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Original Contribution |

Content and Ratings of Teen-Rated Video Games FREE

Kevin Haninger; Kimberly M. Thompson, ScD
[+] Author Affiliations

Author Affiliations: Center on Media and Child Health, Children's Hospital, Boston, Mass, and Kids Risk Project, Harvard School of Public Health, Harvard University, Boston, Mass.


JAMA. 2004;291(7):856-865. doi:10.1001/jama.291.7.856.
Text Size: A A A
Published online

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.

Created in 1994, the Entertainment Software Rating Board (ESRB) rates video games with age-based rating symbols and content descriptors, which game manufacturers display on the game box to inform consumer choices. Game manufacturers submit videotaped game footage and other information to the ESRB for rating and 3 trained ESRB raters each independently review the materials to determine the age-based rating and content descriptors he/she believes are appropriate.1 We previously characterized the content of video games rated E (for "Everyone").2 We applied the same methods to characterize the content of video games rated T (for "Teen"). According to the ESRB, T-rated video games may be suitable for persons aged 13 years or older and may contain violence, mild or strong language, and/or suggestive themes.1

Video games represent a multibillion-dollar industry and a major source of entertainment for children and adolescents. A national study of media use found that 52% of 2- to 7-year-olds and 82% of 8- to 18-year-olds live in homes with at least 1 video game console.3 Children and adolescents who play video games on any given day spend more than an hour playing them.3 Other studies document similar usage patterns and further observe that parents are less likely to supervise video games than other entertainment media.4 Unfortunately, little information exists about the ratings and genres of video games played by children of different ages, sex, family income level, and ethnicity. Consequently, the number and characteristics of children who play T-rated video games remain uncertain, although T-rated video games remain popular, comprising 28% of computer and video sales in 2002.5

The health implications of playing video games also remain uncertain, but concern exists within the broad medical community.6,7 New studies of entertainment media continue to raise new issues. For example, a meta-analysis of experimental and nonexperimental studies found that playing violent video games increased aggression in children and young adults.8 A longitudinal study of children found an association between a higher likelihood of committing aggressive acts against others and the amount of time spent viewing television during adolescence and early adulthood.9 Finally, the results of a recent study on a small sample of adults showed that playing video games may improve visual attentional skills,10 although the implications of this particular type of learning for children remain uncertain. More research is needed to understand how media consumption generally, and video games specifically, affect brain processing, learning, attitudes, and behavior.

No comprehensive analysis exists on the content of T-rated video games or the relationship between game content and the ESRB content descriptors. This study focuses on providing quantitative information to physicians and parents about the content of T-rated video games.

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. At that time, the major video game consoles included Nintendo 64, Sega Dreamcast, Sony PlayStation, and Sony PlayStation 2. Using data from the ESRB1 and several video game Web sites,1113 we verified the release of each game title, recorded the ESRB-assigned content descriptors, and classified each game title by 1 of 10 primary genres: action, adventure, fighting, racing, role-playing, shooting, simulation, sports, strategy, or trivia. For cases in which the Web sites assigned different genres to a game title, we selected the genre most frequently used. We labeled 2 game titles that did not fit any of these genres as "other." Using this method to assign genres resulted in classifying the T-rated game Nuclear Strike as shooting, while we classified the E-rated game Nuclear Strike 64 as action in our previous study.2 Despite the similarities between these games, the different reviewers and publishers classified them differently and our genre assignments reflect this variability.

To quantitatively assess the content of T-rated video games, we stratified the 396 video game titles by genre and randomly selected 20% (n = 80) to play. One selected game title (Final Fantasy Anthology) included 2 separate games (Final Fantasy V and Final Fantasy VI), and consequently we played 81 T-rated video games in our random sample. When possible, we purchased or rented all video games with their original game manuals intact. All of the games that we played remain available for sale or rental. For game titles available on multiple consoles, we chose to represent the consoles as evenly as possible. For consistency, an undergraduate student with considerable video gaming experience played the entire random sample of video games (n = 81) and recorded all game play on videocassettes for later coding. The player first read the manual and played for several hours to become familiar with the game features, then restarted the video game from the beginning and recorded at least 1 hour of game play on a videocassette, including any game introductions and setup.

