Executive Summary
S. Liliana Escobar-Chaves, DrPH*; Susan R. Tortolero, PhD*; Christine M. Markham, PhD*; Barbara J. Low, DrPH*; Patricia Eitel, PhD*; and Patricia Thickstun, PhD‡
A
dolescents in the United States are engagingin sexual activity at early ages and with mul-tiple partners.
• Approximately 47% of high school students have had sexual intercourse, 7.4% of them before the age of 13 years, and 14% withⱖ4 sexual partners.1 • Overall, ⬃822 000 pregnancies occurred among women aged 15 to 19 years in 2000; approximately one third of these pregnancies were among girls
⬍18 years old.2
• Sexually active adolescents are at immediate risk for pregnancy and acquiring sexually transmitted infections. In the United States the risk of acquir-ing a sexually transmitted infection is higher among teenagers than among adults.3
• Sexually active adolescents are at substantially greater risk for depression and suicide.4–7
A critical review of the scientific literature and other sources shows that a largely unexplored factor that may contribute to adolescent sexual activity is their exposure to the mass media.
• The average American youth spends one third of each day with various forms of mass media, mostly without parental oversight.8
• The mass media have been shown to affect a broad range of adolescent attitudes and behaviors in-cluding violence, eating disorders, and tobacco and alcohol use.
Few studies, however, have examined the effects of mass media on adolescent sexual attitudes and behaviors. An extensive systematic review of the relevant biomedical and social science literature shows that only 12 of 2522 research-related docu-ments (⬍1%) involving media and youth address the effects of mass media on adolescent sexual attitudes and behaviors; in addition, there are several studies of college students, which were outside the scope of this review.
• Several studies suggest an association between media exposure and adolescent sexual behaviors, but they are limited because of their study designs, sampling procedures, and small sample sizes. • To date, there has been only 1 longitudinal study
of such effects,9although others are in process (see “Appendix” in Impact of the Media on Adolescent Sexual Attitudes and Behaviors later in the supplement).
What follows is a summary, based on the last 21 years of research (1983–2004), of the little that science knows concerning
• the exposure of American adolescents 11 to 19 years old to various forms of mass media; • the sexual content of those media; and
• the effects of that exposure on their sexual atti-tudes and behaviors.
The gaps in our knowledge are then identified and a program of needed research outlined.
WHAT WE KNOW
Television (Broadcast and Cable) and Music Videos Exposure
The average teenager spends 3 to 4 hours per day watching television.8
Content
In the programming most frequently watched by adolescents, 83% contains some sexual content—not just passing references but an average of 6.7 scenes that include sexual topics per hour—and 20% explic-itly or implicexplic-itly portrays couples engaging in sexual intercourse.10,11This is after a major reduction in the sexual content of television.12
Effects
Adolescents who are exposed to television with sexual content are more likely than other adolescents to
• overestimate the frequency of some sexual behav-iors13; and
• have more permissive attitudes toward premarital sex.14
Moreover, the 1 longitudinal study to date finds that watching sex on television (or even hearing about it) does predict adolescent initiation of sexual behavior.9
However, most studies are of limited generaliz-ability because of their study designs, sampling
pro-From the *Center for Health Promotion and Prevention Research, Univer-sity of Texas Health Science Center, Houston, Texas; and ‡Medical Institute for Sexual Health, Austin, Texas.
Accepted for publication Apr 14, 2005. doi:10.1542/peds.2005-0355B No conflict of interest declared.
Dr Eitel’s current address is: Foote Cone & Belding, New York, NY 10001. Address correspondence to S. Liliana Escobar-Chaves, DrPH, Center for Health Promotion and Prevention Research, School of Public Health, Uni-versity of Texas Health Science Center, PO Box 20036, Houston, TX 77225-0036. E-mail: [email protected]
cedures, and small sample sizes. They therefore can-not serve as the foundation for data-based policy formulation.
Movies
Exposure to R-rated Movies
According to a 1993 study, two thirds of Holly-wood movies made each year are R-rated, and most young people have viewed these movies before they reach the required age of 17 years (previously 16 years).15Recent reductions by theaters on under-age ticket sales have not reduced the ability of adoles-cents to buy such films.16
Exposure to X-rated Movies
In 2001, 30% of sexually active minority adolescent females said they had seen an X-rated movie in a theater or on videotape in the 3 months before the survey.17
Content of R-rated Movies
Two studies have analyzed the content of the top movie videotape rentals and R-rated movies fre-quently viewed by youth15,18; both reported a high amount of sexual content, with the most common sexual activity being intercourse between unmarried partners.
Effects
In at least 1 group of adolescents, those exposed to X-rated movies were more likely to
• have multiple sexual partners; • have sex more frequently; • test positive for chlamydia;
• have more negative attitudes toward using con-doms; and
• not use contraceptives.17
We do not know the effects of the sexual content of R-rated movies on adolescent sexual attitudes and behaviors.
Radio Exposure
In 1993, adolescents listened to radio nearly 40 hours a week.19 A 2000 peer-reviewed study indi-cates dramatic declines from this level.8The current level of exposure is unknown.
