A Serious Game (MyDiabetic) to Support Children's Education in Type 1 Diabetes Mellitus: Iterative Participatory Co-Design and Feasibility Study

BACKGROUND

Serious games, which are gaming applications used for purposes beyond entertainment to educate users on, and address, specific issues, may present a timely approach to promote healthy diabetes management behaviors among children with type 1 diabetes mellitus (T1DM). The lasting benefits associated with these serious games encompass improved patient education; enhanced glycemic control; the reinforcement of bonds within the community of people with diabetes; the facilitation of meaningful dialogues with caregivers, especially within the familial setting; and a significant reduction in the economic burdens associated with subsequent complications.

OBJECTIVE

This paper primarily aims to provide a detailed overview of the iterative design process and the associated evaluation methods used in the development of the educational game. Furthermore, this study aims to enhance motivation for sustained and extended engagement with the game over time. The MyDiabetic game design aims to educate children on various aspects, including the connections among food, insulin, and physical activity. Furthermore, it seeks to impart knowledge related to the operation of a glucometer and an insulin pen, as well as more advanced technologies such as administering glucagon, measuring ketoacidosis, and continuous glucose monitoring.

METHODS

The co-design methodology was applied, involving interviews, design workshops, and prototype feedback sessions. A combination of several approaches, such as tailoring, observational learning, social and family support, decision-making practice, and reward systems, was used to support children's compliance. Moreover, incorporating the literature, guidelines, and current practices into the design ensured that the game was aligned with established health care pathways and included relevant information and best practices for diabetes management.

RESULTS

The game was tested on 32 children in 3 iterations. Positive responses were received from children who tested the game as well as their parents. The game was also presented to 5 schoolmates of children with T1DM who appreciated a better understanding of the disease and the opportunity to support their friends more efficiently in T1DM compensation. The involvement of children and clinicians in participatory co-design contributed to to the game's high acceptance. With regard to the game's impact on education, 1 week of testing revealed an enhancement in educational outcomes.

CONCLUSIONS

The game is especially suitable for children newly diagnosed with T1DM because it acquaints them in a fun way with new terminology; for example, they can try to measure glycemia levels in an interactive way. The game also caters to children who still need to develop reading skills by including an audio guide. The guide ensures that children of all literacy levels can benefit from the game's educational content and interactive experiences. The game is available for download on Google Play and the Apple App Store.

Mindfulness programs for problematic usage of the internet: A systematic review and meta-analysis

Introduction

Problematic usage of the internet (PUI) is an umbrella term for a range of uncontrolled, excessive, and potentially harmful online behaviors. Recently, numerous studies have examined the potential of mindfulness programs (MPs) for reducing PUI. We conducted a comprehensive systematic review and meta-analysis in this emerging field.

Methods

We searched eight databases from inception to October 18, 2022, with no language restrictions. We included randomized controlled trials (RCTs) and nonrandomized trials (NRTs). The primary outcome was change in self-reported PUI, the secondary outcome was change in screen time.

Results

Of 3,473 identified records, 19 RCTs and 20 NRTs with a total of 1,549 participants were included. Participation in an MP was associated with large reductions in PUI in between-group analysis in RCTs (k = 19; g = -1.67; 95% CI -2.15, -1.19) and in within-group pre-post analysis in all studies (k = 35; g = -1.67; 95% CI -1.99, -1.36). Screen time showed a medium reduction in within-group pre-post analysis (k = 10; g = -0.65; 95% CI -0.90, -0.41). The effects for PUI remained significant in a series of sensitivity analyses, such as excluding low quality studies, excluding outliers, adjusting for publication bias, or using follow-up data. Heterogeneity between studies was high and the overall quality of evidence was rated low.

Discussion and conclusions

MPs are probably effective in reducing PUI and might be effective in reducing screen time. Shortcomings in the quality of evidence highlight the need for high-quality controlled trials with long-term follow-ups to confirm results.

Therapeutic Uses of Gaming in Mental Health: An Untapped Potential

Collapse

Gaming motivation and well-being among Norwegian adult gamers: the role of gender and disability

Introduction

Digital gaming is a popular and often social activity, also among adults. However, we need more knowledge of the social dynamics of gaming and its potential benefits for one's well-being. The current study aimed to examine gaming motivation, time spent gaming, and gaming performed together with friends, family, or romantic partner and how these aspects relate to expanded social network and well-being among men and women with and without disability.

Methods

Regular players of the popular game Fortnite Battle Royale (FBR; N = 278, 48.5% women, Mage = 32.38) completed an online questionnaire assessing their motivations for playing FBR (social motivation, achievement motivation, novelty motivation), time spent gaming, whom they usually play with, their psychological well-being, and FBR's impact on their life and social network. Differentiated statistical analyses on gender and disability were performed.

Results and discussion

The results showed that time spent gaming and social motivation to play were associated with larger social networks for all participants (strongest for women). More time spent gaming FBR was also associated with a positive impact on life for those with a disability. Social motivation to play was positively associated with a positive impact on life for men and those without a disability and increased well-being for women. Novelty motivation, which concerns experiencing new features in the game, was associated with a positive impact on life for women and with a decrease in well-being for those with a disability. This study demonstrated that gaming can be an essential social arena associated with positive outcomes for men, women and disabled people, who-when socially motivated-may expand their social networks through gaming.

Effects of a Serious Smartphone Game on Nursing Students' Theoretical Knowledge and Practical Skills in Adult Basic Life Support: Randomized Wait List-Controlled Trial

BACKGROUND

Retention of adult basic life support (BLS) knowledge and skills after professional training declines over time. To combat this, the European Resuscitation Council and the American Heart Association recommend shorter, more frequent BLS sessions. Emphasizing technology-enhanced learning, such as mobile learning, aims to increase out-of-hospital cardiac arrest (OHCA) survival and is becoming more integral in nursing education.

OBJECTIVE

The aim of this study was to investigate whether playing a serious smartphone game called MOBICPR at home can improve and retain nursing students' theoretical knowledge of and practical skills in adult BLS.

METHODS

This study used a randomized wait list-controlled design. Nursing students were randomly assigned in a 1:1 ratio to either a MOBICPR intervention group (MOBICPR-IG) or a wait-list control group (WL-CG), where the latter received the MOBICPR game 2 weeks after the MOBICPR-IG. The aim of the MOBICPR game is to engage participants in using smartphone gestures (eg, tapping) and actions (eg, talking) to perform evidence-based adult BLS on a virtual patient with OHCA. The participants' theoretical knowledge of adult BLS was assessed using a questionnaire, while their practical skills were evaluated on cardiopulmonary resuscitation quality parameters using a manikin and a checklist.

RESULTS

In total, 43 nursing students participated in the study, 22 (51%) in MOBICPR-IG and 21 (49%) in WL-CG. There were differences between the MOBICPR-IG and the WL-CG in theoretical knowledge (P=.04) but not in practical skills (P=.45) after MOBICPR game playing at home. No difference was noted in the retention of participants' theoretical knowledge and practical skills of adult BLS after a 2-week break from playing the MOBICPR game (P=.13). Key observations included challenges in response checks with a face-down manikin and a general neglect of safety protocols when using an automated external defibrillator.

CONCLUSIONS

Playing the MOBICPR game at home has the greatest impact on improving the theoretical knowledge of adult BLS in nursing students but not their practical skills. Our findings underscore the importance of integrating diverse scenarios into adult BLS training.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT05784675); https://clinicaltrials.gov/study/NCT05784675.

Does parents' perceived style of setting limits to gaming matter? The interplay between profiles of parental mediation and BIS/BAS sensitivity in problematic gaming and online gambling

INTRODUCTION

Parents try to prevent possible negative outcomes associated with gaming by setting rules on their adolescent's gaming behavior (i.e., restrictive mediation). Parents can use either more autonomy-supportive or more controlling styles to communicate those rules. Using a person-centered approach, this study aims to, first, identify profiles of parents' perceived degree of restrictive mediation in gaming and styles of communicating these rules (i.e., autonomy-supportive and controlling); second, to examine how adolescents in different profiles differ in terms of maladaptive gaming outcomes (i.e., problematic gaming, simulated, and online gambling); third, to investigate the moderating role of gaming frequency and adolescents' personality (i.e., behavioral inhibition system [BIS] sensitivity and behavioral activation system [BAS] sensitivity) in the associations between the parental profiles and the outcomes.

METHODS

The study used quantitative, cross-sectional survey data from Belgian adolescents (N = 1651, mean age = 14.00 years, 51.2% boys), collected between November 2021 and February 2022 in schools.

RESULTS

Cluster analysis yielded four profiles of perceived restrictive mediation: an exclusively controlling one, an autonomy-supportive one, one where parents used a perceived mix of both communication styles, and one where there was an overall perceived lack of restrictive mediation. Adolescents in the controlling profile displayed the most maladaptive outcomes. Some of the associations between the parental profiles and the outcomes were stronger for more frequent gamers and for adolescents scoring higher on both BIS and BAS sensitivity.

CONCLUSION

Associations between the parental profiles and gaming outcomes were theoretically meaningful, yet small in terms of effect size.

