Video Game Monetization (e.g., ‘Loot Boxes’): a Blueprint for Practical Social Responsibility Measures

What are the odds? Poor compliance with UK loot box probability disclosure industry self-regulation

Loot boxes are purchased in video games to obtain randomised rewards of varying value and are thus psychologically akin to gambling. Disclosing the probabilities of obtaining loot box rewards may reduce overspending, in a similar vein to related disclosure approaches in gambling. Presently, this consumer protection measure has been adopted as law only in the People's Republic of China (PRC). In other countries, the videogaming industry has generally adopted this measure as self-regulation. However, self-regulation conflicts with commercial interests and might not maximally promote public welfare. The loot box prevalence rate amongst the 100 highest-grossing UK iPhone games was 77% in mid-2021. The compliance rate with probability disclosure industry self-regulation was only 64.0%, significantly lower than that of PRC legal regulation (95.6%). In addition, UK games generally made insufficiently prominent and difficult-to-access disclosures both in-game and on the game's official website. Significantly fewer UK games disclosed probabilities on their official websites (21.3%) when compared to 72.5% of PRC games. Only one of 75 UK games (1.3%) adopted the most prominent disclosure format of automatically displaying the probabilities on the in-game purchase page. Policymakers should demand more accountable forms of industry self-regulation or impose direct legal regulation to ensure consumer protection.

Not all games are created equal: Adolescents who play and spend money on simulated gambling games show greater risk for gaming disorder

Research reports positive associations between gaming disorder (GD) in adolescents and loot box purchasing but has not examined this relationship for other types of simulated gambling. This study examined whether greater engagement and expenditure in three types of simulated gambling were associated with meeting the criteria for GD in adolescents. A sample of Australians aged 12-17 years (N = 826) was recruited through an online panel aggregator. It included 646 gamers (57.7% male) with 89 being classified as having past-year GD, as defined and measured by the Internet Gaming Disorder Scale. Independent variables comprised past-month engagement in three simulated gambling activities (games with 'mini' gambling components, social casino games, and loot boxes), loot box purchasing, other microtransactions, impulsiveness, and demographics. Logistic regressions first examined whether engagement in each of the three simulated gambling activities was individually associated with GD, then with all three in the same model, and then controlling for demographic variables and impulsivity. Logistic regressions also examined whether microtransactions and purchasing loot boxes were individually associated with GD, then with both in the same model, and then controlling for demographic variables and impulsivity. Adolescents who had engaged in each simulated gambling activity in the past month were more likely to report meeting the criteria for GD. These relationships remained significant when controlling for common demographics and impulsiveness. Past-month engagement in social casino games increased the odds of GD 2.5 times (95% CI: 1.54; 4.02), 2.4 times for games with 'mini' gambling components (95% CI: 1.42; 3.90) and 2.0 times for engaging in loot boxes (95% CI: 1.22; 3.21), but only social casino games remained significant when controlling for engagement in all three activities. The likelihood of meeting the criteria for GD increased 3.8 times with expenditure on microtransactions (95% CI: 2.32; 6.27) and 4.6 times for buying loot boxes, and each remained significant when both were included in the model. Compared to digital games without simulated gambling elements, simulated gambling appears to attract adolescents who report GD. Implications of the results are discussed in detail.

Skin Gambling Contributes to Gambling Problems and Harm After Controlling for Other Forms of Traditional Gambling

Esports betting and skin gambling involve betting on the outcomes of video game competitions and/or using virtual currencies for betting. The present study evaluated a conceptual model linking video game involvement, video-game related gambling, traditional gambling, and gambling problems and harm. Data were collected via a cross-sectional online survey with 737 participants aged 18 + who engaged in esports cash betting (n = 576), esports skin betting (n = 184), or skin gambling on games of chance (n = 330). The findings highlighted the distinctly different relationships esports cash betting versus skin gambling had with traditional gambling involvement and harmful gambling. Gambling with skins on games of chance was predictive of gambling problems and gambling harm after controlling for participation in traditional gambling (OR = 1.32 and 1.17 respectively). Whereas betting on esports with cash was associated with betting on a variety of other forms of gambling, and there was no unique contribution to problems and harm over and above participation on these other forms (e.g., EGMs, sports betting). Skin gambling is directly implicated in gambling problems and harm, whereas cash betting on esports is only indicative of interest in many forms of potentially harmful gambling. Greater research attention to skin gambling is warranted, and particularly with respect to its role as a virtual currency more easily accessible for gambling.

