Smoking in Video Games: A Systematic Review

Video games and Facebook addiction among Tunisian adolescents: prevalence and associated factors

OBJECTIVES

As social media and online gaming technology have developed very rapidly over the last two decades, their paired issues are of growing concern worldwide. The aim of our study was to assess the prevalence of video game and Facebook addiction and its predictive factors among Tunisian in school adolescents.

METHODS

We conducted a cross-sectional study among in school adolescents in Sousse, Tunisia, over the first academic term of the 2019-2020 school year using a self-administered questionnaire to a randomly selected representative sample of 1,353 students. The valid Arabic version of the Bergen Facebook Addiction Scale (BFAS), the Video Game Addiction Scale (GAS-7), the Beck Depression Inventory Short Form (13 items) and the Screen for Child Anxiety Related Disorders (SCARED-C) were used to assess facebook addiction disorder (FAD), internet gaming disorder (IGD), depression and anxiety respectively.

RESULTS

More than one in four pupils (26.1 %; CI 95 %: 23.8-28.4 %) were identified as problematic video game users and almost a third of participants (32.5 %; CI 95 %: 30-35 %) reported FAD. IGD was significantly associated with FAD (p<0.001). Likewise, pupils exhibiting depressive symptoms as well as those with anxiety symptoms were significantly more likely to be problematic video games and Facebook users (p<0.001 for each). Being addicted to Facebook (AOR=1.83, 95 % CI: 1.18-2.81), experiencing anxiety disorders (AOR=2.43, 95 % CI: 1.52-3.88), being male (AOR=2.51, 95 % CI: 1.95-3.23) and spending more than 4 h per day surfing the net (AOR=2.55, 95 % CI: 1.65-3.96) were the determinants of IGD in the multivariate analysis. Similarly, being addicted to video games (AOR=1.82, 95 % CI: 1.21-2.73), experiencing anxiety disorders (AOR=1.85, 95 % CI: 1.20-2.86), having experienced academic failure (AOR=1.73, 95 % CI: 1.16-2.56), and spending more than 4 h per day on social media (AOR=3.75, 95 % CI: 2.38-5.90) were the predictors of FAD.

CONCLUSIONS

The prevalence of problematic use of video games and Facebook is alarmingly high. Identifying risk factors can help screen high-risk adolescents. We need additional prevention measures addressing not just adolescents, but all risk factors.

Tobacco Imagery in the 20 Best-Selling Video Games of 2018

INTRODUCTION

Video games are played by the majority of American adolescents. A small body of research has shown that video games expose users to tobacco imagery, potentially influencing subsequent smoking behavior. We examine the presence, type, and quantity of tobacco imagery in recent popular video games.

METHODS

After identifying 20 best-selling US video games of 2018 and selecting each YouTube video of all cut scenes and bridging game play, we coded each video for the presence of five types of tobacco imagery. We also recorded the length of time tobacco content was visible during the video.

RESULTS

Seven of the top 20 video games contained tobacco imagery, which comprised between 7 seconds and 38 minutes of game play. All five types of tobacco imagery were accounted for: visible tobacco paraphernalia, tobacco products used to further game play, background characters using tobacco products, and main characters (playable and nonplayble) using tobacco products. Visible tobacco paraphernalia was the most common type of tobacco imagery and included both real and fictionalized tobacco brands that sometimes drew on real cigarette brand imagery. Three games allowed players to control tobacco-using characters.

CONCLUSIONS

Popular video games continue to expose players to tobacco imagery. Because video games are played repeatedly, the potential exists for adolescents to experience even more tobacco imagery than the baseline exposure established here, further increasing the potential for harm. Existing voluntary and regulatory approaches to policing tobacco content are inadequate; thus, policymakers should consider further interventions to minimize tobacco content in video games.

IMPLICATIONS

Video games, popular among youth and young adults, are known to contain tobacco imagery. Less is known about the quantity and type of this imagery among recent popular games. We found that 7 of the 20 best-selling video games of 2018 in the United States contained a variety of tobacco imagery and exposed players to as much as 38 minutes of tobacco content. Given the established link between exposure to tobacco marketing in media such as films and subsequent smoking behavior, policies to minimize tobacco imagery in video games that exceed the scant protections offered by the Master Settlement Agreement could help reduce smoking prevalence among youth.