Examining Cybersexism in Online Gaming Communities: A Scoping Review

Cybersexism in the context of online gaming communities, as epitomized by the Gamergate incident back in 2014, has been an issue for a while for gamer women, yet it has not received proper attention. In this scoping review, we have aimed to assess its main characteristics, its consequences for gamer women, its triggers and predictors, and related prevention and mitigation policies provided by the existing research. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines were applied to the design of the scoping review. Empirical studies were accessed via database searches. The following databases were prospected: Scopus, ProQuest, Web of Science, PsycINFO, PubMed, and ACM from March to May 2021. A total of 33 studies were included in the final analysis after database searching, filtering, and snowballing. Most of the selected studies (66%, n = 22) were focused on the manifestations of cybersexism in gaming communities, with gender-driven trash-talking being the main one. The main drivers and triggers behind cybersexist behaviors were also the research topic in 66% (n = 22) of the studies and the consequences and coping strategies were studied in 52% (n = 17) of the articles. Furthermore, 12% (n = 4) of the studies assessed policies and actions to prevent cybersexism. Cybersexism and its manifestations are a reality that conditions gamer women, provoking avoidance and ultimately withdrawal from gaming and, therefore, creating inequality, impairing full digital citizenship, and widening the digital gender gap.

Red box, green box: A self-report behavioral frequency measurement approach for behavioral addictions research

Behavior frequency measures in behavioral addictions research fail to account for how engagement in the activity relates to each respondent's personal circumstances. We propose a "Red Box, Green Box" method, an alternative to conventional self-report behavior questions. Participants report two distinct time-based values: (1) Green box: time spent engaged in the activity during 'free' time, and (2) Red box: engagement in the activity at times when the respondent should be doing something else (e.g., studying, working, sleeping, exercising, etc.). Some practical examples of the 'red box, green box' method are provided. This method may help to calibrate behavioral frequency for each respondent and yield clearer insights into displacement effects and risks associated with frequency of use. We suggest some future research directions to test the feasibility and utility of this approach in different implementations.

Gender Moderates the Relationship Between Avatar Customization and Enjoyment in Popular Video Games

Using online survey methods (n = 153), this study investigates whether exposure to different levels of customization in games will increase the experiences of enjoyment, both directly and indirectly, through the experience of avatar embodiment, as well as whether these relationships are influenced by gender identity. Results indicate a positive relationship between level of exposure to customization and enjoyment for women-identified participants. These outcomes may provide insight into gendered preference in gaming, potentially providing an avenue by which to make games more inclusive to women gamers.

Assessing the Importance of Content Versus Design for Successful Crowdfunding of Health Education Games: Online Survey Study

Background

Health education games make health-related tasks enjoyable and interactive, thereby encouraging user participation. Entrepreneurs and health educators can leverage online crowdfunding platforms, such as Kickstarter, to transform their innovative ideas into funded projects.

Objective

This research focuses on health education game initiatives on Kickstarter. Through an online user survey, it aims to understand user perceptions and evaluate the significance of 8 distinct components that may influence the success of such crowdfunding initiatives.

Methods

A total of 75 participants evaluated games using 8 dimensions: game rules, learning objectives, narrative, content organization, motivation, interactivity, skill building, and assessment and feedback. The survey data were analyzed using descriptive statistical analysis, exploratory factor analysis, the Wilcoxon-Mann-Whitney test, and multivariate analysis.

Results

Exploratory data analysis showed that, among the 8 dimensions, skill building, content organization, and interactivity were the top-ranking dimensions most closely associated with crowdfunding health education game. The 8 dimensions can be grouped into 3 categories from the exploratory factor analysis: game content-, instruction-, and game design-related components. Further statistical analysis confirmed the correlation between these dimensions with the successful crowdfunding of health education games.

Conclusions

This empirical analysis identified critical factors for game proposal design that can increase the likelihood of securing crowdfunding support.

A Serious Game ("Fight With Virus") for Preventing COVID-19 Health Rumors: Development and Experimental Study

BACKGROUND

Health rumors arbitrarily spread in mainstream social media on the internet. Health rumors emerged in China during the outbreak of COVID-19 in early 2020. Many midelders/elders (age over 40 years) who lived in Wuhan believed these rumors.

OBJECTIVE

This study focused on designing a serious game as an experimental program to prevent and control health rumors. The focus of the study was explicitly on the context of the social networking service for midelders/elders.

METHODS

This research involved 2 major parts: adopting the Transmission Control Protocol model for games and then, based on the model, designing a game named "Fight With Virus" as an experimental platform and developing a cognitive questionnaire with a 5-point Likert scale. The relevant variables for this experimental study were defined, and 10 hypotheses were proposed and tested with an empirical study. In total, 200 participants were selected for the experiments. By collecting relevant data in the experiments, we conducted statistical observations and comparative analysis to test whether the experimental hypotheses could be proved.

RESULTS

We noted that compared to traditional media, serious games are more capable of inspiring interest in research participants toward their understanding of the knowledge and learning of health commonsense. In judging and recognizing the COVID-19 health rumor, the test group that used game education had a stronger ability regarding identification of the rumor and a higher accuracy rate of identification. Results showed that the more educated midelders/elders are, the more effective they are at using serious games.

CONCLUSIONS

Compared to traditional media, serious games can effectively improve midelders'/elders' cognitive abilities while they face a health rumor. The gameplay effect is related to the individual's age and educational background, while income and gender have no impact.

Effect of a Mobile Game-Based Intervention to Enhance Child Safety: Randomized Controlled Trial

BACKGROUND

Evidence supports the effectiveness of serious games in health education, but little is known about their effects on the psychosocial well-being of children in the general population.

OBJECTIVE

This study aimed to investigate the potential of a mobile game-based safety education program in improving children's safety and psychosocial outcomes.

METHODS

Safe City is a mobile roleplaying game specifically designed to educate children in Hong Kong about safety. This randomized controlled trial included 340 children in grades 4 through 6. Intervention arm participants (n=170) were instructed to play the Safe City mobile game for 4 weeks, whereas control arm participants (n=170) received a safety booklet. All participants completed a survey on safety knowledge and behaviors and psychosocial problems at baseline (T1), 1 month postintervention (T2), and 3 months postintervention (T3). Cumulative game scores and mini-game performance were analyzed as a proxy for the extent of exposure to the game. Outcome data were analyzed using 2-sample 2-tailed t tests to compare mean change from T1 to T2 and to T3 for intervention versus control arm participants. The association of game use with outcome changes postintervention was analyzed using generalized additive models.

RESULTS

No significant differences were found in mean changes between the intervention and control arms. However, use analyses showed that higher game scores were associated with improvements in safe behavior (P=.03) and internalizing problems (P=.01) at T3. Matching and Spot the Danger mini-game performance significantly predicted improvements in safety knowledge at T2 and T3.

CONCLUSIONS

Analysis of use has shown that playing the Safe City mobile game can result in significant improvements in safety knowledge and reductions in unsafe behavior and internalizing problems. These findings provide evidence for the positive impact of serious games on psychological and social well-being, highlighting the potential of technology-driven interventions to assist children in learning about safety and preventing injuries.

TRIAL REGISTRATION

ClinicalTrials.org NCT04096196; https://clinicaltrials.gov/show/NCT04096196.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/17756.

A Novel Casual Video Game With Simple Mental Health and Well-Being Concepts (Match Emoji): Mixed Methods Feasibility Study

BACKGROUND

Adolescence is a crucial phase for early intervention and prevention of mental health problems. Casual video games are popular and have promise as a novel mechanism for reaching young people, but this potential has seldom been explored.

OBJECTIVE

This study aimed to explore the acceptability, feasibility, and possible indicators of therapeutic changes after playing a purpose-built novel casual video game (Match Emoji) with simple mental health and well-being content among young adolescents.

METHODS

We conducted a single-arm, nonrandomized trial of Match Emoji with 12- to 14-year-old school students (N=45; 26 [57%] New Zealand European, 12 [26%] Māori; 7 [15%] Asian or Pacific; 27 [60%] boys, 3 [6%] non-binary). Participants were invited to play Match Emoji for 15 minutes, 2-3 times a week over 2 weeks (a total of 60 minutes). Acceptability was assessed through the frequency and duration of use (analytics analyzed at the end of the 2-week intervention period and at weeks 4 and 6) and through participant reports. The Child and Adolescent Mindfulness Measure (CAMM), General Help-Seeking Questionnaire (GHSQ), Flourishing Scale (FS), and Revised Children's Anxiety and Depression Scale (RCADS) were assessed at baseline and week 2 to indicate possible effects. Focus groups were held in week 4.

RESULTS

Most participants (n=39, 87%) used Match Emoji for at least 60 minutes over the 2-week intervention, with 80% (36/45) continuing to play the game after the intervention period. Mean change (from baseline to 2 weeks) on each measure was 1.38 (95% CI -0.03 to 2.79; P=.06) for CAMM; 0.8 (95% CI -2.71 to 4.31; P=.64) for GHSQ; -1.09 (95% CI -2.83 to 0.66; P=.21) for FS; and -3.42 (95% CI -6.84 to -0.001; P=0.49) for RCADS. Focus group feedback suggested that Match Emoji was enjoyable and helpful.

CONCLUSIONS

The casual video game with mental health content appeared to be acceptable and provided a promising indication of possible therapeutic effects. This approach is worthy of further investigation.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/31588.