Do Gamers Play for Money? A Moderated Mediation of Gaming Motives, Relative Deprivation, and Upward Mobility

Past research indicates strong monetary motives for gambling often elevate an individual's risk of experiencing symptoms of gambling disorder, with personal relative deprivation (PRD) and upward mobility (UM) identified as key factors in this relationship. Nevertheless, few studies have examined how financial motives, PRD, and UM might interact for people playing modern video games-many of which offer financial incentives to encourage participation. Due to the overlap between gambling and (video) gaming, evidence suggests disordered gambling and disordered gaming might also share similarities. Therefore, the present study explored whether PRD influences associations between playing video games for financial motives, symptoms of Internet gaming disorder (IGD), and UM in two samples: 797 college students (Study 1) and 179 adult gamers over 25 years old (Study 2). Results from Study 1 revealed more PRD predicted more IGD symptoms, with higher financial gaming motives mediating the relationship. In Study 2, PRD also predicted IGD severity, but only coping motives appeared to mediate the positive association between PRD and IGD severity. In both samples, perceived UM inversely moderated the effect of PRD on one's financial or coping gaming motives. These findings suggest financial motives for video games might lead to more problematic forms of participation for younger adults and negative perceptions of PRD and UM might interact, similar to gambling, to elevate a gamer's vulnerability for IGD.

Understanding the mechanics and consumer risks associated with play-to-earn (P2E) gaming

BACKGROUND AND AIMS

Play-to-earn (P2E) gaming is a newly emerging form of gaming increasingly based on blockchain technology. In this paper, we examine the mechanics and business model of these games and their potential benefits and risks for players.

METHODS

The paper draws upon and critically synthesises the developing published literature on predatory monetization in gaming as well as objective market data drawn from credible online sources.

RESULTS

P2E gaming blurs the boundaries between gaming and trading and may not yield many of the benefits promoted to consumers or otherwise conveyed through marketing and social media messaging. Particular risks include the deflationary nature of reward currencies and the asymmetric reward structures that heavily favour early investors and exploit late adopters.

DISCUSSION AND CONCLUSIONS

This paper highlights the need for greater consumer awareness of the mechanics and risks of these new gaming models. It will be important for business models to be more transparent and designed so as to encourage more equitable game outcomes, sustainable returns, a balance between intrinsic and extrinsic rewards, and protection for potentially vulnerable players.

From one year to the next: Video gaming life-style predicts subsequent psychosocial risk in adolescent boys and girls

AIM

The ubiquitous societal presence of screens and gaming software is ever growing in popularity. However, can this recreational life-style pose risks for children's psychosocial adjustment? We thus examine associations between gaming life-style and later psychosocial development.

METHODS

The study sample originates from the 2120 boys and girls from the Quebec Longitudinal Study of Child Development birth cohort. At age 12, 625 boys and 702 girls from the original sample self-reported the number of hours engaged in video gaming per week and 1 year later, they self-reported psychosocial outcomes.

RESULTS

Among boys, higher weekly video gaming frequency at age 12 forecasted increases in subsequent reactive aggression, emotional distress and ADHD symptoms at age 13. For girls, higher weekly video gaming frequency at age 12 predicted increases in subsequent reactive aggression and ADHD symptoms at age 13. No association between video game use and emotional distress was found for girls.

CONCLUSION

In both boys and girls, a more intense video gaming life-style predicted subsequent risks for reactive aggression and ADHD symptoms, compared with their same sex counterparts reporting less intensity. For boys only, video gaming was associated with subsequent reactive emotional distress, likely due to the gender differences in violent content. Our data were collected at a time when there were less versatile screen-based technologies; therefore, our findings can be interpreted as very conservative compared to current estimates. Paediatric professionals and allied disciplines must take preventive measures to ensure that parents are aware of the risks associated with excessive use by their sons and daughters.

Opening Pandora’s Loot Box: Weak Links Between Gambling and Loot Box Expenditure in China, and Player Opinions on Probability Disclosures and Pity-Timers

Loot boxes are quasi-gambling virtual products in video games that provide randomised rewards of varying value. Previous studies in Western contexts have identified a positive correlation between loot box purchasing and problem gambling severity. A preregistered survey of People’s Republic of China (PRC) video game players (N = 879) failed to replicate this correlation. We observed statistically significant but weak positive correlations between loot box expenditure and past-year gambling participation, and between loot box expenditure and impulsiveness. This study cannot prove that loot boxes are not disproportionately purchased by people with problem gambling symptomatology in the PRC or that PRC players are not potentially at risk of loot box-related harms. Instead, the evidence suggests that the relationship between loot boxes and gambling might be weaker in the PRC than in Western countries. We identified multiple unique factors about the PRC that might be affecting this relationship. For example, the lotteries are the only legally permitted form of gambling. More gamified electronic gambling products are unavailable. The limited availability of gambling meant that a low level of gambling participation (n = 87) was observed, which is a limitation of this study. Additionally, the PRC is presently the only country to legally require loot box probability disclosures as a consumer protection measure. Most loot box purchasers (84.6%) reported seeing loot box probability disclosures, but only 19.3% of this group reported consequently spending less money. Most loot box purchasers (86.9%) thought that pity-timers, which increase the winning probabilities of obtaining rarer rewards, are appropriate for implementation. Future loot box research should give greater consideration to differing cultural contexts and novel consumer protection measures.

