Loot Boxes, Gambling, and Problem Gambling Among Young People: Results from a Cross-Sectional Online Survey

With the introduction of gambling-like features within video games (e.g., loot boxes) new forms of hybrid-gambling products have emerged, yet little is known about their relationship to gambling and problem gambling among those most likely to engage: young people. This article examines the relationship between the purchase of loot boxes, gambling behavior, and problem gambling among young people ages 16–24. Cross-sectional data were analyzed from wave 1 of the Emerging Adults Gambling Survey, an online survey of 3,549 people, aged 16–24. Data were weighted to reflect the age, sex, and regional profile of Great Britain. Measured included past-year purchase of loot boxes, engagement in 17 different forms of gambling (weekly, yearly, and weekly spend); and problem gambling status. Other covariates include impulsivity and sociodemographic status. Young adults who purchase loot boxes are more likely to be gamblers and experience problem gambling than others. In unadjusted regression models, the odds of problem gambling were 11.4 (95% confidence interval [CI] 7.6 to 16.9; p < 0.001) times higher among those who purchased loot boxes with their own money. This relationship attenuated but remained significant (odds ratio 4.5, 95% CI 2.6–7.9) when gambling participation, impulsivity, and sociodemographic factors were taken into account. The purchase of loot boxes was highly associated with problem gambling, the strength of this association being of similar magnitude to gambling online on casino games or slots. Young adults purchasing loot boxes within video games should be considered a high-risk group for the experience of gambling problems.

Temporal association between objectively measured smartphone usage, sleep quality and physical activity among Chinese adolescents and young adults

We studied the association between objectively measured smartphone usage and objectively measured sleep quality and physical activity for seven consecutive days among Hong Kong adolescents and young adults aged 11-25 years (n = 357, 67% female). We installed an app that tracked the subjects' smartphone usage and had them wear an ActiGraph GT3X accelerometer on their wrist to measure their sleep quality and physical activity level. Smartphone usage data were successfully obtained from 187 participants (52.4%). The participants on average spent 2 h 46 min per day on their smartphone. Multilevel regression showed that 1 min of daytime smartphone usage was associated with 0.07 min decrease in total sleeping time that night (p = .043, 95% confidence interval [CI]: -0.14, -0.003). Broken down for different usage purposes, 1 min of daytime social network usage and games and comics was associated with a 0.28 (p = .02, 95% CI: -0.52, -0.04) min and 0.18 min (p = .01, 95% CI: -0.32, -0.04) decrease in total sleeping time that night, respectively. One minute of daytime smartphone usage was associated with an increase of 4.55 steps in the number of steps (p = .001, 95% CI: 1.77, 7.34) on the next day. To conclude, time spent on a smartphone in the daytime was associated with total sleeping time that night and number of steps the next day, but was not associated with sleep efficiency, wake after sleep onset and moderate-to-vigorous-intensity activity (MVPA) among Hong Kong adolescents and young adults.

The relationship between the skill-challenge balance, game expertise, flow and the urge to keep playing complex mobile games

BACKGROUND AND AIMS

Interest surrounding the relationship between flow and problematic gameplay has surged. An important antecedent of flow in the context of video-gaming is the skill-challenge balance, but researchers have only manipulated this balance by changing speed of play. The current research seeks to examine the skill-challenge balance and flow in a mobile game in which challenge is increased via the complexity of puzzles. We predicted games like Candy-Crush would more strongly support a model of flow in which the greatest flow would be experienced by more skilled players and that high flow games would induce the most urge to continue play.

METHODS

We had 60 Candy-Crush players play games near their level standing (maximal skill-challenge balance), or games that were too easy or too hard. Perceived skill, challenge, flow, and urge to continue gameplay were measured after each game.

RESULTS

Players felt the highest degree of skill-challenge balance when playing games around their level standing. Easy games produced the least flow, while both regular and hard games produced comparable flow despite hard games being far more challenging and frustrating. The findings support models of flow positing those with highest perceived skill will experience greater flow. Finally, flow and arousal combine to increase urge to keep playing.

DISCUSSION AND CONCLUSIONS

Our findings suggest those with high perceived skill will experience deep, immersive flow which motivates players to keep playing.

