Psychophysiological Responses in Virtual Reality for Assessing Current Nicotine Use and Future Addiction Risk Among Young Adults: Protocol for a Mixed Methods Study.

Background: Nicotine addiction among youth is a continuing public health concern, and vaping serves as a major pathway to nicotine use. Conventional assessments of craving and addiction risk rely on self-reports, which are prone to bias and lack sensitivity to real-time processes. Virtual reality (VR) enables controlled cue exposure while capturing real-time multimodal data, including subjective experiences, behavioral patterns, and physiological responses, which offer a more implicit and dynamic approach to identifying addiction risk. Objective: This pilot study examines whether subjective craving and psychophysiological responses (eg, eye gaze, heart rate, and electrodermal activity) to vaping-related cues in VR can distinguish young adults who vape from those who do not. Our secondary objective is to explore associations between these multimodal biomarkers and self-reported measures of craving, dependence, motivation to quit, and susceptibility to initiate vaping. Methods: Bespoke VR scenes were developed with input from a youth advisory board to ensure ecological validity. Forty young adults aged 18 to 21 years (20 vapers and 20 nonvapers) will complete a single laboratory session. Participants will experience 3 VR scenes (neutral baseline, vaping cues without social pressure, and vaping cues with social pressure in counterbalanced order). Eye gaze, heart rate, and electrodermal activity will be recorded continuously. Participants will complete standardized assessments of craving, sense of presence, and social presence in VR after each cue scene, followed by a short interview at the end. Quantitative data will be analyzed using mixed-model ANOVAs, correlation metrics, and exploratory regularized regression analyses to examine relationships between physiological responses, behavioral measures, and vaping status. Results: The project received institutional review board approval in August 2025 and was registered publicly in the Open Science Framework in November 2025. Development of the VR stimuli was completed in December 2025. Participant recruitment and data collection began in February 2026, and 7 participants have been enrolled as of March 2026. Conclusions: This protocol outlines a pilot study integrating immersive VR and multimodal biometrics to examine vaping cue reactivity in young adults. The findings will guide the development and evaluation of VR-based psychophysiological tools for identifying early markers of nicotine use risk. This work will also lay the foundation for adapting the approach to younger adolescents to support scalable early detection and prevention of nicotine addiction and initiation.