Because many video games contain more than 1 hour of game play, we emphasize that our method of not playing these games to their conclusion means that we miss some content. In particular, some video games may become more difficult or contain more mature content as the player progresses. However, to strike a reasonable balance between playing more video games and playing individual video games for longer times, we determined that practicing the video game for several hours and then recording 1 hour of game play allowed us to obtain a good sample for any single video game.

One author with considerable video gaming experience (K.H.) reviewed and manually coded all of the game play recorded on the videocassettes using standard coding instruments (available on request) and then entered the data into Microsoft Access (Version 2002, Microsoft Corp, Redmond, Wash). We discussed all parts of games that presented difficulty in coding with the game player. We used a similar coding method as in our earlier study in which we obtained good agreement between coders.2 However, to assess the consistency of our method between coders in this study, a research assistant with considerable video gaming experience (but with no other involvement in this study) independently coded a randomly selected subset of 12 games (ie, 2 used for training and 10 used for comparison with a κ statistic).

Recognizing the challenges associated with defining content, we began by establishing consistent definitions to apply throughout the study. We defined violence as intentional acts in which the aggressor causes or attempts to cause physical injury or death to another character. We did not include actions that led to unintentional physical harm, the effects of natural disasters, or the presence of dangerous obstacles not attributed to another character. We defined characters broadly, including humans and nonhumans (eg, monsters, animals, and personified robots) that attacked the player or other characters. We did not code intentional acts of physical force that represent normal play in a sports game as violence,2 but we coded all punches and kicks in boxing and wrestling games as violence because the intention in these sports is to cause injury. To quantify the amount of violence, we divided the videocassette into 1-second intervals and noted whether each second of game play contained acts of violence.

We defined blood as a red fluid originating from an injured human or any colored fluid from an injured creature. We noted whether each game contained scenes depicting blood and the color of the blood.

We defined sexual themes as behaviors (eg, provocative touching or moaning) or dialogue related to sex, as well as depictions of exposed breasts, buttocks, or genitals. We did not otherwise count pronounced cleavage, large breasts, or provocative clothing as sexual material given the vague ESRB definition of suggestive themes (ie, "mild provocative references or materials"). However, we recognize that some parents might view such content as suggestive. We characterized the type of sexual content present and the sex of the characters involved and noted whether the player could play each game as a male or female character.

We defined profanity as the use of abusive and vulgar language, anatomical references without the use of such words, and obscene gestures involving the middle finger or its full-arm equivalent. We based this list on the ESRB definitions of mild language ("product contains the use of words like ‘damn'") and strong language ("commonly referenced four-letter words") in effect on April 1, 2001. We also noted whether the profanity occurred in the game as dialogue, written text, or song lyrics. We counted uses of "God," "Jesus," and "hell" as profanity only when characters used these words abusively. To quantify profanity, we counted each occurrence and noted the specific gesture used or root word (ie, "God damnit!" counts both as God and a form of damn). We did not otherwise count taunts or mean language as profanity or words censored by bleeps.

We did not quantify depictions of comic mischief because content that met the ESRB's broad definition (ie, "scenes depicting slapstick or gross vulgar humor") frequently overlapped with content suggested by descriptors for mild animated violence, mild language, or suggestive themes.

We defined the depiction of substances as scenes in which characters use or discuss use of alcohol, tobacco, or illicit drugs, or when the player views images of at least 1 substance. We did not count medicinal herbs, tonics, or ambiguous "brew" as substances. To quantify the amount of alcohol, tobacco, and drugs in the video game, we noted whether each second of game play depicted any type of substance.

We defined gambling as scenes in which characters bet money for prizes. We quantified the amount of gambling by counting the number of seconds of game play that depicted gambling.

We performed statistical tests on the sex of characters involved in content that warranted a descriptor for sexual themes using SAS statistical software (Version 8.2 for Windows, SAS Institute Inc, Cary, NC).

