based interventions

  Abroms, 2015 [78]

USA

Opioids

Recovery Warrior

Two modes in game prototype with whole-body motion and voice recognition features. Players shout refusal phrases, e.g., “I’m clean!”; Object of game is to destroy drugs (‘’Recovery Ninja’’) or avoid drugs (‘’Recovery Runner’’)

Young adults in outpatient treatment (n = 9); age range 18–24

Social Cognitive Theory; Repetitive Priming; Reinforcement Theory of Motivation

Pilot survey:

High satisfaction with video game over 4 weeks; all recommended playing the game weekly or more as part of treatment, a third recommended daily use

  Boendermaker, 2015 [79]***

Netherlands

Alcohol

Cheese Ninja game

4 versions of training compared in terms of effects on motivation to train and on alcohol-related memory bias and alcohol use; original training, placebo, gamified and social versions of game compared; three training sessions, held 1–7 days apart

Undergraduate students drinking regularly (n = 77); mean age 22.7 (SD: 3.1); age range 18–29

Cognitive Bias Modification

Non-randomized trial:

No training effects but adding social elements to game-enhanced user experience

  Duncan, 2018 [80]

USA

Alcohol and tobacco

smokeSCREEN Video

Gameplay 1 h, twice a week X 2 weeks; aim is to succeed academically and socially in 30 days of HW; avatar used to make decisions re earning good grades and social points in social situations involving cigarettes and marijuana that threatened success in both areas

Middle school students, naïve to cigarette/marijuana use (n = 25); age range 11–14

Behavioural skills development

Pretest-post-test design:

Improved knowledge on both cigarette and marijuana uses from pre- to post-test, with medium-large effects. Positive reports on gameplay experience

  Earle, 2018 [81]

USA

Alcohol

CampusGANDR v2

Followed earlier research showing efficacy of personalized normative feedback (PNF) college alcohol interventions with added gamified elements (points, change, competition, personal avatars); this study tested a self-sustaining version of game, involving gameplay over 6 weeks (6 rounds); Players received PNF + reflective peer judgements of self-reported drinking behavior, norms

First year university students (n = 276); age: NA

Self-determination Theory; Personalized normative feedback

Non-randomized trial:

Participants drinking heavily, who received both descriptive and reflective feedback on peer alcohol use, had sig. reduced normative perceptions and reduced alcohol use at 2-mo. post-intervention vs. those who received feedback on control topics

  Hides, 2018 [82]

Australia

Alcohol

Ray’s Night Out

Intervention involves taking Ray, a red panda avatar, on a ‘relaxed’ ‘fun’ or ‘crazy’ virtual night out; aim is to provide users with info, motivation, and behavioural skills to set a drinking goal for the night, keeping Ray below his ‘stupid line’ for drinking

Young people, alcohol use in past mo. (n = 197);

age range 16–25

Motivational Interviewing; Information-Motivation-Behavioural skills health behaviour model; Social Learning Theory

RCT:

Immediate access group had sig. greater increase in alcohol knowledge than delayed access group at 1-mo.; no group differences in alcohol use; for both groups, sig. reduction in number of drinks per occasion and in maximum number at 1 mo. and in alcohol-related harms

  Jander, 2016 [83]

Netherlands

Alcohol

Alcohol Alert

Game includes an online baseline questionnaire; adolescents then play 3 sessions of the 2-dimensional game “What happened?!”; tailored to typical consumption in different situations; questions and feedback; action plans provided; 4^th session outside of game and follow-up questionnaire after 4 months

Secondary and vocational students (n = 2,649); mean age 16.3 (SD: 1.2); age range 15–19

I-Change model; Feedback intervention

Cluster RCT:

Intervention reduced binge drinking among adolescents and those 16 years + after at least 2 intervention sessions; prolonged use of game was associated with stronger effects for binge drinking

  LaBrie, 2019 [84]

USA

Alcohol

Gamified PNF with virtual co-presence; level manipulated across 3 conditions, all gamified (PNF Only, PNF + Visual Copresence, and PNF + Maximum Copresence), plus non-gamified PNF control. Same questions about drinking asked and identical PNF delivered on alcohol use but different levels of visual and text-based info about peers from other universities

Undergraduate students reporting consumption of at least one alcoholic drink in previous

2 weeks (n = 235); age: NA

Personalized normative feedback

Randomized trial:

Drinking sig. reduced only in gamified condition with maximum copresence; outcomes relative to standard PNF. Both gamified conditions with copresence sig. improved upon standard PNF in reducing alcohol use at follow-up among people with heavier alcohol use heavier pre-intervention

