Press coverage - This study received national and international attention from the mass media, including coverage on the TODAY Show, CBS Early Show, CNNfN The Biz, CBS News, and hundreds of local television stations that aired the JAMA video news release for this study. A short HSPH Now article described the flurry of press activity. Thompson and Haninger worked with ESPN for a special series on video games for Outside the Lines. Coverage also included numerous web sites and an article in U.S. News & World Report and mention in The New York Times (Science Times section) and Chicago Sun-Times.

Press Release - August 1, 2001
Abstract
Full text
Related letter
Minor corrections to printed article: On page 594, Table 2 should list “Genres” as the column heading instead of “Content Descriptors,” and on the bottom of page 596, left column, the phrase “curb your desire” from the Ridge Race V game should be “control your desire.”

Answers to frequently asked questions -

What are the study’s main findings?
What are the study’s main recommendations?
How did you select the video games? How many video games did you play and review?
How did you define violence?
How did you measure violence?
Which games contained the most violence as a percentage of game play time?
Which games contained the most deaths per minute of game play?
Are video games getting more violent?
Why should parents be concerned about violence in video games?
Is all violence and depiction of other noted content in these games bad?
Background on video game ratings

What are the study’s main findings?

• 35 of the 55 E-rated (for “Everyone”) video games (64%) reviewed contained at least one act of violence against another character.  There is great variation in the amount of violence in these video games, ranging from 1.5% to 91.2% of game play, with an average of 30.7% of game play devoted to violence against other characters.  No games provide messages about not using violence.

• Injuring characters was rewarded or required for advancement in 33 games (60%).  27 games (29%) depicted deaths from violence, with action, adventure, and shooting games leading to the highest numbers of deaths per minute.

• We noted significant differences in the amount of violence among video game genres.  All of the video games played in the action (n=22), adventure (n=3), fighting (n=2), shooting (n=1), strategy (n=1), and simulation (n=1) genres contained violence, while only 2 of 12 sports games (17%) included violence not associated with normal play in a sports game.

• Video games that received an Entertainment Software Rating Board (ESRB) content descriptor for violence contained significantly more violence than video games that did not receive a content descriptor for violence.  Remarkably, however, we found that 14 of the 32 games (44%) that did not receive violence-related content descriptors contained acts of violence, with an average of 37% of game play devoted to violence against other characters.

• Characters used a wide range of weapons in their violent acts.  A total of 30 of 55 games (55%) used the body as a weapon, 27 games (49%) used projectiles, 17 games (31%) used explosives, 16 games (29%) used magic, 13 games (24%) used guns, 6 games (11%) used a knife or sword, 2 games (4%) used toxic substances, and 26 games (47%) used other weapons like fire, hammers, or other household items.

• An E-rating does not automatically signify a level of violence acceptable for all children. The current rating system, which states that E-rated video games “may contain minimal violence,” may suggest less violence exists than found in the context of game play.  Parents need to be aware that violence is common in E-rated video games, and should consider playing these games with their children and taking advantage of opportunities to talk to their kids about violence.

• The study does not suggest that children should be prohibited from playing these video games.  The study concludes that E-rated video games contain material that may be disturbing to young viewers or could be dangerous if imitated.  Parents need to judge for themselves the appropriateness of the material, using information available from the current rating system, information about the game genre, and first-hand experience with their child playing the game.
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• Our experience playing the video games revealed many insights. We believe that the ESRB should play the video games prior to assigning the rating and content descriptors. We recommend that the ESRB not assign different ratings to video games available for play on different consoles when these games have essentially the name and content (see example of the Nuclear Strike games for Nintendo 64 and Sony PlayStation), since this may make game selection confusing.

• We encourage physicians, particularly pediatricians and specialists in adolescent medicine, to ask patients and their parents about their experiences with video games. The medical and public health communities should play an active role in informing parents about the content of video games.
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How did you select the video games? How many video games did you play and review?