Education on Preventing Early Childhood Injuries Using a Video Game: The VirtualSafeHome Platform

Poisonings and household injuries are frequent events among toddlers. We developed VirtualSafeHome (VSH)-a novel self-contained, Internet-based home-safety learning tool-to improve awareness of household hazards. Study aims were to investigate VSH usage characteristics. A prototype, screen-based VSH kitchen was built in Unity and delivered through the web using 3DVista and Wix. Players spot and click 21 embedded hazards. A unique feature is the ability to capture the "child's perspective" in identifying hazards. We recruited a convenience sample of adults in 2021-2022. Outcomes included number of hazards discovered, session duration, and pretest/posttest knowledge scores. Twenty-four adults identified a median 15.5 hazards; median playing time was 1022 seconds. Players reported satisfaction with ease of navigation and game features. Mean pretest/posttest knowledge scores rose from 2.0 to 2.79 (P < .035). A web-enabled video game can provide easily accessed, enjoyable training on home safety.

Going the extra mile? General practitioners' upcoding of fees for home visits

General practitioners' (GPs') income often relies on self-reported activities and performances. They can therefore 'game the system' to maximize their remuneration. We investigate whether Danish GPs game their travel fees for home visits. Combining administrative and geographical data, we measure the difference between GPs' traveled and billed distances. We exploit a rise in the fees for home visits. If there is a link between the rise in fees and upcoding, we interpret this finding as indicative of gaming behavior. We find that upcoding occurs slightly more often than downcoding (16% vs. 13% of visits) for visits that can be both upcoded and downcoded. Using linear probability models with GP fixed effects, we find that the fee rise is associated with a reduction in upcoding of 0.6% of home visits (2.8% for visits where upcoding is feasible) and no change in downcoding. Importantly, we find no statistically significant differences in the reduction in upcoding across distance bands despite large differences in their fee rises. We therefore conclude that there is no causal evidence of GPs gaming their fees.

Promoting mental health in esports

There is growing recognition of the demands and health challenges experienced by esports athletes. The purpose of this perspective paper is to draw specific attention to the mental health of competitive gamers and spur on both future research and applied initiatives focussing on this important but under-addressed topic. We will briefly discuss the prevalence of mental health concerns, domain-specific stressors, and the need for comprehensive mental health support systems tailored to the esports context. It is our hope that, with this perspective paper, we can help set a new research agenda addressing mental health in esports.

The landscape of open science in behavioral addiction research: Current practices and future directions

Open science refers to a set of practices that aim to make scientific research more transparent, accessible, and reproducible, including pre-registration of study protocols, sharing of data and materials, the use of transparent research methods, and open access publishing. In this commentary, we describe and evaluate the current state of open science practices in behavioral addiction research. We highlight the specific value of open science practices for the field; discuss recent field-specific meta-scientific reviews that show the adoption of such practices remains in its infancy; address the challenges to engaging with open science; and make recommendations for how researchers, journals, and scientific institutions can work to overcome these challenges and promote high-quality, transparently reported behavioral addiction research. By collaboratively promoting open science practices, the field can create a more sustainable and productive research environment that benefits both the scientific community and society as a whole.

Improving Social Isolation and Loneliness Among Adolescents With Physical Disabilities Through Group-Based Virtual Reality Gaming: Feasibility Pre-Post Trial Study

BACKGROUND

Adolescents with disabilities experience alarmingly higher rates of depression and isolation than peers without disabilities. There is a need to identify interventions that can improve mental health and isolation among this underserved population. Innovations in virtual reality (VR) gaming "standalone" headsets allow greater access to immersive high-quality digital experiences, due to their relatively low cost.

OBJECTIVE

This study had three purposes, which were to (1) examine the preliminary effects of a low-cost, home-based VR multiplayer recreation and socialization on depression, socialization, and loneliness; (2) quantify the acceptability of the program as measured by participant adherence, total play time, and exercise time; and (3) identify and describe behavioral mechanisms that affected participant engagement.

METHODS

This was a single-group, pre- to postdesign trial. The intervention was conducted at home. Participants were recruited from a children's hospital. The intervention lasted 4 weeks and included 2×1-hour sessions per week of supervised peer-to-peer gaming. Participants used the Meta Quest 2 headset to meet peers and 2 coaches in a private party held digitally. Aim 1 was evaluated with the Children's Depression Inventory 2 Short Form and the University of California, Los Angeles Loneliness Scale 20 items, which are measures of social isolation and loneliness, respectively. Aim 2 was evaluated through the following metrics: participant adherence, the types of games played, friendship building and playtime, and program satisfaction and enjoyment.

RESULTS

In total, 12 people enrolled (mean age 16.6, SD 1.8 years; male: n=9 and female: n=3), and 8 people completed the program. Mean attendance for the 8 participants was 77% (49 sessions of 64 total possible sessions; mean 6, SD 2 sessions). A trend was observed for improved Children's Depression Inventory 2 Short Form scores (mean preintervention score 7.25, SD 4.2; mean postintervention score 5.38, SD 4.1; P=.06; effect size=0.45, 95% CI -0.15 to 3.9), but this was not statistically significant; no difference was observed for University of California, Los Angeles Loneliness Scale 20 items scores. Most participants (7/8, 88%) stated that they became friends with a peer in class; 50% (4/8) reported that they played with other people. Participants reported high levels of enjoyment and satisfaction with how the program was implemented. Qualitative analysis resulted in 4 qualitative themes that explained behavioral mechanisms that determined engagement in the program.

CONCLUSIONS

The study findings demonstrated that a brief VR group program could be valuable for potentially improving mental health among adolescents with physical disabilities. Participants built friendships with peers and other players on the web, using low-cost consumer equipment that provided easy access and strong scale-up potential. Study findings identified factors that can be addressed to enhance the program within a larger clinical trial.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05259462; https://clinicaltrials.gov/study/NCT05259462.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/42651.

Effects of a Preventive Mental Health Curriculum Embedded Into a Scholarly Gaming Course on Adolescent Self-Esteem: Prospective Matched Pairs Experiment

Background

Positive self-esteem predicts happiness and well-being and serves as a protective factor for favorable mental health. Scholarly gaming within the school setting may serve as a channel to deliver a mental health curriculum designed to improve self-esteem.

Objective

This study aims to evaluate the impact of a scholarly gaming curriculum with and without an embedded preventive mental health curriculum, Mental Health Moments (MHM), on adolescents' self-esteem.

Methods

The scholarly gaming curriculum and MHM were developed by 3 educators and a school-based health intervention expert. The scholarly gaming curriculum aligned with academic guidelines from the International Society for Technology Education, teaching technology-based career skills and video game business development. The curriculum consisted of 40 lessons, delivered over 14 weeks for a minimum of 120 minutes per week. A total of 83 schools with previous gaming engagement were invited to participate and 34 agreed. Schools were allocated to +MHM or -MHM arms through a matched pairs experimental design. The -MHM group received the scholarly gaming curriculum alone, whereas the +MHM group received the scholarly gaming curriculum plus MHM embedded into 27 lessons. MHM integrated concepts from the PERMA framework in positive psychology as well as the Collaborative for Academic, Social, and Emotional Learning (CASEL) standards in education, which emphasize self-awareness, self-management, social awareness, relationship skills, and responsible decision-making. Participants in the study were students at schools offering scholarly gaming curricula and were enrolled at recruitment sites. Participants completed a baseline and postintervention survey quantifying self-esteem with the Rosenberg Self-Esteem Scale (score range 0-30). A score <15 characterizes low self-esteem. Participants who completed both baseline and postintervention surveys were included in the analysis.

Results

Of the 471 participants included in the analysis, 235 received the -MHM intervention, and 236 received the +MHM intervention. Around 74.9% (n=353) of participants were in high school, and most (n=429, 91.1%) reported this was their first year participating in scholarly gaming. Most participants were male (n=387, 82.2%). Only 58% (n=273) reported their race as White. The average self-esteem score at baseline was 17.9 (SD 5.1). Low self-esteem was reported in 22.1% (n=104) of participants. About 57.7% (n=60) of participants with low self-esteem at baseline rated themselves within the average level of self-esteem post intervention. When looking at the two groups, self-esteem scores improved by 8.3% among the +MHM group compared to no change among the -MHM group (P=.002). Subgroup analyses revealed that improvements in self-esteem attributed to the +MHM intervention differed by race, gender, and sexual orientation.

Conclusions

Adolescents enrolled in a scholarly gaming curriculum with +MHM had improved self-esteem, shifting some participants from abnormally low self-esteem scores into normal ranges. Adolescent advocates, including health care providers, need to be aware of nontraditional educational instruction to improve students' well-being.

The genetics of gaming: A longitudinal twin study

Background

Gaming is a popular past-time activity among children and adolescents, but it there is also a possible link to negative consequences such as psychological distress and lowered academic achievement. However, there are fundamental knowledge gaps remaining regarding central characteristics of gaming such as heritability, stability over time, and sex differences. We examined the genetic and environmental contribution to gaming behavior, including sex differences, continuity and change, in a longitudinal cohort of twins.

Methods

This is the first longitudinal twin study on gaming, involving 32,006 twins in Sweden. Parents were asked about the twins' gaming at ages 9, 15 and 18. We used univariate and multivariate twin analyses to estimate the relative contribution of genetic and environmental influences at each time-point as well as across time. Sex-differences were also explored.

Results

The results showed large sex differences, where genetics explained more of the variance for boys (31.3%-62.5% depending on age) than for girls (19.4%-23.4%). Genetic factors explained an increasing amount of the variance for boys (31.3% at age 9, 62.5% at age 15 and 53.9% at age 18). Shared environmental factors explained a larger proportion of the variance among girls, which remained relatively stable over time (70.5% at age 9, 61.8% at age 15 and 60.5% at age 18). The results also indicated that most of the variance came from genetic and environmental sources specific to each age.

