Differences in associations between problematic video-gaming, video-gaming duration, and weapon-related and physically violent behaviors in adolescents
Introduction
The rising popularity of playing video, computer, internet, and smart-phone games has raised concerns in prevention research networks regarding maladaptive influences on health and risk behaviors (Fineberg et al., 2018; Kim et al., 2016; Mentzoni et al., 2011). The potential for problematic use of video-games, and associations with mental and physical health problems, has been identified in previous research (Desai et al., 2010; Ferguson et al., 2011; Griffiths, 2008). Indeed, ‘gaming disorder’, characterized by a pattern of persistent or recurrent gaming behavior that may manifest as impaired control, increasing priority given to gaming, and continuation/escalation of gaming despite negative consequences, has recently been included in the International Classification of Diseases 11th revision (ICD-11) within disorders due to substance use and addictive behaviors (Billieux et al., 2017).
An estimated 85% of North American middle- and high-school adolescents reported past-year gaming, and 9.4% reported having at least five concerns related to internet gaming disorder, such as preoccupation, tolerance, loss of control, repetition/relapse, withdrawal, escape, disregard of consequences, and disruption to family/school (Turner et al., 2012). A meta-analysis estimated the overall prevalence of problematic gaming as 3.1–8.9%, and 4.2% in children and adolescents (Ferguson et al., 2011), although lower estimates have been reported for internet gaming disorder in the general population (Przybylski et al., 2017) with possible factors relating to differences across studies involving approaches used, populations studied and other factors (Yao et al., 2017). In a Connecticut (U.S.) high-school sample, 4.9% of adolescent video-gamers endorsed three key gaming-disorder features of unsuccessfully cutting back, experiencing an irresistible urge to play, and experiencing growing tension that was only relieved by gaming (Desai et al., 2010).
Data support relationships between video-gaming and aggression, although findings are seemingly mixed. Longitudinal (Anderson et al., 2008; Coyne et al., 2018; Teng et al., 2019) and meta-analytic (Anderson et al., 2010; Mathur and VanderWeele, 2019; Prescott et al., 2018) research has found associations between gaming and aggression in multiple countries. In laboratory settings, children exposed to violent video-games have demonstrated more dangerous behaviors around simulated fire-arms (Chang and Bushman, 2019). Other studies have reported primarily weak relationships between gaming (including violent games) and aggression (Ferguson, 2015; Ferguson et al., 2012, 2013). However, recent meta-analytic reviews found associations between gaming and overt physical violence in children and adolescents converging across multiple studies (Prescott et al., 2018), and meaningful effect sizes in meta-analytic research (Mathur and VanderWeele, 2019). While some have proposed that violent media may desensitize gamers to violent behaviors (Bartholow et al., 2006), self-regulation problems and inhibitory deficiencies underlying problem gaming, irrespective of content, have been associated with aggression and greater likelihood of violence (Desai et al., 2010; Ferguson, 2011; Mehroof and Griffiths, 2010). However, the relationship between adolescent problem-gaming severity, gaming involvement, and different dimensions of violent behavior (i.e., weapon-carrying, being threatened with weapons, physical fighting, serious fighting leading to injury, and perceived insecurity) is not well understood, and further research is needed to inform prevention of violence and injury in youth.
Preliminary evidence supports a relationship between problematic gaming and violent behavior (Mehroof and Griffiths, 2010). Higher problem-gaming severity, regardless of game content, was prospectively associated with greater propensities for physical aggression (Lemmens et al., 2011). In addition to greater risk of weapon-carrying and serious fighting, adolescents with problematic gaming may also have differences in health and functioning including substance use and depression (Desai et al., 2010). Inasmuch as these health and functioning differences may co-occur with violent behaviors (Franco et al., 2019; Najman et al., 2019; Oram et al., 2014), these “third variables” potentially have confounding effects in video-gaming and violence research (Ferguson, 2015; Prescott et al., 2018). Hence, studies should consider health and functioning differences in these domains to more accurately assess relationships between problematic gaming and violence-related measures.
In light of concerns for potentially overpathologizing normal gaming behavior, recent reports suggest that high levels of gaming involvement are not necessarily problematic (Billieux et al., 2019). As such, it is important to understand both quantity/frequency measures and problem-gaming correlates separately. While physical violence has been associated with gaming duration, its relationship with problematic gaming may vary under different conditions (e.g., game content, gender) (Goldstick et al., 2018; Lemmens et al., 2011). It is also important to understand how measures of violence and aggression may relate both to quantity/frequency measures and problem-gaming correlates separately.
