Engaging Youth in the Design of Prescription Opioid Safety Education for Schools

Abstract

Background

Opioid misuse continues to be a major concern in the United States, affecting both adults and adolescents. Unfortunately, even legitimate prescription opioid misuse in adolescence increases the risk for misuse later in life. Although adolescence is a critical period for learning, little is known about adolescents’ preferences for opioid safety education. One potential avenue for prescription opioid education is the use of serious games. Serious games can result in better health outcomes and understanding for adolescents and allow them to safely experience real-life scenarios. However, few studies have examined the use of serious games for adolescent opioid education.

Objective

This study explored adolescents’ preferences for prescription opioid education and design of a serious game focused on opioid safety education.

Methods

A focus group guide was adapted from two statewide surveys about participants’ perspectives on opioids. Recruitment packets with consent documents and an introduction to the study were sent home to eligible students. Ten focus groups were conducted with 68 middle and high school students in Wisconsin. Adolescents were asked to discuss their preferences for prescription opioid safety education and to design a serious game to educate teens about opioid safety. Focus groups were audio-recorded, professionally transcribed, and underwent content and thematic analyses using NVivo 12 software.

Results

Three preferred approaches for opioid safety education were identified, including the use of presentations, videos and websites, and serious games. Adolescents desired short presentations delivering personal stories to smaller audiences. They preferred websites and brief, engaging videos from reliable sources due to ease of access. Adolescents also preferred serious games for opioid education that were realistic and relatable.

Conclusion

When educating adolescents on prescription opioids, the use of presentations, particularly personal stories, brief and engaging websites and videos, or serious games with realistic and relatable scenarios should be incorporated.

BACKGROUND

The opioid epidemic continues to be a concern in the United States, affecting not only adults, but also adolescents. According to the Youth Risk Behavior Survey, in 2019, 14.3% of high school students reported ever misusing prescription opioids, compared to 14% in 2017.¹ In 2019, 7.2% of these high school students reported misuse within the past 30 days.¹ Adolescent opioid misuse often results from using opioids to relieve physical pain or to get high.^2–6 Opioid misuse may also result from adolescent misconceptions of the addictive and overdose potentials of opioids.⁵ Additionally, unsafe handling and storage of opioids are prevalent among families with adolescents, with parents of children over the age of seven more likely to report unsafe storage.^7–10 In fact, many families have leftover opioids stored in unlocked cabinets.^7–10 Many families also report sharing their leftover prescription opioids.^7–10

According to United States pharmacy data from the IQVIA Longitudinal Prescription Database, in 2019, 3.5% of children and young adults (0 to 21 years old) had filled at least one opioid prescription.¹¹ Of these prescriptions, 45.6% were classified as high risk due to factors such as having a daily morphine milligram equivalent of at least 50, overlap with a benzodiazepine prescription, exceeding a 3 or 7 day supply for opioid naïve patients, or prescribing codeine or tramadol to children 0 to 11 years old.¹¹ Education on proper opioid use and handling is crucial for the adolescent population, as even those that use legitimately prescribed opioids before 12^th grade are more likely to report misuse later in life and are at an increased risk of heroin use.^9,12 Furthermore, opioid-related adverse events among adolescents are more common among those who have filled a valid opioid prescription within the past six months, and often within three days of filling the prescription.¹³

Adolescents have a unique capability to be adaptive, use complex communication skills, practice non-routine problem-solving skills or “think outside of the box”, and apply systems thinking when learning.¹⁴ In addition, matching instructor teaching technique with student learning style increases retention of information.¹⁵ School faculty are interested in opioid training and indicated that their students would benefit from opioid education, particularly those in rural areas.¹⁶ Unfortunately, there has been no characterization of adolescents’ preferred learning style specifically for opioid safety education.

The National Institute on Drug Abuse (NIDA) has created educational resources for students, parents and teachers that focus on education about prescription drug misuse and abuse through lesson plans, videos, and drug facts.¹⁷ Additionally, the NIDA Helping to End Addiction Long-Term (HEAL) Initiative recently funded the creation of PlaySmart, a video game targeted at opioid misuse prevention in older adolescents aged 16 to 19.¹⁸ Other organizations, such as Rx for Addiction, Medication Safety, Overdose Lifeline-This is (Not) About Drugs, The Scenario-Tailored Opioid Messaging Program, and Script Safety have also created curriculum programs, web-based programs, interactive scenarios, and assessments that cover opioid misuse and safety for adolescents, parents, and patients.^{16,17,19,20,21} Project Here has developed resources for Massachusetts-based educators, including a web game designed to educate middle schoolers on the risks of substance misuse.²² Despite these innovative interventions, few involve the use of serious games, a novel approach to deliver information about opioid use and medication safety.^23,24,25