  Sanchez, 2015 [85]

USA

Any substance

Arise

Instructional segments and skill-building games teaching coping skills: relaxation lesson; “Blown away game’’ for diaphragmatic breathing; a lesson on 5 refusal techniques and the ‘’stand up game’’, aimed at selecting an appropriate refusal from several options

Adolescents in substance abuse treatment (n = 9); age range 15–17

Coping skills training

Quantitative descriptive:

High overall usability, acceptability, and utility ratings by adolescents and providers in pilot study. Both relaxation and refusal units were highly rated, but game components ‘’Blown away’’ and ‘’Stand up’’ were rated lower than other components

  Scholten, 2019 [86]

Netherlands

Tobacco

HitnRun

Social mobile or ‘’runner’’ game, where players control an avatar who runs forward and collects points; tailored prompts reminding users with high levels of craving to play the game; 4-member teams encouraged gameplay, with a bonus if everyone played

People who smoke motivated to quit (n = 144); age range 16–27

Peer contagion; Go/No-Go training

Two-arm RCT:

Similar reductions in weekly smoking levels and abstinence rates for both groups; dose effect with HitnRun only: lower weekly smoking levels with longer gameplay; for brochure group, higher dose related to higher weekly smoking levels throughout study

  Skorka-Brown, 2015 [87]

UK

Alcohol, nicotine, caffeine

Tetris

Questionnaire (both groups) + ecological momentary assessment with SMS messages on iPods to prompt craving assessment; intervention group also played Tetris for 3-min. and reported cravings again

Undergraduate psychology students (n = 31); age range 18–27

Elaborated Intrusion Theory; Visual Interference

Randomized trial:

Playing Tetris decreased craving strength for drugs (alcohol, nicotine, caffeine), food and other activities (sex, gaming, exercise); consistent effect across the week

Mobile-based interventions

  Boendermaker

2015 [79] ***

Netherlands

Alcohol

Alcohol Go/No-Go Training

Training to avoid automatic motivational approach tendencies toward alcohol using a mobile application. Motivation and user experience, approach bias, alcohol problems and use, compared to a standard computerized version. Follow-up email questionnaire 2 weeks later

University students- drinking regularly (n = 64); mean age 22.44 (SD: 2.58); age range 18–35

Cognitive bias modification

Pilot study

No training effects

  Carrà, 2015 [88]*

Italy

Alcohol

D-ARIANNA

Questionnaire on binge drinking behaviour and factors contributing to overall risk used to develop a risk estimation model for binge drinking that was incorporated into the D-ARIANNA health app

Adolescents, young adults (n = 110); age range 16–24

Risk Estimation Model

Lit review and development of risk estimation model:

Ten risk factors (5 modifiable) and 2 protective factors were sig. associated with binge drinking and included in the model. Most participants (73%) regarded the eHealth app as helpful to assess binge drinking

  Carrà, 2016 [89]*

Italy

Alcohol

D-ARIANNA

E-health app with questionnaire, identifying risk/protective factors were entered into an algorithm and based on estimation model identified low, moderate and high-risk models for individual participants

Young adults (n = 590); age range 18–24

See above

Quasi-experimental, pre-post study:

Diminished BD shown at follow-up and confirmed in an appropriate generalized estimating equation model with unweighted data on a last observation carried forward basis

  Coughlin, 2021 [90]

USA

Alcohol and cannabis

MiSARA

Smartphone app designed to reduce substance use; 30-day intervention included daily and weekly surveys, tasks, with inspirational messages and reminders; groups randomized to receive tailored message, fun fact on random topic or no message

Youth who binge drank or used cannabis in the past month (n = 39); age range 16–24

Personalized feedback; motivational

interviewing; mindfulness; behavioral activation; support based

Qualitative study:

Most (79%) liked the app. but more interactivity wanted. Substance use declined over time; more frequent users of app reported less substance use at 1-mo. follow-up than others

  Davies, 2017 [66]**

UK

Alcohol

Drinks Meter

Drinks Meter smart phone and online digital app, offers personalized feedback on drinking as compared with peer drinking; info on calories consumed and money spent relative to others; risk assessed and advice on how to reduce consumption

Young adults, self-identified drinkers (n = 488); mean age 21.70 (SD 3.28); age range 18–30

Personalized normative feedback; Psychoeducation

See outcomes above (Davies, 2017)

  Dennis, 2015 [91]

