Category Archives: Research

Video games and health-understanding causes

The headline and message in Sunday’s newspaper article were clear: Video games are a pedophile’s hunting ground, and your child is at risk. But are games really the cause? It’s easy to imagine parents around the world quivering in horror at yet another threat brought on by their child’s video gaming. Games are one of the most popular activities in the world, and where there is the Internet, there are internet games and chat platforms. The article specifically talked about chat platforms as a technology medium where pedophiles engage children in sexually explicit conversations and solicit pictures, because that’s where the children are.

But another specific technology—hyperlinks, this one from the exact article that puts the blame on games—brings us closer to the truth:  the problem of sextortion (extorting sexual videos or pictures) is feuled not by video games, but by “ubiquitous Internet connections and webcams”. To put it in the causal terms of public health, video games are neither necessary nor sufficient: You need the Internet and you need a webcam.

With video game research comes hyperbole. Games are popular activities, they get a lot of negative media attention, and the science behind them is tricky. Scientific studies about video games come from diverse fields, and the views of scientists in these different fields fields have changed over time. Psychiatrists, psychologists, pediatricians and public health scientists have been publishing more research that depicts gaming as neutral or bad. In general medicine, rehabilitation, nonmedical fields or tech-specific research, gaming is generally looking better and better.

But to really understand how gaming itself can be harmful, helpful, or both, we need a clear and simple approach to understanding where it fits in as a cause of health outcomes. Let’s look at a simple public health causal diagram that shows a snapshot of how the headline in the article above implies causation:

Public health causal diagram showing hypothesized link between online games and sexual abuse

Like most headlines, the first causal link is simplistic: A (online game playing) causes B (sexual abuse). The second hyperlink in the article goes to a website that reports on a study showing a different picture with a different enabling technology environment:

Causal diagram showing Internet and webcams as necessary causes

You need that middle enabling technology—without it, A can’t cause B. As we keep reading, more subtleties are revealed. One interviewee suggests that online child sexual abuse might not happen if children never interacted with strangers online and points to changes in the societal norm of not talking to strangers.[1] In this case, it’s an enabling cultural environment that has changed over time:

Causal diagram showing multiple causes on hypothesized pathway

The true picture involves levels of causation that go outside just a person and a behavior. Identifying these causes doesn’t tell us much, however. Is it reasonable for parents to refuse to let their children use the Internet at all or monitor all Internet communications constantly in real time?  This represents a level of restrictive parenting that is probably responsible for a study that shows that teens who play video games have better self-reported mental well-being than no those who don’t. However, another study of parents of young children (ages 3-9) suggests that setting limits on the amount of digital game play is associated with feeling your child is less defiant, more likely to play with other children, and less likely to have problematic gaming.

Research on video games and health needs a new approach. It’s impossible to understand the complex web of causes and how to address them without understanding the multiple levels of contexts where a health outcome takes place. First, we have the Internet and webcams as enabling technology. Then, we have enabling online environments-the communities where interacting with strangers is the new norm. We also have parenting practices and finally actions taken by the individual him/herself such as chatting in online environments.

Diagram showing multiple contexts necessary to understand health effects of video games

Games have enormous potential to help, but playing games is one of many things people do in life that can also lead to problems. The goal of protecting public health won’t be achieved by simplistic explanations of cause and effect or frightening headlines. Stay tuned for more about the need for new standards.


[1]Outside of an online environment, most child sexual abuse is perpetrated by a person the child knows.