Excessive Smartphone Use and Self-Esteem Among Adults With Internet Gaming Disorder: Quantitative Survey Study

Background

Smartphone overuse can harm individual health and well-being. Although several studies have explored the relationship between problematic or excessive smartphone use and mental health, much less is known about effects on self-esteem, which is essential in having a healthy life, among adults with mental health disorders, including internet gaming disorder. Furthermore, given that smartphone usage differs by gender, little is known about gender differences in the relationship between smartphone overuse and self-esteem.

Objective

The objective of this study was to assess self-esteem among individuals with mental health disorders and explore the relationship with excessive smartphone use.

Methods

Participants were selected based on their responses to the internet gaming disorder assessment, which includes 9 items developed based on Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria, from among a Korean cohort of smartphone users aged 20-40 years, resulting in a sample of 189 participants (men:120, women: 69). The Rosenberg self-esteem scale and the Korean smartphone addiction proneness scale were utilized to assess the outcome self-esteem with excessive smartphone use as the primary independent variable. Guided by the Bowlby attachment theory and prior studies, we selected several covariates. Generalized linear regression analyses, as well as subgroup analyses by gender, were performed.

Results

Among adults with internet gaming disorder, the average Korean smartphone addiction proneness scale score was significantly higher in women than that in men (41.30 vs. 37.94; P=.001), and excessive smartphone use was significantly more prevalent in women than it was in men (30.43% vs. 20.83%; P=.02). Our findings from the generalized linear regression analyses indicated that an increase in Korean smartphone addiction proneness scale score had a negative relationship with self-esteem among those with internet gaming disorder (β=–0.18, P=.001). Furthermore, our interaction models showed that, among those with internet gaming disorder, more men than women had lower self-esteem associated with an increase in Korean smartphone addiction proneness scale score and a high degree of smartphone overuse (β=–0.19, P=.004; β=–3.73, P<.001).

Conclusions

Excessive smartphone use was found to be adversely associated with self-esteem among young and middle-aged adults with internet gaming disorder; notably, more men than women were negatively influenced (regarding self-esteem) by smartphone overuse. Based on our findings, more efforts should be made to reduce excessive or problematic smartphone use by considering developing public health interventions or policy, particularly among those with mental health disorders such as internet gaming disorder.

Esport: Fortnite Acutely Increases Heart Rate of Young Men

Esports has rapidly increased in online play and viewing. A myriad of literature focuses on heart rate (HR) during traditional athletic competition, little research has addressed the HR responses of individuals playing esports and none in the esport: Fortnite. The purpose of this study was to compare the HR response during a 3-hour seated session of the esport: Fortnite to resting HR. Male college students (n = 23; age = 21 ± 1.8 years; BMI = 25.7 ± 3.9; Esport mean hours per week = 13 ± 8.7) were recruited to participate in the study. Mean and peak resting HR were collected during two HR measurements in a controlled laboratory setting. Additionally, participants wore the HR monitor to record mean and peak HR during their regular 3-hour esport: Fortnite session at home. Participants were also instructed to record their match statistics from each solo round. Separate paired sample t-tests were conducted to compare mean resting heart rate (rHR) vs. mean seated esport heart rate (eHR) and peak rHR vs. peak eHR. Pearson's r correlations were used to investigate relationships between variables. There was a statistically significant increase in mean eHR compared to mean rHR (76 ± 10 bpm vs. 70 ± 11 bpm; p < 0.05) and peak eHR compared to peak rHR (120 ± 16 bpm vs. 81 ± 11 bpm; p < 0.05). The average number of kills was 29 ± 18.6. This initial study suggests esport: Fortnite increases individuals seated HR, suggesting a physiological stressful event.

The Gendered Nature and Malleability of Gamer Stereotypes

Video gaming is seen as a male space. Female gamers are seen as atypical, have their competence challenged, and face more harassment than male gamers do. This precarious position is increasingly problematic as video gaming is now one of the most prevalent leisure activities, providing an opportunity to both forge and maintain friendships, and to achieve social status and career opportunities. We argue that the marginalization of female gamers is driven by masculine gamer stereotypes. We investigate the content and gendered nature of gamer stereotypes as well as their malleability in response to exposure to female gamers across two studies (N_{Study 1} = 287; N_{Study 2} = 176). We explore the content of gamer stereotypes and find that they contain both negative aspects, such as lacking social skills, and positive aspects, such as being competent and agentic. Both studies demonstrate that gamer stereotypes are more similar to stereotypes of men and boys than those of women and girls. In Study 2 we test whether exposure to a female gamer can change the negative association between female stereotypes and gamer stereotypes, finding support for this prediction. We conclude that gamer stereotypes are highly gendered but may be malleable: increasing the visibility of female gamers could potentially reduce the incompatibility between femininity and gaming.

