Category Archives: Adolescence

Screenage rampage: What should parents know about videogame playing for children?

Last month, the World Health Organisation (WHO) announced that it was planning to include ‘Gaming Disorder’ (GD) in the latest edition of the International Classification of Diseases. This followed the American Psychiatric Association’s decision to include ‘Internet Gaming Disorder’ in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders in 2013. According to the WHO, an individual with GD is a person who lets playing video games “take precedence over other life interests and daily activities,” resulting in “negative consequences” such as “significant impairment in personal, family, social, educational, occupational or other important areas of functioning.”

I have been researching videogame addiction for nearly 30 years, and during that time I have received many letters, emails, and telephone calls from parents wanting advice concerning videogames. Typical examples include ‘Is my child playing too much?’, ‘Will playing videogames spoil my pupils’ education?’, ‘Are videogames bad for children’s health? and ‘How do I know if a child is spending too long playing videogames?’ To answer these and other questions in a simple and helpful way, I have written this article as a way of disseminating this information quickly and easily.

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To begin with parents should begin by finding out what videogames their children are actually playing! Parents might find that some of them contain material that they would prefer them not to be having exposure to. If they have objections to the content of the games they should facilitate discussion with children about this, and if appropriate, have a few rules. A few aims with children should be:

  • To help them choose suitable games which are still fun
  • To talk with them about the content of the games so that they understand the difference between make-believe and reality
  • To discourage solitary game playing
  • To guard against obsessive playing
  • To follow recommendations on the possible risks outlined by videogame manufacturers
  • To ensure that they have plenty of other activities to pursue in their free time besides the playing of videogames

Parents need to remember that in the right context videogames can be educational (helping children to think and learn more quickly), can help raise a child’s self-esteem, and can increase the speed of their reaction times. Parents can also use videogames as a starting point for other activities like painting, drawing, acting or storytelling. All of these things will help a child at school. It needs to be remembered that videogame playing is just one of many activities that a child can do alongside sporting activities, school clubs, reading and watching the television. These can all contribute to a balanced recreational diet.

The most asked question a parent wants answering is ‘How much videogame playing is too much? To help answer this question I devised the following checklist. It is designed to check if a child’s videogame playing is getting out of hand. Ask these simple questions. Does your child:

  • Play videogames every day?
  • Often play videogames for long periods (e.g., 3 to 6 hours at a time)?
  • Play videogames for excitement or ‘buzz’ or as a way of forgetting about other things in their life?
  • Get restless, irritable, and moody if they can’t play videogames?
  • Sacrifice social and sporting activities to play videogames?
  • Play videogames instead of doing their homework?
  • Try to cut down the amount of videogame playing but can’t?

If the answer is ‘yes’ to more than four of these questions, then your child may be playing too much. But what can you do if your child is playing videogames too much?

  • First of all, check the content of the games. Try and give children games that are educational rather than the violent ones. Parents usually have control over what their child watches on television – videogames should not be any different.
  • Secondly, try to encourage video game playing in groups rather than as a solitary activity. This will lead to children talking and working together.
  • Thirdly, set time limits on children’s playing time. Tell them that they can play for a couple of hours after they have done their homework or their chores – not before.
  • Fourthly, parents should always get their children to follow the recommendations by the videogame manufacturers (e.g., sit at least two feet from the screen, play in a well-lit room, never have the screen at maximum brightness, and never play videogames when feeling tired).

I have spent many years examining both the possible dangers and the potential benefits of videogame playing. Evidence suggests that in the right context videogames can have positive health and educational benefits to a large range of different sub-groups. What is also clear from the case studies displaying the more negative consequences of playing is that they all involved children who were excessive users of videogames. From prevalence studies in this area, there is little evidence of serious acute adverse effects on health from moderate play. In fact, in some of my studies, I found that moderate videogame players were more likely to have friends, do homework, and engage in sporting activities, than those who played no videogames at all.

For excessive videogame players, adverse effects are likely to be relatively minor, and temporary, resolving spontaneously with decreased frequency of play, or to affect only a small subgroup of players. Excessive players are the most at-risk from developing health problems although more research is needed. If care is taken in the design, and if they are put into the right context, videogames have the potential to be used as training aids in classrooms and therapeutic settings, and to provide skills in psychomotor coordination, and in simulations of real life events (e.g., training recruits for the armed forces).

Every week I receive emails from parents claiming that their sons are addicted to playing online games or that their daughters are addicted to social media. When I ask them why they think this is the case, they almost all reply “because they spend most of their leisure time in front of a screen.” This is simply a case of parents pathologising their children’s behaviour because they think what they are doing is “a waste of time.” I always ask parents the same three things in relation to their child’s screen use. Does it affect their schoolwork? Does it affect their physical education? Does it affect their peer development and interaction? Usually parents say that none of these things are affected so if that is the case, there is little to worry about when it comes to screen time. Parents also have to bear in mind that this is how today’s children live their lives. Parents need to realise that excessive screen time doesn’t always have negative consequences and that the content and context of their child’s screen use is more important than the amount of screen time.

(N.B. This article is an extended version of an article that was originally published by Parent Zone)

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Griffiths, M.D. (2003).  Videogames: Advice for teachers and parents. Education and Health, 21, 48-49.

Griffiths, M.D. (2009). Online computer gaming: Advice for parents and teachers. Education and Health, 27, 3-6.

Griffiths, M.D., Kuss, D.J. & King, D.L. (2012). Video game addiction: Past, present and future. Current Psychiatry Reviews, 8, 308-318.

Griffiths, M.D., Kuss, D.J. & Pontes, H. (2016). A brief overview of Internet Gaming Disorder and its treatment. Australian Clinical Psychologist, 2(1), 20108.

Griffiths, M.D. & Meredith, A. (2009). Videogame addiction and treatment. Journal of Contemporary Psychotherapy, 39(4), 47-53.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2012). Clinical interventions for technology-based problems: Excessive Internet and video game use. Journal of Cognitive Psychotherapy: An International Quarterly, 26, 43-56.

King, D.L., Delfabbro, P.H., Griffiths, M.D. & Gradisar, M. (2012). Cognitive-behavioural approaches to outpatient treatment of Internet addiction in children and adolescents. Journal of Clinical Psychology, 68, 1185-1195.

Király, O., Nagygyörgy, K., Griffiths, M.D. & Demetrovics, Z. (2014). Problematic online gaming. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.61-95). New York: Elsevier.

Kuss, D.J. & Griffiths, M.D. (2012). Online gaming addiction in adolescence: A literature review of empirical research. Journal of Behavioral Addictions, 1, 3-22.

Kuss, D.J. & Griffiths, M.D. (2012). Internet gaming addiction: A systematic review. International Journal of Mental Health and Addiction, 10, 278-296.

Learning, yearning, but not earning: A brief look at student gambling

Last week, the UK Gambling Commission put out a press release relating to student gambling. Having been in the university sector for as long as I have been researching gambling (i.e., 30 years), student gambling is an area that has always been close to my professional heart. I have published dozens of papers on youth gambling and student gambling over the last three decades (see ‘Further reading’ below for a few examples).

With my daughter leaving home to go to university this week there are lots I could potentially worry about and gambling isn’t necessarily my main concern where my daughter is concerned, but gambling is still of concern to me especially because a study I published back in 2012 with Luke Benson and Dr. Christine Norman (in the International Journal of Mental Health and Addiction) found that first year university students gambled more than final year students and were more susceptible to problem gambling compared to final year students.

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The Gambling Commission have just published their own research into the topic. They hired Youth Sight who conducted 1,000 online interviews with undergraduate students in August 2017 (the students were part of an online panel recruited from applicants through Universities and Colleges Admission Service). The quotas chosen reflected the UK student population in terms of gender, course year and university group. Here are some of their key findings:

  • Two-thirds of students had gambled in the previous month
  • Over half of student gamblers (54%) engaged in gambling to make money
  • Two-fifths of students said they felt guilty after they had gambled
  • One in eight student gamblers had missed lectures due to gambling
  • One in four student gamblers (25%) had spent more money gambling than they could afford
  • One in 25 student gamblers (4%) were in debt because of their gambling
  • One in four students that had a gambling debt, had a debt of over £10,000

The Gambling Commission noted there were are number of limitations with the study. They specifically noted that gambling participation rates may have been higher than if the data had been collected using other methodologies (telephone, face-to-face interviews) due to the self-selecting nature of online surveys. However, online surveys were chosen due to students’ access to technology and the availability of a representative panel via this method. 

On the back of their survey, the Gambling Commission also provided their top ten tips to help students avoid getting into trouble with gambling. I have reproduced them here verbatim.