Loot box engagement: relationships with educational attainment, employment status and earnings in a cohort of 16 000 United Kingdom gamers

BACKGROUND AND AIMS

Loot boxes are purchasable randomised rewards in video games that share structural and psychological similarities with gambling. Systematic review evidence has established reproducible associations between loot box purchasing and both problem gambling and problem video gaming. We aimed to measure the association between loot box engagement and socioeconomic correlates.

DESIGN

The study was a cross-sectional online survey using the recruitment platform, Prolific.

SETTING

United Kingdom (UK).

PARTICIPANTS

A cohort of 16 196 UK adults (18 + years) self-reporting as video gamers.

MEASUREMENTS

Respondents were asked about their game-related purchasing behaviour (including loot boxes), recent monthly spend on loot boxes and gambling engagement (gambling in any form; gambling online; playing 'social casino' games). A range of demographic variables were simultaneously captured, including age, sex, ethnicity, earnings, employment and educational attainment.

FINDINGS

Overall, 17.16% of gamers in our cohort purchased loot boxes, with a mean self-reported monthly spend of £29.12. These loot box purchasers are more likely to gamble (45.97% gamble) than people who make other types of game-related purchases (on aggregate, 28.13% of non-loot box purchasers gamble), and even greater still than those who do not make any game related purchases (24.38% gamble P < 0.001). Loot box engagement (as binary yes/no or as monthly spend normalised to earnings) was significantly associated with younger age (P < 0.001 and P < 0.001; respectively, for binary yes/no and monthly spend, adjusted for false discovery rate correction), male sex (P < 0.001 and P = 0.025), non-university educational attainment (P < 0.001 and P < 0.001) and unemployment (P = 0.003 and P = < 0.001). Lower earners spent a higher proportion of monthly earnings on loot boxes (P < 0.001).

CONCLUSIONS

The demographic associations of video game loot box engagement (younger age, male sex, non-university educational attainment and unemployment) mirror those of other addictive and problematic behaviours, including disordered gambling, drug and alcohol misuse.

Exploring the association between loot boxes and problem gambling: Are video gamers referring to loot boxes when they complete gambling screening tools?

Concerns regarding the similarities between video game 'loot boxes' and gambling have been supported by correlations in survey studies between loot box engagement and problem gambling scores. It is generally noted that this correlation could reflect loot box users migrating to conventional gambling, and/or people with gambling problems being attracted to loot boxes when they play video games. We describe a third possibility, that when gamers complete problem gambling screens they may be referring to harms incurred from their loot box use. Using three secondary datasets from cross-sectional online surveys, we explore this account in two ways. First, in participants who do not endorse any participation in conventional forms of gambling, we compare rates of positive (i.e. non-zero) scores on the Problem Gambling Severity Index (PGSI) in participants with and without loot box use. Second, noting that some PGSI items have less relevance to loot box use versus gambling, we compare endorsement rates of individual PGSI items, in gamers versus gamblers, and loot box users vs non-loot box users (focusing on item 3 "going back another day to win back the money you lost"). In analysis 1, positive PGSI scorers among non-gamblers were significantly elevated in loot box users vs non-loot box users, although absolute numbers were low overall. In analysis 2, there were no reliable differences (gamers vs gamblers, loot box users vs non-loot box users) in PGSI item 3 endorsement rates. We conclude that these results provide partial support for this third option, and highlight a need for future studies to consider this possibility more directly.

Response to the Regulation of Video Games under the Youth Media Protection Act: A Public Health Perspective

The Swiss Youth and Media Act, which is about to enter into force, is an attempt to provide a legislative framework for video game use. Among other inclusions, the law intends to make providers more accountable by taking measures to protect minors from harm that can be caused by improper use of video games. However, it is a challenge to create a legal framework that can adequately regulate the evolving features of video games. Legislators must find a suitable regulatory approach which takes into account the fact that there is an increasing convergence between video games and gambling, particularly with the introduction of loot boxes. Moreover, there is a need for regulation, including the prohibition of misleading designs, the introduction of additional protection for minors, and the assurance of transparency of transactions. Appropriate policy legislation and consumer-protection measures are needed to protect people using these types of products, particularly children and adolescents. Further work should focus on assessing game characteristics to refine regulatory models to promote safe gaming. Based on experiences from the field of psychoactive substances as well as that of gambling, it is now a matter of developing a matrix of harm with elaborated categories: a tool that makes it possible to evaluate the potential harms of certain game design in an evidence-based manner.

Regulating Gambling-Like Video Game Loot Boxes: a Public Health Framework Comparing Industry Self-Regulation, Existing National Legal Approaches, and Other Potential Approaches

Purpose of Review

Loot boxes are gambling-like monetisation mechanics in video games that are purchased for opportunities to obtain randomised in-game rewards. Gambling regulation is increasingly being informed by insights from public health. Despite conceptual similarities between loot boxes and gambling, there is much less international consensus on loot box regulation. Various approaches to regulating loot boxes are reviewed via a public health framework that highlights various trade-offs between individual liberties and harm prevention.

