MEDICINE AND THE MEDIA Violence in E-Rated Video Games Kimberly M. Thompson, ScD Context Children’s exposure to violence, alcohol, tobacco and other substances, and Kevin Haninger sexual messages in the media are a source of public health concern; however, content in video games commonly played by children has not been quantified. REATED IN 1994, THE ENTER- Objectives To quantify and characterize the depiction of violence, alcohol, tobacco tainment Software Rating Board and other substances, and sex in video games rated E (for “Everyone”), analogous to C(ESRB) rates video games ac- the G rating of films, which suggests suitability for all audiences. cording to the categories listed in the Design We created a database of all existing E-rated video games available for rent BOX and using content descriptors, or sale in the United States by April 1, 2001, to identify the distribution of games by which game manufacturers display on genre and to characterize the distribution of content descriptors associated with these the game box to inform consumer games. We played and assessed the content of a convenience sample of 55 E-rated choices.1 Analogous to the G rating of video games released for major home video game consoles between 1985 and 2000. films,2 the E rating (for “Everyone”) of Main Outcome Measures Game genre; duration of violence; number of fatali- video games suggests suitability for all ties; types of weapons used; whether injuring characters or destroying objects is re- audiences, but the E rating does not warded or is required to advance in the game; depiction of alcohol, tobacco and other mean violence-free. substances; and sexual content. Studies on children’s use of various Results Based on analysis of the 672 current E-rated video games played on home media document the popularity of video consoles, 77% were in sports, racing, or action genres and 57% did not receive any games as a major source of entertain- content descriptors. We found that 35 of the 55 games we played (64%) involved intentional violence for an average of 30.7% of game play (range, 1.5%-91.2%), and ment. A recent study found that 70% we noted significant differences in the amount of violence among game genres. In- of children (age, 2-18 years) live in juring characters was rewarded or required for advancement in 33 games (60%). The homes that have at least 1 video game presence of any content descriptor for violence (n=23 games) was significantly cor- console, 33% of children have video related with the presence of intentional violence in the game (at a 5% significance game consoles in their bedrooms, and level based on a 2-sided Wilcoxon rank-sum test, t53=2.59). Notably, 14 of 32 games 30% of children in the study played (44%) that did not receive a content descriptor for violence contained acts of vio- video games the previous day.3 Chil- lence. Action and shooting games led to the largest numbers of deaths from violent dren in the study reported playing video acts, and we found a significant correlation between the proportion of violent game games for 20 min/d on average, although play and the number of deaths per minute of play. We noted potentially objection- able sexual content in 2 games and the presence of alcohol in 1 game. older children (age, 8-18 years) accounted for most of this use (aver- Conclusions Content analysis suggests a significant amount of violence in some E- age, 27 min/d), with boys spending sig- rated video games. The content descriptors provide some information to parents and should be used along with the rating, but the game’s genre also appears to play a role nificantly more time playing video in the amount of violent play. Physicians and parents should understand that popular games than girls and white children E-rated video games may be a source of exposure to violence and other unexpected playing video games for significantly less content for children and that games may reward the players for violent actions. 3 time than black or Hispanic children. JAMA. 2001;286:591-598 www.jama.com Unfortunately, little information exists about the ratings and genres of the The health implications of expo- encing media violence exists within the games that children play as a function sure to video games and other media broad medical community.4,5 Al- of their age, sex, family income level, with violent content remain uncer- though several recent studies repeat and ethnicity, although some differ- tain, but considerable concern about the concerns about the content of video 3 ences in preferences exist. Overall, chil- potential impacts of children experi- games6-10 and the marketing of violent dren appear to play relatively more games in the action, adventure, and Author Affiliations: Harvard School of Public Health, Harvard Center for Risk Analysis, 718 Huntington Ave, 3 Harvard University, Boston, Mass. Boston, MA 02115 (e-mail: [email protected]). sports genres, but this may simply Corresponding Author and Reprints: Kimberly M. Medicine and the Media Section Editor: Annette reflect the types of games available. Thompson, ScD, Harvard School of Public Health, Flanagin, RN, MA, Managing Senior Editor. ©2001 American Medical Association. All rights reserved. (Reprinted) JAMA, August 1, 2001—Vol 286, No. 5 591 Downloaded From: https://jamanetwork.com/ on 09/29/2021 VIOLENCE IN E-RATED VIDEO GAMES selected the genre that was most com- Box. Entertainment Software Rating Board (ESRB) Ratings and Descriptions monly used to describe the game. Us- 1. Early Childhood (EC) ing the database, we then performed sta- Titles rated EC have content suitable for children ages 3 and older and do not tistical analyses to summarize the contain any material that parents would find inappropriate. distribution of games by genre and con- 2. Everyone (E)* tent descriptors. Titles rated E have content suitable for persons ages 6 and older. These titles To quantitatively assess the content will appeal to people of many ages and tastes. They may contain minimal vio- of games, we selected 55 E-rated video lence, some comic mischief (for example, slapstick comedy), or some crude games that represented the distribu- language. 3. Teen (T) tion of content descriptors and genres Titles rated T have content suitable for persons ages 13 and older. Titles in this and that were available for play on one category may contain violent content, mild or strong language, and/or sugges- of the current major home video game tive themes. consoles in the United States (DC, N64, 4. Mature (M) PS, or PS2). We designed the study to Titles rated M have content suitable for persons ages 17 and older. These prod- include several games on each console ucts may include more intense violence or language than products in the Teen and to play a mixture of both the highly category. In addition, these titles may also include mature sexual themes. popular games as well as ones that did 5. Adults Only (AO) not receive widespread consumer in- Titles rated AO have content suitable only for adults. These products may in- terest. clude graphic depictions of sex and/or violence. Adults Only products are not To explore the possibility of trends intended to be sold or rented to persons under the age of 18. 6. Rating Pending (RP) in series of video games, we also se- Product has been submitted to the ESRB and is awaiting final rating. lected 2 of the most popular series by sales for study: The Legend of Zelda se- *Prior to 1998, the “Everyone (E)” rating was named “Kids to Adults (K-A).” ries in the adventure genre and the Su- per Mario Bros. series in the action genre. We played all of the games in entertainment to children,11 more re- able for rent or sale in the United States these series, including games released search on the impact of violent inter- by April 1, 2001 (accessible at http: for older consoles like Nintendo En- active entertainment, including video //www.kidsrisk.harvard.edu) because tertainment System and Super Nin- games, is needed.4,5,9 Remarkably, no we expected that the level of violence tendo Entertainment System. Since the quantitative analysis exists on content in video games might depend on genre. 2 oldest games in The Legend of Zelda in E-rated video games or on the rela- The process involved using data from series were released prior to the cre- tionship between game content and the the ESRB1 and several Internet sites15-18 ation of the ESRB and have not been ESRB content descriptors. This study to identify all 672 E-rated console rated, we did not include them in our focuses on providing quantitative in- games, verify that each game was re- analysis of E-rated games even though formation to physicians and parents leased in the United States, determine we are confident that these games about the content of E-rated video each game’s content descriptor(s), and would receive E ratings. Finally, for his- games. classify each game by 1 of 11 primary torical comparison, we assessed the genres: action, adventure, casino, fight- content of 8 classic arcade games that METHODS ing, puzzle, racing, role-playing, shoot- have been rereleased as E-rated com- Video game console systems continue ing, simulation, sports, and strategy. A pilations or paired with E-rated re- to evolve12,13 with 3 manufacturers pres- small number of games (n=9) could not makes of the original games. Overall, ently dominating the market: Nin- be classified by these genres and were we played a total of 65 games.