According to the Entertainment Software Rating Board (ESRB), the average gamer plays about eight hours of video games per week. In these video games, there are often images of substances like alcohol, drugs or cigarettes. Because people may be exposed to these images at a high rate, a study was conducted to find how the images could be affecting gamers, specifically children and young adults.

The study analyzed 118 games release between 1994 and 2015. All of these games were rated by the ESRB. Over 40 percent of the popular video games featured characters smoking cigarettes, cigars or e-cigarettes. These images are very influential to the viewers because the games are played repeatedly, therefore the gamers are constantly seeing the images.

Young adult between the ages of 12 and 17 are twice as likely to start smoking if they see images of cigarettes in movies. This could be the same for video games as well.