  • Ask yourself why you are gambling: Are you gambling to escape debt or as a way to make quick money? Think carefully about your motivations to gamble. Gambling shouldn’t be seen as the answer to improving your personal finances. If you have concerns about money, speak to a financial adviser or student support services.
  • Monitor how often you’re gambling online: Websites must give you access to historic account activity. This means you can see exactly when, how much and what you’ve been gambling on over time and make well-informed choices about what to do next.
  • Keep track of how much time you’ve spent gambling: With a reality check, you can set alerts to pop up on screen, which help you to monitor the time spent gambling either online or on gaming machines in a betting shop.
  • Limit how much you can spend: If you’re concerned about how much money you’re gambling, you can set a limit on how much you spend across individual gambling products online. You can also set a limit on how much you spend on gaming machines in a betting shop.
  • Give yourself a timeout: During a timeout, you can block yourself from gambling online for a set amount of time, of up to 6 weeks, and even bar yourself from gambling during a specific time of day.
  • Need a longer break? Self-exclude from gambling firms for a minimum of 6 months: If you think you are spending too much time or money gambling – whether online or in gambling premises – you can ask to be self-excluded. This is when you ask the company to stop you from gambling with them for a period of time. The exclusion will last for a minimum of least six months. Self-exclusion can be used if you think you have a problem with gambling and want help to stop. [The Gambling Commission] are also working with industry representatives to develop a national online self-exclusion scheme.
  • Read the terms and conditions: Did you know almost 80% of gamblers haven’t read the terms and conditions on the websites they are gambling on? By taking the time to read the T&Cs, you can ensure you understand exactly what you are gambling on, and what restrictions are attached to promotions and bonus offers (such as a minimum spend level before the bonus is paid) – this will help you make an informed decision.
  • Make sure the website you’re gambling with is licensed: Make sure you’re gambling with a Gambling Commission licensed business. This means you’ll be protected by gambling and consumer protection rules in Great Britain. Licensed gambling businesses must display that they are licensed and provide a link to our licence register where you can see what type of activities they are allowed to offer and also if we have taken any regulatory action against them.
  • Check how your money is protected: Any gambling business that holds customer funds must explain in their T&Cs how customer funds are protected if the business goes bust – this should help you decide who you want to gamble with.
  • Feel it’s getting too much? Talk to someone: There are a number of gambling support groups available if you feel your gambling is getting out of control or too much. More information about the signs of problem gambling can be found on the Gambleaware and Gamcare websites [You can call the National Gambling Helpline on Freephone 0808 8020 133]. They also provide general information about gambling, including how to gamble safely and where to get help if you or someone you know has problems with their gambling.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Benson, L., Norman, C. & Griffiths, M.D. (2012). The role of impulsivity, sensation seeking, coping, and year of study in student gambling: A pilot study. International Journal of Mental Health and Addiction, 10, 461-473.

Canale, N., Griffiths, M.D., Vieno, A., Siciliano, V. & Molinaro, S. (2016). Impact of internet gambling on problem gambling among adolescents in Italy: Findings from a large-scale nationally representative survey. Computers in Human Behavior, 57, 99-106.

Canale, N., Vieno, A., Lenzi, M., Griffiths, M.D., Borraccino, A., Lazzeri, G., Lemma, P., Scacchi, L., Santinello, M. (2017). Income inequality and adolescent gambling severity: Findings from a large-scale Italian representative survey. Frontiers in Psychology, 8, 1318. doi: 10.3389/fpsyg.2017.01318

Gambling Commision (2017). Commission raises awareness of potential risks for students who gamble. September 12. Located at: http://www.gamblingcommission.gov.uk/news-action-and-statistics/news/2017/Commission-raises-awareness-of-potential-risks-for-students-who-gamble.aspx

Griffiths, M.D. (1995). Adolescent Gambling. London: Routledge.

Griffiths, M.D. (2002). Adolescent gambling: What should teachers and parents know? Education and Health, 20, 31-35.

Griffiths, M.D. (2002). Gambling and Gaming Addictions in Adolescence. Leicester: British Psychological Society/Blackwells.

Griffiths, M.D. (2008). Adolescent gambling in Great Britain. Education Today: Quarterly Journal of the College of Teachers. 58(1), 7-11.

Griffiths, M.D. (2013). Adolescent gambling via social networking sites: A brief overview. Education and Health, 31, 84-87.

Griffiths, M.D. (2015). Adolescent gambling and gambling-type games on social networking sites: Issues, concerns, and recommendations. Aloma: Revista de Psicologia, Ciències de l’Educació i de l’Esport, 33(2), 31-37.

Griffiths, M.D. & Calado, F. (2017). Adolescent gambling. Reference Module in Neuroscience and Biobehavioral Psychology (pp. 1-12). Oxford: Elsevier.

Griffiths, M.D. & Linsey, A. (2006). Adolescent gambling: Still a cause for concern? Education and Health, 24, 9-11.

Griffiths, M.D. & Parke, J. (2010). Adolescent gambling on the Internet: A review. International Journal of Adolescent Medicine and Health, 22, 59-75.

Screenagers in love: Adolescent screen time, content, and context

In 1999, the American Academy of Pediatrics (AAP) advocated the ‘2×2’ screen time guidelines to parents that their children should be restricted to no more than 2 hours of screen time a day and that children under 2 years of age should not be exposed to any screen time at all. Not only is this unworkable in today’s multi-media world but the guidelines are not based on scientific evidence. Thankfully, the AAP have revised their guidelines in the light of how today’s children actually engage with screen-based interactive technologies. For me, the issue is not about the amount of screen time but is about the content and the context of screen use. I have three ‘screenagers’ (i.e., children often referred to as ‘digital natives’ who have never known a world without the internet, mobile phones and interactive television) who all – like me – spend a disproportionate amount of their everyday lives on front of a screen for both work/educational and leisure purposes. Engaging in a lot of screen-based activities is not inherently negative – it’s simply a case of doing things differently than we did 20 years ago.

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One online activity that has received a lot of criticism in the media is the playing of online videogames. However there is now a wealth of research which shows that video games can be put to educational and therapeutic uses, as well as many studies which reveal how playing video games can improve reaction times and hand-eye co-ordination. Their interactivity can stimulate learning, allowing individuals to experience novelty, curiosity and challenge that stimulates learning. Although I have published many studies concerning online gaming addiction, there is little empirical evidence that moderate gaming has any negative effects whatsoever. In fact, many excessive players experience detrimental effects.

Over the past 15 years I have spent time researching the excessive playing of online videogames like Everquest and World of Warcraft (WoW). Online gaming involves multiple reinforcements in that different features might be differently rewarding to different people. In video games more generally, the rewards might be intrinsic (e.g. improving your highest score, beating your friend’s high score, getting your name on the “hall of fame”, mastering the game) or extrinsic (e.g. peer admiration).

In online gaming, there is no end to the game and there is the potential for gamers to play endlessly. This can be immensely rewarding and psychologically engrossing. For a small minority of people, this may lead to addiction where online gaming compromises everything else in their lives. However, playing excessively doesn’t necessarily make someone an addict. A few years ago in the International Journal of Mental Health and Addiction, I published two case study accounts of two males who claimed that they were gaming for up to 80 hours a week. They were behaviourally identical in terms of their game playing, but very different in terms of their psychological motivation to play.

The first case was an unemployed single 21-year old male. His favourite online game was World of Warcraft and that since leaving university he had spent an average of 10 to 14 hours a day playing WoW. He claimed that WoW had a positive influence in his life and that most of his social life was online and that it increased his self-esteem. He also argued that he had no other commitments and that he had the time and the flexibility to play WoW for long stretches. Gaming provided a daily routine when there was little else going on. There were no negative detrimental effects in his life. When he got a job and a girlfriend, his playing all but stopped.

The second case was 38-year old male, a financial accountant, married and had two children. He told me that over the previous 18 months, his online playing of Everquest had gone from about 3-4 hours of playing every evening to playing up to 14 hours a day. He claimed that his relationship was breaking down, that he was spending little time with his children, and that he constantly rang in sick to work so that he could spend the day playing online games. He had tried to quit playing on a number of occasions but could not go more than a few days before he experienced “an irresistible urge” to play again – even when his wife threatened to leave him.

Giving up online gaming was worse than giving up smoking and that he was “extremely moody, anxious, depressed and irritable” if he was unable to play online. Things got even worse. He was fired from his job for being unreliable and unproductive (although his employers were totally unaware of his gaming behaviour). As a result of losing his job, his wife also left him. This led to him “playing all day, every day”. It was a vicious circle in that his excessive online gaming was causing all his problems yet the only way he felt he could alleviate his mood state and forget about all of life’s stresses was to play online games even more.

