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Background and Objectives: As the gaming industry experiences exponential growth, concerns about gaming disorder (GD) also grow. It is crucial to understand the structural features of games that can interact with individual characteristics of gamers to promote GD. This research consolidates the views of an international body of panelists to create an assessment tool for gauging the addictive potential of distinct games., Methods: Utilizing the iterative and structured Delphi method, an international panel of researchers, clinicians, and people with lived experience were recruited to offer a multifaceted viewpoint on the addictive risk associated with specific structural elements in games. Two rounds of surveys facilitated consensus., Results: The panel initially included 40 members-ten from research, eight from clinical settings, and 22 with lived experiences. The second round included 27 panelists-seven from research, eight from clinical settings, and 11 with lived experiences. The study identified 25 structural features that contribute to potentially addictive gaming patterns., Discussion and Conclusions: Consensus was found for 25 features, which were distilled into a 23-item evaluation tool. The Saini-Hodgins Addiction Risk Potential of Games Scale (SHARP-G) consists of five overarching categories: 'Social,' 'Gambling-Like Features,' 'Personal Investment,' 'Accessibility,' and 'World Design.' SHARP-G yields a total score indicating level of addiction risk. A case study applying the scale to three games of differing perceived risk levels demonstrated that that score corresponded to game risk as expected. While the SHARP-G scale requires further validation, it provides significant promise for evaluating gaming experiences and products.

Loot boxes can be bought with real-world money to obtain random content inside video games. Loot boxes are viewed by many as gambling-like and are prevalently implemented globally. Previous Western and international studies have consistently found loot box spending to be positively correlated with problem gambling. Previous Western studies presented mixed results as to the correlations between loot box purchasing and gambling-related risk factors, mental wellbeing, and psychological distress. A large-scale survey of adult video game players from the People's Republic of China (PRC) (N = 2601) was conducted through Tencent Survey. The positive correlations between loot box spending and problem gambling, and between loot box spending and problem videogaming, were successfully replicated. However, other potential risk factors (i.e., impulsivity/impulsiveness; binary past-year gambling participation status; and sensation-seeking tendencies) either did not positively correlate with loot box spending or only did so weakly. Contrary to expectations, high impulsivity was negatively associated with loot box engagement. The Risky Loot Box Index (RLI) most strongly positively correlated with, and was the best predictor in multiple linear regression models for, loot box spending. The RLI may be effective at measuring loot box harms cross-culturally. A surprising weak positive correlation was found between loot box engagement and PRC players' mental wellbeing, and high psychological distress unexpectedly negatively predicted loot box purchasing. Although gambling-like, the risk and protective factors of loot boxes are seemingly different, meaning they should rightfully be treated as novel products. Cross-cultural research can contribute to a better understanding of loot box harms., Competing Interests: Declaration of Competing Interest L.Y.X. was employed by LiveMe, then a subsidiary of Cheetah Mobile (NYSE:CMCM), as an in-house counsel intern from July to August 2019 in Beijing, People’s Republic of China. L.Y.X. was not involved with the monetisation of video games by Cheetah Mobile or its subsidiaries. L.Y.X. undertook a brief period of voluntary work experience at Wiggin LLP (Solicitors Regulation Authority (SRA) number: 420659) in London, England in August 2022. L.Y.X. has contributed and continues to contribute to research projects that were enabled by data access provided by the video game industry, specifically Unity Technologies (NYSE:U) (October 2022 – Present). L.Y.X. has met and discussed policy, regulation, and enforcement with the Belgian Gaming Commission [Belgische Kansspelcommissie] (June 2022 & February 2023), the Danish Competition and Consumer Authority [Konkurrence- og Forbrugerstyrelsen] (August 2022), the Department for Digital, Culture, Media and Sport (DCMS) and its successor of the UK Government (August 2022 & August 2023), PEGI (Pan-European Game Information) (January & March 2023), a member of the European Parliament (February 2023), the US Federal Trade Commission (February 2023), the Finnish Gambling Administration at the National Police Board [Poliisihallituksen arpajaishallinto / Polisstyrelsens lotteriförvaltning] (March 2023), the Danish Gambling Authority [Spillemyndigheden] (April 2023), the Netherlands Authority for Consumers and Markets [Autoriteit Consument & Markt] (May & June 2023), and the Swedish Gambling Authority [Spelinspektionen] (June 2023). L.Y.X. has been invited to provide advice to the DCMS on the technical working group for loot boxes and the Video Games Research Framework. L.Y.X. was the recipient of two AFSG (Academic Forum for the Study of Gambling) Postgraduate Research Support Grants that were derived from ‘regulatory settlements applied for socially responsible purposes’ received by the UK Gambling Commission and administered by Gambling Research Exchange Ontario (GREO) (March 2022 & January 2023). L.Y.X. has accepted funding to publish academic papers open access from GREO that was received by the UK Gambling Commission as above (October, November, & December 2022). L.Y.X. has accepted conference travel and attendance grants from