Models of both problematic gaming and violence have suggested common vulnerabilities of inattention, hyperactivity and poor behavioral regulation (Dong and Potenza, 2014; Rohlf et al., 2018; Wojciechowski, 2017). Cognitive-behavioral models indicate that deficiencies in executive control that regulate motivations for reward-seeking and impulsivity may increase risk of problem-gaming behaviors (Dong and Potenza, 2014). Indeed, differences in brain functional activation of executive control networks and performance on inhibition tasks have been observed between individuals with gaming disorders and healthy control participants (Dong et al., 2015, 2017; Dong and Potenza, 2016). Concurrently, ineffective executive or impulse control is also linked to aggression and violence (McCloskey et al., 2009). Childhood deficiencies in executive functioning and impulse control, including planning, inhibition, set-shifting and working memory, prospectively associate with physical aggression (McQuade et al., 2017; Rohlf et al., 2018). Moreover, individuals with poor executive control are up to 4 times more likely to inflict physical violence on others (King et al., 2018). However, further research is needed to examine relationships between problem-gaming severity, executive or impulse control, and aggression and violence.
The aim of this study was to investigate relationships between measures of problem-gaming severity and gaming duration, and measures of violence-related experiences, and whether impulsivity-related tendencies moderated these relationships. We examined data collected from a cross-sectional survey of risk behaviors in Connecticut high-school students. These data have previously been used to examine correlates of problematic gaming, as well as problem-gambling severity between adolescents with and without serious physical fighting (Desai et al., 2010; Slavin et al., 2013). However, prior studies did not examine problem-gaming severity and video-gaming duration in relation to different violent behaviors while controlling for potentially confounding variables. Hence, the current study adjusts for health and functioning differences in addition to socioeconomic characteristics. We hypothesized that: 1) adolescents with greater problem-gaming severity would be more likely to endorse violence-related measures; 2) adolescents with longer weekly time spent gaming would be more likely to endorse violence-related measures; 3) problem-gaming severity would be associated with weekly time spent gaming; 4) impulsivity and sensation-seeking would moderate associations between problem-gaming severity and gaming duration, and violence-related measures.
Section snippets
Participants
Recruitment and survey data, consenting procedures, and sample characteristics have been previously described in detail (Desai et al., 2010; Potenza et al., 2011; Zhai et al., 2017). Briefly, invitations were extended to principals of public 4-year and non-vocational or specialized high schools in Connecticut, USA. Additional targeted recruitment from all geographical quadrants of Connecticut, and schools from the three tiers of the state's family socioeconomic-status-related district reference
Results
Demographic data are reported in Table 1. Among the 3,896 adolescents studied, 27.4% demonstrated LRVG and 23.4% demonstrated ARPVG. Chi-square analyses showed that problem-gaming severity was associated with gender, grade level, and endorsement of Asian regarding race/ethnicity. Additionally, problem-gaming severity was associated with all five violence-related measures. The proportion of adolescents who endorsed each violence-related item was greater in ARPVG adolescents, relative to LRVG and
Discussion
To our knowledge, this is the first study to separately investigate relationships between violence-related measures and both adolescent problem-gaming severity and gaming duration, and moderating effects of sensation-seeking and impulsivity after controlling for potentially confounding health and functioning differences. Largely consistent with the first hypothesis, ARPVG compared to both NVG and LRVG adolescents had greater likelihoods of weapon-carrying, feeling unsafe, having been
Contributors
Drs. RAH SKS and MNP designed the survey. Dr. ZWZ and Mr. JCH conducted analyses and worked with Dr. MNP to develop initial drafts of the manuscript. All authors provided critical feedback with respect to the content of the manuscript. All authors had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Funding sources
This project was supported by National Institute of Health (grant numbers R01 DA019039 and RL1 AA017539). This work was also supported by the Connecticut Mental Health Center, the Connecticut State Department of Mental Health and Addiction Services, the Connecticut Council on Problem Gambling, and a Center of Excellence in Gambling Research Award from the National Center for Responsible Gaming. The funding agencies had no role in data collection or analysis or in the decision to submit the
Ethics
All procedures performed in human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Declaration of competing interest
The authors report no conflicts of interest with respect to the content of this manuscript. Dr. Potenza has: consulted for and advised Shire, INSYS Rivermend Health, Opiant/Lakelight Therapeutics and Jazz Pharmaceuticals; received research support from the National Institutes of Health, Mohegan Sun Casino, and the National Center for Responsible Gaming; participated in surveys, mailings, or telephone consultations related to drug addiction, impulse-control disorders or other health topics;
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