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Background  Video game loot boxes, which can typically be purchased by players or are given as reward, contain random virtual items, or loot, ranging from simple customization options for a player's avatar or character, to game-changing equipment such as weapons and armor. Loot boxes have drawn concern, as purchasing loot boxes might lead to the development of problematic gambling for adolescents. Although parental problem gambling is associated with adolescent problem gambling, no studies have evaluated the prevalence of loot box purchases in adolescents’ parents.    Objective  This study investigated the association between loot box purchasing among adolescents and parents, and problem online gaming in population-based samples.    Methods  In total, 1615 adolescent (aged 14 years) gamers from Japan responded to a questionnaire regarding their loot box purchasing and problem online gaming behaviors. Problem online gaming was defined as four or more of the nine addictive behaviors from the Diagnostic and Statistical Manual of Mental Disorders. The adolescents’ primary caregivers were asked about their loot box purchasing.    Results  Of the 1615 participants, 57 (3.5%) reported loot box purchasing. This prevalence did not differ according to primary caregivers’ loot box purchasing, but adolescents who purchased loot boxes were significantly more likely to exhibit problem online gaming (odds ratio 3.75, 95% CI 2.17-6.48).    Conclusions  Adolescent loot box purchasing is linked to problem online gaming, but not with parents’ loot box purchasing. Measures to reduce these behaviors should target reducing addictive symptoms in young video gamers.

Adolescent Problem Gaming and Loot Box Purchasing in Video Games: Cross-sectional Observational Study Using Population-Based Cohort Data