Table 1 groups ESRB content descriptors by type and compares the 139 content descriptors assigned to the 80 video game titles in the random sample with the 627 content descriptors assigned to all 396 T-rated video game titles. Although we stratified games by genre, no statistically significant difference exists between the 2 distributions of content descriptors. The range of content descriptors reflects the continued evolution of the ESRB rating system (eg, in 2003 the ESRB introduced new content descriptors for violence and now uses separate content descriptors for use of alcohol and use of tobacco).1

Table Graphic Jump LocationTable 1. Entertainment Software Rating Board Content Descriptors Assigned to Game Titles

In Table 1, 94% of game titles that were rated T received content descriptors for violence (ie, descriptors under that heading), 26% for blood, 15% for sexual themes, 14% for profanity, 7% for comic mischief, and 2% for substances. None received content descriptors for gambling. Table 2, Table 3, Table 4, and Table 5 group game titles in the random sample by genre and compare the content we observed with the content descriptors assigned by the ESRB. The tables also show the console and release year.

Table Graphic Jump LocationTable 2. ESRB Content Descriptors Assigned to Action Games in Sample Compared With Observed Content
Table Graphic Jump LocationTable 3. ESRB Content Descriptors Assigned to Fighting Games Compared With Observed Content
Table Graphic Jump LocationTable 4. ESRB Content Descriptors Assigned to Shooting and Role-Playing Games Compared With Observed Content
Table Graphic Jump LocationTable 5. ESRB Content Descriptors Assigned to Adventure, Strategy, Racing, Sports, Simulation, and Trivia Games Compared With Observed Content

We found 79 games (98%) that involved intentional violence for an average of 36% of game play (range, 0.1%-87%), with 77 games (95%) receiving content descriptors for violence. This included 3 games that did not receive content descriptors for violence when we observed violence and 1 game that received a content descriptor for violence when we did not observe violence within 1 hour of game play. These results indicate that an ESRB content descriptor for violence provides a good indication that the game contains violence (using our definition). Overall, we found 73 games (90%) that rewarded or required the player to injure characters and 56 games (69%) that rewarded or required the player to kill.

We observed blood in 34 (42%) of 81 games, with 22 games (27%) receiving content descriptors for blood. The sample included 10 games that did not receive content descriptors for blood when we observed red blood and 2 games that did not receive content descriptors for blood when we observed green blood.

We observed sexual themes in 22 (27%) of 81 games, with 16 games (20%) receiving content descriptors for sexual themes. The sample included 9 games that did not receive content descriptors for sexual themes when we observed such content and 3 games that received content descriptors for sexual themes when we did not observe such content. Seventy-two (89%) of 81 games contained playable male characters, 42 games (52%) contained playable female characters, and 45 games (56%) allowed the player to select among a list of characters or modify characters. Table 6 shows the sex of characters who engaged in dialogue or behaviors related to sex or who had exposed breasts, buttocks, or genitals in the games we played. Games were significantly more likely to depict females partially nude (P<.001) or engaged in sexual behaviors (P<.001) than males (based on a 2-sided binomial test). Expanding our definition of sexual themes to include pronounced cleavage, large breasts, or provocative clothing would imply sexual themes in 37 games (46%).

Table Graphic Jump LocationTable 6. Sex-Related ESRB Content Descriptors Compared With Observed Sexual Themes

Table 7 shows the observed uses of profanity per hour in dialogue, on-screen writing, lyrics, or gestures. We observed the use of profanity in 22 (27%) of 81 games. Fourteen games (17%) received content descriptors for profanity. The sample included 11 games that did not receive content descriptors for profanity when we observed such content and 3 games that received content descriptors for mild language when we did not observe profanity within 1 hour of game play.

Table Graphic Jump LocationTable 7. Profanity-Related ESRB Content Descriptors Compared With Observed Profanity

Table 8 shows the percentage of game play depicting substances in our sample. We observed the depiction or use of substances in 12 (15%) of 81 games, with only 1 game (1%) receiving a content descriptor for substances. Of these 12 games, 9 (75%) depicted characters using substances. The highest percentage of depictions observed was 15% for The Simpsons Wrestling, which contains a playable character named Barney who swings a full mug of beer mug and shouts "I'll kill you for a beer!" at his opponent. We identified illicit drug use in X-Files: The Game, which depicted film clips of stolen painkillers used by a character.

