Press Release - April 3, 2006
Press coverage - This study led to Dr. Thompson presenting a talk on“Media and Kids: What’s in a Game?” for the Congressional Caucus on Sex and Violence in the Media on April 26, 2006. On June 14, 2006 she also gave testimony at a Hearing by the House Subcommittee on Commerce, Trade, and Consumer Protection on “Violent and Explicit Video Games: Informing Parents and Protecting Children.” This study also generated discussion on a number of video game web sites (e.g., FiringSquad.com).

Answers to frequently asked questions -

Why should people care about Mature-rated video games and kids?
What are the study's main findings?
What are the study’s main recommendations?
How did you select the video games? How many video games did you play and review?
What information did you collect about each video game?
How did you define and measure each type of content?
What about any content that you might have missed by only playing the games for 1 hour?
Background on video game ratings

Why should people care about Mature-rated video games and kids?

Although the M-rating should theoretically lead to restrictions on children’s exposure to the content in these games, the limited existing data from studies summarized in the introduction to the paper (with references provided in the paper) suggest that many children under age 17 currently play M-rated video games:

• Recent studies document the increasing popularity of video games among children and adolescents, with 91% of 8-18 year-olds reporting that they played a console video game at least once. In the last five years, the average time spent playing video games by 8-18 year-olds nearly doubled from 26 to 49 minutes per day.
• Although no studies provide detailed information about children’s experiences with M-rated games, 27% and 65% of teen respondents in one study reported they had played Duke Nukem or Grand Theft Auto, respectively, 12% reported playing a game of which their parents would disapprove, and only 17% indicated that their parents check the ratings on games.
• A government report on marketing violent entertainment to children cited industry data showing that in 2002 consumers purchased nearly 40% of M-rated video games for children under age 17 and that 69% of unaccompanied children ages 13-16 participating in its mystery shopper survey successfully purchased M-rated video games. The most recent report (released just before this study on March 30, 2006), shows progress, but still 42% of unaccompanied children ages 13-16 participating in its mystery shopper survey successfully purchased M-rated video games.
• Industry data identify M-rated Grand Theft Auto: San Andreas and Halo 2 as the best-selling video games of 2004.
• A national study of 5,756 students in Canada found that approximately 22% of boys in grades 3-6 and 50% of boys in grades 7-10 identified one or more M-rated video games among their three favorite games.
• A meta-analysis of experimental and nonexperimental studies found that playing violent video games increased aggression in children and young adults. A recent experimental study of mostly adults, designed to detect only moderate or large effects, did not find an increase in aggressive thoughts or behaviors after one month of playing an M-rated online fantasy game.

Given the very limited evidence, understanding the effects of video games on children’s brain processing, learning, attitudes, and behaviors requires additional research, and currently clinicians must offer advice to parents in the absence of good data from rigorous longitudinal studies.
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What are the study’s main findings?

• The absence of a content descriptor assigned by the Entertainment Software Rating Board (ESRB) on the game box does not mean the absence of content that might raise concerns for parents. We identified 29 games (81%) with 45 observations of content that could warrant a content descriptor that did not receive these content descriptors from the ESRB. This statistic excludes images and dialogue related to alcohol, tobacco, and illicit drugs in games released before 2003 since the ESRB assigned content descriptors for only the use of these substances until it introduced content descriptors for references to substances (i.e., “drug reference”). These results suggest that M-rated video games may be source of exposure to a wide range of unexpected content.
  
• Nearly all M-rated games contain violence and blood, and similarly nearly all receive content descriptors for violence and blood. All 36 games in the random sample (100%) contained intentional acts of violence for an average of 22% of game play time. Including the additional game play associated with planning violence and depiction of injuries increased the average to 36% of game play time directly related to violence. We also found 28 games (78%) that rewarded or required the player to destroy objects.
  
• All 36 games rewarded or required the player to injure characters (100%), while 33 games (92%) rewarded or required the player to kill. We observed 6,011 character deaths from violence in approximately 42 hours of game play, occurring at an average rate of 145 character deaths per hour. This included 4,268 human deaths, occurring at an average rate of 104 human deaths per hour. Overall, we identified 24 games (67%) that depicted deaths from violence of nonhuman characters, including the player, and 33 games (92%) that depicted deaths from violence of human characters, including the player.
  
• Analysis of the overall portrayal of violence shows that all 36 games (100%) depicted injuries to human characters and 25 of 36 games (69%) depicted injuries to nonhuman characters, including injuries to the player. Examining the portrayal of violence to human characters, we found that 6 games (17%) portrayed violence characterized as “moderate” and 30 games (83%) portrayed violence characterized as “strong.” Examining the portrayal of violence to nonhuman characters, we found that 9 games (25%) portrayed “moderate” violence and 16 games (44%) portrayed “strong” violence.
  