Exploiting the "video game craze": A case study of the tobacco industry's use of video games as a marketing tool

BACKGROUND

Video games have grown in popularity since the 1970s, and tobacco imagery is present in a substantial subset of games, including those oriented to youth. Much like exposure to tobacco content in films, exposure to tobacco content in video games may influence smoking uptake and use; however, the tobacco industry's role in facilitating or promoting the use of tobacco imagery in video games is unclear. We explored the industry's interest in and use of video games to market their products to youth and young adults.

METHODS

We retrieved and analyzed archival tobacco industry documents. We supplemented information from the documents with current and archived versions of several brand and corporate websites and one website containing user-supplied information on video games.

RESULTS

Tobacco companies recognized the youth appeal and marketing potential of video games as early as 1980. Initial marketing ideas included incorporating video game themes into product packaging and design. More fully realized plans focused on incorporating video games into product promotions in bars, as a high visibility way to attract younger patrons and increase long-term marketing opportunities by generating names for tobacco company direct-marketing databases. Tobacco companies also incorporated video games into in-home product promotions, primarily as components of brand websites, in order to enhance brand image and generate repeat website traffic. A similar desire to attract and keep visitors led to discussions about the inclusion of video games on corporate youth smoking prevention websites, although only one company, Lorillard, followed through.

CONCLUSIONS

Video game players are an attractive target market for tobacco companies. Video games, as used by these companies, facilitate consumer engagement with particular tobacco brands or particular corporate messages. Eliminating the use of video games as a promotional vehicle may require limiting tobacco marketing in both physical and online environments.

Predicting the Time Spent Playing Computer and Mobile Games among Medical Undergraduate Students Using Interpersonal Relations and Social Cognitive Theory: A Cross-Sectional Survey in Chongqing, China

Background: Computer and mobile games are widely used among undergraduate students worldwide, especially in China. Our objective was to predict the time spent playing computer and mobile games based on interpersonal relations and social cognitive theory constructs (i.e., expectation, self-efficacy, and self-control). Methods: The cross-sectional survey was conducted in two medical universities using a sample of 1557 undergraduate students recruited by cluster sampling. The five-point Likert questionnaire was jointly developed by researchers from Chongqing Medical University and Jackson State University. Results: Approximately 30% and 70% of the students played computer and mobile games, respectively. The daily times spent by participants on computer games were 25.61 ± 73.60 min (weekdays) and 49.96 ± 128.60 min (weekends), and 66.07 ± 154.65 min (weekdays) and 91.82 ± 172.94 min (weekends) on mobile games. Students with high scores of interpersonal relations but low scores of self-efficacy spent prolonged time playing computer games on weekdays and weekends (p < 0.05 for all). Students with low scores of expectation spent prolonged time playing computer games on weekdays (p < 0.05). Students with high scores of interpersonal relations but low scores of self-efficacy and self-control spent prolonged time playing mobile games on weekdays and weekends (p < 0.05 for all). Conclusions: The prevalence and duration of playing mobile games were higher than those of playing computer games among medical undergraduate students in Chongqing, China. This study determined the interpersonal relations, self-efficacy, self-control, and expectation of the students at the time of playing computer and mobile games. Future studies may consider studying the interaction among game-related behaviours, environments, and personality characteristics.

Exposure to tobacco in video games and smoking among gamers in Argentina

BACKGROUND

Our objective was to assess whether exposure to tobacco in video games is associated with smoking among adolescent gamers from Argentina.

METHODS

Cross-sectional data were analysed from students in public and private middle schools in Argentina. Tobacco content in video games was estimated using previously validated methods and adolescents' tobacco exposure was assessed by multiplying tobacco content in the top three video games they play by the hours played per day. The primary outcome was current smoking. Multilevel logistic regression models adjusted for clustering within schools, regressing current smoking on tobacco exposure in video games (ie, none, low, high) after controlling for age, sex, parental education, parenting style, parental rules about the use of video games, rebelliousness, sensation seeking and 'technophilia'.

RESULTS

Of the 3114 students who participated, 92% of boys (1685/1802) and 56% of girls (737/1312) played video games and were included in the analytical sample. The prevalence of smoking was 13.8% among boys and 22.0% among girls; 74.5% of boys played video games more than 1 hour per day compared with 47.7% of girls. High exposure to tobacco content in video games compared with no exposure was independently associated with current smoking among girls (OR 1.78; 95% CI 1.02 to 3.09) but not among boys (OR 0.98; 95% CI 0.64 to 1.51).