Recent Findings

Many countries have considered regulation, but as yet only a few countries have taken tangible actions. Existing regulatory approaches vary greatly. More restrictively, Belgium has effectively ‘banned’ paid loot boxes and prohibits their sale to both children and adults. In contrast, more liberally, China only requires disclosure of the probabilities of obtaining potential rewards to provide transparency and perhaps help players to make more informed purchasing decisions. Most other countries (e.g., the UK) have adopted a ‘wait-and-watch’ approach by neither regulating loot box sales nor providing any dedicated consumer protection response. Industry self-regulation has also been adopted, although this appears to elicit lower rates of compliance than comparable national legal regulation.

Summary

Many potential public health approaches to loot box regulation, such as expenditure limits or harm-reducing modifications to loot box design (e.g., fairer reward structures), deserve further attention. The compliance and clinical benefits of existing interventions (including varying degrees of regulation, as adopted by different countries, and industry self-regulation) should be further assessed. The current international variation in loot box regulation presents opportunities to compare the merits of different approaches over time.

Reserve your judgment on "Draconian" Chinese video gaming restrictions on children •

China imposed strict restrictions on young people's participation in videogaming from September 2021. Colder Carras et al.'s commentary (2021) referred to this policy as 'draconian,' i.e., 'excessively harsh and severe.' However, any opinion on whether this policy is 'draconian' is a value judgment, and any judgment on its 'effectiveness' ought to be reserved until proven or disproven by empirical evidence. Indeed, the Chinese policy is neither potentially ineffective nor draconian, and is already providing at least one identifiable benefit: enhancing consumer protection by effectively reducing underage players' monetary spending on videogames, including on randomised, gambling-like mechanics known as 'loot boxes.'

Gambling Features and Monetization in Video Games Create Challenges for Young People, Families, and Clinicians

Video gaming (also known as computer gaming or electronic gaming) has stirred scientific interest since its widespread adoption as a recreational activity in the 1980s. Initial research focused on the negative consequences of violent content and the development of excessive or addictive use by players. Based on evidence showing that some players develop clinically significant addiction-like symptoms such as loss of control and impaired individual, social, and occupational functioning,¹ Gaming Disorder has been recognized as an official diagnosis in the International Classification of Diseases, 11^thedition (ICD-11).² However, recent changes in video games have again produced qualitatively new problems.

Emerging experience with selected new categories in the ICD-11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder

Among the important changes in the ICD-11 is the addition of 21 new mental disorders. New categories are typically proposed to: a) improve the usefulness of morbidity statistics; b) facilitate recognition of a clinically important but poorly classified mental disorder in order to provide appropriate management; and c) stimulate research into more effective treatments. Given the major implications for the field and for World Health Organization (WHO) member states, it is important to examine the impact of these new categories during the early phase of the ICD-11 implementation. This paper focuses on four disorders: complex post-traumatic stress disorder, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. These categories were selected because they have been the focus of considerable activity and/or controversy and because their inclusion in the ICD-11 represents a different decision than was made for the DSM-5. The lead authors invited experts on each of these disorders to provide insight into why it was considered important to add it to the ICD-11, implications for care of not having that diagnostic category, important controversies about adding the disorder, and a review of the evidence generated and other developments related to the category since the WHO signaled its intention to include it in the ICD-11. Each of the four diagnostic categories appears to describe a population with clinically important and distinctive features that had previously gone unrecognized as well as specific treatment needs that would otherwise likely go unmet. The introduction of these categories in the ICD-11 has been followed by a substantial expansion of research in each area, which has generally supported their validity and utility, and by a significant increase in the availability of appropriate services.

How can the potential harms of loot boxes be minimised?: Proposals for understanding and addressing issues at a national level

Background and aims

Loot boxes are in-game items which distribute rewards to players via random-number generation; many games require players to make in-game payments to access their contents. The combination of financial outlay and random rewards has raised concern about similarities to gambling. This debate paper presents a series of themes identified by an inter-institutional working group in Finland, alongside suggested actions, and are presented with the intention of stimulating debate among stakeholders.

Methods

This work uses an exploratory research approach to gather data from a range of sources, including state-of-the-art reports from several fields and qualitative content analysis of invited presentations from a range of stakeholders, including affected individuals, practitioners, and field-specific experts.

Results and Discussion

Several significant themes emerged from the work and are presented alongside a series of proposed action points. Based on this preliminary exploration we propose a series of, non-exhaustive, actions for both primary and secondary prevention. Furthermore, the group identified the potential for responsible gaming practices to be adopted which would help to minimize the harm from overspending in gaming activities. Finally, we identified the need for further research in the field, for example the use of player data and both longitudinal and qualitative studies.

Conclusions

The emergent themes are discussed in relation to both the views of the presenters and existing research in the field and are intended to promote discussion concerning the viability of context-specific approaches to an issue of global reach and significance.

