title: Violence in teen-rated video games.
abstract: BACKGROUND
  Children's exposure to violence in the media remains a source of public health concern; however, violence in video games rated T (for "Teen") by the Entertainment Software Rating Board (ESRB) has not been quantified.
  
  
  OBJECTIVE
  To quantify and characterize the depiction of violence and blood in T-rated video games. According to the ESRB, T-rated video games may be suitable for persons aged 13 years and older and may contain violence, mild or strong language, and/or suggestive themes.
  
  
  METHODS
  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 content descriptors for violence and blood assigned to these games. We randomly sampled 80 game titles (which included 81 games because 1 title included 2 separate games), played each game for at least 1 hour, and quantitatively assessed the content. Given the release of 2 new video game consoles, Microsoft Xbox and Nintendo GameCube, and a significant number of T-rated video games released after we drew our random sample, we played and assessed 9 additional games for these consoles. Finally, we assessed the content of 2 R-rated films, The Matrix and The Matrix: Reloaded, associated with the T-rated video game Enter the Matrix.
  
  
  METHODS
  Game genre; percentage of game play depicting violence; depiction of injury; depiction of blood; number of human and nonhuman fatalities; types of weapons used; whether injuring characters, killing characters, or destroying objects is rewarded or is required to advance in the game; and content that may raise concerns about marketing T-rated video games to children.
  
  
  RESULTS
  Based on analysis of the 396 T-rated video game titles, 93 game titles (23%) received content descriptors for both violence and blood, 280 game titles (71%) received only a content descriptor for violence, 9 game titles (2%) received only a content descriptor for blood, and 14 game titles (4%) received no content descriptors for violence or blood. In the random sample of 81 T-rated video games we played, 79 games (98%) involved intentional violence for an average of 36% of game play time, and 34 games (42%) contained blood. More than half of the games (51%) depicted 5 or more types of weapons, with players able to select weapons in 48 games (59%). We observed 37 games (46%) that rewarded or required the player to destroy objects, 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 a total of 11,499 character deaths in the 81 games, occurring at an average rate of 122 deaths per hour of game play (range 0 to 1310). This included 5689 human deaths, occurring at an average rate of 61 human deaths per hour of game play (range 0 to 1291). Overall, we identified 44 games (54%) that depicted deaths to nonhuman characters and 51 games (63%) that depicted deaths to human characters, including the player.
  
  
  CONCLUSIONS
  Content analysis suggests a significant amount of violence, injury, and death in T-rated video games. Given the large amount of violence involving guns and knives, the relative lack of blood suggests that many T-rated video games do not realistically portray the consequences of violence. Physicians and parents should appreciate that T-rated video games may be a source of exposure to violence and some unexpected content for children and adolescents, and that the majority of T-rated video games provide incentives to the players to commit simulated acts of violence.
authors.affiliation: Center on Media and Child Health, Children's Hospital Boston and Kids Risk Project, Harvard School of Public Health, Harvard University, Boston, Massachusetts, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Haninger
authors.forename: M Seamus
authors.initials: MS
authors.lastname: Ryan
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D000328:Adult; D006801:Humans; D018910:Video Games / Q000145:classification* / Q000706:statistics & numerical data*; D014754:Violence