Internet, gaming, and smartphone usage patterns of children and adolescents in Korea: A c-CURE clinical cohort study

BACKGROUND AND AIM

Whereas many studies on Internet gaming disorder (IGD) have used self-report questionnaires, only a few have adopted clinical interviews and samples. The current study aimed at using data from face-to-face diagnostic interviews, based on the criteria for IGD in the DSM-5, to determine the Internet, gaming, and smartphone usage patterns of children and adolescents.

METHODS

A latent class analysis was conducted using data collected through diagnostic interviews for Internet, gaming, and smartphone addiction with 190 participants (M = 13.14 years, SD = 2.46; 143 boys, 47 girls) who were part of a multicenter clinical cohort study.

RESULTS

Participants were classified into four groups: pleasure-seeking (Class 1), internal-use (Class 2), problematic-use (Class 3), and pathological-use (Class 4). The pleasure-seeking group (8.11%) showed low tendencies in general and proper control. The internal-use group (17.63%) showed significant increases in "cognitive salience" and "craving," with strong internal desires. The problematic-use group (37.28%) had no "interference with role performance"; however, they displayed "difficulty regulating use" and "persistent use despite negative consequences," with a slight functional impairment. The pathological-use group (36.98%) scored the highest on all these items, revealing a severe functional impairment. Compared to the other groups, the pathological-use group had the highest depression and daily stress levels and displayed the lowest levels of happiness.

CONCLUSIONS

This study provides basic data to elucidate Internet, gaming, and smartphone overuse patterns among children and adolescents, which could be used to develop differentiated intervention strategies for each group.

The Emerging Adults Gambling Survey: study protocol

The Emerging Adults Gambling Survey is a longitudinal survey of young adults aged 16-24 living in Great Britain. It aims to explore a range of gambling behaviours and harms among young adults and examine how this changes over time. It is part of a broader project funded by Wellcome into the gambling behaviours of young people and its relationship with technological change. Funding is currently available for two waves of data collection: the first collected in June/August 2019 (n=3549) and the second to be collected in June/August 2020. The second wave of data collection will also obtain information about the immediate impact of coronavirus on gambling behaviours. With a sample size of 3549 for Wave 1, this is one of the largest study of gambling behaviours among young adults to be conducted in Great Britain and is a resource for other researchers to draw on. Data will be deposited in the UK Data Archive upon completion of Wave 2 data collection and analysis.  This protocol is intended to support other researchers to use this resource by setting out the study design and methods.

Demographics and Health Behavior of Video Game and eSports Players in Germany: The eSports Study 2019

The number of video game and eSports players is steadily rising. Since little is known about their health behavior to date, the present study examines the demographics and health behavior of video game and eSports players. In this cross-sectional study, data on demographics, health status, physical activity, nutrition, sleep, and video game usage were assessed via a web-based survey of n = 1066 players (91.9% male; 22.9 ± 5.9 years; body mass index (BMI): 24.6 ± 4.8 kg/m²) in Germany in 2018. The majority of respondents (95%) reported a good to excellent health status. Two thirds (66.9%) engaged in moderate to vigorous physical activity for more than 2.5 h/week. The average duration of sitting and sleep time was 7.7 ± 3.6 h/day and 7.1 ± 1.3 h/day, respectively. Mean fruit and vegetable consumption was 2.7 ± 1.8 portions/day. Video games were played for 24.4 ± 15.9 h/week on average. Partial Spearman correlations revealed poor positive associations of video game play time to sedentary behavior (rho = 0.15; p < 0.01) and BMI (rho = 0.11; p < 0.01), as well as a poor negative association to self-reported health status (rho = -0.14; p < 0.01). These results indicate the good subjective health of this target group. Nevertheless, the high amount of video game play time and its poor negative association to health status indicate a need for specific health promotion strategies for this target group.