Conclusions

Compared to many other behavioral phenotypes, such as gambling, gaming was relatively unstable with a large degree of genetic innovation. There were large sex differences in the contribution of genetic and environmental factors. This suggests that excessive gaming could be the result of age- and sex-specific genetic and environmental factors, and should be taken into account when mapping gaming behaviors, since these behaviors might be under continual etiological transformation.

The Relationship Between Lockdowns and Video Game Playtime: Multilevel Time-Series Analysis Using Massive-Scale Data Telemetry

BACKGROUND

COVID-19 led governments worldwide to enact a variety of containment and closure policies. Substantial attention has been directed toward the idea that these public health measures may have unanticipated negative side effects. One proposed effect relates to video games. There is a nascent evidence base suggesting that individuals played video games for longer and in a more disordered manner during lockdowns and school closures specifically. These increases are commonly framed as a potential health concern in relation to disordered gaming. However, the evidence base regarding changes in gaming during the COVID-19 pandemic is based on self-report and, thus, is susceptible to bias. Therefore, it is unclear what the true consequences of lockdowns were for gaming behavior worldwide.

OBJECTIVE

The primary objective of this study was to estimate whether any specific lockdown policy led to meaningful increases in the amount of time individuals spent playing video games.

METHODS

Rather than relying on self-report, we used >251 billion hours of raw gameplay telemetry data from 184 separate countries to assess the behavioral correlates of COVID-19-related policy decisions. A multilevel model estimated the impact of varying enforcement levels of 8 containment and closure policies on the amount of time that individual users spent in-game. Similar models estimated the impact of policy on overall playtime and the number of users within a country.

RESULTS

No lockdown policy can explain substantial variance in playtime per gamer. School closures were uniquely associated with meaningful increases in total playtime within a country (r2=0.048). However, this was associated with increases in the number of unique individuals playing games (r2=0.057) rather than increases in playtime per gamer (r2<0.001).

CONCLUSIONS

Previous work using self-report data has suggested that important increases in heavy gaming may occur during pandemics because of containment and closure ("lockdown") procedures. This study contrasts with the previous evidence base and finds no evidence of such a relationship. It suggests that significant further work is needed before increases in disordered or heavy gaming are considered when planning public health policies for pandemic preparedness.

Relapse prevention therapy for internet gaming disorder in Swedish child and adolescent psychiatric clinics: a randomized controlled trial

Objectives

To evaluate the effectiveness of relapse prevention (RP) as a treatment for internet gaming disorder (IGD).

Design

Randomized controlled trial.

Setting

Three child and adolescent psychiatry (CAP) units in Region Skåne, Sweden.

Participants

Children aged 13-18 years, coming for their first visit to CAP during 2022, were screened for gaming behavior. Those who met the proposed DSM-5 criteria for IGD were offered participation in the trial, if they had the capacity to provide written informed consent and if they spoke Swedish. A total of 111 CAP patients agreed to participate. Out of those, 11 patients were excluded due to incorrect inclusion such as young age (n = 1), or due to the absence of responses to follow-up measures (n = 9). After exclusion, 102 participants remained (intervention = 47, control = 55).

Interventions

The intervention, RP, is based on cognitive behavioral treatment (CBT) and was provided individually, comprising of five to seven 45-min sessions over a period of 5 to 7 weeks versus treatment as usual.

Outcome measures

Participants were assessed with Game Addiction Scale for Adolescents pre-treatment (GASA) (baseline), post-treatment (treatment group only), and 3 months after baseline (follow-up).

Results

The repeated measures ANOVA showed a significant interaction effect between treatment and time. Both the control group and treatment group lowered their mean GASA score from baseline to follow-up significantly, but the improvement was greater in the treatment group (mean difference in control group -5.1, p < 0.001, 95% CI = - 3.390 to -6.755, mean difference in treatment group -9.9, p < 0.001, 95% CI = -11.746 to -8.105).

Conclusion

RP was found to be superior to treatment as usual in terms of reduction of IGD symptoms. Future research should address which aspects within a given treatment are effective, who benefits from treatment, in what aspects, and why.

Trial registration number

ClinicalTrials.gov, NCT05506384 https://clinicaltrials.gov/ct2/show/NCT05506384.

Twitch Data in Health Promotion Research: Protocol for a Case Study Exploring COVID-19 Vaccination Views Among Young People

BACKGROUND

Social media platforms have emerged as a useful channel for health promotion communication, offering different channels to reach targeted populations. For example, social media has recently been used to disseminate information about COVID-19 vaccination across various demographics. Traditional modes of health communication such as television, health events, and newsletters may not reach all groups within a community. Health communications for younger generations are increasingly disseminated through social media to reflect key information sources. This paper explores a social media gaming platform as an alternative way to reach young people in health promotion research.

OBJECTIVE

This protocol study aimed to pilot-test the potential of Twitch, a live streaming platform initially designed for video gaming, to conduct health promotion research with young people. We used COVID-19 vaccination as a topical case study that was recommended by Australian health authorities at the time of the research.

METHODS

The research team worked with a Twitch Account Manager to design and test a case study within the guidelines and ethics protocols required by Twitch, identify suitable streamers to approach and establish a protocol for conducting research on the platform. This involved conducting a poll to initiate discussion about COVID-19 vaccination, monitoring the chat in 3 live Twitch sessions with 2 streamers to pilot the protocol, and briefly analyze Twitch chat logs to observe the range of response types that may be acquired from this methodology.

RESULTS

The Twitch streams provided logs and videos on demand that were derived from the live session. These included demographics of viewers, chat logs, and polling results. The results of the poll showed a range of engagement in health promotion for the case study topic: the majority of participants had received their vaccination by the time of the poll; however, there was still a proportion that had not received their vaccination yet or had decided to not be vaccinated. Analysis of the Twitch chat logs demonstrated a range of both positive and negative themes regarding health promotion for the case study topic. This included irrelevant comments, misinformation (compared to health authority information at the time of this study), comedic and conspiracy responses, as well as vaccine status, provaccine comments, and vaccine-hesitant comments.

CONCLUSIONS

This study developed and tested a protocol for using Twitch data for health promotion research with young people. With live polling, open text discussion between participants and immediate responses to questions, Twitch can be used to collect both quantitative and qualitative research data from demographics that use social media. The platform also presents some challenges when engaging with independent streamers and sensitive health topics. This study provides an initial protocol for future researchers to use and build on.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/48641.

Translating and Testing a Digital Game Promoting Vegetable Consumption in Young Children: Usability Study

BACKGROUND

Promoting healthy eating in children is key to preventing chronic diseases, and vegetable consumption is notably lower than recommended in this population. Among the interventions tested, gamification has shown promise in promoting familiarization, increasing knowledge, and potentially increasing vegetable intake.

OBJECTIVE

This pilot study aimed first to translate the digital game "Veggies4myHeart" into French and to assess its influence on young children's preferences and willingness to taste vegetables when combined with repeated tasting and education. We also aimed to investigate the acceptability and applicability of the game in 2 classrooms.

METHODS

During 5 consecutive weekly sessions, children from 2 elementary classes played the digital game consisting of 5 mini games on different vegetables (lettuce, carrot, red cabbage, cucumber, and tomato) in pairs for 10-15 minutes. In addition, they discussed one of the vegetables and tasted the 5 vegetables in each session. Pretest and posttest food preferences and willingness to taste the vegetables were compared. Teachers participated in a semistructured interview.

RESULTS

A total of 45 children aged 5 to 6 years tested the French version of the digital game. The children's declared food preferences were already high for carrot, cucumber, and tomato, with scores higher than 4 out of a maximum of 5. The scores did not change significantly after the intervention, except for red cabbage (pretest: mean 2.52, SD 1.49; posttest: mean 3.29, SD 1.67; P=.006) and a composite score (pretest: mean 3.76, SD 1.06; posttest: mean 4.05, SD 1.03; P=.001). Before the intervention, 18 (44%), 30 (73%), 16 (39%), 29 (71%), and 26 (63%) children out of 41 were willing to taste lettuce, carrot, red cabbage, cucumber, and tomato, respectively. After the intervention, no significant statistical differences were observed, with 23 (51%), 36 (80%), 24 (53%), 33 (73%), and 29 (64%) children out of 45 willing to taste lettuce, carrot, red cabbage, cucumber, and tomato, respectively. Teachers supported this tool combined with repeated tasting and education and highlighted facilitators and barriers that should be anticipated to improve implementation in schools.

CONCLUSIONS

In this study, we translated an existing digital game applicable and acceptable to both children and teachers. A larger study is warranted to confirm the effectiveness of interventions using the digital game to promote vegetable preference, willingness to taste, and intake.

Gaming in Pandemic Times: An International Survey Assessing the Effects of COVID-19 Lockdowns on Young Video Gamers' Health

The onset of COVID-19 coincided with the peak growth of video game usage, with 2.7 billion gamers in 2020. During the pandemic, gaming and streaming platforms offered an entertaining, social, and safe alternative to recreation during severe lockdowns and social isolations. This study aimed to examine the impact of the COVID-19 pandemic on health-related outcomes in self-proclaimed video gamers based on the type of lockdown experienced and to discuss the potential role of video games during times of preventive lockdown measures. This was a cross-sectional international survey constructed by two academic institutions, NYIT (NY, USA) and McGill University (Montreal, Canada), and Adamas Esports (BC, Canada). The survey consisted of questions including demographics, multiple choice, ratings, and Likert scales relating to the periods prior to and during the COVID-19 lockdowns. There were 897 respondents from North America (72.7%), Europe (10.9%), Asia (4.9%), and other countries (11.5%), with a mean age of 22 years. Significant increases in game time were reported in casual and competitive gamers during the first months of the pandemic. The level of gaming, type of lockdown, and physical activity level prior to the pandemic were examined as potential moderating factors. Significant increases in sedentary behaviors (video game time and sitting time) were observed, while physical activity levels remained unchanged in most participants, regardless of the type of lockdown. Sleep time, but not sleep quality, increased, while mental health exhibited opposing effects, influenced by the type of lockdown and gaming competition levels. Video games, when played moderately, could offer a cost-effective, safe strategy to promote socialization and mental health and improve the overall well-being of the non-gaming and gaming population during pandemic times when strict lockdowns are in place.

