UCSF

Introduction

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

Methods

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

Results

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

Conclusions

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

Implications

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