Problem mobile gaming: The role of mobile gaming habits, context, and platform

Aims: Mobile gaming is a dominant form of gaming, known for its portability and for game characteristics that motivate continuous play and spending. Such involvement may also turn problematic, but research on problem gaming (PG) has tended to focus on non-mobile forms of gaming. The study was based on a cross-sectional observational design where students in upper secondary schools were recruited to a survey about mobile gaming. The age of the respondents ranged from 16 to 23 years (n = 519; 52.4% men; mean age = 17.2 years, SD = 1.1). Methods: We examined (1) gaming frequency, gaming contexts, and in-game spending in relation to PG; (2) gaming context in relation to academic achievement and sleep quality; and (3) PG according to gaming platform (i.e., playing on mobile, console/computer, or mixed platforms) with Kruskal−Wallis tests, chi-square tests and Spearman rank-order correlations. Results: PG was positively associated with mobile gaming hours per week (η² = .02, p < .01), minutes per session (η² = .03, p < .001), making in-app purchases (Cramer's V = .15, p < .05), and gaming during homework (Cramer's V = .14, p < .05). Statistically significant associations were found between mobile gaming in bed and later sleep midpoint for weekdays (r_s = .18, p < .001) and weekends (r_s = .11, p < .05). Mixed platform gamers had increased likelihood of PG, console/computer gamers had increased likelihood of being at risk for PG, and mobile gamers had lower risk for PG (Cramer's V = .18, p < .001). Conclusion: Future studies should include specific measures of mobile gaming as it appears implicated in problem gaming, albeit to a lesser degree than console and computer gaming.

Loot box purchasing is linked to problem gambling in adolescents when controlling for monetary gambling participation

Background and aims

Purchasing loot boxes in digital games is akin to gambling as it involves risking money for a chance-based reward of uncertain value. Research has linked buying loot boxes to problem gambling amongst adolescents, but has not examined co-occurring gambling participation. This study examined links between loot box purchasing and problem gambling amongst adolescents while controlling for monetary gambling participation.

Methods

Two survey samples of Australians aged 12-17 years were recruited through advertisements (n = 843) and online panels (n = 826). They included n = 421 and n = 128 adolescents, respectively, who met criteria for problem gambling.

Results

Past-month loot box purchasing was significantly related to gambling problems in bivariate analyses. When including age, gender and past-month monetary gambling, loot box purchases were still associated with at-risk and problem gambling in both samples. As expected, these other predictors attenuated the predictive value of recent loot box purchases in relation to gambling problems. The odds-ratios, nevertheless, were still in the predicted direction and remained significant. When controlling for monetary gambling, age and gender, recent loot box purchasing increased the odds of problem gambling 3.7 to 6.0 times, and at-risk gambling 2.8 to 4.3 times.

Discussion and conclusions

While causal relationships between loot box purchasing and problem gambling remain unclear, the results indicate that loot boxes disproportionately attract adolescents experiencing gambling problems, adding to the financial stress already caused by gambling. Consumer protection measures, youth and parental education, and age restrictions on loot box games are needed to protect young people.

What’s in the box? Exploring UK players’ experiences of loot boxes in games; the conceptualisation and parallels with gambling

Loot boxes are a popular mechanic within many video games, but it remains unclear if some forms of loot boxes can be seen of as gambling. However, the perspectives of players are often neglected, such as whether they see them as ‘fair’ game elements and how closely they feel this aligns with gambling. In this paper, we synthesise a conceptualisation for loot boxes through players’ actual experience and explore if there are any parallels with gambling. Twenty-one participants who played video games took part in the research through either an interview or online survey. Thematic analysis suggested that six themes were core to exploring loot boxes: Random Chance Effects, Attitudes Towards Content, Implementation, Parallels with Gambling, Game Design, and The Player. The results suggested both indirect and direct parallels with gambling from the players experiences. Implications of game design and classifying loot boxes as gambling are discussed in relation to game design and risk factors of gambling and purchasing behaviour.

Skin gambling predicts problematic gambling amongst adolescents when controlling for monetary gambling

BACKGROUND AND AIMS

Skin gambling uses in-game items (skins) acquired in video games, to gamble on esports, games of chance, other competitive events and privately with friends. This study examined characteristics of adolescent skin gamblers, their engagement in monetary gambling, and relationships between skin gambling and at risk/problem gambling.

METHODS

Two samples of Australian adolescents aged 12-17 years were recruited to an online survey through advertisements (n = 843) and an online panel provider (n = 826).

RESULTS

In both samples, past-month skin gamblers (n = 466 advertisements sample; n = 185 online panel sample) were more likely to have lower wellbeing, score as having an internet gaming disorder on the IGD, engage in more types of monetary gambling, and meet criteria for problem gambling on the DSM-IV-MR-J. Past-month skin gambling uniquely predicted problem gambling when controlling for past-month gambling on 11 monetary forms and the total number of monetary gambling forms.

DISCUSSION AND CONCLUSIONS

Underage participation in skin gambling is a growing concern. The strong convergence between engagement in skin gambling and monetary gambling suggests common risk factors may increase the propensity of some adolescents to gamble on these multiple forms. Nonetheless, past-month skin gambling predicted problem gambling even when controlling for past-month monetary gambling, indicating its unique contribution to gambling problems and harm. While the study was based on non-probability samples, its results strengthen the case for regulatory reforms, age restrictions and public health education to prevent underage skin gambling and its potentially harmful consequences for children and young people.