Serious games incorporate interactive skill-building exercises, responsive narratives, and self-directed learning by engaging users via role-play and practicing skills through virtual real-life events.^26–31 Users can take the character’s perspective, enabling them to develop empathy and connect to the player’s sense of identity to relate to real-world health behaviors.^32–37 Serious games also provide diverse experiences that resemble and translate to real-life situations, but are safe to explore.^38,39 This engagement can change users’ thoughts, emotions, and beliefs, resulting in greater learning and retention.^40,41 The use of serious games has been shown to result in better causal understanding, self-efficacy, and health outcomes in adolescents through education on diabetes management, asthma, cystic fibrosis, depression, cancer medication adherence and side effect management, and healthy eating serious games.^42–49 However, few studies have examined using serious games specifically for adolescents, focused on opioid use, safe storage, sharing, and proper disposal.

OBJECTIVE

This study aimed to characterize adolescents’ preferred learning style for opioid education and preference for character design, settings, storyline, and educational techniques in a serious game focused on prescription opioid safety education.

METHODS

Participants and Recruitment

Adolescents were recruited from four high schools and one middle school in Wisconsin using “backpack mail.” Recruitment packets containing an introduction to the study and consent forms were sent home from school with eligible students. Eligible participants were students enrolled in grades 7 to 12 who could speak and understand English. Partnering schools were chosen intentionally to represent rural, suburban, and urban areas of the state. Four of the schools distributed recruitment materials to all eligible students, and one school distributed materials to all students enrolled in a required health course. To participate in the study, adolescents under the age of 18 were required to assent and obtain parent or guardian consent, while adolescents 18 years old or above could consent without parent or guardian approval. Participants received $10 in cash for participation.

Study Design

Focus groups were chosen as the method of data collection for this study. Qualitative study design allowed for group collaboration and discussion, thus providing participants the opportunity to describe their preferences and perspectives in detail. Focus groups allowed facilitators to ask follow-up questions, leading to an in-depth understanding of participant responses. A study-specific questionnaire was developed based on surveys from the University of Wisconsin Population Health Institute and the state of Maryland.^50–53 This questionnaire was validated to develop a scale of adolescent opioid safety and learning.⁵³ The study team adapted items from the questionnaire for use in the focus group discussion and adjusted items as needed for age appropriateness. The study team obtained feedback from the University Survey Center on the clarity and content of the discussion guide to ensure it aligned with the study objectives. The guide was then piloted in two after-school youth programs for feedback on content, question clarity, and age appropriateness. The revised guide consisted of open-ended questions regarding educational preferences for learning about prescription opioid safety and serious game design preferences. Participants were asked to work individually or as a team to design and illustrate a serious game on prescription opioid safety, share the reasons for their design decisions, and offer feedback on each other’s game design. Participants’ demographics were collected, including age, gender, grade, race/ethnicity, number of children in the household, and zip code. Study participant demographic information was collected through a paper brief questionnaire consisting of multiple choice and short answer questionss. This study was approved by the University Institutional Review Board.

Data Collection

Ten focus groups, consisting of five to eight participants each, were conducted in May 2019 and February 2020. In each focus group, one study team member facilitated discussion while one or two team members assisted by asking follow-up questions as needed, observing the discussion and taking observation notes. Focus groups were conducted in individual classrooms to provide participant privacy. To maintain confidentiality, participants were asked to avoid using any identifying information during the focus groups and were reminded not to share anything from the focus groups with others. Maintaining privacy and confidentiality was essential in developing an environment where participants could comfortably share their perceptions of prescription opioid misuse. Each focus group lasted approximately 45 to 60 minutes, was audio recorded, and professionally transcribed verbatim. Any identifying information was redacted upon transcription of recordings. Following each focus group, facilitators debriefed and wrote reflection notes on focus group content and observations.

Data Analysis

Prior to data analysis, focus group transcripts were independently reviewed for accuracy by two study team members. Verified transcripts were thematically analyzed by two study team members and coded using NVivo 12 qualitative analysis software (QSR International). Through in-depth content analyses, codes were individually developed, using an inductive and deductive approach. Team members then collaborated to combine codes, create a master codebook, and address any coding discrepancies. The study team then utilized thematic analyses to identify prevalent codes and categorized them into themes and subthemes.