USA

Any substance

ACHESS

Intervention randomly prompted participants with Ecological Momentary Assessments 6 times a day. They could then access ecological momentary interventions including recovery support and motivation, relaxation and social networking

Adolescents at discharge from residential treatment (n = 29); age range 14–18

Ecological Momentary Assessment and Intervention

Non-randomized trial

Sig. higher rates of use for “unrecognized risk” and “current use” groups vs. recognized risk group over a week. Sig. lower use in subsequent week when EMI accessed 2 + times within the hour following an EMA vs. when EMIs not accessed

  Haug, 2017 [92]

UK

Alcohol and tobacco

MobileCoach Tobacco (MCT) vs. expanded MCT + 

Implemented original MCT program targeting smoking cessation only with expanded program (MCT +) that integrated smoking cessation and alcohol reduction

Vocational students who smoke (n = 1,471);

mean age 18.6 (SD 3.1)

Health Action Process Approach (HAPA);

Personalized normative feedback (Social norms approach); Social Cognitive Approach, mindfulness, behavioural activation

2-arm, parallel-group cluster RCT:

No sig. group

differences observed for either primary or secondary outcomes

  Kazemi, 2019 [93]

USA

Alcohol

SmarTrek

SmarTrek addresses alcohol use through eight functions: e.g., tracking features for drinking behaviour, a virtual coach, daily text messages and alerts, strategies and feedback for changing drinking behaviours, education, and links to local resources

Undergraduate students, past month alcohol consumption (n = 10); Mean age 22.7 (SD: 7.66)

Motivational interviewing; Ecological Momentary Intervention; Personalized normative feedback

Mixed methods:

Theater testing, field testing and focus groups found that the SmarTrek app was easy to use, information was useful and had a positive effect on decreasing their drinking

Computer or tablet-based interventions

  Ellis, 2017 [94]

USA

Alcohol

Computer delivered brief intervention (CDBI)

Included 3 components; (1) decisional balance: reported likes/dislikes about alcohol use; (2) normed feedback: info given on drinking compared with others same age and gender; and (3) goal setting aimed at behaviour change. Tailored responses based on participant drinking behaviour

Undergraduate students (n = 103);

age: NA

Brief feedback intervention; Motivational interviewing

2-group experimental study:

High empathy brief intervention participants had increased motivation to reduce drinking, felt more supported and less criticized vs. low empathy condition

  Jacobus, 2018 [95]*

USA

Cannabis

Cannabis Approach Avoidance Training (CAAT)

Computerized CBM focused on impulse to approach rather than avoid a substance cue. The image format directs individual to push a joystick when substance cue is presented, and pull it when nonsubstance cue is presented, thereby training the participant to “avoid” the targeted substance cue

Students using cannabis weekly not seeking treatment (n = 80); mean age: 19; age range 17–21

Cognitive Bias Modification

Mixed models repeated measures analysis:

Sig. group x time interaction effects predicted percent days of cannabis and alcohol use over study enrollment period. For CAAT group, 7% fewer days of cannabis use vs. 0% for controls; for avoid cannabis condition, 10% more alcohol use days vs. 3% more for controls

  Karoly, 2019 [96]*

USA

Cannabis

Cannabis Approach Avoidance Training (CAAT) + pre-post MRI

Six sessions of CAAT training (or CAAT sham – control) twice/wk. over 3 weeks; baseline and post-treatment visit included a 30-min. MRI scan, including a visual cannabis cue-reactivity task

Youth regularly using cannabis (n = 37); age range 17–21

Cognitive Bias Modification

Pre-post intervention:

Group-time interaction for CAAT vs. CAAT-sham reached trend-level sig. Change in approach bias sloped from pre-post treatment was positive for CAAT-sham (increased approach bias) and negative for CAAT training (change to avoidance bias)

  Knight, 2019 [97]

USA

Alcohol and tobacco

Computer-Based Substance Use Screening and Brief Behavioral Counseling

Self-administered screening and brief intervention with immediate feedback on CRAFFT score and level of risk; psychoeducation includes 10 interactive pages of scientific info and true-life vignettes illustrating the health risks of substance use; motivational interviewing offered by practitioners

Youth using cannabis for 23-mo. (n = 965); age range 12–18

Motivational interviewing; Psychoeducation; Brief feedback

Intent to treat RCT:

Adjusted hazards ratios for time to first post-visit use of alcohol or other drugs for CSVI vs. US: alcohol use (0.69), heavy episodic drinking (0.66), and cannabis use [61]

  Tello, 2018 [98]