Contentious Issues and Future Directions in Adolescent Gambling Research

Background. There is currently considerable public policy and regulatory interest in the nature and prevalence of underage gambling. Research in this area has purported to show that adolescents are at elevated risk of problem gambling and that early exposure to gambling or gambling-like activities could be a potential precursor to future harm. Method. In this commentary, we provide a critical appraisal of these arguments with reference to major studies in the field of gambling studies. It is argued that adolescent gambling research is a contentious area. Some questions remain concerning the validity of adolescent problem gambling measures, the strength of the association between adolescent and adult gambling and the impact of simulated gambling activities. Results. The paper summarises the conceptual and methodological issues that should be considered and addressed in future studies to strengthen the validity of research in this area. Conclusion. The paper encourages the greater use of harm-based measures, longitudinal and individual-level transition analyses and questions that capture the influence of activities rather than just their temporal sequencing.

An Evaluation of Gaming-Related Harms in Relation to Gaming Disorder and Loot Box Involvement

The specific nature of harm and functional impairment in the context of gaming disorder (GD) has received limited attention. In this study, we present one of the first concerted attempts to measure the types and degree of harm experienced by people displaying signs of problem gaming. Attempts were made to assess the extent to which types of harm were attributable to gaming as opposed to other factors. The study also investigated potential behavioural indicators of harmful involvement, including exposure to loot boxes. A sample of 471 regular gamers (M = 380, F = 73), recruited through the online platform Prolific, completed a survey where problem gaming was identified using Petry et al.’s (2014) checklist. Individuals who met the cut-off for gaming disorder scored higher than the non-problem group on most dimensions of harm, with physical and psychological types being the most common issues. Loot box expenditure was low (M = $25 in 3 months, for the 10.8% of respondents who played loot boxes) but significantly positively associated with the degree of gaming-related financial harm. This study shows that problem gaming is most strongly associated with physical or psychological harm and that financial harms may manifest in gaming activities that facilitate continuous spending options.

Rare Loot Box Rewards Trigger Larger Arousal and Reward Responses, and Greater Urge to Open More Loot Boxes

Loot boxes are a purchasable video-game feature consisting of randomly determined, in-game virtual items. Due to their chance-based nature, there is much debate as to whether they constitute a form of gambling. We sought to address this issue by examining whether players treat virtual loot box rewards in a way that parallels established reward reactivity for monetary rewards in slots play. Across two sets of experiments, we show that loot boxes containing rarer items are more valuable, arousing, rewarding and urge-inducing to players, similar to the way slots gamblers treat rare large wins in slots play. Importantly, we show in Experiment 2 that the duration of Post Reinforcement Pauses, an index of reward reactivity, are longer for boxes with rarer items. Boxes containing rarer rewards also trigger larger Skin Conductance Responses and larger force responses-indices of positive arousal. Findings of Experiment 2 also revealed that there was an increase in anticipatory arousal prior to the reveal of loot box rewards. Collectively, our results elucidate the structural similarities between loot boxes and specific gambling games. The fact that players find rarer game items hedonically rewarding and motivating has implications for potential risky or excessive loot box use for some players.

"It's the Attraction of Winning That Draws You in"-A Qualitative Investigation of Reasons and Facilitators for Videogame Loot Box Engagement in UK Gamers

Excessive engagement with (increasingly prevalent) loot boxes within games has consistently been linked with disordered gambling and/or gaming. The importance of recognising and managing potential risks associated with loot box involvement means understanding contributing factors is a pressing research priority. Given that motivations for gaming and gambling have been informative in understanding risky engagement with those behaviours, this qualitative study investigated motivations for buying loot boxes, through in-depth interviews with 28 gamers from across the UK. A reflexive thematic analysis categorised reasons for buying into seven “themes”; opening experience; value of box contents; game-related elements; social influences; emotive/impulsive influences; fear of missing out; triggers/facilitators. These themes are described in detail and discussed in relation to the existing literature and motivation theories. This study contributes to understanding ways in which digital items within loot boxes can be highly valued by purchasers, informing the debate around parallels with gambling. Findings that certain motivations were disproportionately endorsed by participants with symptoms of problematic gambling has potential implications for policy and warrants further study.