• We observed blood in 33 of 36 games (92%), with 18% of game play time depicting blood, and 12% of game play time depicting human blood.
  
• On average, games depicted 4 types of weapons in the first hour of game play, with 35 games (97%) depicting weapons other than the body and players able to select weapons in 33 games (92%). A total of 24 games (67%) used the body as a weapon, 27 (75%) used guns, 22 (61%) used projectiles, 18 (50%) used knives or swords, 18 (50%) used explosives, 10 (28%) used fire, 10 (28%) used magic, 2 (6%) used toxic substances, and 13 (36%) used other weapons (e.g., automobile, club, broken bottle). Consistent with our prior studies, these findings represent a subset given our limited game play time.
  
• We observed the use of profanity in 24 games (67%), with 11 games (31%) receiving content descriptors for profanity. The sample included 15 games (42%) that did not receive content descriptors for profanity when we observed such content and 2 games (6%) that received content descriptors for profanity for which we did not observe profanity within 1 hour of game play. On average, the 24 games in which we observed profanity contained 17 uses of profanity per hour. These observations include a game (Twisted Metal: Black) that did not receive a content descriptor for profanity despite containing use of the words “mother fucker,” “bitch,” and “piss.” The game that received a content descriptor for Mild Language (Rogue Ops) contained the same words and number of uses per hour as the group of 15 games with unlabeled profanity.
  
• We observed the depiction or use of substances in 21 games (58%), with only 1 game (3%) receiving a content descriptor for substances. We found 17 games (47%) depicted alcohol, 8 games (22%) depicted tobacco, and 5 games (14%) depicted illicit drugs, with 12 games (33%) depicting characters using substances. On average, the 21 games in which we observed substances depicted substances for 3.4% of game play time, with 1.1% of game play time depicting substance use.
  
• We observed sexual themes (characters engaging in dialogue or behaviors related to sex or showing exposed breasts, buttocks, or genitals) in 13 of 36 games (36%), with 5 games (14%) receiving content descriptors for sexual themes. On average, the 13 games in which we observed sexual themes depicted sexual themes for 4.9% of game play time. Expanding our definition of sexual themes to include pronounced cleavage, large breasts, or provocative clothing would imply sexual themes in 17 games (47%). We observed the depiction of prostitution in 6 games (17%). Overall, 32 games (89%) contained playable male characters, 12 games (33%) contained playable female characters, and 10 games (28%) allowed the player to select among a list of characters or personalize characters. Games were significantly more likely to depict females partially nude than males (p < 0.007).
  
• Remarkably, M-rated video games contained a significantly smaller percentage of violent game play than did T-rated video games (22% for M-rated video games vs. 36% for T-rated video games). However, game players are significantly more likely to encounter blood in M-rated video games than in T-rated video games. Partly because of the increased presence of blood, M-rated video games depict more severe injuries to human and nonhuman characters than do T-rated video games. We also observed a higher rate of human deaths in M-rated video games than in T-rated video games, a result driven by the 23% of T-rated video games that do not depict deaths. Conditioning on the subset of M-rated and T-rated games that depict human deaths, we did not observe different rates.
  
• M-rated video games are significantly more likely to contain unlabelled content than are T-rated video games (81% for M-rated video games vs. 48% for T-rated video games). M-rated video games are significantly more likely than T-rated video games to contain profanity and substances, but not sexual themes.
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What are the study’s main recommendations?

• Our findings continue to suggest the need for greater clarity and transparency in the use of ESRB content descriptors and in the overall rating process. We believe that ESRB content descriptors should provide complete and accurate information about game content so that parents can make informed decisions. We further believe that the ESRB should play the finished video games before assigning a rating for a game to help ensure the absence of content other than that indicated by the materials submitted to the ESRB by the game manufacturers.

• We encourage physicians, particularly pediatricians and specialists in adolescent medicine, to ask patients and their parents about their experiences with video games. We emphasize that parents need to judge for themselves the appropriateness of the game content, both by using the ESRB rating information and by being a part of their child's gaming experience.
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How did you select the video games? How many video games did you play and review?

We developed a database of all 147 M-rated video game titles released on the major video game consoles (Xbox, Sony PlayStation2, and Nintendo GameCube) in the United States by April 1, 2004. The database contained each game title's genre, console, release year, and ESRB-assigned content descriptors. We randomly selected 25% to play (n=37), however, one of the games (Painkiller) was not released prior to completion of the study, so we played, recorded, coded second-by-second, and analyzed only 36 games. For consistency, a game player with considerable video gaming experience played all of the video games. The player first familiarized himself with each video game, then restarted the video game and recorded at least one hour of game play on DVD for coding.
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What information did you collect about each video game?