Effects of Virtual Reality Exercises on Chronic Low Back Pain: Quasi-Experimental Study

BACKGROUND

Low back pain is a common health problem globally. Based on the duration of pain, it is classified as acute, subacute, or chronic low back pain. Different treatment strategies are available to reduce chronic low back pain. Virtual reality (VR) is a novel approach in back pain rehabilitation.

OBJECTIVE

This study aimed to compare the effects of VR games on chronic low back pain.

METHODS

This quasi-experimental study was conducted among 40 patients with chronic low back pain. The data were collected using a nonprobability, convenient sampling technique. Patients visiting the Department of Physiotherapy, Government Services Hospital, Lahore, Pakistan, were recruited and equally divided into 4 groups. Group A received the Reflex Ridge game; group B received the Body Ball game; group C combined the 2 games without back-strengthening exercises; and group D combined the 2 games with back-strengthening exercises. The participants received 8 treatment sessions, with 3 sessions/wk. The outcomes were pre- and posttest measurements of pain intensity, low back disability, and lumbar range of motion. The repeated measurement ANOVA was used for inter- and intragroup comparison, with significance at P≤.05.

RESULTS

The study comprised a sample of 40 patients with low back pain; 12 (40%) were female and 28 (60%) were male, with a mean age of 37.85 (SD 12.15) years. The pre- and posttest mean pain scores were 7.60 (SD 1.84) and 4.20 (SD 1.62) in group A, 6.60 (SD 1.776) and 5.90 (SD 1.73) in group B, 6.90 (SD 1.73) and 5.40 (SD 1.07) in group C, and 7.10 (SD 1.53) and 3.60 (SD 0.97) in group D, respectively. The mean pain score differences of group D (combining the Reflex Ridge and Body Ball games with back-strengthening exercises) compared to groups A, B, and C were -.60 (P=.76), -2.30 (P<.001), and -1.80 (P=.03), respectively. Regarding the range of motion, the forward lumbar flexion mean differences of group D compared to groups A, B, and C were 3.80 (P=.21), 4.80 (P=.07), and 7.40 (P<.001), respectively. Similarly, the right lateral lumbar flexion mean differences of group D compared to groups A, B, and C were 2.80 (P=.04), 5.20 (P<.001), and 4.80 (P<.001), respectively. The left lateral lumbar flexion mean differences of group D compared to groups A, B, and C were 2.80 (P<.001), 4.80 (P=.02), and 2.20 (P<.001). respectively, showing significant pre- and posttreatment effects.

CONCLUSIONS

VR exercises had statistically significant effects on improving pain, low back disability, and range of motion in all groups, but the combination of Reflex Ridge and Body Ball games with back-strengthening exercises had dominant effects compared to the other groups.

TRIAL REGISTRATION

Iranian Registry of Clinical Trial IRCT20200330046895N1; https://en.irct.ir/trial/46916.

Parents' Perceptions of a Serious Game for Educating Families on Prescription Opioid Safety: Qualitative Pilot Study of MedSMARxT: Adventures in PharmaCity

BACKGROUND

Opioid misuse is a pervasive, worsening problem that affects the health of people throughout the United States, including adolescents. There are few adolescent-focused interventions designed to educate them about opioid medication safety. The MedSMARxT: Adventures in PharmaCity, is a serious educational video game that teaches parents and their youths about safe opioid practices.

OBJECTIVE

This study aimed to elucidate parent's perceptions of MedSMARxT: Adventures in PharmaCity and its potential use by parents and their adolescents.

METHODS

Parents of adolescents aged 12 to 18 years who live in the United States were recruited from April to October 2021 via Qualtrics research panels, social media, email listserves, and snowball sampling. The study participants played MedSMARxT: Adventures in PharmaCity for 30 minutes and then participated in a 30-minute postgame interview via WebEx (Cisco). Questions were developed and piloted to examine adults' perceptions of the game. Participants were asked three sets of open-ended questions: (1) questions about the game and elements of the game, (2) what they learned from the game, and (3) questions about their experience with games. Audio recordings were transcribed verbatim. Interview transcripts were coded using content and thematic analysis by study team members to identify major themes and subthemes from the data.

RESULTS

Parent participants (N=67) played MedSMARxT: Adventures in PharmaCity and completed a postgame interview. Analysis extrapolated four primary themes from the data: (1) participant gaming experience, (2) perception of game features, (3) educational purpose of the game, and (4) future use of the game. Most participants (n=56, 84%), had at least some experience with video games. More than half of the participants (n=35, 52%) participants, had positive reactions to the game characters and scenes depicted in MedSMARxT: Adventures in PharmaCity and stated they were realistic for adolescents. Most participants (n=39, 58%), would recommend the game to others. Significant difficulties with gameplay navigation were reported by 38 (57%) participants, as well as a slow game pace. All participants were able to accurately identify the overarching goal of the game: opioid or medication safety. The game reinforced existing knowledge for participants, though many (n=15, 22%), reported a new awareness of the need to store opioid medications in a locked area and the availability of medication disposal drop boxes at pharmacies. Participants stated that they would recommend the game for future use by families and youths in various health care and non-health care settings.

CONCLUSIONS

The use of a tailored serious game is a novel, engaging tool to educate adolescents on opioid safety. MedSMARxT: Adventures in PharmaCity can be used as a tool for parents and adolescents to facilitate meaningful dialogue about safe and appropriate opioid use.

Game Elements in the Design of Simulations in Military Trauma Management Training: Protocol for a Systematic Review

BACKGROUND

Military trauma teams are commonly operating in civilian hospitals during peacetime; in a war situation they must adjust their practices to the austere conditions. Simulations can replicate austere conditions to allow training in a safe environment that tolerates errors. Gamification, understood as the use of game elements to motivate and engage learners in nongame contexts, is gaining interest in medical education and military training. Applying game elements in the design of military trauma management simulations has the potential to provide learners with active learning opportunities and prepare them for providing medical services under austere conditions. Although gamification is known for its engaging and motivational benefits, there are controversies about its pedagogical value. The controversies can be attributed to the fact that various gamification strategies may consist of a different combination of game elements, leading to different outcomes.

OBJECTIVE

This systematic review aims to understand how game elements are used in the design of simulations in military trauma management training and their reported outcomes.

METHODS

We have designed a search strategy for the purpose of the review. Two researchers will independently assess the identified studies based on the defined inclusion and exclusion criteria. The selection process will be represented using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. The search will be repeated and updated as necessary prior to publication of the review. Two reviewers will independently extract and manage the data for each of the articles using a structured data extraction form. Any disagreement that arises between reviewers will be resolved through discussion, and a third review author will be consulted when needed. We are going to conduct a thematic synthesis of the extracted game element descriptions. The results are going to be presented in a diagrammatic or tabular form, alongside a narrative summary. The quality of the studies will be assessed.

RESULTS

We implemented and tested the developed search strategy in May 2023. We retrieved 1168 study abstracts, which were reduced to 630 abstracts after deduplication. We have piloted the screening on 20% (126/630) of the identified abstracts in groups of 2 reviewers.

CONCLUSIONS

Although gamification has the potential to motivate learners in various ways, there is a lack of understanding about specific game elements and how they can inform instructional design in different contexts. Our findings will increase the understanding of how game elements are used in the design of simulations in military trauma management training and, thus, contribute to more effective development of future simulations.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/45969.

A Novel, Expert-Endorsed, Neurocognitive Digital Assessment Tool for Addictive Disorders: Development and Validation Study

BACKGROUND

Many people with harmful addictive behaviors may not meet formal diagnostic thresholds for a disorder. A dimensional approach, by contrast, including clinical and community samples, is potentially key to early detection, prevention, and intervention. Importantly, while neurocognitive dysfunction underpins addictive behaviors, established assessment tools for neurocognitive assessment are lengthy and unengaging, difficult to administer at scale, and not suited to clinical or community needs. The BrainPark Assessment of Cognition (BrainPAC) Project sought to develop and validate an engaging and user-friendly digital assessment tool purpose-built to comprehensively assess the main consensus-driven constructs underpinning addictive behaviors.

OBJECTIVE

The purpose of this study was to psychometrically validate a gamified battery of consensus-based neurocognitive tasks against standard laboratory paradigms, ascertain test-retest reliability, and determine their sensitivity to addictive behaviors (eg, alcohol use) and other risk factors (eg, trait impulsivity).

METHODS

Gold standard laboratory paradigms were selected to measure key neurocognitive constructs (Balloon Analogue Risk Task [BART], Stop Signal Task [SST], Delay Discounting Task [DDT], Value-Modulated Attentional Capture [VMAC] Task, and Sequential Decision-Making Task [SDT]), as endorsed by an international panel of addiction experts; namely, response selection and inhibition, reward valuation, action selection, reward learning, expectancy and reward prediction error, habit, and compulsivity. Working with game developers, BrainPAC tasks were developed and validated in 3 successive cohorts (total N=600) and a separate test-retest cohort (N=50) via Mechanical Turk using a cross-sectional design.