Prevention Strategies to Address Problematic Gaming: An Evaluation of Strategy Support Among Habitual and Problem Gamers

Psychosocial problems arising from excessive gaming are a public health issue across the developed world. In its most serious form, problematic gaming is recognized as gaming disorder (GD) in the ICD-11. Research has tended to focus on the value of outpatient treatment for GD, but less attention has been paid to broader prevention strategies to address less serious but nevertheless harmful gaming behaviors. Another gap in this literature has been the lack of involvement of the gaming community as stakeholders to identify feasible prevention approaches. This study investigated: (1) regular and problematic gamers' level of support for different prevention strategies within primary, secondary, and tertiary approaches; and, (2) whether self-efficacy is associated with greater support for prevention strategies, as predicted by the Health Belief Model. A total of 992 participants completed an online survey that evaluated support for problem gaming prevention strategies and included measures of self-efficacy, gaming involvement, and GD symptoms, psychological distress, and mental health help-seeking behaviors. Participants reported stronger support for primary prevention strategies, including education, screening, and warning labels, than for other prevention approaches. Overall, 61% of participants expressed support for primary prevention as compared to secondary (39%) and tertiary (36%) approaches. There was stronger support for outpatient care (48%) than inpatient services (25%). In-game shutdown features received the lowest support (65% disapproval). Contrary to the Health Belief Model, self-efficacy was not associated with prevention support. Younger, female, and less frequent gamers were more likely to support primary and secondary prevention strategies. These findings suggest that gamers may be more favorable toward prevention measures aligned with informed decision-making, autonomy, and self-directed actions. Gamers may be strongly opposed to modifications to the structure of gaming activities (e.g., shutdown features). Future research should evaluate the efficacy and cost-effectiveness of problem gaming prevention measures in different populations and regions.

Risk Factors of Problem Gaming and Gambling in US Emerging Adult Non-Students: The Role of Loot Boxes, Microtransactions, and Risk-Taking

Video gaming and gambling have increasingly converged with one another (e.g., social casino games). For emerging adults (18-25 years old), who are already at an elevated risk for addictive disorders, this overlap in these activities may increase the likelihood of problematic involvement. At the moment, Internet gaming disorder (IGD) is being considered as a future medical diagnosis by the American Psychiatric Association. Therefore, the purpose of this study was to examine the potential comorbidity between IGD and gambling disorder (GD) in emerging adults, as well as explore if problematic engagement in gaming and gambling may be explained by recent trends in video game microtransactions (e.g., loot boxes) and risk-taking behaviors. An online survey was completed by 300 emerging adult non-students (M_age = 22.79, 49% male) from across the United States. The results revealed that compared to non-gamers, problematic gamers were 6.45 times more likely to problem gamble and compared to non-gamblers, problem gamblers were 5.62 times more likely to problem game. Microtransactions were the major mechanism for the relationship between IGD and GD. Participants with higher severity levels of either disorder demonstrated a greater likelihood of purchasing microtransactions, in addition to displaying significantly less aversion towards several domains of risk-taking. These findings suggest that emerging adults with probable IGD or GD may share common risk factors and patterns of behavior that transdiagnostic treatment approaches may better serve than syndrome-specific models.

Which Implementations of Loot Boxes Constitute Gambling? A UK Legal Perspective on the Potential Harms of Random Reward Mechanisms

Loot boxes are virtual items in video games that offer the player randomised in-game rewards of uncertain in-game and real-world value. Paid loot boxes represent a lucrative and prevalent contemporary monetisation method that encourages repeat purchase through randomisation. The psychology literature has consistently reported a relationship between loot boxes and problem gambling. However, various implementations of loot boxes have not been sufficiently differentiated and separately examined. The literature and gambling regulators have generally argued that only loot boxes that cost real-world money to buy, and offer rewards that can be transferred to other players and are consequently worth real-world money, constitute ‘gambling.’ This paper identifies the potential harms of two other types of loot box: one does not cost real-world money to buy and the other does not offer rewards that are worth real-world money and argues that both may constitute ‘gambling’ under UK law. This paper hypothesises that even loot boxes that neither cost real-world money to buy nor offer rewards that are worth real-world money may be potentially harmful as they may normalise gambling behaviours. This paper highlights that, when the game’s design and economy are exploited by players, a particular implementation of loot boxes may involve real-world money, potentially contrary to the game company’s intentions, and thereby effectively constitute ‘gambling.’ This paper recommends that future empirical research separately examine the potential harms of each type of loot box.

Beyond loot boxes: a variety of gambling-like practices in video games are linked to both problem gambling and disordered gaming

A variety of practices have recently emerged which relate to both video games and gambling. These range from opening loot boxes, to esports betting, real-money video gaming, token wagering, and social casino spending. It is unknown either how harmful or how widespread many of these activities are. A sample of 1,081 adults from the UK aged 18+ was therefore recruited. This sample was purposively recruited via quota sampling to represent the UK population in terms of sex, age, and ethnicity. Engagement in all forms of gaming-related practices were significantly associated with both problem gambling and disordered gaming. A total of 18.5% of the sample had engaged in these activities at least once in the new year. These results suggest a convergent ecosystem of practices that relate to both video games and gambling. Engagement in each of these activities is linked to problem gambling. However, it remains unclear whether engagement in these activities causes problem gambling.