I argued that only the second man appeared to be genuinely addicted to online gaming but that the first man wasn’t. I based this on the context and consequences of his excessive play. Online gaming addiction should be characterized by the extent to which excessive gaming impacts negatively on other areas of the gamers’ lives rather than the amount of time spent playing. For me, an activity cannot be described as an addiction if there are few (or no) negative consequences in the player’s life even if the gamer is playing up to 14 hours a day. The difference between a healthy enthusiasm and an addiction is that healthy enthusiasms add to life, addictions take away from it.

Every week I receive emails from parents claiming that their sons are addicted to playing online games and that their daughters are addicted to social media. When I ask them why they think this is the case, they almost all reply “because they spend most of their leisure time in front of a screen”. This is simply a case of parents pathologising their children’s behaviour because they think what they are doing is “a waste of time”. I always ask parents the same three things in relation to their child’s screen use. Does it affect their schoolwork? Does it affect their physical education? Does it affect their peer development and interaction? Usually parents say that none of these things are affected so if that is the case, there is little to worry about when it comes to screen time. Parents also have to bear in mind that this is how today’s children live their lives. Parents need to realise that excessive screen time doesn’t always have negative consequences and that the content and context of their child’s screen use is more important than the amount of screen time.

(Please note: This article is an extended version of an article that was originally published by the London School of Economics’ Media Policy Project)

Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Griffiths, M.D. (2010). Online video gaming: What should educational psychologists know? Educational Psychology in Practice, 26(1), 35-40.

Griffiths, M.D. (2010). The role of context in online gaming excess and addiction: Some case study evidence. International Journal of Mental Health and Addiction, 8, 119-125.

Griffiths, M.D. (2013). Adolescent gambling via social networking sites: A brief overview. Education and Health, 31, 84-87.

Griffiths, M.D. (2013) Social networking addiction: Emerging themes and issues. Journal of Addiction Research and Therapy, 4: e118. doi: 10.4172/2155-6105.1000e118.

Griffiths, M.D. (2014). Child and adolescent social gaming: What are the issues of concern? Education and Health, 32, 9-12.

Griffiths, M.D. (2014). Gaming addiction in adolescence (revisited). Education and Health, 32, 125-129.

Griffiths, M.D., Kuss, D.J. & King, D.L. (2012). Video game addiction: Past, present and future. Current Psychiatry Reviews, 8, 308-318.

Griffiths, M.D., Kuss, D.J. & Demetrovics, Z. (2014). Social networking addiction: An overview of preliminary findings. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.119-141). New York: Elsevier.

Kuss, D.J. & Griffiths, M.D. (2011). Online social networking and addiction: A literature review of empirical research. International Journal of Environmental and Public Health, 8, 3528-3552.

Kuss, D.J. & Griffiths, M.D. (2012). Online gaming addiction in adolescence: A literature review of empirical research. Journal of Behavioral Addictions, 1, 3-22.

Kuss, D.J. & Griffiths, M.D. (2012). Internet gaming addiction: A systematic review. International Journal of Mental Health and Addiction, 10, 278-296.

Lopez-Fernandez, O., Honrubia-Serrano, M.L., Baguley, T. & Griffiths, M.D. (2014). Pathological video game playing in Spanish and British adolescents: Towards the Internet Gaming Disorder symptomatology. Computers in Human Behavior, 41, 304–312.

Pápay, O., Urbán, R., Griffiths, M.D., Nagygyörgy, K., Farkas, J. Kökönyei, G., Felvinczi, K., Oláh, A., Elekes, Z., Demetrovics, Z. (2013). Psychometric properties of the Problematic Online Gaming Questionnaire Short-Form (POGQ-SF) and prevalence of problematic online gaming in a national sample of adolescents. Cyberpsychology, Behavior, and Social Networking, 16, 340-348.

Tub zero: A brief look at bath-related illnesses and fatalities

Regular readers of my blog will know that I have an interest in all things bizarre and out of the ordinary. In previous blogs I have examined coital cephalagia (people that get headaches from having sex) and masturbatory cephalagia (people that get headaches from masturbation). It was while researching those articles that I came across a 2005 paper on ‘bath-related headaches’ (BRHs) by Dr. Mak and colleagues in the journal Cephalagia.

BRH is rare headache syndrome. They reported 13 case studies (six from their own case files collected over a seven-year period and seven from other reports in the medical literature). They reported that all the cases involved “Oriental women” aged 32 to 67 years (with an average age of 51 years). The cases were reported in females from Hong Kong (n=6), Taiwan (n=4) and Japan (n=3). All of the women reported severe headaches (lasting from 30 minutes to 30 hours) that were triggered by bathing or other activities involving contact with water. Typically, the onset of the headaches were “hyperacute” and were like ‘thunderclap’ headaches (a severe headache that takes seconds to minutes to reach maximum intensity). The paper reported that no underlying secondary causes were identified and that drug treatment was generally unsatisfactory (although use of the drug Nimodipine was reported to shorten the length of the headache in some cases). Unfortunately, the only way that such headaches could be prevented was to avoid bathing.

After reading this paper I looked for other papers relating to bath-related illnesses. A 2000 paper by Dr. S. Cerovac and Dr. A. Roberts reported on 57 cases of burns sustained by hot bath and shower water (in the journal Burns) over an eight-year period. None of the 57 cases died as a result of the burns. The authors worked at Stoke Mandeville Hospital (in the UK) and they divided the cases into child (below the age of 16 years) and adult groups. Most of the children (n=39) were under the age of three years (83%), with two-fifths having superficial burns (41%). Most of these cases occurred due to what the authors described as “inadequate supervision” by the child’s parents (85%). Among the adult group, 83% of the adults were over 60 years of age with around 65% of them having “some form of psycho-motor disorder that predisposed to an accident which should have been anticipated”. The adult group had more extensive burns which resulted in eight deaths (out of 18 cases; 44%). They reported that the number of cases had been declining over the eight-year period but the study highlighted that fatal incidents could be caused by something as simple as bathing.

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A 1995 study by Dr. J. Lavelle in the Annals of Emergency Medicine evaluated the risk factors associated with bathtub submersion injury and their relationship to child abuse and neglect over a 10-year period (1982-1992). They reported that there had been 21 patients treated for bathtub near-drownings (nine of which had subsequently died). Of these, two-thirds of the children (67%) had “historic and/or physical findings suspicious for abuse or neglect, including incompatible history for the injury, other physical injuries, previous child abuse reports, psychiatric history of the caretaker, and/or psychosocial concerns noted in the chart”. The mortality rate of 42% was significant. However, findings showed that no demographic characteristics identified at-risk children.

Perhaps the most common form of bathtub deaths are infant drownings. A paper by Dr. John Pearn and Dr. James Nixon examined the socio-demographic factors surrounding drowning accidents among children aged 0-15 years in a 1978 issue of Social Science & Medicine. Obviously this paper examined all drownings but did note that those that involved bathtub drownings occur “almost exclusively in lower social class homes” In a follow-up study specifically on bathtub drownings, Dr. Pearn and his colleagues reported the cases of seven bathtub drownings in the journal Pediatrics. All of the seven cases were infants in the US state of Hawaii. As with the previous paper, the authors reported that the families of the infant were typically of lower socioeconomic status but also added that the deaths had occurred when the father “had immediate care of the infant at the time of the accident”. In five of the cases, the drowned infant was being looked after by older sibling.

In 1985, Dr. Lawrence Budnick and Dr. D. Ross published a study on bathtub-related drownings in the USA in the American Journal of Public Health. They analysed information (1979-1981) on such deaths using data from the (i) National Center for Health Statistics and (ii) Consumer Product Safety Commission data. They reported 710 individuals had drowned in the bath during this period with an estimated mortality rate of 1.6 per million individuals per year. They reported an excess of deaths in the spring but this was not statistically significant. However, they did note that individuals “at the extremes of age were at greatest risk of death, with mortality rates of 5-6 per million per year”. Unsurprisingly, there was a frequent history of children below the age of five years being left unattended by parents. Amongst young to middle-aged adults, there was a frequent history of seizures or history of alcohol or drug use. Among more elderly individuals there was frequent evidence of having fallen in the bath.

