Health and health-related behaviors in esports players: an international survey of playtime and nationality differences.

Introduction: Esports participation is expanding rapidly, yet evidence on players' health and health-related behaviors remains limited and inconsistent. This study examined health indicators and health-related behaviors in esports players and explored differences by weekly playtime and nationality. Methods: A cross-sectional online survey was completed by 413 esports players from 48 nationalities. Measures included body mass index (BMI), physical activity, smoking, alcohol use, sleep behavior, depressive symptoms, health-related quality of life (HRQoL), and perceived social support. Results: Overall, the sample showed a heterogeneous but not uniformly adverse health profile. Mean BMI was within the normal-weight range, smoking and alcohol consumption were generally low, depressive symptoms were predominantly minimal to mild, and average sleep duration was approximately 8.2 h per night. However, 38.3% of participants were categorized as insufficiently physically active. Weekly playtime was largely unrelated to health indicators. The only significant difference was smoking frequency, with players reporting more than 10 h of weekly playtime smoking slightly more often than those playing 0-10 h. In contrast, nationality was associated with differences in BMI, smoking frequency, drinking frequency, physical activity, and selected HRQoL domains, while no nationality differences were observed for sleep parameters, depressive symptoms, or perceived social support. Discussion: These findings challenge simplified assumptions that esports players exhibit uniformly poor health and suggest that health-related differences may be better explained by subgroup characteristics and sociocultural context than by gaming volume alone. Future longitudinal and intervention-based research is needed to better understand and promote healthy participation in esports.