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Is that video game a health risk? 3 things parents should know

Some games topping holiday wish lists — including the season’s most anticipated release, Call of Duty: Modern Warfare — contain imagery that could be putting the health of young people at risk.

Smoking can be found in many video games, including those rated appropriate for teenagers, and research shows that exposure to images of tobacco — its use still the leading cause of preventable death and disease in the United States — can influence young people to start smoking. In fact, research shows 44% of adolescents who start smoking do so because of smoking images they see in movies. Tobacco use in video games is likely to promote youth smoking in similar ways and may even pose additional concerns since video games are more active and intense experiences.

Video games are part of a pervasive reemergence of smoking in pop culture, including in popular streaming content like the hit Netflix series “Stranger Things.” This reemergence is even more alarming as it coincides with the skyrocketing youth use of e-cigarettes, which is linked with an increased likelihood to smoke cigarettes in the future.

Here are three things parents should know if they are shopping for video games.

Smoking can be found and is often glamorized in video games.

Is their tobacco in video games played by kids?

Tobacco imagery is widespread in video games played by youth and many young gamers described tobacco use as making a character “cooler,” “tougher” or “grittier,” according to Truth Initiative® research.

While a methodical review of games on the U.S. market has yet to be conducted, it is clear from past research that tobacco use is frequently depicted in video games geared toward young people. For example, between 1994 and 2011, 60 out of 78 large video game publishers included tobacco imagery in at least one, and often more, of their games rated appropriate for youth.

A report released this year also revealed that the tobacco industry identified video games as a marketing opportunity. Researchers analyzed tobacco industry documents and found that tobacco companies incorporated games in product promotions, including at marketing events at bars.

Ratings, warnings and content descriptors are often incomplete.

If a game has smoking in it does that make it mature rated?

Just because a game is rated appropriate for youth and teens does not mean it is free of tobacco imagery. Video game content descriptors can also fail to mention tobacco use, making it difficult for parents to use them to monitor for tobacco imagery.

A 2015 survey by the University of California, San Francisco, confirmed tobacco content in 42% of the video games that participants reported playing; however, only 8% of these games had tobacco warnings from the Entertainment Software Rating Board (ESRB), the gaming industry's self-regulatory organization that rates video games and apps.

In its report, "Played: Smoking and Video Games," Truth Initiative called on the ESRB to consistently identify and disclose if any game contains tobacco use or tobacco references. The organization is also urging game developers and publishers to stop including tobacco use and tobacco images in their games, particularly those marketed to or played by youth, regardless of their ESRB rating. Research suggests that pressure on movie producers has succeeded in decreasing tobacco imagery in youth-rated movies, and the same efforts should be used to influence game developers and publishers.

Some games are leaders on the issue.

Did they remove smoking from Gears 5?

While many games contain smoking and some games even include storylines or elements where tobacco use benefits a player, some game developers recognize the risk.

For example, “Gears 5,” the newest installment in the popular third-person shooter “Gears of Wars” series, removed all references to tobacco and is now completely smoke-free. The publisher made the decision after Truth Initiative approached the game’s corporate entities about the issue of tobacco imagery in video games, according to an article in Variety.

Even as national smoking rates have declined to record lows, smoking continues to be portrayed positively on screens. Glamorizing and re-normalizing smoking, and making it appear "cool," could threaten the progress the U.S. has made in decreasing tobacco use, which kills 1,300 Americans every day.

For more information, read the Truth Initiative report “Action needed: Tobacco in pop culture.”