Similarly, in 2006, Dr. G. Somers and colleagues carried out a 20-year review of bathtub drownings published in the American Journal of Forensic Medicine and Pathology. The authors retrospectively retrospective reviewed US autopsy records over a 20-year period (1984–2003). They identified 18 cases of bathtub drownings (8 boys and 10 girls) aged 6 months to 70 months (average of 17 months) almost three-quarters aged under one year (72%). The factors leading to the death were reported as inadequate adult supervision (89%), cobathing (39%), the use of infant bath seats (17%), and coexistent medical disorders predisposing the child to the drowning episode (17%).

A paper by Dr. R. Rauchschwalbe and colleagues in a 1997 issue of Pediatrics examined the role of bathtub seats and rings as a primary cause of death in US infant drowning deaths (1983-1995). The paper reported 32 deaths by drowning involving bath seats/rings with the victims’ ages at the time of the death ranging from 5 to 15 months (average 8 months old). Nine in ten deaths was due to a “reported lapse in adult supervision”. The authors concluded that infant drownings associated with bath seats/rings are increasing in the US and that very young children “should never be left in the bathtub unsupervised, even for brief moments”.

A more recent 2004 study by Dr. R. Byard and Dr. T. Donald in the Journal of Paediatrics and Child Health examined the possible role of infant bathtub seats in drowning and near-drowning (1998-2003). The authors used files from the Forensic Science Centre and Child Protection Unit, Women’s and Children’s Hospital in Adelaide (Australia). In the six-year period, there were six cases of drowning in children aged under two years. They noted:

“One of these cases, a 7-month-old boy, had been left unattended for some time in an adult bath in a bathtub seat. He was found drowned, having submerged after slipping down and becoming trapped in the seat. Three near-drowning episodes occurred in children under the age of 2 years, including two boys aged 7 and 8 months, both of whom had been left for some time in adult baths in bath seats. Both were successfully resuscitated and treated in hospital…These cases demonstrate the vulnerability of infants to immersion incidents when left unattended in bathtubs”.

In a 1984 paper in the Journal of the American Medical Association, Dr. Lawrence Budnick examined bathtub-related electrocutions in the USA (1979 to 1982). He reported that at least 95 Americans had been electrocuted in the bath and that the use of hair dryers in the bathroom had caused 60% of the deaths. It was also noted that two-thirds of the deaths had occurred during spring and winter, and that those under five years of age had the highest mortality rate.

A 2003 paper by Dr. N. Yoshioka and his colleagues in the journal Legal Medicine examined bathtub deaths in Japan. The authors claimed that approximately 100–120 cases of “sudden death in bathroom” are reported there every year and accounts for around “8–10% of the total number of what is considered unnatural deaths”. Most of the deaths occur in winter and 80% of cases involve the elderly and the authors described the deaths as “baffling” as the autopsies rarely locate the exact cause of death. By testing physiological changes 54 volunteers in both winter and summer, the authors reported that many heart conditions occurred during the winter months in their volunteers (e.g., cardiac arrhythmia including ventricular tachycardia, ventricular extrasystole, supraventricular extrasystole, and bradycardia) and that these conditions might lead to an increased risk for cardiac arrest while bathing.

Another possible reason for bathtub-related drownings is epileptic seizures while bathing. A paper by Dr. C. Ryan and Dr. G. examined drowning deaths among epileptics in a 1993 issue of the Canadian Medical Association Journal. The authors retrospectively reviewed deaths from drowning in Alberta (Canada) from 1981 to 1990. Of these drownings in Alberta (n=482), 5% (n=25) were directly related to epileptic seizures of which 60% (n=15) occurred while the individual was taking an unsupervised bath. The authors advised that all people with epilepsy should take showers (while sitting) instead of baths.

While most of these bath-related health issues and fatalities are rare, they do highlight the issue that accidents can happen anywhere and that in the bath can be a vulnerable location for infants left unattended or those with medical conditions that cause immobility.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Budnick, L.D. (1984). Bathtub-related electrocutions in the United States, 1979 to 1982. JAMA, 252(7), 918-920.

Budnick, L.D., & Ross, D.A. (1985). Bathtub-related drownings in the United States, 1979-81. American Journal of Public Health, 75(6), 630-633.

Byard, R. W., & Donald, T. (2004). Infant bath seats, drowning and near‐drowning. Journal of Paediatrics and Child Health, 40(5‐6), 305-307.

Cerovac, S., & Roberts, A.H. (2000). Burns sustained by hot bath and shower water. Burns, 26(3), 251-259.

Lavelle, J. M., Shaw, K. N., Seidl, T., & Ludwig, S. (1995). Ten-year review of pediatric bathtub near-drownings: evaluation for child abuse and neglect. Annals of Emergency Medicine, 25(3), 344-348.

Mak, W., Tsang, K.L., Tsoi, T.H., Au Yeung, K.M., Chan, K.H., Cheng, T. S., … & Ho, S.L. (2005). Bath‐related headache. Cephalalgia, 25(3), 191-198.

Pearn, J. H., Brown, J., Wong, R., & Bart, R. (1979). Bathtub drownings: Report of seven cases. Pediatrics, 64(1), 68-70.

Nixon, J., & Pearn, J. (1978). An investigation of socio-demographic factors surrounding childhood drowning accidents. Social Science & Medicine. Part A: Medical Psychology & Medical Sociology, 12, 387-390.

Rauchschwalbe, R., Brenner, R.A., & Smith, G.S. (1997). The role of bathtub seats and rings in infant drowning deaths. Pediatrics, 100(4), e1.

Ryan, C. A., & Dowling, G. (1993). Drowning deaths in people with epilepsy. CMAJ: Canadian Medical Association Journal, 148(5), 781-784.

Somers, G. R., Chiasson, D. A., & Smith, C. R. (2006). Pediatric drowning: A 20-year review of autopsied cases: III. Bathtub drownings. American Journal of Forensic Medicine and Pathology, 27(2), 113-116.

Yoshioka, N., Chiba, T., Yamauchi, M., Monma, T., & Yoshizaki, K. (2003). Forensic consideration of death in the bathtub. Legal Medicine, 5, S375-S381.

A diction for addiction: A brief overview of our papers at the 2017 International Conference on Behavioral Addictions

This week I attended (and gave one of the keynote papers at) the fourth International Conference on Behavioral Addictions in Haifa (Israel). It was a great conference and I was accompanied by five of my colleagues from Nottingham Trent University all of who were also giving papers. All of the conference abstracts have just been published in the latest issue of the Journal of Behavioral Addictions (reprinted below in today’s blog) and if you would like copies of the presentations then do get in touch with me.

mark-haifa-keynote-2017

Griffiths, M.D. (2017). Behavioural tracking in gambling: Implications for responsible gambling, player protection, and harm minimization. Journal of Behavioral Addictions, 6 (Supplement 1), 2.

  • Social responsibility, responsible gambling, player protection, and harm minimization in gambling have become major issues for both researchers in the gambling studies field and the gaming industry. This has been coupled with the rise of behavioural tracking technologies that allow companies to track every behavioural decision and action made by gamblers on online gambling sites, slot machines, and/or any type of gambling that utilizes player cards. This paper has a number of distinct but related aims including: (i) a brief overview of behavioural tracking technologies accompanied by a critique of both advantages and disadvantages of such technologies for both the gaming industry and researchers; (ii) results from a series of studies carried out using behavioural tracking (particularly in relation to data concerning the use of social responsibility initiatives such as limit setting, pop-up messaging, and behavioural feedback); and (c) a brief overview of the behavioural tracking tool mentor that provides detailed help and feedback to players based on their actual gambling behaviour.

Calado, F., Alexandre, J. & Griffiths, M.D. (2017). Youth problem gambling: A cross-cultural study between Portuguese and English youth. Journal of Behavioral Addictions, 6 (Supplement 1), 7.

  • Background and aims: In spite of age prohibitions, most re- search suggests that a large proportion of adolescents engage in gambling, with a rate of problem gambling significantly higher than adults. There is some evidence suggesting that there are some cultural variables that might explain the development of gambling behaviours among this age group. However, cross­cultural studies on this field are generally lacking. This study aimed to test a model in which individual and family variables are integrated into a single perspective as predictors of youth gambling behaviour, in two different contexts (i.e., Portugal and England). Methods: A total of 1,137 adolescents and young adults (552 Portuguese and 585 English) were surveyed on the measures of problem gambling, gambling frequency, sensation seeking, parental attachment, and cognitive distortions. Results: The results of this study revealed that in both Portuguese and English youth, the most played gambling activities were scratch cards, sports betting, and lotteries. With regard to problem gambling prevalence, English youth showed a higher prevalence of problem gambling. The findings of this study also revealed that sensation seeking was a common predictor in both samples. However, there were some differences on the other predictors be- tween the two samples. Conclusions: The findings of this study suggest that youth problem gambling and its risk factors appear to be influenced by the cultural context and highlights the need to conduct more cross-cultural studies on this field.