RESULTS

A total of 10 focus groups were conducted with 68 middle and high school students. Participants ranged from 7^th through 12^th grades and ages 13 to 19 years old (Table 1). Of the 68 students who participated, 27 were male (39.7%) and 25 were Caucasian (36.8%). Three main themes on adolescent opioid educational preference were identified: use of (1) presentations, (2) videos and websites, and (3) serious games. Verbatim quotes from participants are depicted by focus group numbers (for example, FG1) as shown in Table 2.

Table 1.

Participant Demographic Characteristics (N=68)

Characteristic	N (%)
Grade
7	3 (4.4)
8	4 (5.9)
9	15 (22.1)
10	27 (39.7)
11	13 (19.7)
12	6 (8.8)
Age
13	2 (2.9)
14	6 (8.8)
15	17 (25.0)
16	22 (32.4)
17	16 (23.5)
18	3 (4.4)
19	1 (1.5)
No answer	1 (1.5)
Gender
Male	27 (39.7)
Female	39 (57.4)
In another way	2 (2.9)
People under 18 in household
1	14 (20.6)
2	28 (41.2)
3	19 (27.9)
4	4 (5.9)
5	2 (2.9)
10	1 (1.5)
Race/Ethnicity
Hispanic or Latino	25 (36.8)
White	25 (36.8)
Black or African American	10 (14.7)
American Indian or Alaskan Native	0 (0.0)
Asian	1 (1.5)
Native Hawaiian or Other Pacific Islander	0 (0.0)
Multiraciala	7 (10.3)

^aIndicates that participants chose more than one race or ethnicity.

Table 2.

Themes, Subthemes, and Example Verbatim Quotes

Theme	Subtheme	Quote
Use of Presentations	Content within the Presentation	Probably like activities or the speaker asking questions and then us responding. – FG3
		I liked when we had our officer come in and talk because like he had stories and stuff, and like that’s interesting. – FG5
	Audience Size	Just like in a small room and just talk about it. – FG1
		Yeah, not like a whole big assembly, because then I kind of get scared of that. – FG3
	Presentation Length	Well, it’s a bit different for everybody I guess, so like for me, it’s a little bit like less wordy and more interactive, but yet not that much dependent on to the person talking, because I’m not that good of a listener. – FG3
		Rough number like 20 minutes. – FG3
Use of Videos and Websites	Feasible Access	I’m thinking maybe like the extra side of me would look at like online doctors’ journals from certified doctors, but I’m thinking the more realistic and lazy side of me would just hit up that Wikipedia, dude. – FG3
		I said if I’m bored and I’m on YouTube, I might watch it. – FG9
	Design and Style of Page	I guess it doesn’t really have to be supremely funny, just not too long – FG3
		You can watch someone explain how they went through it. – FG8
	Trustworthiness of Source	Like if it’s a doctor, then he knows what he’s saying, yes. But if it’s a random person then who knows? – FG7
		You can’t trust Wikipedia. They fakes…Anyone could edit it – FG9.
Use of Serious Games	Storyline	So choose your own adventure is where you have different scenarios, and then you’re like the person in the game. And you walk up to the situation, you pick what you would do in the situation. Then if you choose the wrong answer, then it will like show you what happened to the person who was shooting up or whatever. And then if you decide to help them, it will give you another set of options. And it keeps like going on from there until you like, I don’t know, learn and get your correct answer. – FG4
		Like you’re going to collect it and take it into a government facility or like a pharmacy. So like wouldn’t you want to do that, like have people searching for it and then like collecting it and bringing it to a safe place to then, in turn, get like upgrades and … – FG5
	Characters	I was thinking of like one of those like video games that, obviously, tell a story like, I don’t know, with animals. – FG3
		I don’t know. You’re a police officer, and you get to like go to places where people have like died of overdoses. – FG3
	Setting	So Level 1 is like you’re at a party, – FG1
		A high school in Georgia. – FG2

Theme 1: Use of presentations

Adolescents reported that they would prefer to learn about prescription opioid safety using presentations, especially when presentations were short, delivered to smaller audiences, and used personal stories to deliver information.

Content within the presentation.

Adolescents appreciated when speakers used personal stories to deliver educational messages. Personal stories allowed students to connect to the underlying lesson and had a lasting impact. Students stated they desired to hear stories from people who had experience with opioid misuse, police officers, and healthcare professionals.