RESULTS

BrainPAC tasks were significantly correlated with the original laboratory paradigms on most metrics (r=0.18-0.63, P<.05). With the exception of the DDT k function and VMAC total points, all other task metrics across the 5 tasks did not differ between the gamified and nongamified versions (P>.05). Out of 5 tasks, 4 demonstrated adequate to excellent test-retest reliability (intraclass correlation coefficient 0.72-0.91, P<.001; except SDT). Gamified metrics were significantly associated with addictive behaviors on behavioral inventories, though largely independent of trait-based scales known to predict addiction risk.

CONCLUSIONS

A purpose-built battery of digitally gamified tasks is sufficiently valid for the scalable assessment of key neurocognitive processes underpinning addictive behaviors. This validation provides evidence that a novel approach, purported to enhance task engagement, in the assessment of addiction-related neurocognition is feasible and empirically defensible. These findings have significant implications for risk detection and the successful deployment of next-generation assessment tools for substance use or misuse and other mental disorders characterized by neurocognitive anomalies related to motivation and self-regulation. Future development and validation of the BrainPAC tool should consider further enhancing convergence with established measures as well as collecting population-representative data to use clinically as normative comparisons.

Examining the Gambling Behavior of University Students: A Cross-Sectional Survey Applying the Multi-Theory Model (MTM) of Health Behavior Change in a Single Institution

Gambling among college students can start as a pastime activity. However, this pastime can lead to problem gambling and pathological gambling. This cross-sectional study aimed to identify and explain the initiation and sustenance of quitting gambling among university students who had participated in gambling during the past month and those who had not using a novel fourth-generation multi-theory model (MTM) of health behavior change. Data were collected from a sample of 1474 university students at a large southwestern university in the U.S. between January 2023 and February 2023, utilizing a validated 39-item survey. The statistical analyses employed in this study encompassed descriptive statistics, independent samples t-tests, and hierarchical regression modeling. Among students who had engaged in gambling in the past month, the constructs of participatory dialogue (β = 0.052; p < 0.05), behavioral confidence (β = 0.073; p < 0.0001), changes in the physical environment (β = 0.040; p = 0.0137), and demographic variables accounted for 27.7% of the variance in the likelihood of initiating the behavior change. Furthermore, the constructs of emotional transformation (β = 0.104; p = 0.0003) and practice for change (β = 0.060; p = 0.0368), and demographic variables accounted for 22.6% of the variance in the likelihood of sustaining quitting gambling behavior. The Multi-Theory Model (MTM) can be employed to design interventions aimed at reducing problem gambling among college students.

Examining the prevalence and type of technology-use in people with Down syndrome: Perspectives from parents and caregivers

Familiarity with technology has become a requirement for independent living, however there is limited information on technology access and use for people with Down syndrome (DS). The aim of this study is to describe technology, gaming, and social-media use in people with DS. Parents/caregivers (N = 220) of individuals with DS aged 5-35 years (49% female) completed an online questionnaire. They felt that technology and social media use, and to a lesser extent gaming, played an important role in their son/daughter's life. However, many had concerns about their son/daughter's safety online, and identified challenges they faced with using technology, such as using a mouse and speech recognition. We also found substantial parental interest in learning more about technology-use in DS, particularly the impact of using social media. This paper summarises important details about technology-use in people with DS, providing foundational information for the design of effective technology-based activities and support.

Effects of Transcranial Electrical Stimulation on Gambling and Gaming: A Systematic Review of Studies on Healthy Controls, Participants with Gambling/Gaming Disorder, and Substance Use Disorder

Gambling disorder (GD) and internet gaming disorder (IGD) are formally recognized behavioral addictions with a rapidly growing prevalence and limited treatment options. Recently, transcranial electrical stimulation (tES) techniques have emerged as potentially promising interventions for improving treatment outcomes by ameliorating cognitive functions implicated in addictive behaviors. To systematize the current state of evidence and better understand whether and how tES can influence gambling and gaming-related cognitive processes, we conducted a PRISMA-guided systematic review of the literature, focusing on tES effects on gaming and gambling in a diverse range of population samples, including healthy participants, participants with GD and IGD, as well as participants with substance abuse addictions. Following the literature search in three bibliographic databases (PubMed, Web of Science, and Scopus), 40 publications were included in this review, with 26 conducted on healthy participants, 6 focusing on GD and IGD patients, and 8 including participants with other addictions. Most of the studies targeted the dorsolateral prefrontal cortex, using transcranial direct current stimulation (tDCS), and assessed the effects on cognition, using gaming and gambling computerized cognitive tasks measuring risk taking and decision making, e.g., balloon analogue risk task, Iowa gambling task, Cambridge gambling task, etc. The results indicated that tES could change gambling and gaming task performances and positively influence GD and IGD symptoms, with 70% of studies showing neuromodulatory effects. However, the results varied considerably depending on the stimulation parameters, sample characteristics, as well as outcome measures used. We discuss the sources of this variability and provide further directions for the use of tES in the context of GD and IGD treatment.

Gaming among female adolescents: profiling and psychopathological characteristics in the Indian context

Objectives

Gaming is a predominant leisure time activity among adolescents, and the literature suggests that unrestrained gaming behavior might lead to gaming disorder. ICD-11 and DSM-5 have recognized gaming disorder as a psychiatric condition and grouped it under the behavioral addiction category. Research on gaming behavior and addiction is largely based on data from the male population, and problematic gaming has largely been understood from the male perspective. In this study, we are attempting to bridge the existing lacuna in the literature by exploring gaming behavior, gaming disorder, and its related psychopathological characteristics among female adolescents in India.

Methods

The study was conducted on a sample of 707 female adolescent participants who were contacted through schools and academic institutes in a city in Southern India. The study adopted a cross-sectional survey design, and data were administered using the mixed modality of online and offline data collection. The participants filled out the following set of questionnaires: socio-demographic sheet, Internet Gaming Disorder Scale-Short-Form (IGDS9-SF), Strength and Difficulties Questionnaire (SDQ), Rosenberg self-esteem scale, and Brief sensation-seeking scale (BSSS-8). The data gathered from the participants were then statistically analyzed using SPSS software version 26.

Results

The descriptive statistics revealed that 0.8% of the sample (i.e., five participants out of 707) obtained scores meeting gaming addiction criteria. Correlation analysis demonstrated a significant relationship between all the psychological variables with total IGD scale scores (p < 0.05). Total SDQ, total BSSS-8, and domain scores of SDQ, such as emotional symptoms, conduct, hyperactivity, and peer problems, were positively correlated, whereas total Rosenberg scores and domain scores of prosocial behaviors of SDQ were negatively correlated. The Mann-Whitney U-test was employed to compare "with gaming disorder" and "without gaming disorder" categories of female participants. Comparing these two groups revealed significant differences in emotional symptoms, conduct, hyperactivity/inattention, peer problem, and self-esteem scale scores. Furthermore, quantile regression was computed, showing that conduct, peer problem, and self-esteem displayed trend-level prediction for gaming disorder.

Conclusion

Female adolescents prone to gaming addiction can be identified through psychopathological characteristics of conduct, peer problem, and low self-esteem. This understanding can be useful in developing a theoretical model focusing on early screening and preventive strategies for at-risk female adolescents.

Effects of Dietary Supplementation of a Microalgae Extract Containing Fucoxanthin Combined with Guarana on Cognitive Function and Gaming Performance

BACKGROUND

Esports competitive gaming requires selective visual attention, memory, quick judgment, and an ability to sustain psychomotor performance over time. Fucoxanthin is a carotenoid, found in specific microalgae varieties such as Phaeodactylum tricornutum (PT), that has been purported to possess nootropic and neuroprotective effects through its anti-inflammatory and antioxidant properties. This study evaluated whether acute and 30-day supplementation of an extract of PT from microalgae combined with guarana (a natural source of caffeine) affects cognitive function in gamers.

MATERIALS AND METHODS

In a double-blind, placebo-controlled manner, 61 experienced gamers (21.7 ± 4.1 years, 73 ± 13 kg) were randomly assigned to ingest a placebo (PL), a low-dose (LD) supplement containing 440 mg of PT extract including 1% fucoxanthin +500 mg of guarana containing 40-44 mg caffeine (MicroPhyt™, Microphyt, Baillargues, FR), or a high-dose (HD) supplement containing 880 mg of PT extract +500 mg of guarana for 30 days. At baseline, cognitive function tests were administered before supplementation, 15 min post-supplementation, and after 60 min of competitive gameplay with participants' most played video game. Participants continued supplementation for 30 days and then repeated pre-supplementation and post-gaming cognitive function tests. General linear model univariate analyses with repeated measures and changes from baseline with 95% confidence intervals were used to analyze data.

RESULTS

There was some evidence that acute and 30-day ingestion of the PT extract from microalgae with guarana improved reaction times, reasoning, learning, executive control, attention shifting (cognitive flexibility), and impulsiveness. While some effects were seen after acute ingestion, the greatest impact appeared after 30 days of supplementation, with some benefits seen in the LD and HD groups. Moreover, there was evidence that both doses of the PT extract from microalgae with guarana may support mood state after acute and 30-day supplementation. Registered clinical trial #NCT04851899.