Demetrovics, Z., Richman, M., Hende, B., Blum, K., Griffiths,
M.D, Magi, A., Király, O., Barta, C. & Urbán, R. (2017). Reward Deficiency Syndrome Questionnaire (RDSQ):
A new tool to assess the psychological features of reward deficiency. Journal of Behavioral Addictions, 6 (Supplement 1), 11.

  • ‘Reward Deficiency Syndrome’ (RDS) is a theory assuming that specific individuals do not reach a satisfactory state of reward due to the functioning of their hypodopaminergic reward system. For this reason, these people search for further rewarding stimuli in order to stimulate their central reward system (i.e., extreme sports, hypersexuality, substance use and/or other addictive behaviors such as gambling, gaming, etc.). Beside the growing genetic and neurobiological evidence regarding the existence of RDS little re- search has been done over the past two decades on the psychological processes behind this phenomenon. The aim of the present paper is to provide a psychological description of RDS as well as to present the development of the Reward Deficiency Syndrome Questionnaire (developed using a sample of 1,726 participants), a new four-factor instrument assessing the different aspects of reward deficiency. The results indicate that four specific factors contribute to RDS comprise “lack of satisfaction”, “risk seeking behaviors”, “need for being in action”, and “search for overstimulation”. The paper also provides psychological evidence of the association between reward deficiency and addictive disorders. The findings demonstrate that the concept of RDS provides a meaningful and theoretical useful context to the understanding of behavioral addictions.

Demetrovics, Z., Bothe, B., Diaz, J.R., Rahimi­Movaghar, A., Lukavska, K., Hrabec, O., Miovsky, M., Billieux, J., Deleuze,
J., Nuyens, P. Karila, L., Nagygyörgy, K., Griffiths, M.D. & Király, O. (2017). Ten-Item Internet Gaming Disorder Test (IGDT-10): Psychometric properties across seven language-based samples. Journal of Behavioral Addictions, 6 (Supplement 1), 11.

  • Background and aims: The Ten-Item Internet Gaming Disorder Test (IGDT-10) is a brief instrument developed to assess Internet Gaming Disorder as proposed in the DSM­5. The first psychometric analyses carried out among a large sample of Hungarian online gamers demonstrated that the IGDT-10 is a valid and reliable instrument. The present study aimed to test the psychometric properties in a large cross-cultural sample. Methods: Data were collected among Hungarian (n = 5222), Iranian (n = 791), Norwegian (n = 195), Czech (n = 503), Peruvian (n = 804), French­speaking (n = 425) and English­ speaking (n = 769) online gamers through gaming­related websites and gaming-related social networking site groups. Results: Confirmatory factor analysis was applied to test the dimensionality of the IGDT-10. Results showed that the theoretically chosen one-factor structure yielded appropriate to the data in all language­based subsamples. In addition, results indicated measurement invariance across all language-based subgroups and across gen- der in the total sample. Reliability indicators (i.e., Cronbach’s alpha, Guttman’s Lambda-2, and composite reliability) were acceptable in all subgroups. The IGDT- 10 had a strong positive association with the Problematic Online Gaming Questionnaire and was positively and moderately related to psychopathological symptoms, impulsivity and weekly game time supporting the construct validity of the instrument. Conclusions: Due to its satisfactory psychometric characteristics, the IGDT-10 appears to be an adequate tool for the assessment of internet gam- ing disorder as proposed in the DSM-5.

Throuvala, M.A., Kuss, D.J., Rennoldson, M. & Griffiths, M.D. (2017). Delivering school-based prevention regarding digital use for adolescents: A systematic review in the UK. Journal of Behavioral Addictions, 6 (Supplement 1), 54.

  • Background: To date, the evidence base for school-delivered prevention programs for positive digital citizenship for adolescents is limited to internet safety programs. Despite the inclusion of Internet Gaming Disorder (IGD) as a pro- visional disorder in the DSM-5, with arguable worrying prevalence rates for problematic gaming across countries, and a growing societal concern over adolescents’ digital use, no scientifically designed digital citizenship programs have been delivered yet, addressing positive internet use among adolescents. Methods: A systematic database search of quantitative and qualitative research evidence followed by a search for governmental initiatives and policies, as well as, non­profit organizations’ websites and reports was conducted to evaluate if any systematic needs assessment and/or evidence-based, school delivered prevention or intervention programs have been conducted in the UK, targeting positive internet use in adolescent populations. Results: Limited evidence was found for school-based digital citizenship awareness programs and those that were identified mainly focused on the areas of internet safety and cyber bullying. To the authors’ knowledge, no systematic needs assessment has been conducted to assess the needs of relevant stakeholders (e.g., students, parents, schools), and no prevention program has taken place within UK school context to address mindful and positive digital consumption, with the exception of few nascent efforts by non­profit organizations that require systematic evaluation. Conclusions: There is a lack of systematic research in the design and delivery of school-delivered, evidence-based prevention and intervention programs in the UK that endorse more mindful, reflective attitudes that will aid adolescents in adopting healthier internet use habits across their lifetime. Research suggests that adolescence is the highest risk group for the development of internet addictions, with the highest internet usage rates of all age groups. Additionally, the inclusion of IGD in the DSM-5 as provisional disorder, the debatable alarming prevalence rates for problematic gaming and the growing societal focus on adolescents’ internet misuse, renders the review of relevant grey and published research timely, contributing to the development of digital citizenship programs that might effectively promote healthy internet use amongst adolescents.

Bányai, F., Zsila, A., Király, O., Maraz, A., Elekes, Z., Griffiths, M.D., Andreassen, C.S. & Demetrovics, Z. (2017). Problematic social networking sites use among adolescents: A national representative study. Journal of Behavioral Addictions, 6 (Supplement 1), 62.

  • Despite being one of the most popular activities among adolescents nowadays, robust measures of Social Media use and representative prevalence estimates are lacking in the field. N = 5961 adolescents (49.2% male; mean age 16.6 years) completed our survey. Results showed that the one-factor Bergen Social Media Addiction Scale (BSMAS) has appropriate psychometric properties. Based on latent pro le analysis, 4.5% of the adolescents belonged to the at-risk group, who reported low self-esteem, high level of depression and the elevated social media use (34+ hours a week). Conclusively, BSMAS is an adequate measure to identify those adolescents who are at risk of problematic Social Media use and should therefore be targeted by school-based prevention and intervention programs.

Bothe, B., Toth-Király, I. Zsila, A., Griffiths, M.D., Demetrovics, Z. & Orosz, G. (2017). The six-component problematic pornography consumption scale. Journal of Behavioral Addictions, 6 (Supplement 1), 62.

  • Background and aims: To our best knowledge, no scale ex- ists with strong psychometric properties assessing problematic pornography consumption which is based on an over- arching theoretical background. The goal of the present study was to develop a short scale (Problematic Pornography Consumption Scale; PPCS) on the basis of Griffiths` (2005) six-component addiction model that can assess problematic pornography consumption. Methods: The sample comprised 772 respondents (390 females; Mage = 22.56, SD = 4.98 years). Items creation was based on the definitions of the components of Griffiths’ model. Results: A confirmatory factor analysis was carried out leading to an 18­item second­order factor structure. The reliability of the PPCS was good and measurement invariance was established. Considering the sensitivity and specificity values, we identified an optimal cut­off to distinguish between problematic and non-problematic pornography users. In the present sample, 3.6% of the pornography consumers be- longed to the at-risk group. Discussion and Conclusion: The PPCS is a multidimensional scale of problematic pornography consumption with strong theoretical background that also has strong psychometric properties.

Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Don’t blame the game: Parents, videogame content, and age ratings

Back in March 2015, BBC News reported that parents of children in 16 Cheshire county schools had been sent a letter saying that head teachers would report them to the authorities if they allowed their children to play videogames that are rated for adults (i.e., games that have an ‘18’ rating). The teachers claimed that popular games like Grand Theft Auto and Call of Duty are too violent to be played by those under the age of 18 years. They also stated that such games increased sexualised behaviour and left children vulnerable to sexual grooming. The schools also threatened to report parents who let their children play such games because it was a form of parental neglect. The author of the letter, Mary Hennessy Jones, was quoted as saying that:

“We are trying to help parents to keep their children as safe as possible in this digital era. It is so easy for children to end up in the wrong place and parents find it helpful to have some very clear guidelines”.