Social and Behavioral Health Factors Associated with Violent and Mature Gaming in Early Adolescence

We examined how risk level of video games, measured by maturity and violence level, was associated with behavioral health, social impacts, and online social interactions. School-based surveys in two different cohorts assessed self-reported gaming behaviors, health, and social media use. For Study 1, our 700 participants were 52% female and 48% White (mean age 12.7). Middle school students who played the high-risk games reported higher depressive symptoms and problematic internet behaviors, less sleep, more time spent playing games, and higher frequency of checking social media than non-gaming students. Those who played high-risk games were less likely to play alone and to play with strangers than those who played minimal-risk games. For Study 2, our 772 participants were 50% female and 57% White (mean age 12.6). Similar to Study 1, we found that those who played the high-risk games spent significantly more time playing games, were more interactive with other players, and had poorer sleep outcomes than non-high-risk gamers. Additionally, playing high-risk games had significantly different social impacts of gaming compared to less-risky gaming, including spending more money on games, spending less time on homework and with family or skipping meals due to gaming. Mature and violent content of video games and amount of online social interaction associated with gaming play a strong role in behavioral health and social impacts within families. These results can inform guidelines to intervene when problematic behaviors emerge.

Stakeholders' Consensus on Strategies for Self- and Other-Regulation of Video Game Play: A Mixed Methods Study

Background: Little is known about strategies or mechanics to improve self-regulation of video game play that could be developed into novel interventions. This study used a participatory approach with the gaming community to uncover insider knowledge about techniques to promote healthy play and prevent gaming disorder. Methods: We used a pragmatic approach to conduct a convergent-design mixed-methods study with participants attending a science fiction and education convention. Six participants answered questions about gaming engagement and self- or game-based regulation of gaming which were then categorized into pre-determined (a priori) themes by the presenters during the presentation. The categorized themes and examples from participant responses were presented back to participants for review and discussion. Seven participants ranked their top choices of themes for each question. The rankings were analyzed using a nonparametric approach to show consensus around specific themes. Results: Participants suggested several novel potential targets for preventive interventions including specific types of social (e.g., play with others in a group) or self-regulation processes (e.g., set timers or alarms). Suggestions for game mechanics that could help included clear break points and short missions, but loot boxes were not mentioned. Conclusions: Our consensus development approach produced many specific suggestions that could be implemented by game developers or tested as public health interventions, such as encouraging breaks through game mechanics, alarms or other limit setting; encouraging group gaming; and discussing and supporting setting appropriate time or activity goals around gaming (e.g., three quests, one hour). As some suggestions here have not been addressed previously as potential interventions, this suggests the importance of including gamers as stakeholders in research on the prevention of gaming disorder and the promotion of healthy gaming. A large-scale, online approach using these methods with multiple stakeholder groups could make effective use of players’ in-depth knowledge and help speed discovery and translation of possible preventive interventions into practice and policy.

Fortnite microtransaction spending was associated with peers' purchasing behaviors but not gaming disorder symptoms

Monetized video games have received academic and regulatory scrutiny following concerns that these products may foster addiction-like behaviors, including compulsive spending. Previous studies have reported that individuals with markedly higher in-game financial expenditure are more likely to endorse symptoms of addictive behavior (i.e., gaming or gambling disorder). The present study recruited 428 adult Fortnite players from online forums and investigated gaming motivations and behaviors, as well as online social network influences, in relation to microtransaction spending and gaming disorder (GD) symptoms. The results showed that microtransaction spending was predicted by social influences (i.e., the frequency of spending by the participants' closest friend who spends money on Fortnite), greater accessibility to Fortnite across multiple devices, and having a higher in-game level. Spenders reported stronger motivation to acquire in-game rewards and were more likely to perceive game items as representing good value for money. Higher spenders were older and reported using more payment methods, having a close friend who pays for Fortnite more often, and spent more hours playing Fortnite. Problematic gaming was associated with trait impulsivity, weekly time spent playing the game, and the perception that reducing time spent playing would diminish one's sense of self-worth. Fortnite loot box spending was not associated with GD symptoms. These data suggest that different implementations of in-game monetization schemes may have different risk potential for consumers across games.

Screening and assessment tools for gaming disorder: A comprehensive systematic review

The inclusion of gaming disorder (GD) as an official diagnosis in the ICD-11 was a significant milestone for the field. However, the optimal measurement approaches for GD are currently unclear. This comprehensive systematic review aimed to identify and evaluate all available English-language GD tools and their corresponding evidence. A search of PsychINFO, PsychArticles, ScienceDirect, Scopus, Web of Science, and Google Scholar identified 32 tools employed in 320 studies (N = 462,249 participants). The evaluation framework examined tools in relation to: (1) conceptual and practical considerations; (2) alignment with DSM-5 and ICD-11 criteria; (3) type and quantity of studies and samples; and (4) psychometric properties. The evaluation showed that GD instrumentation has proliferated, with 2.5 tools, on average, published annually since 2013. Coverage of DSM-5 and ICD-11 criteria was inconsistent, especially for the criterion of continued use despite harm. Tools converge on the importance of screening for impaired control over gaming and functional impairment. Overall, no single tool was found to be clearly superior, but the AICA-Sgaming, GAS-7, IGDT-10, IGDS9-SF, and Lemmens IGD-9 scales had greater evidential support for their psychometric properties. The GD field would benefit from a standard international tool to identify gaming-related harms across the spectrum of maladaptive gaming behaviors.