Table Graphic Jump LocationTable 8. Observed Occurrences of Substance Use

We observed a player-character gambling for money in 1 game (1%) representing 1% of game play, with no games receiving a content descriptor for gambling.

Overall, we identified 51 observations of content that could warrant a content descriptor in 39 games (48%) that did not receive these content descriptors from the ESRB. We did not observe content indicated by ESRB-assigned content descriptors in 7 games (9%) within 1 hour of game play. We found excellent agreement between the author who coded all of the games and the independent coder who assessed the content in 10 games (κ = .93).

The choice of how long to play the game affects the amount of content observed, and we modeled this relationship (data available from authors). The model suggests that by playing the games for approximately 1 hour we probably observed approximately 90% of the content indicated by the ESRB content descriptors. It also suggests that playing the games for only 10 minutes would lead to missing 1 or more types of game content more than 40% of the time.

Our analyses demonstrate significant differences between the types and degrees of content found in T-rated video games compared with E-rated video games.2 T-rated video games generally contained much more content that warrants an ESRB content descriptor. The ESRB age-based rating symbols and content descriptors provide important information about game content. We emphasize that any content analyses or studies that select a mixture of games of different ratings will generate results biased by the most extreme games.

We believe that information about the game genre also provides useful information about the content in the game. More than 95% of action, adventure, fighting, and shooting games in our sample received content descriptors for violence, so parents may reasonably assume that T-rated video games of these genres will contain violence. However, the T-rating reflects a range of different types of content, not just violence.

Overall, the ESRB content descriptors provide a good indication of content in the game, but the absence of a descriptor does not mean the absence of content. The current content descriptors fail to capture positive messages (eg, the player-character in Shadow of Destiny decides to quit smoking cigarettes exclaiming, "I don't want to die!"). This means game manufacturers may lack good incentives to include positive messages and parents lack the means to find games that do include positive messages. The ESRB's current use of separate content descriptors for use of alcohol, use of tobacco, and use of drugs, and new content descriptors for alcohol reference, tobacco reference, and drug reference will help distinguish between the use and depiction of different types of substances. Our results suggest the need for greater attention to the depiction and use of substances in T-rated video games.

Our identification of content in 48% of the 81 games in our random sample that did not receive ESRB content descriptors raises questions about what the content descriptors specifically represent. We assumed that content descriptors indicate whether the game contains any content of that type, but they could indicate the presence of content above a threshold either in type or amount. While our definitions reflect our subjective judgment and alternative definitions are possible, we were unable to find specific criteria for why the ESRB assigns a given content descriptor. This suggests the need for much greater transparency in the ESRB rating system. Our results also suggest that the ESRB should play the video games as part of its rating process to provide a means to ensure the absence of content other than that indicated in the materials submitted to the ESRB by the game manufacturers. However, we emphasize that game manufacturers should continue to provide all of the information that they currently provide to the ESRB because the raters should not have to play the entire game prior to assigning a rating; anyone playing the games could miss specific content. Because video games represent an interactive medium, we suggest that the game raters should experience parts of the game containing content that could warrant a content descriptor.

We also believe that parents should know that game players gain access to additional material in video games by entering codes readily available from video game Web sites.1113 Our observed game play did not include the use of codes, which means that we missed any important content associated with such codes.