I’m sure the letter to parents was written with the best of intentions but as a parent of three ‘screenagers’ and someone that has spent almost three decades researching the effects of video games on human behaviour, this appears to be a very heavy-handed way to deal with the issue. Although it is illegal for any retailer to sell ‘18’ rated games to minors, it is not illegal for children to play such games, or illegal for parents to allow their children to play such games. Many parents need to be educated about the positives and negatives of playing video games but reporting them to the “authorities” is not the right way forward.

pegi_ratings_system

Back in the early 1990s I was probably the only academic in the UK carrying out scientific research on children’s video game playing. In fact, I was proud of my role in getting age ratings onto all video games in the first place, and for writing the text for educational information leaflets for parents (outlining the effects of excessive playing of such games) sponsored by the National Council for Educational Technology. There are many positive benefits of playing video games (something that I wrote about in a previous article for The Conversation).

I know from first-hand experience that children often play games that are age-inappropriate. Two years ago, my (then) 13-year old son said he was the only boy in his class that did not play or own the Call of Duty video game. This is also borne out by research evidence. One study that I was involved in found that almost two-thirds of children aged 11- to 13-years of age (63%) had played an 18+ video game. Unsurprisingly, boys (76%) were more likely than girls (49%) to have played an 18+ video game. Children were also asked about how often they played 18+ video games. Of the two-thirds who had played them, 8% reported playing them “all the time”, 22% reported playing them “most of the time”, 50% reported playing them “sometimes”, 18% reported playing them “hardly ever”. Again, boys were more likely than girls to play 18+ video games more frequently. Children were asked how they got access to 18+ plus video games. The majority had the games bought for them by family or friends (58%), played them at a friend’s house (35%), swapped them with friends (27%), or bought games themselves (5%). This research certainly appears to suggest that parents and siblings are complicit in the playing of age-inappropriate games.

There is a growing amount of scientific literature that has examined the content of video games designed for adults. For instance, a study led by Dr. Kimberley Thompson and published in the Archives of Pediatric and Adolescent Medicine attempted to quantify the depiction of violence, blood, sexual themes, profanity, substances, and gambling in adult (18+) video games and to assess whether the actual game content matched the content descriptor on the packaging. Although content descriptors for violence and blood provided a good indication of content in the 36 games examined, the authors concluded that 81% of the games studied (n=29) lacked content descriptors of other adult content. Other studies carried out by the same research team have found that adult content can be found in lots of games aimed at young children and teenagers.

Another study led by Dr. David Walsh published in Minerva Pediatrica tested the validity of media rating systems (including video games). Results showed that when the entertainment industry rated a product as inappropriate for children, parents also agreed that it was inappropriate. However, parents disagreed with many industry ratings that were designated as containing material as suitable for children. The products rated as appropriate for adolescents by the industry were of the greatest concern to parents.

The issue of children and adolescents playing 18+ games is no different from the debates about children and adolescents watching 18+ films. However, based on anecdotal evidence appears that parents are more likely to adhere to age ratings on films than they are on video games. This is one area that both media researchers and media educators need to inform parents to be more socially responsible in how they monitor their children’s leisure activity. A school sending out a threatening letter to parents is unlikely to change parental behaviour. Education and informed debate is likely to have a much greater effect in protecting our children from the potential harms of video game playing.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

 Further reading

Anderson, C.A., Gentile, D.A., & Dill, K.E. (2012). Prosocial, antisocial and other effects of recreational video games. In D.G. Singer, & J.L. Singer (Eds), Handbook of Children and the Media, Second Edition, (pp. 249-272). Thousand Oaks, CA: Sage.

Anderson, C. A., Shibuya, A., Ihori, N., Swing, E. L., Bushman, B.J., Sakamoto, A., Rothstein, H.R., & Saleem, M. (2010). Violent video game effects on aggression, empathy, and prosocial behavior in eastern and western countries: a meta-analytic review. Psychological Bulletin, 136, 151-173.

Bartlett, C. P., Anderson, C.A. & Swing, E.L. (2009). Video game effects confirmed, suspected and speculative: A review of the evidence. Simulation and Gaming, 40, 377-403.

Ferguson, C. J. (2007). Evidence for publication bias in video game violence effects literature: A meta analytic review. Aggression and Violent Behavior, 12, 470-482.

Ferguson, C. J. (2013). Violent video games and the supreme court: Lessons for the scientific community in the wake of Brown v. Entertainment Merchants Association. American Psychologists, 68, 57-74.

Ferguson, C. J., San Miguel, S. & Hartley, T. (2009).  Multivariate analysis of youth violence and aggression: The influence of family, peers, depression and media violence. Journal of Paediatrics, 155, 904-908.

Gentile, D. A. & Stone, W. (2005). Violent video game effects in children and adolescents: A review of the literature. Minerva Pediatrics, 57, 337-358.

Griffiths, M.D. (1998). Video games and aggression: A review of the literature. Aggression and Violent Behavior, 4, 203-212.

Griffiths, M.D. (2000). Video game violence and aggression: Comments on ‘Video game playing and its relations with aggressive and prosocial behaviour’ by O. Weigman and E.G.M. van Schie. British Journal of Social Psychology, 39, 147-149.

Griffiths, M.D. (2010). Age ratings on video games: Are the effective? Education and Health, 28, 65-67.

Griffiths, M.D. & McLean, L. (in press). Content effects: Online and offline games. In P. Roessler (Ed.), International Encyclopedia of Media Effects. Chichester: Wiley.

Grüsser, S.M., Thalemann, R. & Griffiths, M.D. (2007). Excessive computer game playing: Evidence for addiction and aggression?  CyberPsychology and Behavior, 10, 290-292.

Ivory, J.D., Colwell, J., Elson, M., Ferguson, C.J., Griffiths, M.D., Markey, P.M., Savage, J. & Williams, K.D. (2015). Manufacturing consensus in a divided field and blurring the line between the aggression concept and violent crime. Psychology of Popular Media Culture, 4, 222–229.

McLean, L. & Griffiths, M.D. (2013). The psychological effects of videogames on young people. Aloma: Revista de Psicologia, Ciències de l’Educació i de l’Esport, 31(1), 119-133.

McLean, L. & Griffiths, M.D. (2013). Violent video games and attitudes towards victims of crime: An empirical study among youth. International Journal of Cyber Behavior, Psychology and Learning, 2(3), 1-16.

Mehroof, M. & Griffiths, M.D. (2010). Online gaming addiction: The role of sensation seeking, self-control, neuroticism, aggression, state anxiety and trait anxiety. Cyberpsychology, Behavior, and Social Networking, 13, 313-316.

Market forces: Does gambling advertising increase problem gambling?

Anyone who watched the Euro 2016 football tournament on ITV a couple of months ago will have noticed the many offers to gamble on the matches. You were encouraged to download the bookies’ mobile apps, or asked to bet-in-play and gamble responsibly. But how do we respond to gambling ads? Do they actually draw us in? Arguably the most noticeable change in the British gambling landscape since the Gambling Act came into force in September 2007 has been the large increase in gambling advertising on television. Prior to this, the only gambling ads allowed on TV were those for National Lottery products, bingo, and the football pools.

In 2013, Ofcom published their research examining the volume, scheduling, frequency and exposure of gambling advertising on British television. The findings showed that there had been a 600% increase in UK gambling advertising between 2006 and 2012 – more specifically, there were 1.39m adverts on television in 2012 compared to 152,000 in 2006. The report also showed that gambling adverts accounted for 4.1% of all advertising seen by viewers in 2012, up from 0.5% in 2006 and 1.7% in 2008.

So is the large increase having any effect on gambling and problem gambling? In 2007, prior to there being widespread gambling ads on TV, the British Gambling Prevalence Survey (BGPS) of over 9,000 people (aged 16 years and over) reported that 0.6% of them were problem gamblers. In the 2010 BGPS, the problem gambling prevalence rate had increased by half to 0.9%. Some of this increase may, arguably, have been due to increased gambling advertising. However, the latest British survey research shows that the prevalence of problem gambling is back down (to 0.5%), so perhaps increased gambling advertising hasn’t resulted in an increase of problem gambling.

Surprisingly, there is relatively little scientific evidence that advertising directly influences gambling participation and problem gambling. This is partly because demonstrating empirically that the negative effects of gambling are solely attributable to advertising is hard. For instance, a study of 1,500 people in New Zealand by Ben Amey, a governmental social science researcher at the Ministry of Internal Affairs, reported an association between participation in gambling activities and recall of gambling advertising. The study fund that over 12 months, 83% of people who had gambled between zero and three times remembered seeing gambling ads during that time. For people that had gambled four or more times, the figure was at 93%.