Content
In 1999, 22% of teen-oriented radio segments con-tained sexual content, 20% of which were “pretty explicit” or “very explicit.”20
Effects
We do not know the effect of exposure to radio on adolescent sexual attitudes and behaviors.
Music Exposure
In 2000, teenagers spent an average of almost 18 hours per week listening to music on the radio, CDs, and audiotapes.8
Content
In 1999, 42% of the songs on 10 top-selling CDs contained sexual content, 41% of which were “pretty explicit” or “very explicit.”20
Effects
We do not know the effects of sexually explicit lyrics on adolescent sexual attitudes and behaviors.
Magazines Exposure
Eighty-five percent of teenagers have read or looked at a magazine in the last 6 months.21
Content
There are few scientific data on the content of the magazines that adolescents read.
Effects
We do not know the effects of either sexually explicit “adult” magazines or “mainstream” publica-tions on adolescent sexual attitudes and behaviors.
Advertising
American adolescents are a specific target audi-ence for much consumer advertising because they spend approximately $153 billion per year, an aver-age of $89 per week per teenaver-ager.22
Exposure
The average American child sees an estimated 20 000 advertisements each year. By the age of 19 years, the average American adolescent has absorbed nearly 300 000 advertisements.23
Content
There are no systematic data concerning the sexual content of the advertising to which adolescents are exposed, although impressions are that it is high.
Effects
We do not know the effect of the sexual content of advertising on adolescent sexual attitudes and be-haviors.
Video and Computer Games Exposure
In 1999, 70% of households surveyed with children aged 8 to 18 years reported having a video-game system.8
Content
There are no systematic data concerning the sexual content of the video and computer games most pop-ular with adolescents.
Effects
We do not know the effects of the sexual content of video and computer games on adolescent sexual at-titudes and behaviors.
The Internet Exposure
On average, children aged 9 to 17 years use the Internet 4 days per week and spend almost 2 hours online at a time.24
• Sixty-one percent of teenagers using computers “surf the net,” and 14% report “seeing something they wouldn’t want their parents to know about.”25
• Sixty percent of youth report accessing chat rooms and Web sites, mainly alone.8
Content
Although pornography is widely available on the Internet, there are no systematic data concerning the sexual content of the sites that are visited by adoles-cents.
Effects
We do not know the effects of Internet sexual content on adolescent sexual attitudes and behaviors.
WHAT WE DO NOT KNOW
Several gaps in our knowledge have been identi-fied:
• We do not know the extent of sexual content in the radio segments, advertising, magazines, or the In-ternet to which American adolescents are exposed. • We do not know the extent of American
adoles-cents’ exposure to such content.
• We do not know the success of various social-cultural, technologic, and media approaches to minimizing that exposure (eg, V-Chips on televi-sion, Internet-blocking software, parental supervi-sion, rating systems) or minimizing the effects of that exposure (eg, media-literacy programs). • There is a notable scarcity of well-conducted,
sci-entifically rigorous studies that examine the effects of sexual content in the media on adolescent sex-ual attitudes and behaviors.
• There are no studies that have examined the cu-mulative effects of sexual content in different types of media over time on developing youth.
FUTURE DIRECTIONS
Based on this review of the scientific literature, research is needed to
• refine methodologies to measure mass media ex-posure and exex-posure to sexual content in the me-dia;
• survey children and adolescents to determine their exposure to forms of mass media for which such data are lacking;
• determine the sexual content of those media; • survey parents and adolescents to assess the
effec-tiveness of parental involvement, communication, supervision, and monitoring of media sexual con-tent on these adolescent exposures;
• evaluate media-literacy programs for their effec-tiveness in reducing exposure or mitigating the
media’s effects and determine best-practice inter-ventions;
• evaluate the effectiveness of other technologic, so-ciobehavioral, and media practices (eg, V-Chips and rating systems) in reducing exposure; and • discover in long-term longitudinal studies the
cu-mulative effects of mass media on child and ado-lescent sexual attitudes and behaviors.
REFERENCES
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STD, and TB Prevention, Division of STD Prevention. STD surveillance, 2000. Available at: www.cdc.gov/std/stats00/TOC2000.htm. Accessed February 3, 2005
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8. Roberts DF. Media and youth: access, exposure, and privatization.J Adolesc Health.2000;27(2 suppl):8 –14
9. Collins RL, Elliott MN, Berry SH, et al. Watching sex on television predicts adolescent initiation of sexual behavior.Pediatrics.2004;114(3). Available at: www.pediatrics.org/cgi/content/full/114/3/e280 10. Cope-Farrar KM, Kunkel D. Sexual messages in teens’ favorite
prime-time television programs. In: Brown JD, Steele JR, Walsh-Childers K, eds.Sexual Teens, Sexual Media: Investigating Media’s Influence on Adoles-cent Sexuality. Mahwah, NJ: Lawrence Erlbaum; 2002:59 –78
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DOI: 10.1542/peds.2005-0355B
2005;116;297
Pediatrics
Low, Patricia Eitel and Patricia Thickstun
S. Liliana Escobar-Chaves, Susan R. Tortolero, Christine M. Markham, Barbara J.
Executive Summary
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DOI: 10.1542/peds.2005-0355B
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