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Video Games Still Have a Big Smoking Problem: Here's Why

​​While the important issue of violence in video games is well-known, many may not realize how many of the story lines feature tobacco use.

Tobacco products are prevalent in video games, used by the "cool" characters to make them "tougher" or "grittier." In some cases, players can choose to make their characters' use tobacco, and in other cases, players have no choice about whether their characters' use tobacco. In addition, tobacco products are often not reflected in a game's rating.

While there is a lot still to be learned about smoking and video games, we know enough to have serious, well-based concerns.

Why Tobacco Use in Video Games is Likely to Promote Youth Smoking:

The U.S. Surgeon General concluded that exposure to tobacco use in films promotes youth smoking. Video games are likely to work in similar ways.

These narratives contribute to the perception that smoking is common, and research has found that youth who perceive smoking to be common in media are more likely to smoke. Advertising is also a key factor in youth tobacco use initiation. The depiction of tobacco use in games serves, in effect, as free advertising for tobacco companies. And, as a tobacco company report famously said in 1984, younger adults are the only source of replacement smokers.

Video Game Overload:

According to the 2015 Common Sense Census, American teens aged 13-18 are exposed to an average of nearly nine hours of entertainment media on any given day.

Playing video games ranks as the second favorite media activity for teens; 56% of teens play video, computer or mobile games on any given day. Those teens who play games average two hours and 25 minutes per day. See Figure A below.

Overall, teens spend more time per day on average playing video, computer or mobile games than using social media. See Constantly Connected: Adverse Effects of Media on Children & Teens for more information.

The Problem with Video Game & App Ratings:

Research shows that video game content descriptors often fail to mention tobacco use, making it difficult for parents to monitor games for tobacco imagery.

A 2012 study found a steady increase over the past decade in tobacco content in video games rated appropriate for kids as young as 10. For example, of all new games introduced in 2011 that were rated "Everyone 10+" (content generally suitable for ages ten and up), 12.6% featured tobacco. The same study found that between 1994 and 2011, 60 out of 78 large publishers included tobacco imagery in at least one, and often more, of their games rated appropriate for youth.

In a 2015 survey, researchers verified tobacco content in 42% of the video games that participants reported playing; however, only 8% of these games had received tobacco warnings from the Entertainment Software Rating Board (ESRB).

About ESRB Ratings:

Created by the Entertainment Software Association in 1994, the ESRB is the gaming industry's self-regulatory organization that rates video games and apps. The ESRB assigns ratings, such as Everyone, Teen and Mature, to video games. It also provides descriptions of the content that factored into each game's rating and interactive elements. The content descriptors are "not intended to be a complete listing of content."

The ESRB uses two different rating processes depending on the game's platform—meaning packaged/boxed games or digitally delivered games:

  1. For packaged or boxed video games, publishers provide information to the ESRB prior to a game's release regarding "pertinent content, which essentially translates to anything that may factor into the game's rating," including the "most extreme content in the game." Pertinent content also includes "other relevant factors such as context, reward systems and the degree of player control." In addition, publishers provide the ESRB with a DVD, including the pertinent content. A committee of at least three ESRB trained raters, individuals with no ties to the video game industry, reviews the submission and recommends a rating and content descriptors. The ESRB reviews the recommendation and finalizes the rating. After the game is released, ESRB staff "play-tests a variety of games" to verify that the content disclosure was accurate and complete.

  2. For digitally delivered games, publishers complete a questionnaire regarding content and interactive components. The rating is generated by an automated process based upon the responses to the questionnaire.

Click here for a full description of the ratings process.

What Parents Can Do:

The American Academy of Pediatrics (AAP) strongly encourages parents and other adults to take these tips into consideration when purchasing games for tweens and teens.

  • Monitor the content of games purchased for and used by youth. Share your family media rules with caregivers or grandparents—especially near gift-giving season—to help ensure rules are consistent.

  • Set limits for video game use; kids need and expect them. Know your children's friends, both online and off. Know what platforms, software, and apps your children are using, what sites they are visiting on the web, and what they are doing online.

  • Play a video game with your kids. It's a good way to demonstrate good sportsmanship and gaming etiquette. You will have the opportunity to introduce and share your own life experiences and perspectives—and talk to your kids about smoking—as you play the game.

  • Recognize that many video games contain tobacco use, and be aware that ESRB content descriptors may fail to mention tobacco content—even when it is present in a game.

  • Remember that your opinion counts—so make your voice heard. Urge the ESRB to rate games containing tobacco with a "Mature" rating and disclose tobacco use in all games where it occurs. Call on game developers and publishers to immediately stop including tobacco use and tobacco images in their games, particularly those marketed to or played by youth.

Additional Information & Resources:


Last Updated
Adapted from (Copyright © 2015)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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