Monday, October 2, 2023
This activity is intended for healthcare professionals.
The goal of this activity is to identify and address media-related healthcare concerns for adolescents.
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Media has become one of the most pervasive forces in the world today. Whether inside our homes, on the road, in the mall, or at a physician's office, we are constantly bombarded with messages and images through different media channels. From television (TV) to radio to the Internet, from billboards to iPods to DVDs in cars, there is really no escaping the reach of this Goliath.
Adolescents, in particular, spend a significant amount of time viewing and interacting with media in the form of TV, video games, music, and the Internet. Considering all of these sources together, children spend more than 6 hours per day using media.[1] Nearly half of that time is spent watching TV. The remainder of the time is spent using other electronic media alone or in combination with TV.[2]
Consider the following:
I believe television is going to be the test of the modern world, and that in this new opportunity to see beyond the range of our vision we shall discover either a new and unbearable disturbance of the general peace or a saving radiance in the sky. We shall stand or fall by television, of that I am sure. -- E.B. White[3]
When E.B. White made the prophecy above in 1938, barely 2% of American families owned a TV. Now 99% of American families have a TV, with the average family owning more than 2 sets.[4] Not surprisingly, of the many forms of media available, TV has become the most dominant. This fact becomes even more important when the amount of time that children and adolescents, especially, spend in front of the TV consuming its content is considered.
Currently, TV watching is the number 1 after-school activity chosen by children ages 6-17.[4] More than half of adolescents (56% of 13- to 17-year-olds) have TVs in their bedrooms. On average, American children, ages 2-17, watch TV almost 25 hours per week or 3.5 hours a day. Nearly 1 in 5 watch more than 44 hours of TV each week.[2] Consequently, adolescents, and children in general, spend more time engaged in watching TV than in any other activity except sleep.[5] Not surprisingly, most of an adolescent's exposure to media comes through TV.
All of this media exposure has long been suspected of having negative effects on child and adolescent health and behavior for a number of reasons. First, media use -- normally a sedentary activity -- is believed to replace physical activity and thus to contribute to the growing obesity problem in the United States. Second, increased exposure to violent images in the media is suspected of encouraging violent behaviors among the nation's youth. This latter opinion has grown in force since the occurrence of multiple school shootings by adolescents in the past decade or so. However, what do data from scientific studies show?
Across all age groups, the percentage of overweight individuals in this country has more than doubled in the past 3 decades. Particularly among adolescents, the percentage has more than tripled -- from 5% to more than 17% -- and another 16% are at risk.[6]
Being overweight is known to increase the risk for many chronic diseases, such has heart disease and diabetes.[7] Specifically, overweight adolescents are at increased risk of being overweight and acquiring coronary artery disease as adults.[8] One study found that the prevalence of overweight among children aged 8-16 years was greatest among those watching the most TV and lowest among those watching the least.[9]
However, this study and another investigation did not find any association between the amount of TV watching and the amount of exercise.[9,10] On the basis of these data, the association between TV viewing time and overweight is not clear. Additional larger studies, particularly longitudinal investigations, are needed to truly understand the media's effect on overweight in adolescence.
Currently, sexual content in the media is widespread. According to Sex on TV 4, a biennial study released in 2005 by the Kaiser Family Foundation, the number of sexual scenes on TV has greatly increased since 1998. This study found that during the 2004-2005 season, 70% of all TV shows aired included some degree of sexual content. These shows averaged 5.0 sexual scenes per hour, compared with 56% of shows aired and 3.2 sexual scenes per hour in 1998.[11] One older study published in the late 1980s showed that a very insignificant amount of TV content dealt with abstinence, birth control, sexually transmitted diseases, or pregnancy.[12]
Of the approximately 19 million sexually transmitted infections diagnosed annually, nearly 50% afflict individuals between 15 and 24 years of age.[13] Additionally, the rate of unplanned teen pregnancy in the United States remains among the highest of all industrialized countries, despite recent declines.[14] Limited studies have assessed the association between sexual content in the media and adolescent sexual behavior. Some investigations have suggested negative effects, such as early first sexual intercourse or increased rates of sexual intercourse,[15] but more data are needed.
