title: Smoking in Video Games: A Systematic Review.
abstract: Video games are played by a majority of adolescents, yet little is known about whether and how video games are associated with smoking behavior and attitudes. This systematic review examines research on the relationship between video games and smoking.
  
  
  
  We searched MEDLINE, psycINFO, and Web of Science through August 20, 2014. Twenty-four studies met inclusion criteria. Studies were synthesized qualitatively in four domains: the prevalence and incidence of smoking imagery in video games (n = 6), video game playing and smoking behavior (n = 11), video game addiction and tobacco addiction (n = 5) and genre-specific game playing and smoking behavior (n = 3).
  
  
  
  Tobacco content was present in a subset of video games. The literature is inconclusive as to whether exposure to video games as a single construct is associated with smoking behavior. Four of five studies found an association between video game addiction and smoking. For genre-specific game playing, studies suggest that the type of game played affected association with smoking behavior.
  
  
  
  Research on how playing video games influences adolescents' perceptions of smoking and smoking behaviors is still in its nascence. Further research is needed to understand how adolescents respond to viewing and manipulating tobacco imagery, and whether engaging in game smoking translates into changes in real-world attitudes or behavior. Smoking imagery in video games may contribute to normalizing adolescent smoking.
  
  
  
  A large body of research has shown that smoking imagery in a variety of media types contributes to adolescent smoking uptake and the normalization of smoking behavior, and almost 90% of adolescents play video games, yet there has never been a published systematic review of the literature on this important topic. This is the first systematic review to examine the research on tobacco and video games.We found that tobacco imagery is indeed present in video games, the relationship between video game playing and smoking remains unclear, there appears to be a correlation between problem gaming and smoking and the genre of games may play a role in adolescent smoking behavior.
authors.affiliation: Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, CA Susan.Forsyth@ucsf.edu.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Forsyth
authors.affiliation: Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, CA.
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Malone
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D016739:Behavior, Addictive; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D012907:Smoking; D018910:Video Games / Q000706:statistics & numerical data*; D055815:Young Adult