Increasing Access to Mental Health Services: Videogame Players' Perspectives

Young men's mental health is at the forefront of global public health concerns. Young males, who have a high incidence of mental health disorders, are a population that accesses services at lower rates than females and makes up the majority of videogame players. By considering the unique perspectives of digitally connected individuals on mental health service delivery, interventions may be designed to address their needs with a higher likelihood of success. This study investigated international male videogamers' perspectives on how their access to mental health services could be improved via an open-ended survey question. From a total of 2515 completed surveys, 761 responded to the qualitative question. Of these, the 71 responses that discussed access to and provision of mental healthcare services are reported in this article. Results suggest that digital mental health services were a promising way to reach this group. Anonymity and confidentiality were found to be important factors when considering online mental health services. Male videogame players identified a preference for both online and in-person services that are delivered synchronously, one-on-one with an expert practitioner, and readily available in settings that individuals find comfortable.

Online digital media use and adolescent mental health

Background

Online digital media are a central part of adolescents' lives, providing opportunities for social connection. However, some research has suggested that online digital media use may be negatively associated with mental health. Little population-based research has examined associations between various types of online digital media use and adolescent mental health.

Data and methods

Data from 13,600 adolescents aged 12 to 17 were drawn from the 2019 Canadian Health Survey on Children and Youth. Adolescents reported on how frequently they used social media, video or instant messaging, and online gaming, as well as their general mental health, eating disorder symptoms and, for those aged 15 to 17, suicidal ideation and attempt. Logistic regression was used to estimate the odds of each outcome from the frequency of each type of digital media use, stratified by sex.

Results

Associations were noted between the frequency of social media and video and instant messaging use, and general mental health, eating disorder symptoms, and suicidal ideation and attempt. After cybervictimization and sleep adequacy were accounted for, associations with eating disorder symptoms remained significant for girls and boys. Never participating in online gaming was associated with lower odds of lower general mental health and suicidal ideation among girls, but not boys.

Interpretation

Different types of online digital media use are differentially associated with mental health outcomes, and associations differ between sexes. The associations between social media and video or instant messaging, and mental ill health may be partially explained by the experience of cybervictimization and sleep adequacy. More research on online gaming, particularly among girls, is needed to clarify associations with mental health.

Time to Think "Meta": A Critical Viewpoint on the Risks and Benefits of Virtual Worlds for Mental Health

The metaverse is gaining traction in the general population and has become a priority of the technological industry. Defined as persistent virtual worlds that exist in virtual or augmented reality, the metaverse proposes to afford a range of activities of daily life, from socializing and relaxing to gaming, shopping, and working. Because of its scope, its projected popularity, and its immersivity, the metaverse may pose unique opportunities and risks for mental health. In this viewpoint article, we integrate existing evidence on the mental health impacts of video games, social media, and virtual reality to anticipate how the metaverse could influence mental health. We outline 2 categories of mechanisms related to mental health: experiences or behaviors afforded by the metaverse and experiences or behaviors displaced by it. The metaverse may benefit mental health by affording control (over an avatar and its virtual environment), cognitive activation, physical activity, social connections, and a sense of autonomy and competence. However, repetitive rewarding experiences may lead to addiction-like behaviors, and high engagement in virtual worlds may facilitate and perpetuate the avoidance of challenges in the offline environment. Further, time spent in virtual worlds may displace (reduce) other determinants of mental health, such as sleep rhythms and offline social capital. Importantly, individuals will differ in their uses of and psychological responses to the metaverse, resulting in heterogeneous impacts on their mental health. Their technological motivations, developmental stage, sociodemographic context, and prior mental health problems are some of the factors that may modify and frame the positive and negative effects of the metaverse on their mental health. In conclusion, as the metaverse is being scaffolded by the industry and by its users, there is a window of opportunity for researchers, clinicians, and people with lived experience to coproduce knowledge on its possible impacts on mental health and illness, with the hope of influencing policy-making, technological development, and counseling of patients.

Attitudes Toward Sexual Orientation and Gender Identity in Online Multiplayer Gaming Spaces

Online video game communities can provide a sense of belonging and support for marginalized people, while at the same time, can be rife with prejudice and discrimination. This study aimed to assess the prevalence of both positive and negative comments about sexual orientation and gender identity during online gaming, and to test the hypothesis that LGBTQ+ people witness or experience more prejudice than do heterosexual and cisgender persons. An online survey, distributed on social media sites and a psychology subject pool, included rating scales and open-ended questions on game-related conversations. Respondents (N = 185) provided negative examples made by others more frequently than positive ones and attributed serious comments to themselves versus jokes and offhand comments to others. Across all respondent gender identities, the targets of the negative comments by others were almost always LGBTQ+ persons. These results bolster critiques of online gaming environments as hostile to members of marginalized groups.

Gaming addiction and screen time in a context of increase of internalizing symptoms: Moderation evaluation

Children and adolescents were largely affected by the psychosocial impact of the 2019-2022 pandemic. During this time, there was an increase in internalizing symptoms, screen and internet use, and internet addiction. However, the interaction of these variables are not fully understood in a stressful time. Here, we have a repeated cross-sectional study aiming to model internalizing symptoms' prediction depending on screen time and game addiction during the COVID-19 pandemic. Parent-reported online data were collected at three timepoints, 6 months apart from each other, from a total of 1211 participants. We found an increase in screen time, game addiction, and internalizing symptoms. Regardless of the time spent in front of screens, higher levels of game addiction were associated with higher levels of internalizing symptoms in children and adolescents. Even if participants demonstrated low screen time, if they were virtually dependent they tended to exhibit higher levels of internalizing symptoms. The same result was found in all three samples. There is a need to investigate the nature of the relationship between internet addiction and internalizing symptoms and the long lasting effects of long hours on the screen.

A cross-sectional study on gaming intensity and social vulnerability in adolescents that have a chronic condition

Background

Adolescents growing up with a chronic condition might experience more social vulnerabilities compared to their healthy peers as an indirect result of their conditions. This can lead to a relatedness need frustration for these adolescents. Consequently, they might spend more time playing video games compared to their peers. Research shows that both social vulnerability and gaming intensity are predictors for problematic gaming. Therefore, we investigated if social vulnerability and gaming intensity are more pronounced in adolescents that have a chronic condition compared to the general population; and if these levels reflect the levels of a clinical group being treated for Internet Gaming Disorder (IGD).

Methods

Data on peer problems and gaming intensity were compared from three separate samples: a national representative sample of adolescents, a clinical sample of adolescents that are undergoing treatment for IGD, and a sample of adolescents diagnosed with a chronic condition.

Results

No differences were found on either peer problems or gaming intensity between the group of adolescents that have chronic conditions and the national representative group. The group with chronic conditions scored significantly lower on gaming intensity than the clinical group. No significant differences were found between these groups on peer problems. We repeated the analyses for boys only. Similar results were found for the group with chronic conditions compared to the national representative group. The group with chronic conditions now scored significantly lower on both peer problems and gaming intensity than the clinical group.

Conclusion

Adolescents growing up with a chronic condition appear similar in their gaming intensity and peer problems compared to their healthy peers.

[Behavioral (non-chemical) addictions and COVID-19]

The review examines the impact of the COVID-19 pandemic on the prevalence, manifestation, as well as the possibility of preventing and treating behavioral (non-chemical) addictions. Particular attention is paid to various manifestations of Internet addiction (IA): gaming, gambling, cybersexual and food addiction (FA). During the pandemic, Internet use increased significantly, leading to an increase in IA, mainly due to gaming, which correlated with the level of psychosocial problems. The increase in gambling occurred mainly in individuals with addiction or risk groups, while in the population the frequency of gambling decreased or did not change. Immediately after the start of the COVID-19 pandemic, the number of requests to porn sites increased dramatically, suggesting an increase in cybersex addiction. However, longitudinal studies in adolescents show a slight decrease in the interest in pornography in boys, and an increase from an initially low level in girls. The proportion of eating disorders and FA significantly increased. An increase in FA was associated with depression, anxiety, and also in obese individuals. In the era of COVID-19 prevention practices and general remedial activity should take into account the needs of the general population, emphasizing the importance of self-regulating and balanced lifestyles with moderate and sensible Internet use during the pandemic.

Worsened Anxiety and Loneliness Influenced Gaming and Gambling during the COVID-19 Pandemic

Aim: To study the prevalence and patterns of problematic gaming and gambling during the COVID-19 pandemic and the association with psychiatric traits and major types of anxiety categories. Method: 1067 young adults participated in both wave 3 (2018) and wave 4 (2021) of the SALVe Cohort. Associations with psychiatric symptoms and anxiety were examined using logistic regression and Chi-square tests. Results: Problematic gaming decreased by 1.3 percentage points to 23.2% since the start of the pandemic, while problematic gambling increased by 0.9 percentage points to 6.5% in w4. Average time spent playing video games/day decreased from 2.2 h (w3) to 1.7 h (w4), while increases in gaming activity were associated with worsened feelings of loneliness (p = 0.002), depression (p < 0.001), and anxiety (p < 0.01) during the pandemic. Predictors for problematic gaming at w4 were previous problematic gaming and social anxiety (p = < 0.001 and 0.01, respectively). Moreover, previous problem gambling also predicted problem gambling at w4 p < 0.001. All anxiety categories were associated with both problematic gaming and gambling when adjusted for age and sex. However, after adjusting for depression and insomnia, social anxiety was associated with problematic gaming (p < 0.001), while panic was associated with problem gambling (p < 0.001). Conclusion: Overall, problematic gaming has decreased since the start of the pandemic, while problem gambling has increased. Worsened feelings of loneliness, depression, and anxiety during the pandemic are associated with increased gaming. Moreover, the association between problematic gaming and gambling and anxiety is independent of depression and sleep problems.