CONCLUSIONS

Greater exposure to tobacco content in video games was associated with higher likelihood of smoking among Argentine girls who play video games, suggesting the need for policies that limit these exposures.

Impact of E-cigarettes on Smoking and Related Outcomes in Veteran Smokers With Psychiatric Comorbidity

OBJECTIVE

Compared to the general U.S. population, smokers with comorbid psychiatric and/or substance use disorders have lower quit rates after evidence-based treatments and disproportionately high smoking-related deaths. Improved modalities for reducing tobacco-related harm in this subpopulation are needed. Because electronic cigarettes (e-cigarettes) can now deliver physiologically relevant levels of nicotine to consumers, they represent an additional nicotine delivery system that could be used in cessation interventions. While current data suggest that the use of e-cigarettes by smokers promotes a reduction in combustible cigarette use, smoking quit rates through use of e-cigarettes appears to be low. The goal of this study was to examine impact of e-cigarette use on combustible tobacco use as well as on the readiness to quit smoking and changes in nicotine dependence in a multimorbid population.

METHODS

We conducted a 4-week, open-label study in 43 military veteran smokers who had no immediate intention to stop smoking and were currently receiving psychiatric services from the Department of Veterans Affairs health care system. Participants were provided with a study e-cigarette they could use ad libitum along with other tobacco products and were encouraged to attend weekly laboratory visits and a one-month follow-up visit. Main outcome measures were number of cigarettes smoked per day (CPD), the frequency of e-cigarette use, the amount of money spent on combustible cigarettes (U.S. dollars/week), alveolar carbon monoxide (CO) levels, and urine cotinine levels.

RESULTS

Mean e-cigarette use was 5.7 days per week and only 9% of participants used the e-cigarette for fewer than 4 days per week. Significant reductions in breath CO (9.3 ppm to 7.3 ppm, p < .02) and CPD (from 16.6 to 5.7, p < .001) were observed across study weeks, and no serious adverse events were reported. Three participants (10% of completers) reported smoking cessation that was corroborated biochemically. At one-month follow-up, motivation to quit smoking remained significantly higher and the level of nicotine dependence was significantly lower than at baseline.

CONCLUSIONS

E-cigarettes are acceptable to smokers with psychiatric comorbidities, as indicated by sustained and frequent e-cigarette use by 90% of participants, and may promote reduction and/or cessation of combustible cigarette use. E-cigarettes appear to be a viable harm reduction modality in smokers with psychiatric comorbidities.

Alcohol and Tobacco Content in UK Video Games and Their Association with Alcohol and Tobacco Use Among Young People

To determine the extent to which video games include alcohol and tobacco content and assess the association between playing them and alcohol and smoking behaviors in adolescent players in Great Britain. Assessment of substance in the 32 UK bestselling video games of 2012/2013; online survey of adolescent playing of 17 games with substance content; and content analysis of the five most popular games. A total of 1,094 adolescents aged 11–17 years were included as participants. Reported presence of substance content in the 32 games; estimated numbers of adolescents who had played games; self-reported substance use; semiquantitative measures of substance content by interval coding of video game cut scenes. Nonofficial sources reported substance content in 17 (44 percent) games but none was reported by the official Pan European Game Information (PEGI) system. Adolescents who had played at least one game were significantly more likely ever to have tried smoking (adjusted odds ratio [OR] 2.70, 95 percent confidence interval [CI] 1.75–4.17) or consumed alcohol (adjusted OR 2.35, 95 percent CI 1.70–3.23). In the five most popular game episodes of alcohol actual use, implied use and paraphernalia occurred in 31 (14 percent), 81 (37 percent), and 41 (19 percent) intervals, respectively. Tobacco actual use, implied use, and paraphernalia occurred in 32 (15 percent), 27 (12 percent), and 53 (24 percent) intervals, respectively. Alcohol and tobacco content is common in the most popular video games but not reported by the official PEGI system. Content analysis identified substantial substance content in a sample of those games. Adolescents who play these video games are more likely to have experimented with tobacco and alcohol.