Virtual reality in school-based health promotion: a mixed-methods evaluation of adolescent alcohol, vaping, and other drug use prevention

School-based health promotion is a key setting for fostering positive youth health behaviours. Digital and immersive technologies offer promising opportunities to engage young people. This study explores a virtual reality (VR) intervention designed to prevent alcohol, vaping, and cannabis use among secondary school students. The intervention allowed students to navigate realistic, branching scenarios simulating peer pressure and substance use, aiming to enhance refusal strategies, critical thinking, and decision-making skills. A mixed-methods evaluation involving 277 students and nine teachers across four Australian schools was conducted. Postintervention surveys assessed engagement, immersion, emotional responses, and skill development, while focus groups and interviews explored participant experiences. Results indicate that students found the VR experience immersive and valuable, particularly for rehearsing peer resistance and evaluating the consequences of risky behaviours. Teachers viewed the intervention as a powerful tool for prompting reflection and discussion and a strong complement to existing health education curricula. Thematic analysis highlighted the importance of realism and interactivity for student engagement. While some technical and content improvements were identified, both students and teachers considered the VR tool effective for enhancing health literacy and behavioural readiness. This study shows that immersive VR can be a scalable, engaging addition to school-based health promotion, improving prevention skills and confidence in managing substance-related situations. As adolescent health behaviours are increasingly shaped by digital environments, immersive interventions such as VR offer a promising avenue for skill building and reflection. Further research should assess long-term impacts, with greater attention to implementation and equity considerations.