How Smoking in Video Games Affects Teenagers

The first systematic review of smoking in video games, published in Nicotine & Tobacco Research (2016), examined 24 studies across four domains [citation:4]. Key findings included:

• Tobacco imagery is present: Smoking appears in a subset of video games, particularly mature-rated titles.
• Inconclusive direct link: The evidence for video game playing as a single construct causing smoking is mixed — but the type of game matters significantly [citation:4].
• Strong addiction correlation: Four of five studies found a significant association between video game addiction and smoking behavior.
• Genre matters: Adolescents who play mature-rated, risk-glorifying (MRRG) games show higher rates of deviant behaviors, including smoking [citation:3].

A landmark longitudinal study by Hull et al. (2014) followed adolescents for four years to examine how playing mature-rated, risk-glorifying (MRRG) games affected behavior [citation:3]. The results were striking:

• Measurable increases in deviant behavior: Playing MRRG games was associated with increases in alcohol use, cigarette smoking, aggression, delinquency, and risky sex [citation:3].
• Mechanism matters: The games affected personality traits including sensation seeking and rebelliousness, which in turn predicted deviant behavior.
• Peer influence: MRRG gameplay was associated with affiliation with deviant peers, further reinforcing risky behaviors.
• Strongest effect for heavy players: The effects were most pronounced among adolescents who played mature-rated games heavily [citation:3].

Perhaps the most consistent finding across studies is the correlation between problematic video gaming (addiction) and tobacco use [citation:4][citation:8].

• 4 out of 5 studies confirm the link: The 2016 systematic review found that most research examining video game addiction and tobacco addiction found a positive association [citation:4].
• Norwegian adolescent study: Boys who used nicotine were almost twice as likely to report problematic gaming compared to non-users [citation:8].
• Psychosocial profile: Problematic gamers showed higher scores on depressive mood, loneliness, social anxiety, and negative self-esteem — all risk factors for substance use [citation:8].
• Shared vulnerability: Researchers suggest that impulsivity and reward-seeking behavior may underlie both gaming addiction and nicotine use.

A 2018 study of 3,114 middle school students in Argentina examined whether exposure to tobacco content in video games was associated with current smoking [citation:10]. The results revealed a significant gender difference:

• For girls: High exposure to tobacco content in video games was independently associated with current smoking (OR 1.78; 95% CI 1.02 to 3.09) [citation:10].
• For boys: No significant association was found (OR 0.98; 95% CI 0.64 to 1.51) [citation:10].
• Prevalence: 92% of boys played video games compared to 56% of girls, but female smokers had higher rates (22% vs 13.8% among boys).
• Interpretation: The researchers concluded that “greater exposure to tobacco content in video games was associated with higher likelihood of smoking among Argentine girls who play video games, suggesting the need for policies that limit these exposures” [citation:10].

A large Canadian national study (CSTADS 2012-13, N = 41,057) examined associations between media usage and multiple wellbeing indicators [citation:9]. Key findings regarding video games and risk behavior:

• Video game playing was negatively associated with: academic achievement, physical activity, school connectedness, self-esteem, and fruit/vegetable consumption [citation:9].
• Increased odds of bullying: Video game time increased the odds of bullying others by 7% (OR 1.07; 99% CI 1.01-1.14) [citation:9].
• While smoking was not directly measured in this study, the established links between gaming and lower wellbeing indicators are concerning — wellbeing factors themselves are associated with higher smoking rates in adolescents [citation:7].

In 2024, researchers at the University of California, Riverside, published an urgent warning in Tobacco Control about a new generation of vaping devices. These “smart vapes” couple nicotine addiction with gaming disorder — a dangerous convergence [citation:1].