France

Alcohol

Evaluative Conditioning Brief intervention

The intervention consisted of repeatedly pairing a word (related to alcohol, soft drink, or neutral) with an image (positive, negative, or neutral). In the evaluative condition (EC), a negative picture followed the words related to alcohol, a positive picture after words related to soft drinks and neutral picture following neutral words, vs. neutral or positive pictures in control condition

Second year university students (n = 122); mean age: 19.84 (SD: 2.02)

Cognitive Bias Modification

Pre-post intervention study:

Evaluative conditioning (EC) did not change the implicit evaluation of alcohol but did reduce drinking behaviour. This effect was independent of hazardous drinking behaviour, but was especially pronounced among participants with the most positive implicit evaluation of alcohol before the intervention

  Walton, 2015 [99]

USA

Alcohol

Brief alcohol interventions

Three conditions included: a Therapist Brief Intervention (TBI), Computer Brief Intervention (CBI) and an enhanced usual care control. The TBI used a computerized workbook with tailored feedback, with screens containing prompts to structure the session. The CBI was an offline Facebook-style program for tablet computers, with sections on normative feedback, personal strengths, and better things to do. The order of completion was optional

ED patients with positive screens for risky drinking (n = 836); age range 14–20

Motivational Interviewing; Cognitive Behavioral Therapy; Self-determination Theory; Personalized normative feedback

Pre-post-test survey:

Sig. post-test increase for TBI on “importance to cut down” and “readiness to stop” and for CBI in “importance and likelihood to cut-down”. BI components positively associated with post-test outcomes: identification of personal strengths, protective behavioral strategies, benefits of change, and alternative activities (sports). Providing info during the TBI was negatively associated with post-test outcomes

Virtual reality (VR)-based interventions

  Guo, 2021 [100]

Taiwan

Tobacco

Virtual Reality Game in

Smoking-Prevention Education

The educational VR games included a whack-a-mole game, a wire loop game, a square baseball game, and a Taiko drum game. Participating students wore a head-mounted display (HMD), enabling them to have immersive experiences with 3D images. For challenge tasks, participants interacted with the virtual environments using joysticks; they received in-game guidance from an avatar

High school students (n = 130);

Mean age: 16.64

Keller’s ARCS (attention,

relevance, confidence, and satisfaction) motivation model

Prospective observational study:

Sig. improvement in knowledge; most students perceived themselves as persuaded to abstain from smoking and were sig. influenced by attention, relevance, and satisfaction

  Man, 2020 [101]

China

Ketamine

Virtual reality-based vocational training system

Intervention for cognitive and vocational enhancement. The VR group used a 3D non-immersive virtual reality-based vocational training system (VRVTS) to create a virtual boutique. The Tutor-administered Group (TAG) had similar content but was administered by a tutor, using the programme manual. The program included three levels, five sessions each: pre-trainee level, trainee level and sales level. To enter the sales level, participants had to complete tests for advanced attention, memory and problem solving

People using ketamine (n = 90); mean age 22.80 (SD: 5.41)

Cognitive and vocational skills training

RCT:

Sig. improvement in attention and memory for VRG, maintained at 3-mo. follow-up; both VRG and TAG showed improved vocational skills after training, maintained at follow-up, and improved self-efficacy

  Weser, 2021 [102]*

USA

Tobacco/

Nicotine

Invite Only VR

A Vaping prevention game, that teaches about health risks of vaping e-cigarettes and provides a virtual environment for adolescents to practice refusing vaping of e-cigarettes. Player uses four abilities to resist peer pressure: (1) observation of the environment, (2) ability to apply new knowledge about vaping in conversations, (3) deciphering

vaping colloquialisms and (4) ability to refuse peers effectively

Adolescent students (n = 47); age range 13–15

Behaviour change theories, including theory of planned

behaviour and Social Cognitive Theory

2-group pre-post intervention study:

Pre-post increase in player knowledge, and perceptions of e-cigarette harm; decreased likelihood of future e-cigarette use. Game enjoyment and willingness to recommend the game were high

  Weser, 2021a [103]*

USA

Tobacco/

Nicotine

See above

Middle School students (n = 287);

mean age 12.45, range 11–14

See above

Non-equivalent control group study:

Sig. results from baseline to 6 mo. for intervention group on e-cigarette knowledge, nicotine addiction knowledge, perceived addictiveness of e-cigarettes, perceptions of harm, and social perceptions about e-cigarette use, vs. controls. High ratings on gameplay and VR experience and satisfaction