Relationships between Severity of Internet Gaming Disorder, Severity of Problematic Social Media Use, Sleep Quality and Psychological Distress

Internet gaming and social media use are prevalent and integral to many people's lives. However, excessive engagement in either could lead to negative health impacts. This study aimed to investigate relationships between severities of internet gaming disorder (IGD) and problematic social media use (operationalized as social media addiction; SMA) with sleep quality and psychological distress among young adults. A cross-sectional study with snowball sampling was conducted among Hong Kong university students in 2019. All participants (n = 300; mean (SD) age = 20.89 (1.48); 122 males (40.67%)) responded to an online survey that included Chinese versions of the Internet Gaming Disorder Scale-Short Form (IGDS9-SF), Bergen Social Media Addiction Scale (BSMAS), Pittsburgh Sleep Quality Index (PSQI), and Depression Anxiety Stress Scales (DASS-21). Multiple linear regressions demonstrated that IGDS-SF9 scores demonstrated associations with psychological distress measures (standardized coefficient (β) = 0.295 for depression, 0.325 for anxiety, 0.339 for stress, all p < 0.001). BSMAS scores showed similar albeit numerically less robust associations (β = 0.235 for depression, p < 0.001; 0.219 for anxiety, p = 0.001; 0.262 for stress, p < 0.001). BSMAS scores demonstrated associations with poorer sleep quality (β = 0.292; p < 0.001) and IGDS9-SF scores (β = 0.157; p = 0.024) showed a significantly less robust association (p = 0.01 for comparing the two βs). These findings suggest that both severities of IGD and SMA associate with more psychological distress and poorer sleep quality, although the strengths of associations may differ.

A Pilot Study of CPR Quality Comparing an Augmented Reality Application vs. a Standard Audio-Visual Feedback Manikin

Background: Guidelines-based cardiopulmonary resuscitation (CPR) during in-hospital cardiac arrest is a significant predictor of survival, yet the quality of healthcare provider (HCP) CPR (e.g., nurses, physicians etc.) has been shown to be poor. Studies have found that providing HCPs with simulated CPR refresher trainings can improve their CPR quality, however, no studies have compared the use of an augmented reality (AR) CPR refresher training with a standard audio-visual (AV) feedback manikin to improve HCP training.

Objectives: In our pilot study, HCPs were randomized to a refresher CPR simulation training with either our AR CPR training application (CPReality) or a standard AV feedback manikin. All subjects completed 2 min of CPR on their respective CPR training modalities, followed by an additional 2 min post-simulation CPR evaluation with no feedback. We hypothesized that the AR CPR training application would confer improved CPR quality defined as chest compression rate and depth compared with the standard AV feedback training.

Results: Between January 2019 and May 2019, 100 HCPs were enrolled (50 in the CPReality cohort and 50 in the standard AV manikin cohort). The mean chest compression (CC) rate for all subjects during the intervention was 118 ± 15 cpm, and CC depth was 50 ± 8; post-intervention the CC rate was 120 ± 13 and CC depth was 51 ± 8. The mean CC rate for those trained with CPReality was 121 ± 3 compared with the standard CPR manikin training which was 114 ± 1 cpm (p < 0.006); CC depth was 48 ± 1 mm vs. 52 ± 1 (p = 0.007), respectively. Post-simulation CPR quality with no feedback showed a mean CC rate for the CPReality application at 122 ± 15 cpm compared with the standard CPR manikin at 117 ± 11 cpm (p = 0.09); depth was 49 ± 8 mm vs. 52 ± 8 (p = 0.095), respectively. In the post-survey, 79% of CPReality subjects agreed that the AR application provided a realistic patient presence compared with 59% (p = 0.07) of subjects in the standard CPR manikin cohort.

Conclusions: In a randomized trial of an AR CPR training application compared with a standard CPR manikin training, the AR CPR application did not improve the quality of CPR performed during a CPR refresher training compared with the standard training in HCPs. Future studies should investigate the use of this and other digital technologies for CPR training and education.