the Socio-Legal Studies Association (February 2022 & February 2023); the Current Advances in Gambling Research Conference Organising Committee with support from GREO (February 2022); the International Relations Office of The Jagiellonian University (Uniwersytet Jagielloński), the Polish National Agency for Academic Exchange (NAWA; Narodowa Agencja Wymiany Akademickiej), and the Republic of Poland (Rzeczpospolita Polska) with co-financing from the European Social Fund of the European Commission of the European Union under the Knowledge Education Development Operational Programme (May 2022); the Society for the Study of Addiction (November 2022 & March 2023); and the organisers of the 13th Nordic SNSUS (Stiftelsen Nordiska Sällskapet för Upplysning om Spelberoende; the Nordic Society Foundation for Information about Problem Gambling) Conference, which received gambling industry sponsorship (January 2023). L.Y.X. has received an honorarium from the Center for Ludomani for contributing a parent guide about a mobile game for Tjekspillet.dk, which is funded by the Danish Ministry of Health’s gambling addiction pool (Sundhedsministeriets Ludomanipulje) (March 2023). The up-to-date version of L.Y.X.’s conflict of interest statement is available via: https://sites.google.com/view/leon-xiao/about/conflict-of-interest. T.C.F. declares no conflicts of interest. R.K.L.N. has received an honorarium from the Center for Ludomani for contributing parent guides about different games for Tjekspillet.dk, which is funded by the Danish Ministry of Health’s gambling disorder pool (Sundhedsministeriets Ludomanipulje). R.K.L.N. has served as an expert witness in a legal case about whether ‘loot boxes’ should be considered a form of gambling, R.K.L.N. did not receive an honorarium or any other type of payment for this work; the honorarium was instead donated to an unknown charity. The content of the expert witness statement was identical to arguments made in R.K.L.N.’s published research. P.W.S.N. is a member of the Advisory Board for Safer Gambling –an advisory group of the Gambling Commission in Great Britain, and in 2020 was a special advisor to the House of Lords Select Committee Enquiry on the Social and Economic Impact of the Gambling Industry. In the last three years, P.W.S.N. has contributed to research projects funded by the Academic Forum for the Study of Gambling, Clean Up Gambling, Gambling Research Australia, NSW Responsible Gambling Fund, and the Victorian Responsible Gambling Foundation. P.W.S.N. has received open access fee grant income from Gambling Research Exchange Ontario., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Digital or video games are played by millions of adolescents and young adults around the world and are one of the technologies used by youths to access mental health services. Youths with mental health problems strongly endorse the use of technologies, including mobile and online platforms, to receive information, support their treatment journeys (eg, decision-making tools), and facilitate recovery. A growing body of literature explores the advantages of playing digital games for improving attention span and memory, managing emotions, promoting behavior change, and supporting treatment for mental illness (eg, anxiety, depression, or posttraumatic stress disorder). The research field has also focused on the negative impact of video games, describing potential harms related to aggression, addiction, and depression. To promote clarity on this matter, there is a great need for knowledge synthesis offering recommendations on how video games can be safely and effectively adopted and integrated into youth mental health services., Objective: The Gaming My Way to Recovery scoping review project assesses existing evidence on the use of digital game interventions within the context of mental health services for youths (aged 11-29 years) using the stepped care model as the conceptual framework. The research question is as follows: For which youth mental health conditions have digital games been used and what broad objectives (eg, prevention, treatment) have they addressed?, Methods: Using the methodology proposed by Arksey and O'Malley, this scoping review will map the available evidence on the use of digital games for youths between 11 and 29 years old with mental health or substance use problems, or both., Results: The review will bring together evidence-based knowledge to assist mental health providers and policymakers in evaluating the potential benefits and risks of these interventions. Following funding of the project in September 2018, we completed the search in November 2018, and carried out data screening and stakeholder engagement activities during preparation of the protocol. We will conduct a knowledge synthesis based on specific disorders, treatment level and modality, type of service, population, settings, ethical practices, and user engagement and offer recommendations concerning the integration of video game technologies and programs, future research and practice, and knowledge dissemination., Conclusions: Digital game interventions employ unique, experiential, and interactive features that potentially improve skills and facilitate learning among players. Digital games may also provide a new treatment platform for youths with mental health conditions. Assessing current knowledge on video game technology and interventions may potentially improve the range of interventions offered by youth mental health services while supporting prevention, intervention, and treatment., International Registered Report Identifier (irrid): PRR1-10.2196/13834., (©Manuela Ferrari, Sarah V McIlwaine, Jennifer Ann Reynolds, Suzanne Archie, Katherine Boydell, Shalini Lal, Jai L Shah, Joanna Henderson, Mario Alvarez-Jimenez, Neil Andersson, Jill Boruff, Rune Kristian Lundedal Nielsen, Srividya N Iyer. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 24.06.2020.)

