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E-rated games contain significant amount of violence  Many video games with an “E” rating (for “Everyone”) contain a significant amount of violence and may reward players for violent actions and may not be suitable for very young players, according to an article in The Journal of the American Medical Association (JAMA), a theme issue on violence and human rights.    Kimberly M. Thompson, Sc.D., and Kevin Haninger, of the Harvard School of Public Health, Boston, quantified and characterized the depiction of violence, sex, alcohol, tobacco and other substances in video games rated “E” - analogous to the “G” rating of films, which suggests suitability for all audiences. The authors created a database of all existing E-rated video games available for rental or sale in the United States by April 1. They report 99 percent of these games were available for play on at least one of the major home consoles used in the study—Sega Dreamcast, Nintendo 64, Sony PlayStation, and PlayStation 2.   According to background information cited in the article, studies on children's use of various media document the popularity of video games as a major source of entertainment.  A recent study found 70 percent of children aged two to 18 live in homes that have at least one video game console, 33 percent of children have video game consoles in their bedrooms, and 30 percent of children in the study played video games the previous day. Although children’s exposure to violence, alcohol, tobacco and other substances, and sexual messages in the media are a source of public health concern, content in video games commonly played by children has not been quantified.   Among 672 E-rated video games included in the database created by the authors, 77 percent involved sports, racing, or action genres, and 57 percent were not assigned content descriptors. The authors played and assessed the content of a sample of 55 games that represented the distribution of content descriptors and genres. They focused on game genre, duration of violence, number of fatalities, types of weapons used, whether injuring characters or destroying objects is rewarded or is required to advance in the game.    “We found that 35 of the 55 games we played (64 percent) involved intentional violence for an average of 30.7 percent of game play, and we noted significant differences in the amount of violence among game genres,” the authors write. “Injuring characters was rewarded or required for advancement in 33 games (60 percent).”   The authors found that the genre of the game played a role in the amount of violent play it contained.  “Action and shooting games led to the largest numbers of deaths from violent acts, and we found a significant correlation between the proportion of violent game play and the number of deaths per minute of play,” they write.   “With all of the questions about the impact of violence in video games on children, this is the first study to our knowledge to quantify the amount of violence in E-rated video games and to show that many E-rated games do involve violence, killing, and the use of weapons in the course of normal play,” the authors write. “No games provide messages about not using violence, and some games reward or require violence and the destruction of objects.”   “Our content analysis suggests that many E-rated video games contain a significant amount of violence and that an ‘E’ rating does not automatically signify a level of violence acceptable for very young game players,” they continue.  “Physicians and parents should understand that popular E-rated video games may be a source of exposure to violence for children that rewards them for violent actions and that they may contain other content that is not expected given the E rating.”   “We believe that physicians, particularly pediatricians, should consider asking patients about their experience with video games and the medical and public health communities should play an active role in informing parents about the content in video games,” the authors conclude.