We developed a database of all 672 E-rated video game titles released on the major video game consoles in the United States by April 1, 2001. The database contained each game title's genre, console, release year, and ESRB-assigned content descriptors. The game titles can be viewed alphabetically or by genre. To quantitatively assess the content of E-rated video games, we selected 55 games that were released in the United States between 1985 and 2000. To explore the possibility of trends in two popular video game series, we played two additional games that were released prior to the creation of the Entertainment Software Rating Board (ESRB). Finally, for historical comparison, we played eight classic arcade games that were re-released as an E-rated anthology. Overall, we played a total of 65 video games. For consistency, an undergraduate student (Seamus Ryan) with considerable video gaming experience played all of the video games. The player first familiarized himself with each video game, then restarted the video game and recorded at least 90 minutes of game play or until the game's conclusion, whichever occurred first.
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How did you define violence?

We defined violence as acts in which the aggressor causes or attempts to cause physical injury or death to another character.  We did not include damage to objects, accidental actions that unintentionally harmed another character, the effects of natural disasters, or the presence of dangerous obstacles that could not be attributed to the actions of a particular character.  We also did not count as violence any intentional acts of physical force that represented normal play in a sports game (e.g., tacking in football or checking in hockey), because the intention of the player is technically to stop the other player without causing injury.  We did count excessive physical contact in sports games, such as punching or otherwise attacking another player (e.g., after the football play was over).
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How did you measure violence?

One author (Kevin Haninger) reviewed and coded all of the recorded game play, noting the starting and ending times of each incident of violence toward other characters, the type of weapons used for violence, whether the violent incident resulted in injury or death, and the number of character deaths attributable to the violent incident. The JAMA article contains a table that lists each video game we played, as well as the genre, console, release year, ESRB-assigned content descriptors, and our measures of violence.
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Which games contained the most violence as a percentage of game play time?

Game Title	Genre	Console	Percentage
Nuclear Strike 64	Action	Nintendo 64	91.2
Centipede	Shooting	Sega Dreamcast	85.0
Worms Armageddon	Strategy	Nintendo 64	76.8
Pokemon Stadium	Fighting	Nintendo 64	73.9
Kirby 64: The Crystal Shards	Action	Nintendo 64	71.7

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Which games contained the most deaths per minute of game play?

Are video games getting more violent?

While our study focused on currently available E-rated video games, we did explore trends in two of the most popular video game series ever released: The Legend of Zelda series in the adventure genre and the Super Mario Bros. series in the action genre.  We played all of the games in these series, including older games for Nintendo Entertainment System and Super Nintendo Entertainment System.  We observed that each successive game in The Legend of Zelda series had progressively less violence and fewer deaths per minute; a less clear trend was demonstrated for the Super Mario Bros. series.  One explanation that is consistent with our experience is that successive games in series may tend to involve more complexity in character development and engage the player in more exploration and discovery activities that will help him or her achieve a goal.  However, as console technology advances, this trend of less violence may be offset by the tendency for successive games to portray violence more graphically and more realistically. The limited evidence of these two series should not be overgeneralized.
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Why should parents be concerned about violence in video games?

Parents should be concerned about violence in all contexts, not just in video games, but also in films, books, television, music, and the world around us. We are highlighting an important opportunity for parents to use video games to talk with their children about violence and other important content.
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That is a question for all of us.  Our study finds that many E-rated video games contain a significant amount of violence.  Once parents are aware of the violence, they can talk to their children about this question.
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The Entertainment Software Rating Board (ESRB) is a self-regulatory body created in 1994 by the computer and video game industry. The ESRB is responsible for applying and enforcing the rating and advertising standards adopted by the industry. The ESRB video game ratings include age-based rating symbols and content descriptors. Age-based rating symbols include EC (for "Early Childhood"), E (for "Everyone"), E10 (for "Everyone 10+"),T (for "Teen"), M (for "Mature 17+"), and AO (for "Adults Only 18+") that game manufacturers display on the front of the game box. Content descriptors are short phrases that indicate game content (e.g., "Violence" or "Mild Language") that game manufacturers display on the back of the game box. To receive a rating, game manufacturers provide the ESRB with videotaped game footage and other information about game content. Three trained ESRB raters independently review the materials submitted by manufacturers and assign the rating and content descriptors they believe are appropriate, but they do not play the final games that consumers ultimately purchase as part of the process of assigning the rating.
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http://www.kidsrisk.harvard.edu/faqs3.html