I feel like also if you do it in a large group, you need to have somebody that has gone through that, so like they can form an emotional connection with the audience.

– FG3

Students enjoyed when presenters involved the audience through interactive activities. Interactive items included presenters asking questions and bringing in relevant items to reinforce and retain information shared.

…I feel like it would be, I don’t want to say cool, but like really eye-opening if like they made us, like they had things that you put on your tongue to make it so you could feel how nasty it would feel, or like you put, they have a makeup person coming in, make your face look like it did for if you took meth or something like that, and so this is what would happen to you…

- FG4

Presenters with personal experience were considered trustworthy by adolescents, as they perceived the stories from those who dealt with opioids firsthand.

Some people don’t listen to the teachers, but I feel like they would listen to the person, because they’re more trustworthy.

– FG7

Audience size.

Students preferred presentations with smaller audiences, particularly when they could interact with the presenter. Adolescents explained that large audiences could be intimidating or decrease the value of the message, as it is harder to retain students’ attention in a large group.

Something where it’s freely and open and like not, like somewhere where they don’t have to worry about getting judged.

– FG1

If it’s a big group, I feel like it loses the value of it.

– FG5

Presentation Length.

Adolescents cited short attention spans among their peers as a reason to avoid long presentations. They felt that shorter presentations are more valuable, as the speaker is more likely to retain the audience’s attention for the entire presentation.

I feel like most people would pay attention if it wasn’t super long …

– FG1

Theme 2: Use of videos and websites

Adolescents preferred videos and websites for prescription opioid education, due to the ease of access. They reported a preference for websites or videos that were brief, engaging, and shared by a reliable source.

Feasible Access.

Participants stated that they liked to use websites and videos for education because they can easily access quick, understandable answers. Many preferred videos over written material, as it was easier for them to watch someone explain the desired information than to read it. Adolescents used websites like Google, YouTube, and Wikipedia to find information.

Because if you like, let’s say you are at your house and you were looking for information. You don’t want to read like a whole paragraph. It’s easier to watch a video than to read a paragraph.

– FG8

Wikipedia maybe or like if you like look up like a disease or a medication, it’s like that little like medical box at the side, probably read that. That’s what I do.

– FG3

Design and style of page.

Adolescents preferred informative websites and videos that are short in length and visually appealing. In terms of content, they preferred when information was presented in an interesting, funny, and/or informative way and when personal stories were involved.

Well, my personal preference, probably like as artistic as possible like as many like drawings on there.

– FG3

Yeah. I feel like in some videos, they show how a person does it, and then they explain to you what they went through and how they, like they didn’t like the experience they went through.

– FG7

Trustworthiness of source.

Students felt they could trust information being presented in websites and videos if a trusted healthcare professional shared it or it was from another reliable source. Adolescents were skeptical of information being shared without evidence or from easily edited websites.

As long it’s like from like a trusted source, like a doctor is like sharing it, then, yeah.

– FG3

Theme 3: Use of serious games

Adolescents reported a preference for serious games as an education source, particularly if the game was realistic and relatable. Most adolescents referred to pre-existing games as inspiration when designing a serious game or expressing game preferences.

Storyline.

Several participants preferred the idea of a game where the player chooses their own path to create their personalized story. Choosing the “correct” path would lead to favorable outcomes in the game, while choosing the “incorrect” path would lead to unfavorable outcomes in the game. Some participants introduced realistic scenarios into their game design, such as visiting a friend’s house, dealing with an injury or opioid addiction, or maneuvering through an emotionally difficult time in a character’s life.

So first she breaks her ankle and gets pain medication. She could either go to her friend’s house or go home. And then if she goes to her friend’s house, which is named Leslie, Leslie like wants some. And she can either give them to her or choose to go home.

– FG2

Students offered different means for players to “win” their game. In some cases, players could win by beating the last and most difficult level. Games that had a realistic, addiction-based storyline had an end goal of overcoming the addiction. Other ways to “win” games included answering questions correctly or making correct choices in the game. Some groups gave the character a set number of “lives,” allowing the player to make incorrect decisions several times before losing the game. Adolescents suggested that lost lives should be accompanied by an explanation as to why the choice was incorrect and what lead to the character’s “death”.

Ooh, kind of like with the, what you were saying, if you had like three lives, and like if you die, then you get like a saying at the end. Like this is why you shouldn’t, and this is what affects you.

