Over the last few years, many health-officials and public-health agencies have been working diligently to systematically remove smoking from our day-to-day lives, and it’s probably for the better. The Center for Disease Control published an incredible data-set back in 2015, which outlined the dangers and the influence that smoking could have on children and young-adults when shown in films. The report was enough to convince Disney, and other studios that release content directed at children, to remove all smoking and tobacco imagery from future films. Daytime television, primetime specials, TV series and even regular non-animated films have cut out smoking and tobacco use, but video games have not. The disturbing fact to remember is that children and young-adults spend more time playing video games than watching movies, so games could influence children more than the films that have already changed their ways.

Smoking laws here in the United States have also banned smoking in most public places, both inside and outside, and taxes on cigarettes in states like New York have made choosing to smoke too costly for most users. Now the Truth campaign wants to take the same information that the CDC learned from smoking in movies, and apply that to video-games.

A new report, released today by the Truth Initiative, finds that most parents are unaware that video-games can include tobacco use, and how often these tobacco images are shown throughout the game. The reported stated that 93% of parents surveyed were unaware of recent UCSF research, which found that 42% of the video games studied contained tobacco images. The report, “Played: Smoking and Video Games,” comes just as the year’s best games are about to hit homes over the holidays.

Research shows a correlation between exposure to smoking imagery and the likelihood to smoke among young people. In fact, the data suggests that up to 44% of adolescents who start smoking do so because of smoking images seen in the movies. Considering teens spend much more time playing video games than going to the movies—25x more on average, the report raises cause for concern and the need for action.

“When it comes to smoking and video games, there are no winners,” said Robin Koval, CEO and President of Truth Initiative. “We need to shine a light on the gaming industry, much like with movies, and all smoking imagery should be removed from video games played by youth. Far too many games feature characters who smoke and are portrayed as strong and powerful, sending a very dangerous message to young people that couldn’t be further from the truth. Smoking remains the leading cause of preventable death. This report should sound an alarm for parents and be a wakeup call to the industry that tobacco has no place in video games.”

Of the 2016 new releases, more than a dozen major video games contain tobacco use, including “Overwatch”, which is rated “T for Teen.”  Now I personally love Overwatch, but it does include a character that smokes a cigar, who is designed to resemble Clint Eastwood’s iconic character from “The Good, the Bad and the Ugly”. His name is McCree and you can see his picture from the game above.

If you’re wondering , that cigar in his mouth is present almost every-time that McCree is shown on the screen.  Since its release in May, “Overwatch” has attracted millions of young players,  and surpassed over 15 million players in the first three months alone. The game is live-streamed to millions of viewers each day, and the characters are beloved and shared on online forums and fan-sties. That’s a lot of people seeing McCree smoking, and a lot of great advertising for the tobacco companies. A game like “Overwatch” is being sold under the idea that it is appropriate for teens, and removing the tobacco images would have zero effect on the gameplay. When considering those two facts, and compiling the data collected by the CDC , it would be very easy to ague that most tobacco use in games could easily be cut-out.

No one likes the idea of censoring video-games, but changing the ESRB classification on tobacco wouldn’t ban tobacco use in games, it would only be a factor in how a game is rated. Now this wouldn’t really effect “Mature”- rated games like “Call of Duty,” “Grand Theft Auto,” and “Halo,” all of which contain tobacco use as well, since “M” games aren’t marketed towards children.

Movies have already started cutting out smoking, and so have popular shows and series all across the globe, and it hasn’t changing the way that we enjoy our media. It would make sense for video-games to follow suit, and I don’t think that many people would even notice.

In the 2015 University of California, San Francisco survey, researchers verified tobacco content in 42% of the video games that participants reported having played; however, only 8% of these games had received tobacco warnings from the Entertainment Software Rating Board (ESRB), the gaming industry’s self-regulatory organization that rates video games and apps. The Truth Initiative 2016 survey also shows that 65% of parents would not purchase these video games once aware of the tobacco imagery.

Truth Initiative also commissioned video interviews with 44 teen and young adult “gamers.” All 44 recalled seeing smoking images in video games on a regular basis. Tobacco use was viewed as making a character “tougher” or “grittier.” The report also reveals that while the majority of teens surveyed say they would play video games despite smoking images, more than 50 percent of these teens expressed concern about the impact smoking images would have on their younger siblings who often watch them play video games to learn themselves.

According to the Truth Campaign, these are Actions needed to reduce the risk of smoking initiation among teens and young adults who could be influenced by video games to use tobacco:

  • Game developers and publishers should stop including images of tobacco use in their games, particularly those marketed to or played by youth, regardless of their ESRB rating.
  • The Entertainment Software Rating Board should consistently identify and disclose whether a game contains images of tobacco use or tobacco references and rate games containing those images with a “Mature” rating.
  • Parents and adults should recognize that many video games contain images of tobacco use and be aware that ESRB content descriptors may fail to mention it. Adults should take this into consideration when purchasing games for tweens and teens.
  • Public health advocates should build public awareness about the issue of tobacco use in video games and support research to learn more about its implications. The public health community should insist that game developers eliminate tobacco content in video games. Public health researchers should conduct more studies of the relationship between video games and tobacco use, including longitudinal studies that can shed light on the question of whether exposure to tobacco use in video games leads to increased use, or facilitates progression to regular use, of tobacco.
  • Policymakers should recognize that the prevalence of tobacco use in video games may undermine public health gains in the reduction of youth tobacco use.