Last year, research colleagues from the University of Bergen in Norway and I published one of the largest studies carried out on gambling advertising. It involved more than 6,000 people and examined three specific dimensions of gambling advertising impacts: gambling-related attitudes, interest, and behavior (“involvement”); knowledge about gambling options and providers (“knowledge”); and the degree to which people are aware of gambling advertising (“awareness”). Overall, we found that impacts were strongest for the “knowledge” dimension. We also found that for all three dimensions, the impact increased with the level of advertising exposure.

We then compared the responses from problem gamblers against those of recreational (non-problem) gamblers. We found that problem gamblers were more likely than recreational gamblers to agree that gambling advertising increased their gambling involvement and knowledge, and that they were more aware of gambling advertising. In simple terms, our study showed that gambling advertising has a greater impact on problem gamblers than recreational gamblers. This indirectly supports previous research showing that problem gamblers often mention that gambling advertising acts as a trigger to their gambling.

We also found that younger gamblers were more likely than older ones to agree that advertising increased their gambling involvement and knowledge. This supports previous research showing that problem gambling is associated with stronger perceived advertising impacts among adolescents. One of the more worrying statistics reported in the Ofcom study was that children under 16 years of age were each exposed to an average of 211 gambling adverts a year (adults saw an average of 630). I am a firm believer that gambling is an adult activity and that gambling adverts should be shown only after the 9pm watershed. Unfortunately, all televised sporting events such as Euro 2016 can feature gambling ads at any time of the day, and that means that tens of thousands of schoolchildren have been bombarded with gambling ads over the last month.

Most of us who work in the field of responsible gambling agree that advertising “normalises” gambling and that all relevant governmental gambling regulatory agencies should prohibit aggressive advertising strategies, especially those that target impoverished individuals or youths. Most of the research data on gambling advertising uses self-report data (surveys, focus groups, interviews, etc.) and very little of these data provide an insight into the relationship between advertising and problem gambling. A review by the British lawyer Simon Planzer and Heather Wardle (the lead author of the last two BGPS surveys) concluded that gambling advertising is an environmental factor that has the power to shape attitudes and behaviours relating to gambling – but just how powerful it is remains unclear.

Overall, the small body of research on the relationship between gambling advertising and problem gambling has few definitive conclusions. If gambling advertising does have an effect, it appears to impact specific groups (such as problem gamblers and adolescents) but most of this research uses self-reported data that has been shown to be unreliable among gamblers.

At best, the scientific research only hints at the potential dangers of gambling ads. But in order to challenge the increasing normalisation of gambling among these most-at-risk groups, we need more robust evidence. Only then will we be able to understand the psychosocial impact of the kind of blanket advertising seen by children and adults during major sporting events such as Euro 2016.

(N.B. A version of this article was first published in The Conversation)

Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Griffiths, M.D. (1997). Children and gambling: The effect of television coverage and advertising. Media Education Journal, 22, 25-27.

Griffiths, M.D. (2005). Does advertising of gambling increase gambling addiction? International Journal of Mental Health and Addiction, 3(2), 15-25.

Griffiths, M.D. (2010). Media and advertising influences on adolescent risk behaviour. Education and Health, 28(1), 2-5.

Griffiths, M.D. (2010). Social responsibility in marketing for online gaming affiliates. i-Gaming Business Affiliate, June/July, p.32.

Griffiths, M.D. (2013). Responsible marketing and advertising of gambling. i-Gaming Business Affiliate, August/September, 50.

Hanss, D., Mentzoni, R.A., Griffiths, M.D., & Pallesen, S. (2015). The impact of gambling advertising: Problem gamblers report stronger impacts on involvement, knowledge, and awareness than recreational gamblers. Psychology of Addictive Behaviors, 29, 483-491.

Lopez-Gonzalez, H. & Griffiths, M.D. (2016). Is European online gambling regulation adequately addressing in-play betting advertising? Gaming Law Review and Economics, in press.

Reid, J. & Griffiths, M.D. (2004). Lotteries, television advertising, and televised lottery draws, Panorama (European State Lotteries and Toto Association), 15, 8-9.

Zangeneh, M., Griffiths, M.D. & Parke, J. (2008). The marketing of gambling. In Zangeneh, M., Blaszczynski, A., and Turner, N. (Eds.), In The Pursuit Of Winning (pp. 135-153). New York: Springer.

Test augmentation: 10 reasons why ‘Pokémon Go’ is so appealing

“Pokémon Go is a free-to-play location-based augmented reality mobile game developed…Making use of GPS and the camera of compatible devices, the game allows players to capture, battle, and train virtual creatures, called Pokémon [pocket monsters] who appear on device screens as though in the real world. The game is free-to-play, although it supports in-app purchases of additional gameplay items” (Wikipedia, 2016)

Unless you’re news-shy, off-grid, and/or a hermit, you can’t fail to have noticed all the media hype surrounding Pokémon Go. My youngest son and seemingly all of is friends have been out and about enjoying playing the latest gaming phenomenon. A lot of the press stories that I have read concentrate on the allegedly ‘addictive’ properties of the game (see ‘Further reading’ below). But what makes Pokémon Go such an appealing game? Here are my top ten reasons:

(1) It’s a popular franchise with a novel twist

Pokémon is a huge franchise with lots of associated spin-offs (animates films, carton television show, card games, figures to collect, etc.). And unlike some franchises, it’s a game that appears to be popular across age and gender but various aspects of the game (such as the use of augmented reality) give the game a novel twist on most other games (by utilizing real-world locations in which players explore their neighbourhood locality or wherever they happen to be).

(2) It’s fun, free to play, easy to play, and easy to access

Unlike many popular games, you don’t need a dedicated console to play the game. There is little in the way of barriers to entry. Anyone who has a smartphone can download Pokémon Go and it can be played anywhere at any time because it is played on a mobile device in which players try to catch Pokémon at specific locations (‘PokéStops’). This means that the number of potential users is huge, even in comparison to console games. In addition, there are no complicated buttons to press or controls to use. Most importantly it’s fun and free to play (but players can buy in-game items, an area that I’ve done a bit of research on which I outlined in a previous blog).

(3) It’s nostalgic and a ‘blast from the past’

Pokémon Go features many of the early ‘classic’ Pokémon characters (the ones that you could name in a pub quiz) hailing back to the 1990s. As well as attracting new and younger players, adults who loved Pokémon as a child or teenager can now re-live some of their childhood and adolescence. In short, some players can experience something new yet familiar. A research review carried out by Dr. Constantine Sedikides and Dr. Tim Wildschut demonstrated that “nostalgia has remarkable implications for one’s future. It strengthens approach orientation, raises optimism, evokes inspiration, boosts creativity, and kindles prosociality. Far from reflecting escapism from the present, nostalgia potentiates an attainable future”. A number of online articles coomenting on the popularity of Pokémon have included quotes about the game’s nostalgic element from Dr. Jamie Madigan (author of the 2015 book Getting Gamers: The Psychology of Video Games and Their Impact on People Who Play Them). He asserted that if nostalgia is in play, and it evokes this positive emotion…our brain can substitute the question, ‘Does this make me happy’ for ‘Is this a good game?’”

(4) It’s a social game (if you want it to be)

Back in the early and mid-2000s I published a number of studies showing that the most important reason for playing online multiplayer games was for social reasons and to connect and interact with other players. The great think about Pokémon Go is that meeting other players face-to-face is almost inevitable as the game is played outside and on the move, and it’s easy to spot other like-minded players. People can make new friendships or consolidate existing ones. Players talk to each other and can share their experiences. Some may even have shared memories that plugs into feelings of nostalgia. However, Pokémon Go players (if they so wish) can play on their own too. The game is flexible enough to adapt to the player.

(5) It features augmented reality

One of the defining features of Pokémon Go is that augmented reality is a fundamental (and arguably the main) part of the game. Augmented reality (AR) is defined as “a live direct or indirect view of a physical, real-world environment whose elements are augmented (or supplemented) by computer-generated sensory input such as sound, video, graphics or GPS [global positioning system] data”. Pokémon Go has successfully managed to embed AR into the game which some players claim makes characters feel “more alive”. An article on the phenomenon in Time magazine said that Pokémon Go provides “the illusion that wild Pokémon are out there in the real world, waiting to be caught”. There are also some claims (such as a paper by Dr. Keith Bujak and his colleagues in a paper published in a 2013 issue of the journal Computers and Education) that augmented reality can be potentially addictive. The authors claim that children are most at risk from AR addiction and assert that:

“Augmented reality does not separate the user from his reality but instead uses it and realistically transforms it…This effect can cause a high degree of surprise and curiosity in users”.

