Copyright American Medical Association. The Entertainment Software Rating Board ESRB assigns age-based rating symbols and content descriptors that appear on video game boxes to inform consumers about game content.
San Andreas and Halo 2 as the best-selling video games of Legislative efforts to restrict the sale of violent video games to minors 13 and lawsuits covered in the popular media demonstrate the public concern about the potential health impacts of video games on children.
To our knowledge, this study provides the first set of quantitative data available to physicians and parents to help them better understand the content of M-rated video games and the accuracy of the rating information provided. Using data from the ESRB 1 and several video game Web sites, 16 - 18 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. However, given the postponed release of Painkiller untilwe played only 36 games.
All of the games played remain available for sale or rental. When possible, we purchased or rented the games with their original game manuals intact. For consistency, a research assistant with considerable video-gaming experience played the entire random sample of video games and recorded all game play on DVD for later coding. The player first read the manual and played the game to become familiar with the game features, then restarted the video game from the beginning and recorded at least 1 hour of game play, including any required game introductions and setup.
One of us with considerable video-gaming experience K. Figure 1 provides the definitions of content we used. To further characterize the overall portrayal of violence, we used the 3 categories defined in Figure 1 to separately code the highest and most severe portrayal of injuries depicted to human and nonhuman characters using a method previously shown to provide good agreement between independent coders.
To quantify the amount of blood, we noted whether each second of game play depicted blood and further identified whether each second depicted human or nonhuman blood. We did not code blood as a depiction of injury unless the blood came from a known act of violence. We also noted whether the game depicted the mutilation or severing of body parts.
We also noted the sex of the characters involved and whether the player could play each game as a male or female character. To quantify profanity, we counted each occurrence and noted the specific gesture or word s used.
We noted whether the profanity occurred M For Mature Games the game as dialogue, written text, or song lyrics. To quantify the amount of alcohol, tobacco, and drugs in the game, we noted whether each second of game play depicted any type of substance, and we separately noted whether each second involved substance use.
Finally, we counted the number of seconds of game play that depicted gambling. Definitions of content used in the study. We performed statistical tests using SAS statistical software Version 9. Table 1 lists ESRB content descriptors by type and compares the 89 content descriptors assigned to the 36 video game titles in the random sample with the content descriptors assigned to all M-rated video game titles.
No M For Mature Games significant difference exists between the 2 distributions of content descriptors. The range of content descriptors reflects continued changes to the ESRB rating system.
For example, inthe ESRB added new content descriptors for violence intense violence, sexual violence, fantasy violence, and cartoon violence and for substances alcohol reference, tobacco reference, and drug reference. Table 2 lists game titles in the random sample by genre, along with their console and release year, and compares the content we observed with the ESRB-assigned content descriptors.
This statistic excludes images and dialogue related to alcohol, tobacco, and
M For Mature Games drugs in games released before when the ESRB assigned content descriptors for only the use of these substances.
We also know from extended play of some games that content for which the ESRB did not assign a content descriptor sometimes occurs after 1 hour of game play eg, a sexually provocative female character in Ninja Gaiden and tobacco use in Soldier of Fortune II: We found excellent agreement between the 2 of us K. Table 3 summarizes our observations of violence and blood.
These results indicate that ESRB content descriptors for violence and blood provide a good indication that an M-rated video game contains such content. We observed character deaths from violence in approximately 42 hours of game play, occurring at an average rate of character deaths per hour range, This included human deaths, occurring at an average rate of human deaths per hour range, These findings represent a subset given our limited game play time.
Table 4 lists game titles "M For Mature Games" ESRB content descriptor for sexual themes and shows our observations of characters engaging in dialogue or behaviors related to sex or showing exposed breasts, buttocks, or genitals.
On average, the 13 games in which we observed sexual themes sexual themes for 4. Table 5 lists game titles by ESRB content descriptor for profanity and presents the observed uses of profanity per hour in dialogue, writing, lyrics, or gestures.
On average, the 24 games in which we observed profanity contained 17 uses of profanity per hour range, 0. These observations include a game Twisted Metal: Table 6 lists game titles by ESRB content descriptor for substances and shows the percentage of game play depicting substances.
On average, the 21 games in which we observed substances depicted substances for M For Mature Games.
We did not observe gambling for money in any of the games, with no games receiving a content descriptor for gambling. Conditioning on the subset of M-rated and T-rated games that depict human deaths, we did not observe different rates.
Because most video games contain more than 1 hour of game play, we emphasize that our method means that we miss some content.
These findings are consistent with our prior sample of T-rated video games 2 as also shown. Cumulative percentage of video games with all content types observed by duration of game play. The results of our study suggest that parents and physicians should pay careful attention to the actual content of any M-rated video game that their children might play, particularly since the M-rating indicates that the intended audience is for ages 17 years and older.
Compared with our studies of T-rated video games, we found significantly more blood, severe injuries, and human deaths in M-rated games, although we also found a significantly smaller percentage of violent "M For Mature Games" play in M-rated video games.
We believe that current discussions about restricting children's access to violent games may miss the reality that both T-rated and M-rated games contain
M For Mature Games amounts of violence. These results confirm that the presence of an ESRB content descriptor means that game players likely will find the indicated content in the game but that parents should not interpret the absence of a content descriptor to mean the absence of content.
Parents should recognize that the content descriptors on M-rated video games usually do not provide information about all types of content in the game, notably the depiction
M For Mature Games substances. While some might argue about the need to provide content descriptors for M-rated video games given the intended audience of ages 17 years and older, we note that the ESRB does not provide specific criteria for assigning content descriptors.
Even within a rating category, the ESRB assigns content descriptors to some games but not others with the same content, which creates confusion for parents who seek accurate and consistent rating information. We emphasize that the ESRB should provide greater clarity about its content descriptors and rating standards.
In addition, since our studies consistently found content for which the ESRB did not assign content descriptors, we continue to believe that the ESRB should play the video games before assigning its ratings M For Mature Games provide assurance to parents and to the public about the quality of the rating information.
This study relies on the same methods and consequently implies the same methodological limitations as our other studies of video games. In the context of evolving games and ratings, this sample represents a cross-section of M-rated video games. We did not unlock additional material in games by entering codes eg, from Web sites 16 - 18but parents should know that codes can alter game play.
We emphasize that no study or rating system can replace parental engagement with children "M For Mature Games" adolescents experiencing video games and that more research is needed to understand the health impacts of video games on children and adolescents.
Parents and physicians should
M For Mature Games that popular M-rated video games contain a wide range of content and may expose children and adolescents to messages that may negatively influence their perceptions, attitudes, and behaviors.
Arch Pediatr Adolesc Med. Back to top Article Information. New York, NY Crown. Media in the Lives of Year-Olds. San Andreas revokes M mature rating July 20, Available at http: Sign in to access your subscriptions Sign in to your personal account. Create a free personal account to download free article PDFs, sign up for alerts, and more. Purchase access Subscribe to the journal. Create a free personal account to access your subscriptions, sign up for alerts, and more.
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List of every mature rated (M) game for the Nintendo Switch. This list includes every ESRB M-Rated Nintendo Switch games released in North. Items 1 - M For Mature Games of Titles rated M (Mature) have content that may be suitable for persons games for all platforms that are marked as ESRB Rating: Mature.
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