Some important limitations exist in this study. Our method does not benefit from the same information supplied by game manufacturers to the ESRB, as suggested by the fact that we did not observe all of the content that received descriptors. Further, the random sample of games that we played represented only 20% of the T-rated video games available by April 1, 2001, and best reflects the games and the ESRB rating process in place prior to that date. Video games continue to evolve with increasing technological sophistication and with the use of film clips that influence the realism of games. While our use of a random sample provides the best strategy for generalizing the findings to the full population of games, it gives a snapshot at a fixed point in time from an otherwise growing population. We emphasize, however, that neither the game's content nor the ESRB rating information printed on the game box changes after a game's release, and that all of the games we played remain available for sale or rental. Our results also depend on the actual game play that we recorded and the methods we used for coding information, which introduce limitations associated with some subjective judgment in the definitions and in implementation. Our approach of using a single player and a separate coder for all of the games reduces variability and eliminates the need for comparing the reliability and consistency of multiple players or coders that do not review the same material. However, it limits the representativeness of the game play for players of different skill and does not characterize differences in perception that could arise with more coders. Still, our method of recording the game play on a videocassette and coding screen times for incidents provides an opportunity for reproducing our database and results.

Despite these limitations, we believe that as the only rigorous, independent, and quantitative review of the ESRB rating information for T-rated video games, this study provides important and useful information to parents and physicians about the content and ratings of these games. The ESRB rating system remains the only one that uses both age-based rating symbols and content descriptors, and we believe that the content information remains valuable to parents.14

This independent research, however, provides an important check on the industry's voluntary rating system and offers insights regarding opportunities for improvement. Given our experience with E-rated, T-rated, and M-rated (for "Mature") games, we believe that the ESRB should consider adding age-based rating symbols between E and T (eg, a youth symbol for ages ≥10 years) and between T and M (eg, a T-15 symbol for ages ≥15 years). We also believe that the use of a content descriptor for mature sexual themes on T-rated video games seems inconsistent because parents might logically expect this content descriptor to appear only on M-rated video games. We further emphasize the need for greater clarity and transparency in the ESRB definitions for content descriptors and rating process.

This study cannot substitute for parental engagement with children and adolescents in their experiences playing video games or for active awareness and use of information about game ratings, content descriptors, and genre in the process of selecting video games. We emphasize that video games, like other media, provide an opportunity for parents to engage children and adolescents in discussions of game content. Parents need not necessarily play the games; they can easily observe and be part of their child's experience.

We suspect that the biggest challenges with respect to children's exposure to popular media lie ahead given the technological changes that continue to make computer and video games more interactive and realistic. The popularity of Internet gaming combined with the growing realism of games suggests the need for parents to take advantage of opportunities to talk with children and adolescents about video game content.

T-rated video games contain a wide range of content and physicians and parents should be aware that these games may be a source of exposure to messages that do not promote health. We believe that physicians, particularly pediatricians and specialists in adolescent medicine, should ask patients and their parents about their experience with video games, and that the medical and public health communities should continue to have an active role in educating parents about video game content.

 Entertainment Software Rating Board. Available at: http://www.esrb.org. Accessed April 1, 2001.
Thompson KM, Haninger K. Violence in E-rated video games.  JAMA.2001;286:591-598.
PubMed
Roberts DF, Foehr UG, Rideout VJ, Brodie M. Kids & Media @ the New Millennium: A Comprehensive Analysis of Children's Media Use. Menlo Park, Calif: Kaiser Family Foundation; 1999.
Woodard EH, Gridina N. Media in the Home: The Fifth Annual Survey of Parents and Children. Philadelphia, Pa: Annenberg Public Policy Center; 2000.
Interactive Digital Software Association.  Essential Facts About the Computer and Video Game Industry: 2003 Sales, Demographics, and Usage Data. Washington, DC: Interactive Digital Software Association; 2003.
American Academy of Pediatrics, American Medical Association, American Academy of Child & Adolescent Psychiatry, American Psychological Association, American Academy of Family Physicians, and the American Psychiatric Association.  Joint Statement on the Impact of Entertainment Violence on Children, Congressional Public Health Summit, July 26, 2000. Available at: http://www.aap.org/advocacy/releases/jstmtevc.htm. Accessed August 1, 2003.
American Academy of Pediatrics, Committee on Communications.  Media violence.  Pediatrics.1995;95:949-951.
PubMed
Anderson CA, Bushman BJ. Effects of violent video games on aggressive behavior, aggressive cognition, aggressive affect, physiological arousal, and prosocial behavior: a meta-analytic review of the scientific literature.  Psychol Sci.2001;12:353-359.
PubMed
Johnson JG, Cohen P, Smailes EM, Kasen S, Brook JS. Television viewing and aggressive behavior during adolescence and adulthood.  Science.2002;295:2468-2471.
PubMed
Green CS, Bavelier D. Action video game modifies visual selective attention.  Nature.2003;423:534-537.
PubMed
 IGN Games. Available at: http://games.ign.com. Accessed April 1, 2001.
 CNET Networks GameSpot .Available at: http://www.gamespot.com. Accessed April 1, 2001.
 GameFAQs. Available at: http://www.gamefags.com. Accessed April 1, 2001.
Cantor J. Ratings for program content: the role of research findings.  Ann Am Acad Polit Soc Sci.1998;557:54-69.

