Global review of assessments of online video gaming policies affecting young people: Loot boxes, age ratings, gameplay time restrictions, and beyond

Online video gaming is a highly popular activity, especially amongst young people (aged ≤25), with entertainment, emotional, and social benefits. However, stakeholders are also concerned about potential risks and harms, including exposure to inappropriate ( e.g. , violent, sexual) content; excessive use ( i.e. , ‘addiction’ and ‘gaming disorder’); and overspending, particularly in relation to gambling-like products ( e.g. , loot boxes). Various regulatory policies have been adopted worldwide in response. We reviewed empirical evaluations of the implementation of these policies. Results showed that age rating systems that provide information on the suitability of a game's content are widely adopted; however, many young people and their parents do not follow the guidance. Restrictions on how long and when young people can play video games in Asia could be easily circumvented and are not obviously beneficial. Regulations governing gambling-like loot boxes and in-game monetary spending in Europe and Asia are poorly complied with and enforced, leaving significant consumer protection concerns unaddressed. Many aspects of the adopted policies remain untested, and the regulatory situation in many countries remains unreported in the English academic literature. Stricter enforcement of pre-existing regulations, which has not occurred, may address many concerns. More research is needed to ensure all adopted policies are regularly monitored and tested: effective policies should be considered for adoption elsewhere, whilst ineffective policies should either be improved or repealed. Governments should fund more research into countermeasures to reduce the unwanted psychosocial effects of video games. • Age ratings for video games are global but often ignored by youths and parents. • Asia's online gaming time limits are easily bypassed, showing no clear benefits. • Loot box rules in Europe/Asia are poorly enforced, leaving spending risks unaddressed. • Many policies have been adopted but remain untested; stricter enforcement may address key risks. • Fund research to monitor policy implementation and reduce potential psychosocial harms.