(6) It’s motivating

Any one who plays videogames or researches in the area knows that successful games have to be motivating to play. Rewards within Pokémon Go help players to foster achievement, and achieving goals within the game drives motivation. As an article on the Keep It Suitable website noted: “The self-confidence that arises from the achievement of a goal – catching a Pikachu – motivates people to play more and more…and ‘Pokémon Go’ players are indeed very motivated…The ease with which the reward comes every time your phone buzzes, alerting you that a Pokémon is nearby, is very basic psychological conditioning”.

(7) It involves collecting

In a number of my previous blogs I have written about the psychology of collecting and this also appears to be one of the attractions concerning all things Pokémon (in fact the Pokémon mantra has always been “Gotta catch ‘em all”). In my articles I have always referenced the work of Professor Russell Belk who has written a lot of books and papers on the topic. He was interviewed by Forbes magazine on the topic of Pokémon Go. The Forbes article noted:

“In a 1991 article published in the ‘Journal of Social Behavior and Personality’, Belk described two main types of collecting: aesthetic and taxonomic. Aesthetic collecting occurs when objects aren’t in limited supply and so adding things to your collection depends on personal preferences. This includes artwork, but not pocket monsters. ‘I expect no matter how beautiful or ugly the Pokémon is, there’s relatively little aesthetic judgment,” says Belk…’You want them all — or as many as possible’. Collecting Pokémon is a lot like building a coin or stamp collection. It involves taxonomy – the process of naming and classifying things into groups. Taxonomic collecting can end temporarily but continue later: the original Game Boy games (Pokémon Red and Pokémon Blue) featured 151 monster ‘species,’ but sequels have pushed that number over 700. If ‘Pokémon Go’ remains popular and profitable in the long term, the app’s developer will no doubt add new species. Belk adds that the desire to collect isn’t driven by a need to complete a collection. ‘You’re not striving for that closure as much as striving for bigger and better collections…That implies some social comparisons – that your collection is in some sense better than theirs.”

In the same article, reference was also made to a just published literature review (‘Extended self and the digital world’) by Professor Belk in the journal Current Opinion in Psychology. In the paper Belk claims collecting has now gone beyond physical items and can now include the collecting of digital artefacts. As Belk notes:

“Collecting digital objects can have advantages over physical possessions. While coins and stamps are kept in cabinets at home, you can store an entire collection of ‘Pokémon’ on your phone to show friends…One reason why ‘Pokémon Go’ is so popular is that it puts digital monsters in the real world. Like finding a rare book in an antique shop, this turns the discovery of Pokémon — the challenge or thrill of the chase — into a story. With augmented reality, they’ve made the ‘thrill of the hunt’ in a version where you can tweet about it, you can post about it on your website, you can carry around images of the Pokémon that you’ve collected…That’s a conversation piece, and something you can carry with you or brag about online.”

(8) It gets people active without them really knowing it

A number of articles on Pokémon Go have noted that playing the game has meant players having to go outdoors and walk miles to catch the Pokémon. In short, if you want to do well in the game, you have to get out the house and do some exercise. As one article summed up on this aspect: ‘The running meme is that Pokémon Go managed to do in 24 hours what Michelle Obama could not manage over the course of 8 years: get people outside and active…It turns out gamification of healthy activities can be done and that’s potentially a huge win for the gaming subset of our society that doesn’t exactly have the healthiest track record”. Personally, I’m not convinced that Pokémon Go is as good as more traditional ‘exergaming’ (such as playing Wii Sports) but I can’t deny that it gets people out of a sedentary routine.

(9) It’s a never-ending game

Pokémon Go is a non-linear game in which every user’s playing experience is different given that it uses the person’s individual geo-location. Like many massively multiplayer online games, there is no end to the game and some players continue playing because of FOMO (fear of missing out). Ultimately there is theoretically no limit to how many Pokémon a player can catch or how the game might evolve over time.

(10) The rewards are unpredictable

Over the years I have written countless papers talking about the role of random ratio reinforcement schedules (operant condition processes) that underlie repetitive behaviour (that in extreme cases can result in gambling and gaming addictions). In simple terms, playing a videogame or a slot machine results in intermittent and unpredictable rewards. Knowing when a reward is coming gets boring in the long run but games where the player doesn’t know when the next reward is coming (like when in the Pokémon Go game, the player will next see a Pokémon to catch). Anticipated rewards (similarly to actual rewards) also facilitate dopamine (one of the most important ‘feel good’ neurotransmitters in the human body) release in the body. In fact, a paper by Dr. Patrick Anselm and Dr. Mike Robinson published in the journal Frontiers in Behavioral Neuroscience argued that dopamine release “seems to reflect the unpredictability of reward delivery rather than reward per se” and suggests that the motivation to gamble or play videogames “is strongly (though not entirely) determined by the inability to predict reward occurrence”. In short, playing Pokémon Go can keep you playing longer than you might have originally intended.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Anselme, P. & Robinson, M.J.F. (2013) What motivates gambling behavior? Insight into dopamine’s role. Frontiers in Behavioral Neuroscience, 7, 182. doi: 10.3389/fnbeh. 2013.00182

Belk, R. W. (1991). The ineluctable mysteries of possessions. Journal of Social Behavior and Personality, 6(6), 17-55.

Belk, R. (2016). Extended self and the digital world. Current Opinion in Psychology, 10, 50-54.

Bujak, K.R., Radu, I., Catrambone, R., Macintyre, B., Zheng, R., & Golubski, G. (2013). A psychological perspective on augmented reality in the mathematics classroom. Computers & Education, 68, 536-544.

Chamary, J.V. (2016). Science explains why you’re addicted to Pokémon GO. Forbes, July, 12. Located at: http://www.forbes.com/sites/jvchamary/2016/07/12/science-collecting-pokemon/#276f49ac6d2e

Cleghorn, J. & Griffiths, M.D. (2015). Why do gamers buy ‘virtual assets’? An insight in to the psychology behind purchase behaviour. Digital Education Review, 27, 98-117.

Cole, H. & Griffiths, M.D. (2007). Social interactions in Massively Multiplayer Online Role-Playing gamers. CyberPsychology and Behavior, 10, 575-583.

Griffiths, M.D., Davies, M.N.O. & Chappell, D. (2003). Breaking the stereotype: The case of online gaming. CyberPsychology and Behavior, 6, 81-91.

Griffiths, M.D., Davies, M.N.O. & Chappell, D. (2004). Demographic factors and playing variables in online computer gaming. CyberPsychology and Behavior, 7, 479-487.

Griffiths, M.D., Davies, M.N.O. & Chappell, D. (2004). Online computer gaming: A comparison of adolescent and adult gamers. Journal of Adolescence, 27, 87-96.

Duhi, A. (2016). Caught ’em all?: Why Pokémon Go is so addicting. FSU News, July 19. Located at: http://www.fsunews.com/story/news/2016/07/19/caught-em-all-why-pokemon-go-so-addicting/87309612/

Eadiccio, L. (2016). Psychology experts explain why ‘Pokemon Go’ is so addictive. Time, July 12. Located at: http://time.com/4402123/pokemon-go-nostalgia/

Goodwin, R. (2016). Why the hell is everyone so addicted to Pokemon Go? Know Your Mobile, July 14. Located at: http://www.knowyourmobile.com/games/pokemon-go/23690/why-hell-everyone-so-addicted-pokemon-go

Keep It Suitable (2016). 10 Reasons from real users: Why is Pokemon Go so addictive? July 16. Located at: http://www.keepitusable.com/blog/?p=3579

Kubas-Meyer, A. (2016). Pokémon GO Is the most addictive gaming app ever. Daily Beast, July 11. Located at: http://www.thedailybeast.com/articles/2016/07/11/pokemon-go-is-the-most-addictive-gaming-app-ever.html

Sedikides, C., & Wildschut, T. (2016). Past forward: Nostalgia as a motivational force. Trends In Cognitive Sciences, 20(5), 319-321.

Smith, C. (2016). Science explains why you’re so addicted to Pokemon Go. BGR.com, July 13. Located at: http://bgr.com/2016/07/13/pokemon-go-game-addiction/

Wikipedia (2016). Pokémon Go. Located at: https://en.wikipedia.org/wiki/Pokémon_Go

Williams, C. (2016). Why everyone is addicted to Pokemon Go. Looper, July 14. Located at: http://www.looper.com/18330/everyone-addicted-pokemon-go/