Problematic Video Game Use and Mental Health among Spanish Adolescents

Current scientific evidence points to the importance of studying the link between mental health and problematic video game use in adolescents. The aim of this study was to analyse the correlation between gender and stage of adolescence and problematic video game use, as well as to study the correlation between internalizing and externalizing symptomatology, prosocial behaviour and video game use, and the correlation between video gaming and mental health issues in Spanish 12- to 18-year-olds (M = 14.51; SD = 1.57). For this purpose, the Strengths and Difficulties Questionnaire (SDQ) and the Video Game-Related Experiences Questionnaire (VGEQ) were administered to 1448 secondary school students in Extremadura (Spain), of which 50.8% were women and 49.8% men. The results show that (a) males present more problematic video game use, (b) prosocial behaviour negatively correlates with problematic video game use, and (c) mental health issues and problematic video game use correlate in a negative way. However, the stage of adolescence was not seen to have any effect on the problematic video game use. In conclusion, this study points the effects that problematic video game use can have on the mental health of adolescents and the possible protective role that prosocial behaviours can have on the prevention of problematic video game use.

Time Spent Gaming, Device Type, Addiction Scores, and Well-being of Adolescent English Gamers in the 2021 OxWell Survey: Latent Profile Analysis

BACKGROUND

The shift in the last decades to screen-based and increasingly web-based gaming activity has raised concerns about its impact on the development of children and adolescents. Despite decades of research into gaming and related psychosocial effects, the question remains how best to identify what degree or context of gaming may be a cause for concern.

OBJECTIVE

This study aimed to classify adolescents into gamer profiles based on both gaming behaviors and well-being. Once we distinguished the different gamer profiles, we aimed to explore whether membership to a specific profile could be predicted based on a range of personal characteristics and experiences that could then help identify those at risk.

METHODS

We explored gaming and well-being in an adolescent school population (aged 12-18 years) in England as part of the 2021 OxWell student survey. Self-report measures of time spent playing games on computers or consoles, time spent playing games on mobile phones, the Game Addiction Scale, and the Warwick-Edinburgh Mental Well-being Scale were used to classify adolescent heavy gamers (playing games for at least 3.5 hours a day) using latent profile analysis. We used multinomial logistic regression analysis to predict the profile membership based on a range of personal characteristics and experiences.

RESULTS

In total, 12,725 participants answered the OxWell gaming questions. Almost one-third (3970/12,725, 31.2%) indicated that they play games for at least 3.5 hours a day. The correlation between time spent playing video games overall and well-being was not significant (P=.41). The latent profile analysis distinguished 6 profiles of adolescent heavy gamers: adaptive computer gamers (1747/3970, 44%); casual computer gamers (873/3970, 22%); casual phone gamers (595/3970, 15%); unknown device gamers (476/3970, 12%); maladaptive computer gamers (238/3970, 6%); and maladaptive phone gamers (79/3970, 2%). In comparison with adaptive computer gamers, maladaptive phone gamers were mostly female (odds ratio [OR] 0.08, 95% CI 0.03-0.21) and were more likely to have experienced abuse or neglect (OR 3.18, 95% CI 1.34-7.55). Maladaptive computer gamers, who reported gaming both on their mobile phones and on the computer, were mostly male and more likely to report anxiety (OR 2.25, 95% CI 1.23-4.12), aggressive behavior (OR 2.83, 95% CI 1.65-4.88), and web-based gambling (OR 2.18, 95% CI 1.24-3.81).

CONCLUSIONS

A substantial number of adolescents are spending ≥3.5 hours gaming each day, with almost 1 in 10 (317/3970, 8%) reporting co-occurring gaming and well-being issues. Long hours gaming using mobile phones, particularly common in female gamers, may signal poorer functioning and indicate a need for additional support. Although increased time gaming might be changing how adolescents spend their free time and might thus have public health implications, it does not seem to relate to co-occurring well-being issues or mental ill-health for the majority of adolescent gamers.

Security Concerns in MMO Games-Analysis of a Potent Application Layer DDoS Threat

The application layer in the Internet protocol suite offers a significant degree of freedom regarding the orchestration of distributed denial-of-service attacks due to many different and unstandardized protocols. The primary focus of defending against application-layer distributed denial-of-service attacks has traditionally been Hypertext Transfer Protocols oriented while observing individual users' actions independently from one another. In this paper, we present and analyze a novel application-layer DDoS attack in massively multiplayer online games that utilize the cooperative efforts of the attackers to deplete the server's or players' bandwidth. The attack exploits in-game dependencies between players to cause a massive spike in bandwidth while the attackers' traffic remains legitimate. We introduce a multiplayer-relations graph to model user behavior on a game server. Additionally, we demonstrate the attack's devastating capabilities on an emulated World of Warcraft server. Lastly, we discuss flaws of the existing defense mechanisms and possible approaches for the detection of these attacks using graph theory and multiplayer-relations graphs.

ADHD-Gaming Disorder Comorbidity in Children and Adolescents: A Narrative Review

Attention Deficit/Hyperactivity Disorder (ADHD) is a neurobiological condition characterized by developmentally inadequate levels of inattention, hyperactivity, and impulsivity, and a neurobiological disruption in brain neurotransmitters and circuitry causing abnormal responses to rewards. Playing electronic games generates a biological response that activates the neuronal circuits linked to pleasure and reward, and there is a growing attention to this type of activity, which can also turn into a mental health condition. The existence and the boundaries between the functional and the dysfunctional are still a source of debate, with the recognition of 'Internet Gaming Disorder' (IGD) as a condition belonging to the broader area of addiction requiring more in-depth study with respect to the DSM-5, while 'Gaming Disorder' (GD) was officially recognized as a new diagnosis by the World Health Organization (WHO) in the updated revision of the International Classification of Diseases (ICD-11). Notwithstanding, the suggested criteria for the diagnosis of Gaming Disorder are still debated. Since ADHD has been reported as a risk factor for developing addictions, this narrative review aims to provide the current state-of-the art of the knowledge about the comorbidity between ADHD and Gaming Disorder. For this aim, a literature search was conducted using a combination of specific keywords and the results are discussed within the R-Do-C framework and dimensions, and implications for treatment are considered.

Escapism and Excessive Online Behaviors: A Three-Wave Longitudinal Study in Finland during the COVID-19 Pandemic

Excessive online behaviors refer to harmful or disproportionate use of digital network applications. Such behaviors are likely to be associated with escapist motives. Our aim was to analyze whether escapism predicts excessive gambling, excessive gaming, and excessive internet use over time. A longitudinal sample of Finnish residents aged 18-75 years (n = 1022, 51.27% male) was surveyed at three time points during the COVID-19 pandemic in 6-month intervals: April 2021 (Time 1), October-November 2021 (Time 2), and April-May 2022 (Time 3). Of the original Time 1 respondents, 66.80% took part in the surveys at both Time 2 and Time 3. All surveys included measures for excessive gambling (Problem Gambling Severity Index), excessive gaming (Internet Gaming Disorder Test), and excessive internet use (Compulsive Internet Use Scale). Three escapism-specific questions were used to construct a dedicated escapism variable. Socio-demographic variables, alcohol consumption, and psychological distress were used as controls. The study was conducted with multilevel regression analyses using hybrid models. Our research showed that escapism had strong within-person effects on excessive gambling, B = 0.18, p = 0.003; excessive gaming, B = 0.50, p < 0.001; and excessive internet use, B = 0.77, p < 0.001 over time. The between-person effect of escapism was demonstrated on excessive gaming B = 0.91, p < 0.001, and excessive internet use B = 0.61, p = 0.036. Adverse societal events and uncertain times can manifest in excessive online behaviors motivated by escapism, highlighting a need to focus prevention efforts on healthy coping methods.

The Use of Compression Stockings to Reduce Water Retention in the Legs During Gaming and Esports: Randomized Controlled Field Study

Background

With the increasing digitalization of daily life, internet-based entertainment such as gaming and streaming has advanced to one of the megatrends of the 21st century. Besides offering a multitude of controversially discussed opportunities for entertainment and social interaction, there is reasonable concern about health issues caused by the absence of physical activity among activities linked to gaming and streaming.

Objective

The aim of this study is to compare the water balance of recreational gamers with and those without compression stockings during a gaming event.

Methods

We measured body composition and water balance with 8-electrode bioelectrical impedance analysis among 46 recreational gamers with an average age of 27.1 (SD 6.5) years (5/46, 11% women and 41/46, 89% men) before and after 24 hours at a gaming event. Of the 46 gamers, 23 (50%) gamers wore compression stockings for the duration of the study.

Results

Our study shows that prolonged gaming and associated behaviors during a 24-hour time frame lead to an increase in total body water (+0.76 L; P<.001) and a decrease of phase angle in the lower extremities (−0.47°; P<.001) but not in the upper extremities (+0.09°; P=.80), when no compression is used. Gamers using compression socks did not show any significant negative effects on their body composition.

Conclusions

Prolonged gaming and streaming are serious risk factors for diseases associated with water retention in the legs, and these risks can be measured by bioelectrical impedance and reduced by wearing compression stockings. We conclude that these findings should be discussed and replicated in larger studies and that there is a considerably large market for compression stockings among gamers and live streamers.