The affects of media violence on the health of children and adolescents, however, are clearly negative. Exposures come in the form of music videos as well as TV programming. There are numerous studies showing the association of exposure to violent images in the media and violent behaviors in these age groups.[15-19]
Given the extent of exposure to violence in the media, these links are not surprising. For example, by age 18, most adolescents will have been exposed to more than 200,000 acts of violence exclusively on TV. Many media programs and feature films, including animated films, portray violent images -- much of it glamorizing a disproportionate number of blacks and women.[1] One study, a randomized controlled trial, showed how an educational intervention that led to reduced media use also reduced aggressive behavior in elementary school-aged children.[17]
Therefore, scientific studies show an association between violence in the media and violent behaviors in children and adolescents and the suggestion of an association between media exposures and obesity and negative sexual behaviors. Because it pertains to its effect on violence, mass media joins the list of already identified contributors to violent behaviors in children -- poverty, racism, inadequate supervision, and history of violence.[15] However, more work needs to be done to fully understand the extent of this contribution. As to its contribution to obesity and sexual behaviors, there is a definite need for more and larger studies in varied populations to fully understand these potential links. Also, because many of these studies focus on young children, or on a range of ages grouped together, more work focused on adolescents needs to be conducted.
"Television and other media represent one of the most important and under-recognized influences on children and adolescents' health and behavior in the 1990s. Their impact should be eliciting serious concern, not just from parents and educators but from physicians, public health advocates, and politicians as well," wrote Strasburger and Donnerstein in a review published in the Journal of Pediatrics in 1999.[15] They are not alone; numerous other researchers and public health officials have come to the same conclusion. The public is also becoming concerned about the impact of the media on the nation's youth. For example, the majority of parents say that they are "very" concerned about the amount of sex (60%) and violence (53%) that their children are exposed to on TV.[4] Additionally, 53% of respondents in a Time Magazine poll indicated that the Federal Communications Commission (FCC) should place stricter controls on broadcast channel shows depicting sex and violence. A large majority of these respondents (68%) also believed that the entertainment industry has lost touch with viewers' moral standards.[4]
There are several ways to change the influence of media on the nation's children, ranging from changing the media itself to better supervision of what -- and how much -- media access children have. However, the first line of defense starts with the media itself -- knowing that media will change or remove what the public will not watch. Consequently, if the entertainment industry has truly lost touch with the viewing public's moral standards, then we, as the public, need to make sure they get that message by not watching, using, and buying what we don't want our children to see.
Advertisers that fund these media products will not advertise their products in a medium that gets no viewership or use. Additionally, many parents find the multiple rating systems for each type of medium (TV, music, movies, and games) inadequate or confusing.[1] Therefore, in addition to advocating a more uniform and user-friendly rating system, the American Academy of Pediatrics (AAP) has published a brochure that can help parents to better understand and use the current system.[20]
The next line of defense comes from the healthcare industry, particularly from healthcare providers who care for children and adolescents. Here, too, the AAP has specific recommendations that providers reach out to parents and adolescents. These include taking a media history during well-child visits and encouraging parents to follow AAP media guidelines for media viewing. They also stress the importance of collaboration among healthcare professionals to press for change and to keep media issues on the public agenda in order to fund more and better research, media policies, and group recommendations to the media industry.[1]
However, pending the above-mentioned changes, the last line of defense comes from the adults who care for children, whether parents, babysitters, or other guardians. The AAP also provides recommendations to help these guardians to better protect their children and adolescents, including viewing and using media sources with their children, limiting viewing time and content, and keeping media sources out of children's bedrooms. For example, the AAP specifically recommends that children younger than 2 years of age refrain from watching TV, and children older than age 2 watch no more than 2 hours per day.[1]
However, no one of these lines of defense carries all the blame or the only answer. Each citizen has the potential to play a positive role in 1 or more of these lines. The healthcare provider's role is to be the link between the front and last lines of defense by reaching out to both the media and patients.