• Games require vaping to progress: The “URSA Pocket” contains a virtual pet that you feed with coins acquired by vaping. Another game counts puffs with leaderboards that can be submitted to social media for prizes [citation:1].
• CB15K vape: Endorsed by a celebrity, this device offers trading cards with QR codes and animated displays that change as users puff [citation:1].
• Craftbox V-Play: Can run classic arcade games including Pac-Man, Tetris, and F22 [citation:1][citation:6].
• Three addictions in one: These devices potentially exploit nicotine dependence, gaming disorder, and screen time obsession simultaneously [citation:1].
• Affordable for youth: Priced at $15-20 — roughly the same as older vapes — but offering more features, higher power, and smart functionality [citation:1].

Adolescence is a critical period of brain development characterized by increased reward-seeking, impulsivity, and sensitivity to peer influence [citation:7]. Research has identified several mechanisms that make teens uniquely vulnerable to both gaming addiction and tobacco use:

• Dopamine dysregulation: Both video games and nicotine trigger dopamine release in the brain’s reward pathway. Adolescents have heightened reward sensitivity, making them more susceptible to both [citation:3].
• Structural brain changes: Neuroscientists have found that excessive video gaming can cause “structural brain change” in even non-excessive users, predisposing players to impulsive and risky behaviors [citation:5].
• Early onset risk: Early use of tobacco is linked to higher risk of long-term addiction. Video games that normalize smoking may lower the perceived risk of trying a cigarette [citation:7].
• Escapism: Both gaming and smoking can serve as coping mechanisms for stress, anxiety, and depression — common in adolescence [citation:8].

In a groundbreaking 2022 ruling, a Quebec Superior Court judge authorized a class action lawsuit against Epic Games, the maker of Fortnite. Justice Sylvain Lussier compared the harmful effects of video games to tobacco [citation:5].

• Parallel to tobacco litigation: “The harmful effect of tobacco was not recognized or admitted overnight” — Justice Lussier drew a direct parallel between how society slowly recognized tobacco dangers and how we are now recognizing gaming addiction [citation:5].
• Parents allege harm: Three parents sued Epic Games, claiming Fortnite prompted developmental and behavioural issues in their children.
• Addiction recognition: The case highlights growing legal acceptance that video game addiction can cause real, compensable harm — similar to tobacco addiction [citation:5].
• Implications for tobacco content: If game companies can be held liable for addictive design, pressure to remove smoking imagery may increase.

Based on the research, here are actionable steps for parents concerned about video game smoking content and adolescent nicotine use:

• Check game ratings: Mature-rated (M for Mature) games are more likely to contain smoking imagery. The Entertainment Software Rating Board (ESRB) now includes “Tobacco Reference” in content descriptors — look for it.
• Monitor playtime: The Dartmouth study found that heavy play of mature-rated games produced the strongest effects on deviant behavior [citation:3].
• Watch for smart vapes: Be aware that vaping devices now look like handheld gaming consoles. The “Craftbox V-Play” and similar products are designed to appeal to youth who love video games [citation:1][citation:6].
• Discuss the difference: Talk to teens about the difference between virtual smoking (a character in a game) and real smoking (serious health consequences).
• Watch for problematic gaming: If gaming interferes with sleep, school, or social relationships, it may be a risk factor for substance use [citation:8].
• Set parental controls: Most consoles and game platforms allow parents to restrict mature-rated content.

The 2016 systematic review concluded that research on this topic is “still in its nascence” [citation:4]. Important unanswered questions remain:

• Causality vs. correlation: Most studies are cross-sectional, making it difficult to determine whether gaming causes smoking or whether a third factor (impulsivity, family environment) causes both [citation:4].
• Long-term effects: Few longitudinal studies have tracked adolescents for extended periods to see if gaming-related smoking exposure leads to later initiation.
• Game mechanics: Does controlling a character who smokes (first-person) have a different effect than watching a non-playable character smoke? This remains unstudied.
• User-generated content: In games like Grand Theft Auto Online or Roblox, players can create smoking content — the impact of this user-generated imagery is unknown.
• Vape-gaming convergence: The emergence of vaping devices with built-in games is too recent for long-term studies [citation:1].