We greatly appreciate the care and thought that is evident in the 10 commentaries that discuss our debate paper, the majority of which argued in favor of a formalized ICD-11 gaming disorder. We agree that there are some people whose play of video games is related to life problems. We believe that understanding this population and the nature and severity of the problems they experience should be a focus area for future research. However, moving from research construct to formal disorder requires a much stronger evidence base than we currently have. The burden of evidence and the clinical utility should be extremely high, because there is a genuine risk of abuse of diagnoses. We provide suggestions about the level of evidence that might be required: transparent and preregistered studies, a better demarcation of the subject area that includes a rationale for focusing on gaming particularly versus a more general behavioral addictions concept, the exploration of non-addiction approaches, and the unbiased exploration of clinical approaches that treat potentially underlying issues, such as depressive mood or social anxiety first. We acknowledge there could be benefits to formalizing gaming disorder, many of which were highlighted by colleagues in their commentaries, but we think they do not yet outweigh the wider societal and public health risks involved. Given the gravity of diagnostic classification and its wider societal impact, we urge our colleagues at the WHO to err on the side of caution for now and postpone the formalization.

Concerns about problematic gaming behaviors deserve our full attention. However, we claim that it is far from clear that these problems can or should be attributed to a new disorder. The empirical basis for a Gaming Disorder proposal, such as in the new ICD-11, suffers from fundamental issues. Our main concerns are the low quality of the research base, the fact that the current operationalization leans too heavily on substance use and gambling criteria, and the lack of consensus on symptomatology and assessment of problematic gaming. The act of formalizing this disorder, even as a proposal, has negative medical, scientific, public-health, societal, and human rights fallout that should be considered. Of particular concern are moral panics around the harm of video gaming. They might result in premature application of diagnosis in the medical community and the treatment of abundant false-positive cases, especially for children and adolescents. Second, research will be locked into a confirmatory approach, rather than an exploration of the boundaries of normal versus pathological. Third, the healthy majority of gamers will be affected negatively. We expect that the premature inclusion of Gaming Disorder as a diagnosis in ICD-11 will cause significant stigma to the millions of children who play video games as a part of a normal, healthy life. At this point, suggesting formal diagnoses and categories is premature: the ICD-11 proposal for Gaming Disorder should be removed to avoid a waste of public health resources as well as to avoid causing harm to healthy video gamers around the world.

Parents and policy makers are often concerned that sexy media (media depicting or discussing sexual encounters) may promote sexual behavior in young viewers. There has been some debate among scholars regarding whether such media promote sexual behaviors. It remains unclear to what extent sexy media is a risk factor for increased sexual behavior among youth. The current study employed a meta-analysis of 22 correlational and longitudinal studies of sexy media effects on teen sexual behavior (n = 22,172). Moderator analyses examined methodological and science culture issues such as citation bias. Results indicated the presence only of very weak effects. General media use did not correlate with sexual behaviors (r = 0.005), and sexy media use correlated only weakly with sexual behaviors (r = 0.082) once other factors had been controlled. Higher effects were seen for studies with citation bias, and lower effects when family environment is controlled. The impact of media on teen sexuality was minimal with effect sizes near to zero.