Pathways of migration from gaming to gambling

Gaming and gambling have been studied in terms of similarity of its manifestations. There is a dearth of empirical-based evidence for the exploration of pathways to understand the shift from gaming to gambling. A 23-year-old male from a nuclear family was assessed using clinical interview for the pathways for shifting from gaming to gambling. The pathways were personality predispositions, maladaptive coping, interpersonal distress, peer pressure, variable reward anticipation, addiction characteristics in the form of craving, loss of control and use despite having consequences. These findings suggest that there is a need to create awareness among young adults about these potential causes related to transition from gaming to gambling.

All that glitters is not gold. The rise of gaming in the COVID-19 pandemic

The COVID-19 pandemic has led to an unprecedented situation, with incalculable health, social, and economic consequences. At the start of the outbreak, the financial markets collapsed, although not all sectors suffered equally. The gaming and eSports industry is one of those that has suffered the least from the fall in the markets. Millions of people locked up at home, bored, stressed, and anguished, gave gaming and eSports companies growing prominence throughout the first half of 2020. This prominence has elicited interest in analyzing which variables can influence the returns in an industry in better financial health than many others. Using a logit–probit model, this research aims to analyze the relationship between financial (VIX, S&P GSCI Gold Index) and social (worldwide daily variation in total deaths from COVID-19 and worldwide Google attention on coronavirus) variables and the returns offered by the video game and eSports exchange traded fund (ESPO). The results show that the influence of social variables is weaker than the influence of financial variables. There is a significant inverse relationship between market volatility and ESPO returns and a highly significant relationship between ESPO returns and gold returns. While the relationship of ESPO returns with worldwide Google attention on coronavirus is significant, the relationship with worldwide daily variation in total deaths from COVID-19 is not. The conclusions of the study are discussed at the end of the paper.

A Perspective on Age Restrictions and Other Harm Reduction Approaches Targeting Youth Online Gambling, Considering Convergences of Gambling and Videogaming

Internet gambling has become a popular activity among some youth. Vulnerable youth may be particularly at risk due to limited harm reduction and enforcement measures. This article explores age restrictions and other harm reduction measures relating to youth and young adult online gambling. A systematic rapid review was conducted by searching eight databases. Additional articles on online gambling (e.g., from references) were later included. To place this perspective into context, articles on adult gambling, land-based gambling, and substance use and other problematic behaviors were also considered. Several studies show promising findings for legally restricting youth from gambling in that such restrictions may reduce the amount of youth gambling and gambling-related harms. However, simply labeling an activity as "age-restricted" may not deter youth from gambling; in some instances, it may generate increased appeal for gambling. Therefore, advertising and warning labels should be examined in conjunction with age restrictions. Recommendations for age enforcement strategies, advertising, education, and warning labels are made to help multiple stakeholders including policymakers and public health officials internationally. Age restrictions in online gambling should consider multiple populations including youth and young adults. Prevention and harm reduction in gambling should examine how age-restriction strategies may affect problem gambling and how they may be best enforced across gambling platforms. More research is needed to protect youth with respect to online gambling.

Youth Gaming Addiction: Implications for School Nurses

Technology is pervasive in society and reaches across all age-groups. The use of technology in youth has risen steadily in the past two decades through access to television, internet, computers, social media, and gaming in various formats. Due to this increased exposure and access, concerns have developed among mental health and healthcare providers regarding gaming addiction in youth. The American Psychiatric Association mentioned internet gaming disorder in the 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.). While not recognized as a specific diagnosis at the time of publication, there was a call for further research and evaluation of this phenomenon. Research indicates there are negative impacts on academic performance, social development, and self-concept in game-addicted youth. The purpose of this article is to provide the school nurse with information needed to recognize and care for youth at risk for and those experiencing gaming addiction. The school nurse is poised to provide nursing care in the school setting to educate, prevent, and help manage youth with gaming addiction risks and experiences, as part of an interdisciplinary team.

DSM-5 Internet gaming disorder among a sample of Mexican first-year college students

BACKGROUND AND AIMS

DSM-5 includes Internet gaming disorder (IGD) as a condition for further study. While online and offline gaming may produce undesired negative effects on players, we know little about the nosology of IGD and its prevalence, especially in countries with emerging economies.

METHODS

A self-administered survey has been employed to estimate prevalence of DSM-5 IGD and study the structure and performance of an instrument in Spanish to measure DSM-5 IGD among 7,022 first-year students in 5 Mexican universities that participated in the University Project for Healthy Students (PUERTAS), part of the World Health Organization's World Mental Health International College Student Initiative.