One author (Karen Tepichin) reviewed and coded all of the recorded game play. We collected information about the following types of content in each game: violence, blood, sexual themes, profanity, substances, and gambling. The article contains tables that list each video game we played, as well as the genre, console, release year, ESRB-assigned content descriptors, and our observations of game content.
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How did you define and measure each type of content?

We established consistent definitions and measures to apply through the study.

• Violence - Intentional acts in which the aggressor causes or attempts to cause physical injury or death to another character. We exclude actions that lead to unintentional physical harm, the effects of natural disasters, or the presence of dangerous obstacles not attributed to another character. Note that characters include humans and nonhumans (e.g., monsters, ghosts, animals, and personified robots) that attack the player or other characters.
  - Planning violence: Precursor acts in which a character selects, modifies, or acquires a weapon; acquires ammunition; aims prior to committing violence; or discusses detailed plans for killing or injuring other characters.
  - Depictions of injury: An injured or dead character lying on the ground or remnants of blood from a known violent act.
  - Portrayal of violence:
  • Mild: The most severe depiction of violence in the game involves minor auditory or visual representations of injury and pain that primarily serve to notify the player that a character is injured (e.g., characters grunt or turn red when injured but do not scream or bleed).
  • Moderate: The most severe depiction of violence involves more realistic representations of injury and pain (e.g., characters scream, fall over, or bleed when injured).
  • Strong: The most severe depiction of violence involves graphic representations of injury and pain that exaggerate or focus attention on suffering (e.g., characters scream in agony or bleed excessively when injured or when otherwise physically tortured).
    
• Blood
- A red fluid originating from an injured human or any colored fluid originating from an injured creature.

• Sexual Themes - Behaviors (e.g., provocative touching or moaning) or dialog related to sex and prostitution, as well as depictions of exposed breasts, buttocks, or genitals. We otherwise exclude pronounced cleavage, large breasts, or provocative clothing as sexual material given the vague ESRB definition of “Suggestive Themes” (i.e., “mild provocative references or materials”).

• Profanity - Use of abusive and vulgar language, anatomical references without the use of such words, and obscene gestures involving the middle finger or its full-arm equivalent. We include use of “God,” “Jesus,” and “hell” only when characters use these words abusively, but we otherwise exclude taunts, mean language, or words censored by bleeps.

• Gambling - Characters betting money for prizes.

• Substances
- Use of alcohol, tobacco, or elicit drugs; scenes in which the player views images related to at least 1 substance; or scenes in which characters discuss drug deals or using substances. We exclude medicinal herbs, tonics, or ambiguous “potions.”
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What about any content that you might have missed by only playing the games for 1 hour?

We emphasized in the paper that our method may miss some game content since we do not have access to the information submitted to the ESRB from game manufacturers and since we only played each game for one hour. In this study, we did not observe content indicated by 4 ESRB-assigned content descriptors in 4 games (11%) within our one hour of game play for these games, although we note that this content occurs later in these games. We also know from extended play of some games that content for which the ESRB did not assign a content descriptor sometimes occurs after 1 hour of game play (e.g., a sexually provocative female character in Ninja Gaiden and tobacco use in Soldier of Fortune II: Double Helix). We recognize that the choice of how long to play the game clearly affects the amount of content observed, and we model this relationship in Figure 2 of the paper. To construct the Figure, we first noted the time (i.e., the seconds from the beginning of the game) when we initially observed each type of content. Next, for each game we identified the latest time where we first observed a new type of content, since the latest time corresponds to the length of time required to observe all new types of content in the game. We know from experience that content in some games occurs after 1 hour of game play, and our method misses that content.
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The Entertainment Software Rating Board (ESRB) is a self-regulatory body created in 1994 by the computer and video game industry. The ESRB is responsible for applying and enforcing the rating and advertising standards adopted by the industry. The ESRB video game ratings include age-based rating symbols and content descriptors. Age-based rating symbols include EC (for "Early Childhood"), E (for "Everyone"), E10 (for "Everyone 10+"),T (for "Teen"), M (for "Mature 17+), and AO (for "Adults Only 18+") that game manufacturers display these on the front of the game box. Content descriptors are short phrases that indicate game content (e.g., "Violence" or "Mild Language") that game manufacturers display these on the back of the game box. To receive a rating, game manufacturers provide the ESRB with videotaped game footage and other information about game content. Three trained ESRB raters independently review the materials submitted by manufacturers and assign the rating and content descriptors they believe are appropriate, but they do not play the final games that consumers ultimately purchase as part of the process of assigning the rating.
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