–FG1

Participants emphasized the importance of knowing where they went wrong so they do not make the same mistake again in the game or in real life. Explanation of consequences allows for learning and understanding to take place before proceeding. Participants also suggested replaying through the bad choice the player made so they can correct their actions and see what happens when they make the right choice.

… like put you in a situation to like do stuff like that. But then like it just, you can also like replay it. So like if you choose the bad path, you could like replay it, and then you can pick a better path. And then in the end, I had something like they thought of like this is why, this is what, kind of like, on, like cigarette packets and stuff like that, like this is why you don’t smoke.

– FG1

One group designed their game with the goal of collecting medications that were found throughout the game and returning them to a local drug disposal location. Another group emphasized the importance of storing opioids appropriately to avoid unintentional harm to others, including children. Several students designed games consisting of multiple levels. Game levels included stages of opioid addiction or scenarios such as how to dispose of opioid medications properly.

So, it’s two different, you know, like the ending of the games. So this is an ending of the game, so if you don’t lock the opioids up, and you just leave them on your nightstand and just leave out the door, then the baby could get to them and die. But if you lock them up, then the baby don’t get to them.

– FG10

Characters.

Most focus groups expressed their interest in human characters to make the game more relatable. Diversity was also important so that everyone could feel connected to their character. Many groups wanted their characters to reflect people in their own lives, such as teenagers, athletes, and students.

Just relatable characters, I guess. But have like enough diversity that you can kind of like, you know.

– FG2

One group incorporated police officers and scientists into their game. Their role as a character would be to investigate information to help solve or understand the opioid epidemic.

You could be a cop and then also be the scientist trying to figure out the opioid epidemic

– FG3

Some groups included non-human characters in their videogame. Examples include pills, pill bottles, or animals such as fish or birds. Pills and pill bottles were depicted as antagonists, where characters had to “fight” them as a part of the game. One group designed their characters based on pre-existing games, specifically Mario.

I was thinking of like one of those like video games that, obviously, tell a story like, I don’t know, with animals.

– FG3

Setting.

Several groups chose high schools for their videogame setting, due to the relevance of that setting in their everyday lives. Two focus groups chose parties as a game setting, and one group included a doctor’s office in their game. Adolescents used the party scene to introduce the character to opioids and a “quack doctor’s office” to introduce to an unqualified physician into the game. Another group designed a game that takes place in a body of water, such as an ocean or a lake in which opioids were dropped.

… And then we have some settings. You can go to the club, high school party, quack doctor, locker rooms, and dark alleys.

– FG5

One group specified that they would prefer the game to occur in the United States, since the audience is primarily American.

Yeah. United States, broadly.

– FG2

Incorporation of educational aspects.

Most groups suggested using an educational game in class, either as required for a grade or as extra credit. Participants also offered ways to incorporate educational material into their video games, such as links to an informational video or picture or pop-ups with facts about opioids.

…Yeah, something like that. I’m not going to talk about drugs. Every opioid comes with a pop up that tells you about that opioid, tells you facts. And then at the end of each level, you have to pass a quiz to be able to win.

– FG5

DISCUSSION

This study identified adolescent preferences for design of educational interventions on prescription opioid safety. Students preferred short educational presentations with a smaller audience, the use of personal stories, and presenter interaction with the audience. Videos and websites that are easily accessible, visually appealing, and perceived as trustworthy were also favored by adolescents for opioid education. Serious games were valued as a form of education when they included a “choose your own path” style storyline, the opportunity to learn from incorrect choices, human characters, realistic settings, and educational components displayed through pop-up facts and links. Findings from this study can be used to design tailored opioid educational interventions towards adolescents to address the opioid epidemic affecting this population. Additionally, educators and healthcare professionals can consider findings from this study to inform and personalize how they provide prescription opioid education to adolescents.

It is critical to develop educational interventions tailored to adolescent preferences to curb opioid misuse in adolescence and later in life.^9,12 Literature has identified gaps in adolescent knowledge of proper opioid use and storage.⁵⁴ This lack of awareness in adolescents can be addressed through by developing proper educational interventions that conform not only to opioid use knowledge, but also to adolescents’ educational preferences. School nurses support the need for adolescent opioid education; approximately 70% of school nurses believed that high school and middle school students would benefit from additional education centered on opioids.¹⁷ Middle and high school students in this study expressed a preference for education through presentations, personal stories, and engaging videos. Nurses have also expressed that students would likely respond best to using a video featuring students in their age range or a presentation given by an older student.¹⁷ Current opioid education programs have demonstrated improvement in adolescent safety knowledge or behaviors using interactive sessions and technology- or web-based interventions, supporting the potential effectiveness of adolescents’ preferred education sources.^17,19,20,21