RESULTS

The scale for IGD showed unidimensionality with factor loadings between 0.694 and 0.838 and a Cronbach's α = .816. Items derived from gaming and from substance disorders symptoms mixed together. We found a 12-month prevalence of IGD of 5.2% in the total sample; prevalence was different for males (10.2%) and females (1.2%), but similar for ages 18-19 years (5.0%) and age 20+ (5.8%) years. Among gamers, the prevalence was 8.6%. Students with IGD were more likely to report lifetime psychological or medical treatment [OR = 1.8 (1.4-2.4)] and any severe role impairment [OR = 2.4 (1.7-3.3)]. Adding any severe role impairment to the diagnostic criteria decreased the 12-month prevalence of IGD to 0.7%.

DISCUSSION AND CONCLUSIONS

Prevalence of DSM-5 IGD and the performance of diagnostic criteria in this Mexican sample were within the bounds of what is reported elsewhere. Importantly, about one in every seven students with IGD showed levels of impairment that would qualify them for treatment under DSM-5.

[Kahoot: Applications and Effects in Education]

Stimulating learning motivation and enhancing learning effectiveness are particularly difficult challenges for nursing educators in educating Generation Z learners, who are part of the first generation of true "digital natives". In response, teachers are beginning to integrate gamification techniques into their classrooms in order to motivate classroom participation and to conduct learning evaluation. Kahoot is a free, online quiz platform and instant feedback system that helps teachers create a fun competitive-gaming environment. Learners may access the platform using a mobile phone or tablet to answer multiple-choice questions. The platform may be introduced at different stages of learning activities or combined with the flipped classroom model in order to achieve various teaching goals. This article provides a brief introduction of the gamification of learning and then discusses the operational skills needed to use Kahoot and the effectiveness of this platform, including advantages, limitations, and user feedback. Finally, the authors share their Kahoot-related teaching designs and experiences. It is suggested that nurse educators may apply Kahoot in their innovative teaching practices.

Impact of Novel Active-Learning Approaches Through iBooks and Gamification in a Reformatted Pharmacy Course

Objective. To compare pharmacy students' assessment and evaluation ratings of a newly formatted nonprescription products course that used innovative technology and gaming to that for a traditional nonprescription products course. Methods. Examination scores and course evaluations of students who completed the traditional course on nonprescription products were analyzed and compared with those of students who completed a revised course on nonprescription products that used teaching techniques in educational technology. Results. Students in the traditional course significantly outperformed those in the comparator group in eight nonprescription categories on examinations, while students in the new course significantly outperformed those in the comparator group in four categories. Students in the new course outperformed those in the traditional course in two additional examination categories, however these were not significant. Almost all students in both courses agreed or strongly agreed with each course evaluation item, including those items where use of gamification and iBooks were most likely considered. Conclusion. Improvements in student examination performance and course satisfaction may not be immediately seen in a course in which new teaching techniques using educational technology including gamification and iBooks are introduced.

The association between problematic online gaming and perceived stress: The moderating effect of psychological resilience

BACKGROUND AND AIMS

Vulnerability to stress appears to be a potential predisposing factor for developing specific internet-use disorders, such as Internet Gaming Disorder (IGD). Studies investigating the protective effect of psychological resilience against the impact of perceived stress on IGD and weekly gameplay have yet to be reported in the existing literature. The aim of this study was to examine the potential moderating relationships between perceived stress and online gaming (more specifically operationalized as IGD and weekly gameplay) with psychological resilience.

METHODS

An online survey was administered to 605 participants (males = 82%, M_age = 24.01 years, SD_age = 6.11). A multivariate multiple regression model was applied to test for the possible contribution of perceived stress and psychological resilience to weekly gameplay and IGD.

RESULTS

Perceived stress was associated with higher scores of IGD, whereas psychological resilience was related to lower scores of IGD. In addition, the combination of having higher perceived stress and lower level of psychological resilience was associated with a particularly high hours of gameplay per week.

DISCUSSION AND CONCLUSIONS

These findings further support the importance of personal traits (perceived stress and psychological resilience) in online gaming (IGD severity and weekly gameplay), and also emphasize the unique moderating relationship between perceived stress and weekly gameplay with lack of resilience. Enhancing psychological resilience to decrease the likelihood of online gamers who experience higher level of stress from spending more hours per week gaming is recommended.

