Context Children's exposure to violence, blood, sexual themes, profanity, substances,
and gambling in the media remains a source of public health concern. However,
content in video games played by older children and adolescents has not been
quantified or compared with the rating information provided to consumers by
the Entertainment Software Rating Board (ESRB).
Objectives To quantify and characterize the content in video games rated T (for
"Teen") and to measure the agreement between the content observed in game
play and the ESRB-assigned content descriptors displayed on the game box.
Design and Setting We created a database of all 396 T-rated video game titles released
on the major video game consoles in the United States by April 1, 2001, to
identify the distribution of games by genre and to characterize the distribution
of ESRB-assigned content descriptors. We randomly sampled 80 video game titles
(which included 81 games because 1 title included 2 separate games), played
each game for at least 1 hour, quantitatively assessed the content, and compared
the content we observed with the content descriptors assigned by the ESRB.
Main Outcome Measures Depictions of violence, blood, sexual themes, gambling, and alcohol,
tobacco, or other drugs; whether injuring or killing characters is rewarded
or is required to advance in the game; characterization of gender associated
with sexual themes; and use of profanity in dialogue, lyrics, or gestures.
Results Analysis of all content descriptors assigned to the 396 T-rated video
game titles showed 373 (94%) received content descriptors for violence, 102
(26%) for blood, 60 (15%) for sexual themes, 57 (14%) for profanity, 26 (7%)
for comic mischief, 6 (2%) for substances, and none for gambling. In the random
sample of 81 games we played, we found that 79 (98%) involved intentional
violence for an average of 36% of game play, 73 (90%) rewarded or required
the player to injure characters, 56 (69%) rewarded or required the player
to kill, 34 (42%) depicted blood, 22 (27%) depicted sexual themes, 22 (27%)
contained profanity, 12 (15%) depicted substances, and 1 (1%) involved gambling.
Our observations of 81 games match the ESRB content descriptors for violence
in 77 games (95%), for blood in 22 (27%), for sexual themes in 16 (20%), for
profanity in 14 (17%), and for substances in 1 (1%). Games were significantly
more likely to depict females partially nude or engaged in sexual behaviors
than males. Overall, we identified 51 observations of content that could warrant
a content descriptor in 39 games (48%) in which the ESRB had not assigned
a content descriptor. We found that the ESRB assigned 7 content descriptors
for 7 games (9%) in which we did not observe the content indicated within
1 hour of game play.
Conclusions Content analysis suggests a significant amount of content in T-rated
video games that might surprise adolescent players and their parents given
the presence of this content in games without ESRB content descriptors. Physicians
and parents should be aware that popular T-rated video games may be a source
of exposure to a wide range of unexpected content.