Figures

Tables

Table Graphic Jump LocationTable 1. Entertainment Software Rating Board Content Descriptors Assigned to Game Titles
Table Graphic Jump LocationTable 2. ESRB Content Descriptors Assigned to Action Games in Sample Compared With Observed Content
Table Graphic Jump LocationTable 3. ESRB Content Descriptors Assigned to Fighting Games Compared With Observed Content
Table Graphic Jump LocationTable 4. ESRB Content Descriptors Assigned to Shooting and Role-Playing Games Compared With Observed Content
Table Graphic Jump LocationTable 5. ESRB Content Descriptors Assigned to Adventure, Strategy, Racing, Sports, Simulation, and Trivia Games Compared With Observed Content
Table Graphic Jump LocationTable 6. Sex-Related ESRB Content Descriptors Compared With Observed Sexual Themes
Table Graphic Jump LocationTable 7. Profanity-Related ESRB Content Descriptors Compared With Observed Profanity
Table Graphic Jump LocationTable 8. Observed Occurrences of Substance Use

References

 Entertainment Software Rating Board. Available at: http://www.esrb.org. Accessed April 1, 2001.
Thompson KM, Haninger K. Violence in E-rated video games.  JAMA.2001;286:591-598.
PubMed
Roberts DF, Foehr UG, Rideout VJ, Brodie M. Kids & Media @ the New Millennium: A Comprehensive Analysis of Children's Media Use. Menlo Park, Calif: Kaiser Family Foundation; 1999.
Woodard EH, Gridina N. Media in the Home: The Fifth Annual Survey of Parents and Children. Philadelphia, Pa: Annenberg Public Policy Center; 2000.
Interactive Digital Software Association.  Essential Facts About the Computer and Video Game Industry: 2003 Sales, Demographics, and Usage Data. Washington, DC: Interactive Digital Software Association; 2003.
American Academy of Pediatrics, American Medical Association, American Academy of Child & Adolescent Psychiatry, American Psychological Association, American Academy of Family Physicians, and the American Psychiatric Association.  Joint Statement on the Impact of Entertainment Violence on Children, Congressional Public Health Summit, July 26, 2000. Available at: http://www.aap.org/advocacy/releases/jstmtevc.htm. Accessed August 1, 2003.
American Academy of Pediatrics, Committee on Communications.  Media violence.  Pediatrics.1995;95:949-951.
PubMed
Anderson CA, Bushman BJ. Effects of violent video games on aggressive behavior, aggressive cognition, aggressive affect, physiological arousal, and prosocial behavior: a meta-analytic review of the scientific literature.  Psychol Sci.2001;12:353-359.
PubMed
Johnson JG, Cohen P, Smailes EM, Kasen S, Brook JS. Television viewing and aggressive behavior during adolescence and adulthood.  Science.2002;295:2468-2471.
PubMed
Green CS, Bavelier D. Action video game modifies visual selective attention.  Nature.2003;423:534-537.
PubMed
 IGN Games. Available at: http://games.ign.com. Accessed April 1, 2001.
 CNET Networks GameSpot .Available at: http://www.gamespot.com. Accessed April 1, 2001.
 GameFAQs. Available at: http://www.gamefags.com. Accessed April 1, 2001.
Cantor J. Ratings for program content: the role of research findings.  Ann Am Acad Polit Soc Sci.1998;557:54-69.

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