Esports: The Chess of the 21st Century

For many decades, researchers have explored the true potential of human achievement. The expertise field has come a long way since the early works of de Groot (1965) and Chase and Simon (1973). Since then, this inquiry has expanded into the areas of music, science, technology, sport, academia, and art. Despite the vast amount of research to date, the capability of study methodologies to truly capture the nature of expertise remains questionable. Some considerations include (i) the individual bias in the retrospective recall of developmental activities, (ii) the ability to develop ecologically valid tasks, and (iii) difficulties capturing the influence of confounding factors on expertise. This article proposes that expertise research in electronic sports (esports) presents an opportunity to overcome some of these considerations. Esports involves individuals or teams of players that compete in video game competitions via human-computer interaction. Advantages of applying the expert performance approach in esports include (i) developmental activities are objectively tracked and automatically logged online, (ii) the constraints of representative tasks correspond with the real-world environment of esports performance, and (iii) expertise has emerged without the influence of guided systematic training environments. Therefore, this article argues that esports research provides an ideal opportunity to further advance research on the development and assessment of human expertise.

Enhancing health among youth living with HIV using an iPhone game

BACKGROUND

Despite promising outcomes of antiretroviral therapy (ART), challenges to improving adherence among youth living with HIV (YLWH) exist. Mobile games are popular among youth and may improve skills related to resilience, coping, and ART adherence. This study examines the preliminary effects of an iPhone game/app on ART adherence, viral load, and relevant knowledge and attitudes among YLWH in Jackson, MS.

METHODS

A RCT with 61 YLWH tested the impact of BattleViro, an ART-related iPhone game, over 16 weeks. Participants, ages 14-26, were recruited from HIV clinics and randomly assigned to receive BattleViro or a non-HIV-related game. All participants received a medication monitoring device. Chi-square and t-test analyses examined baseline differences between conditions. Continuous outcomes were examined using analyses of covariance (ANCOVAs) controlling for baseline scores. Cohen's d effect size differences (ESD) between groups were calculated.

RESULTS

The sample was 79% male, 97% Black, and 74% non-heterosexual, with a mean age of 22 years. A third had started ART in the past 3 months. There were no demographic differences between conditions. Examination of ESDs revealed that BattleViro demonstrated promising, but nonsignificant, improvements in HIV knowledge (ESD = 0.50), ART knowledge (ESD = 0.42) and social support (ESD = 0.62). Exploratory moderation analyses revealed interactions between BattleViro and newly starting ART. Those newly starting ART in the BattleViro condition, compared to those in the control, experienced a 0.96 log greater decrease in viral load (ESD=-2.21, F = 4.33, p = 0.04), better adherence (71% vs. 48%; ESD = 1.15, F = 3.90, p = 0.05), more HIV knowledge (ESD = 0.90), and more ART knowledge (ESD = 0.72).

CONCLUSION

BattleViro showed promising improvements in HIV knowledge, ART knowledge and social support. Also, there was improved adherence and viral load outcomes specifically among those newly starting ART. ART initiation may be an opportunity to empower and motivate YLWH to build healthy skills.

School-based Prevention for Adolescent Internet Addiction: Prevention is the Key. A Systematic Literature Review

Adolescents' media use represents a normative need for information, communication, recreation and functionality, yet problematic Internet use has increased. Given the arguably alarming prevalence rates worldwide and the increasingly problematic use of gaming and social media, the need for an integration of prevention efforts appears to be timely. The aim of this systematic literature review is (i) to identify school-based prevention programmes or protocols for Internet Addiction targeting adolescents within the school context and to examine the programmes' effectiveness, and (ii) to highlight strengths, limitations, and best practices to inform the design of new initiatives, by capitalizing on these studies' recommendations. The findings of the reviewed studies to date presented mixed outcomes and are in need of further empirical evidence. The current review identified the following needs to be addressed in future designs to: (i) define the clinical status of Internet Addiction (IA) more precisely, (ii) use more current psychometrically robust assessment tools for the measurement of effectiveness (based on the most recent empirical developments), (iii) reconsider the main outcome of Internet time reduction as it appears to be problematic, (iv) build methodologically sound evidence-based prevention programmes, (v) focus on skill enhancement and the use of protective and harm-reducing factors, and (vi) include IA as one of the risk behaviours in multi-risk behaviour interventions. These appear to be crucial factors in addressing future research designs and the formulation of new prevention initiatives. Validated findings could then inform promising strategies for IA and gaming prevention in public policy and education.

