INSPIRE

INSPIRE

Led by Drs. Ozer and Lester, INSPIRE builds on gaming techniques to create an environment in which teens participate in unfolding narratives that address peer pressure, social norms, and alternative consequences of alcohol use. Players adopt the role of a teen protagonist who “relives” a high-school get-together involving alcohol, with virtual characters who model a range of health behaviors. Outcomes in the story line are actively shaped by the player’s decisions. INSPIRE encourages players to set goals, adopt problem-solving strategies, reason about the consequences of their actions, and reflect on their observed outcomes to adjust their future behaviors.  The fully implemented version of INSPIRE is designed to be integrated into primary care clinics with a linkage to the learning environment through the primary care provider.

There are three episodes of INSPIRE, and the intervention has been integrated into the UCSF AYA Medicine Clinic. Pilot testing of INSPIRE’s impacts on adolescent self-efficacy and knowledge around alcohol use is ongoing. Two manuscripts based on the clinic integration and self-efficacy/knowledge testing are in preparation.

Primarily supported by the National Science Foundation, INSPIRE has also received support from a NIH/National Cancer Institute R01 grant. Supplemental funds awarded to the AYAH-RN have supported finalizing the INSPIRE episodes, piloting the integration of INSPIRE within the UCSF AYA Medicine clinic, and submission of a peer reviewed publication of the INSPIRE clinic implementation model. For more information see:

• Ozer EM, Rowe J, Tebb KP, Berna M, Penilla C, Giovanelli A, Jasik C & Lester J. Fostering engagement in health behavior change: Iterative development of an interactive narrative environment to enhance adolescent preventive health services. J Adolesc Health 2020;67:S34-44.

An abstract based on this work was presented at the 13th World Congress on Adolescent Health in Jamaica, May, 2026.

Several additional AYAH-RN projects have built on this work. Dr. Giovanelli, AYAH-RN co-investigator, and Dr. Jonathan Rowe, former member of the INSPIRE team at North Carolina State University, led a paper that used INSPIRE as a case study for the potential of Artificial Intelligence in Digital Heath Behavior Change Interventions.

Another project focused on Alcohol Use Prevention in Youth with ADHD. The AYAH-RN conducted a feasibility and acceptability study, pilot testing INSPIRE with adolescents who have been diagnosed with ADHD to determine if this intervention is also engaging for youth with ADHD or needs further adaptation to be utilized in this population. The project was led by Dr. Pugatch, a former health services research post-doctoral fellow at UCSF and current assistant Professor at Lurie Children’s Hospital in Chicago, in collaboration with two other MCH Research Networks (Life Course Intervention and Developmental-Behavioral Pediatrics Research Network). Dr. Pugatch also lead the the Prepare and INSPIRE study, a three-Network collaboration (AYAH-RN, LCT-RN, and DBPNet) piloting the use of video clips of INSPIRE in the at Harvard/Boston Children’s Hospital. The project leveraged INSPIRE for use with adolescents with substance use disorders in their Adolescent Substance Use and Addiction Program (ASAP).

Additionally, Dr. Penilla, AYAH-RN co-investigator, has been leading an investigation examining the impact of INSPIRE on adolescent self-efficacy and knowledge around alcohol use. Analyses suggest that adolescents who played INSPIRE enhanced their efficacy beliefs for avoiding risky alcohol use as well as their knowledge about alcohol risk. The study also found that adolescents were engaged in the gameplay and that they used four different types of behavioral strategies to avoid alcohol use in INSPIRE. An abstract based on this work was also accepted for oral presentation at the 13th World Congress on Adolescent Health and a manuscript has been submitted.

A manuscript describing the implementation of INSPIRE into the UCSF AYA Medicine Clinic using the Diffusion of Innovations framework and led by early career investigator Dr. Anoushka Sinha was published in JAMA. INSPIRE and AYAH-RN PI Dr. Elizabeth Ozer also published an editorial on The Potential and Challenges of Interactive Virtual Environments to Support Behavior Change in Adolescents based on her work with INSPIRE.

Giovanelli A, Rowe J, Taylor M, Berna M, Tebb KP, Penilla C, Pugatch M, Lester J, & Ozer EM. (2023). Supporting Adolescent Engagement with AI-Driven Digital Health Behavior Change Interventions. Journal of Medical Internet Research.

Pugatch M, Blum NJ, Barbaresi WJ, Rowe J, Berna M, Hennigan S, Giovanelli A, Penilla C, Tebb KP, Mott M, Kumaran V, Buckelew S, Lester JC and Ozer E (2024). Engagement of adolescents with ADHD in a narrative-centered game-based behavior change environment to reduce alcohol use. Front. Educ. 8:1183994. doi: 10.3389/feduc.2023.1183994

Sinha, A., Rowe, J., & Ozer, E. (2024). Narrative Play—Promoting Adolescent Health With Interactive Games. JAMA, 331(16), 1345-1346.

Penilla, et al., INSPIRE: An AI-driven interactive narrative intervention to reduce adolescent alcohol use. JMIR Serious Games. (Under Review)

Ozer, E. M. (2026). The Potential and Challenges of Interactive Virtual Environments to Support Behavior Change in Adolescents. Journal of Adolescent Health, 78(3), 371-372.

Learn more: http://projects.intellimedia.ncsu.edu/inspire/