Educational groups have begun to develop innovative educational material to address the adolescent opioid epidemic, with some reporting success. The Robert Crown Center for Health Education has developed lesson plans for specific grade levels to educate on opioid knowledge, resisting substance misuse, and self-efficacy.^55,56 With this intervention, student’s overall knowledge assessment scores increased with gains noticed in self-efficacy against substance misuse and likelihood to engage in drug resistance.^55,56 A serious game, The Reconstructors: A Plaguing Problem, was created to focus on pain management and the science behind pain relieving medications.⁵⁷ The game was able to show increases in the players’ overall knowledge after each level played.⁵⁷ Pop4Teens utilized adolescents’ true stories about their opioid use disorders with accompanying lessons, videos, and quizzes and found that adolescents’ knowledge about the prevention of prescription opioid misuse increased after their intervention.² Despite these educational interventions utilizing innovative approaches, they were missing critical opioid educational topics in which adolescents have limited knowledge and/or do not fully take into consideration the adolescents’ preferences for learning. Addressing adolescents’ opioid knowledge gaps could be improved through interventions that use engaging videos, personal stories, and serious games with realistic storylines, characters, and settings.

This study also examined what adolescents would like to see reflected in a serious game, from general game design to characters and settings. Adolescents desire to see their preferences reflected in a serious game, as it allows them to become more engaged. This immersion leads to increased health beliefs, attitudes, and behaviors, as the students will identify with the thoughts, emotions, and actions that the character goes through.⁴⁰ In this study, adolescents expressed a desire for a “choose your own story” game design and the opportunity to learn from their mistakes. Similarly, previous developed serious games such as PlaySmart utilize relatable storylines with player choices, based on feedback from youth and other stakeholders.^18,23 Considering the seriousness of opioid use, and the risk that opioids pose, the use of serious games allows adolescents to practice safe use and storage without fatal consequences.⁵⁸ Adolescents may be allowed to repeat the scene and learn from both their failure and success, giving the student more exposure to the opioid material. Therefore, serious games should be considered when developing educational materials on opioid safety.

Limitations

Study findings may have limited generalizability, as data were collected from five schools in Wisconsin with a predominantly White and Latino student population. Some students may not have been exposed to certain educational intervention strategies and could not envision how they would be used to give their opinion on preference. Additionally, participants may not have shared their personal preferences for opioid education but instead may have answered based on what they believe most people their age would prefer. Due to the sensitive nature of the topic, some students may have felt uncomfortable sharing their opinions in a group setting. Future research should tailor interventions to meet adolescent preferences and evaluate the efficacy of such interventions among a more representative national sample.

CONCLUSION

This study characterized adolescents’ preferences for prescription opioid education and preference on character design, settings, story line, and content in a serious game focused on opioid safety. Adolescents preferred to learn about prescription opioid safety through presentations, videos and websites, and serious games. Adolescents expressed interest in personal stories presented in an interactive format to a small audience. When videos and websites are used, they should include brief, engaging content delivered by a trustworthy source. Adolescents also valued the use of serious games for learning about prescription opioid safety, particularly games with a realistic, “choose your own path” style storyline and relatable characters and settings. Serious games pose a promising solution for opioid safety education in a safe, engaging format. In addition to their current methods for educating adolescents about prescription opioids, healthcare professionals and educators can consider incorporating serious games, videos and websites, personal stories, and small group presentations. Researchers, healthcare professionals, and educators should also keep these preferences in mind when designing or delivering adolescent opioid education to effectively engage them in learning.

Key Points:

Background:

• Adolescents are affected by the opioid epidemic in the United States, with 14.3% of high school students in 2019 reporting having misused prescription opioids in the past.

• Educating adolescents on prescription opioid safety is crucial, as even the use of legitimately prescribed use can increase risk of misuse later in life or lead to adverse events.

• Serious games can provide a safe environment for adolescents to virtually experience real-life situations to improve health behaviors.

Findings:

• Adolescents prefer to learn about prescription opioid safety through presentations that are short, are delivered to small audiences, and use personal stories.

• Websites and videos are also preferred due to ease of access, particularly if they are brief, engaging, and provided by a reliable source.

• Adolescents prefer serious games for opioid safety, particularly if the game features diverse and relatable characters, personalized or realistic storylines, and real-life settings.