A Latent Class Approach for Classifying the Problem and Disordered Gamers in a Group of Adolescence

Gaming disorder is not yet recognized as a formal psychiatric disorder, and consensus is still lacking in the field concerning the definition of gaming disorder and what methods should be used to measure it. In order to deal with methodological challenges related to previously suggested approaches, the aim of the present study was to develop an alternative assessment procedure for gaming disorder using a latent class cluster approach, and to compare the criterion validity of this procedure with existing assessment procedures. A representative sample of 3,000 adolescents (n = 1,500 female) aged 17.5 years was drawn from the National Registry, and 2,055 participants responded (yielding a response rate of 70.3%). The Gaming Addiction Scale for Adolescents was used to measure gaming disorder and measures of loneliness, anxiety, depression, and aggression were used to test criterion validity. A model with five Latent Class Clusters represented the best fit [BIC(LL) = 21,253,7; L² = 3,881,204; df = 1,978; Class. Err. = 0.1239]. The five different groups were labeled never symptoms (46.2%), rarely symptoms (22.3%), occasionally symptoms (23.5%), problem gamers (6.9%), and disordered gamers (1.2%). The groups displayed different probabilities of responses (never/rarely/sometimes/often/very often) to the seven Gaming Addiction Scale items. Regarding criterion validity, MANOVA revealed a significant overall main effect of latent classes [F_{(20, 6359)} = 13.50, p < 0.001; Wilks Lambda = 0.871]. All dependent variables (loneliness, depression, anxiety, verbal, and physical aggression) reached statistical significance when results from the dependent variables were considered separately. Comparing the present approach with previous suggested classifications of gaming addiction offered by Lemmens et al. and Charlton and Danforth, the present approach showed greater specificity in terms of number of classes identified. We conclude that the Latent Class approach identifying five different groups of gamers offers a more refined view on addiction compared to previous assessment procedures.

Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke (RHOMBUS): protocol of an intervention feasibility trial

INTRODUCTION

Effective interventions to promote upper-limb recovery poststroke are characterised by intensive and repetitive movements. However, the repetitive nature of practice may adversely impact on adherence. Therefore, the development of rehabilitation devices that can be used safely and easily at home, and are motivating, enjoyable and affordable is essential to the health and well-being of stroke survivors.The Neurofenix platform is a non-immersive virtual reality device for poststroke upper-limb rehabilitation. The platform uses a hand controller (a NeuroBall) or arm bands (NeuroBands) that facilitate upper-limb exercise via games displayed on a tablet. The Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke trial aims to determine the safety, feasibility and acceptability of the Neurofenix platform for home-based rehabilitation of the upper-limb poststroke.

METHODS AND ANALYSIS

Thirty people poststroke will be provided with a Neurofenix platform, consisting of a NeuroBall or NeuroBands (dependent on impairment level), seven specially designed games, a tablet and handbook to independently exercise their upper limb for 7 weeks. Training commences with a home visit from a research therapist to teach the participant how to safely use the device. Outcomes assessed at baseline and 8 weeks and 12 weeks are gross level of disability, pain, objectively measured arm function and impairment, self-reported arm function, passive range of movement, spasticity, fatigue, participation, quality of life (QOL) and health service use. A parallel process evaluation will assess feasibility, acceptability and safety of the intervention through assessment of fidelity to the intervention measured objectively through the Neurofenix platform, a postintervention questionnaire and semistructured interviews exploring participants' experiences of the intervention. The feasibility of conducting an economic evaluation will be determined by collecting data on QOL and resource use.

ETHICS AND DISSEMINATION

Ethics approval granted from Brunel University London (10249-MHR-Mar/2018-12322-2). Trial results will be submitted for publication in journals, presented at national and international conferences and distributed to people with stroke.

TRIAL REGISTRATION NUMBER

ISRCTN60291412; Pre-results.